*Ovunque proteggi -Ricostruire un accesso universale alle cure perché non è andato tutto bene

Da più di un anno la pandemia da Sars-Cov2 detta legge, nel mondo e nelle vite delle persone. Siamo stati esposti, giorno dopo giorno, a un cambio radicale di abitudini, al dolore dei malati e all’impotenza di un intero sistema sanitario. In particolare il sistema sanitario lombardo che fino a prima della pandemia era indicato come una vera e propria eccellenza, sia a livello nazionale che europeo. Ad oggi sappiamo che, se la Lombardia fosse uno stato indipendente, sarebbe al primo posto nel mondo per numero di morti ufficiali da Covid. Nel mondo.
Come Collettiva* abbiamo sentito il bisogno di capire meglio e abbiamo organizzato, lo scorso 13 aprile, un incontro in-formativo aperto dedicato al tema della sanità invitando Vittorio Agnoletto (medico, docente e attivista), Giancarlo Ardizzoia (segretario confederale CGIL Varese), Gianna Moretto (segretario generale Funziona pubblica CGIL Varese) e Tatiana Irmici (infermiera rianimazione Covid 19 presso Asst 7 Laghi).

L’intervento di Vittorio Agnoletto ha chiarito in modo puntuale i vari momenti in cui la sanità lombarda ha mostrato la propria incapacità di reazione, dalla mancanza di un piano pandemico aggiornato all’incapacità di avviare studi epidemiologici, o un contact tracing efficace, o anche solo di fornire ai medici di base le protezioni individuali minime.

Vittorio Agnoletto: medico, docente, attivista, autore di Senza respiro,
libro inchiesta sulla pandemia


La carenza di strutture di medicina territoriale in grado di attutire l’impatto del virus sugli ospedali, ha fatto sì che le persone con sintomi si riversassero tutte nei pronto soccorso e da lì negli ospedali, che hanno presto esaurito i posti disponibili. Ricordiamo tutti la delibera con cui Regione Lombardia, l’8 marzo 2020, ha invitato le RSA ad accogliere i pazienti Covid e la carneficina che ne è derivata. Eppure sarebbe stato possibile scegliere diversamente: i sindaci e i presidenti di regione ad esempio avrebbero potuto requisire strumenti e immobili utili a fronteggiare la pandemia, ad esempio quelle cliniche private non accreditate e non convenzionate che non hanno partecipato (e tuttora non partecipano) alla lotta contro il Covid.
Lo smantellamento della medicina territoriale è uno degli effetti della particolare struttura del sistema sanitario lombardo, costruito attraverso precise scelte politiche, a partire da metà anni ’90.
Innanzitutto, la sanità lombarda è centrata tutta esclusivamente sull’apice della cura, sulla cura più avanzata, indipendentemente dai costi economici. Gli investimenti si sono concentrati tutti su questo pezzetto di medicina all’avanguardia che interessa cure disponibili per un numero limitatissimo di persone.
Inoltre, il principio della cosiddetta sussidiarietà, introdotto da Formigoni dal 1996 e via via confermato, ha posto pubblico e privato sullo stesso piano: ma il privato ha, per sua natura, l’obiettivo di generare profitto e quindi, se è libero di farlo (e in Lombardia lo è), sceglie di accreditarsi nei settori maggiormente redditizi, lasciando al pubblico tutto il resto, ad esempio la gestione delle emergenze, economicamente svantaggiosa.
Dovrebbe essere chiaro a tutti ma ripeterlo non può far male: il privato non ha interesse a investire in medicina preventiva perché guadagna sulla malattia, non sulla salute, mentre il servizio sanitario guadagna sulla salute, non sulla malattia, perché meno persone si ammalano più la collettività risparmia in termini di spesa pubblica.
Per garantire un accesso universale alle cure e sistemi sanitari efficaci, occorre ricostruire una medicina ampia, democratica, che consideri i bisogni di benessere e salute del più ampio numero di persone. A monte, si tratta di riequilibrare politiche che, al di là dei proclami, hanno fatto costantemente prevalere gli interessi di pochi su quelli di tutti, riaffermando invece con forza la vocazione autenticamente pubblica della sanità.
Lo stesso copione vediamo all’opera in questi mesi per la campagna vaccinale: le vite di 7 miliardi e 800 milioni di persone, tra i quali 460 milioni di abitanti dell’Unione europea, sono nelle mani di un ristrettissimo gruppo di grandi aziende farmaceutiche che, in base agli accordi TRIPs, hanno l’esclusiva proprietà per vent’anni dei loro vaccini, potendo determinare dove, quando e come produrre.

