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Urban Suffering Studies Center

 

 

The urban dimension: obstacle and opportunity for mental health without exclusion

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Bianca Maisano Gonzalo Castro Cedeno

 

The Rome Caritas experience

The Caritas, theoretical and operative expression of the Italian Church's attention to all forms of exclusion and social injustice, was started in Rome in 1979 by don Luigi Di Liegro. In the living fabric of the city, touched by the same deep rooted "ills"[1] then as it is now, he could see how civil responsibility could be expressed prevalently through identifying the places and spaces of suffering and human hope to be in tune with the city, its life, its hopes.

Di Liegro was attentive to aspects pertaining to the care and the right to the protection of health: coming into contact with every person with the respect and value of each life, whatever the culture or story they belong to, to know, understand and take on with love the promotion of health especially for those who are less fortunate, so that they can be recognized, affirmed and promoted on every level, by individuals, by the community and by institutions, rights and dignity for all, without any exclusions. On the wake of this ideological push, in 1938 the specific Area Sanitaria di Caritas was started. The Stazione Termini in Rome was identified as the first place in which to promote health care for illegal immigrants. This experience coagulated from the start hundreds of volunteer groups from different socio-cultural walks of life and professions. Beside the many volunteer doctors, nurses and pharmacists, motivated citizens came along side recognizing the four important pillars of the mission that inspires the whole project:

· a trans-cultural approach that values the centrality of the recipient of aid operations

· deeper cultural understanding and research

· the training of workers and citizens

· political action to promote the health rights of every person

 

Health care and the trans-cultural approach

In these last thirty years of history almost eighty thousand people from one hundred and thirty different nationalities have come through the Area Sanitaria for health reasons, and one thousand five hundred volunteers of different ages, professions, religions, walks of life, cultural and political opinions have participated. An enormous and dynamic workshop of trans-cultural relations where health has served as an opportunity for the meeting of people that have identified in the same humanity.Not unlike the migrants, today's medicine, based on the criteria of scientific evidence, must go through a migratory process, become a migrant, be put into question.A flexible and dialogic attitude is one of the most important characteristics of the doctors that work at the Poliambulatorio Caritas. Listening to the stories of migrants it does seem that a lot of their basic problems are like a magnifying glass of the same problems that the general population of this country have. Naturally there are specifics, but it is undeniable that especially migrants have helped medicine to realize that losing focus of the relationship with the person equals making the scientific (and often economic) effort of caring ineffective. An excessive focus on specialization and technology has made medicine an almost exclusively mechanical discipline, in which the person is identified with a disease and the complexity as a suffering individual is "forgotten".Medicine that is attentive to migrants rediscovers itself and becomes a better medicine for all. An approach that becomes more trans-cultural each day is able to promote a dialogue with everyone and to take into consideration its own cultural characteristics and those of the patient as part of a constantly changing heritage.From this point of view we find that the attention of the doctors and health workers should be turned towards, not just the pathology, but also factors and processes connected to people and populations; factors that are not only bacterial or viral but also political and social. If we observe the trends in pathologies of migrants over time, for example over the last twenty years, we see that real progress in the field of health care has been achieved, not with the discovery of new drugs for new pathologies, but mostly through policies for sheltering and integration, by choosing inclusion, access and usability of universal health care services. For example this is easily shown in the case of AIDS or tuberculosis where epidemiologically a significant improvement in the incidence of this disease is observed. Therefore a medicine that migrants help us to rethink in terms of global health, connected with society, anthropology, sociology and policy and in the words of the epidemiologist Geoffrey Rose: the primary factors of diseases are prevalently political and social, therefore the appropriate remedies must be political and social. Medicine and politics cannot and must not be kept separate[2].

