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Medical pluralism: Supporting co-existing diverse therapeutic traditions in mental health

This was first published in the Spring 2015 edition (Issue 41) of the Federation of Ethnic Councils of Australia (FECCA) national magazine, Australian Mosaic. Cite as: DeSouza, R. (2015). Medical pluralism: Supporting co-existing diverse therapeutic traditions in mental health. Australian Mosaic (FECCA). 41, 34-36.

Decades afterward, I still recall the frequent waking, getting out of bed and moving around our Nairobi house in the dark. Sometimes I moved pots and pans, re-arranged furniture, but mostly I caused a disturbance. My parents decided to address my distressing behaviour by taking me to an older woman from our Goan community who chanted
prayers and anointed me with chilli and garlic. Her incantations arrested the nocturnal disturbances, which never perturbed me again. The evil eye was diagnosed, the somnambulism caused by envy, inflicted on me with a look. I later learned that the
evil eye is seen as the cause of many problems and illnesses globally with a multitude of rituals and remedies to either prevent or cure it.

Charm- Niall Corbet on Flickr

My own experience of being a multiple migrant and then a clinician, led me to consider many possible antecedents to mental illness. The dominance of biomedicine to manage health and illness, assumes cross-cultural universals. Yet, mental health is a contested specialty with problematic treatments. Culturally derived norms and values from a specific location impose labels on behaviour from another context, which drive treatments, or management that flattens those contexts. Psychiatry and counseling are often viewed skeptically by people from refugee and migrant backgrounds who instead turn first to informal sources outside the health system including self-help, family, community, social networks, various forms of spirituality, religion and church. Increasingly, clinicians are appreciating the part these sources of support play.

Once mental health services are accessed, if staff focus on mental illness without understanding the cultural context or without realising that clients and their families might integrate both biomedical and more “traditional” beliefs, quality psychiatric assessment can be impaired and the potential for inaccurate diagnosis and inappropriate treatment and care can occur. Incorrectly identifying culturally appropriate behaviour or experiences as psychopathology is problematic, just as assuming that something is cultural rather than psychopathology or symptoms. However, every culture has frameworks for understanding health and illness and how these are demarcated.

In Aotearoa New Zealand, where I have spent most of my life, Maori psychiatrist Mason Durie has conceptualised Maori health as encompassing mental (hinengaro), physical (tinana), family/social (whänau), and spiritual (wairua) dimensions. In Australia, the National Aboriginal Health Strategy (1989) views wellbeing through a communal lens, broadening the concept of well-being beyond the to the social, emotional and cultural well-being of the whole community. Situating Aboriginal and Torres Strait Islander mental health within a framework of social and emotional wellbeing emphasise wellness, harmony and balance rather than illness and symptom reduction (AIHW 2012). Connection to land, culture, spirituality, ancestry, family and community, interdependence between families, communities, land, sea and spirit are also seen as necessary for health. The Ways Forward National Aboriginal and Islander Mental Health Policy Report 3 (pp19-20) adapted from Swan and Raphael also prioritises holism, self-determination, the need for cultural understanding, the impact of history in trauma and loss, human rights, acknowledges the impact of racism and stigma, kinship, cultural diversity and Aboriginal strengths.

Contemporary neoliberal health discourses have co-opted patient rights movements and positioned patients as consumers ­­-active partners in health who are responsible for their own health. Consumer engagement and health literacy form a suite of strategies for inducing medical citizenship, so that individuals can participate and become knowledgeable consumers. Some would argue these are assimilatory processes. However, in order for medical citizenship to be a two way process, one’s own beliefs about the causes of illness and the corresponding treatments must also be considered. Health literate organisations must also be open to a multiplicity of illness explanations and to those locations from which such beliefs are derived. As Beijers and de Freitas (p.245), note:

Health care is transforming social suffering into illnesses and diagnoses, while often denying the social and moral origins and implications of the suffering

David Ingleby suggests that two perspectives are available for thinking about culture and mental illness. A technical perspective assumes mainstream frameworks and treatments can be universalised to all patients/clients and that more sensitivity and overcoming linguistic and cultural barriers will assist therapeutic efforts. With a technical approach to mental health, the goal of care is to deliver it efficiently and increase utilization (efficacy). Strategies can include access to language matched information and professional interpreting services, or improving mental health literacy and awareness, supporting community resilience and coping strategies. However, technical approaches do not ask questions about power imbalances between groups.

On the other hand when care is given through a critical lens (equity), the questions become what is going on when interventions developed for one population are applied to another? What are the underlying power relations? Whose interests are being served? Is there a covert attempt to impose the values and perspectives of the dominant group? Ingelby suggests that becoming a user of Western health care involves accepting its underlying philosophy and values and “acquiring health literacy”.

It is important that collaborations between traditional healing mechanisms and western practice are made possible, however within professional discourses traditional healing is frequently viewed as primitive and unprofessional, yet people often utilize different health beliefs simultaneously in their search for optimal treatment. Furthermore, assimilation and acculturation into the dominant culture are thought to negatively impact on migrant health status and to contribute to migrant ill health and disparities as the healthy migrant advantage that people arrive with reduces after a year. Developing collaborative models that combine traditional and Western health knowledges and combining health literacy and consumer participation with better access and quality of staff can indeed facilitate better health outcomes.

As an educator, I am interested in how I can do my part to increase the awareness and openness to pluralism, so that the next generation of nurses can be effective and therapeutic. There is guidance available from The Cultural Diversity Plan for Victoria’s Specialist Mental Health Services. There is an emphasis on being respectful and having non-judgmental curiosity about other cultures. Mental health workers are encouraged to seek cultural knowledge in an appropriate way, tolerate ambiguity and develop the ability to handle the stress of ambiguous situations. In addition, developing a family-sensitive practice, where family and community resources are viewed as partners in recovery as appropriate allow syncretism and innovation to take place. There are significant institutional barriers remaining to this in mental particularly the emphases on privacy, independence and the one-to-one relationship between consumer and professional.

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Knowledge and action, developing evidence for an equity agenda

Speech given at the launch of a partnership between Monash University and Centre for Culture, Ethnicity and Health (CEH) April 29th 2015 and the celebration of CEH’s 21st birthday.

I would like to show my respect and acknowledge the traditional custodians of this land on which this launch takes place, the Wurundjeri-willam people of the Kulin Nation, their elders past and present. I’d also like to acknowledge our special guests: The Honorable Robin Scott – Minister for Multicultural Affairs/Minister for Finance, Phillip Vlahogiannis the Mayor of the City of Yarra, Chris Atlis the Deputy Chair of North Richmond Community Health (NRCH), Councillor Misha Coleman and Baraka Emmy, Youth Ambassador for Multicultural Health and Support Services. I’d also like to acknowledge: Professor Wendy Cross; CEO of the Centre for Culture Ethnicity and Health (CEH) Demos Krouskos; General Manager of CEH Michal Morris, representatives from the Department of Health and Human Services and other government departments, healthcare service partners, clients, NRCH and CEH staff and community members.

It’s an honour to take up this joint appointment between the Centre for Culture Ethnicity and Health (CEH) and Monash School of Nursing and Midwifery, there are some wonderful synergies which allow both organisations to jointly advance a shared goal of equity and quality in health care for our communities, and in particular for people from refugee and migrant background communities. As most of you know, Victoria is the most culturally diverse state in Australia, with almost a quarter of our population born overseas. Victorians come from over 230 countries, speak over 200 languages and follow more than 135 different faiths. This role is an acknowledgement of this diversity, and the need for health and social services that are equitable, culturally responsive and evidence based.

The gap this role addresses

Monash takes its name from Sir John Monash:  an Australian, well known for being both a scholar and a man of action. He is quoted as having said “…equip yourself for life, not solely for your own benefit but for the benefit of the whole community.” I am excited about the ways in which this new role can both strengthen CEH’s leadership and expertise in culture and health; and strengthen Monash’s position as a provider of dynamic and collaborative research-led education. In thinking about the world of the university and the world of practice, the words of Abu Bakr resonate: “Without knowledge, action is useless and knowledge without action is futile.”

