I have had another incredible week here in San Giovanni en Fiore. My Italian "small talk" is improving as well as my conversation at restaurants. The physicians, patients, and people in town continue to be exceptionally lovely and welcoming.
This week I traveled to some other small towns in Calabria to appreciate hospital wards, medical clinics, and even a high school with some incredibly intelligent and motivated students. I learned to appreciate more cultural differences in medical services and education in southern Italy compared to the United States. I will highlight some of those differences in this post.
This week I had the opportunity to visit two different pediatric wards in Calabria. Patients there are admitted for similar reasons as in the United States - fever, cancer, anemia, dehydration, appendicitis, hypoxia, etc. Most patients share rooms with other patients - sometimes three to four patients in a room. They likely share restrooms and common spaces as well. Meals are delivered to their rooms, and the hallways are decorated with paintings of familiar Disney characters.
In the hospital, the healthcare team sometimes rounded by visiting the patient rooms and other times rounded by having the patients visit the doctor's exam room where there was access to an ultrasound machine, an exam table, exam tools, nurses, and other healthcare staff. Both were efficient ways of seeing the patient and collaborating with the team. Most hospital medical records are handwritten and contain individualized patient charts with logs of the daily vitals, labs, and exams. The nursing staff was excellent with the pediatric patients!
One of the major differences I have noticed when comparing to medicine in the USA is that most health records in the hospitals of southern Italy are kept in paper books with the patient's list of vitals, labs, and scheduled medications. Some hospital systems do utilize electronic labs and imaging for each patient, particularly for research trials. However, this varies widely depending on the departments and healthcare associations. Many Italian physicians are eager to make this advance in the future, as it could allow for more collaboration with specialists and colleagues. They were inquisitive about our use of the electronic health record in the USA.
The medicine practiced here is largely the same as the USA with similar protocols and algorithms to treat specific disease states. The process in which they round, chart, and see patients in clinic is just a little different. At many primary care clinics, patients do not have appointments and simply enter the physician's office as they arrive. Visits are quick and in no particular order. Each patient or their caregiver is largely responsible for bringing personal health records to each healthcare visit. This can include referral forms, prescriptions, and CD's containing imaging studies.
The Italian work schedule is also very different from a typical American physician 8AM-5PM clinic. Italian clinics are often available to patients from 8AM -1PM, closed for lunch, and available to patients again at 3PM until 6PM or 8PM. The afternoon break is very important for all types of professions in Italy - lunch and rest are critical parts of their midday. Clinics, shops, grocery stores, restaurants, and bars all lock up their doors in the afternoon to eat, nap, and unwind!
Another highlight of my week was the privilege to visit a local high school and speak with Italian students on what it is like to study medicine in the United States. I met two groups of very intelligent, driven, and polite students who study English, Math, Physics, and Science intensely. Some of them have aspirations to become physicians in the future. We talked about the decision to study medicine, the workload of medical school, and the differences in medical eduction in the United States compared to Italy.
In Italy, the initial study of medicine occurs over six years and begins immediately after high school. There are medical schools all over the country, and placement depends on a standardized exam called the IMAT. Medicine and dental studies are often combined at these schools. After six years of medical school, physicians graduate and accept positions in specializations. These specializations are most similar to a "residency" or "fellowship" in the USA. This continuation of training can last a varied number of years, depending on the specialty. Pediatric specialization in Italy occurs over three years.
It was an amazing week appreciating the culture of medicine and healthcare in Calabria. It was also unforgettable opportunity for me to celebrate my first Easter Sunday in Italy. Most of the community here in San Giovanni in Fiore is Catholic, so their Pascal celebrations are important and beautiful. I had the opportunity to attend mass on Holy Thursday at the church of Santa Maria delle Grazie which is near the campus of the Cappuccini convent. I attended mass again on Easter Sunday with the local family that is hosting the exchange. Both were beautiful opportunities.
"Buona Pasqua" translates Happy Easter.
"Buonna Pasquetta" translates Happy Little Easter.
On Easter Sunday afternoon we were invited to the home of our lovely exchange hosts in San Giovanni for a delicious home-cooked meal. I was excited to find out that I would sit at the "kid's table" with the other young adults in the family. It felt just like home! The others at my table were so wonderful and spoke English very well due to their educations at universities and travel to metropolitan cities. We enjoyed a meal of pasta, polpetta (mini meatball), roast beef, pork, escarole, zucchini, and fresh bread. I also learned about the traditional Neapolitan cake called Pastiera, which is an Easter dessert made with ricotta, sugar, eggs, dried fruits, and delicious crust. I sampled slices homemade by three different people this week, and they were all so incredibly delicious.
I was so thankful to spend the Easter holiday with such an incredible family, but even more thankful that the Italian Easter holiday continues to Monday. This day is known as Pasquetta which translates in English to "little Easter". This national holiday is typically spent by packing a picnic basket full of Easter leftovers and heading to the countryside or beach to enjoy more food, wine, and barbeque. We spent our Pasquetta at a family's vineyard enjoying another delicious meal and great company. We enjoyed more pastiera and Easter chocolate. I also really loved a homemade Neapolitan Tortano which is a savory bunt bread made with meats and cheeses. It was like a very fancy version of a pepperoni roll.
It is hard to believe my exchange is halfway done here in Italy. Every day I am inspired by the sense of community in this small town. People work hard but also make time to rest and relax with their families. Physicians are so proud of the work that they do and their ability to care for their neighbors and friends. It is so heartwarming to be welcomed into such a wonderful place.
I am looking forward to the weeks to come - appreciating medicine and culture in this beautiful southern town of San Giovanni.
Here are some other highlights of my week.
Ciao! 🇮🇹
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