, , , , , , , , , , , ,

Refugee women in New Zealand: Findings and recommendations

Today on International Women’s Day, it seems apt to share this article that I wrote on behalf of our research team for the Women’s Health Action Update, volume 16, Number 43, December 2012. Women’s Health Action is a charitable trust, that works to “provide women with high quality information and education services to enable them to maintain their health and make informed choices about their health care”. Their focus is on health promotion and disease prevention and they are particularly supportive of breastfeeding and screening. Their vision is ‘Well women empowered in a healthy world’.

More than 80 per cent of the world’s refugees are women and their dependent children. Often women of refugee backgrounds [1]are constructed within deficit frames as having high needs. This representation is problematic as it deflects attention from considering broader historical, social, systemic and political factors and the adequacy of resettlement support.

Little is known about the experiences of women who enter New Zealand through the Women at Risk category identified by The Office of the United Nations High Commissioner for Refugees (UNHCR). This category constitutes up to 75 places (10%) of New Zealand’s annual refugee quota of 750. Refugee Services worked with AUT University and the three Strengthening Refugee Voices Groups in Auckland, Wellington and Christchurch to undertake a project to examine the resettlement experiences of women who enter New Zealand through this category or become sole heads of households as a consequence of their resettlement experiences. This project was funded by the Lotteries Community Sector Research Fund.

The project was important not only for its findings but also for the research process, which focused on strengths, social justice, community development and transformative research. This transformative agenda aimed to enhance the wellbeing of refugee background women by focussing on the roots of inequality in the structures and processes of society rather than in personal or community pathology (Ledwith, 2011). Within this frame we were committed to constructing refugee women as an asset rather than deploying a deficit model of refugee women as a burden for the receiving society (Butler, 2005).

Focus groups were held in 2009 and 2010 with women who entered New Zealand as refugees under the formal category ‘Women at Risk’ or became women who were sole heads of households once they arrived in New Zealand. Women that took part had lived in New Zealand from between five months to sixteen years.  Lengthy consultations were held with the three Strengthening Refugee Voices groups in Auckland, Wellington and Christchurch prior to undertaking data collection, in order to scope and refine the research focus and process. These groups were subsequently contracted to provide services and support.

Key findings

Although support needs are similar to all refugees arriving in New Zealand, there were unique and exacerbated gender issues. Refugee background women experienced a double burden of stress with half the support, especially as they parented on their own. This is despite the tremendous unpaid and voluntary support provided by faith and ethnic community members. Women frequently postponed their own aspirations in order to assure the future of their children. When they were ready to take up further education (including English language classes) or employment, limited assistance was then available (given the focus on early resettlement) leading to women feel disadvantaged.

We have made several recommendations based around several specific themes. More broadly we recommended that:

  • More intensive and longer term instititutional support be made available from agencies such as Refugee Services.
  • Subsidised practical help be made available.
  • Assistance to broaden sources of support and networks is goven.
  • Subsidised English language lessons and childcare are available.
  • That a one stop shop/holistic support from culturally and linguistically skilled refugee community insiders be provided.

Parenting

Raising children in New Zealand brought new stresses. These included concern about the loss of culture, values and language and losing their children to less palatable values including the consumption of alcohol and drugs, gender mixing and loss of respect for elders. Women addressed these issues in a range of ways that included trying different less hierarchical styles of parenting, attempting to spend more time with their children, engaging them in broader supports eg mosque. However, a few women had the experience of losing their children through the intervention of CYFS and felt disempowered in their interactions with CYFS and with schools.

  • Programme for parenting for Refugee women, particularly around issues such as discipline, inter-generational gender issues
  • Programmes for young people.
  • Cultural competence training for CYFS.

Family reunification

Living in New Zealand is difficult for women who are conscious of their own comfort while other family members struggle. However, the cost of bringing family members over is prohibitive and the costs involved in providing support in the form of phone calls and remittances add a burden to already stretched lives of the women. The importance of extended family is highlighted for women on their own and the kinds of help that could be provided by family members. Additional stresses are the requirement that refugee women are able to support their families once they arrive in New Zealand. The process is also made difficult by the lack of transparency in the immigration process.

  • Prioritise the reunification with family for women who are here on their own.
  • Provide financial support to women.
  • Increase transparency of the processes and decisions that are made.

Health system

Women encountered a different health system that at times was difficult to navigate. Many women felt that their health concerns were not taken seriously and that the health system created new problems. In terms of some health beliefs and stigma there was value in having more culturally appropriate services available. The surfeit of refugee background health professionals was a potential resource that was not being used.

