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- Convenors:
-
Brigit Obrist van Eeuwijk
(University of Basel)
Christiane Falge (University of Bremen)
Roos Willems (University of Antwerp)
Send message to Convenors
- Chairs:
-
Christiane Falge
(University of Bremen)
Roos Willems (University of Antwerp)
- Discussants:
-
Andrea Kuckert
(Amsterdam University of Applied Sciences)
Alexander Rödlach (Creighton University)
Piet van Eeuwijk (University of Basel)
- Format:
- Workshops
- Location:
- 6
- Sessions:
- Friday 29 August, -, -
Time zone: Europe/Ljubljana
Short Abstract:
The use of the terms "culture" and "ethnicity" in explanatory models of health institutions have shown to result in a reduction of migrants' access to health care, because health providers fail to integrate mutuality, interdependence, reciprocity and sharing in their work with migrants.
Long Abstract:
The increasing heterogeneity of contemporary societies as a result of transnational migration comes with increasing structural inequality. Several studies indicate that migrants' inclusion into the host society and their access to health care is often constrained, which exposes them to various health risks. Research further indicates that, even though the first generation of migrants often succeeds in overcoming barriers to health care, second-generation migrants remain more vulnerable than other members of the host society.
As part of their resilience against marginalisation and social disenfranchisement migrants develop creative mechanisms in addressing their health needs. They draw on and creatively adapt to different cultural systems and develop support networks and alternative health care structures aiming to overcome access barriers. Ironically, the successful use of multiple cultural systems by migrants, contrasts with the problematic use of "culture" and "ethnicity" in explanatory models of health institutions, which often reduce a lack of access to health care to a single cause, cultural difference. The emphasis on the latter blames the migrant and thereby veils actual constraints to access such as structural inequality and discrimination.
Research has shown that institutionalized efforts and access models are more likely to result in improved access to health care and a better overall health of migrants when they focus on mutuality, i.e. bringing together health care providers, migrants, and their support networks.
We invite paper submissions that address health issues faced by transnational migrants considering aspects such as resilience, mutuality between individuals and health care providers, and mutuality between state health institutions and non-state actors.
Accepted papers:
Session 1 Friday 29 August, 2008, -Alexander Rödlach (Creighton University)
Paper short abstract:
The virtually non-existent care for AIDS sufferers in Zimbabwe motivates many individuals to emigrate in order to procure funds for purchasing antiretroviral medication for their sick relatives. The paper analyzes a master narrative of successful émigrés.
Paper long abstract:
Zimbabwe's health care system is desperately under-funded resulting in a low morale among health care professionals, massive emigration of physicians and nurses, and a crumbling infrastructure. The high HIV infection rate in the country further exacerbates this situation with AIDS patients inundating the already overburdened health sector. Subsequently, most AIDS sufferers are looked after at home. However, due to the rising costs of living even the most basic care cannot be provided. This problematic health situation motivates some individuals to emigrate in order to raise funds for relatives suffering from AIDS.
A yearlong research in an urban township in Bulawayo, the second largest city in Zimbabwe, documents some motifs of individuals for emigrating. Particularly the young ponder leaving the country in order to make money that will enable them to purchase antiretroviral (ARV) medication for their ailing relatives. Stories about émigrés who succeeded in providing such support became a master narrative encouraging migration and provide hope for AIDS sufferers and their households. Other stories of migrants' economic failure and inability to send ARV drugs are blended out. These would have destroyed the last hope of AIDS sufferers and their households. They have already given up expecting support from the governmental health sector or from non-governmental health organizations.
My paper interprets this master narrative as an aspect in migrant's resilience to access health care even across barriers such as national borders. Migrating is seen as a minor barrier compared with the precarious and desperate health care situation in Zimbabwe.
Roos Willems (University of Antwerp)
Paper short abstract:
The incongruity between the demands for solidarity, put upon individual Senegalese men and women by their extended families, and the decreasing economic possibilities to satisfy those demands, often lead to increased levels of stress, albeit the onset of depression, to which only out-migration is perceived to provide an adequate solution.
