In Turkey, Covid-19 had unprecedented consequences on the health and economy of working-class households with members suffering from silicosis—a chronic lung disease caused by the inhalation of dust particles that form irreversible scarring in the lungs. While their chronic condition put them in a high-risk group, the suspension of key healthcare services due Covid-19 further intensified their vulnerability. However, these workers responded to the pandemic flexibly due to their long histories of seeking care and recognition across medico-legal institutions. With support from the SSRC’s Covid-19 Rapid-Response Research Grants, we conducted biweekly surveys1We used a four-module survey tool designed by Veena Das and Clara Han with their permission. We would like to thank them for allowing us to use this tool. We also prepared a supplementary module to track the management of health risks at the household level. and semistructured interviews with 20 workers with silicosis over the course of three months in the fall of 2020 to trace the changes in their everyday lives as the pandemic unfolded in Turkey. We were especially interested in how workers with occupational diseases coped with the unprecedented pressures caused by the pandemic on household economies and their health.
Our primary findings suggest that these workers have continued to work on how they and their families endure against the hardships of Covid-19. Workers combined biomedical treatment options, practices of self-care, and everyday solidarities as key mechanisms for coping with the financial and health-related effects of Covid-19 in their lives. In what follows, we first summarize Turkey’s response to the Covid-19 pandemic and then discuss some examples from workers’ lives to explore mechanisms of endurance.
Turkey’s response to Covid-19 pandemic“The Turkish Ministry of Health postponed elective treatments and monitoring of patients with chronic diseases to lighten the burden on healthcare staff.”
The Turkish government banned the nonessential movement of the elderly and people with comorbidities intermittently for several periods following March 2020. Yet, at the same time, it severely curtailed medical services for those same populations with chronic illnesses. The Turkish Ministry of Health postponed elective treatments and monitoring of patients with chronic diseases to lighten the burden on healthcare staff. While trying to protect people with chronic diseases by limiting their movement, workplaces remained open except for intermittent nationwide lockdowns imposed during several weekends. Even in the last 17-day “full lockdown” in May 2021, 22 million workers in several industries were exempted from quarantine measures.
Turkey’s selective lockdown aimed at vulnerable populations (i.e., chronic patients and the elderly), described as “class immunity”2Evren Balta and Soli Özel, “The Battle Over the Numbers: Turkey’s Low Case Fatality Rate,” Institut Montaigne, April 5, 2020. by critics, actively excluded the working class, rendering those with occupational chronic illnesses extremely vulnerable. Workers with occupational lung diseases belong to a high-risk group, yet they are expected to show up at work. To make the matters worse, the Ministry of Health converted the two most specialized occupational disease hospitals into “pandemic hospitals” to help mitigate the shortage of beds and healthcare personnel for treating coronavirus patients. Many of the workers with silicosis, therefore, had to cancel their routine treatments at these hospitals or had to wait months to get an appointment.
These changes significantly slowed down workers’ efforts to renew their reports to get their monthly occupational disability pensions and medications. When they were able to secure an appointment, these mandatory visits to the occupational disease hospital made them vulnerable to the coronavirus due to the time they had to spend on the road, as many of them were traveling from rural areas to Istanbul where the hospital is located. Also, oftentimes doctors asked them to spend several nights at the hospital for further tests and examinations. This made them further susceptible to catching the virus. Even in our small sample, at least three of the workers were infected with Covid-19 after they visited the occupational hospital.“The limited therapeutic options available for silicosis push workers to seek healing through self-care practices.”
All of the workers in our study have long histories of visits to occupational disease hospitals to seek care for and recognition of the symptoms of occupational silicosis. The processes of diagnosis and recognition of occupational lung diseases are “critical moments” in these workers’ lives because being diagnosed makes them feel expendable and close to death.3Oakland, CA: University of California Press, 2012More Info → Yet, once workers begin to come to terms with their diagnosis and accept their illness, they start to acquire a distinctive form of bodily awareness through their continuous encounters with medical institutions. The limited therapeutic options available for silicosis push workers to seek healing through self-care practices.
We noticed that, while narrating their disease and work experiences, workers with silicosis often reflected on their bodies and movements: how many steps they can climb, how many hours they can spend doing this or that, how many kilometers they can walk without respite, what time of the year their conditions worsen, what sort of foods (such as special pickles) would increase the vigor of the body, what sorts of alternative medicines would work, and so on. This reflexive awareness of one’s body and health translated into practices of self-care that can be traced back to their experiences of seeking care and recognition for silicosis for years.
Fear of infection, bodily vulnerability, and self-care
The ubiquitous fear of infection transformed into a fear of permanent disability or death for these workers. Similar to the way they examined occupational comorbidities such as hearing loss, musculoskeletal disorders, and other work-related injuries to make their case against their employers, they insisted that their bodies would rapidly deteriorate if infected with the coronavirus. Many of our research participants believed they would not survive if they were infected. Thus, they encountered the Covid-19 pandemic not only with fear and already vulnerable lungs; they also had reflective knowledge about their bodies and health. Considering the heightened attention to the capabilities and limits of their bodies, silicosis gave these workers a way to interpret the health risks associated with the coronavirus and the pandemic.
