Author: gabrielbiondo

From my time volunteering in a clinic in Italy, I’ve come to realize how prominently a society’s core values are reflected in its healthcare system. In the clinic for refugees, I’ve seen Italian physicians embody a “care for all” mentality, making accessibility and comprehensive care their top priorities. Contrastly, in the United States, where I’m involved in epilepsy research, the focus in healthcare often leans toward cutting-edge innovation and a forward-looking approach. Although both systems are deeply committed to patient well-being, the paths that are followed to achieve these values are noticeably different.

On my very first day at the volunteer clinic in Italy, the communal well-being approach was evident. What struck me most was the fact that each physician here provides their care for free and operates independently of government subsidies. Equally remarkable was our ability to see 20 patients in just 4 hours. In the US, a typical patient visit can last anywhere from 30 minutes to an hour. The difference in Italy showed a focused, efficient approach as opposed to the often time-intensive and individual-oriented consultations I was accustomed to back home.

Drawing from Hofstede’s D6 model for national culture, Italy’s approach aligns closely with the “Collectivist” dimension, where the welfare of the society takes precedence over individual achievements. In stark contrast, the U.S. tends more toward “Individualism,” with an emphasis on personal rights and achievements. This dynamic begs the question: how might a collectivist perceive an individualist, and vice-versa? Coming from an individualistic background, I initially regarded the Italian approach as less progressive. Concurrently, I sense that my Italian colleagues might view my keen enthusiasm for innovation as somewhat impersonal, potentially prioritizing scientific advancements over genuine human connection.

This distinction in cultural dimensions brings to mind the heterostereotype of Americans being “driven” and “forward-looking,” while Italians might be seen as “community-oriented” and “nurturing.” Though stereotypes can be overly simplistic and reductive, they can stem from real, observable cultural traits.

Recognizing these differences has been a transformative experience for me – I’ve gained further perspective beyond the American lens through which I initially viewed Italy’s healthcare system. I have grown to deeply appreciate the heartfelt care central to Italy’s communal approach. I’m now an advocate for nurturing patient relationships as a priority, while holding onto the belief that there can be a harmonious balance with technological and medical advancements.

I find myself hoping for a deeper understanding of how these cultural dimensions have historically evolved in both nations, and how these values have permeated other sectors of society. Moving forward, this newfound awareness doesn’t complicate, but rather enriches my perspective on both cultures. It serves as a reminder that various approaches can coexist, each contributing its unique strengths.

Last week, a patient arrived at our clinic presenting a deeply concerning injury. At first glance, his nearly absent tricep, seemingly the consequence of an unsuccessful surgery, propelled me into a series of rapid assumptions about the quality of care he had received. Guided by my cultural and professional expectations, I mistakenly surmised this as a clear case of medical neglect. I even wondered if he might have received inadequate treatment in another country en route to Italy. Little did I know, the truth was that he had tried to self-care for a gunshot wound.

But as I delved further into his medical background, a distressing story came to light. This wasn’t merely a surgical oversight; it bore testimony to a gunshot wound he endured during his difficult journey to Italy. The scar became a silent testament to the traumas many refugees face. Realizing the depth of his trauma, both emotional and physical, weighed heavily on me. My initial view was constrained, focusing primarily on the external injury. However, deeper reflection revealed that my initial biases had clouded my understanding. The methodology emphasized recognizing the broader context of each patient’s experiences, rather than just their obvious symptoms.

Upon introspection, I found myself grappling with intense feelings of empathy and remorse. Empathy, recognizing the profound physical and psychological anguish he had been subjected to, and remorse for my premature judgments. Now, when I look back, I am filled with gratitude for the invaluable lessons learned and the evolution of my patient care approach. 

When consulting with the lead physician, he highlighted the importance of comprehending the origins and implications of such injuries. His expertise illuminated not just the tangible effects of the wound but also the psychological implications. This newfound knowledge has refined my approach, making me more receptive to the subtle stories that patients might bring with them, ones that might not be instantly evident.

The D.I.V.E. methodology (Describe, Interpret, Verify, Evaluate) has been transformative in my professional journey. It champions introspection and a comprehensive evaluation of circumstances, preventing hasty judgments. I am committed to incorporating it into my professional interactions, whether they be routine or as intense as this one. Moving forward, I know that I will be able to utilize my experiences in the clinic such as this one to cultivate a more informed and compassionate approach to patient care.

The above photo is of one of my Italian students and I after seeing me walking through the city. Yesterday, he had stopped me to express his gratitude for having the ability to sustain conversations in a language completely foreign to him a couple months back. He further wanted to take a picture with me so he could remember his journey seeking to settle down and assimilate to his new life living in Italy.