What we have in common

I believe this relationship combines knowledge and action which will benefit both organisations and their staff, but even more importantly the communities that we are all here to serve. Key to this partnership success is the generous and collaborative spirit with which the leadership of both organisations have come together and which bodes well for the future. What we have in common as organisations is:

  • Firstly, a commitment to responsive clinical models of care that consider social determinants of health. In a world where health is increasingly industrialised and individualised, both Monash and CEH affirm the importance of communities in a healthy society
  • Secondly, both organisations aim to develop a health and social workforce that can work effectively and safely with our communities. CEH and NRCH know how to work with communities, having expertise in advocacy and community-building roles advocacy and community-building roles to contribute to healthier social and physical environments. Monash know how to educate and inspire practitioners to link their practical knowledge to the centuries of research and scholarship that universities are custodians of around the world.
  • Thirdly, the two organisations aim to keep clients and their families at the centre of care, to recognise that despite all our professional expertise it is the recipient of care who ultimately determines successful outcomes.
  • Fourthly, the organisations seek a system of care that is both just and equitable – just as the university seeks truths that are universal while we research in the here and now, so too we need more than ever to maintain our ideal of a healthy society for all.
Dr Ruth De Souza, Professor Wendy Cross, Michal Morris, The Hon Robin Scott – Minister for Multicultural Affairs/Minister for Finance.

Dr Ruth De Souza, Professor Wendy Cross, Michal Morris, The Hon Robin Scott – Minister for Multicultural Affairs/Minister for Finance.

 Benefits of the relationship

I forsee a number of benefits for both organisations from this role. CEH has a distinguished track record in supporting health and social practitioners to respond sensitively and effectively to the issues faced by people people from refugee and migrant backgrounds , and this will be of benefit to students and staff at Monash as we prepare a rapidly changing workforce for a  rapidly changing workplace.

Monash has an international reputation for high quality and research and education, and CEH will use this expertise to advocate and campaign for change. CEH will be exposed to the university’s dynamic intellectual environment and its knowledge of global currents in cultural research and health research, strengthening its expertise in cultural competence and giving the organisation a platform to lead a much needed translational research agenda.

There have been enormous amounts of work undertaken internationally in my own research areas of cultural safety and cultural competence. Yet there is still so much more to be known about what works and how institutions and practitioners can respond to our changing world. The relationship with Monash will provide both organisations with an opportunity for research output that is grounded, that can be disseminated both in academic settings such as conferences, academic  books and journals, into the sphere of practice and to a range of audiences. The relationship allows for a reciprocal re- examination of priorities and practices about equity in health in research, teaching, and service delivery. I am excited to be working in this dynamic partnership and look forward to helping the partners in their quest for an innovative, resilient and responsive health system for our changing world.

To conclude, I am grateful to the leadership that has made this role and partnership happen, my profound thanks go to the CEO of CEH Demos Krouskous, GM Michal Morris, Professor Wendy Cross, all the magnificent staff here at Monash and at CEH who have made me so very very welcome and lastly to all of you here who have made time to provide your presence and support.

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Cultural safety in Aotearoa New Zealand 2nd Edition

Very excited about the 2nd Edition of Cultural safety in Aotearoa New Zealand being published by Cambridge Press in December 2015.

I’ve contributed two chapters and I have excerpted the introduction of each chapter below:

8. Navigating the ethical in cultural safety

Caring is an ethical activity with a deep moral commitment that relies on a trusting relationship (Holstein & Mitzen, 2001). Health professionals are expected to be caring, skilful, and knowledgeable providers of appropriate and effective care to vulnerable people. Through universal services they are expected to meet the needs of both individual clients and broader communities, which are activities requiring sensitivity and responsiveness. In an increasingly complex globalised world, ethical reflection is required so that practitioners can recognise plurality: in illness explanations; in treatment systems; in the varying roles of family/whanau or community in decision making; and in the range of values around interventions and outcomes. To work effectively in multiple contexts, practitioners must be able to morally locate their practice in both historical legacies of their institutional world and the diversifying community environment. This chapter examines the frameworks that health professionals can use for cross-cultural interactions.I then explore how they can select the most appropriate one depending on the person or group being cared for.

IMG_2910

13. Culturally safe care for ethnically and religiously diverse communities

Cultural safety is borne from a specific challenge from indigenous nurses to Western healthcare systems.It is increasingly being developed by scholars and practitioners as a methodological imperative toward universal health care in a culturally diverse world. The extension of cultural safety, outside an indigenous context, reflects two issues: a theoretical concern with the culture of healthcare systems and the pragmatic challenges of competently caring for ethnically and religiously diverse communities. As discussed throughout this book, the term ‘culture’ covers an enormous domain and a precise definition is not straightforward. For the Nursing Council of New Zealand (‘the Nursing Council’) (2009), for example, ‘culture includes, but is not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual belief; and disability’.

In an attempt at a precise two-page definition, Gayatri Chakravorty Spivak (2006, p. 359), captures the reflexive orientation required to grasp how the term ‘culture’ works:

Every definition or description of culture comes from the cultural assumptions of the investigator. Euro-US academic culture… is so widespread and powerful that it is thought of as transparent and capable of reporting on all cultures. […] Cultural information should be received proactively, as always open-ended, always susceptible to a changed understanding. […] Culture is a package of largely unacknowledged assumptions, loosely held by a loosely outlined group of people, mapping negotiations between the sacred and the profane, and the relationship between the sexes.

Spivak’s discussion of the sacred and the profane links culture to the more formal institution of religion, which has historically provided the main discourse for discussion of cultural difference. Particularly important for cultural safety is her discussion of Euro-US academic culture, a ‘culture of no culture’, which has a specific lineage in the sciences of European Protestantantism. Through much of the 19th century, for example, compatibility with Christianity was largely assumed and required in scientific and medical knowledge, even as scientists began to remove explicit Christian references from their literature. This historical perspective helps us see how the technoscientific world of the healthcare system, and those of us in secular education, are working in the legacy of white Christian ideals, where the presence of other cultures becomes a ‘problem’ requiring ‘solutions’. Cultural safety, however, attempts to locate the problem where change can be achieved in the healthcare system itself.

 

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Other contributors include: Irihapeti Ramsden, Liz Banks, Maureen Kelly, Elaine Papps, Rachel Vernon, Denise Wilson, Riripeti Haretuku, Deb Spence, Robin Kearns, Isabel Dyck, Ruth Crawford, Fran Richardson, Rosemary McEldowney, Thelma Puckey, Katarina Jean Te Huia, Liz Kiata, Ngaire Kerse, Sallie Greenwood and Huhana Hickey.

Book cover

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Learning to listen: Mental health and migration for CALD communities

In Victoria the goal of the Victorian Mental Health Reform Strategy 2009-2019 is to achieve better social and economic outcomes for people with mental illness, their families, carers and friends. Specifically Reform Area 6 outlines areas for reducing inequalities. The Cultural Diversity Plan for Victoria’s Specialist Mental Health Services, 2006-2010 suggests that achieving more culturally responsive services for culturally and linguistically diverse (CALD) and refugee communities is a clear priority given that:

  • Victoria has a diverse population with 24 per cent of Victorians being born overseas.
  • A third of this group come from non-English speaking countries.
  • Culturally and linguistically diverse (CALD) groups often have poorer mental health outcomes compared to Australian-born people, because they tend to present to services when their illness is more severe and therefore are also likely to experience higher rates of involuntary treatment.
  • There are sub-groups articularly refugees and older people who are at risk of developing a mental health problem.
  • Each year Victoria accepts over 3,500 humanitarian entrants (refugees and asylum seekers).
  • Victoria’s CALD population is increasingly being dispersed across the state. in regional and rural areas which requires primary health and mental health services provide culturally appropriate care.
  • Almost half of all CALD Victorians report having experienced some type of discrimination based on their ethnicity or nationality.
  • Experiences of discrimination are associated with depression, stress, anxiety and problematic substance use.

Better mental health outcomes for people of CALD backgrounds must include:

  • Strategies to promote social inclusion;
  • Acceptance of cultural diversity;
  • Workforce development ie develop work practices and cultures in mental health services that support high quality, effective, consumer-focused and carer-inclusive care;
  • Improving access to culturally competent mental health care at earlier stages of illness;
  • Enhancing the capacity of primary health services and workers in CALD community settings to identify, respond earlier to, and refer people with emerging mental health problems;
  • Enhancing mental health literacy and reduce stigma among refugee and asylum seeker groups;
  • Provide mental health literacy training to multicultural, ethno-specific and refugee agencies to improve their understanding of mental illness, so that workers in these agencies can better navigate the mental health service system on behalf of CALD consumers and;
  • Encourage practical partnerships between these agencies and specialist mental health services to facilitate culturally-specific input into clinical treatment and psychosocial rehabilitation plans;
  • Address language needs of CALD clients in specialist mental health services and address supply of interpreters  and promote client and carer awareness of language services;
  • Build on the work of Victorian Transcultural Mental Health and the Action on Disability within Ethnic Communities (ADEC) to improve training.