Deeper understanding, research and knowledge

The database of the Area Sanitaria contains the health care records of the Poliambulatorio with approximately 80.000 patient files and over 500.000 service records from 1983 to today. The gathering of information and the organization in the database is transformed into the permanent observatory of the presence of illegal immigrants by country of origin, age, gender, education. A population of people otherwise invisible to health records because of their state of illegality and the fragmentary institutional data emerges. This careful, constant and up to date observation enables the selection of suitable courses of action, discrediting prejudices about the health of migrants; the data collected supports the Caritas policies in the field of human rights and raises the awareness of institutions for the formulation and application of regulations capable of guaranteeing the right to healthcare. On an internal level, the monitoring of affluence, the pathologies and services helps both with the constant organizational monitoring and the detection of the need for special training courses for the volunteers that work in this field.In 2000 the study and documentation center (C.Sel) was started dedicated specifically to issues of health and immigration, on the occasion of the renovation of the headquarters of the Area Sanitaria: it collects and organizes materials on these subjects and offers a space to answer the need for deeper understanding and knowledge that is born from the health and social experiences of encountering other cultures; the C.Sel is aimed primarily at workers and volunteers of the health care and services of the Caritas: students, scholars and researchers of all fields. It is also open to the public, for anyone interested in deepening their understanding of matters of trans-cultural medicine. It currently includes over 2.150 documents between books, thesis, journals, articles and collaborates with other similar services. The C.Sel hosts the l'Osservatorio per le Politiche Sanitarie Locali per Immigrati e Rom e il progetto SaluteZingara that, in collaboration with the health services of the Sistema Pubblico and the GrIS Lazio - Gruppo Immigrazione e Salute, local chapter of the Società Italiana di Medicina delle Migrazioni (SIMM) - has held various prevention and training campaigns in various Rom camps present in Rome.

Training and motivation

The questions raised by clinical experience with numerous urban immigrants have awakened in the workers the need for training as an on the road necessity. For those walking this road leading to the first hand experience of trans-cultural medicine there is the basic course for volunteers organized twice a year by the Rome Caritas; it includes a specific three day module on trans-cultural medicine. Afterwards the initiatives of life-long training offered to the staff of the Area Sanitaria give the volunteers a space to deepen their understanding and make a style of service their own that, although localized in a specific and limited field, gains a deeper and wider meaning through the participation in the Area Sanitaria: the promotion of health especially for those who are less fortunate, so that they can be recognized, affirmed and promoted on every level, by individuals, by the community and by institutions, rights and dignity for all, without any exclusions. So that the ripple may widen in the ‘90s the Corso di Medicina delle Migrazioni (MdM) was created, today in its XIX cycle: it is held every year in Rome in the month of October and the participants come from different regions of Italy. It consists of a resident course of approximately 20 hours for socio-health workers that wish to deepen their understanding of subjects pertaining to epidemiology, the relationship and communication with patients from different cultures, health legislation. Though the years the MdM course has become a reference point and a connection in a network of relationships with those that, for work or social involvement, deal with migrants and their health throughout Italy. The network of GrIS (local chapters of Gruppi Immigrazione Salute) was created and is consolidated also thanks to these courses. The MdM course has gone on the road and is currently being presented as a training program in other cities as well, aimed at workers of the public and private social sector. An intensely cultivated ground that has been the humus for the creation of the Master's. The Master's in Emigration, Migration and Poverty Medicine (MEMP), started in 1999 and now in its fifth cycle in 2010, is organized by the Area Sanitaria Caritas Roma and the Fondazione Idente di Studi e Ricerca; throughout its five cycles (each lasting two years) it has trained 230 workers from different professional and regional contexts. It is the first Master's in Italy on the subject of medical and socio-health assistance to immigrants, marginalized individuals and in general all those suffering from social trauma. The MEMP aims to supply the knowledge and methodological instruments, relational and clinical-scientific proficiency to workers in the fields of health and socio-health promotion that are committed to facing issues of inequality, diversity, lack of official visibility of the problems of marginalized, migrant and poor people groups.

