LIFE Summer Fellowship Reflections: Crossing the Cultural Divide: Healthcare Access for African Migrants in Northern and Southern Italy

This is the third blog post in a series written by the 2021 recipients of the Duke University Libraries Summer Research Fellowship for LIFE Students. Isaiah Mason is a senior majoring in International Comparative Studies, with a concentration in Europe. You can find the other posts here and here.

Within the past ten years, the migrant crisis in the Mediterranean Sea has become a hot button issue and site of humanitarian efforts. Connected with the events of the Arab spring, there has been significantly increased movement of migrants and refugees into Europe. In the relatively short time since its unification in 1861, Italy has transformed from a country of emigration to one of immigration, partially due to its status as a primary port of entry into Europe. Due to this, Italy becomes a place where a lot of African migrants come for varying amounts of time seeking aid. This is in addition to other migrants flows from Africa that became a subject of political focus in the early 1990s concerning the legal status of foreigners within Italy. Additionally, Italy’s colonial history within the Horn of Africa might serve to complicate African migrant access to resources and community formation, impacting the ways that they navigate life within a new country.

Another consideration that I had was the impact of location within Italy as affecting the situation of migrants. There is a strong culture within Italy of identifying with the region where one is born which compounds with distinctions between the Northern and Southern economies. As the North has a more significant history with industrialization than do many regions of the South, the presence of certain labor and manufacturing jobs creates push for Northern migration flows. In considering the displacement of migrant communities within Italy following arrival, I thought that migratory pressures might have an influence on understanding African migrant life, integration, and access to Italian society.

My project investigates the sociocultural access to Italy for African migrants, specifically the degree of healthcare access within Northern and Southern Italy to understand the presence of structural barriers and facilitators that impact the quality of care. After considering how access to healthcare could look different across Italy due to economic differences between rural and urban regions, I decided to try to include migrants from regions across Northern and Southern Italy to be able to compare their relative experiences with both aspects of building and maintaining community as well as experiences with the healthcare system. To accomplish this, I organized an ethnographic approach to interview migrants and reflect on their personal accounts within family units. Since there was a university travel ban in place, I had to shift my methodology to accommodate remote research so that I would complete the interviews over Zoom.

This project synthesizes my interests in public health with my studies of Italian language and culture throughout my time at Duke. Additionally, I chose Italy as a site of study because of the interplay between regionalism and the public healthcare system. In Italy, there is a national health service, known as the Servizio Sanitario Nazionale (SSN), that is administered on a regional basis. Italy is also divided into 20 different regions, which creates health systems with various levels of development. The SSN is also a relatively new development, having only been created in 1978. Considering the vulnerability of minorities within a public discourse would also allow me to critique the effectiveness of national policies to serve all the constituents within Italy and possibly identity areas for recourse to improve health services. Beyond the interest in healthcare, I wanted to understand Italy from the context of functioning as a space within several types of borders. Moving from the context of the nation, I was interested in determining whether region mattered in the sense of how African migrants can establish community, both in terms of family unification and preserving cultural ties with their country of origin.

Through the Duke University Libraries LIFE Undergraduate Research Grant, I set out to understand the extent of medical literature in Italy that would allow me to investigate the intersection of policy and identity for African migrants. This led first to understanding the significance of space on the degree of treatment disparities and the interesting fact that each region governs a separate healthcare system and that migrant health investigations at the national level would require comparisons of the data available in government documents and journal articles. In this process, I discovered the dominant narrative was Italian citizens that offered their analysis of the cause for various disparities concentrated in the healthcare sector.

Diving into this topic led me to new bodies of knowledge and consideration of different kinds of resources that I have not engaged with through my classes. Looking specifically into Italian government documents led me to investigate the role of language in governing access in reference to Italian citizens. Thus, the Italian government implicated legal status across time as an important consideration, meaning that the importance of holding papers becomes a strictly migrant experience that is related to phenotype. Italian comes to mean white, while the question of identity for anyone that does not fit that scope becomes a question of legitimacy.

While I reflect on some of the pitfalls of my research, namely the difficulty that I had in establishing contact with African migrants in Italy due to COVID, I think about the ways that this presented new opportunities to re-center my research on the relationship between the African migrant and Italy through labor. This research experience has caused me to go outside my comfort zone and explore different methods to appropriately write within the discourse. I would encourage anyone that has a similar interest to not count themselves out of conducting research because it is new. Before engaging with this project, I had always considered that research not directly linked to a class was not something that I saw myself doing, but this project helped me grow and seek out resources at Duke to receive guidance. As I move forward with this project throughout the following year for my honors thesis, I am excited to see what else I will be able to discover and the journey that it will take me on.

I would like to thank the Duke Libraries for the support in starting to work through key aspects of my project and providing funding to allow me to do my research during the summer. I am grateful to my faculty mentor, Professor Roberto Dainotto, and Duke Librarians Hannah Rozear and Arianne Hartsell-Gundy for the continuous support and helping me generate alternatives, without which this project would not be possible. I look forward to continuing my research on the place and agency of African migrants within Italy and building upon this work.



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