Racism – Page 4 – ruthdesouza-dreamhosters

Colonialism, Indigenous, Inequalities, Multiculturalism, Racism

Identity politics: A response to Garth George

My response to a piece by Garth George (August 5th 2010) where he argues that [we] “have become unthinking victims of the doctrine of multiculturalism, in all its politically correct dissimulation and deception”.

There are some good reasons for the rise in identity politics among minority groups, dismissed by Garth George as a “culture of victimhood. The idealised portrayal of liberal democracy (with values such as freedom and equality) ignores three key issues. First, the destructive and dehumanising practices of slavery and colonisation occurred within liberal frameworks. Liberal values were withheld from the colonised as well as many Western subjects (women for example). Secondly, while liberal agendas of freedom and equality, and conceptions of universal human rights have been powerful and central to liberation struggles, often Eurocentric, Western norms have been privileged and the universal person taken to mean white, male and middle class. Finally, the deployment of notions of equality and universalism for ameliorating conflicts between groups of people, has created new problems such as unequal power relations and differential health and social outcomes. The location of culture in the public or private sphere is an important conversation. When it suits, the metaphor of enrichment is used to consume diversity, through festivals, restaurants and more. Placing cultural needs firmly in the private sphere reflects a reluctance to extend a reciprocal courtesy and make our institutions more responsive.

August 7, 2010/by ruth

Africa, Colonialism, Goa, Indigenous, Migration, Racism, Te Tiriti o Waitangi/Treaty of Waitangi, Writing

A view from a Goan in Aotearoa/New Zealand

The ocean is what we have in common: Relationships between indigenous and migrant people.

This piece was previously published in the Goanet Reader: Mon, 30 Nov 2009

Legend has it that Lord Parashuram (Lord Vishnu’s sixth incarnation) shot an arrow into the Arabian Sea from a mountain peak. The arrow hit Baannaavali (Benaulim) and made the sea recede, reclaiming the land of Goa. A similar story about land being fished from the sea by a God is told in Aotearoa, New Zealand, where Maui dropped his magic fish hook over the side of his boat (waka) in the Pacific Ocean and pulled up Te Ika a Maui (the fish of Maui), the North Island of New Zealand.

The first story comes from the place of my ancestors, Goa, in India and the second story comes from the place I now call home, Aotearoa, New Zealand. Both stories highlight the divine origins of these lands and the significance of the sea, as my friend Karlo Mila says “The ocean is another source of sustenance, connection and identity…. It is the all encompassing and inclusive metaphor of the sea. No matter how much we try to divide her up and mark her territory, she eludes us with her ever-moving expansiveness. The ocean is what we have in common.”

This piece for Goanet Reader is an attempt to create some engagement and discussion among the Goan diaspora about the relationships we have with indigenous and settler communities in the countries we have migrated to, and to ask, what our responsibilities and positions are as a group implicated in colonial processes?

My life has been shaped by three versions of colonialism: German, Portuguese and British, and continues to be shaped by colonialism’s continuing effects in the white settler nation of Aotearoa/New Zealand. Diasporic Goans have frequently occupied what Pamila Gupta calls positions of “disquiet” or uneasiness within various colonial hierarchies. For me, this has involved trying to understand what being a Goan means, far away from Goa and to understand the impact of colonisation.

I was born in Tanzania, brought up in Kenya and am now resident of Aotearoa/New Zealand with a commitment to social justice and decolonising projects. What disquieting position do I occupy here?

Both sets of my grandparents migrated to Tanganyika in the early part of the 20th Century. Tanganyika was a German colony from 1880 to 1919, which became a British trust territory from 1919 to 1961. Tanganyika became Tanzania after forming a union with Zanzibar in 1964.

On my father’s side, my great-grandfather and grandfather had already worked in Burma because of the lack of employment opportunities in Goa. Then when my grandfather lost his job in the Great Depression, he took the opportunity to go to Tanzania and work.

Indians had been trading with Africa as far back as the first century AD. The British indentured labour scheme was operational and had replaced slave labour as a mechanism for accessing cheap and reliable labour for plantations and railway construction, contributing to the development of the Indian diaspora in the 19th and 20th century.

