Ferretti: “La nostra pneumologia continua a crescere, e guardiamo al futuro con l’ottimismo della volontà”

Ferretti Gabriele“Il complimento più bello, non a me ma all’intero reparto, lo fece qualche tempo fa una figura di eccellenza del nostro settore, dicendomi: ‘devo ammettere che voi fate davvero tutto ciò che dite di fare, e non succede così spesso’”. Che il dottor Gabriele Ferretti, primario della pneumologia dell’Azienda Ospedaliera Santi Antonio e Biagio di Alessandria, sia ancora un entusiasta del suo lavoro, dopo tanti anni di attività, lo si capisce dalla passione con cui intrattiene l’interlocutore, mostrando con orgoglio la nuova strumentazione che sarà adottata nel giro di qualche settimana (“si chiama Ebus, siamo i primi ad utilizzarla in Piemonte”), ma anche la sua ‘collezione’ di corpi estranei estratti dai bronchi dei pazienti: e si va da un fischietto all’ago di una siringa, tanto per capirci. Al dottor Ferretti abbiamo chiesto di illustrarci l’attività della pneumologia, le sue aree di eccellenza ma anche, certamente, di evidenziare le criticità: neanche a dirlo, tutte legate alle risorse sempre più scarse, e ad un organico medico e paramedico che fa con stoicismo i salti mortali, con un numero di prestazioni e servizi in costante crescita, e turni affrontati senza risparmio di energia, e di tempo.

 

Dottor Ferretti, cosa fare in pneumologia ad Alessandria? Partiamo con qualche numero, che rende sempre l’idea….
Volentieri, anche se glieli cito a memoria, per cui valgono come ordine di grandezza, ma non sono precisi in senso assoluto. Comunque: nel 2014 abbiamo superato le 1.000 broncoscopie (al cui interno sono comprese anche le estrazioni di corpi estranei, circa 200 all’anno), e abbiamo gestito un centinaio di ricoveri in terapia intensiva respiratoria. Ma aggiungiamoci anche più o meno spirometrie, il che significa oltre 10 mila visite specialistiche. E poi 1.500 test allergologici, e almeno 300 polisonnografie, ossia lo studio delle apnee notturne.

Tutti dati che, peraltro, evidenziano un segno più, quanto a crescita nel tempo delGiorgione 3 numero delle prestazioni.
E’ così, e con un organico bloccato da anni, e certamente non per responsabilità dei nostri vertici aziendali, con cui esiste una collaborazione costante: non lo dico per dire, ero al telefono con il nostro direttore generale, Nicola Giorgione, non più di 20 minuti fa….

Per lamentarsi?
No, assolutamente: per aggiornarci su alcuni aspetti tecnico-organizzativi. Davvero qui, a livello di Azienda Ospedaliera, c’è un livello di collaborazione eccellente: però è innegabile che il mio staff, dai 7 medici al personale paramedico, fa i salti mortali, e con un entusiasmo che qualche volta mi genera addirittura imbarazzo. Si consideri che la nostra attività è aperta 365 giorni l’anno, notti comprese: perché qualcuno per le emergenze deve esserci sempre, e i volumi delle attività, che ho sintetizzato in numeri, sono tali da richiedere un impegno che definire full time è riduttivo.

Lo scenario di tagli e razionalizzazioni lo si conosce ormai a menadito, in sanità come altrove. All’orizzonte non c’è quindi speranza di un rafforzamento dell’organico?
(sorride e allarga le mani, ndr) Chi lo sa, noi speriamo, e qualche motivo di speranza di recente ci è stato dato. Anche se poi, da qualche parte, ho letto che potrebbero essere privilegiate le strutture che, negli ultimi anni, hanno avuto un evidente calo di prestazioni e produttività: sarebbe bella no? Noi che, nonostante tutto, abbiamo sempre stretto i denti e addirittura fatto crescere attività e prestazioni verremmo penalizzati: cornuti e mazziati insomma. Ma speriamo siano solo voci.

EbusParliamo di innovazione tecnologica dottor Ferretti: quanto ‘pesa’ oggi in pneumologia, e dove trovate le risorse necessarie?
Pesa tantissimo, perché sempre più gli strumenti consentono interventi inimmaginabili solo l’altro ieri. E da questo punto di vista, soprattutto grazie alla lungimiranza della Fondazione Uspidalet, non solo il nostro reparto, ma direi l’intera Azienda Ospedaliera non ha finora perso colpi, anzi. Le cito (e ce lo mostra anche, con non poco orgoglio) l’Ebus, un nuovo endoscopio che entrerà nelle prossime settimane in funzione qui da noi, prima tecnologia di questo genere in tutto il Piemonte. In sostanza serve per la diagnosi e la ‘stadiazione’ del tumore al polmone, e consente una corretta definizione dei linfonodi mediastinici: ossia, detto in maniera semplificata e comprensibile, ci aiuta a capire se un tumore è operabile oppure no. E’ un macchinario che costa circa 157 mila euro, e che ci consentirà davvero un nuovo salto di qualità.

