Welcome to my second blog! I am happy to see that you are still interested in the health of elderly with a Turkish migrant background living in the Netherlands! In this blog, I will inform you about the care for elderly with a Moroccan and Turkish migrant background in the Netherlands, based on an interview with Ahmed Marcouch*. Mister Marcouch came to the Netherlands from Morocco when he was only ten years old, because his father migrated to the Netherlands to work as a labour immigrant. Therefore, he has seen first-hand how people take care of the elderly with a Moroccan and Turkish migrant background, and what the elderly need.

 

In the Moroccan and Turkish culture**, it is expected that children take care of their parents when they grow old. The children live close to their parents to care for them, or the parents move in with their children. Nowadays, the first-generation labour immigrants from Morocco and Turkey are old and need to be taken care of. Many of them expect their children to take care of them. However, the children of the Moroccan and Turkish labour immigrants integrated into the Dutch culture very quickly during the past decades. In the Dutch culture, people are often more individualized, and both men and women are working. This results in the situation that children do not have time to take care of their parents. The elderly with a Moroccan and Turkish migrant background are more often sent to Dutch nursing homes, instead of that the children care for them themselves.

 

When they were younger, the elderly with a Moroccan and Turkish migrant background were always very focused on their own family, and making enough money to take care of their family. This has led to the situation in which the elderly often do not have a big social network and they do not speak the Dutch language very well, resulting in that they cannot talk to their nurses or other people living in their nursing home. Therefore, the elderly can get very lonely when their children are not able to take care of them¹. In addition to loneliness, another difficulty is that the elderly do not get all the medical information they need due to the language barrier. To overcome these struggles, it is important that the Dutch government focusses on culturally sensitive care. The essence of culturally sensitive care is that care responds to a patient’s cultural values, beliefs, feelings and personal circumstances, such as which language they speak². Nowadays, culturally sensitive nursing homes are on the rise. These nursing homes accept a person’s religious background, and are able to provide information in a language the elderly can understand. Besides nursing homes, it is also important that general practitioners are able to provide information to the elderly with a Moroccan and Turkish migrant background in an understandable language. This might be very hard for general practitioners, but a good solution you see more often is that the mosque helps to spread information from the general practitioners to the elderly.

 

In this blog, I have described how elderly with a Moroccan and Turkish migrant background are more often sent to Dutch nursing homes. This has led to a lot of loneliness and ignorance among these elderly. It is important to focus on providing culturally sensitive care for these elderly, and it is up to our generation to make this happen and care for the elderly in the best and most suitable way possible!

 

I hope you found blog interesting, and I will see you next week!

 

Greetings,

Emmy

 

 

*If you are interested in reading the whole interview, click on the following link: https://gerontijdschrift.nl/artikelen/in-het-praten-over-migratie-en-migranten-hebben-we-het-in-nederland-veel-vaker-over-hoe-ze-hier-zijn-gekomen-dan-over-het-waarom/

 
**We talk about the Moroccan and Turkish culture, but keep in mind that within a culture there are cultural differences like I explained in my previous blog!

1.     van Tilburg, T. G., & Fokkema, T. (2021). Stronger feelings of loneliness among Moroccan and Turkish older adults in the Netherlands: in search for an explanation. European journal of ageing, 18(3), 311-322.

2.     Tucker, C. M., Arthur, T. M., Roncoroni, J., Wall, W., & Sanchez, J. (2015). Patient-centered, culturally sensitive health care. American Journal of Lifestyle Medicine, 9(1), 63-77.