Migrating minds

In the last week of March 2015 I was honoured to be one of six panelists ranging from consumers, carers, filmmakers, and mental health practitioners to be part of a panel at an event called Migrating Minds: A forum on mental health within Culturally and Linguistically Diverse (CALD) migrant communities.The panel was organised by Colourfest in partnership with Victorian Transcultural Mental Health and held at the State Library of Victoria (SLV). Colourfest celebrates films about diaspora and migrant experiences and shares them with the broader community through free events, professional development/training, distributing films and producing resources.

What was especially wonderful about Colourfest was that consumers and carers were central to the event and got to tell their own stories in the films at the start and in the panel discussion at the end. The event began with seven short films which were stories told by people with a personal experience of mental health issues and perspectives of relatives/carers. Five of the short films were produced by Multicultural Mental Health Australia (MHiMA) and Victorian Transcultural Mental Health. There was also an international short film produced by a second-generation Vietnamese-American who shares their experiences with Depression and Post-Traumatic Stress Disorder.

These fabulous examples of cross-sectoral collaboration were evident in the partnership between Mental Health in Multicultural Australia (MHiMA) in conjunction with the Australian Centre for the Moving Image (ACMI) to produce Finding our way. This unique project focused on migrant and refugee stories where the personal stories of people living with emotional and mental health issues who were negotiating migrancy. Managed by Victorian Transcultural Mental Health (VTMH), St Vincent’s Hospital, Melbourne and the Global and Cultural Mental Health Unit at the University of Melbourne. Erminia Colucci & Susan McDonough coordinated the project for MHiMA. We watched The Visual Conductor by Maria. A story about family expectations, taking charge and staying well involving art, personal goals and play. We also viewed Dear Self by Akeemi, which was about childhood memories, moving to a new country, feelings of isolation and efforts to connect including original drawings and paintings. Both Maria Dimopoulos  and Akeemi from the Finding Our Way film project were also on the panel.

The Our Voices project told the stories of carers from refugee and migrant backgrounds through five short films, showing a poignant insight into the lives of carers from migrant and refugee backgrounds. At the Colourfest panel we were fortunate to view Kevser‘s story. Kevser arrived from Turkey in the late 60’s with her husband and is the primary carer for her daughter. What was extraordinary about this film and the other four (from Afghani, Egyptian, Somali and Vietnamese communities) were the common challenges they faced in finding culturally sensitive and culturally-responsive mental health care and support. The aim of the forum was to help healthcare practitioners, community workers and the general population to understand some of the needs of the CALD community and the films were a powerful mechanism for leading the audience to empathise with the experiences of families. Leyla Altinkaya spoke on behalf of her mother, Kevser on the panel. Our other panelists were Munira Yusuf , a young person speaking from a youth perspective on their lived experiences with mental health issues and David Belasic: A psychologist based at Drummond Street Services. He has a strong interest in community psychology and queer mental health.

Me answering a question from Pham Phu Thanh Hang Colourfest Melbourne Coordinator. Also in the shot from left to right, fellow panellists Akeemi, Maria Dimopoulos, Munira Yusuf and David Belasic.

Me answering a question from Pham Phu Thanh Hang Colourfest Melbourne Coordinator. Also in the shot from left to right, fellow panellists Akeemi, Maria Dimopoulos, Munira Yusuf and David Belasic.

One of the priorities of The Framework for Mental Health in Multicultural Australia: Towards culturally inclusive service delivery is that services evaluate their cultural responsiveness and develop action plans to enhance their delivery of services to CALD communities as part of core business. Central to this responsiveness is having processes where consumers, carers and family members can have a say in the planning, development, delivery and evaluation of services. Particularly important given that CALD consumer and carer participation lags behind mainstream participation. Hence, the importance of this event which placed the experiences of consumers and carers at the forefront.

Cultural competence in mental health emphasises the attributes of the service provider and outcomes of the cross-cultural encounter rather than the unfamiliar culture of the consumer/carer. I love the key elements of cultural competence identified in the Cultural diversity plan for Victoria’s specialist mental health services 2006-2010:

  • Respectful and non-judgemental curiosity about other cultures, and the ability to seek cultural knowledge in an appropriate way;
  • Tolerance of ambiguity and ability to handle the stress of ambiguous situations;
  • Readiness to adapt behaviours and communicative conventions for intercultural communication.

What’s lovely about this list is that it does not constitute a recipe or tick box that can be memorised and then deployed in every intercultural encounter. These qualities are about how we developing a capacity for being in relationship with other people when we cannot assume common ground (which is really kinda always).  I believe that watching the films provided a way to facilitate the beginnings of such a journey..

I am grateful to all those who made the films happen and for making visible the experiences of CALD consumers and carers. A grateful thanks to Gary Paramanathan and Pham Phu Thanh Hang Colourfest Melbourne Coordinator for the opportunity to be part of this wonderful panel.

Note that the Victorian Mental Health Reform Strategy 2009-2019 defines Cultural and linguistic diversity as:

the diversity of society in terms of cultural identity, nationality, ethnicity, language, and increasingly faith. Individuals from a CALD background are those who identify as having a specific cultural or linguistic affiliation by virtue of their place of birth, ancestry, ethnic origin, religion, preferred language, language(s) spoken at home, or because of their parents’ identification on a similar basis. CALD does not refer to an homogenous group of people, but rather to a range of cultural and language group communities.
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Ethnic migrant media: Weaving ourselves a home

Exploring the role, benefits, challenges & potential of ethnic media in NZ .

Paper presented at the Ethnic Migrant Media Forum, Unitec Institute of Technology, Auckland, New Zealand. Also available as pdf from conference proceedings DeSouza keynote.

Tena koutou, tena koutou, tena koutou katoa, it’s an honour to be invited to speak at this forum where we are gathered to talk about ethnic media and the possibilities it offers for our communities. I wish to acknowledge this magnificent whare whakairo (carved meeting house) ‘Ngākau Māhaki’, built and designed by Dr Lyonel Grant which I think is the most beautiful building in the entire world. Kia ora to matua Hare Paniora for the whaikōrero, whaea Lynda Toki for the karanga and this pōwhiri. I acknowledge Ngāti Whātua as mana whenua of Unitec and Te Noho Kotahitanga marae. I acknowledge the organisers of this forum, Unitec’s Department of Communication Studies and Niche Media & Ethnic Media Information NZ, in particular Associate Professor Evangelia Papoutsaki, Dr Elena Kolesova, Lisa Engledew and Dr Jocelyn Williams and all the participants gathered here today.

As a migrant to Aotearoa and now Australia, there are a few places that I call home. Tamaki makau rau and Unitec specifically would be one of those places. This whenua has been central to my own growth and development. I love these grounds, I walked them when I was a student nurse at Oakley hospital in 1986 and then worked in Building 1 or as it was known then Ward 12 at Carrington Psychiatric Hospital in 1987. I also worked here at Unitec as a nursing lecturer from 1998-2004. I have this beautiful Whaariki (woven mat) made from Harakeke (NZ Flax) grown, dyed and woven at Unitec that has accompanied me for over three house moves since I left Unitec and more recently across the Tasman.

Whaariki from Unitec, gifted to Ruth DeSouza

Whaariki from Unitec, gifted to Ruth DeSouza

It is this being at home that interests me as a migrant. Home is the safe space where I can be myself and where there are other people like me. It’s a place where I can be nurtured and supported, where I can thrive in my similarities and in my differences. Where I can see my norms and values reflected around me. I believe that the media can have a special place in helping us to see ourselves as woven through like this exquisite mat as belonging to something larger than ourselves. I believe that it can contribute to helping us feel at home, through it we can feel embraced and included, we can be part of a conversation that can see us in all our glory. However, too often it is also a site where if we are already marginalised, we can be further marginalised.

Advert in the Australian 2013

Advert in the Australian 2013

Today, I am going to briefly talk about the limitations of mainstream media, review some key functions of ethnic media and conclude with some challenges and opportunities for ethnic media. As you’ll see from my bio, I co-founded the Aotearoa Ethnic Network, an email list and journal in 2006 to provide a communication channel for the growing number of people in the “ethnic” category. I’ve been passionately interested in the role of media practices in intercultural relations in health, and also on the relations between settlers, migrants and indigenous peoples in Aotearoa New Zealand. I have been actively involved in ethnic community issues, governance, research and education in New Zealand and Australia.

