By Francesca Piscioneri and Crispian Balmer
LOCRI, Italy (Reuters) – Doctors from Communist Cuba are used to being dispatched to help in medical hotspots in Africa, Asia and South America. But less so to well-off Europe.
Highlighting the strains facing health services in Italy, the southern region of Calabria has signed a three-year deal to draft in almost 500 medics from the Caribbean island to help overcome a severe staffing shortage.
“It was a surprise for me to think Italy had a healthcare problem,” said Elizabeth Balbuena Delgado, a cardiologist from Santiago de Cuba. She accepted a temporary assignment to work in Locri, a seaside town on the underside of Italy’s toe.
“None of us had ever been to Europe,” Delgado said of the first wave of 51 Cubans who arrived in Italy’s poorest region in January.
   It is not just Calabria that faces manpower problems. Health Minister Orazio Schillaci has said staff shortages nationwide represented “a real emergency”. Italy needs to attract more foreign clinicians to its thinly staffed wards, he said.
   “We must strike agreements with foreign countries to have an adequate number of nurses,” Schillaci told a news conference on Sept. 15, adding that he was close to reaching a deal with India, which has hundreds of thousands of its nurses working abroad.
Italy’s health ministry declined to provide further details. A senior Indian Health Ministry official said that a memorandum signed after Italian Prime Minister Giorgia Meloni visited India in March contemplated easing labour mobility for nurses and paramedics, including with language training.
Without swift action, the situation in Italy’s hospitals could get worse, quickly.
Almost a quarter of the 102,000 doctors working in the public health service are eligible for retirement by 2025, unions say, meaning administrators will face an ever-growing battle to keep wards, clinics and even whole hospitals open.
Authorities are increasingly looking to hire from abroad to fill the many gaps — something Italy has traditionally shied away from, unlike other wealthy nations.
The Paris-based Organisation for Economic Co-operation and Development (OECD), a group of 38 member countries that aims to establish international standards, says foreign-trained doctors made up just 0.9% of all doctors in Italy in 2019 — the most recent year for which data is available. This compared with 11.6% in France, 13.1% in Germany and 30% in Britain.
While Italy has previously succeeded in training the vast majority of doctors and nurses it needed, a combination of low salaries and burnout have thinned the ranks — especially in demanding specialities like accident and emergency care.
Reuters spoke to more than a dozen doctors, union leaders and health officials who said that attempts to ramp up overseas hiring is not proving easy, with the problems that plague Italy’s health service — including uncompetitive salaries, crumbling infrastructure, long hours and bureaucracy — making it hard to attract foreign talent.
Part of the problem is also cultural. Unlike English or Spanish, relatively few foreigners learn Italian in school or speak it fluently, meaning there has never been a ready pool of skilled foreign workers.
“Italy is not a multi-cultural society. It isn’t used to this dynamic,” said Andrea Filippi, a medic and national secretary of the CGIL union of public service doctors.
Previous governments, looking to protect domestic workers, have also made it difficult for outsiders to get recognition of their qualifications.
  “In Italy it takes a year, or a year and a half to get (international) diplomas recognised. People are leaving Italy because of it,” said Professor Foad Aodi, head of the Italian association of foreign doctors.
“Italy always looked to hire domestically even when it was obvious they faced shortages in key areas … It was a major mistake that other countries didn’t make.”
“DESPERATION”
Roberto Occhiuto, president of the Calabria region, told Reuters he had to look abroad for physicians after failing to attract enough Italians to fill an array of empty posts. But it was not as easy as he had hoped.
“I tried with Albanian doctors, but they told me that while they can earn five to six times more in Italy than back home, they could make much, much more than that in Germany,” he said.
He then contacted Havana, which sends thousands of medics abroad on international missions each year in exchange for badly needed cash or goods.
“The idea came to me out of desperation,” Occhiuto said.
The COVID-19 pandemic laid bare the failings of the national health service in Italy, which suffered the second-highest death toll from the pandemic in Europe after Britain. Italy registered 191,469 deaths.
Politicians of all colours promised at the time to boost health spending and reverse a decade of cuts. However, with the virus receding, spending is again in decline as the faltering economy forces the government to make difficult budget choices.
Meloni’s right-wing coalition has said state health care spending this year will come in at 6.6% of gross domestic product (GDP), down from 6.8%Â in 2022 and will fall to 6.2% next year, resulting in a real drop in spending.
Health professionals say a decade of austerity has had a devastating impact on staff morale, causing an exodus from the public health system into smaller, but better paid, private clinics, or else into more lucrative freelance contracts.
“Our salaries are among the lowest in the world. You can’t always work for the glory,” said Rosanna Curinga, 41, a surgeon who works in Locri alongside the Cubans. “You work so much that you easily burn out, yet you hold people’s lives in your hands.”
NOT ATTRACTIVE
The OECD database says a specialist doctor earns on average $82,000 a year in Italy against $99,000 in France, $156,000 in Britain and $175,000 in Germany.
This discrepancy means other destinations are more attractive for oversees doctors looking to build a career in Europe, says Aodi, the foreign medics chief, who is Palestinian.
During COVID, Italy eased restrictions for hiring foreign medics, suspending the rules that said they could only come from European Union states or else had to have residency papers — a lengthy bureaucratic procedure that deterred many outsiders.
The emergency rules remain in place for now, but that doesn’t mean there is a queue of qualified health workers at the door.
  A small hospital in the town of Morbegno, north of Milan, is fully equipped but cannot open because it cannot find nine nurses. Administrators had hoped to hire them from Peru, but the deal fell through in July and no new solution is in sight.
The 15-bed hospital only requires a team of 17 staff to open.
“This is an out-of-the-way spot and not considered attractive. Furthermore, just cross the border, you find yourself in Switzerland where you earn more,” said Lorenzo Grillo Della Berta, head of healthcare in Morbegno.
“If here a nurse earns 1,500 euro (a month), in Switzerland you earn more than double that.”
Higher salaries and better working conditions elsewhere are also proving a lure for Italy’s own medical professionals, Italy’s health unions say, exacerbating staff shortages.
OECD data says that 11,358 Italian doctors were working abroad in 21 OECD states where data was available for 2021, including 1,644 in France and 1,408 in Germany. By contrast, just 107 French doctors and 316 Germans were working in Italy.
Italian medics are also being lured to non-OECD nations.
The Nursing Up union – which had more than 24,500 members last year – said last month that 550 Italian nurses had put their names down to go and work in Abu Dhabi, where they earn 3,400 euros net a month, plus housing and travel costs.
“The geography of world healthcare has changed. Countries in the Middle East are investing around 10% of their GDP in healthcare and the gap with nations like ours is in danger of becoming unbridgeable,” said Nursing Up chief Antonio De Palma.
In Calabria, the arrival of the 497 Cuban medics will only provide temporary relief. They are due to leave in 2025 and the region is not counting on them putting down roots.
“I will stay for as long as the agreement between Italy and Cuba stipulates, but I don’t want to stay here. I want to go back with my mum, to my home,” said the cardiologist Delgado.
($1 = 0.9323 euros)
(Reporting by Francesca Piscioneri in Locri and Crispian Balmer in Rome; Additional reporting by Rupam Nair in Delhi; Editing by Daniel Flynn)