 

 

One of the episodes is dedicated to Forky's question, "What is a computer?". Forky has no idea what a computer is or how to use the device. All that is known to him is that a person using a computer clicks a lot and often yells at the screen. He wonders whether a person must have gone to university before being able to use a computer and whether it was a traumatic experience to learn to use it. When the other character in the episode, Trixie, tries to explain the functioning of a computer to Forky, Forky's immediate reaction is "You've lost me, and I don't know if I'll be ever found. Help, help!". After Trixie feels that it is impossible to explain the device, she simplifies her explanation by agreeing with Forky's definition: "With a computer you click and yell at the screen". Forky then thinks he understands the device; he clicks on the computer keyboard as often as he can. The result is that Forky still does not understand the computer and the computer is completely broken.³ 

 

Not that I want to compare my grandmother to a fork that came out of the rubbish bin, but the short film does remind me of my grandmother. Unfortunately, it is currently not possible to interview her, but often enough I have observed my grandmother trying to understand technical devices, such as a laptop or a mobile phone. These brief participant observations gave me insights into some barriers and requirements for using digital devices of my grandmother; someone with low digital skills.⁴ My grandmother is someone who always thinks she understands everything and doesn't easily admit to not understanding something, a family thing perhaps... However, learning to understand digital devices is difficult. There are many aspects to digital technology. It is incomparable to most everyday skills; learning to understand digital equipment is like learning to understand a whole new world: the digital world.⁵ 

Just imagine being expected to know and interact with a new world from one day to another. A world of written letters and numbers that you may not even understand because you have never learned to read or write; you are low literate.⁶ Imagine, moreover, that you speak a different language than the one spoken in the world you have arrived in. How would you feel and what would you need to live and function in this world? Personally, I find it difficult to imagine this for myself. That is why I find it interesting to do research on the feelings and needs that come along with such a situation. Linked to the research I will do myself from February onwards, I will focus on the feelings and needs of kidney patients with a migration background and low health literacy; a group that is far away from me, probably far away from many researchers, but therefore very important to do research on. For this blog, I unfortunately did not manage to conduct or find an interview with a person belonging to this group. Therefore, I hope to be able to inform you and the rest of the world about this after my own research! 

 

For now, I hope I have been able to teach you about the difficulties of participating in the digital world, since for many people this is one of the main reasons for not using it.⁷

 

I look forward to seeing you next week on my final blog!

 

1. Disney/Pixar. Theatrical shorts. 2022. [Internet]. Available from: https://www.pixar.com/theatrical-shorts [Accessed 26^th January 2022]. 

 

2. Disney. Forky asks a question. 2020. [Internet]. Available from: https://disneyplusoriginals.disney.com/show/forky-asks-a-question. [Accessed 26^th January 2022].

 

3. Disney. Forky Asks a Question: What is a computer? 2022. [Internet]. Available from: https://www.disneyplus.com/nl-nl/movies/vorkie-stelt-een-vraag-wat-is-een-computer. [Accessed 26^th January 2022].

 

4. Spradley JP. Participant Observation. 1st edition. New York, NY, USA: Holt, Rinehart and Winston; 1980. 

 

5. Hodson R. Digital revolution. Nature. 2018; 563(7733). doi: 10.1038/d41586-018-07500-z.

 

6. Rijksoverheid. Aanpak laaggeletterdheid. 2015. [Internet]. Available from: https://www.rijksoverheid.nl/onderwerpen/taal-rekenen-digitale-vaardigheden/aanpak-laaggeletterdheid. [Accessed 26^th January 2022].

 

7. Le C, Finbråten HS, Pettersen KS, Joranger P, Guttersrud Ø. Health Literacy in Five Immigrant Populations in Norway: Pakistan, Poland, Somalia, Turkey, and             Vietnam. English Summary. In Helsekompetansen i fem innvandrerpopulasjoner i          Norge: Pakistan, Polen, Somalia, Tyrkia og Vietnam. Befolkningens helsekompetanse,      del II. The Norwegian Directorate of Health. 2021.

Daniella is a 22-year-old technical school graduate who sought an abortion in San Diego due to the restrictive abortion laws in her state in Mexico. She said that abortion in Mexico is illegal and that she did not want to do something illegal and was scared of the legal penalties. She explained that to get her abortion she needed a passport, visa and money to pay for the procedure and transport. Luckily Daniella had enough money to pay for it but this is not always the case for women. Because one of the main reasons why women want an abortion is due to their low financial resources to care for a child. The women who attain an abortion by migrating to another country said that they know they are the ‘lucky ones’ and acknowledge that many women do not have the privilege to travel this far.

