Healthcare encounters between asylum seekers and health professionals in Maltese primary care

Abstract

Background

There is a substantial body of literature that discusses the problematic nature of asylum seeker healthcare in several European countries. However, little is known about how asylum seekers experience primary healthcare in Malta.

Aim

This paper draws on a qualitative study that aimed to explore the nature of healthcare encounters between asylum seekers and healthcare professionals in Maltese primary healthcare and the contextual processes which influence these interactions.

Methodology

The study utilised critical ethnography, informed by postcolonial theory. Data were collected through observation of encounters between healthcare professionals and asylum seekers (130 hours) and in-depth interviews with asylum seekers (n11), cultural mediators (n4) and Maltese healthcare professionals (n7).

Results

Thematic analysis of the combined data resulted in three themes: ‘the impact of seeking refuge’, ‘seeking mutual understanding’ and ‘seeking resolution’. Healthcare encounters between asylum seekers and professionals are characterised by ‘othering’ practices, pre-conceived expectations and mutual mistrust. These are shaped by a complex interplay of factors, including damaging experiences of migration, derogatory political and public discourses and inadequate resources.

Conclusion

In Maltese primary care, healthcare encounters are highly problematic for both patients and professionals. Nurses could take the lead in developing services to assess complex needs and aid asylum seekers in navigating the healthcare system.

Keywords

asylum seekers cross-cultural healthcare encounters healthcare provision primary healthcare

Get full access to this article

View all access options for this article.

References

Alpers

(2018) Distrust and patients in intercultural healthcare: a qualitative interview study. Nursing Ethics 25(3): 313–323.

Amnesty International (2016) Refugees and migrants fleeing sexual violence, abuse and exploitation in Libya, 1 July. News. Available at: https://www.amnesty.org/en/latest/news/2016/07/refugees-and-migrants-fleeing-sexual-violence-abuse-and-exploitation-in-Libya (accessed 5 February 2020).

Amnesty International (2020) Malta: waves of impunity. Available at: https://www.amnesty.org/download/Documents/EUR3329672020ENGLISH.PDF (accessed 2 October 2020).

Asylum Information Database (AIDA) (2020). Country report: malta, april. Available at: https://Users/Joanna/Downloads/aida_mt_2019update(5).pdf (accessed 9 June, 2020).

AIDA (2021) Country report: duration of detention. Available at: https://asylumineurope.org/reports/country/malta/detention-asylum-seekers/legal-framework-detention/duration-detention/

Bradby

Thaper-Bjorket

Hamed

, et al. (2019) Undoing the unspeakable: researching racism in Swedish healthcare using a participatory process to build dialogue. Health Research and Policy Systems 17(2). DOI: 10.1186/s12961-019-0443-0.

Braun

Clarke

(2006) Using thematic analysis in psychology. Qualtitative Research in Psychology 3(2): 77–101. DOI: 10.1191/1478088706qp063oa.

Carabott

(2021) Unsafe, inhumane, illegal: inside malta’s migrant centres during a pandemic”. Times of malta. 10^th March. Available at: https://timesofmalta.com/articles/view/unsafe-inhumane-illegal-inside-maltas-migrant-centres-during-a.857119

Cassar

(2020) Using the internationally recognised frameworks of Nursing competencies to address the challenges of nurse refugees without documentation. Tuning Journal for Higher Education 8(1): 53–73. DOI: 10.18543/tjhe-8(1)-2020.

10.

Chiarenza

Dauvrin

Chiesa

, et al. (2019) Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure. BMC Health Services Research 19: 513. DOI: 10.1186/s/2913-019-4353-1.

11.

Costa

(2020) Malta will not tolerate lack of EU solution on migration. Commissioner johansson told”. MaltaToday, 24 February. Available at: https://www.maltatoday.com.mt/news/national/100589/malta_will_not_tolerate_lack_of_eu_solution_on_migration_commissioner_johansson_told#.X23DDpMzYn0 (accessed 1 April 2020).

12.

DaSilva Rebelo

Fernandez

Achotegui

(2018) Mistrust, andger and hostility in refugees, asylum seekers and immigrants: a systematic review. Canadian Psychology 59(3): 239–251. DOI: 10.1037/cap0000131.

13.

Depares

(2016) Asylum Seekers and Primary Care in Malta: A Critical Exploration of Healthcare Encounters. Unpublished PhD. Available at: https://dora.dmu.ac.uk/bitstream/handle/2086/17474/'e-thesissubmission(JoannaDepares)'-AsylumSeekers&PrimaryCareinMalta-Acriticalexplorationofhealthcareencounters.pdf?sequence=1

14.

Dixon-Woods

Kirk

Agarwal

, et al. (2006) Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology 6: 35. DOI: 10.1186/1471-2288-6-35.

15.

El-Gamal

Hanefeld

(2020) Access to health-care policies for refugees and asylum-seekers. International Journal of Migration, Health and Social Care 16(1): 22–45.

16.

European Commission (2021) Malta: new policy denies asylum seekers from safe countries the right to work. European website on integration, 11 June. Accessed at: https://ec.europa.eu/migrant-integration/news/malta-new-policy-denies-asylum-seekers-from-safe-countriesthe-right-to-work

17.

Falzon

Micallef

(2008) Sacred islands or world empire? Locating far-right movements in and beyond malta. Journal of Contemporary European Studies 16(3): 393–406. DOI: 10.1080/14782800802501039.

