The adverbial phrase a malapena means barely, scarcely, hardly, just about or only just in English.
In both languages, these expressions often (albeit not always) imply some degree of hardship or difficulty.
Il paziente con la bronchite riesce a malapena a respirare.
The patient with bronchitis is hardly able to breathe.
The patient with bronchitis is scarcely able to breathe.
It is the union of two words: malo/a (an ancient adjective meaning bad, often seen in its truncated form mal in modern Italian) and pena (pain, suffering).
Senza gli occhiali, vedo a malapena la scritta sul cartello.
Without my glasses, I can barely see the writing on the sign.
Without my glasses, I can only just see the writing on the sign.
Important: The word malapena is always accompanied by the preposition a (to).
Some possible Italian synonyms for a malapena include a stento (with difficulty, just about) and a fatica (with difficulty).