E sul fronte della formazione? Avete rapporti con Università?
Anche qui posso citarle un progetto in via di definizione: stiamo ultimando la convenzione con l’Università di Milano, per la durata di cinque anni accademici, per ora, per ricevere gli specializzandi, e offrire loro un’importante occasione di attività ‘sul campo’, alternando teoria e pratica. Analogamente, da ottobre partiremo con un corso di endoscopia diagnostica interventistica: una full immersion di una settimana, 8 ore al giorno, a beneficio di 8 medici preumologici che desiderino approfondire davvero la materia, e la tecnica.

L’endoscopia interventistica, del resto, è da sempre uno dei vostri fiori all’occhiello…
Direi di sì, anche se non bisogna creare confusione: l’intervento col laser non è naturalmente sostitutivo rispetto all’intervento chirurgico, semmai palliativo. E’ una tecnica che può essere utilizzata solo in determinati casi, per tumori endo-tracheo-bronchiali.

Dottor Ferretti, le classifiche sull’incidenza tumorale all’apparato respiratorioMesotelioma continuano a collocarci, come territorio provinciale, ai primi posti a livello nazionale?
Purtroppo le neoplasie sono sempre a livelli di incidenza molto significativi, sì. Da questo punto di vista noi aderiamo a due importanti gruppi interdisciplinari (i cosiddetti GIC), uno sul tumore al polmone, e l’altro su quella terribile peculiarità del nostro territorio (ma anche di altri, come Mestre), che è il mesotelioma. Non sono io la persona più indicata a fornire tutti i dati, ma la dottoressa Federica Grosso, che coordina un team di specialisti e un progetto specifico: in ogni caso quel che si legge comunemente è vero. I casi di mesotelioma pleurico sono ancora in aumento, e lo saranno per diversi anni, dato il lungo tempo di latenza prima del manifestarsi della malattia. E, per quanto si stia facendo molta sperimentazione, una cura ancora purtroppo non esiste.

Chudiamo con la rete territoriale: voi avete anticipato i tempi, creandola di fatto, su scala provinciale, almeno una decina di anni fa, quando ancora razionalizzazione non era una parola d’ordine così stringente…
E’ vero: la sinergia con gli altri ospedali esistenti nelle province di Alessandria ed Asti è da sempre molto forte, e di stretta collaborazione. In alcuni ospedali ci sono pneumologi, anche se non esiste uno specifico reparto: per cui diventa importantissimo consolidare un rapporto bilaterale: noi siamo ovviamente ‘attrattivi’ perché dotati di strumentazioni e know-how che altrove non ci sono (e lo siamo anche in senso lato: il 7-8% dei nostri pazienti arriva da altri territori), ma la rete funziona anche all’inverso, nel senso che là dove possibile affidiamo poi anche i pazienti ai colleghi ubicati nei diversi presidi, privilegiando ovviamente anche le ragioni di comodità logistica dei malati”.

Ettore Grassano

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    A working day trip sailing to Lembongan Island and snorkelling
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    Nusa Lembongan is a extremely peaceful position away from the vibrant lights,
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    If you want the tranquillity to past a small longer there are resorts
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    Arriving in Bali

    I flew to Bali from Singapore. Immediate flights to Bali are offered from most airports
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    Dependent on your nationality, you could or may not call for a visa to enter Bali.
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    There are many operators presenting transfers to Lembongan Island.
    A speed boat will just take about 30 minutes from Bali.
    If you are immediately after a much more
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    I desire sailing to speedboats. I obtain sailing on a wonderful working day far more calming and fewer jarring than a bumpy ride in a quickly speedboat.
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    I booked a sailing day excursion with a tour operator who collected me from my hotel in the morning and
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    There was a small group of around a dozen people today of all ages on the catamaran when we sailed.
    There was adequate place on board for us all to spread out.
    You could select to lounge on the deck in the sun or sit in the lounge under in the
    shade. A good deal of complimentary refreshments ended up out there to continue to keep you hydrated in the heat.

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    snorkelling, browsing a nearby day spa, or strolling around the peaceful streets of a close
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    A large buffet lunch was delivered with a selection of nearby and western style meals.

    Our group was pretty sociable and seated on their own around prolonged trestle tables to get pleasure from lunch and a chat to their companions.

    Snorkelling

    The water all over Lembongan Island is a distinct blue inexperienced color from above and a wonderful deep blue under.
    There is a compact coral reef a limited boat ride from the seashore exactly
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    The boat has a glass bottom which permits you to see the maritime everyday living down below.

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    The reef was marked with a ring of rope and floats to maintain boats absent
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    The area is well known with providers educating scuba diving.
    You can look at the pupils and academics practising together in pairs
    beneath the drinking water.

    The reef is frequented by hundreds of vibrant tropical fish who appear delighted to swim amongst the snorkellers and divers.

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    Seaweed Farming

    The locals of Nusa Lembongan rely mostly on tourism for their cash flow.
    Some regular industries these kinds of as seaweed farming continue
    to endure. The seaweed beds are laid out in the bay like a chequer board beneath the drinking water.

    The weed is harvested at reduced tide and spread out on mats to dry in the sunshine.

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    Gala-Gala Underground Residence

    Our working day journey Lembongan incorporated a tour all around a smaller town on the island.
    The tour introduced us to the strange composition of Gala-Gala.

    The Gala-Gala underground dwelling took one particular male, 12 decades to
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    The residence is composed of a bed room, dining room, kitchen area,
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