When travelling to another country is no option women seek help in illegal settings. This mainly leads to unsafe abortion carried out by an individual without the necessary training or environment that confirms to minimal medical standards stated by the WHO. Women told that they experienced a lot of pain, infections and other complications after the unsafe abortion. Sofia is a 23-year-old high school student who had an unsafe abortion provided by a gynaecologist in an illegal setting. She said that she had a lot of pain after her abortion due to a perforation of her uterus:

Other women induced the abortion by themself by squeezing or tying a rope around the abdomen or undertaking excessive exercise. Annemarie said that she waited until the pregnancy was far enough to exert enough force on her lower abdomen to end the pregnancy:

When I read Annemarie her story I cried for her, what she has to endure is inhumane. Annemarie said that after the abortion she was feeling relieved. This feeling of being relieved is shared by many women who had an abortion. Women explained that the fact they otherwise had to carry out the pregnancy outweighed how painful their unsafe abortion was.

The last way how women in legally restrictive countries attain an abortion is via NGOs. Some NGOs help women by gathering the needed money to migrate to another country for an abortion or providing them temporary housing after the abortion. Other NGOs provide women with information, medical guidance and remotely provide medical abortion by sending medication. Sophia had a medical abortion at home with remotely help from an NGO. They sent her the medication and information to induce the abortion at home. She said that a medical abortion at home was a more comfortable method because she was able to do it at home in a safe environment with people she trusts.  

To conclude, throughout this blog you could see that restrictive abortion laws do not decrease abortion rates because women find different ways to attain them. It only endangers women’s lives through unsafe abortion. In my opinion countries with restrictive abortion laws violates many fundamental human rights. Because why had Daniella go to another country to achieve her right to health? Why did a country take away the right to life and the right to freedom of cruel, inhuman and degrading treatment from Sofia and Annemarie? I can go on and on about these violations of human rights but that does not change the fact that still, 41% of women live in countries with restrictive abortion laws. Fortunately, NGOs are a beacon of hope for these women in oppressed situations. They are the ones who are fighting for human rights and provide the health care that these women are entitled to! 

I invite you to share your thoughts related to these stories, for example, how would you react to Annemarie when she tells you her story? Looking forward to your comments! Hopefully, I see you next weeks blog in which I will give you insight into my attitudes, beliefs and experiences related to abortion access. 

Warm regard, Romy. 

Reference:

Boydell, N., Reynolds‐Wright, J. J., Cameron, S. T., & Harden, J. (2021). Women’s experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID‐19) pandemic: A qualitative evaluation. BJOG: An International Journal of Obstetrics & Gynaecology.

Grossman, D., Garcia, S. G., Kingston, J., & Schweikert, S. (2012). Mexican women seeking safe abortion services in San Diego, California. Health care for women international, 33(11), 1060-1069.

Juarez, F., Bankole, A., & Palma, J. L. (2019). Women's abortion seeking behavior under restrictive abortion laws in Mexico. PloS one, 14(12), e0226522.

Reed-Sandoval, A. (2021). Travel for Abortion as a Form of Migration. Essays in Philosophy.

Vallely, L. M., Homiehombo, P., Kelly-Hanku, A., & Whittaker, A. (2015). Unsafe abortion requiring hospital admission in the Eastern Highlands of Papua New Guinea-a descriptive study of women’s and health care workers’ experiences. Reproductive health, 12(1), 1-11.

Joseph found out that he was living with Bipolar Affective Disorder. He has to bear the burden of mood swings, moving between elation and despair. Fortunately, he was able to receive help in Ugandas only psychiatric hospital: Butabika. In Uganda, only 30 psychiatrists work in the country that exists out of 43 million people. The treatment consisted of medication, psychological therapy, group strengthening, and peer support in the hospital. Nevertheless, Joseph also went to traditional healers – from who he really believed this healer saved his life. But Joseph is not the only one: 90% of Ugandans believe that mental illness is linked to curses and demons. "I was treated in this spiritual healer's crude structures, but I am well now" he says. "Even conventional medicine has its advantages and disadvantages. So, I can't quite discard this spiritual healer as somebody who didn't contribute at all to the wellness that I'm enjoying right now."

