By Isaiah Mason, ’22

Structure of the Italian National Health System from this source (Lo Scalzo, Alessandra & Donatini, Andrea & Orzella, Letizia & Cicchetti, Americo & Profili, Silvia & Maresso, A.. (2009). Italy: Health system review. Health Systems in Transition. 11. 1-216.

My research this summer focuses on healthcare access for African migrants in Northern and Southern Italy, to serve as the foundation for my senior thesis. 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.

The primary purpose of my project is to better understand the impact of Italian social and cultural forces on African migrants’ quality of life. As a minority in Italy, African migrants account for about 1.6 million of Italy’s reported 6.2 million migrants, though the actual figure is hard to access. Healthcare access represents one dynamic system that reflects how Italian citizens interact with African migrants. Through conducting a literature, some of the influential factors moderating the interactions are the language barrier, lack of education resources about the services available to different classes of migrants, and medical recordkeeping for migrants that could aid continuity 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. Remote research introduced the challenge of mediating relationships with potential participants through members of my social network. The main issue that I encountered was trying to establish rapport with the migrants. Since I was primarily communicating through email, the only information that I could convey about the study were delivered through documents by my contacts. In a way, I felt detached from the process and on standby until someone contacted me to express interest in moving forward with the interviews.

Regions of Italy from Touropia.com

Additionally, I encountered the harsh reality of trying to conduct research during the COVID pandemic. I became aware of how quarantine impacted social relations in Italy, as my site of study. Most of the organizations that I contacted to help with research participant recruitment had to stop most of their programming. Apart from this, it was hard to get organizations to respond even after sending follow-up emails. Some of these programs assisted African migrants with learning Italian, finding temporary housing, and locating resources in the area. My goal for the project was to be reflective of participant experiences and help add to the conversation about migrant health in Italy from the perspective of the migrants, and, while I was aware of the difficulties in reaching my population of interest as a vulnerable social group, I have begun to understand how a health crisis informs healthcare access when considering new questions of vulnerability to COVID and access to vaccines which are ongoing developments.