Healthcare Workers are not heroes but models of civilization

Personification of a contemporary Aeneas, during the Covid-19 emergency healthcare workers have been models of pietas, adding a sense of duty to humanity.


It was a Spring of deaths. We brought blooming flowers next to the corpses. We brought flowers with our mind, of course, because it was forbidden to go outside. A Spring of suspense. The feeling no one could deny to have felt was the desire to plan, share, live. But during this stagnation something tireless, crucial – feverish stirred. The work of healthcare workers who, called to action, was being the backbone of a whole country.


During the lockdown and the following months, many words have been pronounced to thank doctors, nurses and all healthcare workers –  dutiful, well-deserved, proper words. Nevertheless, there is one – heroes – used as a simplistic summary of an experience of months. And I think that it depletes humanity underlying an exhausting work done in exceptional and dangerous circumstances. Moreover, it is likely to place vocation above sense of duty, heroes above men.

An episode in book II of Aeneid, which I had the chance to present on an evening in homage to the First Aid of Pesaro (Marche, Italy), helped me to spell out such a line of reasoning.

healthcare workers are modern heroes of literatures

Wanderings and storms haunt Aeneas’ escape from Troy and lead him to the court of Dido, queen of Carthago. There, the survivor tells what happened in that dark dreadful night when Greeks came into the city thanks to the famous Trojan horse.

Aeneas remembers the city on fire, clearly burnt by enemies’ fires and by the terror of massacres, but also the pain of not having understood earlier what was about to happen, the pain of have not listened to those who had made some hypothesis. He remembers a city burnt by the pain of powerless people who had to face the fear of losing loved ones or even themselves. Greeks get into Troy under a new unknown guise and assault it – almost the effect of the pandemic we lived and are still living: on the one hand, feeling frustrated as we were deceived, on the other hand, stubborn as we do not want to lose faith.

Aeneas tells about a very harsh, trampling and bloody battle that seems not to give way to the future. While chaos stirs around and death meanders into streets, everything he can do is just trying to get away. Everything he can do is just trying to save withstanding lives. Aeneas takes up the journey facing many dangers to himself and to others because he wants to take away from the tragedy his father, son, wife and even his servants.

Looking for salvation, Aeneas takes his father on his shoulders and his son by the hand. In this image that ties together three souls there is the thread of life summed up: weaken and fatigued Anchises on his son’s shoulders; little and unaware Iulo who, taken by the hand of his father, tries to follow him; Aeneas who is a son, a father and a man taking more care of others than of himself. Past and future are tied together by the present, which takes action, no matter what struggles, thanks to a hope: whether “danger is sole and common”, then “sole and common is salvation, too”.

During the emergency period, healthcare workers behaved as the personification of a contemporary Aeneas, taking on their shoulders and by the hand ill people, their families and the whole society. They did exactly this: they underwent the burden and tied together the split tatters of a country’s lives – they gave us an active, concrete and resilient demonstration of pietas.

Thanks to their pietas, healthcare personnel added a deep sense of responsibility to the love for their dearest ones, overshadowing their own needs, helping and taking care at the expense of their own health, standing by ill people in all the ways a man can stand by another man – being an example of civilization.

Brave and fearless in clashes with armed warriors, Aeneas shivers in front of the swishing wind when it comes to protect another life in a tragically exceptional circumstance. Aeneas is afraid; he suffers, he strains while he tries not to give up neither his duty nor his hope – to save what is mortal, fragile and precarious. Aeneas is a man above everything else, and only then he is a hero. So, that is why healthcare workers, like Aeneas, cannot be anything else than men and women who are able to put themselves to the service of the society despite fear, pain and danger. They are men and women we need to keep up hope. They are models to think about to behave responsibly until the future opens its arms to us. Also, we should remember Oriana Fallaci’s words in A Man

“spectacular behaviors and private heroisms never change reality: they are shows of individual and shallow pride, actions of romance that exhaust in their own sake because they stay closed within the borders of its uniqueness”.

Oriana Fallcai - A Man


A Man, Oriana Fallaci

Aeneid, Virgil


* All translations of quotes have been made by the author

Lack of healthcare personnel: is Europe ready?

The social and health crisis that has hit the world in the last few months has made more and more evident that National Health Systems (NHSs) are not sustainable for most of the world’s countries, both in the case of  public and universalistic or private and insurance-based systems[1].

Many factors are at play behind the overall consequences NHSs will face in the short term if no concrete actions are taken by every single country involved in the current crisis: lack of fundings, centralization of healthcare facilities in large urban areas, redefinition of fundamental assistance. Above them all, the one that might affect us the harshest is the lack of healthcare providers operating in public facilities in the near future.

According to the World Health Organization and United Nations forecasts, by 2030 there will be a shortage of more than 18 million[2] healthcare professionals, including doctors,nurses, biotech lab experts, social assistants and all other health-related workers.Despite the popular idea that this crisis will hit Third World and developing countries harder, European nations cannot feel safe from the health wreck coming from it.

The European Commission itself points out that already in 2020 we are facing a deficit of around 1 million workers in European NHSs.[3]

That can’t but have dramatic consequences on the quality that healthcare systems can offer to the national populations.

In Europe…

The uneven distribution of health professionals both inside each country and within different countries can only make things worse. The urbanization of high quality healthcare centers, usually college-based, has been leaving rural and suburban areas with an insufficient and underfinanced healthcare system[4] unable to respond the the health needs of an ageing population with chronic and non communicable diseases.[5] This is true not only in richer, but it has become a common phenomenon throughout Europe

At the same time, on a transnational level, better wages and working conditions act as pull factors on healthcare workers from eastern Europe toward those countries in the central and northern part of the continent.[6]

This results on the one hand in a shortage that their home countries struggle to compensate; and on the other in an excess of healthcare workers that NHSs are not able to absorb with obvious implications such as the widespread inequality.

