Changing perspectives, Infrastructuring care

MICHELA COZZA

On 21 March 2020, during the first COVID-19 pandemic peak in Italy, a group of doctors working at the Papa Giovanni XXIII Hospital in Bergamo, published an article titled “At the epicenter of the Covid-19 pandemic and humanitarian crises in Italy: Changing perspectives on preparation and mitigation” (Nacoti et al., 2020). This title prefigures the tone of the publication, whose words embody the catastrophe unfolding in the country, and convey the seriousness of the situation: “This outbreak is more than an intensive care phenomenon, rather it is a public health and humanitarian crisis” (emphasis in original, no page). The doctors’ article is, therefore, other than a usual medical publication: it is a plea for changing perspectives on preparation and mitigation for the next pandemic – as the second part of the title indicates. The situation is highlighting the need of a long-term plan whose development “requires [the involvement of] social scientists, epidemiologists, experts in logistics, psychologists, and social workers”, the doctors write.

As social scientist, I engage in writing on the unfolding outbreak (which is still, literally, affecting the world while I am writing) for two main reasons. First, the spreading of the virus is an international matter of concern that goes beyond the Italian case and calls for an international scientific debate across disciplines; second of all, it foregrounds the limits of the Western approach to care in health and welfare infrastructures on which people depend in case of need.

I am using the term ‘infrastructure’ to mean a layered set of interrelated social, organizational, and technical/technological components. The term evokes vast sets of collective equipment necessary to human activities (here, related to health and welfare services) so in the common sense, an infrastructure is envisioned as a system of substrates – for example, pipes and plumbing, electrical power plants, and wires. However, an infrastructure may be seen as much more than just wires and machines (Bowker et al., 2010; Star, 1999). Here, I take (health and welfare) ‘infrastructure’ as a broad category referring to ubiquitous resources enabling (health and welfare) practices and activities, and which is relational as it unfolds the political, ethical, and social choices that have been made throughout its design and development. Therefore, I prefer to use ‘infrastructuring’, rather than ‘infrastructure’ (that might evoke a static object) as a more comprehensive term to account for the social, political, and economic work needed to produce an (health or welfare) infrastructure and make it work (Star and Bowker, 2002).

There is one key passage of the Italian doctors’ article that I would like to bring to attention as it highlights what is critical in this crisis regarding caring. The authors of the article base their call for change on their experience as clinicians working in a public hospital and it is precisely their ‘privileged position’ (sociologically speaking) that urges them to make the plea: “Western health care systems have been built around the concept of patient-centered care, but an epidemic requires a change of perspective toward a concept of community-centered care. What we are painfully learning is that we need experts in public health and epidemics, yet this has not been the focus of decision makers at the national, regional, and hospital levels. We lack expertise on epidemic conditions, guiding us to adopt special measures to reduce epidemiologically negative behaviors” (emphasis in original, no page).

This excerpt goes straight to the point that I deem representing a priority for the years to come: we need to focus on and redefine the concept of community in the light of the multiple and heretogeneous actors and relationships that this pandemic is foregrounding, and reconfigure our caring practices accordingly. 

The coronavirus pandemic is an infrastructural crisis – as already well articulated by Bertuzzo (2020) in this blog. Or, to put it bluntly, it has laid bare the unpreparedness of health and welfare infrastructures, from Italy to Sweden – to take them as extremes of a continuum along which to position the variety of policies implemented in different countries during the outbreak (on the ‘Swedish experiment’ see Irwin (2020) in this blog). The multiple fragilities of health and welfare infrastructures is not a new issue but they are made even more visible by the COVID-19 pandemic: the first pandemic in times of social media that gives an unprecedented prominence to the disease and everything relating to it.

Social researchers should not only analyse the short-term implications of such a diffused precarity but also work on alternatives to the previous health and welfare organisational models. An approach aimed at infrastructuring care might be beneficial to overcome the limits of such models, which is mainly based on an idea of human exceptionalism and primacy over all forms of life. Allow me to unpack this.