This hui is timely, given discussions about: biculturalism and multiculturalism; the Maori media renaissance, the growth of Pacific and Asian owned or run media including radio, newspapers, online media; television, web based news services; the underrepresentation of Maori, Pacific and Ethnic in media and journalism; the growth of blogs through early 2000s and the growth in social media (FB, Twitter) in the last decade. It’s also part of a longer conversation, I’m thinking about the forum we had in 2005 organised by the Auckland City Council and Human Rights Commission after the Danish cartoon fiasco, where I talked about the role of media in terms of “fixing” difference or supporting complexity; the role of media in making society more cohesive or divisive or exclusive and the relevance of New Zealand media relevant in the context of growing diasporic media. In that forum I suggested that there was a need for: ethnic media but also adequate representation in mainstream media; the showing of complex multicultural relationships not just ethnic enclaves and ways for people of ethnic backgrounds to be included in national and international conversations. Me and others have also taken mainstream media to task over representations of Asians (Asian Angst story by Debra Coddington);Paul Brennan’s Islamophobic comments on National Radio and Paul Henry’s comments about then Governor General Anand Satyanand. An editorial in the AEN Journal also examines the role of mainstream media in inter-cultural exchange and promoting inter-cultural awareness and understanding. I also challenged media representations of Maori and Pacific people as evidenced in cartoons by Al Nisbet, which were printed in New Zealand media. More recently, I’ve written with colleagues Nairn, Moewaka Barnes, Rankine,  Borell, and McCreanor about the role and implications of media news practices for those committed to social justice and health equity.

Let me start by introducing a fairly binary definition of ethnic media that I am going to use as referring to media created for/by immigrants, ethnic and language minority groups and indigenous groups (Matsaganis et al., 2011). In contrast, media that produces content about and for the mainstream is known as the mainstream media. However, as most of you will know there’s a lot of blurriness and consumers consume both. I also want to preface this talk  by introducing two key words which I am going to use as a lens for this keynote. I believe that these lenses are more important than ever in an era where critique is becoming censured for those in academia and in the context of corporate governance of media. Foucault’s notion of critique which is

“..a critique is not a matter of saying that things are not right as they are. It is a matter of pointing out on what kinds of assumptions, what kinds of familiar, unchallenged, unconsidered modes of thought the practices we accept rest” (Foucault, 1988, p.154).

and Stuart Hall’s definition of ideology:

Ideology: “The mental frameworks – the language, concepts, categories, imagery of thought and system of representation – which different classes and social groups deploy in order to make sense of, define, figure out and render intelligible the way society works” (Hall, 1996 p. 26).

 

It’s in the spirit of critique that I want to talk about the mainstream media’s role in co-option and converting audiences into seeing “like the media”. As Augie Fleras observes, media messages reflect and advance dominant discourses which are expertly concealed and normalised so as to appear without bias or perspective. The integrative role of  mainstream media reflects and amplifies the concerns of particular groupings of power so that attention is drawn to norms and values that are considered appropriate within society. In this way attitudes are created and reinforced, opinions and understandings are managed and cultures are constructed and reinvented. The headline below shows the ways in which language is used to create an “other”, the picture out of focus, the beard a stand in for evil and fear, a threat to national security.

Sponsor a jihad

Sponsor a jihad

Thus mainstream media’s main function becomes commercial, selling by pooling groups together for the purposes of advertising and marketing and in so doing must appeal to a large audience. It can’t be too controversial (unless it’s also supporting larger official agendas such as guarding against the insider Islamic threat or deterring the hordes of maritime arrivals through forcibly turning back the boats) and it cannot segment its audiences with any kind of nuance. I think this meme floating around Facebook captures this idea of communicating some kind of national identity and values well.

team australia

Consequently social media, the internet and ethnic media are seen as able to service more specific audiences. In the case of social media, there’s some great opportunities for connecting beyond the nation state:

As the internet surpasses the nation-state limitations and usually the legislative limitations that bind other media, it opens up new possibilities for sustaining diasporic community relations and even for reinventing diasporic relations and communication that were either weak or non- existent in the past (Georgiou 2002: 25).

 

Moving on to ethnic media, I see several functions or imperatives loosely using the typology by Viswanath & Arora (2000): Ethnic media as form of cultural transmission, community booster, sentinel, assimilator, information provider and one lesser mentioned in the literature, as having a professional development function.

The most obvious role of ethnic media is to provide information for the community, events both local and from the homeland are paid attention to. In the break I was talking to a journalist from Radio Torana who is flying to Brisbane for the G20 summit and to cover Modi’s visit to Australia. Through him I found out about the Modi express. For the first time ever, a train service is running under the name of an Indian Prime Minister from Melbourne to Sydney carrying some 200 passengers who are planning to attend Prime Minister Narendra Modi’s public address in Sydney during his visit to Australia, the first by an Indian premier in 28 years (Rajiv Gandhi was the last, he met with Bob Hawke in 1986). The organisers have arranged for music and dance troupes to entertain the passengers along with free Gujarati specialties like ‘Modi Dhokla’ and ‘Modi Fafda’ (Fafda is crunchy snack made from chick pea flour and served with hot fried chillis or chutney and Dhokla is snack item made from a fermented batter of chickpeas accompanied with green chutney and tamarind chutney).

Photo from India2Australia.com

Photo from India2Australia.com

In its role as cultural transmitter, it has a distributive function to publish or broadcast information that is important to the ethnic community, so information about events and celebrations comes to the fore. This in turn sustains and fosters a sense of belonging to an imagined community, that feels coherent, united and connected to a homeland. However, rarely in that role does it also act as a critic of community institutions or powerful groups within that community.

A second role of ethnic media is as a community booster. In this role the media presents the community as doing well, being successful and achieving. The communities served by the media expect that a positive image is reflected both to its own members and outside the community. Typically close links are fostered between local reporters and editors and the community elite. Stories consist of human interest features, profiles of successful members, particularly those that are volunteers or contribute. There many be a reluctance to feature more radical or critical voices or critical stories as these many adversely affect the community image and the commercial imperative.

A third role is the ethnic media as a sentinel or watch dog. There’s very little about this in the literature but in fulfilling this role, the ethnic media produce stories on issues that could affect the rights of communities, crime against immigrants and so on.

A more common function is that of assimilation, where ethnic media play a part in assisting their community members to be more successful; through learning the ropes of the system. Ethnic media coverage then focuses on the role of the community in local politics and fostering positive relations and feelings between that of the ethnic group’s homeland and adopted country.

Another crucial function which is rarely articulated in this literature, but has been pivotal to my development is that of the ethnic media as space for professional development. Through engagement in ethnic media, members of ethnic communities develop transferrable skills and the capacity to write, broadcast and present. This one is very personally relevant. Through writing for the Migrant News and Global Indian, I refined my writing skills. Through talking on ethnic radio stations like Samut Sari and Planet FM I developed and refined my own capacity to articulate thoughts and ideas. Being featured in stories on Asia Downunder I realised my own ability to speak on television. These opportunities led to developing the confidence to develop my own online journal, the Aotearoa Ethnic Network Journal and write peer reviewed publications and feature on commercial radio and television.  This would never have happened without the support of those ethnic media pioneers. I acknowledge them all.

However, ethnic media is on rapidly shifting terrain. Increasingly consumers are negotiating the availability of media from their place of origin via the internet. Ethnic media are having to consider their roles and business models in the context of neoliberalism and the withdrawal of the state from cultural funding.

The end of the charter. Picture via Against the Current

The end of the charter. Picture via Against the Current

Recently Television New Zealand the public service broadcaster announced that it intended to outsource production of Māori programmes (Marae, Waka Huia) and Pacific (Fresh and Tagata Pasifika) programmes. A depressing move given the unrelenting negative representations of people in these communities who are socially and culturally marginalised in New Zealand mainstream media (see my blog post on how blame for the disparities in health is attributed to individuals and communities rather than neoliberal and austerity policies). This very manoeuvre was used to outsource Asia Downunder a programme which ran from 1994-2011 for Asians in New Zealand and featured the activities of Asians in New Zealand and New Zealand Asians abroad gutted Asian institutional knowledge and capacity within TVNZ when it was replaced with Neighbourhood. Asia Downunder was a casualty of the loss of the Television New Zealand Charter which was introduced in 2003 by the Labour government and removed in 2011 by the National government on the basis that meeting its public service obligations were a barrier to its commercial obligations. The Charter encouraged TVNZ to show programmes that reflect New Zealand’s identity and provided funding. You can read more about its history and gestation and what has been lost in The End of an Error? The Death of the TVNZ Charter and its implications for broadcasting policy in New Zealand by Peter A. Thompson, Senior Lecturer, Media Studies Programme, Victoria University of Wellington.

In this context, I end with several questions. Given that ethnic media institutions help their audiences to reimage or sustain themselves and their place in the cultural and socio-political milieu of their new home (Gentles-Peart):

  • What is the relationship between ethnic media and the ‘mainstream ideological apparatus of power? (Shi, 2009: 599)
  • What is the relevance of ethnic media in terms of the next generation?
  • What is the relationship between ethnic media and indigenous media?
  • How do ethnic media import or reinforce or critique the power structures of immigrants’ homelands including gender, class and sexuality?
  • Are there opportunities for ethnic media to lobby and advocate for their communities?
  • What opportunities and possibilities are available for inter-ethnic media work?

