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Hi everyone,

Welcome back! Good to see that you still want to read about contraceptives use among migrants. For this week i want you to tell my own personal experiences of being a migrant.

There is a reason why I am so inspired by this topic. Before we begin, I will tell you a little more about my background. I am born and raised in Gouda, The Netherlands and still living there. However, my father comes from Spain. He moved to The Netherlands when he was 25 years old the reunite with his parents, who were working here as migrant workers. After a few years of living here, he met my mother, a Dutch woman. This makes me a second-generation migrant. I cannot say that i fully identify myself completely as a migrant. Like I said I have lived in The Netherlands my whole life, but i am raised between two cultures and I have seen the difference of these cultures with my own eyes. Some of you may think that there is no big difference between these, because The Netherlands and Spain are both western countries. However, i can tell you that there are many differences. Especially when it comes to sensitive topics, like contraception.

I always see my family as two parts, my Dutch side, and my Spanish side. I am the first grandchild that was not fully Spanish, so I always felt a little different than my cousins, on both sides. When my and me cousins grow older, I noticed these difference more and more. There is one moment in life where the cultures differences about contraception was clearly visible. I has one cousin that still lived in Spain when she was younger. Both her parents died when she was younger and she lived with her grandmother. When she was 15 she came to the Netherlands to live with our aunt. Not long after she arrived, she found out she was pregnant from her boyfriend that still lived Spain I remember that conversation as the day of yesterday, I just turned 14 around that time. She told to me that she was embarrassed to tell it to our aunt. In Spain sexual education was not given at school and she thought she was not able to get pregnant because it did not happen before. i could not believe that she really thought like this. I think this is the first thing that we learn in sexual education. At that moment I just thought that she was stupid to think like that. But by know I know that she  did not receive the right education and once she lived in the Netherlands, everyone just thought that contraception is something that everyone knows about. Unfortunately, my cousin passed away five years ago. But I have a beautiful niece that reminds of her every time i see her.

By following this course, I learned a lot about how culture plays a role in our health. For me, the use of contraceptives is common sense if you do not want to get pregnant. But I am aware that this is not common sense for everyone. Like I wrote in the blog of last week, we should not look with our ‘white lens’. It is important that we take people’s background  into account when we provide care.

Time to wrap things up. This was already my last blogpost. I hope you enjoyed reading them. I think we all have had experiences with culture differences regarding to health. I would like to read your experiences regarding this topic and maybe we see each other again in the future!

Greetings,

Ivanna

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Welcome to this wall with your third blogs and comments!

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Welcome to this wall with your third blogs and comments!

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Hi everyone, welcome back to my last blog post of this series.

In the past few weeks I have tried to create some awareness about the current status quo in reproductive health care for women, and mainly the importance of a cultural sensitive approach in addressing this. Ofcourse this topic is too broad to cover all of it in four weeks, but I have tried to highlight some aspects of it. I’ve discussed how unfortunately women’s reproductive health is still a taboo topic, the lack of the right education, causing a lower uptake of health care services and leading to adverse health outcomes. I’ve discussed how reproductive health inequality is correlated with lack of access and racial discrimination.  Luckily more and more initiatives are being taken in order to set the record straight. Such as the exhibitions that display the stories of women created through creative writing, the use of narrative medicine, giving a voice to women from all backgrounds. Initiatives that can lead to higher cultural sensitive awareness, more fitting interventions and eventually better health outcomes.

It is clear by now that my experiences as a midwife have shaped my thoughts about this topic, such as the story I’ve shared last week. However, I also want to acknowledge the influence of one of my best friends who was born in Israel , but has been living in the Netherlands for the past 18 years. She really opened my eyes to being more aware of cultural differences, as I witnessed the contradictory challenges she faced (as a woman) living in two cultures essentially for the past 15 years. I’m really happy to see that more effort is being put into changing the status quo, during this course I found the lecture by Alana Helberg-Proctor really inspiring and promising. It really taught me to be more sensitive towards using different terms. It inspired me to be more critical towards protocols and guidelines that are now in place. Why do women with a certain ethnicity have an indication to do a specific test, when ‘’white’’ women don’t? How was that research conducted and was that data really generalizable for a certain group of people? For that matter, I’m really excited for what the future holds for research, and I really hope to be a part of it. I hope more people will feel represented and more people will be reached. I’m really encouraged to dive into narrative medicine and put research into practice, as I’m eager to develop the skill of a cultural sensitive approach that I described in my introduction:

A set of skills that allow you to understand and learn about people, being aware that cultural differences and similarities exist without assigning them a value, these differences and similarities have an effect on values, learning and behaviour.

