ROME LETTER/Paddy Agnew: This is the story of an Italian dream gone wrong. Ten days ago, a distinguished surgeon, Ignazio Marino,formerly director of the Palermo-based Ismett transplant centre, packed his bags and returned to the US.
Genoa-born, 47-year-old Dr Marino had tried to live out the expatriate dream of returning to his homeland to offer his specific skills, honed in foreign parts, for the greater common good.
Having graduated in medicine in Rome in 1979, he worked as a transplant specialist in the UK and the US before definitively establishing himself in the States in the 1990s, working at the Thomas E. Starzi Transplantation Institute at the University of Pittsburgh.
In 1999, however, 20 years after he had left Italy, Dr Marino returned to head the Imett (Meditteranean Institute of Transplantation and Advanced Specialised Therapies) centre in Palermo, Sicily. This was a bold and innovative joint venture between Pittsburgh and two public hospitals in Palermo, the Civico and the Cervello.
The University of Pittsburgh Medical Centre (UPMC) had been exploring the possibility of an overseas adventure for some time. The idea was to export their expertise in "solid organ transplantation" to a healthcare environment in Europe where that expertise could make a difference. After negotiations between UPMC, the two Palermo hospitals and the Italian (then centre-left) government, a nine-year agreement was reached.
Given that there were no transplant programme services south of Rome, UPMC had been able to persuade both national and local governments that the cost of setting up and running such a centre (it currently costs the Sicily Regional Authority €13 million a year) could be offset by the savings made when Sicilians and southern Italians no longer had to be sent elsewhere for transplants.
Most experts concur that Ismett has been both successful and busy (255 patients went through the Intensive Care Unit in a 13-month period between September 2000 and October 2001). Yet 10 days ago Dr Marino prompted dismay when he announced he was packing his bags and heading to the US, this time to the Thomas Jefferson Institute of Philadelphia.
He may well have his own good reasons for returning to the States, irrespective of his problems in the running of Ismett. Yet he was also able to highlight some fairly obvious logistical and bureaucratic shortcomings in Palermo.
For a start, there was the occasion when, in the middle of the new institute's first-ever liver transplant operation on a hot, 40° July day in 1999, the air-conditioning equipment failed.
"Without the right temperature in the operating room, the patient's health is at risk, not to mention the effectiveness of the transplanted organ," Dr Marino told the Rome daily, La Repubblica.
"Furthermore, the possibility of error by the medical team increases. I'll never forget that day, in all my life",
Then, too, there were the bureaucratic problems which stopped Ismett becoming, as originally intended, a transplant centre for heart, lung and intestine as well as for liver and kidney. Dr Marino also cited his frustration with colleagues who wished to work simultaneously in both the public service and privately.
He wryly recalls looking for students with computer skills to help with the hospital's work. He wrote 30 letters to Sicilian faculty heads, receiving just three replies, all of them by way of polite formality but indicating no names. All this in a region where unemployment among the under-30s can reach 40 per cent or higher.
Dr Marino's conclusions at the end of his Palermo days are hardly encouraging. "Italy is plagued by a widespread reluctance to change and a great ability to defend big or small interests at the expense of the common good," he said.
"The country's culture is one of personal privilege, one in which you put obstacles in the way of someone doing a good job rather than trying to do things better.".
Even the Health Minister, Mr Girolamo Sirchia, was forced to concede that Dr Marino was right when he highlighted problems such as nepotism and corruption in the university system, problems which block genuine research and which blight the promotion prospects of the most talented (but least well-connected, politically) in both the health and university systems.
Dr Marino's departure is symptomatic of a widespread malaise. Mr Augusto Palombini, secretary of the Italian Researchers' Association, ADI, put it this way: "Marino's choice is a vivid demonstration that the principles of meritocracy do not apply in Italy".