I look forward to summing up the korero at the end of our forum, to report back to the roopu about the strands we’ve woven together and to enjoying the robust and dynamic discussions that I know are going to happen today. No reira me mihi nui kia koutou katoa ano, tena koutou tena koutou, tena ra koutou katoa.

Update: 12th March 2017: the curated conference proceedings of the Ethnic Migrant Media Forum are now available. Edited by Evangelia Papoutsaki & Elena Kolesova with Laura Stephenson.

 

 

 

 

 

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“Kiwi food is okay for Kiwis, but it isn’t okay for us”: Special food in the perinatal period for migrant mothers

I attended the 5th International Conference on Nutrition and Nurture in Infancy and Childhood: Relational, Bio-cultural and Spatial Perspectives from Wednesday, 5 November 2014 – Friday, 7 November 2014.

Those who know me or follow my work will know that I am deeply interested in eating and thinking about food. I’m interested in how food structures our days and our lives,it nourishes and sustains us, reminds us of people, events, history, all in a mouthful.

Birthday cake

A special birthday cake, made for a surfer on his special birthday.

I’ve written elsewhere about how migrants perform identity through food preparation and consumption. I’ve also written about consumptive multiculturalism. I’m also interested in the provision of food in (monocultural) institutional contexts such as health where people are racialised by the foods that they eat and how the processes of hospitalisation strip people of their cultural and social identities and often lead people into being unable to access culturally appropriate food. This presentation brings those ideas together.

Abstract

Food, its preparation and ingestion, constitutes a source of physical, emotional, spiritual and cultural nourishment. Food structures both daily life and major life transitions, including the transition to parenthood, where food is prepared and consumed that recognises the unique status of the mother. However, the reductive focus of hospitals where efficiency, economy and a focus on nutrients dominate and where birth is viewed as a normal event can mean that there is a mismatch between the cultural and religious dietary needs of migrant mothers with the food that is available from Western instititutional environments. In this paper I outline a research study, which examined the transition to parenthood among new migrant groups in New Zealand. Based on a number of focus groups with mothers and fathers, the data were analysed using a postcolonial feminist lens and drew upon Foucauldian concepts to examine the transition to parenthood. The findings show that Asian new migrant parents construct the postnatal body as vulnerable, requiring specific kinds of foods to facilitate recovery from the trials of pregnancy and delivery and optimize long term recovery from pregnancy. This discourse of risk contrasts with the dominant discourse of birth as normal, and signals the limitations of a universal diet for all postnatal mothers, where consuming the wrong food can pose a threat to good maternal health. Paying attention to what nutrition and nurturing might mean for different cultural groups during the perinatal period can contribute to long term maternal well-being and cultural safety. Health practitioners need to understand the meanings and significance attached to specific foods and eating practices in the perinatal period. I propose that institutional arrangements become responsive to dietary needs and practices by providing facilities and resources to facilitate food preparation.

I’m hoping that the written form of the paper becomes part of an edited book about mothers and food. Fingers crossed, it’s under review at the moment.

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‘This child is a planned baby’: skilled migrant fathers and reproductive decision-making

Article first published online: 13 MAY 2014  De Souza, Ruth Noreen Argie. (2014). ‘This child is a planned baby’: skilled migrant fathers and reproductive decision-making. Journal of Advanced Nursing. doi: 10.1111/jan.12448

Risk management and life planning are a feature of contemporary parenting, which enable children to be shaped into responsible citizens, who are successful and do not unduly burden the state (Shirani et al. 2012). This neoliberal project of intensive parenting and parental responsibility (typically gendered as maternal) involves child centredness and detailed knowledge of child development (Hays 1998). Simultaneously, contemporary masculinities are increasingly being situated beyond the traditional Western binary of the active home-caring mother and passive breadwinning father. Following Connell (1995), the plural word masculinities refers to the many definitions and practices of masculinity (See e.g. Archer 2001, Cleaver 2002, Finn & Henwood 2009, Haggis & Schech 2009, Walsh 2011). Broader and more inclusive repertoires of fathering emerge from diverse family practices and formations including queer/homoparental families; cohabitation; new technologies; changing domestic labour arrangements; the changing organization of childcare and growing involvement of fathers; and social policy initiatives including parental leave and family-friendly employment practices (Draper 2003).

These rapid societal changes have ushered in new forms of participatory fathering and family involvement for men in the Western world. However, the pressure to integrate traditional breadwinner and authority figure roles with contemporary demands for involvement in all aspects of the perinatal period has not been matched by reduced work pressures or the provision of active societal support and preparation (Barclay & Lupton 1999). As a result, men often feel isolated, excluded, uninformed and unable to obtain resources and support in the perinatal period placing pressure on relationships, challenging feelings of competence and requiring negotiation of competing demands (Deave & Johnson 2008). Furthermore, men have gender- specific risk factors for perinatal distress including their more limited support networks; dependence on partners for support; additional exposure to financial and work stresses; a more idealized view of pregnancy, childbirth and parent- hood stemming from a lack of exposure to contemporary models of parenting; and lastly being less keen to seek help with emotional problems (Condon et al. 2004). All of these factors are compounded by practitioners and services oriented towards mothers and babies marginalizing fathers (Deave & Johnson 2008, Lohan et al. 2013).

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Babies on board: Families in detention

The rather time-worn yellow sign “Baby on Board” seen in the back window of vehicles is meant to encourage safe driving, but also is a public announcement of one’s new status as a parent (It’s also a pun referring to pregnant women commuters in London, as an incitement for commuters to offer their seats to pregnant women). In Australia, when I think of “Babies on Board” there is a poignancy and a deep and overwhelming sadness, because it evokes images of people seeking asylum via boat. The official term is “unauthorised maritime arrivals”, a dehumanising and bureaucratic term rather like the hardline policies of deterrence and detention. Abbott’s cruel “stop-the-boats” strategy ensures that maternity and infancy cannot be the celebrations they are in every culture. Mothers, babies, children and families will encounter the opposite of tender loving care at the hands of the Australian Government who will send them to detention centres in remote locations run by global companies including G4S, Serco and Transfield (See Cathy Alexanders Crikey post for more details). This outsourcing of misery costs the Australian taxpayer a load of money ($2.97 billion has been budgeted by the Federal Government (2013-2014) for detention-related services and offshore asylum seeker management while $19.3 million is  allocated ($65.8 million over four years) for regional solutions).

baby-on-board-2

Consistent with other responses to asylum seekers in western countries, Australia has developed policies of deterrence and detention for boat arrivals without a valid visa. Australia’s Migration Act 1958 requires all “unlawful non-citizens” (people who are not Australian citizens and do not have permission to be in the country) to be detained, until they are granted a visa or leave the country. This detention policy was introduced in 1992 and continues until today. What makes Australia’s response to a legitimate right to seek asylum is the uniquely cruel policy of mandatory, indefinite detention and offshore processing. Without an age exemption it means that detainees can include families and unaccompanied children with processing taking months or years. A range of international literature shows that detention is highly distressing for both adults and children with long-term consequences. The majority of asylum seekers are found to be refugees under the 1951 Convention.

Everyone has the right to seek and enjoy in other countries asylum from persecution. Article 14, Universal Declaration of Human Rights (signed by member countries in 1948, including Australia).

The child shall have the right to adequate nutrition, housing, recreation and medical services. Principle 4. United Nations Declaration of the Rights of the Child. Proclaimed by General Assembly resolution 1386(XIV) of 20 November 1959.

I am horrified that many new babies and new parents will be starting their lives in detention, the latter having already navigated treacherous borders, war strife and dangerous seas but now officialdom to meet the needs of their babies. Most of my professional career has involved supporting new parents. Aside from working on a postnatal ward, I helped to set up a service for women with postnatal depression in Auckland in the mid-nineties, my colleagues and I offered assessment, consultation and therapy to women. Aside from the hundreds of women I met I also heard many stories in the weekly support group I facilitated for depressed women for three years. My Master’s research considered the experiences of new migrant mothers and the challenges of establishing a new life without support and access to cultural rituals. In my PhD research I looked at the “the politics of the womb” and the role of maternity in projects of capitalism, nation building, imperialism and globalisation. See my other blog posts on supporting migrant fathering, ‘good’ mothering, pronatalist and antinatalist policies (including Australia’s forcible removal of Aboriginal – and some Torres Strait Islander – children). I’ve also researched and written about the experiences of Refugee women in New Zealand, Korean migrant mothers and the discursive repertoires of Plunket Nurses. I have spent decades educating organisations and professionals about the needs of new mothers and I developed a brochure about Postnatal depression for the New Zealand Mental Health Foundation with the help of consumer organisations and many new parents and professionals. So you could say I know a little about what new mothers and babies might need to help them thrive.