To wrap this all up, the quote in the picture that I added to this post is ‘’Think Global, Act Local’’, which is actually a quote referring to climate action. However, it always reminds me of the fact that everybody you encounter comes from somewhere across the world and has their own story (good or bad), so you should never judge, but be kind.

I hope you’ve enjoyed reading my blog, I hope we’ll meet again!

Have a nice day!

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Take it like that: the longing for acceptance

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Take it like that: the longing for acceptance

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In light of the Eurocentrism versus the Afrocentrism theme, it got me personally thinking… What is right and what is wrong? I tried to immerse myself in this subject and it became clear to me: answering this question is immense and almost impossible. I noticed how reflective I looked back to how I grew up and which norms and values I carry. Given the perception of what 'good' healthcare is my experiences as a nurse-to-be shaped this reality. And with all the growing and developing innovations in healthcare (think of the latest news of the successful very first transplanted pig heart in a human being) I ask myself: do we evolve and improve too much and too fast in our Western world? The acceptance of being left in the dark and the acknowledgement of life and death, seems hard to find in this scientific revolution. These thoughts could be conflicting with the fact that I study Health Sciences: a scientific study based on the pursuit of finding the reality. Nevertheless, I think the willingness to accept one’s own nescience (or ne-science) could lead to enlightenment. Ignoramus or ‘we don’t know’, is an important vital of departure in life.

So, what did I then learn of some of the African cultures? If you look at the actual numbers of economic growth and the morbidity/mortality rates in terms of disease, most African countries are way “behind” most Western countries. But the real question then is, ‘what is the quality of life?’. To what extent do those numbers really matter? I personally directly have an image of how it would be to be poor, living underneath a corrugated roof, sleeping in one bed with my three other brothers and sisters. But is that a correct image of life when being poor? Is there no sunshine and happiness, but only suffering and sadness? One classmate once told me when she visited Ghana that people she had met lived exactly as how I described it. So, they had two pieces of furniture: a bed… And, yes, you will never guess it: an enormous flatscreen tv. Oh, and they mocked my classmate with the fact she had the older version of the iPhone. Yeah, that story really dazed me.

One of the reflections I had the past few weeks was: what do I want to do then, in life? What kind of work do I want to perform? Because thinking of how healthcare could be “better” and more innovative in a country such as the Netherlands sometimes really agitates me. Is it not already good enough? Can’t we be satisfied with how far we have come and acknowledge the ignoramus? On the other hand, to what extent do African countries (e.g., Ghana) want to change and innovate if the priorities are so different from Western countries? If my life is shaped and biased with my Western lens, I ask myself if I could even work in a developing country such as Ghana. These questions remain and will not be answered in a short-time notice. Though, what I know and learned in this course: the western countries could sometime learn a bit more from other non-Western cultures, habits, and the outlook on life.

Take it like that.

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How I envision a more inclusive vaccination program

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How I envision a more inclusive vaccination program

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Dear reader,

long time no see! Well, actually just a week ago. Anyways, let’s dive right into this week’s blog, which will be the last one of this series. After I have written a lot about migrants getting vaccinated in the last weeks, especially regarding the current COVID-19 pandemic, I want to use this opportunity to conclude this conversation by giving my own perspective on this topic and, like it was requested by you, how I would tackle the issue.

As I have already mentioned last week, I see two main reasons for this situation: The barriers to access the vaccines, as part of a general struggle to access health services as a migrant, and the existing hesitancy among migrants to get the vaccine. These two reasons are very simplified and present themselves slightly differently and more detailed, depending on the actual situation of the vaccination program. But they should be the two areas, where current vaccination programs need the most change if you want to have high vaccination coverage among migrants.