  • Train and employ a more ethnically, religiously, and linguistically diverse health workforce at all levels
  • Develop culturally responsive services.
  • Examine the affordability of services.
  • Develop cultural competence of staff working in health services.

Education

The cost and availability of day care for Refugee women on their own is prohibitive in some cases consuming the lion’s share of their income/benefit. Taking up loans in order to finance their own educations is also a problem. This prevents women from achieving their own goals such as learning English, driving or further education, which would assist them in the long term with employment and independence. Women generally considered their own advancement as secondary to their children. If women were resourced financially to gain an education this would assist them to also be a resource for their children. Having long-term support to enter the workforce would also be of benefit.

  • Subsidised day care for women on their own.
  • Mentoring.
  • Scholarships for further education.

Employment

Women were concerned that their children were not getting employed despite tertiary qualifications. Barriers to employment included: ‘lack’ of New Zealand experience, language barriers, their perceived difference (clothing, culture, skin colour) and paucity of appropriate childcare, poor public transport. The impacts of unemployment included losing their dignity, health impacts of taking inappropriate jobs, boredom

  • Subsidised driving lessons, support with transport
  • More work with employers to destigmatise refugee workers
  • Work mentoring/brokering services
  • Support for family members who come into New Zealand through the reunification category to obtain further education

Racism

Refugee women and their families experienced a range of racism related harms that were instititutional and interpersonal taking physical and verbal forms. Their clothes and accent marked them out, and verbal altercations saw stereotypes being invoked particularly around Islamophobia and discourses of war on terror. Women deployed a range of strategies to cope with racism including minimising the racism and helping their children to cope with it.

  • Social marketing campaigns
  • Community education
  • Addressing structural racism
  • National conversation on racism
  • National campaign against racism

The research team hope that this research provides a snapshot of the role and value of various sectors in enabling or constraining the resettlement of refugee background women. This could contribute to better informing theory, practice and policy in order that the self-determination and resilience of refugee background women and their communities is supported.

 

[1] Note that terms like ‘refugee background women’ and ‘communities’ refer to highly diverse groups of people (Butler, 2005). In capturing the experiences of refugee women as sole heads of households, we were mindful of the potential that using a category could imply a “single, essential, transhistorical refugee condition” (Malkki, 1995, p.511).

 

/by
, , , , , , , , ,

A fair go? Using liberal principles to support Islamophobia and racism.

I am interested in the issue of fairness. Anyone with siblings might be I would think. Whether it’s about making sure everyone gets an equally sized piece of cake or equal chances to speak, fairness has been a driving force in my life that I might have inherited.  As one of three daughters it was very important to our parents that we were treated fairly. So every birthday and Christmas we got the same kinds of presents, matching housecoats, matching crockery and so on. I kinda like the way I can go to both my sisters’ houses and enjoy drinking from the same cups. But over the years I’ve realised that treating people the same (is universalism) isn’t always all it’s cracked up to be and sometimes we need to treat people differently (particularism) to support them to get their needs met. For example, my parents have a prolific avocado tree and out of all my sisters I like avocados the most (hint hint), therefore is it fair that we all get the same number of them? This issue has resonance in health too, treating everyone the same can result in differential outcomes and sometimes you need to treat people differently to get the same outcome-for example for different population groups to have a long life different strategies might be needed. Which brings me to the issue that’s driving this blog post. How can we ensure that what we do is fair? and how do we define what fairness is? How might discourses invoking equality reinforce inequity and oppression?

The backlash against KONY 2012 did something useful. It made people think twice before re-posting items on their newsfeed and drew attention to the ways in which activism through social media can go horribly wrong. Joshua Foust says KONY 2012 accentuated the challenges “of enthusiastic support for someone who seems to be doing the right thing without really investigating whether their methods are the best, and privileging the easy and fun over the constructive”. In the case of the social media whirl around Russian punk band Pussy Riot, Foust’s criticism is that a serious concern about the erosion of political freedoms and civil liberties has been converted into a celebration of feminist punk music and art, detracting from the brutality and mistreatment being meted by Putin’s government to Russian activists or political prisoners.