Parenting and mothering are not easy. The transition is challenging emotionally, physically and socially. That’s why so many cultures have rituals for protecting and nurturing new mothers, whether it’s special foods, attention or ceremonies. The mother has experienced a massive transition requiring time to recoup, hence postpartum rest and loving attentive care are provided to women. Maternity professionals have a unique role in supporting the health and wellbeing of new migrant and refugee families, as they have privileged access to women at a time that is culturally and spiritually important to a woman and her family. However, women’s experiences of maternity services that are designed to meet their needs, can lead them to feel isolated, disrespected and invisible (and that’s when they aren’t in detention). 

Detention centres have been called factories for mental illness. The conditions in immigration detention are not conducive to establishing or maintaining family life, let alone helping families thrive. For asylum seekers who may have experienced torture or trauma, there is a vulnerable to experiencing mental health problems even before they reach countries of resettlement. The conditions of detention are demanding and difficult without the resources and support of family and friends, community and culture, no direct access to services and support. This situation is exacerbated by the unknown length for which people will be detained and to where they might be sent. It is further compounded by the punitive and coercive ways in which people are treated in detention. Existing trauma is only exacerbated while in prolonged detention which has an impact not only on the individuals in a family, but families themselves with the role of parent being undermined. Imagine powerless parents in unpredictable, hostile and degrading surroundings who cannot ensure their children’s safety or comfort. Yes, Australian policies of detention and deterrence are contributing to long term mental ill health for children and their families. Detention facilities have been criticised for the “culture of punishment, humiliating treatment of detainees, including children, and a failure to provide appropriate psychological support for high-risk populations”.

Children in detention

 In all actions concerning children … the best interests of the child shall be a primary consideration. UN Convention on the Rights of the Child (1989)  – Article 3.

.. a child who is seeking refugee status … whether unaccompanied or accompanied … [shall] receive appropriate protection and humanitarian assistance.

UN Convention on the Rights of the Child  (1989) – Article 22 .

 

No child shall be deprived of his or her liberty unlawfully or arbitrarily. The arrest, detention or imprisonment of a child shall be in conformity with the law and shall be used only as a measure of last resort and for the shortest appropriate period of time.

UN Convention on the Rights of the Child  (1989) – Article 37 (b).

 

Children subjected to abuse, torture or armed conflicts should recover in an environment which fosters the health, self-respect and dignity of the child.

UN Convention on the Rights of the Child (1989) Article 39.

Children, accompanied or on their own, account for as up to half of all asylum seekers in the industrialized world. Australia is not the only country to detain children, The United States, the United Kingdom, Germany and Italy also directly contradict The Convention on the Rights of the Child (UNCRC), which stresses that detention of children should only be a last resort and for the shortest appropriate period of time. In Australia up till 1994 there was a 273-day time limit on detention, however, after this time indefinite detention became the norm with no exemptions made for children or unaccompanied minors. A Human Rights Commission National Inquiry into Children in Immigration Detention in 2001 noted that (CRC)  requires the detention of children to be ‘a measure of last resort’, but Australia’s detention laws make detention of unauthorised arrival children ‘the first, and only, resort’. Mandatory detention overrides the rights and protections of child asylum seekers as enshrined in other international and regional conventions and declarations the European Convention on Human Rights, the Geneva Convention, the International Covenant on Civil and Political Rights, and the International Covenant on Economic, Social and Cultural Rights. 

Source: Department of Immigration and Citizenship, 13 September 2013. Adapted by the Australian Human Rights Commission.

Source: Department of Immigration and Citizenship, 13 September 2013. Adapted by the Australian Human Rights Commission.

The Australian Department of Immigration and Border Protection (DIBP) statistics (2014) show that:

  • 1106 children are held in Australia’s secure immigration detention facilities,
  • 356 on Christmas Island and 177 of the children in Nauru
  • 1579 are detained in the community under residence determinations.
  • 1816 children live in the community on Bridging Visas (their parents have no work rights and limited access to Government support).

Research shows that even “brief” detention is detrimental to children. Prior to 2008, all children seeking asylum In Australia were faced with mandatory detention for an average of two years. In a summary of the impacts on children’s physical and mental health, Kronick, Rousseau, & Cleveland (2011) noted all manner of behvioural problems including disruptive conduct, nighttime bedwetting, separation anxiety, sleep disturbance, nightmares and impaired cognitive development. More severe symptoms includied mutism, stereotypic behaviours, and refusal to eat and drink. Mental health problems such as post-traumatic stress disorder, major depression, self harm and suicidal ideation were common. Younger children experienced developmental delays, attachment and behavioural problems Parents self-reported a decrease in the capacity to parent while in detention, and detention can trigger memories of previous trauma, humiliation and hopelessness. United Kingdom research has also found behavioural difficulties, developmental delay, weight loss, difficulty breast-feeding in infants, food refusal and loss of previously obtained developmental milestones. The neurodevelopmental vulnerability of infants means that they are highly sensitive to their socio-cultural environments. The Australian Human Rights Commission is conducting an inquiry into children in immigration detention. You can read powerful testimonials from children themselves, educators and health professionals including this account from Paediatrician Karen Zwi who visited Christmas Island:

Babies are unable to crawl because the ground is so rough and the only playground is unusable during the day due to the extreme heat.New mothers are forced to queue up for strictly rationed nappies, baby wipes and powdered milk, with staff telling them constantly they will never be resettled in Australia.

Parenting in detention

Changes to the Migration Act since July 19, 2013 mean that pregnant asylum seekers in offshore detention (classed as “unauthorised maritime arrivals”) can be removed offshore. Recently babies have been sent from Darwin to Nauru and Greens Senator Sarah Hanson-Young plans to introduce a bill banning the removal of Australian-born babies to offshore detention centres to Parliament in May. She says:

‘‘We are, by incarcerating these newborn babies, creating the next damaged generation . . . we know the damage the detention of children has (on them),’’ she said. ‘‘If we allow this to continue, we are knowingly destroying them,’’ she said. ‘‘I don’t think that’s a political issue, it’s a moral issue.’’

(Note that Section 21(8) of the Australian Citizenship Act makes clear that a baby, born in Australia, who is stateless, is eligible to apply for Australian citizenship).

Louise Newman (see reference below) has worked extensively with women asylum seekers and notes that they have unique health and mental health needs related to pregnancy and delivery which can be exacerbated by limited antenatal care or screening. Their histories can include sexual trauma and abuse and perinatal loss. Receiving perinatal “care” in a detention facility means that professionals are balancing competing priorities and subject to varying forms of regulation and administration which put complex demands on their time. There may be ambiguity about how to respond to the needs of pregnant or postpartum women who they might be ill-equipped or resourced to support as reports have indicated.

In a detention context, women are isolated from their cultural traditions and supports and sometimes physical isolation begins weeks prior to delivery. This cultural isolation compounded with a lack of access to interpreters during delivery can increased fear and distress and is implicated in the high rates of postnatal depression and anxiety and attachment difficulties with infants seen in women in detention. Newman notes that research in the United Kingdom would resonate with women’s experiences and clinician observations in Australia. Where women expressed high levels of of distress and reported poor care. The context also impacted on their capacity to parent with women feeling isolated, incompetent, ashamed and guilty for delivering a baby in detention. Consequently, a highly anticipated, magnificent, sacred and profound time in a woman and her family’s life becomes one that is painful. In a powerful article describing his visit to Christmas Island, acting for some 26 babies born in detention Jacob Varghese notes how cruel asylum seeker policy is for new parents:

…what it is like being a new parent in a remote prison, with no control over your circumstances, every daily routine determined for you by guards and bureaucrats.

 

How the Australian government reports on conditions in detention differs from the reality. In an article for Crikey, Caroline de Costa, Professor of Obstetrics and Gynaecology and Director of the Clinical School at James Cook University School of Medicine, Cairns Campus in North Queensland notes:

We were told that there is 24/7 access to a nursing triage service, with a doctor on call, for asylum seekers (male and female, adults and children) in all three camps.  We were also told that there are regular playgroups and ‘Mums and Bubs’ sessions held in all three camps for pregnant women and new mothers. Meeting individual asylum seekers, in the visitors’ rooms of all three facilities, in the two days following our formal visit, we heard stories quite different from the official accounts. We observed in many parts of the camps that asylum seekers including children and women are routinely listed, dealt with and addressed by the numbers given to them on arrival by boat in Australia, rather than by their names.