From my perspective, it seems, that in the first developments of vaccination programs, often none or fewer voices from or representing different cultures and migrants were involved. Because measures to specifically address people from other nationalities were mostly added later during the running of programs. For example in Germany, additional placards in Turkish were added later to the advertisement campaign (see cover image). The same can be seen in regard to lowering the barriers for undocumented migrants. In the beginning in several countries, it was necessary to show proof of identity and other documents to get a vaccine. Why it might have been necessary to ensure safe and controlled administration of vaccines, it hindered undocumented migrants to get a vaccine. And even if you lower the barriers for the undocumented, it is necessary to clearly communicate that this action will not interfere in any way with their residence status and process of migration. Because this seems to be one of the biggest fears of these people when using health services. In general, it could help to ensure easy and safe access to all kinds of health services for migrants, gaining more trust from undocumented migrants in that area. But this of course something interfering more with general migration policy and will not be discussed further here.

Another way to ensure higher vaccination coverage rates among migrants could be the use of idols or spokespersons of migrant communities, who promote the vaccine and its benefits. This is often done with mainstream celebrities from media, sport, and culture. So why not do that with people addressing certain sub-populations like migrants? Additionally, the institution responsible for the vaccination program could support local initiatives/organizations, which work towards better migrant health, to support migrants getting the necessary information, the access to vaccination, and hopefully in the end decide to get the vaccine.

Last but not least, the need to gain more information about the actual situation within migrant communities is needed. At the moment, less information is available about vaccination coverage and reasons for low coverage rates. If these resources would be available, even more targeted approaches, tailored for addressing migrant populations, could be designed.

As you might see, I have a few ideas, where changes need to be done, to tackle this imbalance in vaccination coverage rates between the general population and migrant populations. I hope, I was able to give you some ideas about what could be done and inspired you a little bit to think about solutions to this issue by yourself. In general, I’m happy that you stick around with me for the last four weeks and were interested in my blog about this important topic.

Best,

Maurice

Cover image: BzgA

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Hello everyone!

Welcome back to my blog form my final post. This week I will reflect on the lessons I have learned during this series of posts. Hopefully you will enjoy my analysis of the Western aid to Africa. Please comment your questions or remarks!

To start with honesty, I really do not have made my full opinion on Western, in every form, to the African continent. The book of Moyo I promoted in the first week, and last weeks’ interview of Arjen Nijeboer both focussed on the economical part of humanitarian aid. The aim of aid should be, in my opinion, short-term dependency to create long-term independency. But many researchers and opinion leaders state that this generous idea does not hold up in practice. Billions of dollars are spent for decades, but none of these countries is financially stable. That means that something is going wrong, very wrong. I think that we should reconsider the economic structure of aid as it is done now. Financial independency for both the individual and the country should be the main issue.

Important to mention: we simply cannot disconnect the financial IV directly. There is a new player on the block. And his name is China. Investments of the economic world power in Africa are on an idiotic rise. Exactly what those countries need for independency, right? Well, the honesty of these investments is quite disputable, and maybe done to increase the power over African states*. This will lead to another dependency, not form the West but from the East. And that is exactly what we do not want.

There is also a part of aid that is underexposed, namely the goal to create a better place for those who are in the highest need. This part is much closer to me: health care. I understand that every problem in the African region is interlinked with socio-economic problems – problems that might be maintained by Western help. Though, health related issues cannot wait for some actors to agree on what to do, or not. The COVID-19 pandemic showed us that health is unpredictable. And Western health related programmes were/are very effective in the battle against HIV for example. Quitting these programmes because it might intervene with independency of countries is the worst thing to do. The profits that are made regarding health and well-being are way higher than the dependency that comes along with it.

Overall, I truly believe in the power and need of humanitarian missions we execute right now. Though, we must be critical in every aspect of it. This means that we should reconsider our own role in the lacked growth of many low- and middle-income-countries. At the same time, we must invest in sustainable solutions for health-related issues. Whenever a country, in Europe or Africa, faces tremendous health issues, we must help them. We are all human beings; we all have the right to health care so it should not matter if you were born in the Netherlands or in a low-income country. We all must help each other.

*This can be seen in the documentary series of Ruben Terlou about China’s influence in the African region. The series can be found here: https://www.vpro.nl/programmas/de-wereld-van-de-chinezen.html

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Hi all!

