Latin American migrants in London – accessing their rights?

Jasmine Gideon Birkbeck College

Outline

• Conceptual framework • Latin Americans in the UK• The study• Health seeking behaviour among Latin

Americans in London• Constraints to accessing ‘the queue’ • Exiting ‘the queue’

Access to health care

• Rights and entitlements to health care determined by migration policy in destination country

• Even where migrants have right of access other criteria may exist to determine ‘real’ access

• ‘Rules’ govern ‘access to queue’ (Sabates Wheeler and MacAuslan, 2007; Schaffer, 1971)

• Formal and informal rules in operation• Rules are gender biased and do not accommodate

‘new players’ (Goetz, 1997)• ‘Healthy migrant’ model (gender biased)

Latin Americans in London • Size of population estimated between 700.000 –

1million • Largest population groups are Brazilians,

Colombians and Peruvians • Predominantly concentrated in London• Recent influx are predominantly economic

migrants many of whom have arrived via Spain • Concentrated in low paid low status work• Unrecognised as minority group and lack voice in

public arena

Health seeking behaviour among Latin Americans in London

• 81% of respondents had access to a GP • 44% had used A&E services • 39% of respondents have used a private doctor

(Ecuadorians most likely to use private system and Brazilians least likely)

• Majority of respondents stated perceived quality of care was reason for use of private sector

• 29% respondents return home to use medical and dental services (Peruvians most likely and Bolivians least likely to do so)

• More women than men had used a GP and women more likely to go to the private sector (source: Mcilwaine, forthcoming)

The Study

• Pilot study conducted with 25 participants• Participants predominantly recruited through

London-based NGO (LAWRS) and other contacts as well as snowballing technique

• Participants predominantly female• Semi-structured interviews conducted of up to

an hour each

Constraints to accessing the queue

• Entry status– Gendered nature of entry status

• Lack of knowledge of rules – ‘healthy migrant’ category – health not a priority– Gender roles and responsibilities around finding out

info– Lack of knowledge on part of health providers

• Cultural values and expectations– Lack of understanding of GP role – Dissatisfaction with ‘paracetamol treatment’

Exiting the queue

• Transnational health seeking strategies – Return to Latin American for treatment – Ring health professional in Lat Am – Ask family members to send medication – Ask family members to visit traditional healer– Use of internet counselling

Exiting the queue

• Self diagnosis and medication – Migrants may stock up on medication before coming

to UK – Problem of mis-use and out-of-date medication – Nature of work performed by migrants often means

they lack time to attend GP surgery or clinics and do not understand rights in terms of sick leave

• Visit Latin doctors in UK – One of private consultations with registered GPs – Use of unregulated doctors - ‘El Shaman’

‘I was working really hard and it is difficult for me to take time off work. I had a fever and was not well, I had some tablets that I have taken back home so I took them but then I was really ill, I think they must have been out of date. I started vomiting really badly and had a really high fever and chronic pains in my stomach. Luckily my cousin was with me so he rang an ambulance. When they came though they just thought that I had taken drugs but my cousin kept trying to explain to them what had happened. This then led to lots of other problems with my stomach afterwards and I am sure it was because these tablets were out-of-date’.

‘We knew that he wasn’t a ‘real’ doctor as his surgery was at the back of a hairdressing salon in Elephant and Castle. He told us he had trained in Concepcion and was here doing an internship at Kings. We just thought he was moonlighting…I remember that he gave my nephew some tablets from a big box with a label on and then dispensed them into a plastic box and said something about having to keep the box himself’

‘…the thing is that in the end my nephew said that El Shaman was the only doctor who had really helped him’

Role of networks

– Link between networks and health outcomes– women play predominate role in networks around health

knowledge and information – Transnational / national/ local networks in operation– Networks shown to play contradictory roles among Latin

community in UK (McIlwaine) – Many Latin women lead fairly isolated lives due to nature

or work in UK – Can have advantages and disadvantages– Can serve to reinforce gendered roles and responsibilities

around health care

Conclusions

• Implications for longer term health needs of Latin American migrants in UK and health of their children

• Need to strengthen ‘voice’ of Latin community in debates around health provision in UK

• Role of governments in ensuring citizens understand UK health system (Colombian Embassy initiative)

• Need for empirical studies that address the gap between legal entitlements and actual access to resources