The Calabria federation of the Communist Front denounces yet another tragedy due to the conditions of the local health service. A 48-year-old man died two days ago in Calabria aboard an ambulance on State Road 107, after feeling ill in the afternoon. He had arrived at the San Giovanni in Fiore emergency room, where health workers immediately realised his serious condition and mobilised to transfer him elsewhere. However, due to the fog, the helicopter was unable to intervene and there was no doctor available in the ER for immediate transport by ambulance. The delay in transport was therefore fatal.
This drama, linked to the cuts in the National Health Service, represents very well how much Calabria is one of the territories that have paid the most for these decades of classist policies, in which a heap of subsidies to businesses, the accreditation of numerous private clinics and costly outsourcing of collateral health services to profiteers and cooperatives through tenders and subcontracts has been preferred to adequate funding of public health and specialisation schools for health workers. In general, at the national level, the preference has been to give in to the blackmail of financial capital and its demand to dismantle public services under the pretext of budgetary constraints. All this has laid the material foundations, in Calabria, for tragedies such as the following: hospital closures (18 since the beginning of the public debt rehabilitation plan, which has been in force for 12 years now), staff cuts (up to 5,000 fewer staff members than 12 years ago), the non-existence of territorial medicine, the impoverishment of mountain hospitals and, in general, of peripheral hospitals, and, lastly, a shortage of resources in ER departments and the 118 service. Added to this is the phenomenon of health migration, which costs Calabria more than 300 million € every year and forces thousands of citizens to travel to other regions to receive adequate care.
This picture is evident, for example, if one takes a look at the impoverishment of the ‘periphery’ hospitals of one of the poorest provinces in the country, that of Vibo Valentia. In the case of the hospital in Tropea, which in the tourist period has to serve a catchment area of up to 150,000 people, we have gone from having an almost complete hospital twenty years ago to having, today, a health facility with only three functioning wards: oncology, dialysis and general medicine, in addition to the emergency room, radiology and analysis laboratory services. We have departments and services that suffer almost daily staff shortages: the general medicine department, for example, has found itself operating for a few days with only one doctor and one nurse. All this because the Vibo Valentia health authority has distinguished itself as the only health authority in Italy not to have stabilised the Covid-era temporary workers. The renewal was secured only for 4 health care assistants and 13 nurses, while 23 job posts remained empty when their contracts expired. This caused a staffing issue in the hospital of Vibo Valentia, the largest in the province, which was filled by the commissioner trio that now runs the health authority by declaring a large number of staff from the Tropean hospital redundant, from which about 10 professionals were transferred to Vibo. With linear cuts to public health, needs are covered in one hospital, leaving another hospital uncovered.
The same applies to the hospital of Serra San Bruno, which was initially a general hospital, downgraded as a hospital of a disadvantaged area in 2010, in which obstetrics, gynaecology, cardiology and general surgery were closed in recent years, leaving only the long-stay department and general medicine active, which were later merged. Surgery was closed, in particular, after a renovation of the operating theatres that cost 800,000 €. The inhabitants of Serra San Bruno, a mountain town, who have to drive two hours on an uncomfortable road to reach the hospital in Vibo Valentia, used to have anaesthetists, radiologists, and a cardiologist, while today they have a surgery outpatient clinic, for outpatient operations, and a cardiology outpatient clinic where in less than a month the cardiologist who runs it will retire. Today, for cardiology and surgery consultations and for CT scans, patients are transported to Vibo Valentia or to other hospitals, and radiology works with tele-radiology: the images are always sent to Vibo Valentia.
In the Cosenza area, the situation of the Lungro health centre is no exception. Since the mid-1990s, the former hospital has been gradually deprived of services and wards until the now infamous Rehabilitation Plan decreed its closure.