Large-scale migrations of Indians to Africa began with the construction of the great railway from Mombasa to Lake Victoria in Uganda in the late nineteenth century. Indians were recruited to run the railways after they were built, with Goans coming to dominate the colonial civil services.

Some 15,000 of the 16,000 men that worked on the railroads were Indian, recruited for their work ethic and competitiveness. Sadly, a quarter of them returned to India either dead or disabled. Asians who made up one percent of the total population originated from the Gujarat, Kutch, and Kathiawar regions of western India, Goa and Punjab and played significant roles as middlemen and skilled labourers in colonial Tanganyika.

During the Zanzibar Revolution of 1964, over 10,000 Asians were forced to migrate to the mainland as a result of violent attacks (also directed at Arabs), with many moving to Dar es Salaam. In the 1970s over 50,000 Asians left Tanzania.

President Nyerere issued the Arusha Declaration in February 1967, which called for egalitarianism, socialism, and self-reliance. He introduced a form of African socialism termed Ujamaa (“pulling together”). Factories and plantations were nationalized, and major investments were made in primary schools and health care.

My parents migrated to Kenya in 1966. The newly independent East African countries of Tanzania (1961), Uganda (1962), and Kenya (1963) moved toward Africanising their economies post-independence which led to many Asians finding themselves surplus to requirements and resulting in many Asians leaving East Africa, a period known as the ‘Exodus’.

A major crisis loomed for United Kingdom Prime Minister Harold Wilson’s government with legislation rushed through to prevent the entry into Britain of immigrants from East Africa. The Immigration Act of 1968 deprived Kenyan Asians of their automatic right to British citizenship and was retroactive, meaning that it deprived them of an already existing right.

Murad Rayani argues that the vulnerability of Asians was compounded by the ambiguity of their relationship with the sub-continent, and with Britain whose subjects Asians had become when brought to East Africa.

Enoch Powell’s now infamous speech followed where he asserted that letting immigrants into Britain would lead to “rivers of blood” flowing down British streets. The Immigration Act of 1971 further restricted citizenship to subjects of the Commonwealth who could trace their ancestry to the United Kingdom.

In 1972 Idi Amin gave Uganda’s 75,000 Asians 90 days to leave. My parents decided to migrate to New Zealand in 1975.

While ‘Asians’ (South Asians) were discriminated against in relationship to the British, they were relatively privileged in relationship to indigenous Africans. As Pamila Gupta says, Goans were viewed with uncertainty by both colonisers and the colonised. Yet, the Kenyan freedom struggle was supported by many Asians such as lawyers like A. Kapila and J.M. Nazareth, who represented detained people without trial provisions during the Mau Mau movement. Others like Pio Gama Pinto fought for Kenya’s freedom, and was assassinated. Joseph Zuzarte whose mother was Masai and father was from Goa rose to become Kenya’s Vice-President. There was Jawaharlal Rodrigues, a journalist and pro-independence fighter and many many more. In 1914, an East African Indian National Congress was established to encourage joint action with the indigenous African community against colonial powers.

In the two migrations I have described, Goans occupied a precarious position and much has been documented about this in the African context. However, what precarious place do Goans occupy now especially in white settler societies?

Sherene Razack describes a white settler society as: ” … one established by Europeans on non-European soil. Its origins lie in the dispossession and near extermination of Indigenous populations by the conquering Europeans. As it evolves, a white settler society continues to be structured by a racial hierarchy. In the national mythologies of such societies, it is believed that white people came first and that it is they who principally developed the land; Aboriginal peoples are presumed to be mostly dead or assimilated. European settlers thus become the original inhabitants and the group most entitled to the fruits of citizenship. A quintessential feature of white settler mythologies is therefore, the disavowal of conquest, genocide, slavery, and the exploitation of the labour of peoples of colour.”

I’d like to explore this issue in the context of Aotearoa/New Zealand where identities are hierarchically divided into three main social groups categories. First in the hierarchy are Pakeha New Zealanders or settlers of Anglo-Celtic background. The first European to arrive was Tasman in 1642, followed by Cook in 1769 with organised settlement following the signing of the Treaty of Waitangi in 1840. The second group are Maori, the indigenous people of New Zealand who are thought to have arrived from Hawaiki around 1300 AD and originated from South-East Asia. The third group are “migrants” visibly different Pacific Islanders or Asians make the largest groups within this category with growing numbers of Middle Eastern, Latin American and African communities. This latter group are not the first group that come to mind when the category of New Zealander is evoked and they are more likely to be thought of as “new” New Zealanders (especially Asians).

