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Simone's OncOpinion: A Cancer Center in Sicily?

Simone, Joseph V. MD

doi: 10.1097/01.COT.0000400082.89813.e7


As we planned a trip to Sicily I informed my friend, Giuseppe Longo, a hematologist-oncologist who trained in the US, of our visit to Taormina, which is near his home and work. He is head of hematology-oncology at the only hospital in Taormina. For some time he had wanted to start a cancer center there and asked if I would help him. The hospital is a state-run facility with no medical school in town, though the school in Catania is within easy driving distance.

He asked me to do two things during my visit. First, if he were able to arrange an appointment, to speak with the President (governor) of Sicily, Mr. Rafaelle Lombardo, about the importance of having a formal cancer program in the area, and also to offer my help. Giuseppe had already sent my CV and a letter from me to Lombardo touting the importance of a formal cancer program.

To my surprise, he did arrange it. Lombardo spoke no English, but I got along with some translation by Giuseppe. Lombardo was kind and supportive. His bottom line: It's a good idea; go see the Minister of Health. I came away discouraged that he just punted the problem down the line. But Giuseppe said the fact that he had agreed to meet with me would be known in medical circles almost immediately and that alone gave credibility to the cancer center plans.

His second request was that I give a lecture on cancer center development to the leadership and staff of the hospital. I stated the obvious—my Italian was not good enough. He said I could speak English if I spoke slowly and if the slides were clear, because most of the staff followed the cancer literature in English language journals.

So I made slides in Italian (Giuseppe corrected my errors}. I gave the talk and spoke partly in English and partly in Italian. There was a very good turnout, and the talk went well. It was followed by an active discussion about feasibility, support, and other practical matters. Giuseppe was, once again, very pleased with the outcome, particularly the engagement of the staff.

So what are the chances that he can establish a cancer center? It is a long shot for many reasons. Though the President of Sicily is very powerful and is from nearby Catania (very important), there are many competing priorities. But there are already some organizational features in place at the hospital—e.g., a multidisciplinary breast cancer clinic and a marrow transplant unit. So I believe it is possible to develop broader cancer center features for both cancer care and clinical research.

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The Values of Sicilians

But this is Sicily, which is not rich by any means and has a culture that must be taken into account. I shall describe a few essential qualities that speak to the values of Sicilians. This is not easy to do, even though I have visited various parts of Italy many times and Sicily four times. Also, my mother was born there and I still have cousins there.

We rented an apartment with breathtaking views of the perpetually smoking Mt. Etna, the azure Ionian Sea, and the towns south of Taormina, all with ancient histories and Greek influences. We ate in restaurants, at the home of friends, and we shopped for groceries and cooked for ourselves.

Our visit to Limina, my mother's hometown, occurred on the Feast of St. Philip, the patron saint of the town. The highlight was an all-day procession with young men carrying the statue of the saint standing in an ornate covered sedan (like the sedan chair, not the automobile). Two long timbers that were carried on their shoulders supported the sedan.

The men, about 24 at any one time, carried the one-ton load up and down the hilly roads around the town, often running with the statue. When they got to the piazza of the town, they spun the statue around rapidly so that it tipped precariously side to side (“it has fallen only once,” my cousin said).

A side effect for some men who carried the saint was a large hematoma on the shoulder. It was a badge of honor and a proof of strength, but sometimes it became fibrotic and required surgical removal—another badge of honor.

Out of all these seemingly disconnected events layered on top of the influence of my mother's family in Chicago, my colleagues in Sicily, and the visits, I can venture a few opinions about the essence of Sicily. Indirectly, they have some influence on the likelihood of Giuseppe getting his cancer center.