Its transformation into a house of health and its subsequent promotion to a territorial periphery ospital have never really respected the functionality necessary for it to remain an efficient territorial presidium: about four years ago the analysis laboratory was closed down despite being in full operation; for more than two years (due to the retirement of the last technician) radiology has turned into an intermittent service despite the replacement of the X-ray machine; the outpatient services (which are also active only a few days a month, making the service inefficient for users) lack adequate equipment – computers, labelling machines and some basic diagnostic instruments are missing – and it is impossible to use the helicopter landing pad, which has therefore been moved 2 kilometres away from the facility. The former hospital of Lungro, in its current state, guarantees the functioning of a constantly understaffed dialysis ward, a small medicalised long-stay department and a meagre first-response unit.
This is the bleak picture of a hospital that is supposed to serve tens of thousands of people in the Esaro-Pollino district and that instead, for the interests of private individuals, has been weakened and made inefficient.
The cutbacks in public health services in Calabria have gone hand in hand with an increase in the power of private medicine. An emblematic example of this drift is the decision to reserve four beds for payment in the thoracic surgery department of Cosenza’s Annunziata hospital. This decision institutionalises a two-speed system, where those who can afford to pay immediately access treatment, while those without the financial resources remain trapped on long waiting lists. One case that caused a stir and indignation was that of Roberto Occhiuto, the president of the region, who relied on a surgeon from a private clinic to operate at the Catanzaro polyclinic, being able to take advantage of a non-invasive method of surgery that is precluded to the vast majority of the region’s inhabitants. And while for those who have the money and the right relationships, the Catanzaro polyclinic hosts specialised operations, when it comes to training doctors for the public sector it offers services that fall short of the law: in order for the city’s medical school trainees to have the case histories necessary for their training, the law stipulates that 1200 ordinary admissions and day hospitals are required, but in reality, according to Agenas data obtained from patients’ medical records, the number of them at the polyclinic is only 581.
In short, there are three preconditions for an efficient public health service, which can only be achieved through the struggles of the proletariat, the same struggles that made the establishment of the public healthcare system possible in the 1970s. These conditions are a massive resumption of funding for public health facilities, the integration of the fragmented regional health services into a single national health service, and the complete internalisation of private medicine into the public sector. Particularly with regard to this last point, it should be noted that private practitioners and private clinics, being inextricably linked to the public sector administrations, play an active role in influencing general policy and in increasingly pushing for the delegation of services to the private sector: efficient public healthcare and private healthcare are incompatible.
The Communist Front’s immediate objective is the abolition of the regional health rehabilitation plan, a pretext for diverting all services to private medicine, and the restoration of the beds and staff numbers cut in public hospitals since the plan came into force. This requires the diversion into public health care of the huge resources that are now at the mercy of, for example, corporate subsidies, tax avoidance, and gifts to private clinics. The overall objective is to strive for an efficient public health service, increasing structural investments so as to ensure an adequate number of health personnel and hospital garrisons on the territory, organised in a single national health system, investing more resources in structures and personnel with a view to prevention and not just treatment.
It is necessary, then, to claim the principle of the universal gratuitousness of health services, against the logic of ‘health companies’ that conceive medical services as a commodity, the abolition of health co-payments and all similar forms of taxation that burden patients, the abolition of conscientious objection under law 194/78, which makes Calabria a place where abortion is difficult to perform in public hospitals, the implementation of functioning family counselling centres and health services for children and adolescents. Public health must become a service that aims to emancipate proletarians from the blackmail between health and work, also guaranteeing the necessary protection and certification to wage earners suffering from totally or partially invalidating illnesses or who suffer accidents in the workplace, which are often minimised in hospital wards due to the political link between health professionals, business and local administration.
Such an ambitious plan can only be achieved by an organised uprising of the working class, the local and national working class, in the absence of which the blackmail of capital at all levels will prevail. Finally, in the long run, only a change in the mode of production, as history has taught us, guarantees immunity from the blackmail of capital and the stabilisation of a truly universalist health service.