Caroline de Costa also “unequivocally” states that neither Manus nor Nauru are suitable places for the detention of very young babies and their families. She suggests that:

the greatest and most pervasive risk is to the mental health of children and their families. The fact of ongoing uncertain detention is bad enough; adding to it with an extremely isolated hot and crowded environment with few diversions within the detention facility and none outside is demonstrably contributing to very high levels of psychiatric presentations among asylum seekers, well documented by many of my colleagues in recent weeks. My own observations of recent mothers I met in Darwin is of a high level of postnatal depression that is continuing on well past the postnatal period…

The Australian Immigration Minister’s (Scott Morrison) office says:

the Government’s policy is to transfer illegal boat arrivals to offshore processing centres and families are transferred to Nauru. The statement says creating exemptions for offshore processing will only create dangerous incentives for people smugglers to fill boats with women and children.

Cartoon by Oslo Davis Source: Museum Victoria

Cartoon by Oslo Davis
Source: Museum Victoria

So what can we do?

The good news is that there is plenty of resistance both professionally, in the community and among refugee advocacy organisations. DASSAN (Darwin Asylum Seekers Support and Advocacy Network) believe that families should not be detained and babies should not be born into detention. They advocate for policy change but have also been providing practical help and support including: making welcome packs for new babies; sewing gifts: and collecting clothes for babies and women in detention on Christmas Island. They observe:

At a time when families should be focused on preparing for the joy of welcoming new life, they are instead dealing with the trauma of having fled from their home, the great anxiety of being told they will be sent to Nauru or Manus Island, and the daily despair of being kept locked up.

(Note, if you’d like to support their work there are details on the DASSAN site). Chilout (Children out of immigration detention) have worked tirelessly to lobby for children aged from zero to eighteen. I recommend reading their Factsheet and accessing the extensive range of resources and reports on their website.

The use of prolonged detention for pregnant women and mothers with young children inflicts physical and psychological harm disproportionate to the policy aim of immigration control and should be stopped immediately .

 

The Royal Australasian College of Physicians (RACP) made a passionate plea on World  Refugee Day for the Australian Government to end the mandatory detention of children and adolescents seeking asylum in Australia and in offshore centres. Their Position Statement Towards better health for refugee children and young people in Australia and New Zealand advocates for the abolition of  Australian legislation that allows children to be housed in detention centres and they propose that the Australian Government  immediately place detained children in the community with their families where they can be provided with appropriate health and social support. There is a Paediatrics & Child Health advocacy campaign for health and well-being of children in detention/refugees which was launched on 7 June 2013. Information and template letters addressed to Government Ministers can be used to advocate for health of children in detention. These are just a few of the national and local responses to mothers, children and families in detention.
There is also a National Inquiry into Children in Immigration Detention 2014: Discussion Paper. The the Australian Human Rights Commission (HRC) is investigating the ways in which life in immigration detention affects the health, well-being and development of children and inviting people previously detained as children in closed immigration detention and assessing the current circumstances and responses of children to immigration detention. A follow up to their report ten years ago A last resort? the report of the National Inquiry into Children in Immigration Detention (National Inquiry). After the National Inquiry positive developments including the removal of children from high security Immigration Detention Centres, the creation of the Community Detention system and the use of bridging visas for asylum seekers who arrive by boat. However, there are still around 1,000 children in closed immigration detention, a higher number than the last inquiry, and the Commission’s monitoring work reveals that key concerns remain. Their aim is to discover if there have been any changes in the ten years since the last investigation, and whether Australia is meeting its obligations under the Convention on the Rights of the Child (CRC). You can read the inquiry discussion paper and make a submission that addresses the inquiry terms of reference. This inquiry is focused on closed detention facilities (not community) and the impact of detention on children under 18 years. You can also read about their work on alternatives to closed detention The last words really belong to Murray Watt who in an article Why is an Australian baby locked up in detention? says:

 

It’s not fair that children – or anyone for that matter – should be locked up for years on end, without any consideration of their claims to protection.   It’s not fair that the conditions in offshore detention camps, overseen by our own government, are dangerous, inhumane and deliberately designed to break people’s spirit.   And it’s not fair that Australia – ranked by the IMF as the 10th richest country in the world – should pass our refugee “problem” on to countries that are far poorer and less safe than many of the countries from which refugees come in the first place.   Australia can do better than this. Over our history, we have led the world in protecting others in distress, and in improving the rights and living conditions of our citizens and those across the world. We should live up to our history.

References

  • Kronick, Rachel, Rousseau, Cécile, & Cleveland, Janet. (2011). Mandatory detention of refugee children: A public health issue? Paediatrics & child health, 16(8), e65.
  • Mares, Newman, Dudley, & Gale, (2002). Seeking Refuge, Losing Hope: Parents and Children in Immigration Detention. Australasian Psychiatry, 10(2), 91-96. doi: 10.1046/j.1440-1665.2002.00414.x)
  • Newman, Louise K, & Steel, Zachary. (2008). The child asylum seeker: psychological and developmental impact of immigration detention. Child and adolescent psychiatric clinics of North America, 17(3), 665-683.
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Enhancing the role of fathers

First published in Viewpoint, March 2014 Issue of the Kai Tiaki: Nursing New Zealand.

March 2014 Midwives at work

March 2014 Midwives at work

Reference as: DeSouza, Ruth. (2014). Enhancing the role of fathers. Kai Tiaki: Nursing New Zealand, 20(2), 26-27 (download 3.2 MB pdf DeSouza Migrant Dads).

Mkono mmoja haulei mwana. A single hand cannot nurse a child. Kiswahili proverb

I spent the first ten years of my life in Tanzania and Kenya where this Kiswahili proverb comes from. My father played a prominent part in childcare and the raising of three daughters. We migrated twice, first to Kenya and then to New Zealand. As migrants we only had our nuclear family to fall back on and my father took a central role in raising us while my mother studied. His philosophy was that that everything that needed to be done to keep the household going was a labour of love that we should all expect to contribute freely and lovingly to. This idea of pulling together and being self-sufficient reminds me of another Kiswahili phrase Harambee which means to pull together. Jomo Kenyatta was the first president of Kenya and this catch phrase that he popularized can also be seen on the Kenyan flag. Which brings me to the purpose of this article, which is to talk about pulling together around a family, especially one that has migrated and in particular pulling “in” fathers during the transition to parenthood.

Including fathers in care

It is not possible to address the needs of women, infants and children in heterosexual families without addressing the needs of a child’s father (Buckelew, Pierrie, & Chabra, 2006). Pregnancy and childbirth are pivotal periods where individuals can grow as they adjust to the transition (Montigny & Lacharite, 2004).The perinatal period is a critical developmental touch point where health professionals can have a profound influence in assisting fathers and mothers in their transition. Often interventions focus on the mother and serve to increase her developing expertise, which subsequently tends to increase parental conflict (Montigny & Lacharite, 2004). Health professionals can have a significant role in fostering interactions between both partners (Montigny & Lacharite, 2004).

Most immigration studies focus on the negative consequences of immigration for families and for parenting. For example, immigration is perceived predominantly in the literature as a source of stress and a risk factor for families and children. Engaging women in groups or developing couples’ groups that would also serve the needs of new fathers could educate participants and provide support and information. Supporting the whole migrant family is critical, particularly when often a key motivation for migration is to provide a better life for children (DeSouza 2005; Roer-Strier et al 2005). Families can provide a buffer and the strength and safety to cope with what might seem an unfamiliar, and at times hostile, receiving community (Roer-Strier et al 2005).

Parenthood, combined with recent migration, can lead to a process of extended change and adaptation in all domains of a parent’s life. These changes can include adjusting to a new home, social environment, language, culture, place of work and profession. Often, economic, social and familial support systems are lost or changed. Under such circumstances, parents’ physical and psychological health, self-image, ability to withstand stress and anxiety levels may all be challenged (Roer-Strier, Strier, Este, Shimoni, & Clark, 2005). For new migrant families, support needs are critically important and in the absence of usual support networks, partners and husbands play an important role in providing care and support that would normally be received from mothers, family and peers. Systems need to be ‘father-friendly’ as husbands are the key support for migrant women who have often left behind friends and family.

So, what can be done to reorient services so that they are more father-friendly? Fatherhood is changing, influenced by diverse family practices and formations, which challenge the male breadwinner-female home carer division of labour. The shift from being a breadwinner and authority figure to being involved in all aspects of the perinatal period has become an expectation in the Western world (Deave & Johnson, 2008). Fathers play a crucial role in the couple’s relationship and the father-infant relationship and they contribute to individual and family well-being (Goodman, 2005). where men are required to provide practical and emotional support to mothers and children However, Barclay and Lupton (1999) suggest that active societal support and preparation are not readily available to men despite the expectation that men will fill the gaps that were previously filled by neighbours and women relatives.