Within European countries…

The consequences of such disproportions on the national healthcare systems of both areas are easily foreseeable.

in the past few years, various national and international associations and institutions have been focusing on finding realistic solutions to this puzzle. Although very little, if any, concrete implementation has been put into practice by national governments.

Looking at the Italian case we notice that, before the Covid-19 crisis, the country’s 2019 Budget Law contained a financing of 337,7 million euros for medical residencies for the five years between 2019 and 2023; plus 10 more million euros each year of the same timeframe for general practitioners’ education[7]. These investments are deemed as insufficient by many experts as they can’t provide for the number of doctors that would be necessary to replace the ones retiring from the italian NHS in the next 15 years[8].

These dynamics can be found all over Europe. Decades of expansionary policies had allowed Portugal to rely on a proportion between physicians and citizens higher than the European average (in 2017 the country had 497,6 physicians for each 100.000 inhabitants while the European average was of 372)[9]. These positive numbers are now at risk due to the reduction in the number of specialty spots offered by portuguese medical schools in more recent years. In 2019 the national call for medical residencies received 2641 applications[10] for 1830 spots[11], leaving 811 medical graduates unable to work in the portuguese NHS.

In a federative nation like Germany, the differences in healthcare delivery among the various regions get even stronger. Despite the existence of some guidelines developed by the central government regarding health workforce planning (Bedarfsplanungsrichtlinie), their implementation is left to local policies in each member state (Länder). The latter have the power to elaborate their own healthcare plans in terms of facilities-population ratio[12]. While at a first glance this might seem a proper strategy to ensure an adequate workforce planning, within the bigger picture the inequities among different states become much more evident[13].

The IFMSA is the International Federation of Medical Students’ Associations. It is a NGO associating all Medical students.

The urgency and relevance of this catastrophic picture has been pushing medical students from all over Europe to advocate towards more competent institution that could provide efficient solutions. This would avoid further emergencies whose impact can already be seen in the recent events, but it would also require a forward-looking response on the planning and implementation of long term healthcare policies.[14]

All actors involved, from patients to health workers, students and institutions are nowadays fully aware of the consequences that the current situation will have on European healthcare systems.

Whatever the solutions to these problems will be, they will need to structurally reform the way we conceive our NHSs and guarantee continuity, efficiency and proficiency in the long term. They cannot be a temporary solution only to face the unprevented emergency situation healthcare systems have been facing for the last few weeks.

The future of each healthcare system in Europe depends on the proper education of future professionals. It cannot disregard an appropriate assessment of the required skills and competencies and the adequate number of health workers needed country by country.

All other solutions, such as the broadening of available positions in med schools without a coherent increase in funding for medical specialties/specializations, are pure demagogy that tries to deceive the population and it’s likely to make things worse in a future closer than we might expect.[15]

So far the  policies implemented by the EU and its member states appear pale and weak compared to the gravity of the crisis. They also proved ineffective when it comes to ensuring healthcare workers the right skills, at the right time and place and in the right amount[16] so as to meet the health needs of the whole population, regardless of their wealth or home address.

Matteo Cavagnacchi



[1] “Country Health Systems Surveillance Platform” – WHO Department for Health Statistics and Informatics (2010)

[2] UN Agenda 2030 for Sustainable Development

[3]  Health 2020: the European policy for health and well-being

[4] Report Osservatorio GIMBE n.6/2019 “La Mobilità Sanitaria Interregionale nel 2017”

[5] The 2009 Ageing Report: Underlying Assumptions and Projection Methodologies for the EU-27

Member States (2007-2060), Joint Report prepared by the European Commission (DG ECFIN) and

the Economic Policy Committee (AWG)

[6] “Recruitment and Retention of the Health Workforce in Europe”, European Health Management

Association, April 2015

[7] Report Osservatorio GIMBE n.7/2019 “Il Definanziamento 2010/2019 del Servizio Sanitario Nazionale”

[8] La Programmazione del Fabbisogno di Personale Medico, Proiezioni per il Periodo 2018-2025: Curve di Pensionamento e Fabbisogni Specialistici – ANAAO AssoMed

[9]  Eurostat/Instituto Nacional de Estatística

[10]  Lista definitiva retificada de candidatos admitidos e excluídos ao Procedimento Concursal IM 2020 – Administração Central do Sistema de Saúde

[11] Mapa de Capacidades Formativas Nacional Procedimento Concursal IM 2020 – Administração Central do Sistema de Saúde

[12] User Guidelines on Qualitative Methods in Health Workforce Planning and Forecasting“Germany, Country Profile” WP6, Centre for Workforce Intelligence, United Kingdom. Fellow and Edwards 2014

[13] Kuhlmann, E., Lauxen, O. & Larsen, C. Regional health workforce monitoring as governance innovation: a German model to coordinate sectoral demand, skill mix and mobility. Hum Resour Health 14, 71 (2016).

[14]  International Federation of Medical Students Associations (IFMSA) – European Regional Priorities 2019/2020

[15] Anelli F. “No all’aumento dei posti a Medicina senza aver prima azzerato l’imbuto formativo” FNOMcEO 2020


[16] Stokker, Judy & Hallam, Gillian. (2009). The right person, in the right job, with the right skills, at the right time. A workforce-planning model that goes beyond metrics. Library Management. 30. 10.1108/01435120911006520.


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