By reading this narrative of Joseph, you can detect the Western mental health aspects and the more traditional African mental health aspects. An interesting mix that is also affected by the enormous shortage of psychiatrists. Nevertheless, Joseph got the chance of being admitted to Butabika, but he did believe that only the traditional healer had actually put his protecting cloak over Joseph to walk the path of healing. And that is what this story makes so interesting because the two different forms of mental health cross each other and collide together to help mentally ill persons. Regardless, there is still an immense taboo concerning mental illnesses resting in Uganda, which also affects the traditional heeling negatively. Namely, one of Joseph’s friends was taken in by a pastor who looked after the sick. "He'd chain up his patients until his prayers had an effect," says Maureen Ainembabazi, who has schizophrenia. "I had to run away."

To conclude, a step towards a more accepting world would possibly help to break the taboo of mental illnesses. Joseph, a full-time activist for mental health causes, is one of the rare voices speaking publicly about his illness – and he is with that a beautiful example of the attempt to break the wheel. From my Western point of view, I am still struggling with understanding what traditional healing really means. It feels like something floaty or vague and does not justice the fact that mental illness is as much a disturbance of the body as breaking a leg. But on the other hand, if it helped Joseph to heal, why not introduce this more often into our Western world? 

 

Good to see you back! Already one week has passed since my last post. We talked about how artwork can be related to the use of contraceptives, and I gave you a brief lesson about the history of contraceptives. This week we will dive a little bit deeper. From the previous blogs we already know that having a migration background can contribute to the choice of using contraceptives, but now we will look in what way this is visible in practice. To get clear vision of this topic, I want you to tell the story of midwife Astrid who works in The Hague, The Netherlands. Astrid is interviewed by Rutgers, a Dutch organization that plays an important role when it comes to sexual and reproductive health.  Astrid works in a midwifery practice where almost exclusively people come with a migration background. During the interview she explains why a midwife can make a difference when it comes to unintended pregnancies and contraceptives and how non-migrant caregivers look through their 'white lens' . 

 

If you want to start with using contraceptives in the Netherlands you must go to your general practitioner (GP), in Dutch “de huisarts”. Contraceptives are not provided in the basic health insurance package when you are above the age of 21, but they are not expensive. This raises the question: Why are migrants going to the midwifery practice to talk about contraception? It all comes back to what I have mentioned before; migrants often have unmet needs regarding their sexual and reproductive health. This also includes less usage of healthcare facilities compared to non-migrants. For first generation there can be a language barrier, making it more difficult to go to an appointment. 

 

Coming back to the interview with Astrid. She explains how the practice where she works is different from others. She mentions that they not only provide maternal care, but also everything beyond that. One important element of this care is contraception counseling. Migrants can come to the practice to make an appointment without having to wait a long time. Astrid says:

 

 

She explains what role contraceptives play in her work. She says that the demand for contraceptives is different among migrants. Often, they want to start when they are done having kids or right after marriage. She states that most of the women do not have intercourse before marriage and that virginity is very important. Astrid also mentions that some women do not know much about contraceptives and how to use them. According to Astrid, it is important that you take the time to discuss contraception and dispel myths to reach migrant groups in preventing unintended pregnancy. There is one story where the knowledge about contraceptives was clearly described:

 

 

In conclusion, this narrative of Astrid describes how the approach towards migrants differs when it comes to contraceptives. It makes me realize that it is important to respond to the needs of migrant when it comes to their sexual and reproductive health. I hope you liked this, and I hope to see you next week!

 

Greeting, 

Ivanna 

If you want to read the full interview, here is the link: https://seksindepraktijk.nl/stories/anticonceptiecounseling-voor-migranten/ 

 

Welcome back to my blog! Today I'll write about TB and stigma, which is persistent for both TB disease as well as latent TB, and the experience of patients diagnosed with it.