Health and social services and nurses who work in them often fail to engage fathers successfully and can even pose a barrier to their engagement (Williams, Hewison, Wildman, & Roskell, 2013). The ‘new involved father’ benchmark (Lupton & Barclay, 1997a) requires that fathers participate in antenatal classes, labour and delivery. In the absence of social networks, family and peers groups, partners and health professionals often need to fill in the gaps. Fathers are key persons who strongly influence the perinatal decisions women make. Migration often requires changed roles for fathers, especially if they have not grown up with expectations about their roles as active participants.

Fatherhood can be difficult and fathers need support and guidance to prepare them for the transition and to develop competence Men can sometimes lack appropriate models and emotional support for fathering, requiring that they be encouraged to develop support for their parenting beyond their partner (Goodman, 2005). Each stage of the paternal lifecycle including pregnancy, labour and delivery, postpartum period and parenthood poses challenges for new parents to be. Labour and delivery are particularly difficult times for fathers who can feel coerced, ill-prepared, ineffective, and/or psychologically excluded from the event (Bartlett, 2004).

The postpartum period, particularly the first year after childbirth, is a time of emotional upheaval for first-time fathers, who have to adapt to the presence of an infant who is a priority. Research on first-time fathers’ prenatal expectations of the experience compared with perceptions after the birth found that they expected to be treated as part of a labouring couple, but were often relegated to a supporting role. Fathers were confident of their ability to support their wives, but labour was more work and scary than they had anticipated. The focus also changed postpartum from their wives to their babies. The study found that fathers need to be better included and supported in their role as coach and friend (Chandler & Field, 1997).

The first year of parenting is often experienced as overwhelming (Nyström & Öhrling, 2004). Anticipatory guidance is critically important for expectant fathers, as many men (like women) hold unrealistic expectations about parenthood that can hinder their adjustment to the realities of fatherhood (Goodman, 2005). Supporting fathers prenatally can improve their transition to fatherhood (Buist, Morse, & Durkin, 2003). Interventions that can help prepare men for the changes and stresses of becoming a parent include not only ensuring that men are included in childbirth preparation classes but that the content relates to the concerns of fathers and which promotes paternal involvement in all aspects of infant care. Fathers should be given opportunities to develop skills and confidence in infant care, both before and after their infant’s birth. Fathers- only classes could help men develop competence and confidence away from their partner whom they could perceive as being more capable.

Obstacles to greater involvement in fathering include work, parental modelling after one’s own father, maternal gate-keeping from wives or female partners, co-constructed processes of “doing gender” by both mothers and fathers, gender identities and ideologies and discourses of fatherhood (Doucet, (2005).

Fathers’ breastfeeding role

An infant’s father has a pivotal role in maternal initiation and continuation of breastfeeding (Littman, Medendorp, & Goldfarb, 1994), hence breastfeeding education and promotion should be directed to expectant fathers as well as mothers. Littman, Medendorp, and Goldfarb suggest that breastfeeding education should include appropriate anticipatory guidance related to managing feeling excluded when mothers are breastfeeding. Ways for new fathers to experience closeness with their infants can be suggested, and nurses can encourage the development of men’s nurturing qualities while supporting the importance of their particular role as father. Skill acquisition in infant care is a crucial step in facilitating father-infant bonding. 8. Fathers are excluded in research.

Maternal and infant health has enjoyed extensive attention from researchers, medical practitioners, and policymakers. However, little is known about the physical and psychological health of fathers, but with gender roles changing and an increasing emphasis on paternal involvement in all aspects of parenting, adjustments are required for both men and women (Goodman, 2004). Research on fatherhood lags behind that on maternal health, a disparity that is a significant gap in family research and theory. This disparity is a serious omission in knowledge and scholarship because becoming a father is a major developmental milestone (Bartlett, 2004). In order to provide optimal support to new fathers it is important to understand fathers’ experiences from the perspectives of fathers themselves (Goodman, 2005).

Interactions with significant others (nurses and partners) have a significant impact on both parents’ perceptions of parental efficacy (Montigny & Lacharite, 2004) Health professionals are well placed to support fathers in a way that empowers them to feel good about themselves, their abilities, and their infant, which in turn enhances their motivation to interact with and care for their infant (Bandura, 1996; (Bryan (2000) cited inMontigny & Lacharite, 2004)

Conclusion

The transition to fatherhood is significant with many men feeling overwhelmed or excluded. However, services that provide prior guidance and are male- friendly can increase involvement and participation. Little is known about how this transition is managed especially the needs of migrant fathers and the mediating role of social and psychological factors. However the participation of men is linked with positive outcomes for the whole family. By supporting father- friendly services, families can benefit especially families separated from support systems like migrant families. Nurses can play a pivotal role in pulling fathers ‘in’ and helping families pull together in the transition to fatherhood so that all families can thrive.

References

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  • Barclay, Lesley, & Lupton, Deborah. (1999). The experiences of new fatherhood: a socio-cultural analysis. Journal of Advanced Nursing, 29(4 %R doi:10.1046/j.1365-2648.1999.00978.x), 1013-1020.
  • Bartlett, E.E. (2004). The effects of fatherhood on the health of men: A review of the literature. Journal of Men’s Health and Gender, 1(2-3), 159-169.
  • Buckelew, Sara M. , Pierrie, Herb , & Chabra, Anand (2006). What Fathers need: A countywide assessment of the needs of fathers of young children. Maternal and Child Health Journal,, 10(3).
  • Buist, A, Morse, C A, & Durkin, S. (2003). Men’s adjustment to fatherhood: Implications for obstetric health care. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32(2), 172-180.
  • Chandler, S., & Field, P.A. (1997). Becoming a father: First-time fathers’ experience of labor and delivery. Journal of Nurse-Midwifery, 42(1), 17-24.
  • Deave, T., & Johnson, D. (2008). The transition to parenthood: what does it mean for fathers? Journal of Advanced Nursing, 63(6), 626-633. doi: 10.1111/j.1365-2648.2008.04748.x
  • DeSouza, R. (2006). New spaces and possibilities: The adjustment to parenthood for new migrant mothers. Wellington: Families Commission.
  • Doucet, A. (2005). It’s almost like I have a job, but I don’t get paid’: Fathers at home reconfiguring work, care, and community. Fathering: A Journal of Theory, Research, and Practice about Men as Fathers, 2(3), 277-303.
  • Goodman, J.H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1), 26-35.
  • Goodman, J.H. (2005). Becoming an involved father of an infant. JOGNN – Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34(2), 190-200.
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Korean migrant mothers on giving birth in Aotearoa New Zealand

Cite as: DeSouza, Ruth. (2014). One woman’s empowerment is another’s oppression: Korean migrant mothers on giving birth in Aotearoa New Zealand. Journal of Transcultural Nursing. doi: 10.1177/1043659614523472.  Download pdf (262KB) DeSouza J Transcult Nurs-2014.

Published online before print on February 28, 2014.

Abstract

Purpose: To critically analyze the power relations underpinning New Zealand maternity, through analysis of discourses used by Korean migrant mothers. Design: Data from a focus group with Korean new mothers was subjected to a secondary analysis using a discourse analysis drawing on postcolonial feminist and Foucauldian theoretical ideas. Results: Korean mothers in the study framed the maternal body as an at-risk body, which meant that they struggled to fit into the local discursive landscape of maternity as empowering. They described feeling silenced, unrecognized, and uncared for. Discussion and Conclusions: The Korean mothers’ culturally different beliefs and practices were not incorporated into their care. They were interpellated into understanding themselves as problematic and othered, evidenced in their take up of marginalized discourses. Implications for practice: Providing culturally safe services in maternity requires considering their affects on culturally different women and expanding the discourses that are available.

Keywords: focus group interview, cultural safety, Korean women, maternal, postcolonial, Foucault.

Introduction

A feature of contemporary maternity is the notion that birth can be empowering for women if they take charge of the experience by being informed consumers. However, maternity is not necessarily empowering for all mothers. In this article, I suggest that the discourses of the Pākehā maternity system discipline and normalize culturally different women by rendering their mothering practices as deviant and patho- logical. Using the example of Korean migrant mothers, I begin the article by contextualizing maternity care in New Zealand and outlining Korean migration to New Zealand. The research project is then detailed, followed by the findings, which show the ways in which Korean mothers are interpellated as others in maternity services in New Zealand. I conclude the article with a brief discussion on the implications for nursing and midwifery with a particular focus on cultural safety.

You can read the rest at: Journal of Transcultural Nursing or download DeSouza TCN proof.

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