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FATEBENEFRATELLI in Capitolo Generale 2012: DOVE VA LA MEDICINA? – A. Nocent

IN PUNTA DI PIEDI VERSO IL CAPITOLO GENERALE 2012

L’ OSPEDALE DEL FUTURO:

ORIGINI, EVOLUZIONI, PROSPETTIVE

Prima di affrontare il tema,  è necessario porre una premessa, senza la quale non avrebbe senso trattare l’argomento tra persone che nella struttura ospedaliera ci lavorano ma che non hanno la specifica incombenza di immaginare il futuro della sanità, chiamati invece all’impegno di vivere al meglio il presente.

I discepoli di San Giovanni di Dio, giustamente orgogliosi del loro patriarca, specialmente da quando Cesare Beccaria lo ha definito “fondatore dell’ospedale moderno”, rischiano di cullarsi nei ricordi:

  • il primo ospedale a Granada, come lo voleva lui…
  • i celebri frati medici e farmacisti dell’ 800, che aggiunsero lustro e prestigio all’Ordine.

Tutto vero e molto bello, ma…

È ora adesso di provare a passare all’oggi, per vedere che cosa possiamo imparare da questo inizio degli inizi del movimento ospedaliero.

La prima illusione da evitare è quella di poter riprodurre nelle forme esterne e concrete l’esperienza di Giovanni di Dio. La vita e la storia sono come un fiume: non tornano mai indietro.

Dobbiamo anzitutto metterci nella prospettiva giusta:

  • Quando Giovanni di Dio guardava indietro vedeva Cristo;
  • quando noi guardiamo indietro vediamo il Mendicante di Granada.
  • La differenza tra lui e noi è tutta qui, ma è enorme.

Domanda: In che consiste allora il carisma giovandiano?

Risposta: Nel guardare a Cristo con gli occhi di Giovanni di Dio!

Perchè il carisma dell’Ordine non si coltiva guardando Giovanni di Dio, ma guardando Cristo con gli occhi di Giovanni di Dio.

Solo che il messaggio che viene fatto passare o magari frainteso, talvolta sembra proprio di segno opposto.

Cristo è tutto per Giovanni di Dio: è la sua sola sapienza e la sua vita.

Sulla sua bocca e nelle lettere c’è sempre questo ritornello: “Dio sopra tutte le cose del mondo. Amen Gesù“.

E dovrebbe anche essere il leitmotiv, ossia il motivo conduttore ricorrente,  da associare alla sua persona e alla sua idea.

A chi ha vissuto l’ “anno paolino” voluto dal Papa, non sarà sfuggito un confronto tra la conversione di Paolo e quella di Giovanni di Dio.

  • L’una e l’altra sono state un incontro di fuoco con la persona di Gesù;
  • Entrambi sono stati “afferrati da Cristo” (Fil 3, 12).
  • Entrambi hanno potuto dire: ”Per me vivere è Cristo” e “Non sono più io che vivo, Cristo vive in me” (Fil 1, 21; Gal 2,20);
  • Entrambi hanno potuto dire “io porto le stimmate di Gesù nel mio corpo” (Gal 6,17).

Se c’è un messaggio equivocante  veicolato nel nostro tempo, è l’identificazione di Giovanni di Dio con l’ospitalità, ossia la concentrazione sul fare più che sull’ essere.

Se nel francescanesimo è passata la famosa metafora delle nozze di Francesco con Madonna Povertà, lasciando tracce profonde nell’arte e nella poesia francescane, qualcosa di analogo è avvenuto con san Giovanni di Dio.

E’ vero, lui e l’ospitalità sono una carne sola. E l’iconografia quasi sempre ce lo mostra sotto il peso di fardelli e poveri sulle spalle. Tanto che deve venirgli in soccorso l’arcangelo San Raffaele. Ma lui fa perché è. Perciò, non dico che sia sbagliato, ma può essere deviante e va rilevato con altrettanta determinazione. Perché

  • non ci si innamora di una virtù, fosse pure la somma, ossia la carità espressa nell’ospitalità;
  • ci si innamora di una Persona.

Le nozze di Giovanni di Dio con la povertà, la castità, l’obbedienza, l’ospitalità, sono state, come quelle di altri mistici, uno sposalizio con Cristo. Guai a confondere, a mal interpretare. Anzi, proprio perché non  risulta che  il Santo di Granada abbia emesso dei voti particolari, è evidente che la Sposa  di Giovanni di Dio non è un mazzo di virtù bellissime ma il tesoro nascosto e la perla preziosa, cioè Cristo, il Regno dei cieli già in mezzo a noi (Luca 17, 21).