Throughout my internship at a free medical clinic for refugees in Italy, I have interacted with a diverse array of medical professionals and patients accustomed to various healthcare systems. One recurring theme that has intrigued me is the hetero-stereotype many Italian colleagues hold about the United States healthcare system, a topic that often arises in our professional exchanges.

Many healthcare workers here hold the belief that the US healthcare system is prohibitively expensive and largely inaccessible to low-income individuals. These perceptions are shaped partly by personal anecdotes, international media narratives, and stories they’ve heard about individuals grappling with medical costs in the U.S.

Earlier this week, I had a revealing conversation with one of the physicians I work with. He recounted a visit to the US several years ago where he was taken aback by the high costs of emergency healthcare services for a seemingly minor injury. His understanding of the US healthcare system was also shaped by news reports and films portraying Americans struggling with medical expenses.

Interestingly, he acknowledged the exceptional quality of healthcare in the U.S. He also recognized the considerable funding and resources devoted to research and volunteer services in America, a facet he found illuminating.
In contrast, as an American university student who has volunteered in U.S. medical services, my perspective is layered. While I agree with the perceived high costs, I’m also aware of the numerous safety nets in place to ensure that healthcare isn’t completely out of reach for the less affluent. My experiences in both countries have been quite distinct yet share parallels.

Italian healthcare professionals perceive healthcare as a fundamental right for all citizens, reflecting the ethos of Italy’s universal healthcare system. In contrast, the US system is regarded as a valuable service, yet one heavily influenced by market dynamics.

Prior to this internship, I held hetero-stereotypes about Italian healthcare, imagining it as a sluggish and inefficient system—a perception partially influenced by complaints from my relatives. However, my hands-on experience in the refugee clinic has completely shattered these assumptions. We routinely see all patients who come for help within a three-hour window—a testament to the efficiency of this system. It’s been humbling and inspiring to witness the dedication and commitment of healthcare professionals in this setting.

Engaging in these exchanges has been invaluable in broadening my understanding of healthcare systems in different cultural contexts. As healthcare providers, it’s vital that we challenge our stereotypes, foster open dialogues, and cultivate empathy to ensure quality care for all—no matter where we practice.

It has been approximately a month since starting my internship and I have smoothly transitioned into my diverse daily routine. I initially started out my mornings teaching Italian to refugees from the Middle East alongside another professor but now I have assumed a new role teaching Ukranian refugees by myself as the primary instructor. During the afternoon, I head to the DONK Humanitarian Medicine office where I dive into my research into the psychological disturbances affecting refugees in Italy. And finally, in the evenings, I find myself in the heart of Trieste, volunteering in the clinic alongside a physician providing free medical care to immigrants.

Though I have become quite used to my daily schedule, I always have daily surprises. For example, last week a 60-year-old Iranian refugee walked into our clinic seeking psychological help. Being the only Iranian immigrant currently being welcomed into Trieste by our group, he has found himself isolated both by language barriers and cultural differences. Searching for someone to confide in, he comes to us to speak about his experiences and what he hopes for in the future.

Personally hearing his story for the first time, I could not grasp how he could have such unceasing optimism. Following his first visit with us, I took it upon myself to reach out to him for daily activities in which he could express himself and have a friend to confide in. Despite the challenges he has faced, being able to talk with me daily has given him hope and he has fondly called me his best friend right now. Our daily interactions are invariably concluded with a heartfelt phrase that has since found a home in my heart, “You give me hope, really, you give me hope.” This phrase not only touches me deeply but it has also instilled a sense of responsibility and purpose in my humanitarian service. His sense of isolation is born from the cultural and linguistic barriers he faces. Yet, his recurring message of hope underscores the universal language of friendship that surpasses all cultural boundaries.

Reflecting on these interactions now, I’m overwhelmed by profound gratitude. Our relationship underpins the importance of cultural understanding and empathy. As an Italian american, connecting with an Iranian requires a conscious cultural balancing act.

This journey has been an enlightening teacher, revealing that even amidst isolation and hardship, the human spirit’s capacity for hope never wavers. Furthermore, it has emphasized the profound influence of seemingly small gestures, such as our shared walks and talks. I am incredibly grateful for the friendship I have been able to cultivate even with those who I had least expected.

With more updates to come soon,

Gabe

PS. Out of respect for the refugee discussed in this blog, he has requested that I do not publish any photos with him. The photos below were taken with two of my students who I teach Italian. They had consented to these photos and their publication prior.