A young Italian doctor’s human approach to healthcare in Portugal

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In Lisbon’s multiethnic center, nestled between the hills of Alfama and Mouraria on one side and Martim Moniz square on the other, bordered by the Rua do Benformoso, lies Baixa—a troubled neighborhood, afflicted by drug addiction and prostitution, but on a positive path to improvement. A new Centro de Saude (Health Center) was set up there a few years ago, offering medical care to the whole neighborhood. The head of the Unidade de Saude Familiar (“Family Health Unit” – USF) in Baixa is Dr. Martino Gliozzi, a 36-year-old Italian.

Dr. Gliozzi, it’s not easy to explain in a few words what a Centro de Saude is, as the Portuguese family medicine system is different from the Italian one. Can you summarize it quickly?

One can say that the health centers are public structures that function under the leadership of a manager. All family doctors working for them are public servants, and have the same rights and duties as doctors in hospitals. We work in teams that can be smaller or larger, and the health centers are spaces managed by the Health Ministry, with a presence throughout the country.

How did you get to be in charge of the Baixa health center?

It all started with a management problem, which made radical change necessary, because the doctors, nurses and administrative staff who worked there were frustrated and could not make heads or tails of the situation. All this meant that many conflicts were developing, both within the team and externally, with the patients. As a result, the idea came up of having someone younger in charge, someone less disillusioned, who would be willing to change things and who would be able to establish a constructive relationship between the institution and the community.

Were you selected as part of an already-existing reform project, or were you the one who proposed the plan?

The idea was mine. The managers wanted nothing more than for things to improve. I gave them one condition: that the staff should be completely new and that I should be the one to choose the doctors. I did that because I needed people who were motivated.

The change you have brought here was not just a change in management.

Baixa was a place where nobody wanted to go, and the new staff that decided to come work here did so on the basis of a completely new project. It wouldn’t have been enough to just replace the person at the top, it was necessary to bring together people who shared a common vision.

Who uses the services of the health center?

We have 15,000 people registered, including people from 94 countries: Bangladesh, Nepal, Pakistan, China, etc. Around 30% of those registered with us are immigrants—but, if we look at the full picture, most of our patients are elderly Portuguese.

What were the main changes that took place at the center?

Previously, the patients had to adapt to the rules of the center: a 20-minute visit, only available in Portuguese. But we realized that the only way things could work well was if we were going to be the ones who adapted to the people who came to us. Our goal has been to be able to communicate, so we speak English, but many patients don’t speak English either—so we try using gestures, Google Translate, images from the Internet… Basically, we had to have more patience and a greater desire to understand each other, focusing on the person who is in front of us: an individual who is different from everyone else.

It all reminds me of the Carnation Revolution: you are a kind of “collective” yourselves.

Yes, the bond between us is very strong, especially in the medical team, we trust each other and we have a similar vision about how the center should be managed. Our strength is the great solidarity among us, as we know that we are fighting for the same cause. This is probably a result of the fact that we all knew what we were getting into.

Are there any problems because of religious differences?

Our patients are Catholics, Hindus, Muslims, Sikhs—in short, it’s a very diverse mix. Everyone has their own religion and their own way of seeing things. It’s not just an issue of religion, but of cultural imprinting and cultural background. Thus, women’s issues—contraception, gynecological visits—are difficult to approach, because many times women are immigrating after the men in their family and do not have a community life like the men, and they don’t speak Portuguese because they spend much more time at home.

Can you say more about your approach to these issues?

One part of it is research, a more profound understanding of certain cultures; another part is curiosity, because people are all different, and not only when it comes to religion. The crucial point is having an attitude of cultural humility—a concept from anthropology that cannot be reduced to particular skills or abilities. It means you have a duty to go beyond prejudices. This changes the way we interact with those who use our clinic.

Your project has expanded far beyond the realm of healthcare.

In addition to our main work, we have decided to invest in projects that did not exist before and which go beyond medical care. For example, we organize walks with our patients once a month. We talk about many different topics on these walks—it’s basically an activity that serves to build stronger bonds between the community and the health center by developing a relationship of trust.

Almost everywhere in Europe, politics nowadays tends to avoid showing a too-welcoming attitude towards immigrants. But here, the politicians are showing they are proud of your Center in a number of ways.

Despite its problematic past as a colonial power, Portugal nowadays has become an inclusive country, much more so than Italy. António Costa, the current Prime Minister, decided to invest in this area with many problems, and in our center.

Prime Minister Costa himself has Indian roots.

Indeed. A new health center with good infrastructure and offering good conditions is something rare. The government has spent a lot of money to create this place, and I think it was probably the first time that a Prime Minister attended the inauguration of a Centro de Saude.

Has your center achieved significant results?

Thanks to our center, people that the institutions would usually need to keep an eye on, people who have made trouble in the past, are more integrated, and, as a result, less “problematic,” so to speak.

The extreme right feeds on insecurity, which takes root where there is no strong community. The fact that a common point of reference exists, like what you provide, undermines this process.

Where the state is absent, organized crime and insecurity arise. So, yes, for us diversity becomes a strength. When people ask me if it’s hard to work here, I answer that it’s much more fun and gives you much more satisfaction. Politics appeals to people’s lower impulses, but it should be done with the head and not the belly. That is precisely what is needed to manage a high-immigration area. It is essential to offer people services. Failing to provide medical care to everyone, including illegal immigrants—as is happening in Italy—is pure masochism, even from a strictly medical point of view.

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Originally published at https://ilmanifesto.it/investire-nella-salute-pubblica-a-lisbona-si-puo-e-funziona-bene/ on 2019-04-25