“Learning from Covid-related disruptions”
Giulia Mezzetti is the former PhD representative of the IMISCOE PhD network. She is currently pursuing a postdoc with the Catholic University of Milan as well as working for ISMU. We spoke with her about her time as a PhD representative and how she looks back at it, as well as about her research and how her work was affected by the Covid crisis. For this issue she was interviewed by Marina Lazëri.
How were you involved with the IMISCOE PhD Network previously? How was your time there? Are there things you wish you could have done differently?
I started out as a member of the Networking group. We were contributing a lot to the organization of some very interesting activities, and after a very active year I decided to apply for the position of PhD representative. I had never had a leadership role before and wanted to experiment. I held the position from 2018 to 2019. I enjoyed it a lot even though it was quite demanding, but this is something you know from the outset. The reward is that you get to know IMISCOE and the people in it very well. On top of that, I felt a bit like a trade union representative: us PhD students fighting for our rights and for more room within IMISCOE. With the PhD Network members, I worked at including PhD students in all that IMISCOE does and was especially happy with the inclusion of PhDs in the standing committees.
We also wanted to organize an intranet for PhD students to exchange advice, bibliography, papers and more. We were unable to do that, but it might be more possible with the new website and all the options that come with it.
What was your PhD thesis on? How does it relate to your current postdoc?
My PhD was about young Italians of a migrant background with a Muslim heritage and issues of religiosity and activism. I spoke with young people belonging to and actively involved in religious organisations, as well as young people who were religious but not involved. I conducted this fieldwork in Milan and Turin. My current postdoc, on the other hand, is on migration and healthcare, and the link with my PhD expertise is methodological. For my PhD I conducted biographical (life story) interviews and that was exactly the expertise needed for this project on migration and healthcare.
What kind of research were you going to do in this project on migration and healthcare?
I was accepted for a postdoc at the Catholic University in Milan, which was meant to take place between January 2020 and December 2020. I started working within a larger project, namely the opening of an ambulatory clinic for asylum seekers at the university hospital, which is part of the medical faculty located in Rome. This project was funded by the Ministry of the Interior with European funds and it was intended as a way to provide asylum seekers with general screening opportunities, as well as help them orientate in the Italian national healthcare system. My own part within this project was related to the assessment of the healthcare needs of this population, based on the reconstruction of their “story of health” and “story of illness”. Such a reconstruction should be based on the conduction of interviews akin to life-story interviews. I was meant to interview around 30 asylum seekers with the aid of cultural mediators as well as carry out focus groups with nurses, doctors, and cultural mediators. These asylum seekers are often quite vulnerable, have multiple health issues, have been traumatized by the experience of forced migration and have different experiences, perceptions and expectations about “the hospital” as an institution.
How was this project affected by the Covid crisis?
Right when I started making arrangements to start the interviews, all activities in Lombardy were subjected to a partial halt. We had a form of curfew and various other restrictions, and on March 9th all of the country was put in a lockdown. The university hospital became a covid specialized hospital and the ambulatory unit was one of the first projects to be halted. I could not travel, interview, or assess how the ambulatory unit was responding to the asylum seekers’ healthcare needs. The only thing I could do remotely was contributing to build the "foundations” of the database of the project’s beneficiaries, so as to be able to obtain descriptive statistics (gender, age, national origin, main health issues) about the asylum seekers who access the ambulatory, once the ambulatory will reopen and I will have to hand in the research report. This is why it was decided that as of June 2020, my project would be halted and it would resume for the period between January and June 2021. If all goes well, I will be able to conduct my research, but I will have to compress everything in 6 months. It is not ideal, but there was a fixed amount of money available, only for a 12-month total.
It seems like corona is here to stay. How has the project been adjusted to deal with that?
Even though we are experiencing a large outbreak again, the hospital is trying to set up the ambulatory unit in order to not be too affected by the coronavirus because we do indeed need to coexist with this virus. All of the other health problems are here to stay as well.. Now the hospital wants to set up their activities in a way as to not be affected by covid. For this reason, they are also using the ambulatory unit as an opportunity to experiment with telemedicine. The first contact with the asylum seekers will be online, and asylum seekers will only come to the university hospital in person for urgent health problems or to do visits with specialists.
We considered whether I could do my interviews online as well but quickly excluded that possibility. These interviews are already delicate on their own. First of all, they will be carried out with a cultural mediator, the presence of whom is essential since there is a language barrier. That presence can be both a resource and an obstacle. On the one hand, they already know and trust the cultural mediator, and this greatly facilitates interactions. On the other hand, the presence of two individuals asking questions – me in one language, the cultural mediator in another language – could significantly increase power imbalances in the interview setting. Secondly, speaking about healthcare problems with people who are traumatized or have different experiences in terms of access to and knowledge of healthcare structures is an additional challenge: perceptions about “the body” and about “cures” are culturally-laden, and health issues are very intimate for everybody. Conducting these kind of interviews would already be challenging in-person, let alone doing it online. This is why we discarded this possibility immediately.
You mention the presence of cultural mediators can be an obstacle for your interviews. Would this not be the case as well for the telemedicine proposed by the university hospital?
I don’t think this would be a problem. As I said, these asylum seekers already know the cultural mediator and have some degree of trust in them. Furthermore, the cultural mediator will be sitting next to the person during the online consultation, therefore it is expected that it would work for the practical aspects. Nonetheless, the consults are already very difficult in person. I was referred that, in some instances, patients would tell things about their conditions to the cultural mediator, but ask them to not tell the doctor because they are embarrassed. The cultural mediator needs to balance respecting the will of the asylum seekers and telling the doctor information that is important for their health. I need to be careful myself, so I am not perceived as yet another intrusive “inspector”. I will need the cultural mediators to explain well what my role is and what the goal of the interview is, before I introduce myself.
Do you think the health of these asylum seekers has been affected by the delay?
Possibly, but keep in mind that the ambulatory unit is exceptional on its own and an additional service. There are no other dedicated services for asylum seekers in reception centres: they only go to the emergency room if they have problems. The ambulatory unit project is also about helping the asylum seekers familiarize themselves with the healthcare system, something they themselves desire. These asylum seekers will all almost certainly receive refugee status because they are mostly from Syria and Eritrea, therefore it is important to be familiarized with these services as part of their integration trajectories. Most frustration due to covid was caused because expectations were not met. Some of them had already been visited and received advise to follow up with a specialist. When that became suddenly impossible, they started being worried since they were told their issue was urgent.
Your work as a postdoc was not the only activity you were doing during this period. You also work for a research centre in Milan. What is your work there, and how was it affected by Covid?
I work for the ISMU Foundation (Fondazione Ismu - Initiative e Studi sulla Multietnicità) which is also an IMISCOE member institute. This is a research centre on migration and integration, and we do various activities, like project implementation of EU or government-funded projects, as well as training activities (e.g. train the trainer). I was lucky to be able to increase my working time at ISMU after having initially decreased my working hours to focus on my postdoc and therefore it was possible for me to sustain myself financially after the postdoc was halted. Our activities at ISMU were not really affected by covid, except for some trainings, which were then moved online. Once some adjustments were made, most activities could continue as normal – and I am very much aware of how lucky I am, considering the economic crisis surrounding us.