‘Giving us oxygen’: Italy turns to Cuba to help revive ailing health system

The Guardian | Wednesday, 17 January 2024 | Click here for original article

Some of the Cuban medical workers in Calabria, August 2023

Some of the Cuban medical workers in Calabria, August 2023

Almost 500 Cuban health workers deployed across Calabria amid severe shortage of doctors.

In the operating theatre at a hospital in Calabria, Asbel Díaz Fonseca and his team are preparing to perform abdominal surgery on a man in his sixties. They deliberate over which medical technique to use – the French or US model – before deciding on the latter.

But their main topic of pre-op conversation is food, namely which pizza is best: Neapolitan or Calabrian. There are subtle differences between the two, they say, but with a Neapolitan medic in the room, diplomacy prevails and they conclude that both types taste as good as each other.

This may not sound out of the ordinary for Italian chitchat, but Fonseca is not a local man. He has worked at the Santa Maria degli Ungheresi hospital in Polistena, a town surrounded by mountains in the southern Italian region, for a year. But he is originally from Cuba.

The 38-year-old surgeon is among the hundreds of health workers from the Caribbean island brought in to fill a drastic shortage of doctors across Calabria, one of the poorest regions in western Europe.

“The main principles of our training are solidarity and humanity,” said Fonseca. “We take our skills to countries in need, especially where the health system is suffering. Italy has good doctors and all the right technology, but is lacking professionals in many specialties.”

Two nationwide strikes in December brought the myriad issues blighting Italy’s healthcare system to the fore. Spurred by government proposals to reduce pensions, the 24-hour strikes reignited the debate over gruelling shift patterns and poor pay amid an exodus of staff.

The coronavirus pandemic was the catalyst for many to leave; more than 11,000 health workers have left the public system since 2021. Italian medics were frontline heroes when the country became the first in Europe to be engulfed by Covid-19. However, the fines issued to some for flouting overtime rules during the pandemic were a reflection of how quickly their efforts were forgotten.

Stressed medical professionals are now either retiring early, switching to the private sector, or seeking better opportunities abroad.

In Italy’s poorer south, the public health system had endured neglect for years before the pandemic, with severe cost-cutting leading to the closure of dozens of hospitals. The mafia and political corruption have also taken their toll on services.

Polistena has a population of almost 10,000, but its hospital, one of the last surviving in the area, serves 200,000 people in towns across neighbouring provinces.

To remedy the problem, Calabria’s regional government called on Cuba, famous worldwide for dispatching medical brigades to assist with saving lives, most often during times of humanitarian calamity.

The pandemic paved the way for the first missions to otherwise prosperous European countries – specifically to Bergamo, the northern Italian province that experienced one of the deadliest outbreaks of Covid-19, and Andorra. Portugal has also recently sought Cuban reinforcements after suffering shortages.

Almost 500 health workers from Cuba, covering all specialisms, are now scattered across hospitals in Calabria. Eighteen are in Polistena.

The Cuban assistance was initially met with scepticism from the Italian health workers. “They didn’t like it,” said Francesca Liotta, the director of Santa Maria degli Ungheresi hospital.

But that changed once the Cuban medics learned the Italian language and got to know their colleagues, bringing a fresh wave of energy to the hospital team.

“They have the kind of enthusiasm I remember having when I started my career,” said Liotta, who is close to retiring. “I always say this: they are giving us oxygen.”

The Guardian visited Polistena after a holiday weekend during which the hospital, a building in desperate need of modernisation, was busy dealing with emergency operations after an increase in road accidents. Internet problems were also causing delays in registering patients.

“It’s relentless,” said Liotta. “You fix one problem, and then something else breaks.”

This is Fonseca’s first mission in Europe. A surgeon with 10 years’ experience, he has been dispatched on postings around the globe, including two years in Mauritania.

The overseas brigades generate huge revenues for Cuba’s communist government, making it a crucial economic lifeline for the country. The missions are also a way of increasing Havana’s soft power. However, Fonseca rejects critics who say health workers are being exploited in order to fill the regime’s coffers.

“This is a total lie,” he said. “There is no obligation for us to do this. We are here because we want to be here. We also learn from the experiences. It is a two-way exchange.”

To date, the initiative in Calabria has proven to be so effective that it has been extended until at least 2025. 

Eduardo Gongora, 36, works in the emergency unit and has just signed a new one-year contract. “The most satisfying thing is working alongside our Calabrian colleagues. They have a similar warmth to Cubans and have been very welcoming,” he said.

The medics from Cuba have similarly been embraced by residents in Polistena, using downtime to go to the gym, trek in the mountains or let off steam in the karaoke bar.

“Some of us do enjoy a little singing,” said Saidy Gallegos Pérez, a physiatrist (rehabilitation medicine) who has opted to spend another year in the town.

Roberto Occhiuto, the rightwing president of the Calabrian region, was criticised when he first broached the idea of calling in Cuban reinforcements. “But the experiment has been positive,” he said. “It’s not me saying it, but the Italian doctors who are working with Cubans, and the Calabrian patients.

“I knew that Cuban medicine was one of the best in the world and today the same people who criticised me are clamouring for more Caribbean medicine.”

But for Liotta, who still frets over being able to fill the hospital shift schedule with an adequate number of staff, a longer-term cure is needed.

“There are just not enough people going into the public system,” she said. “I look at the young ones, and they are well prepared, but exhausted. The Cubans have helped revive the team spirit, but I worry about what will happen after 2025.”

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