Part of a series discussing Romani Chronicles of Covid-19: Testimonies of Harm and Resilience, edited by Paloma Gay y Blasco and Martin Fotta (Berghahn: New York and Oxford, 2023).
Romani Chronicles of COVID-19: Testimonies of Harm and Resilience is an admirable and personal account not only of various Roma peoples’ resilience and tenacity but also of the humanity of each of the individual authors amidst a pandemic. The different backgrounds and social roles of the chroniclers, ranging from Roma activists and first-time authors to non-Roma researchers of ‘Roma issues’ and governmental health policy advisers, correspond to the multidimensionality of social life in a time of increased public health risks. The book, however, misses some of the (national) cobblestones in the footpath leading to understanding the pandemic reality of the Roma in the country (or countries) Czecho-Slovakia.
In the Slovak account, Andrej Belák,a medical anthropologist, gives in two articles (Part III: Chapter 13, Chapter 18) a detailed, personalized explanation of his underappreciated and politically delicate position of a social researcher working as a lead advisor to the Ministry of Health on culturally sensitive quarantines and disease prevention in the segregated communities. However, the voices of family members residing inside the locked down (quarantined) settlements remains mostly absent. One exception is the inclusion of an account of Slovak families returning from England who experienced border detention due to COVID-testing. At the same time, the Slovak pandemic experience is wonderfully documented by a first-hand account of one of the 300+ Roma health mediators, who are local community health promoters organized throughout Slovakia by Healthy Regions (Zdravé regiony). This is a Slovak government-supported organization that has inspired introducing similar health mediator positions in the Czech Republic. However, health mediators in the Czech Republic are not represented in Romani Chronicles. The input of Roma health mediators is one of the essential cobblestones in the Czech national pathway to comprehend epidemic management. In their chapters (Part V: Chapter 22 and Chapter 24), Yasar Abu Ghosh, a non-Roma ethnologist, and Gwendolyn Albert, a non-Roma activist, point out and illustrate with examples a view generally shared by most Czech health authorities – that the pre-existing structural, social and health deficits translated into a significantly greater vulnerability and disease susceptibility for members of socially disadvantaged communities. Furthermore, they argue that the state authorities and the media did not address the specific needs and situations of the so-called socially excluded localities (SELs). However, their arguments do not fully cover the processes that took place. These processes, summed in the text that follows, have played an essential role in contributing to the Czech Roma community work that aims at systematic and sustainable change towards health improvement and equality at a grassroots level and began just before the pandemic.
In 2018, the National Institute of Public Health (Státní zdravotní ústav), which is coordinated by the Ministry of Health, established a network of Regional Centers of Public Health (RCPZ), allotting one center per each Czech region, fourteen all together. Their goal was public health promotion, including health literacy and improvement of access to health care services by people residing in SELs. The development of the network was part of a five-year EU project focused on reduction of health inequalities in the country. The original project proposal intended to implement social workers (with the requirement of a university level education) as the main tool to carry out the project activities. However, the governmental Agency for Social Inclusion then joined forces with the Institute and offered a set of guidelines, written by this review’s author, for the implementation of a low-threshold work position – the community health mediator. Applicants for the position were not required to have a formal education but were hired with the condition that they take a professional 80-hour training course at the Institute, partly taught by experts from the Slovak Healthy Regions and partly by Czech healthcare providers and health educators. By the year 2020 there were up to 60 health mediators, mostly Roma, trained to work across the fourteen regions; three regions also employed Roma coordinators (managing RCPZ). One of them was Jan Dužda, cited in Abu Ghosh’s account; the second one was Lucie Fuková, recently appointed by the Czech government as a Government Commissioner for Roma Minority Affairs. When the COVID pandemic hit, the health mediators were at first told by Prague management to protect themselves by making contacts with the Roma clients via phone and internet because there was a complete lack of protective wear. Finding a swift way around the material deficiencies, the mediators proved their readiness and professional competency by sewing facemasks for both themselves and their clients. They assisted individuals and families with getting their medications, transporting them to doctors, shopping for and otherwise assisting the elderly and chronically ill who had the greatest risks of severe illness. They kept the people in SELs updated on the frequent changes in the governmental epidemic-related instructions.
Without any special training for a pandemic, the Roma health mediators assumed all the key state responsibilities in protecting its citizens during a time of health crisis. During the second half of the epidemic, the RCPZ’s coordinators and mediators, especially in the two regions with the highest numbers of socially disadvantaged Roma – the Ústecký and Moravskoslezský – assisted the Czech Health Institute (Zdravotní ústav) in reaching families living in SELs via vaccination mobile ambulances. This initiative received significant media coverage. The media reported on the need for special vaccination programs for the Roma due to the fact that many of them were not registered at any practitioner’s office. At the same time, the media showed the limited success of this national vaccination campaign. While mediators promoted the safety of vaccination through educating their clients, many of the Roma declined (voluntary) vaccination due to a general mistrust in state authorities. Yet, many of the Roma who got vaccinated did so following the example of their mediators. Unlike the Slovak Healthy Regions, the National Institute of Public Health, under whom the health mediators worked, failed to collect any COVID-related data in the SELs. Likewise, it failed to secure a continuation of the needed health mediator positions under the state system. In 2022 the Institute let about 30 of the Roma health mediators go and handed the rest over to the UNICEF which provided funding for their work only until July 2024 as a part of their post-COVID health support for families with children initiative.
The only continuation of the Roma health mediation position is currently secured by three-year EU projects (most of them ending in 2026) running in eight Czech cities and towns – Brno, Česká Kamenice, Roudnice nad Labem, Ústí nad Labem, Ostrava, Frýdek-Místek, Velké Hamry and Liberec. The majority of Roma health mediators in these eight localitieshave created a grassroots network through which they collect data from their fieldwork. The data include the types of assistance in health promotion their clients need most and the changes in quality of life to which health mediation contributes. They also actively seek the support of public institutions, such as WHO, the Ministry of Health and the Ministry of Labor and Social Affairs, as well as the First Lady, Ms. Pavlová, who supports social and health care, in their effort not only to prevent the disappearance of their positions, but also to establish the position of health mediators (while it may be under a different label) in the Czech state system.
References
Mosaad Pěničková, D. 2021. Zdraví: příručka dobré praxe – inspirace pro sociální začleňování [Health: Examples of Good Practice in Social Inclusion]. Editorka a autorka. Odbor pro sociální začleňování (Agentura) MMR ČR [Social Inclusion Department (Agency), Ministry of Regional Development of the Czech Republic]. https://www.socialni-zaclenovani.cz/dokument/zdravi/
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