In the US, our primary healthcare is mostly delivered via the fee-for-service model. Interactions between providers and patients under this model are mediated by insurance companies. In order to bypass health insurance companies, some primary care physicians have opened direct primary care clinics which charge a monthly fee for unlimited care. As part of my undergraduate thesis for the anthropology honors program, I investigated two clinics operating under this model in the Pacific Northwest using participant observation and semi-structured interviews with physicians. My aim was to determine how the direct primary care model affects the agency of physicians and influences the therapeutic process via the clinical encounter. I found that physicians in the US face a unique dilemma of role conflict between the competing identities of business owner and doctor. Additionally, I explored how the expectations of patients differ for male and female physicians and how direct primary care can play into this. My findings highlighted the inadequacies of our existing healthcare system in the United States. Further, I concluded that although direct primary care is a solution to this broken system for some patients and some physicians, systemic changes must be made in order to make primary care a more desirable field for physicians and to provide equitable and quality care for all patients.

The Field of Cultural Mediation, along with Linguistic Mediation, has gained popularity in Italy as the country is increasingly a destination for immigration. As EU migration policies have become more selective, solidifying dangerous paths for “irregular migration” such as the Mediterranean and Balkan routes, reception systems become more complicated, borders become more violent, and public opinion polarizes (Lo Bianco, personal communication, 2023). In this context, it is increasingly important to ensure migrants have someone to facilitate communication between them and the various actors they encounter in an increasingly complicated and dispersed reception system built to dispel them. Thus, the Cultural Mediator, often a former migrant themselves, is increasingly employed by public institutions and social cooperatives to facilitate communication, integration, and to inform newcomers of their rights (Cuiban, 2019). There is inherent precariousness in being placed between these two often conflicting sides, requiring a high degree of social, emotional, and institutional expertise in addition to mere linguistic and cultural knowledge. Due to a lack of national regulation and decentralization, Cultural Mediators in Italy face social and emotional difficulties as well a lack of respect, proper regulation, payment, and support in their jobs. In this paper, I investigate the struggles Cultural Mediators in Italy face, which I argue is a product of the broader decentralization of the “Migration Industry”. By conducting surveys and Interviews regarding the Struggles Cultural Mediators in Italy face in comparison to existing primary and secondary resources, I aim to identify these struggles as well as their contexts.