Dunque, io discepolo, ovunque vada, chiunque accosti, sono lì per dire che ho trovato il tesoro nascosto e la perla preziosa. E vorrei condividere questa ricchezza con i “poveri” in tutti i sensi e di tutte le latitudini. Non solo a parole,  ma perfino con gli stessi gesti del Maestro, il Gesù di Nazareth, un uomo – come  raccontano quelli che sono stati coinvolti nella sua vita, che hanno vissuto e mangiato con lui

  • Che passava per le città e i villaggi della terra di Israele facendo il bene, curando, guarendo, consolando tutti quelli che incontrava.
  • Un Gesù  che parlava anche “di un Dio che appariva “altro” per gli uomini religiosi del suo tempo“;
  • Un Gesù “che rendeva “vangelo”, buona notizia, quel Dio al quale gli uomini avevano finito per dare immagini perverse proiettandovi i loro desideri mondani“;
  • Un Gesù che “annunciava un Dio il cui amore non deve essere mai meritato“;
  • un Dio “che ci ama sempre e gratuitamente“;
  • un Dio “che non castiga ma perdona quelli che cadono nel male”;
  • un Dio “che chiede riconciliazione e amore reciproco tra gli uomini;
  • un Dio “che vuole riconoscimento e culto come mezzi in vista dell’amore, perché egli stesso è amore”;
  • un Gesù che “aveva parole durissime per i detentori del potere religioso, sacerdoti e dottori della legge,
  • perché costoro si rendevano esenti dai pesi che facevano portare agli altri,
  • perché cercavano di apparire esemplari senza mai tentare di esserlo realmente”;
  • un Gesù “scomodo, e per questo ebbe nemici, calunniatori che lo chiamavano falso profeta e indemoniato.
  • Questi nemici riuscirono, mediante un illegale processo-farsa, a condannarlo come bestemmiatore di Dio e convinsero il potere politico che Gesù era anche un pericolo per l’autorità di Cesare.
  • E così il potere religioso e quello politico, concordi tra loro, lo condannarono alla morte in croce, sentenza eseguita il 7 aprile dell’anno 30 della nostra era“;
  • Quel Gesù che “in croce appariva come un maledetto da Dio e dagli uomini per i credenti giudei, come un uomo nocivo per l’impero agli occhi dei romani:
  • nudo,
  • nella vergogna,
  • che muore senza difendersi,
  •  senza rispondere alla violenza,
  • amando e perdonando “fino alla fine”, come aveva vissuto. (Enzo Bianchi).

E i frati di San Giovanni di Dio che si pongono alla sequela di Cristo non basta che pongano l’accento sul carisma specifico dell’Ordine, paradigma interpretativo del Vangelo e dello stile di vita di Cristo, ma devono mettere ben in risalto il radicalismo evangelico, ossia di tutte quelle espressioni usate da Gesù per manifestare le conseguenze radicali della adesione a Lui. Tali espressioni riguardano

  • i beni materiali (rinuncia a tutto per stare con lui),
  • gli affetti familiari (da non far prevalere sulla sequela),
  • le relazioni sociali (per esempio l’amore ai nemici, allo straniero, il legame con politici e possidenti in vista di…),
  • la disponibilità assoluta (prendere ogni giorno la croce),
  • la fede piena (per esempio, pregare incessantemente, vedere nel Cristo il Padre).

Come si vede, il radicalismo evangelico è sostanzialmente più ampio degli impegni pubblicamente assunti con i tre consigli evangelici che non intendono selezionare il Vangelo in valori principali e valori secondari, quanto piuttosto abbracciare la totalità a partire da tre settori chiave:

  • affetti,
  • possesso,
  • autonomia.

Tutto ciò è quel “distinguo” che deve riflettersi come luce sull’intera Famiglia Ospedaliera, pena un’omologazione che, al di là dei proclami e delle buone intenzioni, può far appiattire tutti e dissecare la pianta che così si rivela per quello che era: un grande albero dei sogni.

Dopo questa necessaria premessa, è il momento di affrontare il tema. Con una battuta si potrebbe dire che la medicina del domani passerà ancora per l’ospedale ma la TELEMEDICINA rappresenterà una professione con un grande futuro.

Anche se sono molti a lamentare la lentezza con cui si procede in Italia a sviluppare la telemedicina su vasta scala, prima o poi assisteremo ad un’accelerazione con progetti su vasta scala. Anche perché, secondo la Commissione Europea, sono proprio quelli che possono apportare benefici ai pazienti, ai sistemi sanitari, alla società.