An idea of a city

We want a different city, a new city, that belongs to everyone because made by everyone. A city that is the city of interaction. The interaction of its citizens, between faith and technique, between aspirations and commitments. This is how don Luigi di Liegro again speaks, dreaming of a Rome with a more livable and participated dimension. The data that emerges today on this city seem more like a nightmare than a dream. Rome, like many other metropolises, has in these last years gone through a recurrence of the disadvantage and the social exclusion that affects ever wider people groups. Foreigners are also more present among the fragile and vulnerable: young people arrived only recently in Italy that cannot integrate, asylum seekers and refused applicants (denied entrance), refugees with difficulty finding work, but increasingly often we find among the excluded elderly foreigners, who arrived twenty or even thirty years ago, that have watched their migratory project fail or that because of a disease have lost and cannot regain a legal status. And certainly these situations of disadvantage become more evident when health is lacking. To bring into the light and denounce the inadequacies and the denied or hidden rights, supporting our statements scientifically, is not enough if our effort does not propose policies and feasible options on an organizational level: instruments and operative models, projects that are permeable to the weakest often hidden requests. It is a commitment to justice, a commitment that cannot be neutral, above sides, but aligned with the weak and supported by experience that is not delegate but lived out first hand. The challenge lies in having policy first, and accordingly the planning and organization of services, take on this priority where the efficiency and efficacy of the system is pitted against the ability to intercept and respond adequately to the needs of that part of the population that is weak or partially so. This is not rhetoric because it means foreseeing social and health policies that are not based on economic standards and market logic (competition rather than planning, excellence in operations instead of basic care...), but that take into account real needs, the overall quality of life, the capacity for autonomy in possible decisions[3]. There are in fact several situations of practically invisible health marginalization - and therefore almost completely ignored - for which the private social sector must act as a sentinel. The Rom are an example of this with whom we have been working with since 1987 through the SaluteZingara project and more recently with the Chinese. Through direct contact with the Chinese community, in a welcoming climate that is attentive towards linguistic and cultural diversity like that of the Poliambulatorio della Stazione Termini, a demand for basic healthcare on the part of the Chinese population has been brought to light, through the analysis and recent publication of the collected data[4], that the public healthcare system is not yet able to intercept. In these cases it is necessary to suggest projects that foresee the operational mode of active intervention in the urban territory among the population that is to be reached, to bring it gradually, through relationships, to direct contact with public services, until the Chinese population is effectively involved in the planning and organization of culturally competent services. And so in this complex and multifaceted city, crossed each year by more than ten million tourists from all over the world, but also rich in contrasting and new and strident forms of poverty, always used to being visited, crossed and found with the intention of bettering itself[5], constantly invites us now more than ever, to reflect on the cultural and political dynamics that are beneath the surface of every clinical and social operation.A political action that tirelessly can start over, involve - even when the processes of transformation seem exasperatingly slow[6] - because guided by a vision that sees in the obstacle, in the complexity of the urban fabric, the frontier of a new opportunity for transformation.

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* Responsible respectively for the Centro Studi e documentazione C.SeI and for project management and training within the Direzione dell'Area Sanitaria della Caritas di Roma

[1] In February 1974, Don Luigi started the famous conference on the ills of Rome: La responsabilità dei cristiani di fronte alle attese di giustizia e di carità nella diocesi di Roma. Started on the 12th of February in the basilica of S. Giovanni in Laterano, the conference brought to light and denounced the weaknesses and faults of Rome, along with those responsible.

[2] Geoffrey Rose in Le strategie della medicina preventiva - Il Pensiero Scientifico Editore - Roma, 2001.

[3] Salvatore Geraci, Head Doctor of the Area Sanitaria Caritas in Roma Caritas Salute senza esclusione La politica e l'impegno della Caritas Diocesana - Rome February 2002

[4] As published in Una porta aperta. La salute come occasione d'incontro con la comunità cinese a cura di Salvatore Geraci e Bianca Maisano Edizioni Lombar Key Ottobre 2010

[5] Quote from the research Esquilino dei mondi lontani - che tanto vicini non sono mai stati - by Fabio Vando. Roma 2007

 

[6] The walk of ideas is exasperatingly slow, especially when they cross interests and passions, but it is continuous when the proposed ideas are right and truly useful. Persevering is necessary because every slowness gets to the finish line if the tiredness does not prevail over the desire to continue and carry out these ideas. Quote taken from the speech by G. B. Scalabrini, bishop of Piacenza and father and apostle to migrants. at the second conference on emigration, 1898

 

 


 
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The study centre wishes to study the phenomenon of urban suffering, in other words the suffering that is specific to the great metropolises. Urban Suffering is a category that describes the meeting of individual suffering with the social fabric that they inhabit. The description, the understanding and the transformation of the psychological and social dynamics that develop from the meeting of ...

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