 

My first idea was to get in contact with people who themselves experienced TB or latent TB, but I don’t personally know people who experienced this. TB prevalence is really low in the Netherlands, were only 623 cases or TB disease were known in 2020, and 896 cases with latent TB (1). TB screening is available for people coming from high TB burden countries, such as Eritrea, Morocco and India. I decided to think of other ways I could share TB patients experiences with you and dived into blogs written by patients, YouTube videos and quotes of articles I've read, and in this blog post I'll share these stories with you. 

 

One of the first stories I found was the story of Paulina Siniatkina (2). Paulina is a Russian artist and TB disease survivor. She was 25 when she got TB and was sent to a hospital for treatment where she isolated with other TB patients. Paulina describes her time in the hospital as one of “fear, misunderstanding, anger, despair, loneliness, silence, love, friendship and hope.”. What I think is strong in Paulina’s story is that she not only talks about the burden of the disease, but also what the disease has brought her such as the new friendships she build up in the hospital and the hope her treatment gives her. As an artist, Pauline decided to make a series of paintings called ‘hold your breath’ during her time in the hospital, with these painting she tells her own story and the stories of patients she met. Above you can find one of her paintings ‘Don’t speak!’ which she based on fear of stigma, after one of her doctors told her to not tell anybody that she had TB disease, because she would be branded for life. 

 

This stigma is also visible in the qualitative research I’ve been reading about latent TB (3). I decided to copy some quotes to show you how people might feel. 

 

 

 

As a researcher I think it is important to share these kind of stories, both to show how people feel and to educate people. Telling and forwarding these stories might be one of the most powerful tools we have to overcome stigma. It is important however to keep in mind to be sensitive about the topic, so if anyone tells you about their own experience, ask them about how they would feel if you would share these stories with someone else. Furthermore, pleas ask me questions if you have any, together we can break the circle of persisting stigmatisation. 

 

Links

1.       https://www.rivm.nl/bibliotheek/rapporten/2021-0192.pdf 

2.       https://www.finddx.org/impact/paulina-2/ 

3.       https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09697-z 

Welcome back! Happy to see that you’re still interested in my blog posts and want to hear more from me. 

This week I’ll give you more insight into the situation of migrants and their access to the COVID-19 vaccines. For this purpose, I’m going to use an interview of Oscar Londoño, conducted by NPR (National Public Radio) in March 2021. The original interview in a written and an audio version can be found here. I would have love to include the voice of a migrant and their experience of the current situation but wasn’t able to find existing interviews or get in contact personally. So, I hope you’ll find the insight of Oscar Londoño interesting.

Oscar Londoño is the executive director of WeCount!, a membership-based organization for immigrant workers in Homestead, Florida of the United States of America. He is explaining the situation of the Latino community and giving reasons why the vaccination coverage rate among the member of that community is low. The reasons that he is giving a diverse. First, there is a lot of misinformation and mistrust within the community, which is facilitated by social media and ongoing rumour between the people. Therefore, a lot of myths exist around the vaccine and its effects. And because the access to information is limited due to language barriers, these misinformation don’t get resolved. But the hesitancy because of the misinformation isn’t the limiting factor, as the immigrants also struggle with simple access to the vaccines. Even before the pandemic the community had problems with access to health in general, e.g. because of the lack of housing (therefore not having an addres), not having access to the internet to apply for an vaccine or not having an photo ID. A third problem is the fear of legal consequence if they get in contact with health services while being an undocumented migrant. 

The organisation WeCount! is trying to provide help by creating solutions for the migrants. They are doing this by providing information in the native language of the people (a variety of Mayan indigenous languages) and supporting the migrants in the online application process in their own computer lab. 

This example, even though it is from nearly one year ago and set in a slightly different situation regarding vaccine distribution, gives us a brief snapshot of the situation migrants can face in this pandemic. From my perspective, there are two main emerging themes. On one hand the barriers to access the vaccines and on the other hand the hesitancy to get the vaccine. The impact of each theme on the vaccination coverage might differ between country/region but seem to still be there. For each of them, there are solution needed and should be solved by the responsible health authority. Especially, if there is the aim to achieve high vaccination coverage rates. Therefore, one can just hope, that the vaccination programs get a more migrant tailored and targeted approach to reach this vulnerable population within our society. 