In un recente convegno a Milano la dr.ssa Maria Carla Gilardi, dell’Istituto di Bioimmagini e Fisiologia Molecolare del CNR, componente del Consiglio Superiore di Sanità, a riguardo della telemedicina ha detto:

numerose iniziative a livello europeo e nazionale testimoniano un’attenzione crescente verso servizi di telemedicina, con i quali rispondere alle mutate esigenze assistenziali dei pazienti. Infatti la domanda di assistenza cresce ed è sempre più caratterizzata da una quota sempre più significativa di pazienti anziani, affetti da patologie croniche.

Una situazione che impone una revisione strutturale ed organizzativa delle reti di assistenza, volta a garantire la sostenibilità del sistema sanitario attraverso un opportuno “bilanciamento” delle risorse disponibili, spostandone le basi dall’ospedale al territorio“.

NON MI SEMBRA UNA COSA DA POCO: spostando le basi dall’ospedale al territorio.

AL  CAPITOLO GENERALE DI UN ORDINE OSPEDALIERO (“Ti ho posto per sentinella” [Ez 3,16]) che sogna di ricomporsi in UNA GRANDE FAMIGLIA, viene in mente di interpellare la “sentinella del mattino” per fiutare il nuovo che avanza in sanità, prima di imbarcarsi in spericolate avventure, limitandosi a navigare a vista, senza sofisticati strumenti di bordo?

Il profeta Isaia lo farebbe di sicuro: “sentinella, quanto resta della notte?” [Is 21,11].

Non esperto quale sono, ho identificato in ELIO GUZZANTI, il 92enne medico e politico italiano dell’Università Cattolica del S. Cuore, la sentinella da interpellare perché ha scrutato scrupolosamente l’orizzone e dell’argomento sa tante cose di ieri, di oggi e del domani.

Elio Guzzanti
Direttore Scientifico, IRCCS Associazione Oasi Maria SS, Troina (Enna).

RIASSUNTO. Le origini dell’ospedale moderno risalgono agli inizi del XX secolo, a seguito degli sviluppi nel campo dell’anestesia, del controllo delle infezioni e delle scienze e tecnologie mediche. Nonostante i continui cambiamenti nel settore sanitario e i progressi della medicina specialistica, i costi sempre crescenti dell’assistenza medica nonché l’invecchiamento della popolazione e i pazienti sempre più esigenti richiedono nuove soluzioni. In molti casi, i servizi di assistenza primaria possono trattare i casi meno complessi di malattie acute e di infortuni, praticare la chirurgia ambulatoriale e fornire l’assistenza intermedia – per esempio assistenza domiciliare o residenziale – in luoghi più accessibili ai pazienti e alle famiglie. Quindi, è impossibile predire – come lo era un secolo fa – quale sarà l’ospedale del futuro, ma di certo si tende verso una rete di ospedali snella, basata sul modello “Hub & Spoke”, con una configurazione interna che ha come riferimento le esigenze del paziente, collegata a un rafforzato sistema di assistenza primaria attraverso la condivisione di obiettivi, di linee guida e dell’utilizzo delle telecomunicazioni.

Parole chiave.

  • Assistenza centrata sul paziente;
  • innovazione medica, tecnologica e delle telecomunicazioni;
  •  invecchiamento della popolazione e disabilità;
  • ospedale;
  • servizi di assistenza primaria.

Summary. The hospital of the future: origins, evolution and perspectives. The origins of the modern hospital date back to the beginning of the XX century, following the developments in anaesthesia, control of infections, and medical science and technology. Despite continuing changes in medicine and specialisation advancements, the increasingly higher costs for medical care, the population ageing and the more demanding patient require new solutions. In many cases, primary care services can deliver minor acute disease and injury treatment, ambulatory surgery and intermediate care – such as home health and residential care – in settings that are more accessible for patients and their families. Therefore, it’s impossible – as it was a century ago – to predict what the hospital of the future will look like, but the trend is towards a lean network of hospitals based on the “hub and spoke” model, with a patient-centered internal configuration and linked with a strong primary care system by shared goals, guidelines and telecommunications.

Key words. Medical, technological and telecommunications innovation, modern hospital, patient-centered care, population ageing and disability, primary care services.

Data la lunghezza della trattazione, invio a leggere il Guzzanti per intero qui:

L‘ospedale del futuro: origini, evoluzione, prospettive

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