Welcome back to my final blog! In this blog I will tell you how I became interested in the health of elderly with a Turkish migrant background in the Netherlands. I will divide this blog into two parts. First, I will explain how I became interested in health care in general. Second, I will tell you how I became interested in people with a migrant background.

The first thing I want to dive into is how I got interested in health care in the first place. This part is quite easy to explain. My parents both studied nursing. And after studying nursing, my mom additionally studied Health Sciences. Since my parents both had a background in health care, this was a topic that was very often discussed while having family dinners. Therefore, since a young age I have been surrounded with stories about nursing and health care organizations, which have sparked my interest in health care.

The other thing I want to tell you, how I got interested in people with a migrant background, is a bit of a longer story. During high school, I did not know anyone with a migrant or refugee background. And to be honest, I did not really think about it at all. After high school I moved to Groningen to study there, and that is the place where my interest in migrants and refugees is awakened. A friend of mine asked me if I knew someone who wanted to become a language coach of a Syrian refugee. At that time, I was not satisfied by only focussing on my studies and I really wanted to give something back to society. Therefore, I decided that I wanted to become the language coach of the Syrian refugee. I think this was the thing I did during my student days that most shaped my view on the world.

I really enjoyed being a language coach, and after a while he told me more and more stories about Syria and his journey to the Netherlands. Those stories made a really big impression on me. I became very aware of my privileged position I obtained since I was born in the Netherlands, and I had the strong feeling I had to do something to make the life of refugees and migrants a bit better. Therefore, I decided to go to Greece and help out at a refugee camp at the Greek island Lesvos. I was really happy I got to do something for the people in the camp. But being there also made me very sad, because I saw all those beautiful people who did nothing wrong but who were victims of war or bad government. It made me realize that I cannot solve all the problems in the world by myself, but that I do have the power to light up someone’s day, even if it is just for a brief moment. When I was back in the Netherlands, I was determined to focus on making life better for refugees and migrants in the Netherlands. As a volunteer, I organized sport lessons for children in a Dutch asylum centre and I also became the language coach of a Turkish woman.

At this moment, I almost finished my studies and I have to think about what I want to do afterwards. I plan on combining my interest in health care and my interest in people with a migrant or refugee background. I truly belief that everyone has the right to quality health care and I want to positively contribute to the lives of people with a migrant or refugee background in the Netherlands. Therefore, my aim is to improve health care for migrants and refugees in the Netherland.

I want to end my blog with an inspiring quote “Be the change you want to see in the world”, because I believe that everyone has to power to contribute to a better world.

Greetings,

Emmy

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A Blog by Kirsten Reijbroek

Dear Readers,

Today it’s already time for my last blog posts. My course almost finishes and I’m happy to share that I learned a lot about migration and culture in combination with health and research over this period as it has been a great opportunity to get more in depth about these topics. I’m happy to take these experiences with me in my internship, which I’ll start in the next semester. In today’s blog post I will therefore take the time to look back on the course, and to reflect on my own experiences writing these blogs and learning about TB and TB related stigma.

In this course I learned it might be the most difficult thing to reflect on your own culture and how this influences your thinking and your behaviour. Writing this last blog post I found myself struggling to reflect on this. I realized it is indeed challenging to find out which cultural factors influence my daily life and which would most likely have an influence on my professional behaviour. Especially because cultural factors are not fixed or stable, and views can change over time.

I didn’t really know where to start, so the first thing I did was to try to list some facts about myself. I’m Dutch and was born in small village in the province Brabant. Dutch is my native language and I started to learn to speak English in primary school. My granddad is from Indonesia. I lived in Maastricht for 5 years and studied Health Sciences at Maastricht University. I was a member of the student rowing association and was in the race rowing team. I lived in Finland for half a year where I studied at the University of Helsinki. I started the master biomedical science but quitted. I worked as a care assistant and worked on policies around the quality of health care in the same nursing home. I now study international public health and bioethics at the VU and live in Amsterdam.

