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“Morbus Mediterraneus” – how racist codes endanger people’s health

In conversation with Alissa Jändrosch from Rhineland-Palatinate

Unfortunately, racist prejudices can be found everywhere. In our “Initiative for Workplace Democratic Competence”, people throughout Germany are working with heart and attitude to push back racist prejudices and conspiracy narratives with competence and knowledge transfer. During a project visit in Mainz, we met Alissa, who, together with her colleagues, reported on their democracy work in the health care system. In the conversation, a term came up that we did not immediately understand, but which basically lacks nothing in clarity. “Morbus Mediterraneus.” In the first moment we still thought, probably triggered by the well-known Latin term Morbus, that it is a disease that we do not know or that just occurs very rarely. But in fact it is unfortunately quite different, as Alissa from the project “We are diverse – We are strong – Racism free care” explains in our interview.

Alissa, you and your team are working on developing democracy skills in the field of nursing. What exactly do I have to imagine by that? What are you doing and, most importantly, with whom?

Alissa: That’s right, my team from AGARP and I are participating in the nationwide program “Our Work: Our Diversity. Initiative for Workplace Democratic Competence.” Our project is called “We are diverse/ We are strong – racism-free care” and is aimed at care workers throughout Rhineland-Palatinate.

The main reason for our focus on the care sector was a study by the University of Vechta[1]which shows that the already difficult working conditions in the care sector are becoming even more difficult for care workers with a migration history. According to the study, they receive less recognition from superiors and family members, are exposed to racist comments, work overtime more often, and as a result feel exhausted more often. We saw this study as alarming and it also poses a challenge to society. Especially against the backdrop of demographic change, in which people are getting older and older, professional care is taking on an increasingly important role in society. The field of nursing care represents one of the crucial issues for the future of Western industrial societies.

The focus of our project is therefore on the employees of care institutions, both those affected by racism and those who are not. Only if each individual deals with the mechanisms that contribute to the maintenance of racist structures, we can fight racism in institutions and facilities sustainably.

To this end, we have developed two series of workshops to raise awareness and educate on the topic of racism in the workplace. Both workshops always begin with a critical examination of the concept of racism. More specifically, how racism as a socially complex phenomenon can produce power and inequality relations.

[1] Caregivers with a migration background in professional care in Germany: Between successful integration and disadvantage

What are the objectives of the workshops and what methods do you use?

The empowerment workshop is exclusively aimed at employees of care institutions with experiences of racism in order to create a protected space for the participants. First and foremost in empowerment workshops is the resource or strengths perspective, which focuses on activating one’s own resources in a positive and valorizing way.

The second workshop is an awareness workshop, which is generally aimed at employees in the health care sector. It aims to redirect the focus to the people who perpetuate racism, albeit unconsciously and without meaning to, through their behavior.

Participants will be encouraged to critically examine their own prejudices and stereotypes. In another part of the workshop, the impact of racism in medicine/nursing on patients* in particular will be considered and discussed. To get a feeling for unequal treatment of patients* with migration history, I recommend the video from RBB “What to do against racism in medicine” with Alice Hasters. Afterwards, the consternation is usually great. The video can be found on Youtube.

Of course, we can also be met with resistance in various forms, because the confrontation with racism is inevitably associated with a high emotionality, but the overwhelming feedback is positive and the participants show their gratitude.

During our visit to your office in Mainz, you introduced us to a term that had me very confused for a brief moment. “Morbus Mediterraneus”. Is that about a special disease?

Alissa: The term “Morbus Mediterraneus”, also called “Morbus Bosporus” or “Balkan Syndrome”, is not a real existing disease. Rather, it is a pseudoscientific “disease” designation by nurses and doctors, which is fed by racist and stigmatizing prejudices.

It describes an alleged phenomenon according to which patients from the Mediterranean region have a lower pain threshold than white Europeans, are generally more snivelling and overdramatize their complaints. This can lead to concrete discrimination of people with a migration history by medical staff, for example through less attention to complaints, hasty diagnoses, disrespect in communication or the danger of even being sent away.

What exactly is meant by Mediterranean space, however, is not further defined, so it is not a clearly delineated geographic space. Rather, the term “Morbus Mediterraneus” refers to people who are outwardly classified as non-white.

Racism takes place in every area of society, however, nursing and related institutions present a unique situation when racist stereotypes on the part of medical staff lead to misprovision or underprovision. For then racism can actually kill.

Of course, it would now be easy to stigmatize affected nurses and physicians as racist, however, that would be too short-sighted and wrong at its core. We have all adopted prejudices and stereotypes through our socialization in a racist system, no one can be free of it. People with a migration history experience being reduced to their cultural or ethnic origin on a daily basis and thus no longer being perceived as individuals but as representatives of a homogeneous group.

The difficult working conditions that push employees in the health care industry to the edge of their capacity are also involved in the development of phenomena such as “Morbus Mediterraneus”. For example, in a qualitative study, nurses[2] from 2021 reported that they found themselves falling back on prejudices and stereotypes in the stressful and hectic daily routine regarding their patients in order to save time and avoid unsafe situations.

Thus, the treatment of people with immigrant histories in the health care industry is also closely linked to the well-being of caregivers.

[2] “The system has to be health literate, too” – perspectives among healthcare professionals on health literacy in transcultural treatment settings

Thank you very much for this important classification. One last question. How exactly can your democracy work be supported? Can people just call your office and you guys come by?

Alissa: Absolutely, we would be happy to come by your care facility. Since we are funded by the Federal Ministry of Labor and Social Affairs, there are no costs for our participants and partner institutions. On the contrary, we want the players in the care sector to benefit from us in many ways. So just send us an email with a request or give us a call and we will come to you.

Of course, we are also aware that training courses like ours are time-consuming. Here we are able to respond flexibly to the wishes and working conditions of the participants. We have already successfully covered annual training courses for practice supervisors and have also trained vocational students in class. Both online and in presence.

Of course, we will also be happy to contact you if you are interested and start planning together with you.

You can support us by making us better known, by sharing us and talking about us(click here for the project page with contact and further information).

The interview was conducted by Sandro Witt, project manager “Coordination Project Initiative for Workplace Democracy Competence”