Paper long abstract:
The widely media covered waves of out-migration from West Africa, in particular Senegal, to the Canary Islands in 2006, which took place in small pirogues carrying sometimes up to 100 men and women, have given rise to the image of destitute and desperate clandestine migrants. Recent research among repatriated Senegalese clandestine migrants by the author has shown however that the reality is more complex and that there exist under- researched socio-cultural causes underlying the unstoppable stream of African out-migration to Europe.
The cultural dissonance experienced by many Senegalese individuals results from the incongruity between the demands imposed upon them by the traditional social systems of support (that continue to exist even in urbanized setting), and the increasing scarcity of economic opportunities to fulfil one's obligations to one's relatives. The socio-cultural and economic effects of a the system of gerontocracy and a widespread kleptocracy add further to the stress experienced by the average individual, and may in some cases leads to the onset of depression.
In a society fraught with economic problems and increasing levels of poverty, there is little attention for or interest in stress and depression, let alone enough material and human resources for clinical facilities to treat these types of afflictions . This paper documents the resilience of the men and women undergoing the effects of cultural dissonance in looking pro-actively for solutions to their situation rather than passively undergoing it.
Alessandra Miklavcic (Douglas Institute - McGill University)
Paper short abstract:
Access to health care is often difficult for illegal immigrants in Canada to obtain. The clinical setting is a place in which understandings of citizenship and care are negotiated and contended. Through use of strategies, networks and discursive practices, illegal immigrants and clinical practitioners navigate this tenuous terrain of health/care.
Paper long abstract:
Modern multicultural societies are confronted with the challenge of providing health care for their diverse populations. Taking on this social and political challenge means examining how access is granted, how political decisions shape services, and weighing different ideological claims about patients. These can range from a universalistic vision of the patient as a citizen, as an immigrant, as a specific "minority" other, as refugee in need of legal protection, and as an "illegal" to question. In Canada, the illegal immigrant population is comprised mainly of non-status immigrants who enter legally but stay after their legal status expires. Because of their "non-status," they avoid institutional encounters and have no rights to the health care system. What happens, then, if they get sick?
Drawing on current research among medical institutions in Montreal, this paper looks at
how non-status immigrants and health practitioners construct and negotiate, through use of strategies, networks, and discursive practices, a tenuous field of health/care. In particular, it examines how the discourses and regimes of the hospital and of citizenship intersect at a particular mental health facility offering cultural consultations in the treatment of immigrant and refugee patients. The case of a patient referred for consultation in virtue of her being a "cultural other" offers a starting point from which to explore the dissonances between policy and practice. Such an investigation brings to the forefront illegal immigrants' resilience in negotiating their visibility and invisibility, and the political, institutional, and ethical roles of psychiatrists in treating politically vulnerable patients.
Christiane Falge (University of Bremen)
Paper short abstract:
The analysis of discursive frames of psychotherapists with a migrant background in the German health care system shows how shifting between a processual and a reifying discourse on cultural identities ultimately must form part of a multicultural society.
Paper long abstract:
The German health care system is currently experiencing a debate about the accomodation of cultural diversity. Claims of health professionals for an intercultural aperture of the health system are the salient voices in this debate. This paper analyses discursive frames of a group of mental health experts with a migrant background in their process of transformation from a loose network to an institutionalized, claim-making group of professionals. During its annual meetings, this group which largely identifies with a turkish/kurdish background offers as much a space for professional exchange as well as for the practicing and signalling of their cultural identities.
Confronted with immigrants severe access barriers to mental health care, high access barriers for experts and patients with migrant backgrounds and a fierce competition within the German health market, members of the association began to formalise the association and develop strategies that legitimize them as "culturally sensitive migrant experts". The paper analyses the multiculturalist discourse that emerges in this process and the strategic ways with which members of this group shift between the reification and relativisation of their cultural identities. This includes an analysis of their 1. multidimensional roles as cultural watch dogs over their culture as an exclusive club, 2. own alienation from aspects of 'their culture' and 3. role as psychotherapists. Their shift between these two poles will be discussed and abstracted as an central aspect of multicultural societies in Europe.
