Slow teaching in Italy

Between November 2016 and February 2017, I worked at the University of Parma in Italy. 

The teachable moment

The students swung around to each other with a mixture of shock and bemusement on their faces. It was November 2nd. They had just been told that their next three

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Parma in Northern Italy (in light green)

 months of teaching with the visiting professor from Australia would all be in English, not Italian. As this was a course in Health Communication, this miscommunication would become a teachable moment. By the end of the course, we had a mutual respect for jointly overcoming our language barriers.

Here were a group of young people still immersed in lectures on anatomy, physics and chemistry who spoke basic English. I spoke virtually no Italian.
They were students of dentistry. I’m an ex-nurse who teaches mostly professionals and postgraduates. They are interested in dentistry. I am interested in behavioural science, mostly through the lens of vaccination and environmental health. Where did we overlap?

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Parma is the home of Parmesan cheese.

We did, and it was in the area of health communication. Fortunately, I had decided to abandon my tendency to over-prepare and go with the flow, once I learnt more about them. I prepared a basic curriculum of clinical communication, health promotion and incident (‘crisis’) communication. It was to be taught through 24 hours of face-to-face, an online exercise, and an assessment, all spread over the 3 months. So for this first session I gave them a survey to try to quickly learn more about them. It covered what they found challenging, would like to learn more about in communication, in vaccination, and Australia. The curriculum incorporated things that were relevant to dentistry from my repertoire of knowledge: the social determinants of oral health, dental anxiety, water fluoridation, and debunking. I reached into the expertise of colleagues in medical communication, health promotion, and dental public health with plaintive emails. To them I’m extremely grateful. I translated key concepts into Italian on the slides and had the students translate them for their peers. Group work and working in pairs was particularly useful, as the students could discuss questions together in Italian and report back to the class in English. Each session lasted 2 hours, giving us plenty of time to cover concepts. It felt like the Slow Cooking of academic teaching. 

That first week in Parma in November was intense. Day 2 off the plane was that first 2 hour lecture; day 5 was four hours teaching students of medicine and nursing in Milan; but day 3 had been speaking at a symposium on Vaccinazioni Communicazione in Fano on the Adriatic Coast. Many citizen advocates attended the symposium – a jeweller, a butcher, a mother whose child had had whooping cough. Italy has seen a worrying decline in vaccination rates in recent years. This has galvanized the citizens. Discussions with them over lunch led us to begin dreaming of a future global meeting for citizen advocates of immunisation for peer support and learning. 

Parma life

Parma  (population 193,000) is a delightful town south of Milan in Italy’s north, near the top of the ‘boot’. City streets are cobbled and narrow and tiny shops nestle into the walls.

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The local commute.

Cycling is the norm and the centre of town restricts cars to locals only. Nobody wears helmets but the cars are accommodating. Since Parma is off the main tourist route, English is not spoken as much as you would find it in places like Milan or Rome. A crucial sentence to learn was, “I’m sorry I don’t speak very good Italian. Do you speak English?” Some people could say a few things and they were mostly helpful and patient. Being without the language was like a fog. On the one hand I could insulate myself from the greater complexities and obligations that verbal communication brings. On the other, everything was more cumbersome: accessing healthcare, getting a bus ticket, or even buying stamps. If one were to write learning competencies for a 3 month stint in Italy, one would be to “Send a package overseas from a post office”. This extra layer of complexity with everything requiring communication firmed my resolve to focus more on language translation in our resource development back in Australia. I’m grateful to kind Italians for their help. Shared humanity and kindness go well beyond spoken language.

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An interior wall of Parma’s cathedral.

The Italian bureaucracy is as formal, intricate and old as a cathedral ceiling. I required a Codice Fiscale, visa, Dichiarazione di Valore, translated CV, validated course testamurs, a nulla osta, Permisso di Sojourne, and then visits to the DFAT and consulate in Sydney three times, offices in three university locations, Comuni di Parma, Prefetture di Parma, Tabacci, and post office. I tried to view it as part of the cultural experience and the people at the university were helpful and sympathetic. It was clear that these were quality problems and I was not the first to encounter them.

After three weeks, I was navigating the narrow streets successfully, ordering a café macchiato, and learning where to find the tiny local supermarket. I got used to the more relaxed give and take of the roads, which are more used to bikes. Walking around was like the set from Woody Allen’s Shadows and Fog. In December, each shop nestled into the walls bordering narrow streets was decorated with hundreds of tiny fairy lights. After about 5pm the streets would become very crowded with people taking a stroll in their puffer jackets. For a few days the temperature reached a maximum of 2 degrees. Intense heatwaves in Australia’s summer would dominate news back home. I felt lucky.

My office was in a large grey faculty building on the local hospital campus 1.6km from the town centre. It was filled with cheerful lab staff and epidemiologists whose work involves being a reference lab for influenza and other viruses. Being winter and their flu season, the staff were busy. From here I could observe how much non-verbal communication tells you about a workplace. 

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My office at the University of Parma. 

Staff would arrive and say ‘buongiorno’ as they passed through the corridor. At 11am ‘café’ would be announced. We all crowded into a small room lined with cupboards of vials and brown lab packages. An enormous espresso maker  filled with strong coffee would sit on the bench next to which sat tiny demitasse cups. Staff would sip their coffee while chatting. I would pick up a conversation about wholemeal flour or a weekend party. Most of the staff spoke little English but had kindness in abundance and made an effort to chat if they could, or help me with new Italian words. My academic hosts, Dr Anna Odone and Professor Carlo Signorelli, made sure I was welcomed and Anna helped me with many details in settling-in. They were also keen to have local students and public health residents exposed to teaching in English – that is the language of most of the journals they will read and international engagements they might have in future.  