Queste aziende farmaceutiche chiedono ora agli Stati, che pure ne hanno finanziato la ricerca, di liberarle da eventuali oneri di risarcimento per danni provocati dai vaccini. L’Unione Europea sta portando avanti una trattativa sul punto, i cui esiti ha deciso di secretare. L’Argentina, dopo aver partecipato ai trial per Pfizer, ha rinunciato ad acquistarlo per la richiesta di porre le risorse pubbliche nazionali a garanzia di eventuali risarcimenti.
Vittorio Agnoletto (portavoce del Comitato italiano), Silvio Garattini, don Luigi Ciotti, Gino Strada, e molti altri, hanno promosso la campagna No Profit on Pandemic (Nessun profitto sulla pandemia) per chiedere all’Europa:
⦁ di appoggiare la proposta di una moratoria sui vaccini Covid, presentata da India e Sudafrica,
⦁ di desecretare gli accordi con le aziende farmaceutiche lavorando affinché i brevetti co-finanziati da fondi pubblici appartengano anche all’Unione Europea
⦁ di prevedere che gli Stati europei possano ricorrere alla licenza obbligatoria, prevista dagli accordi Trips (art. 31 comma B), che consente ai paesi in condizione di pandemia di scavalcare i brevetti per produrre in autonomia i farmaci di cui hanno bisogno.


Giancarlo Ardizzoia
e Gianna Moretto, entrambi impegnati nella CGIL di Varese, hanno mostrato come il modello descritto da Vittorio Agnoletto si riproponga anche a livello territoriale.

I progressivi tagli al Servizio Sanitario Nazionale hanno ridotto il personale, il numero dei posti letto e un adeguato aggiornamento degli strumenti diagnostici favorendo lo sviluppo delle strutture sanitarie in regime privato/convenzionato e lo smantellamento della medicina territoriale pubblica.
A Varese le strutture ospedaliere ricorrono sempre più spesso all’esternalizzazione dei servizi che, pur avendo l’obiettivo dichiarato di abbassare i costi, in realtà produce spesso un peggioramento del livello delle prestazioni, e anche delle condizioni di lavoro e dei salari.

Giancarlo Ardizzoia: Segretario confederale CGIL
Varese


Proprio l’indebolimento del servizio pubblico e delle strutture sanitarie territoriali, effetto del favore di cui gode il privato, è stato poi anche causa, durante la pandemia, di un ulteriore rafforzamento delle strutture private: con le strutture ospedaliere tutte impegnate a gestire la pandemia e in assenza di strutture sanitarie pubbliche alternative sul territorio, le persone con bisogni sanitari legati a patologie non Covid si sono dovute rivolgere al privato, incrementandone il giro d’affari.

Gianna Moretto: segretaria generale Funziona pubblica
CGIL Varese


Gianna Moretto sottolinea l’importanza di una presa di coscienza da parte dei cittadini affinché riconoscano l’importanza di difendere il servizio pubblico, magari affiancandosi alle lotte dei lavoratori della sanità, stremati dalla pandemia e da una cronica mancanza di personale.

E qui è arrivata la testimonianza di Tatiana Irmici, a chiudere il cerchio, portandoci dentro le stanze della terapia intensiva, dove malati e operatori sanitari hanno portato avanti battaglie diverse eppure simili. Con pochi mezzi, vivere. Con pochi mezzi, far bene il proprio lavoro.

Tatiana Irmici: infermiera rianimazione Covid-19
presso Asst 7 Laghi


Ci racconta che, all’inizio della pandemia, non c’erano nemmeno i dispositivi di protezione individuale: la difficoltà maggiore è però la cronica carenza di personale, peggiorata dal trasferimento di parte degli operatori esperti in Fiera Milano. A quel punto nei reparti dell’ospedale di Varese sono entrate persone nuove, appena laureate, cui è stato concesso un affiancamento brevissimo nonostante la delicatezza e la complessità dei compiti. Il personale sanitario, e gli infermieri in particolare, oltre a un carico enorme di fatica fisica per via dei turni massacranti, delle bardature da astronauta, delle continue pronazioni, hanno anche un carico emotivo devastante: non solo sono i più vicini ai pazienti, ma spesso sono il loro unico contatto umano. Da poco nelle fasi terminali si sta permettendo ai parenti un’ultima visita: Tatiana dice di aver capito che questo incontro serve tanto anche agli operatori, oltre che ai pazienti, perché consente loro di condividere l’aspetto emotivo di una morte che altrimenti avrebbero vissuto da soli.
Tatiana è sfinita e anche arrabbiata: per un sistema che non funziona e che la costringe a lottare tutti i giorni per poter svolgere bene il suo lavoro. Eppure Tatiana non vuole andarsene, come altri colleghi, magari in Svizzera: “Voglio rimanere qui, a lavorare nel mio ospedale, voglio che i cittadini possano essere curati bene nella sanità pubblica in cui noi crediamo”.
Al di là della retorica dell’eroe temporaneamente in auge circa un anno fa, ci sono cose molto concrete in grado di esprimere un rispetto autentico verso i lavoratori della sanità: contratti dignitosi, diritto al riposo, diritto a strumenti e tempi adeguati per svolgere il proprio lavoro in modo deontologicamente adeguato.

Grazie Tatiana, grazie a tutti.

Collettiva*

*Per chi volesse approfondire i temi esposti, segnaliamo il libro “Senza respiro. Un’inchiesta indipendente sulla pandemia Coronavirus, in Lombardia, Italia, Europa. Come ripensare un modello di sanità pubblica” di Vittorio Agnoletto. I diritti d’autore saranno devoluti all’Ospedale Sacco di Milano, struttura pubblica che ha svolto un importante lavoro sul Covid-19. Qui maggiori info: https://altreconomia.it/prodotto/senza-respiro



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