  • Family: In Sicily, family ties seem even more essential than in the rest of Italy. The commitment to family is a key to the essence of Sicily, and I believe this is partly due to its history. Its people have been invaded, abused, impoverished, robbed of their resources, and virtually enslaved by the Greeks, Arabs, Normans, Spaniards, French, and by the more prosperous Northern Italy for over 2,000 years. (President Lombardo heads a political party with one main purpose—more autonomy for the South of Italy.)
  • No wonder they distrust the government and politicians even more than other Italians do. Italy has been a unified country only since the 1860s. From the fall of the Roman Empire until then, Italy was largely colonized by political and military powers of succeeding eras, and Sicily was a breadbasket for those empires. In that environment, family has been the one reliable, beneficent group.
  • Food: It is difficult to get a bad meal in Sicily, and most are superb. The cuisine has three qualities that set it apart. It is fresh, seasonal and treated with respect. One can see the fresh food delivered to restaurants every day. Sicily is surrounded by ocean, so fish is a mainstay of the diet and it is always fresh (the swordfish involtini is to die for).
  • One can buy freshly picked fruit and vegetables from street vendors every day; they sell only what is ripe and ready to eat. Everything is seasonal and most is local with very limited importation of fresh food. Certain fish and many fruits and vegetables are available only part of the year. This is not a handicap; it is a blessing because the wide variety of preparations sharpens the palate and one's anticipation and enjoyment.
  • In addition, the meal and food are treated with great respect. Food is almost always made to order. It is served with class, but not ostentation. A meal is not merely nutrition and, especially the main meal of the day, is treated as if it were a religious rite with gratitude, pride, joy, and, perhaps, reverence.
  • Serving a meal at home or in a restaurant is an important form of communication of respect for one's family, guests, and customers, and of one's skill and pleasure at giving pleasure. That is what I remember growing up. Needless to say, this is uncommon in our society.
  • Land and Terrain: Owning land is very important to Sicilians. It is a source of stability and respect in their community. When my mother's family came to America, the first order of business was that everyone worked to make the money for a down payment on a two- or three-flat apartment in Chicago. My mother worked in a candy factory and all of her earnings were turned over to her mother for this purpose.
  • Sicily is mountainous with many sharp peaks making large areas unsuitable for habitation or cultivation. It also means there is a great deal of walking up and down hills in most of the country. From the Corso Umberto, the major street for shopping and people watching in Taormina, we had a steep climb up stairs and roads to the apartment; it seemed even steeper when carrying a load.
  • The mountains and the sea contribute to the essence of Sicily, combining hardship and bounty. The volcano and the sea are dangerous, but the volcanic soil and sea are also bountiful. The volcano of Mt. Etna erupts now and then, sometimes taking lives and towns, but lava rock is also used for construction, including an entire church in the small town of Sant' Alfio.
  • Thus, Sicilians view hardship as a natural part of life. I remember that my mother became a bit nervous and suspicious when things seemed to be going very well (“too well”) because she knew that hardship or disappointment would eventually rise up sometime.
  • Religion: Sicilians are mostly Roman Catholics. Church attendance is down and the priests are mostly old, just like elsewhere. Some Sicilians are pious, but most have a more pragmatic attitude toward the church—i.e., it is there mainly to serve the needs of the people with baptisms, weddings, funerals, and holy day celebrations. It is also there to serve as another pillar, along with family, food, and the land, that sustains their ancient culture and way of life.
  • This sketch of Sicilians is an oversimplification, of course, but strands of it touch on the cancer center issue. First, the people are hard working and realistic. My friend Giuseppe works long hours seeing patients, running a program and working for development of the cancer center. He and his team are optimistic, like most oncologists. He understands the importance of political support, but has a pragmatic view of the feasible and possible.
  • The family is his anchor that allows him to work and dream. We had two meals at his home and the care and preparation were almost as impressive as the wonderful flavors and unique varieties of food and wine. Attention to meals of high quality is not sacrificed to save time. Typically, Giuseppe's mother-in-law prepared some of it in her own style.
  • What has this to do with a cancer center? Things that are valued in the Sicilian culture are done with great care, and I believe that is the approach that has been taken in Taormina. Hardships are expected on the road to success and, as with politics and religion, pragmatism and perseverance are the foundations needed.
  • Thus, I believe they can have a cancer center in Taormina and I will help them as much as possible. My optimism and solidarity with Giuseppe should not be a surprise. After all I am an oncologist and I am half Sicilian. My elementary grasp of the essence of the Sicilian people is heartfelt, but I am a rank amateur.
  • It seems that I must return to Sicily again and again to try to get it right and to help them get their cancer center.
© 2011 Lippincott Williams & Wilkins, Inc.
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