By Stephen Hessler

My brother Richard, who had polycystic kidney disease (PKD) and was a dialysis patient for 20 years, died last year. One of my great consolations was that 10 months prior to his death, Richard, my wife Caterina and I took a two-week trip to Italy.

This was the only time Richard had gone overseas since going on dialysis. I want to tell the story of our trip in the hope that other dialysis patients might be encouraged to discover the wonderful world we live in. 

In September 2000, the New York Times Travel section featured a story on the Basilicata province in the southeast corner of Italy. The article highlighted an Italian Appalachia with beautiful scenery, rustic food and an infamous city called Matera. I had read the article on Sunday morning. Later that day I was stunned when Richard called me and told me he would like to go there. I often had trouble convincing Richard to take local trips, so this request was quite unexpected. Not only did he want to go to Basilicata, he also wanted to visit Pompeii. 

In January of 2001, I began planning the trip in earnest using a three-week calendar. My brother normally had dialysis on Monday, Wednesday and Friday, so the first thing I did was plot his dialysis sessions on those days. In order to keep him on as close to a normal schedule as possible, I decided he could dialyze in the United States on Monday, we could leave Tuesday evening, arrive in Italy on Wednesday morning and dialyze Wednesday afternoon. Next, I penciled in a preliminary itinerary. We would fly to Milan in order to visit some of my wife's family. Richard would dialyze in Milan on Wednesday and Friday. We would sightsee on Thursday. On Saturday, we would fly to southern Italy and spend seven days, with one dialysis session near Pompeii and two near Basilicata. We would then return to Milan on the following Saturday, he would dialyze in Milan on Monday and we could fly back to the states on Tuesday. We decided to take the trip in March of 2001.

The next step was to line up the dialysis centers. The Internet proved invaluable. I did a search using the Italian word for dialysis ("dialisi") and the word "Italia." The search results led me to several useful sites, including one that listed over 700 dialysis centers in Italy by region containing e-mail addresses and names of directors. I also found the name and e-mail address of a nephrologist who was a professor at a university in Bari on the southeast coast. I sent an e-mail to the professor to ask his recommendation of a dialysis facility near Bari. I also contacted both of the dialysis groups that had centers near Pompeii and sent several e-mails to centers in Milan. In the first e-mail, I wanted to determine the willingness to accept a traveling patient and the availability of the days we needed.

Once we had found locations that were available, Richard prepared a questionnaire in English to determine if the centers had the proper type of equipment, if they could perform the same type of dialysis he received in America and what the cost would be. With the help of my Italian-speaking wife, I translated the questionnaire and sent it via e-mail to the centers. All of the centers we selected could provide the services we needed. The costs, particularly in southern Italy, were significantly below what dialysis cost in New Jersey. After double and triple confirming the dialysis reservations, we were ready to go.

On March 13, 2001, we flew to Milan. We arrived Wednesday morning and after some rest and food, we went to the Ospedale Fatebenefratelli (roughly, the Good Works Brothers Hospital). We met with the doctors and staff, reviewed Richard's dialysis requirements and were given an invoice for the services to be performed. While I went to pay for the services, Richard was prepared for dialysis. Everything went extremely well; and four hours later, his session was over. We returned to my sister-in-law's house for a delicious home cooked meal and much needed rest.

The following day we began to tour Italy. Richard and I took the bus and subway to the center of Milan, got out and started to walk. We visited Il Duomo (the cathedral) and other sites in downtown Milan. We had panini (sandwiches) in a café and then we visited the Brera Museum. Richard chose the Brera as one of the places he wanted to visit. It is a wonderful museum with a spectacular collection of well-displayed art. After a full day of sight-seeing, Richard's dialysis session on Friday was almost as routine as it would have been at home in the United States.

On Saturday, we flew to Rome and rented a car to drive towards Naples and Pompeii. Richard's research had discovered that the best way to appreciate Pompeii was to first visit the Archaeological Museum in Naples where many of the artifacts from Pompeii are housed. On Sunday morning, we drove into Naples, parked at the museum and went to the Pompeii section. The display included a model of ancient Pompeii and an extensive collection of artifacts from the city. Around noon, we drove to the ruins of Pompeii. We entered the site and explored it for several hours. It provides a fantastic snapshot of life in 79AD, complete with shops, temples, homes and an amphitheater. As you wander around the site, you can almost feel the people who lived and died there.

On Monday morning, we headed south towards our next dialysis center in Montesano Scalo. After another successful dialysis session, we hopped in the car to explore the local roads. We saw Roman ruins and modern dams, small towns and ancient farms. Eventually we arrived at the Ionian Sea on Italy's southeast coast and spent the night in the seaside town of Scanzano.

Wednesday morning we headed northeast to Bari and to the next dialysis center. While we were speaking with the doctor, he was entering Richard's dialysis information into a terminal on his desk. The doctor inserted a plastic key-like device in a terminal and it encoded Richard's information on the key. The key was inserted in the dialysis machine and automatically set the machine for the dialysis session. This was the first time Richard had seen one of these machines. After the session, we drove to Matera, one of the primary goals of our trip. Matera is an ancient and historically poor city built on steep hills on two sides of a ravine. The houses were actually caves carved into soft limestone. We stayed in the Albergo Hostel Sassi, where each room is a former cave house.

In the morning, with the help of the hotel owner, we hired a guide who took us on a fascinating three-hour tour of the cave city. As we later drove through the countryside, we were greeted with the beautiful spring colors of green fields and pink and white blossoms on the fruit trees. We traveled in an arc around Matera enjoying the view from a hilltop town.

On Friday, we were back in Bari for dialysis. After Richard was treated, we were off to Melfi in the north central part of Basilicata. It became dark while we were driving and we could see all the hilltop towns sparkling like stars in the sky. It was truly beautiful. For dinner, we tried a local restaurant that the New York Times article recommended. Dinner for three that included pasta, a main course and wine cost the equivalent of $25. What a deal!

On Saturday, we left Basilicata. We had navigated the province from south to north. We flew back to Rome and then flew to Milan. Richard dialyzed at Fatebenefratelli on Monday and we returned to the United States on Tuesday. It was a great trip and now a wonderful consolation.

Final Thoughts

• This type of trip would be possible for almost all dialysis patients. Many of the dialysis centers in Italy were equal to or better equipped than the one Richard went to in the United States. More importantly, the doctors and staff at each center went out of their way to provide professional and friendly service.  
• Medicare does not cover dialysis treatments outside the United States. Sessions ranged in cost from $150 to $400. 
• I brought along a printout of all the centers in the regions we were going to visit in case we ran into any difficulties with the ones we selected. This proved to be unnecessary in our case, but is recommended for anyone who travels. 
• The one thing we could have improved on would be to have Richard's treatment prescription written in Italian. The doctors in Milan performed the translation for us making preliminary work in the other centers go more smoothly. 
• It also helped that my wife speaks Italian, but it is not necessary to have an Italian speaker if the dialysis prescription is clearly outlined in Italian. At each center, someone spoke English. 

Stephen Hessler resides in Ridgewood, New Jersey. He is also a member of AAKP.

This article originally appeared in the July 2003 issue of aakpRENALIFE, Vol. 19, No.1.

The article on Basilicata appeared in the New York Times, September 3, 2000, Travel section.

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