23 February 2017

There are moments, I have to admit, when my fellow townspeople make me furious. I stomped away in a rage one evening this week from a well attended meeting at which tutting, stony-faced locals watched as our mayor, various health-service related bods and the president of the Umbria regional government patted themselves on their collective backs about the major overhaul which is just about to engulf our little hospital.

Oddly, it wasn’t these long-winded politicos who left me fuming but the ordinary townsfolk: not one of them had a question to ask or a point to make at the end of the interminable speeches. But that was only because they were saving their breath for mumbled carping as they exited.

“They didn’t have a single thing to say.” “Well that was pointless, it’s all just a big con.” “Anything to make us pay more and give us less for our money.” “They never do anything except make our lives more miserable.” And so on and so forth. Ad nauseam.

Actually, pievesi, I’m going to argue that they did say a lot of things. Perhaps they were things that I should already have known. Perhaps they were things you really didn’t want to hear. But though I’m sure that a better look at some of the details of the big hospital changes would probably make me pretty angry too, the general premise is – regrettably? – quite reasonable. Our hospital (a hospital that locals, incidentally, do nothing but moan about most of the time) is simply too small to risk doing many of the major things it tries to do without putting lives seriously at risk. That is statistically proven truth. Ergo it needs to do something different, better.

Those official bods argued (I paraphrase, but this was the gist) that we need to see our hospital not as an individual entity but as part of an articulated, integrated region-wide health service, focussing on providing services to the particular demographic in our area, feeding those that need major-league interventions into large hospitals properly set up to deal with them. Here, we need to focus on first-response handling of emergencies, and on wide-ranging primary care, upgrading in particular the kind of care needed by an ageing population. Now, I’m not so naïve as to think that our hospital, when it emerges shiny and new from what they promise will be just 12 months (haha) of building work, will do all that in a seamlessly stream-lined fashion but… I personally can’t see any reason to argue with the general concept.

The rather wonderful Atul Gawande wrote a fine essay for the New Yorker magazine recently, arguing that it’s not emergency interventions but a slow drip drip drip of incremental care that should be the model for health services in an age when indexed data collection means that a complete life-long portrait of the health situation of every individual can be built up, providing a superb basis for targeted, tailored care when emergencies do arise. It seems to me that Umbria, with its focus on prevention and its decision to upgrade primary care at micro-local levels, is doing just this. From where I stand, it all looks rather laudable.

It was not so, however, for the attendees at yesterday’s meeting. Ask locals about our hospital in general, and you’ll set off an avalanche of gripes and recriminations. As I’ve mentioned on various occasions , I’ve found that the staff in our hospital – under-funded and thinly spread as they are – provide a remarkable service. Where would L be without the ministrations of our A&E? Just the other day C and I passed by to do some bit of bureaucracy and our dismay at finding we’d arrived too late must have showed: the man in the office told us to come back after lunch and he’d deal with our case anyway, completely out-of-hours.

There’s a huge well of humanity there which, as I said, meets almost exclusively with cantankerous negativity. There have been several occasions when I’ve feared that my spontaneous thanks for kindness and skill were going to make doctors break into grateful tears.

Yet people feel entitled. If they looked around them, they might see that the number of towns in this (or any other) country with not even 8000 inhabitants which can boast a fully functioning hospital are… very few indeed. They might perhaps realise how extremely privileged we are, and value it a little more rather than taking it for granted and abusing it at every turn. They might even take the side of the beleaguered staff and show some support rather than making their tasks more thankless.

Now that it’s going in its present form (there will be a few hospital beds, especially for social care patients, but the emphasis will be on A&E, minor procedures at day hospital level and specialist visits) people are up in arms. If they wanted something more, then a decade ago when the inexorable down-sizing began (and half the structure was turned into a money-making eating disorders centre) might have been a good time to man the barricades. As it is, I think we should be mighty thankful we have anything at all.

“Oh yeah,” said my builder the next day, “we’ll see how you feel about it when you have a stroke and you die on the 40-minute trip to the nearest big hospital.” (Our tiny stroke unit here has always been famously good, ranking ninth or tenth in the whole country by results.)