Increasingly, indigenous rights and increased migration from non-source countries have been seen as a threat to the white origins of the nation. While, the Maori translation of Te Tiriti o Waitangi may be acknowledged as the founding document of Aotearoa/New Zealand and enshrined in health and social policy, the extent to which policy ameliorates the harmful effects of colonisation remain minimal.

This can be seen in my field of health, where Maori ill health is directly correlated with colonisation. Maori nurses like Aroha Webby suggest that the Articles of the Treaty have been unfulfilled and the overall objective of the Treaty to protect Maori well-being therefore breached. This is evidenced in Article Two of the Treaty which guarantees tino rangatiratanga (self-determination) for Maori collectively and Article Three which guarantees equality and equity between Maori and other New Zealanders.

However, Maori don’t have autonomy in health policy and care delivery, and the disparities between Maori and non-Maori health status, point to neither equality nor equity being achieved for Maori. In addition, colonisation has led to the marginalising and dismantling of Maori mechanisms and processes for healing, educating, making laws, negotiating and meeting the everyday needs of whanau (family) and individuals.

So in addition to experiencing barriers to access and inclusion, Maori face threats to their sovereignty and self-determination. Issues such as legal ownership of resources, specific property rights and fiscal compensation are fundamental to Maori well being. Thus, the Treaty as a founding document has been poorly understood and adhered to by Pakeha or white settlers, in terms of recognising Maori sovereignty and land ownership.

Allen Bartley says that inter-cultural relationships have been traditionally shaped by New Zealand’s historical reliance on the United Kingdom and Ireland, leading to the foregrounding of Anglo-centric concerns. Discourses of a unified nation have been predicated on a core Pakeha New Zealand cultural group, with other groups existing outside the core such as Maori and migrants.

This monoculturalism began to be challenged by the increased prominence of Maori concerns during the 1970s over indigenous rights and the Treaty of Waitangi. The perception of a benign colonial history of New Zealand — an imperial exception to harsh rule — supplanted with a growing understanding that the Crown policies that were implemented with colonisation were not there to protect Maori interests despite the mythology of the unified nation with the best race relations in the world that attracted my family to New Zealand to settle.

So while countries such as Canada and Australia were developing multicultural policies, New Zealand was debating issues of indigeneity and the relationship with tangata whenua (Maori). More recently people from ethnic backgrounds have been asking whether a bicultural framework can contain multi-cultural aspirations. New Zealand has not developed a local response to cultural diversity (multiculturalism) that complements the bicultural (Maori and Pakeha) and Treaty of Waitangi initiatives that have occurred. However, many are worried that a multicultural agenda is a mechanism for silencing Maori and placating mainstream New Zealanders.

So is there a place/space for Goans in New Zealand? Or are we again occupying a disquieting space/place? According to Jacqui Leckie, one of the first Indians to arrive in New Zealand in 1853 was a Goan nicknamed ‘Black Peter’. Small numbers of Indians had been arriving since the 1800s, Lascars (Indian seamen) and Sepoys (Indian soldiers) arrived after deserting their British East India Company ships in the late 1800s.

The Indians that followed mainly came from Gujarat and Punjab, areas exposed to economic emigration. Indians were considered British subjects and could enter New Zealand freely until the Immigration Restriction Act (1899) came into being. Migration increased until 1920, when the New Zealand Government introduced restrictions under a “permit system”.

Later, in 1926, The White New Zealand League was formed as concern grew about the apparent threat that Chinese and Indian men appeared to present in terms of miscegenation and alien values and lifestyle. Discrimination against Indians took the form of being prevented from joining associations and accessing amenities such as barbers and movie theatres.

By 1945, families (mostly of shopkeepers and fruiterers) were getting established, and marriages of second-generation New Zealand Indians occurring. The profile of Indians changed after 1980, from the dominance of people born in or descended from Gujarat and Punjab. Indians began coming from Fiji, Africa, Malaysia, the Caribbean, North America, the United Kingdom and Western Europe.