It’s been a lousy few weeks for women in the west. The Julian Assange saga, Republican Todd Akin’s stupidity and comments that women can’t get pregnant from rape and more. But even more grump inducing has been the appearance on my Facebook feed of more white saviour complex campaigns, this time run by white feminists. Feminism is supposedly about building a fairer and more just society for women, but these campaigns only reinforce the limitations of western feminisms for engaging with axes of oppression such as ethnicity, racialisation and social class. This isn’t my only beef with western feminisms, the others are that they have a decidedly liberal tone with a focus on individual rights and also the frequency with which feminist discourses are co-opted for neoliberal ends. For example, the way in which western feminisms have legitimated expansionist neoliberalism, think Muslim women needing to be rescued from the Taleban by the Enlightened West in Afghanistan.

This hero/martyr narrative in this annoying image from Feminists United is illustrative of a hierarchy that pits western women against non-Western women.

The advert represents a white woman as a hero, both educated and modern and able to freely exercise choice and control over her own body. In contrast, the ‘non Western woman’ is represented as oppressed by her culture, other women and tradition, all of which impinge on her sexuality. The comments on this image included:”Indeed, a horrific practice that comes from satan’s kingdom of darkness and needs to end; ” and “In Africa 3000 girls every day!!!”. Thankfully commentators also pointed out the racist and imperial assumptions of this advert. The comments recentre Western feminisms rather than expose the limitations of Western epistemological frameworks for making sense of women’s experiences outside the West. Given my own health background, I’m conscious of the ways in which FGM/C is constructed as a health issue. The image implicitly reifies the superiority of Western medicine for having the values most emblematic of Western civilisation such as enlightenment, benevolence and humanitarianism. We’ll just ignore the collusion of Christian missionary medicine and biomedicine in the advancement of colonialism and imperialism.

One of my intellectual and political concerns is with the ways in which certain practices and subjectivities are privileged through liberal feminist discourses that actually replicate the colonising impacts of heteropatriarchy (even though feminism was developed to critique it). These liberal feminist discourses construct femininity within particular norms such as being liberated that are within normative modes of middle class white behaviour. Racialised “oppressed” women are constituted as a threat to the liberal and neoliberal projects of self regulation and improvement which in turn reinforce the centrality of a white world view

The comments on the second set of images that popped up on my feed were also disturbing, viewing Muslim women as victims of their male partners. The comments framed the woman as unagentic and Muslim males as dominating and unable to control their sexual drives. The inability to recognise sexism and misogyny closer to home in the context of Todd Akin talking about “legitimate rape” were interestingly absent. This ‘fighting sexism with racism’as Sherene Razack (1995) calls it fills me with dismay, especially when differences are framed as a civilisational clash between western liberal values of equality and individualism versus the patriarchal, hierarchical and communal values of the ‘other’.

As Arundhati Roy articulates in a pointed essay:

Western-liberal feminism (by virtue of its being the most funded brand) [has become], the standard-bearer of what constitutes feminism. The battles as usual, have been played out on women’s bodies, extruding Botox at one end and Burkhas at the other. (And then there are those who suffer the double-whammy, Botox and the Burkha.) When, as happened recently in France, an attempt is made to coerce women out of the burkha rather than creating a situation in which a woman can choose what she wishes to do, it’s not about liberating her, but about unclothing her. It becomes an act of humiliation and cultural imperialism. Coercing a woman out of her burkha is as bad as coercing her into one. It’s not about the burkha. It’s about the coercion. Viewing gender in this way, shorn of social, political and economic context, makes it an issue of identity, a battle of props and costumes. It’s what allowed the US Government to use western feminist liberal groups as moral cover when it invaded Afghanistan in 2001. Afghan women were (and are) in terrible trouble under the Taliban. But dropping daisy-cutters on them was not going to solve the problem.

These coercive aspects reeking of cultural imperialism and humiliation have been close to home this week in Aotearoa with the furore over the decision by Lower Hutt’s Dowse Art Museum to ban men from seeing a video work by Qatari-American Sophia Al-Maria. The video Cinderazahd: For your eyes only was filmed in a woman only section of her grandmother’s home in Doha and shows Muslim women preparing for a relative’s wedding without their veils. Al-Maria requested that it only be shown to women and children in keeping with the belief that male strangers should not see their faces. However, this ban on mail viewers has resulted in complaints of gender discrimination to the Human Rights Commission.

The Dominion Post argues:

The real issue is that the Dowse is a ratepayer-funded organisation. As such, it should not be using the public purse to stage exhibits from which some ratepayers are excluded. The sum involved in this case – $6000 for the complete exhibition of 17 artists – is small, but the principle is important.

Clearly, the conflict between Al-Maria offering a work that can be seen only by women and the gallery’s duty to ensure equal access to all those who contribute towards funding it cannot be reconciled. That being the case, the Dowse should withdraw the video from the exhibition and Al-Maria should find a private gallery in which to show it.