Take the following case. Mehmet was working in a ceramic factory in Kars before he and dozens of his friends were diagnosed in 2014 with silicosis due to a lack of safety measures in the workplace. After that, Mehmet spent six months in the occupational disease hospital, was diagnosed with depression, and went through a divorce, which he attributed to his ill health. Mehmet then lost his job and started to work in irregular and informal jobs in the agricultural and construction industries to take care of his three children who stayed with him after the divorce. When Covid-19 hit, he was in the middle of his medical and legal struggle to get his disease documented so he could receive compensation from the company. In our conversations, Mehmet frequently expressed his worry about the rising cases in the city where he lives.“These novel ways of relating to one’s body through the experience of silicosis fold into the everyday strategies of workers, making them extra aware and cautious about the risks and challenges in the context of the pandemic.”
While reflecting on people’s approach to Covid-19 measures in his city, Mehmet drew a parallel between the pandemic and silicosis to emphasize the value of bodily health. In Mehmet’s words, “If people do not wear masks, we will tell them what it means to lose their health. People act without much fear, thinking nothing would happen to them. I would tell them: Ask someone who has experienced such things before.” What Mehmet evoked here is a unique form of knowledge he gained through years-long navigations across medical and legal institutions because of silicosis. This bodily knowledge taught him that one should never take for granted one’s health and bodily wellbeing. This knowledge is also tied to wider ecologies of care and recognition around occupational diseases and informal patient networks. These novel ways of relating to one’s body through the experience of silicosis fold into the everyday strategies of workers, making them extra aware and cautious about the risks and challenges in the context of the pandemic. Their narratives are filled with idiosyncratic strategies to prevent viruses from entering their bodies and to keep themselves healthy: They take various pills and use folk remedies to strengthen their immune system. They avoid using public transportation. They do not socialize with friends if it is not absolutely necessary. They pay attention to what they eat. All in all, they start to imagine their social activities and everyday practices as an extension of their individual body that needs to be cared for and protected. Appropriation and embodiment of medico-legal discourses about the body and health and the awareness of bodily vulnerability help them achieve endurance only in so far as these workers are embedded within a wider relational network that emotionally and materially support them in times of the pandemic.
“That’s how we live”: Continuity and relationality during the pandemic
Besides extreme awareness of one’s own body and treatment options, everyday acts of care for kin and social relations can amplify worker capacity to move on despite the challenges posed by Covid-19. Let’s consider Mehmet’s life once again. At the outset of Covid-19, Mehmet and his three children packed their belongings and moved back to his village where his parents still live. That offered both him and his children an escape from the crowded city life and a way to manage economic hardships caused by unemployment. For many months, Mehmet received financial help from his father Huseyin whose only stable income was his pension. In one of our conversations, Mehmet said that, despite all these difficulties, he managed to host a small feast for a friend who was headed for military service. He invited a small group of people to an open field in the village and provided food and drinks. “I might be doing bad financially,” Mehmet told one of us, “but under any condition, I would organize this feast for this soldier. That’s how we have lived, that’s how we have known, and that’s how we have seen.” (“Durumum kötü olabilir ama hangi koşulda olursa olsun bu asker için bu yemeği veririm. Böyle yaşadık, böyle bildik, böyle gördük.”) We could feel Mehmet’s pride during the conversation. In the face of Covid-19 disruptions, the will to mobilize acts of kindness seemed to empower his sense of self. As his reiteration of the phrase “that’s how” (“böyle” in Turkish) illustrates, the act of sharing through a feast provided a sense of continuity of sociality and way of life in the midst of the uncertainties caused by the pandemic. Like many other afflicted workers, Mehmet strived to do what he is supposed to do against all odds. This is the way one could retain control over one’s life.“Some others felt empowered when they hosted a small feast for a friend or gave coworkers a ride to the workplace when public transport was too risky for infection.”
For Mehmet and other workers, the pandemic introduced novel moral questions and challenges at the intersection of bodily health, self-care, and care for others. In tackling these issues, workers were constantly reflecting on to what extent they could rely on their support networks for economic, social, and other purposes. We were able to hear workers as they reassessed their relationships with people such as the landlord who denied flexibility for rent payments, the fellow worker who hid the knowledge that he was infected, and the local grocery store owner who spread stigma-laden words about those who caught the virus. Others, on the other hand, expressed their gratitude for the friend who arranged a temporary job and the neighbor who showed up with groceries at the doorstep. Some others felt empowered when they hosted a small feast for a friend or gave coworkers a ride to the workplace when public transport was too risky for infection.
The pandemic redefined the kin and social networks of workers who went through experiences ranging from betrayal to unexpected support as they navigated bureaucratic, financial, and health-related uncertainties. Some workers were fortunate to find temporary jobs and receive assistance from the government and relatives. There were some others who have been failed by their governments and social networks, losing their lives or livelihoods.
In this brief reflection, we tried to illustrate why the efforts of workers and their families to secure some semblance of normalcy during the pandemic are neither ahistorical nor devoid of creativity. Through the narratives of workers like Mehmet, we have seen that workers’ previous encounters with bio-medical institutions and their histories of chronic illness impacts how they responded to the pandemic and the moral, social, and personal challenges it posed. The flexibility of workers in deploying everyday tactics demonstrates their capacity to mobilize their unique bodily knowledge to reflect on their social relations and to achieve endurance in uneasy situations.
Banner photo: Çağlar Oskay/Unsplash.