Medical clinics in Naples on the brink of collapse

"My father died because the administration of the national health service is so abysmal — the hospital is only 1 kilometer (about half a mile) away from his home but the emergency room has been shut down," said Ipazia Ruotolo. She said her 74-year-old politically active father, Francesco, had fought unsuccessfully for its reopening. "If it was open, he would have survived."  

When he began to feel unwell in mid-October, he was not initially tested for COVID-19 because the national health service staff did not regard his condition as worrying, despite his age.

Read more: Italians search for hope in times of coronavirus

Francesco turned to a private hospital for testing, and by the end of the month, it was clear he was infected with the coronavirus and in an increasingly critical condition. He and his family called various hospitals daily to get him admitted while relatives watched his condition worsen. At the beginning of November, he was finally admitted to a clinic and isolated. Francesco died on November 15 at the Antonio Cardarelli Hospital, one of the largest medical centers in Naples.

The hospital has become a symbol of the dramatic situation in the region's hospitals after a video posted on social media showed the lifeless body of a COVID-19 patient who had collapsed and died on the toilet in a hospital bathroom.

Losing battle for proper health care

On her walk to a neighborhood chapel to commemorate her father's life, Ipazia Ruotolo passed by large banners strung up to honor his commitment to the community, reading, for instance, "You will live on forever in our struggle." Francesco had helped redevelop streets in his neighborhood, he had campaigned for a new hospital as well as improved patient-centered care in the existing clinic. He protested vehemently against the closure of other clinics. "This struggle became a symbol of his death," said his daughter Ipazia.

Francesco's death is just one example for the precarious state the southern Italian health system finds itself in.

In Italy, the severe second wave of the coronavirus has seen about 30,000 new infections  every day. Naples and the Campania region, which is one of the country's poorest, were largely spared by the pandemic in the first wave. Now there are more than 600 COVID-19 cases per 100,000 inhabitants, according to the National Health Institute (ISS), a figure well above the national average. Classified as a red zone, Campania has now imposed a curfew on residents.

Doctors, medical staff are helpless and frustrated

Hospitals can no longer accept every patient. "At the moment all our beds are occupied, both in the intensive care unit and in the other wards," said Elio Manzillo, head of Ospedale Cotugno, a hospital that specializes in infectious diseases. "We only treat COVID patients," he said, adding that even more patients were in the waiting room, hoping to be admitted.

The region is paying dearly for the government's budget cuts, many doctors say. Several hospitals have been privatized while public clinics have downsized their medical staff and physicians. They were overworked even before the pandemic hit — meanwhile, the situation has worsened significantly.

The situation is bad for the patients and it is bad for the health workers who feel helpless because "the austerity measures in our region prevent us from meeting the people's needs," said Simona, a Naples physician who only wanted to give her first name. To make up for the shortage, the hospitals employ trainees and doctors from other fields — neither are trained for such crisis situations. COVID patients are treated by ophthalmologists, gynecologists and medical students from geriatrics, for example, said Lello, an anesthesiologist.

In addition to the medical challenges these doctors and nurses face, they are afraid of contracting the virus and infecting their family members at home.

Poor region, poor hospitals

The difficulties the southern Italian health care system faces are not new. The pandemic has only increased the inequality between private hospitals and the public health sector.

The politicians bear some of the responsibility, they could have done a better job in handling the crisis, said Mario Coppeto, a left-wing politician, doctor and member of the Naples City Council. The structure of the health system is the problem, he argued. "The regions shoulder the responsibility, which creates many imbalances — resources, funding and organization are different in every single region."

The Naples public health system has yet to see the worst, predicted Ospedale Cotugno's Elio Manzillo. "We expect the infection curve to rise, the coming weeks will be tough."

Getting ready for her father Francesco's funeral, Ipazia Ruotolo said medical workers were not to blame for her father's death. The system is to blame, she said, not the people who work for it.

This article was translated from German by Dagmar Breitenbach.