© 2018 Marina Bakhmatova

2018 — №1 (15)

Снимок экрана 2018-10-15 в 14.13.29Key words: Italy, mass migration, multicultural society, Italian health system, cultural and linguistic barriers, diagnostic and treatment approaches, relations between patient and practitioner, culture shock, cultural mediation, cultural mediator, medical anthropology, ethnopsychology, female circumcision

Abstract: This paper focuses on the practices of cultural and ethnic mediation in the field of healthcare in Italy.  It examines ways to achieve optimal results in intercultural communication at the state level. The author addresses the issues of training of specialists in the field of cultural and medical anthropology, including training of medical students; she also describes the special units in medical institutions where specialists have been successfully conducting cultural mediation in the past twenty years. The discussion concentrates on the problems associated with the rise of the new profession, its regulation, and on the prospects for the development of the practices of cultural and ethnic mediation in the times of immigration flows and development of a multicultural society in Italy at the turn of the XX-XXI centuries.

Despite facing mass migration later than other Western countries, Italy has recently begun a process of transformation into a multicultural society. Italy was previously a country of emigrants: between 20 and 30 million Italians emigrated abroad, and their descendants, called “oriundi”, constitute one of the biggest diasporas in the world. Now, however, Italy has become a country of immigrants.

Immigration flows reached Italy as a result of geopolitical changes during the end of the XXth century. After the fall of Gadhafi’s regime in Libya in 2011, the barriers that prevented African population from crossing the sea disintegrated, and Italy saw an unprecedented flow of migrants.

The Italian peninsula became a natural geographical bridge, used by thousands of migrants and refugees as a gateway to the European borders. A significant percentage of migrants settled in Italy, either after applying for a legal permit, or in a precarious and illegal situation. Every migrant will sooner or later encounter the Italian health system, whose principle is to guarantee health services to everyone, independently from their legal status.

Experience shows that cultural and linguistic barriers are the main causes of a chain of negative events both for the migrant patient and for the healthcare providers. The first problem is that migrants don’t know how the health system works and as a result their access to resources is limited. When the patients finally meet a practitioner, health providers might encounter difficulties in establishing a diagnosis: the patients are not always able to explain their problems and it is sometimes impossible to reconstruct their medical history. All these difficulties can lead to medical errors in diagnosis and therapy.

My experience as a cultural mediator with a focus on health in Verona from 2002 to 2009 shows the existence of misunderstanding stemming from cultural differences, for example when a simple routine operation is perceived by the patient as a potential threat to his or her physical or mental integrity. Moreover, if a migrant doesn’t speak Italian, his or her privacy might not be respected. The relative acting as a translator during the appointment might not be neutral and his or her presence result in psychological pressure on the patient and on the practitioner.

Unfortunately, migrant patients also face obstacles beyond linguistic ones. Even migrants who master the language of the country are confronted with differences in the diagnostic and treatment approaches, in the relations between patient and practitioner, and in medical terminology, among others. Sometimes these differences can trigger a state of culture shock, making medical help difficult to obtain. There are other problems that arise on the side of the health providers too. Indeed, they might not realize the importance of cross-cultural communication, as they are often “monoculturally naïve”. Yet, failures in cross-cultural communication might undermine their efforts.

Each country’s health system is based on that country’s local and national culture, which corresponds to the needs and criteria of the society of that country. The expertise of a cultural mediator plays a role in helping new migrants integrate in the host country, a challenge that the Italian government has been trying to address in the past twenty years.

The key legal initiative aimed at providing a normative basis for regulating intercultural conflicts is the Legislative Decree N. 40 “Disciplina dell’immigrazione e norme sulla condizione dello straniero”, published on March 6, 1998, also known as “Turco-Napolitano”, from the names of its authors. This law endorses an over-arching approach to the phenomenon, and crucially reframes immigration as a source of development for the country, instead of as a source of challenges. The focus is on the integration process of migrants in the Italian society, so that they can become its full members.

This law also lays the foundations for a two-sided approach to the resolution of multicultural conflicts: the law not only mentions the necessity on the side of the migrants to adapt to their host country, but also the necessity on the side of the society to foster a dialogue with the new citizens. This is why, alongside the role of a cultural mediator (a foreigner who has lived in the host country for a long time and who speaks the language) as a bridge between the Italian society and the new migrants, the law also encourages the development of awareness in Italian citizens towards the presence of members with a different background and/or language within the Italian society. The aim is to support the transformation of the Italian society into a multicultural one (“società multiculturale”). Universities play a central role in this process, by creating new courses and degrees for future doctors and cultural mediators. Courses in medical anthropology can teach doctors multicultural competences, which will help in their work with patients from a different cultural background. Courses in cultural mediation in the health sector can teach Italian and foreign cultural mediators knowledge in the domains of medicine, anthropology and ethnopsychology, which will help in supporting communication between the doctor and the foreigner patient.

Even if many Italian physicians prefer working with Italian cultural mediators whom they trust more, migration flows from Asian and African countries require the presence of cultural mediators who also speak the languages of those countries. Currently all main Italian hospitals have PR centers with a cultural mediation department and mediators speaking the most demanded languages. Hospitals provide options for cases when a cultural mediator is necessary (such as for meetings before an abortion, informed consent before a chirurgical operation, etc.). This is even more crucial when working with patients coming from countries practicing female genital mutilation. In 2006 Italy banned all kinds of female genital mutilation and has been trying to attract to mediation women who are familiar with this practice.

Cultural mediation is a new field and cultural mediator is a new job title. It is still a work in progress. Nonetheless, the migration flows in the past years have shown how central the role of the cultural mediator is. The mediator sometimes becomes the only link between the migrant who finds her or himself in a new cultural milieu, and the host society. The practice of cultural mediation has proved effective and useful in many contexts, and the study of existing experiences could be of interest for the Russian medical and anthropological sectors.

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