This is of course just part of the list of things that identify me, but I used it as a starting point to identify cultural groups I might be part of or that might have influenced me. This are for example being Dutch, some influences from the Indonesian culture, a profound influence of academic culture and education, the rowing culture and student association I was part of, and the Finnish culture I got to know while living there. The next step would then be to think of how this might have influenced my view on the world, which actually is difficult as things don’t just add up but result of a complex interaction between all my experiences. A funny and reflexive way I found is to look up how people from other cultures see your culture. Some accounts I would recommend if you are Dutch are Sjoerd Scott (1) and Claudia Arroyo (2) on TikTok, where they for example point out the typical Dutch way to celebrate someone’s birthday (‘kringverjaardagen’), Dutch way of having lunch, but also problems are pointed out with Dutch honesty and consultations at GP’s.

So, how to use this as a researcher? I think the most important thing is to be aware of cultural influences that might have shaped you. For example, as a Dutch person I’m always very direct. For some people that might be uncomfortable, certainly when talking about sensitive topics such as a TB diagnosis or stigmatization, as for the topic I’m interested in. I therefore try to give people the room to explain how they feel, without interrupting or commenting to create a safe place. I think we should be aware that there are always more aspects to something than we initially thought of, and we should be curious and open to discover these things. As for reflexivity I think it is hard to be fully aware of everything, but we can at least try to discover the most important aspects that influence our way of thinking.

Links:

1.       https://www.tiktok.com/@sjoerdscottt

2.       https://www.tiktok.com/@latina_in_thenetherlands

* Picture retrieved from: https://www.istockphoto.com/nl/vector/vrouwelijke-hand-met-een-kleine-ronde-spiegel-met-een-weerspiegeling-van-haar-oog-gm980628038-266385765

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My dad, my life-saver in the digital world

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My dad, my life-saver in the digital world

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Hi everyone, welcome back to my blog! This week I am linking the overarching theme of all the blogs, digital in- and exclusion, to myself. In all my previous blogs, I asked you to relate the situations I outlined to yourself. This week I am doing that on myself. Because what exactly is my experience in relation to digital inclusion/exclusion? Also, what have I learned from blogging these past three weeks?

I was born in 1996. Smartphones already existed for four years and computers for 52 years. You see, I grew up in a digital world. Yet it was quite different from today. Digital devices of the past are not the devices of today. I remember being 14 years old when I held a smartphone in my hands for the first time, my good old Samsung Star. A phone on which I played games and sometimes sent a text message to friends. WhatsApp had only just been launched and apps like Instagram did not yet exist. Before I had this phone, I communicated via MSN. This was a cool thing to do in this period. The only two other applications I knew on a computer were Microsoft Word and Google. Although 'know' is quite a big word with the maximum of two websites that I could look up by myself. If something went wrong on the computer, I called my father and he solved it. Pretty handy when your father is an ICT-er! By the way, you can find him with me in the picture at the top of the blog.

I have always seen this as 'normal'. My father always solved all the problems with a computer or smartphone. Also, when I got older. For my previous study, nursing, I was asked to process feedback from a teacher during my holiday. It had to be done within three working days. At that time, however, I was some 4,000 kilometers away from home and, of course, had not brought my laptop. So, what did I do after all? I... My father I mean, asked the hotel staff if I could use the hotel computer to process my feedback. This was approved and I could continue working on my report here. Unfortunately, once I started, everything on the computer turned out to be written in Spanish and even the keyboard of the computer was a Spanish keyboard. I was under a lot of stress to finish my assignment, but I really didn't understand anything about the computer which was my only option to finish it. But then again, who was there to help me? My father! Without him, I would never have finished my assignment and might not have received my degree.

Blogging about digital exclusion has made me realize how lucky I am to have a father who can solve all my digital problems, but also how much harder my life would be without a person like this around. How are people from migrant backgrounds supposed to feel when they don't speak or read Dutch and yet are expected to look for information themselves via the internet? Maybe they don't understand our keyboard either, but don't have a father or other person around to help them with these obstacles to participate in the digital world. I can imagine that, with all the high expectations around them, these people feel very small. Especially in healthcare, where patient self-management is being pursued through various healthcare apps, for example.

So, as I mentioned in my previous blogs, there is a need to investigate what the needs of patients with a migrant background (who are currently not included in digital care) are in relation to digital care and how to respond to them. I'm excited to be able to do something for these patients and contribute to a more inclusive digital world of healthcare.

Thank you for your presence and input in recent weeks. I hope to be able to tell you more about my research results in the future!