Luckily there’s been some great responses from the blogosphere. Especially from QOT who says:

There’s a lot of argument going down around the fact that the Dowse is publicly-funded, is this discrimination, do we owe it to the poor oppressed brown women to tear away their autonomy because they’re too stupid to know they’re oppressed … yeah, guess where I fall on that one.

QOT checks our Human Rights legislation and notes that it is not unlawful to discriminate on the ground of religious belief (within particular circumstances). QOT acidly remarks that this legislation is what enables Catholics to ban women from the priesthood, but who’s complaining? If the primary complainant was a male student taking a third-year compulsory Art History paper where half the final exam marks were based on the film this would then disadvantage the males in the class. But is not being able to see that exhibit going to disadvantage the complainant really? Wise words also from Gaayathri, pointing out how important it is for those who are marginalised to be able to create and have access to safe spaces. Gaayathri cynically notes how the incident smacks of using Islamic women’s rights as a political football and if we indeed gave a damn then listening to their wishes would be a great start, and even better respecting the boundaries that have been set for the viewing of the work.

Contemporary racism is covert and subtle, a response to the social taboo against the open expression of racist sentiments. It is also more likely to be denied by majority group members.What I find most interesting about the Dowse drama is how the parameters of cultural consumption can only be set by the dominant culture. Whether it’s invoking the white saviour discourse or railing against so-called Islamic oppression, it’s the dominant white settler culture who decides how much culture is palatable and in what form. Setting boundaries results in the range of devastating comments that you can see on the interweb and it shows me that the veneer of civility is wafer thin. Kiwis can indeed hold negative views of particular groups in tandem with liberal principles of equality, tolerance, fairness and justice and just as quickly invoke these liberal values of fairness and equity in the service of  Islamophobia and racism. Our attitudes and beliefs in New Zealand haven’t been tested in the same way Australians have. They are forever in the spotlight about asylum seekers, but what it does make me think is that we should not be too complacent in New Zealand about the moral high ground. In all of this, what I am most grateful for is that like KONY 2012, these frustrating and painful incidents provide an opportunity to consider more deeply questions of freedom and liberation and more importantly to find out who our allies are.

/by
, , , , , , , , , , , ,

Sisters, friends or whānau?

This is a lengthier version of an editorial published in this month’s Kai Tiaki New Zealand Nursing Journal. It is based on an invited address I gave at the 10th Annual Conference of the Women’s Health Section:’Divine Secrets of the Sisterhood’ on April 26th  2012.

I recently spoke at the NZNO Women’s health conference about sisterhood. Not that I don’t care about men (I do deeply), but as one of three sisters and as a woman who has spent most of my adult life working in the female dominated profession of nursing, relationships between women are of great personal and professional interest. The call to action in the women’s movement almost thirty years ago emphasised sisterhood and demanded the end of oppression and the commitment to women as a social group (Klein & Hawthorne, 1994). However, the movement also raised questions of difference. Many suggested that in order to understand what women had in common they also needed to pay attention to what they didn’t have in common such as race, gender and sexuality. Focusing on similarity erased and overlooked important differences, but only focusing on difference led to the “othering” of others, stereotyping and pushing people away.

I believe these questions remain important for nursing, because I think our differences can make nursing stronger. An understanding of our differences can help us to better understand our similarities. As Audre Lorde points out “it is within our differences that we are both most powerful and most vulnerable, and some of the most difficult tasks of our lives are the claiming of differences and learning to use those differences for bridges rather than as barriers between us”. So I believe an important question for nurses is how can we capitalise on the energy and movement in difference and resist the coercive force of sameness?

One of the challenges is that differences raise critical issues of power, because differences are often institutionalised (Crenshaw,1994, p.411). Take the idea of the implicit ideal nurse-typically the ideal nurse is female, white, middle class, heterosexual, able bodied, nice, obedient and nurturing (Giddings, 2005; Reverby, 2001). Those nurses that fit the norm experience privilege and those that don’t are marginalised. Internationally, women of colour are present in practice settings with less prestige, lower wages, less security, and less professional autonomy (Gustafson, 2007). While, a disproportionate number of white men and women are ensconced in nursing management, academia and research, whose world view is supported by the dominance of white, Western, biomedical interpretations of health and illness. Grada Kilomba defines whiteness as “a political definition, which represents historical, political and social privileges of a certain group that has access to dominant structures and institutions of society”.  As Ang-Lygate (1997, p,2) points out “political sisterhood is suspect unless those sisters who enjoy privileges denied to other sisters are seen to share the responsibility of dismantling the differences”.