I hope you have learned something new this week and got a brief insight into the actual situation of migrants. See you next week for my last blog post, where I’ll wrap things up. 

Best,

Maurice

Last week I talked about creative initiatives that are being taken in order to shift the current status quo in reproductive health care for women, namely creative writing. This week I would like to dig a little bit deeper and talk to you about narrative medicine, and reflect on how this concept can help us put cultural sensitivity into practice. 

Narrative medicine focuses on the experiental world of the patients and runs on the basic principles that they are individuals, rather than cases or variables. Patients can interpret their own health experiences and communicate their perceptions of treatment. Researchers who take on narrative medicine aim to tell the stories of patients who have been marginalized. One of these researchers is Dr. Shameka Poetry Thomas¹. Her grandmother was a traditional healer and a medicine-woman in Georgia’s rural south, and ‘’holding space’’ when talking to women, meaning: listening. This inspired her to go into narrative medicine, she says:

‘’ Holding space, the keystone of my approach to narrative medicine, is defined as the ability to center the lived-experience via the practice of compassion and stillness, without blame, shame, or judgement.’’

Her research focuses on black women’s reproductive health in the U.S., the goal is to contextualize and measure how implicit (and explicit) racial bias manifests at the clinical encounter, concentrating on the lived-experiencies of these women. Reproductive health inequality is correlated with lack of access and racial discrimination. When trying to understand these women’s perspectives, this can help to identify areas for improvement and interventions for vulnerable populations. This can help us develope a cultural sensitive approach in reproductive health care. 

What I really take from this narrative medicine, is the importance of storytelling by all those women. Even more so the opportunity they get to be able to tell their story and be listened to, and actually being heard! Giving them a sense of feeling heard will make huge differences in their experiences and adherence to health care. At least, that is what I experienced myself when working at an Asylum Seeker Centre (ASC). As I have shared with you, I am also working as a midwife. A few years ago I worked at a practice that also provided midwifery care to women living at the ASC. These women come from different countries with numerous different beliefs and traditions. All these contradictory beliefs can be quite challenging to cope with as a woman new to this country and culture. Unfortunately, health care providers do not always make this challenge easier, due to their own discomfort or the lack of patience or willingness to really understand their patient. I could share different stories here, but a story that really moved me is a story about a young woman who had fled Syria with her husband and three children. During their journey they encountered a little boy who had lost his parents when fleeing, so they took him into their family. Once she came for her check up with us, she mentioned that she preferred not to be treated by a male doctor. This did not come as a shock, we’re used to women asking this. We are aware that women have different standards of modesty and that this can affect their wishes and utilization of health care.²  When discussing these wishes with the gynaecologist, his primary reaction was ‘’too bad, that is not how the Dutch system works’’. Which is, in fact, true. However, the ease with which he brushed it off the table struck me. Especially since I knew the whole story. Ofcourse the beliefs of this woman played a role in her not preferring a male doctor, but the most important reason was the fact that she was abused by men from the Taliban in her home country. Because we took the time to let her tell her story we were able to understand where she was coming from regarding her wishes, able to explain how the Dutch system works and able to come to a solution where we could not guarantee that there was going to be a female doctor, but could about a female nurse being present. Most importantly, she felt heard and supported. Luckily not all stories are this massive, sometimes it was just about being able to carry out a tradition or conversations about different views on contraceptives. But these stories always remind me of the power of listening. 

Listening, a skill I believe we could apply more in daily life as well. 

Hope to see you back next week!

1.       https://nimhd.blogs.govdelivery.com/2021/10/05/storytelling-through-narrative-medicine-measuring-the-lived-experiences-of-black-womens-reproductive-health/ 

2.       Andrews, C. S. (2006). Modesty and healthcare for women: understanding cultural sensitivities. Community Oncology, 7(3), 443-446.