Pandemic and foreign people in Torino: an intercultural approach
The following article was first published in Italian on the Regional Center for Documentation for Health Promotion website. Its main focus is the ongoing collaboration between ASL (the local Health Agency), the City Administration and the Network of community associations Torino Plurale, to contain and prevent the spread of Covid.
About the author: Lucia Portis, Professor in Professional Educator and Health Anthropology at the University of Torino and ASL (the local Agency for Health).
The intercultural perception of the pandemic
During the Covid-19 epidemic, community associations [associations whose membership is mainly or entirely composed by persons with a different ethnic, cultural or religious background] became an invaluable resource for their capacity to bridge between languages and symbolic systems. ASL, the local Health Agency, and the network Torino Plurale [whose members are the City Administration and thirty community associations] have cooperated to ensure a fair access to information for migrants and foreign communities.
The care and management of positive foreigners was, and still is, particularly problematic since the Italian Health Agencies not always take into account the cultural differences in the meaning of concepts like sickness, contagion, disease. The ideas of health and illness embody fundamental cultural dimensions, i.e. interpretations associated with different physical and psychological conditions of suffering and / or well-being, but also systems of knowledge and practices that have evolved to alleviate and prevent suffering or promote well-being. In order to construct and implement culturally appropriate interventions it is therefore necessary to understand these interpretations (activating what Marianella Scavi calls “a cognitive bisociation”) with the support of the beneficiaries, who become protagonists through participatory processes.
As Ivo Quaranta writes,
“Social sciences taught us that what makes the difference [in managing a pandemic] is the behavior of the people and, therefore, the ability to actively involve them in the processes that affect them”.
Therefore, changing individual and collective behaviors implies complex social processes and requires analytical frameworks that take into consideration the perspectives of individuals and communities.
Starting from this assumption, we have developed a joint and intersectoral action with the Municipality of Turin and the community associations belonging to the Torino Plurale Network to reflect on the perception of the risks associated with the virus and about supporting positive people.
This helped us overcome a “generalist”, universalist vision, which neglects individual and cultural differences regarding the pandemic, in favor of a tailor-made strategy aiming at dealing with the health inequalities caused by confinement and at establishing participatory methods, which may be useful in other areas of health promotion.
The critical issues from the point of view of foreigners
The most considerable problems are related to the obligation to stay at home in isolation. In Italy, one in four migrant / foreigner lives in absolute poverty (a situation which has been exacerbated by the Covid pandemic, but already dramatic). In terms of infection containment, this means that very often, migrants and foreign people have irregular or informal jobs; do not have access to income support measures; do not have a family network that can support them during the period of quarantine; live in smaller, often shared apartments and cannot maintain the necessary distancing measures. Furthermore, due to the different interpretations of health and disease within some communities, the need for confinement of a “healthy” persons (positive but without symptoms) is often incomprehensible.
Cultural mediators, although present and very useful, are not always able to perceive and work on differences in signification either because they belong to other cultural contexts, or because their role is simply “linguistic”, or even because they are not considered reliable by the their counterparts.
During the developing of the pandemic emergency situation and tanks the cooperation with the Torino Plurale Network, migrant associations have been considered an invaluable resource, because they use the same languages and symbolic systems, and involved in channeling information about social distance measures and their adherence. Furthermore, even in the almost total absence of public funds, communities had already taken steps to deliver basic support to people in isolation and their families, economically but also psychologically.
The prevention of Covid-19 risk starting from cultures
Prevention strategies must always be “located” — that is, adapted to their targets. In fact, risk prevention has often been criticized for its ethnocentrism and the evident “acceptance” of the superiority of Western scientific culture. Many projects, in different parts of the world, have been developed to help public health workers to convince people to act more rationally, to use preventive services, to obey the doctors’ “orders”. These projects are based on the assumption that beliefs relating to health must be corrected through “hard knowledge”, always biomedical, about the severity of disorders or the effectiveness of particular behaviors or therapies.
The vast array of meanings associated with the concept of disease in local cultures is undervalued in favor of biomedical knowledge deemed scientifically valid, compromising adherence to protective and preventive behaviors.
Therefore, even for the Covid-19 pandemic, an in-depth cultural analysis is useful for planning and developing health-promotion and -prevention interventions; to decide when, where, with whom, how and on what issues to intervene. Thick decription is a description of human social action that describes not just physical behaviors, but their context as interpreted by the actors as well, so that it can be better understood by an outsider. The beliefs of the patients on the causes, treatment and prevention of diseases; their lifestyle (and what they mean); the connections between social stratification and access to material and immaterial goods: all these elements help address changes in beliefs and habits.
Consequently, the City-Torino Plurale-ASL joint project intends to negotiate risk prevention strategies related to the Covid 19 pandemic through participatory processes involving the representatives of the communities, and to implement those strategies after understanding the communities’ cultural needs and the and symbolic universes.
Collaboration with the Bengali community
In July 2020, during the tracking activities, some Bengali families residing in Turin resulted infected. The contact with them was not easy because of language barriers and behavioral differences linked to the concept of “asymptomatic positive” — infected and contagious, but not sick (in the sense a bearer of symptoms and therefore of physical suffering).
Thanks to Torino Plurale, it was possible to meet and collaborate with I_, the charismatic leader of the community. They pictured a grim image of the economic difficulties of the Bengali families, whose only means of subsistence are small family retail business. In this situation, it is very difficult to enforce the isolation of the positive person and the quarantine of family members. Faced with this emergency, I_ and the Bengali community have put in place forms of material (expenditure and basic necessities) and psychological
(listening to community members) support. Also the contact tracing activity was boosted because, thanks to I_, ASL personnel was able to contact and test more quickly all the contacts of the positive cases.
I_’s persuasiveness, their knowledge of the Bengali community and the respect they enjoyed were invaluable assets which allowed ASL and the City to overcome difficulties and stereotypes that often accompany tracking activities.
Collaboration with the Peruvian community
During the summer, Torino local police reported several illegal gatherings organized by people from the Peruvian community. Normally, these parties help the Peruvian community to meet and socialize; during the first months of the pandemic, however, social gatherings were strictly forbidden (moreover, food and alcohol was illegally sold without license).
ASL, the City, Torino Plurale, the Peruvian Consulate and other associations of the Peruvian community engaged in an information campaign on the riskiness of meetings in parks during a pandemic period. The consulate sent a communication to the community which reminded about the dangers of unauthorized gatherings, and the associations took charge of disseminating this material among Peruvian citizens.
Using the appropriate and specific language facilitated the circulation of the message, the understanding of the risk, and reduced the number of gatherings. This kind of action, carried out in synergy with other institutions and the third sector, represent an implementation of the “intersectoral” approach required within the “Health promotion and Prevention Plan”. Building networks and being able to discuss issues related to health, behavior and protective measures with the target audience paves the way to achieve the desired results.
The next steps will be the creation of specific information for each community on the covid-19 vaccine and the implementation of projects to facilitate access to health services, also designed together with the network and the target population. These examples of collaborative practices clarifies that community participation is fundamental both in health promotion activities and in the containment of infections from Covid 19.
Conclusions
A big step forward is to think, paradoxically, of the pandemic as an opportunity to produce health through forms of knowledge and skills capable of enhancing its social dimensions and participatory logic. The emergency situation highlighted the need to pay attention to the contexts and to the targets. Qualitative as well as quantitative research tools and skills are needed, paired with approaches designed to make different (and often culturally distant communities) interact with each other.
As Antonella Bena states:
“To fight the pandemic effectively, it is not only necessary to investigate
knowledge about the virus but also the way people make decisions, organizations act, and communities react ».