On a very personal level, he has a point. But he’s also doing the very thing that has got us into this mess in the first place. It’s a harsh rule, but reasoning as if we were an isolated case, and not part of an integrated system, will not help us in the long run.


This week is plaster week at my project in town. I was kind of thinking of plaster-spreading as the construction equivalent of the turf-laying moment in garden making – the moment that magically pulls together tragic confusion, transforming it into a hopeful scene of incipient grace and elegance. It isn’t. Yet.

Instead it’s looking less crazily indented and is spouting fewer bits of corrugated tube, but it’s unsatisfyingly patchier.

You’d have thought I’d have learnt to be patient by now.

But there’s something nicely end-approaching about even the most difficult of irrevocable decisions that I’ve been putting off for so long but now have to stop prevaricating about.

What plaster to choose, for a start. In our own home we were purists, opting for old-fashioned lime plaster with no additives – the same kind of thing that would have been smeared about here two, three or five hundred years ago. But that’s an expensive choice and in town, I’ve had to face reality and have new interior walls finished off with a less expensive cement-based product. Or at least that’s what I’m trying to have done, against the howls of my fundamentalist builder who has, however, twisted my arm to force me to use a lime option on exposed bits of original walls.

The long corridor into the house from the street is another thing I’ve tried hard not to think about through all these months. There’s damp all down its length, from floor level rising up about 80cm. This is inevitable in ancient buildings where stone walls rest on earth below. There’s every chance that the damp will reappear, whatever I do. But what to do?

A ventilated layer of plasterboard was mooted. But I don’t want damp oozing gradually over the years through plasterboard which is awash with noxious chemicals.

This is another of those cases in my house where false hollow-brick walls have been raised to hide the original stone and brick: I could have the false wall removed, and the old one plastered with anti-damp plaster. But this is very messy and very expensive.

I could just have the existing fine top-layer plaster scraped back a little, then put any old plaster on it – cheap but probably pointless.

So I’m opting for something which, according to my builder, I am probably going to regret. In ten years’ time. I’m having all the existing plaster chipped off to about one metre up the wall, and replaced with the type that claims to keep damp at bay. We shall see.

I am, on the other hand, planning to use plasterboard to encase my latest discovery, another hidden doorway of the type that pops into view any time you pull down one of those false walls. It’s beautiful – far too beautiful to bury in cement-based plaster. Someone restoring that house long after me will happen across this beauty.


We’ve had a fantastic run of what I think of as ‘stolen’ days – those blue, shiny February days which could just as easily throw snow and/or extreme cold at us but instead hearten us with bird-filled glory.

I rushed out and took advantage, getting going with my rose pruning and my pulling out of winter weeds. Little bits of my messy garden have returned to some semblance of order. There are stretches of grass which have been freed from their leaf cover (I’ve been truly lazy to date), scarified and fed. The little bed behind the chicken house has been liberated of the ever-huger Carex that I’ve been meaning to pull up for years, and filled with Hemerocallis and Anemone. And onion and garlic sets have been planted in the one corner of my new vegetable garden where I’ve managed to have the existing soil broken up and great wheelbarrow loads of good composty soil salvaged from beds in the old orto added.

About Gardens, Food & Umbria

I am a garden and landscape designer, working throughout central Italy and beyond. I have lived in Italy for over 35 years – first in Rome but now in Città della Pieve, Umbria, where I have restored my country home and transformed a medieval townhouse into three rental suites. To relax, I tinker endlessly with two and a half hectares of land, some of which is my garden.
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1 Response to 23 February 2017

  1. Carol Nunan says:

    I think CDP is lucky to have a such an effective small hospital for its citizens. People SHOULD ask questions and be heard but they need to appreciate the way these things work, too. Our experience with the local commune, especially the architetto, was extremely frustrating and backward in its attitude, so I can only imagine how it must feel to deal with other authorities. On the other hand, for the most part, local people are warm, welcoming and inclusive, with open hearts and minds. I hope this all gets sorted without too much blood on the ground!

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