This dominance of whiteness in our workforce and our ideas about health and illness are present in nursing in New Zealand too. We are undergoing a period of unprecedented diversity. Transitioning from largely New Zealand-born European to being increasingly ethnically diverse, our dependence on overseas-born migrant nurses is evident in their composition of 29% of the workforce- one of the highest proportions in the OECD. At the same time Māori and Pacific Islands nurses are under-represented in our workforce while these communities experience the greatest health need. This inequity is challenging and as Margaret Southwick notes provides “justification (if one be needed) for the claim that nursing needs to take seriously the challenge of working with diverse and marginalised groups within society is to be found in the health status of these very same groups of people.” (Southwick, 2001).

So given the diversities in nursing and the health inequities that confront our communities, new strategies are necessary. I’m proposing moving away from sisterhood which implies the shared experience of being a woman and experiencing gender oppression to consider a new metaphor that allows greater consideration of our differences so that we can better articulate our similarities (Simmonds, 1997). There’s friendship for a start, a relationship based on equals who have affection, and interest in each other (Friedman, 1993, p.189). Its etymology is in the word free. It means to love, to love our own freedom, and to love and encourage the freedom of the other (Mary Daly, 1987). Friendship allows us to work in each other’s interests because part of what is compelling is our differences.

The notion of friendship as an alliance within the context of difference can be seen in this brilliant blog post entitled Queer Sisters Keep Saving Me: The Brilliantly Selfish Act of Being an Ally by Black Artemis

Heterosexual people especially women owe a tremendous debt to the LGBTQ struggle for some of the sexual freedoms we enjoy…the boundaries queer people bend and bust at the risk of their own lives in many ways expand our heteronormative privilege. Their radical decision to be simply who they are makes it much safer for the rest of us to redefine who we may want to be. We have a broader range of acceptable sexual expression because of the queer liberation movement for every time they push the envelope, they set a new “normal,” and it’s not even they who benefit the most for their courage. Rather it is those of us whose sexual identity is already validated.

If we are going to use the metaphor of sisterhood we consider the idea of a “chosen family” used by LGBTQ communities or the Māori concept of whānau. It too is based on love rather than biology and includes people as who are a source of love and support outside the heteronormative idea of family.

I’d like us to strengthen nursing by strengthening ourselves, for creating space for all nurses to be able to come together with our diverse traditions and values, to be united based on solidarity not sameness. I’d like us to be able to articulate our shared beliefs and practices while acknowledging how we differ.

I’m proud to be a nurse in New Zealand, I value the shared commitment to caring and to social justice in the shape of cultural safety. I’d like to build on our legacy and see nurses critically examine the values, goals, and intents shaping our profession. I’d like us to have some challenging conversations about power and privilege, to deconstruct our own classism, racism, and homophobia and to think about recognition and reparation. I leave my final words to Audre Lorde:

So this is a call for each of you to remember herself and himself, to reach for new definitions of that self, and to live intensely. To not settle for the safety of pretended sameness and the false security that sameness seems to offer. To feel the consequences of who you wish to be, lest you bring nothing of lasting worth because you have withheld some piece of the essential, which is you.

References

ANG-LYGATE, M., CORRIN, C. & HENRY, M. S. 1997. Desperately seeking sisterhood: Still challenging and building, London, Taylor and Francis.

CRENSHAW, K. 1994. Mapping the margins: Intersectionality, identity politics, and violence against women of color. In: FINEMAN, M. A. & MYKITIUK, R. (eds.) The public nature of private violence. New York: Routledge.

DALY, M. (1978) Gyn/Ecology: The Metaethics of Radical Feminism, Boston: Beacon.

FRIEDMAN, M. 1993. What are friends for?: feminist perspectives on personal relationships and moral theory, New York: Cornell University Press.

GIDDINGS, L. S. 2005. Health disparities, social injustice, and the culture of nursing. Nursing Research, 54, 304.

GUSTAFSON, D. L. 2007. White on whiteness: Becoming radicalized about race. Nursing Inquiry, 14, 153-161.

HAWTHORNE, S. & KLEIN, R. 1994. Australia for Women: travel and culture, New York, Spinifex Press.

LORDE, A. 2009. Difference and Survival: An Address to Hunter College” Rudolph, New York:, Oxford University Press.