Making the most of a base in Europe

Travel within Italy was ideal by train. On the Frecchiarossa (red arrow), you would go through long tunnels broken by a flash of the outside: gentle hills and small clusters of buildings coloured pale yellow or peach, even occasional wind turbines large enough to make Joe Hockey’s eyes water. Solar panels abound, on this small patch of European land, showing Australia what can be done.

It is the Age Of Things that I found so breathtaking in Italy. Then I reminded myself that in IMG_3305.JPGAustralia we have the oldest living culture, with more subtle artefacts, and with strong and surviving peoples. The Italians are proud of their heritage and culture, and I imagined how it would be for them to lose their land and have  cultural identities threatened from a colonial invasion, like happened in Australia to Aboriginal and Torres Strait Islander peoples.

Being in Europe was like being in the travel equivalent of a lolly shop. It takes a total of 27 hours to get here from home in Sydney. However, from Parma, Milan is 80 mins north on a train. Then a plane takes you to most European cities within 2 hours. I travelled to Cardiff, London, Madrid, Paris, and Stockholm while there. The latter was for the World Health Organization’s European office, reviewing their guide to increasing immunisation rates, called Tailoring Immunization Programmes (TIP). Sometimes in life, the best things take you by surprise. For 3 days in Sweden, we sat in a small room – five behavioural scientists who work in vaccination. They were from various global and regional agencies, Canada and Australia. Between us we had seen how Bulgaria, England, Romania and Sweden used the TIP tool. We wrote the report together. 

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The Stockholm review team.

Then each night over dinner we would discuss a global vaccine supply shortage or global politics surrounding vaccination. All of us shared a commitment to seeing vaccines reach all those who need them. It broadened my perspective of vaccine acceptance problems in other countries and how it manifests. I saw how Australia and working with NCIRS for 12 years had taught me a lot about the global issues, serving as a microcosm for them.

I also travelled to Cardiff to work with long-time collaborator, Professor Paul Kinnersley. We recorded videos of vaccine conversations between doctors and hesitant parent actors.  This is part of the wider SKAI project mentioned in a previous blog and here. Simulating these conversations and seeing how our tool worked was valuable – finding ‘bugs’ in the toolkit so it can be adapted into primary care. In Cardiff, Paul also introduced me to one of the gurus in Motivational Interviewing, Stephen Rollnick and he offered some thoughts about SKAI.

My family arrived in December and we travelled south. Naples was a brief intense window into the socio-economic differences between Italy’s North and South.

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A warning sign near the crater of Mt Vesuvius.

From the crowded streets and incessant tooting, to the poverty, street rubbish, and dilapidated 17th Century buildings in the suburb in which we stayed. Our hostel was found after a noisy rail trip 20 minutes out of central Naples in Ercolano, in Mt Vesuvius’ Red Zone, housing a population of 1,000,000 where the volcano danger is highest. At the crater the next day, a guide gave us insight into how the risk response issues from the volcano affect everything from the local politics to the tendency to not want to inform people of much at all, lest they panic. I took lots of photographs and began planning my next session on crisis communication in January.

For Christmas we travelled 800km away to south western France to join my brother and family. This was a daunting car journey where we drove on the ‘wrong’ side of the road, the wrong side of the car, in a manual with the gearstick on the wrong side of the driver – a white knuckled venture on the autostrada (in Australia, everything is opposite). Despite the slight wildness of their urban driving, the Italians and French practice great discipline on freeways where you are virtually run off the road if you stay in the outside lane. 

Reflections on teaching across the language barrier

Sometimes preparing the lessons was quite challenging. My Parma students possessed enough differences to other audiences to require a IMG_4018.JPGvirtual complete re-build of my previous teaching. The English had to be simple, even though we were communicating abstract ideas that assumed much more life experience. (But on the other hand, never underestimate young people.) To overcome the barrier, I would ask those with better English to translate key concepts for peers into Italian, give permission for side conversations if they were for translation, and include lots of small group work where they could speak to each other in Italian and report back in English. On the slides, key headings would also be in Italian, as were assignment instructions. Sometimes this produced amusing moments. In English, a component of trust is ‘consistency’. Google translate gives you ‘consistenza’ which received a few giggles as it pertains to the texture of a material. The most enlightening exercise was to have them critique a website based on debunking literature with some creative and thoughtful answers. What I had learnt in short courses at the University of Sydney about student-centred learning was exceptionally useful in this cross cultural context. The University of Parma’s coordinator of internationalisation, Professor Francesca Zanella, had already heard of Australia’s innovations in teaching and assessment and was keen to learn more.

The late shift with Australia

Throughout this 3 1/2 months overseas, I continued my Australian work from a distance. I would often work in the

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The Rockefeller Foundation’s Bellagio Centre, where I spent the final three days for a meeting to plan a global research collaboration.

evenings and then wake early for a 6am teleconference or answer new emails. The quieter days in the Parma office provided a chance to finish writing papers long overdue. The team back home – Nina Berry and Penelope Robinson – kept things going on the SKAI project while I advised from a distance. I am now back in Sydney and hit the ground running with various grant proposals, papers, and long awaited
face-to-face meetings with colleagues and students, carrying some good memories and an expanded knowledge and perspective on teaching, health communication, and public health. 

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