It may be hard to predict when a pandemic will be controlled and it is all the more difficult to foresee its long-term effects. However, a pandemic should not be described as impacting on society from the outside, but as connected with our way of being, living, and co-existing with Others instead, whether other humans as well as critters other-than-human (Haraway, 2003). In this regard, changing perspectives on preparation for the next pandemic would necessitate an analysis of deep interconnections between different living beings (humans and more-than-humans) (Barad, 2003; 2007). That is, analysing how beings are entangled in producing and re-producing both the conditions that can cause an outbreak and the measures that may mitigate it. An infrastructural perspective enables us to look between the layers, and highlights the multiple relationships between aspects that would be taken for granted or overlooked otherwise.

In 2009 during the ‘swine flu’ outbreak, Dr. Anthony Fauci, who oversaw the US government’s clinical trials of the H1N1 vaccine, said “‘we have enough H1N1 to worry about without worrying about turkeys’. He concluded that turkey infection is a ‘Department of Agriculture issue’” (Jerolmack, 2013: 201). Such a view proves that whilst diseases disregard boundaries between species and socially constructed categories of animals (e.g. pets, wildlife), human actors and their organisations keep working separately, according to a ‘silos culture’. Such an approach is not only limited in its capacity to respond to infrastructural health and welfare crises but is also detrimental because it overlooks the pandemic as ‘global’, including in the way in which it strikes between (infra-) layers of interconnected assemblages of people, other living beings, things, practices, and processes (-structures).

This argument speaks to the question of moving towards a care model grounded in an infrastructural view. It seeks to enable seeing communities as ‘ecologies’ of different actors that mutually constitute the ecology itself. In a post-pandemic world, we cannot retain an anthropomorphic idea of what a community is, rather, we should acknowledge the deep intra-species interrelations it is built on. Health and welfare infrastructures belong to such a community and they should be reconfigured to account for such interconnected layers.

ABOUT THE AUTHOR

Michela Cozza, PhD, is Senior Lecturer at Mälardalen University, Sweden. Feminist Science and Technology Studies inform her research. She is interested in exploring health and welfare infrastructures from a posthuman perspective (https://michelacozza.wordpress.com).

REFERENCES

Barad, K. (2007). Meeting the universe halfway. Quantum physic and the entanglement of matter and meaning. Durham and London: Duke University Press.

Barad, K. (2003). Posthumananist performativity: Toward an understanding of how matter come to matter. Signs: Journal of Women in Culture and Society. 28, 3, 801-831.

Bertuzzo, E. T. (2020). Coronavirus as infra-structural crisis: Some thoughts from locked-down India. UCL Medical Anthropology “Consciously Quarantined: A COVID-19 response from the Social Sciences”, March 2020. https://medanthucl.com/2020/04/05/coronavirus-as-infra-structural-crisis-some-thoughts-from-locked-down-india/

Bowker, G. C., Baker, K., Millerand, F. and Ribes, D. (2010). Toward information infrastructure studies: Ways of knowing in a networked environment. In: J. Hinsinger, L. Klastrup and M. Allen, eds. International handbook of Internet research. New York, London: Springer, pp. 97-117.

Haraway, D. (2003). The Companion Species Manifesto. Dogs, People, and Significant Otherness.  Chicago: Prickly Paradigm Press.

Irwin, R. (2020). The ‘Swedish Experiment’. UCL Medical Anthropology “Consciously Quarantined: A COVID-19 response from the Social Sciences”, April 2020. https://medanthucl.com/2020/04/06/the-swedish-experiment/

Nacoti, M., Ciocca, A., Giupponi, A., Brambillasca, P., Lussana, F., Pisano, M., Goisis, G., Bonacina, F.F., Naspro, R., Longhi, L., Cereda, M. and Montaguti, C. (2020). At the epicenter of the Covid-19 pandemic and humanitarian crises in Italy: Changing perspectives on preparation and mitigation, NEJM Catalyst [online]. [Viewed March 29 2020]. Available from: doi: 10.1056/CAT.20.0080

Star, S.L. and Bowker, G.C. (2002). How to Infrastructure. In: L. Lievrouw and S. Livingstone eds. The handbook of new media: Social shaping and consequences of ICTs. London: Sage. pp. 151-162. 

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