REVERBY, S. 2001. A caring dilemma: Womanhood and nursing in historical perspective. In: HEIN, E. C. (ed.) Nursing issues in the twenty-first century: Perspectives from the literature. Philadelphia: Lippincott, Williams and Wilkins.

SIMMONDS, F. N. 1997. Who Are the Sisters? Difference, Feminism, and Friendship. 19-30. In ANG-LYGATE, M., CORRIN, C. & HENRY, M. S. 1997. Desperately seeking sisterhood: Still challenging and building, London, Taylor and Francis.

SIMMONDS, F. N. 1997. Who Are the Sisters? Difference, Feminism, and Friendship. Desperately Seeking Sisterhood: Still challenging and building, 19-30.

SOUTHWICK, M. R. 2001. Pacific women’s stories of becoming a nurse in New Zealand: A radical hermeneutic reconstruction of marginality. Unpublished Doctoral thesis, Wellington: Victoria University of Wellington.

 

/by
, , , , , ,

Questions haunt nursing student

In 2007 a student nurse called Lisa Kenyon wrote to the Kai Tiaki asking questions about nursing. I’ve reprinted her letter here and then my response. It seems relevant at the moment

I am a year-one nursing student from Waiariki Institute of Technology, doing my bachelor of nursing at Windermere in Tauranga. I have recently been out on my first practicum for three weeks and have come away with a multitude of questions. I am a 34-year-old married woman with a child, and consider myself experienced in the traumas and joys that life can bring. After finishing my practicum, which I thoroughly enjoyed, I was left reflecting on my personal experience with the elderly.

I cared for a dear man who unfortunately died in my second week of being his student nurse; I was so privileged to have spent that time with him and his family. But I was left with a list of questions and thoughts to which I have no answers. Maybe there are no answers and maybe, with more nursing experience, these questions will make sense, but for now I want to share my thoughts and wonder how other experienced nurses or student nurses have overcome these difficulties.

The questions that bother me are: Can a nurse “care” too much? Don’t patients deserve everything I can give them? How do I protect myself and still engage on a deeper level with the patient? How do I avoid burnout? Why can’t I push practice boundaries, when I see there could be room for adjustment or improvement? Isn’t it okay to feet emotionally connected to the patient? Don’t I need to continually ask questions, if nursing is to change, or will that just get me fired?! Finally, am I just being a laughable year-one student, with hopes and dreams and in need of a reality check?

I would really appreciate feedback from other student nurses who have felt the same or from experienced nurses with some insight into these questions, as I am left doubting what kind of nurse I am going to be.

Lisa Kenyon, nursing student, Waiariki Institute of Technology, Tauranga.

My response below:

I was pleased to see Lisa Kenyon’s letter, Questions haunt nursing student, in the December/ January 2006/2007 issue of Kai Tioki Nursing New Zealand (p4). The questions she has reflected on indicate she is going to be an amazing nurse.

I believe nursing is both an art and a science, and our biggest tools are our heart and who we are as human beings. I was moved by her letter and thought I’d share my thoughts. The questions she posed were important because the minute we stop asking them, we risk losing what makes us compassionate and caring human beings.

Let me try to give my responses to some of the questions Lisa raised–I’ve been reflecting on them my whole career and continue to do so.

1) Can a nurse “care” too much?

Yes, when we use caring for others as a way of ignoring our own “issues”. No, when we are fully present in the moment when we are with a client.

2) Don’t patients deserve everything I can give them?

They deserve the best of your skills, compassion and knowledge. Sometimes we can’t give everything because of what is happening in our own lives, but we can do our best and remember we are part of a team, and collaborate and develop synergy with others, so we are resourced and can give our best.

3) How do I protect myself and still engage on a deeper level with the patient?

I think we have to look after our energy and maintain a balance in our personal lives, so we can do our work weft. We also need healthy boundaries so we can have therapeutic communication.

4) How do I avoid burnout?

Pace yourself, get your needs met outside work, have good colleagues and friends, find mentors who have walked the same road to support you. I’ve had breaks from nursing so I could replenish myself.

5) Why can’t I push practice boundaries, when I see there could be room for adjustment or improvement?

I think you can and should, but always find allies and justification for doing something. Sometimes you have to be a squeaky wheel

6) Isn’t it okay to feet emotionally connected to the patient?

Yes, it is okay to feel emotionally connected to the patient, but we also have to remember that this is a job and our feelings need transmutation into the ones we live with daily.

7) Don’t I need to continually ask questions, if nursing is to change, or will that just get me fired?

Yes, you do have to ask questions but it is a risky business. Things don’t change if we don’t have pioneers and change makers.

