Beginning in April 2020, a team of graduate students from the University of South Florida (USF) Department of Anthropology, and multilingual community leaders including Dr. Dillon Mahoney, Dr. Roberta Baer, Dr. Krista Billingsley, Renice Obure, Michaela Inks, and Eugenie Umurutasate began an assessment of the impacts of pandemic policies on refugees in Hillsborough County.
The team started with 21 interviews with household heads of refugee families from the Democratic Republic of the Congo (DRC) and have since completed similar evaluations with Arabic and Spanish-speakers. The interviews addressed issues including: understandings of COVID-19 and how it is spread, ability to practice social/physical distancing, access to food assistance, helping children learn via online classes, and workplace disruptions, including the need to file for unemployment.
“We found that Congolese refugees were concerned, fearful, and cautious. They had considerable knowledge about causes, symptoms, and treatments for the disease (including some traditional treatments to alleviate symptoms),” explained Mahoney. “There was a clear understanding of social distancing, but many families were unable to practice preventative measures such as distancing to the degree they desired because of household size and employment obligations. This, in turn, created fear and stress as respondents felt that they could not protect their families.”
Family obligations and the high cost of living necessitate living in close quarters with many family members. Distancing and quarantine mandates assume a certain level of privilege and capacity that these families lack. Many families lost all income and could pay neither rent nor bills (including for electricity and internet). To feed their families and avoid eviction, people have had to work jobs, considered “essential” (although low-paying), in industries such as fish processing, construction, and healthcare, that make physical distancing impossible. Because help is generally sought in person, “social distancing” mandates have made getting assistance even more difficult. With limited access to computers outside of smart phones, the poorest are particularly isolated. Further, remote learning policies for schooling have severely set back students already struggling to learn both educational materials and the structure of the US school system.
“We also found an underlying layer of fear/mistrust of hospitals and vaccines that shed some light on why people who had said they would get tested became very reluctant once the first Congolese tested positive. Our use of open-ended interviews gave us the advantage of collecting data beyond reductive multiple choice or yes/no answers,” continued Mahoney.
One man interviewed expressed fear of learning he would test positive, as well as of the bill for the test, noting “there is no cure, after all, so what would be the point?” It was only because the team was able to capture such complexity through the open-ended interviews that they could quickly and efficiently help the Department of Health and local physicians address community members’ hesitations about testing.
While refugees understand, and generally trust the pandemic policies/guidelines, they are unable to fully operationalize them. Families can only wash more if they can afford soap, and can only socially distance if they work in safe workplaces and live in houses where multiple people are not sharing beds and bedrooms. It is not culture that has made a difference, but differential access to resources. While “community education” is often seen as the answer to every public health issue, the team’s findings speak to larger issues of structural violence and the need to address structural and systemic reform if the desired public health impacts are to be achieved. Assumptions that refugees simply need more education and attempts to do standard health education by emailing materials with links to other internet-based resources are neither likely to be effective nor reach the neediest families. The research team have developed a more culturally appropriate approach, involving Swahili YouTube videos and social media to address some of the key issues affecting refugees.
The project illustrates the applied role anthropologists can play during a disease outbreak. Anthropologists that have experience working with refugees can fill immediate gaps left by budget cuts to agencies that would otherwise be working directly with the neediest families. Anthropologists have the linguistic and cultural knowledge to engage in “immediate anthropology,” brokering relationships between community members and physicians and public health officials. We distributed masks, food, and soap to all families who participated in our study. While Congolese refugees still lack many of the critical resources to address their risk of COVID-19, they are survivors--of the Congo Wars and the refugee camps--and they are optimistic about surviving the current pandemic.
Initial findings have been accepted for publication in the journal Human Organization and have been shared via report with local physicians, resettlement staff, politicians, and state organizations such as the Department of Health. The complete report specifically addresses underlying inequities for resettling refugees that the COVID-19 pandemic has exposed: language barriers and access to public health information, food, healthcare, housing, and employment.