Some observations on the meeting in Geneva Meeting, dated 26.11. 2009:

Part III (by Rashmi Singla)

 

Some observations on the meeting in Geneva Meeting, dated 26.11. 2009

by Rashmi Singla, Associate Professor, Roskilde University, Denmark

Member of the COST HOME action's Management Committee

 

These notes are fragmentary and do not set out to give a complete report on the meeting but just highlight certain themes on two of the presentations on the first day of the meeting.

 

Migration of health Workers - Migrants as partners and resources

In this meeting the main theme is perception of migrants and migrant health workers not just as problems; but as a resource and partners. This relatively under focused theme in relation to the migrants´ health and social  care  was covered by macro as well as micro level studies in diverse geographical contexts within differential disciplines and approaches. Not only the issues such as health professional shortage, workforce crisis, brain drain and brain gain in the transnational context were dealt with, an array of critical evaluations of some strategies and some viable solutions to these controversial issues were also covered.

 

Nadav Davidovitch, Ben Gurion University, Israel

Recognising and Absorbing the Immigrant Physician: The Israeli Experience with Physicians from the Former Soviet Union, 1970-2000

Within the framework of a historical perspective from Israel, this presentation documented the salience of the political ideology and willingness for a well managed integration of health professionals and thereby could be a relevant source of inspiration for the current phenomena of such migration from the developing countries to the so called developed countries, especially in Europe. The unique narrative of absorption of 12,000 physicians from the former Soviet Union with just 9000 Israeli physicians in the 90s is embedded in focus on health as a part of the Zionist ideology and the states´ inclusive policy supporting a fast procedure of re-licencing the recently migrated physicians. The factors of ulpan (intensive linguistic courses), alya stipend (economic support), temporary housing and positioning in the military can be summed up as the basis for the successful professional and cultural integration of these health professionals. A follow up five year later further confirmed the success as almost 4/5 of the physicians were still professionally active. However, the critical points such as the ambivalence in the state policies “I need you. I will help you, I don’t need you,” the fate of the physicians who could not be relicenced depending on the age, experience, ‘dedication’ factor should also be considered.

A number of questions were raised after the presentation. The answer to the questions were related to the presence of non-Jewish doctors in Israel indicated that there are a limited number of non-Jewish Physicians, as most of the middle class Palestinians ‘left’ the country in the fifties. However there are a large number of Arab male nurses. The question about the children of the Jewish doctors in the UK, who came as medical refugees and left for the US and Canada, was not answered and pointed as a theme for further research. While the reply to the question regarding the fate of the ‘unsuccessful’ indicated that a number of them worked as nurses and some migrated further to the US or Canada. Furthermore, it was mentioned as a response to a question about the processes of positioning of the target group that even the ‘successful’ physicians were placed in the peripheral areas and the army implying subtle processes of discrimination for the migrant health professionals exercised by the powerful system organisations such as Israeli Medical Association, chamber of doctors, Ministry of health, in spite of the apt metaphor of ‘an experienced sponge’ for Israel.

The presentation thus illustrated succinctly the supportive aspects and barriers in the successful absorption of migrant health professionals in the receiving society, primarily at a structural and intergroup level, which could inspire the other countries grappling with the challenges and dilemmas of current phenomenon of migrant health professionals.

 

Julia Pueblo Fortier, Resources for Cross Cultural Health Care

The next presentation“ Use of foreign Workers as Cultural Intermediaries” , focused on the American and Canadian context in the contemporary time, provided inspiration for constructive ways of perceiving migrants as resources by including practice based knowledge from a couple of projects. With a starting point at the intergroup and personal level, the challenges facing the migrant health professionals such as linguistic proficiency, differential model of patient care (such as traditional, paternalistic, patient centered), differential values related to the psychosocial issues etc. were delineated. With about 12% foreign born health workers, the salience of creation of synergy between the needs of patients and the staff is emphasized. Against the backdrop of shortage of trained health workers in the US, the NGO initiated project “Welcome back” directed attention towards the immigrant health professionals who were trained in the country of origin and were not working in the health sector. The subjective barriers at different levels in the licensing process and the systematic focus on the educational qualifications etc. was mapped out for number of person, which formed basis for relevant training, support leading to job placement. There were a large wift of related jobs such as medical secretarial training, medical transcription work. The results indicated that about 50 % of the approximately 2000 persons contacted by the project managed to get their licenses and jobs in the health sector. Thus focus on the resources of the migrants and supportive training could lead to minimising of the “brain loss”.

The question asked was related to the problem of generalising the situation of the migrants  “putting them all in one basket”, and the answer emphasized the need to avoid the negative stereotype and perceive the unique person behind the “migrant” label. While the reply to the question about the concept of “cultural competence” as ignoring the power dimension, pointed to the problems involved in the reductionist conceptualisation. Our colleague from the UK, psychiatrist Albert Persaud  problematised culture as a knowledge tool, popularly perceived as “samosa, saree and curry” in the British ( South Asian) context! This discussion thereby illustrated further need to add nuances to the taken – for - granted concepts.

 

Comment: On the whole the presentations did provide some answers to the problems related to shortage of health professionals and their migration formation. A simultaneous focus on the global changes, broad societal aspects in the country of origin and the country of residence and the health professionals’ subjective psychosocial situation is needed to deal with these issues.