A hard-to-heal wound: a case study on the collaboration between nonprofit and Public Health Sector in South Italy

Abstract

This paper presents a case study of the barriers to care faced by a 44-year-old patient from Ivory Coast who has been living in Italy for 15 years. The patient visited his general practitioner (GP) in his neighborhood in southern Italy, seeking treatment for a workplace complex hand injury for which parenteral antibiotic therapy was recommended. During the medical examination, the physician also diagnosed the patient with diabetes mellitus and prescribed specialist examinations (i.e., diabetology, physiatry, surgery). Even if the patient was regularly residing in Italy, he encountered difficulties in navigating the health system to obtain the recommended services (i.e., administration of parenteral antibiotic therapy, serial dressings for the wound, booking several medical appointments). The local office of the Italian non-governmental organization EMERGENCY (EMR) stepped in to support the patient in facilitating the health system navigation, and collaborated with his GP on a diagnostic and therapeutic strategy. The course was regular and the patient did not develop any complications (i.e., gangrene, sepsis). The synergy between EMR, the patient, and his GP has resulted in (1) an effective clinical pathway, (2) reduced barriers to access, and (3) increased patient empowerment. However, this approach proved to be extremely resource-intensive. Organizing these resources with more planning and forethought would have granted many more patients access to care. Were the SSN to provide this type of comprehensive healthcare to every patient, regardless of the presence of NGOs, there would be better outcomes for marginalized health seekers, and resources would be used more efficiently and sustainably.