8) Finally, am I just being a laughable year-one student with hopes and dreams, and in need of a reality check?

No, your wisdom and promise are shining through already and we want more people like you. Kia Kaha!

Ruth DeSouza RN, GradDipAdv, MA, Centre co-ordinator/Senior Research Fellow, Centre for Asian and Migrant Health Research, National Institute for Public Health and Mental Health Research Auckland University of Technology

/by
, , , ,

When activists become oppressors: Nurses and migrant mothers.

This Sunday I’ll be doing a Picnic lecture where I’ll be sharing stories from nurses and migrant mothers from my PhD to discuss how well intentioned activism can become a form of oppression. The lecture will be held in the Albert Park rotunda in Auckland on Sunday 1st April at 3pm and is linked with Te Tuhi’s What do you mean, we? exhibition which brings together an international selection of artists to examine prejudice.

The kinds of questions that my work has been concerned with are:

  • What subjectivities and beliefs and values are being reproduced when a woman has a baby in neoliberal Aotearoa New Zealand?
  • How does a maternal health care system provide services for birthing women whose subjectivities have been partially or significantly formed outside a white settler nation context and specifically outside the colonial dyad of settler and indigenous?
  • Do the policy rhetoric of biculturalism in response to Treaty of Waitangi obligations and the requirement for culturally competent practice actually improve the care migrant mothers receive?
  • Do the liberal feminist aspirations for birth as an empowering experience extend to women outside the world of white middle-class feminism?
/by
, , ,

Power relations

Hot off the press! I’ve just had this chapter on power relations published in S. Shaw, A. Haxell & T. Weblemoe (Eds.), Communication and lifespan development. Melbourne: Oxford University Press

Many practitioners see themselves as apolitical and powerless, particularly with regard to their relationships with the structures of medicine and management. However, in reality practitioners are powerful both as individuals and as members of the groups with which they identify. The structures and cultures within which most health and disability practitioners exist and work are based on beliefs and practices that constrain autonomy. These constraints are at work through a number of mechanisms, such as the market, the infusion of targets and performance measures and quality programmes (Newman & Vidler, 2006). In addition, the changing role of consumers or service users from passive recipients of care in the past to people who may be informed, empowered, articulate and ‘demanding’ poses a threat to the ‘knowledge–power knot’ on which professional power rests.

When practitioners view themselves as people who are doing good, they tend to lack awareness of their complicity and embeddedness in relations of power that structure inequality. Yet, power is embedded in everyday practices and interactions (Bradbury Jones, Sambrook & Irvine, 2008). Practitioners within the wider health and disability sectors contribute to social regulation through their roles as employees of the state. They enact government policies for the benefit of the health of the citizens of the state; so they are both governed and governing. Members of recognised professional groups are provided with a moral authority by their capacity to define problems and pose solutions, and their role in defining and evaluating good or normal behaviour and health practices through surveillance of the population and the criteria for interventions on behalf of the state (Gilbert, 2001, p. 201).

These ambivalent relationships with power that are evident among health professionals require exploration. This can be done by considering the various ways in which power is conceptualised and the micro and macro definitions of empowerment. Some shifts in power have occurred in the last few decades, largely influenced by various social movements. Maternity and mental health are two particular examples of professional practice and service delivery in which power can be recognised and ideas of empowerment can be translated meaningful engagement between service delivery and those who engage with the service.

/by
, ,

How can nurses truly celebrate cultural diversity?

Editorial published in Kai Tiaki: Nursing New Zealand 13.4 (May 2007): p2(1).

American feminist psychologist and theorist Carol Gilligan once said that without voice there cannot be relationship, and without relationship there cannot be voice. (1) How do we have relationships with people who are different from us? How do we and the other person have a voice in the relationship, if we don’t know what our common ground is?

The 2006 Census reveals European New Zealanders make up 67.6 percent of the population, 14.6 percent of people self-identify as Maori, Pacific peoples make up 6.9 percent of the population, Asians 9.2 percent and Middle Eastern, Latin American and African people, 0.9 percent. (2) The Census also revealed that nearly 23 per cent of New Zealand’s population was born overseas, compared with 19.5 per cent in 2001. In terms of religious affiliation, 55 per cent said they were Christian, down from 60.6 per cent in 2001. And 1.3 million New Zealanders said they had no religion. The number of Hindus increased by 61.8 percent to 64,392, Muslims went up 52.6 percent to 36,072 people and the number of Sikhs was 9507, up 83 percent. (2)

This religious and cultural diversity has implications for nurses and those we care for. How do we have relationships with people of different cultures and religions? How can we, as nurses, cultivate relationships and ensure we have a voice, and ensure our colleagues and clients who are “diverse”, have a voice too? What does celebrating cultural diversity actually mean for nurses, other than taking part in a cultural festival or having friends from diverse backgrounds? What does it mean for systems that are primarily monocultural and are striving to be bicultural? And what does that mean for the increasing number of people from diverse ethno-religious communities?

