Covid, the solitude of GPs. That’s why territorial medicine doesn’t work

We MUST return rigorously to an issue that had been one of the turning points of the health reform of ’78. I cannot fail to remember the very human words of that law: territory, community, closeness, equity, freedom, dignity. Words that have been betrayed over the course of 40 years, one piece at a time, without us noticing. That time was health minister Tina Anselmi, the young partisan Gabriella. And instead the failure of the health system, hospital at the center and so much private, in some regions more than in others, is now indisputableis; we understand that the solitude of the general practitioner, the paucity of the territorial social and health networks, the misery we encounter today of so many welfare policies and, finally, the horror of the slaughter of the old, come from afar.

The patient as a person

That time we young people discovered that the person is always his story, that one cannot live without each other and that even in moments of greatest suffering, fragility, withdrawal – and also when old age is looming and we begin to exchange a pen for a fork – each of us always has a desire to be there. Being there means we who are together, everyone, without exception …

In recent months with Covid we have learned to know people of unquestionable value: one of them is Professor Galli, whom I do not know and yet I respect very much, who with increasing insistence has denounced the absence of a territorial medicine. Territorial medicine that finds a disconcerting simplification in the infinite (and often useless) public debates. First of all it is to say that territorial medicine means to dispose of family doctors.

The family doctor

The presence of this professional figure is indisputable but what is missing, and a lot, is everything that must develop in well-defined territorial areas: starting with a socio-sanitary district / home of health in constant relationship with the hospital, capable of managing entrances and ensuring safe discharge, and continuity of care. A district that has within it resources, different professional figures, tools to know and cross the territories. Which must promote and coordinate actions that are also very different from each other and often original: from the specialist visit to the home presence, to the daily attention of the most fragile people, of the carriers of long-lasting diseases and certainly of people who age, especially when they live in loneliness and in a condition of poverty. A district that manages to identify micro-areas of the territory and converge all available opportunities on these.

Covid: clogged medical offices and drive-in queues: this is why we are in trouble

by Letizia Gabaglio, Simone Valesini

22 October 2020

Attention to daily life should mean knowing where and how people sleep, what relationships they have, how and how much they eat, what is activated to increase exchanges within life contexts, and many other things that have to do with person and not only with the disease.

People’s life

Little is said about this and above all it is taken for granted that people who age, when alone and barely capable, defined by the non self-sufficient evaluation scales, are condemned to climb, recalcitrant, the stairs of retirement homes. People thus begin to cost to reproduce non-self-sufficiency and not, as it would be better, to bet on further autonomy.

There are many practices to help people stay at home, even with severe impediments and long-term illnesses, using resources differently. In several health organizations the use of the health budget, or the individual therapeutic project, has been experimented with very encouraging results. It will be the district that will promote the integration and the concurrence of several services and institutions, first of all the municipal social service in delimited areas of the territory, which we have begun to call micro-areas.

An aging population

More than 300,000 people age and go from year to year to magnify this painful population. On average, the cost in a retirement home is between 3 and 4 thousand euros / month, more than 10 billion / year. The great “administrative revolution” that began amid a thousand impediments in Trieste and Friuli Venezia Giulia for 15 years (and is being tested in other Italian regions) uses the cost of the tuition to support individual and / or micro-group projects. Projects and resources that organize not only home care but also the presence of a person, a carer of the cooperative, for several hours a day or even for the entire 24 hours. The direction of the district can only be “strong”, in arranging the resources of the territory, public, private and private social.

While the territories are explored and people’s needs are recognized, visions and objectives are clarified: enhancing the human capital that everyone always has; enrich social capital, relationships, exchanges; to bring social, educational and health services that were created to be crossed by citizens.

The social and health districts

Social-health districts and micro-areas for widespread interventions in the suburbsare now a possible answer. A research carried out by the epidemiologists of the University of Udine and Turin on the district and the micro-areas of Trieste has recently come to an end. The results are very positive and encouraging, especially in terms ofenrichment of the share capital.

Giving in to nostalgia, I recently returned to meet the operators in the local services of my city. I wanted to ask about the Microaree project and its evolutions. “Microaree – the young operators told me with pride – is an exciting project to create community, to improve health, to address inequalities, to give everyone the right to treatment and to feel ourselves in a beautiful dream of the future”.

The doctor in people’s homes

They told me about their going to people’s homes, about many old people alone, perhaps on the fifth floor without a lift, to feel their pain, nostalgia, sadness or joy for a small party to share; and always invent something just to stay at home, in the ward, with the neighbor who now attends meetings and goes to help, and with the young people in the social caretaker who ask how it goes every day, and with the community nurse who helps taking medicines without making a mistake, who comes to measure the blood pressure, to do the blood sugar test; and the family doctor, district doctor and specialists who go home with the nurses when needed.

The work of volunteers

“We do everything – they told me – so that especially the oldest, the most battered, the most grumpy can stay at home, perhaps with the carer of the cooperative, with the help of the social worker of the municipality, perhaps with a daily lunch at home, with the heating working, and a coat for the winter and a shirt for the summer; with the company of a boy or girl from the civil service, with the ladies of the parish ”. And again, they tell of the involvement of volunteer groups, for the most diverse activities: from dance school to courses for digital skills, to reading groups, to events that tend to create knowledge among people, where today many times the neighbor home from a stranger ends up becoming an enemy.

Peppe Dell’Acqua, psychiatrist, has been for many years director of the Trieste Department of Mental Health. In 1971 he began working with Franco Basaglia in the Trieste psychiatric hospital and participated in the change and closure of the asylum


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