For patients, a room at the casa

Julito Zepeda was born in Combarbala, a mining town on an arid plain in the foothills of the Chilean Andes Mountains. Since his birth, he has dealt with a medical condition that causes veins to proliferate and swell on his face, requiring three to four operations a year.

Seven-year-old Julito is among nine people currently staying at the Casa Monte Cassino, which was founded in 1987 as a refuge for the families of Italian children awaiting treatment at Boston's medical centers, whose international offices contact the Casa to book stays for patients. For the past eight years, the Casa has taken in children at no charge from around the world as well as the United States.

Julito's condition, vascular malformation, has required him to undergo 17 operations so far, according to his father, Julio, who said that Julito had one operation in Chile with virtually no benefits. The advice from doctors there was to go to Children's Hospital in Boston.

Giovanna and Maurizio Tognetti, two new live-in co-managers at the Casa, work with the families on a daily basis and witness the problems they face.

''Without this organization, they wouldn't have been able to come," Giovanna said on a recent afternoon, translating Julio's choked-up sentiments -- and adding a few tears of her own.

''They probably wouldn't have been able to cure him without the Casa providing housing," she said Julio told her.

The Tognettis, an Italian couple from Milford, were hired in February 2003, and with the new duo at the administrative helm, expanded the Casa's capabilities.

''This is a major enhancement for Casa," said Tino Valdesolo, a member of Casa's board of directors. ''They do everything."

Giovanna is fluent in Italian, French, and Spanish, which helps in coping with the abundance of languages spoken in the Casa. Last year 35 familes from 13 countries -- including Argentina, Sri Lanka, Mexico, and Uruguay -- stayed there. She has served as an interpreter of cultures as well as languages, helping bridge gaps between families, both in their communication with hospitals and with each other.

''When you are in a foreign country, you are very nervous with people you don't know," Giovanna said. ''Sometimes [the people staying] at the Casa don't understand each other, and you have to be the peacemaker."

Misunderstandings can arise over such simple things as who can use the stove next or who is using the phone too often.

''You are already in such a difficult time in your life, not understanding each other can make things worse," she said.

Giovanna was teaching Italian at the St. John's school in the North End when she and her husband met Valdesolo, director of the school's Italian language program. They had recently retired from the travel business they owned. Giovanna and Maurizio asked him if the Casa needed volunteers, and as it happened, the business manager was leaving.

While he would have been happy getting one new manager, gaining two was a bonus that Guido Vittiglio, president and co-founder of Casa Monte Cassino, could not pass up.

''I saw that they were very sincere, smart people, and they really wanted to do good for the Casa," Vittiglio said.

Casa was founded by Vittiglio and his brother, the late Ferdinando ''Fred" Vittiglio, both immigrants from Italy. The five-story brick building on Tileston Street that houses the Casa, originally a convent, was named for the founders' hometown, Cassino, situated between Rome and Naples at the foot of a small mountain, Monte Cassino.

The brothers were moved to found the Casa in response to local parish priests seeking homes for families of Italian children coming to the United States in need of medical treatment for eye maladies.

Running the Casa includes juggling account-handling and bill-paying, coordinating patients' hospital visits and setting appointments, and organizing passports and other paperwork for the Casa's guests to enter the United States.

''It's a unique situation to have two such bright, motivated people from the same background [Italian] who know and can communicate with the community, and understand the immigration issues," that families who stay at the Casa deal with, said Guido's son, Joseph Vittiglio, a Boston attorney and board member at Casa.

This summer, the Casa expects to launch a website in English, Italian, and Spanish that will have booking information and photos of rooms and the bright and open shared living spaces, where people can talk or watch television.

The need for 24/7 staffing was evident recently when Giovanna had to make a late-night emergency call for an ambulance to pick up a patient and rush her to the hospital.

''There is no set list of things to do," she said. ''You do what you have to do in whatever situation comes up." Although donations are welcomed, payment is not required, and there is no time limit on a stay. Funding for the Casa comes from private donors and fund-raisers run by Casa board members. Families have their own bedrooms and bathrooms but share the living room and kitchen areas.

For Julito and his family, there is no answer to when the treatments will end.

''It's a long process, but Julito improves with each operation, and Julio is confident that he will be cured," Giovanna translated for Julio.