How Cuban doctors helped a small city in Italy tackle Covid-19
By World Healthcare Journal-
In March 2020, the mayor of a small city near Lombardy called on the support of Cuban health professionals. A decision that has helped the city minimise damage from the pandemic and has prompted its mayor to reflect on the wider Italian healthcare system.
Venice, June 12 2021. I am sitting at a dinner table in a pub, chatting with some friends. Instinctively, I look at my watch: 12.40am. Customers at the other tables are laughing while drinking their beers, and they don’t even seem to notice or think about it: a week ago this scenario would not have been possible. After more than seven months of strict curfew starting at 10pm, having after-dinner drinks almost feels unreal. Most of us are vaccinated by now, and life is starting again from where we left it. Or so it seems.
Looking at the numbers is also encouraging. Since the start of the pandemic, the region of Veneto has registered 424.708 cases, with 11.600 deaths. Today, only 30 new cases have been recorded, 126 people in total are currently hospitalised. This is largely reflective of the wider national situation: new national cases are down to 1,723, the lowest since September 2020.
In the meantime, more than 36 per cent of the population have already had the vaccine. Almost all Italian regions were labelled ‘white’ on June 14, meaning their R(t) index is lower than 0.1, and fewer than 50 cases per 100.000 citizens a week have been registered for three weeks in a row.
The economic front is not looking as dark as one may think either. Predictions made by the research team at Confindustria, the Italian representative organisation for the industries and services sectors, show signs of a positive recovery trend already under way: 130.000 new jobs have been created between January and April 2021, and the GDP value is expected to grow in the third and fourth trimesters. The interruption of the layoffs block, which has been in force since the first pandemic wave and should be cancelled by the end of the month, is still a critical point.
However, as intensive care units unwind, businesses reopen and society starts switching back to its pre-Covid routine, this should be the right time to analyse how the pandemic has been handled, to understand how the national healthcare system might be rethought or improved.
Looking back, the most severe aspect, which has cost thousands of lives, is probably the outdated 2006 anti-pandemic plan. Viruses’ mutations and spillovers proved to be ever more frequent and threatening over the past decades, aided by the rise in amount and speed of travels and international trade of goods.
As a consequence, viruses don’t just mutate and migrate from species to species more often, but they also spread more quickly around the globe. Yet, even after experiences such as the first SARS epidemy, Ebola and Mers, Italy had virtually no anti-pandemic strategy defined.
Covid-19 took the country by complete surprise. Hospitals and sanitary facilities were not ready to handle the amount of people they had to, nor were general practitioners, who found themselves at the mercy of an insufficient co-ordination between national and regional institutions.
In this context, an interesting example to be analysed is represented by the city of Crema. A relatively small town (about 35.000 people) in the province of Cremona, Lombardy, Crema faced the healthcare crisis in a somewhat peculiar way. Barely 25 km away from Codogno, where the first case of Covid-19 in Italy was reported, Crema was immediately and heavily hit by the pandemic.
The path of the city in fighting against the virus took a turn the night between 21 and 22 March 2020: after the mayor had alerted national and international authorities asking for help due to the dramatic overcrowding of local hospitals. That night the Henry Reeve Brigade, made of 52 Cuban healthcare professionals, arrived in Crema.
A different system of care
From that moment on, mayor Stefania Bonaldi and her medical and political staff had the chance to work side by side with the Cuban health humanitarian workforce, while coming into contact with a radically different system of thinking about and structuring the administration of care. “Their sense of humanity left us overwhelmed” Bonaldi told World Healthcare Journal, underlying how they showed “a particular sensibility and attention that characterises their way of looking at the world”. The whole city of Crema had the chance to see first-hand a system of care that is organised door to door, where “the relationship between doctors and their patients is much closer”.
On the direct experience with the Cuban team, the mayor comments: “I believe that this should push us to think about the fact that healthcare should be public, at least for the most part. ” The Italian healthcare system is controlled on a regional basis, a system that makes every region fairly independent in the decision-making process.
Lombardy has been investing in the privatisation of healthcare for the past decade, which has brought the region to have fewer public hospitals – but also to de facto categorise first practitioners as independent professionals working in agreement with the state. This has made a dramatic difference, causing, for instance, the inability for health workers to have access to adequate PPE to work in high-risk conditions.
A public healthcare system such as the Cuban one, conversely, might mean that more rights are guaranteed for all: indeed, if it is true that private practices have to make a profit to stay afloat, “it is also evident that a right such as the one to health cannot differ according to wealth and cannot be anything but equal for all,” says Bonaldi. The pandemic, according to her, “has highlighted a level of inequality of treatment that should be unacceptable”. The Cuban model may prove to be more efficient, if the goal is equality.
The Cuban model may prove to be more efficient, if the goal is equality.
The numbers seem to tell the same story. Cuba and Lombardy have comparable populations: about 10 million people live in Lombardy and about 11 million in Cuba. However, the pandemic had very different outcomes in the two areas: deaths caused by Covid-19 in Lombardy have surpassed 33.000, whereas in Cuba they just touched 1,000.
Even considering that Lombardy was one of the first regions to be affected, the difference remains noticeable – what it seems to suggest is that in Italy some serious thought on the very system providing care to citizens is overdue. Looking at the case of Crema might be a good place to start. Either way, the biggest risk we run with re-openings, numbers going down and the recovery plan on the way, is to forget how bad the consequences can be if we do not pay enough attention when the emergency feels far away.
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