New Zealand has a long history of migration, but the range and number of migrants in New Zealand has been on an unparalleled scale since 1987. With that have come demographic changes. I recently gave a two-hour talk about diversity, and afterwards a nurse asked “What about our (Pakeha) identity? What is going to happen to it?” She is not the only person worded about the loss of identity, as witnessed by the cry “What has happened to my country?” in letters to the editor and heard on talkback radio. For those of us who have migrated here, it is hard to understand why people from the dominant culture feel marginalised, when we are surrounded by Pakeha/white New Zealand culture, in terms of all the institutions and power bearers.

Interaction rather than co-existence

These concerns highlight a need for dialogue and I am reminded of the work of Lebanese-Australian anthropology professor, Ghassan Hage, who suggests the way forward is through interaction, rather than co-existence. (3) When we co-exist, we can idealise or demonise the other, but never really get to know them. But when we interact, it requires us to move forward in relationship, even when it is tough and frustrating. There are potential gifts of working from a place of interaction and these occur when we can say “Let’s take the best of both/many cultures and see what new and wonderful things we can create”.

Richard Florida has written about the creative class where new ideas and technologies have been developed in the United States as a result of attracting the best and the brightest from around the world and harnessing the creativity inherent in diversity. (4) This is where interaction comes in–we have to rub up against one another, experience conflict and find a way forward for creativity to kick in.

To harness such potential in health in New Zealand we need to address the political and policy Landscape of health. Nursing Council statistics show that migrant nurses made up 51 percent of new registrations in 2005-2006. (5) This percentage raises many questions: What do we have in place to assist the effective integration of new migrant nurses? What is good practice for those who employ migrant nurses? Who is responsible for ensuring that this happens well? What support mechanisms need to be in place to create innovation in health? How do receiving nurses create new spaces and places for cultural diversity?

Migration has always had an element of economic necessity, a tap which could be turned on and off, as and when we needed more labour. But, increasingly, receiving countries are beginning to realise people don’t just migrate for a job. They migrate for a life and for their dreams and aspirations. This means they put down roots and settle and want a home and a voice in their new country. In the short-term period of settlement, it is about such things as getting a job, financial independence, establishing a social network and adapting to various aspects of lifestyle. In the long-term period of integration, it is about career advancement, income parity, accessing institutions, redefining cultural identity, adapting or reassessing values, and participating in political parties and socio-political movements.

I have a number of suggestions about how we move forward with diversity: use it for our creative endeavours; see newcomers as a source of innovation; along with maintaining our obligations to Maori under Te Tiriti o Waitangi, ensure all who live in Aotearoa/New Zealand enjoy equitable access to services and enjoy equal rights, responsibilities and opportunities to participate in, contribute to and benefit from all aspects of life. Finally, recognise that we all share responsibility for the continuing development of Aotearoa New Zealand as a cohesive and harmonious society. Contributing to our own communities and venturing outside them, would be a great start.

References

(1) Gilligan, C. (1982) In a Different Voice: Psychological Theory and Women’s Development. Cambridge, Massachusetts: Harvard University Press.

(2) New Zealand’s 2006 Census of Populatino and Dwellings. (2006) 2006 Census Date. Statistics New Zealand. http://www.stats.govt.nz.ezproxy.aut.ac.nz/census/default/htm. Retrieved 20/04/07.

(3) Hage, G. (2002) Against Paranoid Nationalism: Searching for Hope in a Shrinking Society. Australia: Pluto Press.

(4) Florida, R. (2002) The Rise of the Creative Class and How it’s Transforming Work, Leisure, Community and Everyday Life. http://www.amazon.com/Rise-Creative-Class-Transforming-Community/dp/ 0465024769. Retrieved 20/04/07.

(5) Clark, M. and Ayling, B. (2006) Workforce Statistics 2006 Update. Presentation to Nursing Council Forums. http://www.nursingcouncil.org.nz/forum.html. Retrieved 20/04/07.

“How can nurses truly celebrate cultural diversity?” Kai Tiaki: Nursing New Zealand 13.4 (2007): 2.

/by