Now is the Time for a Collective Moral Courage.

By Rosaleen McDonagh

Culture, gender, history, tradition; identity, sexism, ableism, homophobia and racism are all complex issues, and conversations need to be had around them; particularly when dealing with a world pandemic. Jurisdictions, the denigration and disregard for certain members of society in the context of public health care and access to health information tells a story of austerity, noninterference and negligence.

COVID-19 has already killed more than 10,000 people around the world.  A global and national crisis is unfolding. This situation illuminates the connection between ethnicity, class, poverty and racism. The Lombardy region in Italy has been seriously affected. Due to a lack of intensive care beds, medical professionals have to prioritise who to treat. Our history has always been to focus on the notion of survival of the fittest. Primal instincts are awakening by the unfolding situation. In the current COVID-19 crisis, many medics and other professionals have articulated this, albeit in a nuanced fashion.

How will decisions be made on who has access to essential treatment?

Those of us with complex needs and underlying medical conditions are really worried. This includes older people, children with suppressed immune systems, adults and children with significant disabilities. How will decisions be made on who has access to essential treatment?  Historic tensions between the minority ethnic groups and the medical community remain. The fear is that unconscious bias against ethnic minority groups or Travellers or the ideology that categorised certain groups of people as ‘eugenically inferior’ might resurface.

Dilapidated, unsafe accommodation carries systematic endemic inequalities and the continual vilification of poor people has violent fallouts. Modernity with all its contemporary technologies continues to fail poor people.  Many Travellers live in overcrowded confined spaces, including sites where access to proper hand hygiene facilities, including running water, is a luxury. The existing inequalities for Travellers in relation to health is reflected in the disproportionate numbers of those with chronic health conditions, the 134 excess Traveller deaths per year and a mortality rate that is 3.5 times higher than the general population. Lack of Traveller representation is intrinsically linked to the lack of progress when it comes to policy implementation in areas such as accommodation, health and education.

Every person matters; every single person and individual matters.

In a crisis there may not be time to reflect on our attitudes or practices. Our language slips. Questions of ethics get blurred in the chaos of trying to manage a crisis that is continually unfolding. Unattended poverty often results in natural disasters that highlight human failures. Echoes of history are reemerging, where marginalised and vulnerable people are exposed to dangerous exclusionary health care policies. Society’s moral rectitude has the potential to descend into disarray.  Travellers have always been left behind the general population in public health practices.  Travellers, Roma and other black and ethnic minorities who carry the legacy of  racism were being categorised as non- productive or unfixable will know exactly what the term ‘useless eaters’ means.  Dr Mike Ryan, Executive Director of the World Health Organisation,  (WHO),  in a daily press briefing on COVID-19 on  9th of March reminded us that we are all equal, we all matter, saying, “Our elderly, people with underlying conditions, with cancer on chemotherapy, and others are precious members of our society. Every person matters; every single person and individual matters.”

Everything possible should be done in a responsive and flexible manner to protect vulnerable groups.

Much of the coverage in the media points out that COVID-19 primarily affects the elderly or ‘high risk individuals.’ There is a danger that this message may lead to complacency. We need to be clearer that measures and restrictions undertaken to reduce the spread of virus are measures to decrease the risks for vulnerable groups. Responsibility for respecting those measures rests on all our shoulders. Due to racism, some marginalised categories such as Travellers and Roma are often seen as “hard to reach” groups, particularly in the area of public health policies.

Traveller organisations and Traveller Primary Health Care Projects within those organisations must be resourced and supported to circulate accessible and culturally appropriate information. The HSE and the government have taken steps to reduce the spread of this virus. More needs to be done to ensure that Travellers and Roma, Traveller organisations and specific service providers are consulted in relation to measures that affect us as this crisis unfolds. Everything possible should be done in a responsive and flexible manner to protect vulnerable groups.

These are some of the issues highlighted by the Eastern Region Traveller Health Unit that Travellers may experience with regard to protecting ourselves and our families from the infection COVID-19 (Pavee Point, March 2020):

  • Make provision for Traveller self-isolation (i.e. trailer or pod for sole purpose of isolation).
  • Where empty bays are available, these could be used for extra/additional trailer or pod for sole purpose of isolation.
  • Void housing should be prioritised for Travellers who have been advised to self-isolate.
  • Fly-tipping on a number of sites throughout the region is at dangerous levels and therefore emergency vehicle services, (if needed), would be obstructed from entering to help families.
  • Where local authority land is available beside the site and Travellers are advised to self-isolate- could land be used for isolation trailers/pods?
  • There has to be a safe distance between alternative isolation accommodation/pods.
  • Social spaces for homeless Travellers living in hotels, hostels, etc. who come to sites to spend their days with their families.
  • To provide a deep clean once individual has finished isolation
  • Key concern around self-isolation of children or parents who get sick, and are responsible for young children in particular.
  • Access to hand sanitisers; bleach and water are proactive measures to protect Travellers living in overcrowded conditions.
  • Increase the number of Portaloos on sites, and provide access to regular disposal.
  • For families on unofficial sites and roadsides, make provisions to support access to additional water tanks.
  • To provide personal protection equipment for sites with shared facilities.

Over the last twenty years, peer-led Traveller Primary Health Care Projects have been the cornerstone on which health services are delivered effectively to Travellers, with eight per cent of Travellers receiving health information from these projects. Traveller community health workers working in these projects are a vital resource to our community, providing clear and accessible public health information. In the current environment where public health is paramount, to ensure key health messages reach Traveller families, Traveller Primary Health Care workers are best placed to do this work, but they must be supported with necessary personal protection equipment (hand sanitisers and face masks, etc.). The Irish nation is frightened by this virus. The global media are struggling to find a balance between responsible public broadcasting information and alarming sensational over- exaggerated news stories. The virus is dangerous; we are all at risk. Our community is small. Embellishing or sharing misinformation does not help anybody. There is a moral panic. A moral panic has five elements, concern, hostility, consensus, disproportionality, and volatility. It’s difficult to disengage from the atmosphere of crisis and panic. To paraphrase Dr Tedros, the Director General of WHO; if anything is going to hurt the world, it is ignoring the deaths of vulnerable people. He went on to say, “This is the first of many signs of moral decay.” Now is the time for collective moral courage.

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