18.

Falzon

(2019, 9 May) A matter of human rights: malta’s experience of migration. The Green European Journal. Accessed at: https://www.greeneuropeanjournal.eu/a-matter-of-human-rights-maltas-experience-of-migration/

19.

Fang

Sixsmith

Lawthom

, et al. (2015) Experiencing ‘pathologized presence and normalized absence’; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status. BMC Public Health 15: 923. DOI: 10.1186/s12889-015-2279-z.

20.

Gandhi

(1998) Postcolonial Theory: A Critical Introduction. 2nd edition. New York, NY: Columbia University Press.

21.

Grove

Zwi

(2006) Our health and theirs: forced migration, othering and public health. Social Science & Medicine 62: 1931–1942.

22.

HUMA (2011) Access to healthcare and living conditions of asylum seekers and undocumented migrants in Cyprus, Malta, Poland and Romania. Available at: https://ec.europa.eu/migrant-integration/librarydoc/access-to-healthcare-and-living-conditions-of-asylum-seekers-and-undocumented-migrants-in-cyprus-malta-poland-and-romania (accessed 10 January 2011).

23.

Human Rights Directorate (n.d.) Intercultural and anti-racism unit. Accessed at: https://humanrights.gov.mt/en/Pages/InterculturalandAnti-RacismUnit/About-the-Intercultural-and-Anti-Racism-Unit.aspx

24.

International Organisation for Migration (2020) Missing migrants: tracking deaths along the migratory routes. Available at: https://missingmigrants.iom.int/region/mediterranean (accessed 28 July 2020).

25.

Kang

Tomkow

Farrington

(2019) Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK. British Journal of General Practice 69(685): e537–e545. DOI: 10.3399/bjgp19X701309.

, et al. (2021) Asylum seekers and refugees experiences of accessing healthcare: a qualitative study. BJGP Open 5(6): 0059. DOI: 10.3399/BJGPO.2021.0059 .

27.

Lodge

(2014) African refugees in the southern mediterranean. In: Grech

Wohlfeld

(eds) Migration in the Mediterranean: Human Rights, Security and Development Perspectives.Malta, UK: Medac.

, et al. (2016) The value of the theoretical framework of candidacy in exploring access and experiences of healthcare services. Health Psychology Update 25: 3–11.

29.

Migrant Liaison Office (2019) Culture mediator service. Available at: https://deputyprimeminister.gov.mt/en/phc/mhlo/Pages/cmiph.aspx (accessed February 2020).

30.

Mohammed

(2006) Moving beyond the “exotic”. Applying postcolonial theory in health research. ANS. Advances in Nursing Science 29(2): 98–109.

31.

Nimführ

Otto

Samateh

(2020) Denying, while demanding integration: an analysis of the integration paradox in Malta and refugees’ coping strategies. In: Hinger

Schweitzer

(eds) Politics of (Dis)Integration. IMISCOE Research Series. Cham, Germany: Springer. DOI: 10.1007/978-3-030-25089-8_9.

32.

NSO (2021) News release. World Population Day. Available at: https://nso.gov.mt/en/News_Releases/Documents/2021/07/News2021_122.pdf (accessed 11 July 2021).

33.

Olsen

El-Bialy

Mckelvie

, et al. (2016) Other” troubles: deconstructing perceptions and changing responses to refugees in Canada. Journal of Immigrant Minority Health 1: 58–66.

34.

Phillimore

Bradby

Brand

, et al. (2021) Exploring Welfare Bricolage in Europe’s Superdiverse Neighbourhoods. Oxfordshire, UK: Taylor & Francis Ltd.

35.

PICUM (2010) Healthcare in NOWHERELAND: Improving Services for Undocumented Migrants in the EU. Work Package No.6: The Voices of Undocumented Migrants. Malta, UK: Undocumented Migrants’ Health Needs and Strategies to Access Healthcare in 17 EU countries Country Report.

36.

Roberts

MLA

Schiavenato

(2017) Othering in the nursing context: a concept analysis. Nursing Open 4(3): 174–181. DOI: 10.1002/nop2.82.

(2017) Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ Open 7: e015981. DOI: 10.1136/bmjopen-2017-015981.

38.

Sansone

(2020) Maltatoday survey/migration, the opposition and COVID-19 are the top three concerns. MaltaToday, 28th July. Available at: https://www.maltatoday.com.mt/news/data_and_surveys/103830/migration_the_opposition_and_covid19_are_top_three_concerns#.YS33VNMzZQI

39.

Svenberg

Mattson

Lepp

(2013) Encounters with patients from Somalia: experience among vocational trainees in Swedish general practice. International Journal of Medical Education 4: 162–169. DOI: 10.5116/ijme.51fc.dc05.

40.

Teal

Street

(2009) Critical elements of culturally competent communication in the medical encounter: a review and model. Social Science and Medicine 68(3): 533–543. DOI: 10.1016/j.soscimed.2008.10.015.

41.

Thomas

(1993) Doing Critical Ethnography: Qualitative Research Methods Series 26. United States of America. Thousand Oaks, CA: SAGE Publications.

42.

Van Liempt

Bilger

(2012) Ethical challenges in researh with vulnerable migrants. In: Vargas-Silva (ed) Handbook of Research Methods in Migration. Camberley, UK: Edward Elgar Publishing Ltd.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.54 MB