Sjaak van der Geest (University of Amsterdam)
Paper short abstract:
(in cooperation with Silvana Rugolotto) Migrants do not only face problems of exclusion from or limited access to health care in European countries. Ironically, they also play an increasing role in offering care to members of the host community who are in need of help.
Paper long abstract:
East-European women leave their families and become caregivers to children and elderly in West-European countries. Their responsibilities at home are sacrificed for work in other people's households in order to earn money to secure a better future for those at home. Silvana Rugolotto carried out fieldwork in her hometown Verona, Northern Italy, among Badanti, migrant women taking care of Italian frail elderly people. Badanti, Italian families and elderly people find themselves locked in an uneasy contract; Badanti because they are exploited and unable to find better, formal employment; Italian families because they are aware that they fail to render their moral duty to their old parents and grandparents; and elderly people because they feel neglected and maltreated by their children and often do not accept the services of an unrelated migrant woman. The three parties also need each other, however. With the help of the others each party manages to make the best out of an almost impossible situation.
Both authors worked together to analyse the Badanti case in the light of critical medical anthropology. The situation of the Badanti and the Italian elderly shows how the internal contradictions of European macro and Italian domestic politics affect morality and care of individuals at the household level. The study illustrates the whimsical character of inclusion and exclusion of marginal groups in today's Europe.
Susana Carro-Ripalda (University of the Basque Country and Independent Researcher) Megan Warin (University of Adelaide)
Paper short abstract:
The growing academic and popular terminology surrounding the ways in which British people access and use Spanish health services highlights fundamental tensions that have arisen from flows in transnational migration. These tensions point to a disjuncture between the flows of globalisation and the friction of crossing health care borders.
Paper long abstract:
Recent European Union normatives to open up cross border health care have sparked a political debate in the media which highlight the tensions between the transnational flow of people and their use of health care services in multiple EU states. This paper specifically examines the use of local public health services in Spain by UK 'health tourists' and migrants, and the conflict that has arisen between those using and providing health services. We examine how these tensions are strategically played out in both the Spanish and UK media, arguing that discourses of 'health tourism' (and 'retirement migration') speak directly to ideological conflicts at the heart of health mobility. UK migrants who have lost entitlements to access the NHS because of their changed status are represented as 'outside users' who burden the Spanish health system. Alternatively, those who seek specific and short term health services in Spain are encouraged to do so by the UK government under the EU policy on access to health care across EU states. These competing discourses of health care use, provision, and entitlement can be seen as metaphorically referring to wider issues concerning the permeability (or impermeability) of state borders, the endurance of national identities, and resulting difficulties in the construction of a European identity and citizenship.)
Andrea Kuckert (Amsterdam University of Applied Sciences)
Paper short abstract:
The programme Global Nursing uses the heterogeneous class of nursing students to stimulate exchanging perspectives and experiencing diversity. Students are than prepared for their work in other societies, independent if the differences are based on gender, ethnicity, class, religion among others.
Paper long abstract:
The last two decades there has been a discussion in Europe on successful training of nurses with regard to an increasing diversification of their patients. Transcultural Nursing, Intercultural Communication among other theories and models were discussed and implemented to increase the sensitivity and professionalism of nursing staff towards ethnic minority patients. Reacting to this condition the Faculty of Nursing developed and implemented a programme, called Global Nursing that aims at teaching nursing students how to work with heterogeneous patient's populations in Amsterdam as well as in other countries. The programme is based on a definition of heterogeneity beyond culture including differences such as gender, sexual orientation, age, socio-economic status, educational level.
In the programme Global Nursing English is the teaching language, and hence the interest of international students increases. Therefore, learning communities develop, enhancing the learning process, in which students and teachers have a diversity of backgrounds, not only in the point of view of the country of origin but others as well. In the different modules nursing students experience diversity by participating rather than only reading, writing and talking over diversity. Through discussions, organization of an exhibition, project work, internships their task is to research, practice and taking responsibility on all kinds of diversity issues.
The aim of this paper is the presentation of the programme Global Nursing, its challenges and the difficulty in measuring the learning outcomes - are nursing students really prepared for their work in heterogeneous societies?