Migrants are implicated in the ongoing colonial practices of the state and as Damien Riggs says the imposition of both colonisers and other migrants onto land traditionally owned by Maori maintains Maori disadvantage at the same time that economic, social and political advantage accrues to non-Maori.

But my friend Kumanan Rasanathan says that our accountabilities are different: “Some argue that we are on the Pakeha or coloniser side. Well I know I’m not Pakeha. I have a very specific knowledge of my own whakapapa, culture and ethnic identity and it’s not akeha. It also stretches the imagination to suggest we are part of the colonising culture, given that it’s not our cultural norms and institutions which dominate this country” (Rasanathan, 2005, p. 2).

Typically indigenous and migrant communities have been set up in opposition to one another as competitors for resources and recognition, which actually disguises the real issue which is monoculturalism, as Danny Butt suggests. My friend Donna Cormack adds that this construction of competing Others is a key technique in the (re)production of whiteness.

My conclusion is that until there is redress and justice for Maori as the indigenous people of New Zealand, there won’t be a place/space for me.

As Damien Riggs points out, the colonising intentions of Pakeha people continues as seen in the contemporary debates over Maori property rights of the foreshore and seabed which contradict the Treaty and highlight how Maori sovereignty remains denied or challenged by Pakeha.

My well being and belonging are tied up with that of Maori. Maori have paved the way for others to be here in Aotearoa/New Zealand, yet have a unique status that distinguishes them from migrant and settler groups. After all I can go to Goa to access my own culture but the only place for Maori is Aotearoa/New Zealand.

Increasingly, the longer I’ve lived in Aotearoa/New Zealand and spent time with Maori, the more I’ve begun to understand and value the basis of Maori relationships with the various other social groups living here as being underpinned by manaakitanga (hospitality), a concept that creates the possibility for creating a just society. Understanding and supporting Treaty of Waitangi claims for redress and Maori self-determination (tino rangatiratanga) allows for the possibility for the development of a social space that is better for all of us.

November 30, 2009/by ruth

Inequalities, Mental health, Migration, Racism, Women

Submission to the New Zealand Suicide Prevention Strategy 2008

Congratulations on a wonderful job in developing the New Zealand Suicide Prevention Strategy. I am pleased to see an inter-sectoral approach that is both evidence and strengths based. It is also encouraging to see mention of diverse communities and an approach that integrates protection, promotion, early identification, crisis support, attention to families and support in the aftermath of suicide. Thanks for the opportunity to add my rather swiftly developed submission to the New Zealand suicide prevention strategy. I am focussing this submission on Asians and South Asians in particular, but am aware (as per our teleconference on Friday) that these issues pertain to other migrant and refugee groups as well.

My key points are:

Asians are a high risk group for suicide and attempted suicide according to overseas research (especially South Asian young women).
We need better ethnicity data collection practices as data is limited.
There are issues with the umbrella term Asian which disguise differenceswithin groups.
There are significant barriers in accessing services, particularly mental health services.
Further research is needed that is clinical and epidemiological in order to identify prevention and intervention strategies that may vary from other groups.

Asians and statistics

Asians are a growing population in New Zealand. By 2016 they are expected to make up 9% of New Zealand’s and 20% of the Auckland Region’s total population. As such the health and social service needs of Asians must be considered by service providers. As you are aware there is limited research data available in New Zealand, 12 Asian people died by suicide (10 males and two females) in 2002, compared to 20 deaths

in 2001 and 21 deaths in 2000 (Ministry of Health, 2005). In our teleconference we also expressed concern the underreporting of suicide and coronial issues. I am concerned about the category as there is diversity within the people subsumed into the category Asian, with some groups especially at risk and others well protected) and the concept has limited use (Aspinall, 2003; Henare & Ehrhardt, 2004).

High rates of suicide and attempted suicide

Disproportionally high rates of suicide and attempted suicide have been found among South Asians in the diaspora (Batsleer, Chantler, & Burman, 2003; Bhugra & Desai, 2002; Bhugra & Hicks, 2004; Burr, 2002; Hicks & Bhugra, 2003). The highest were in young women of South Asian origin who have rates that are double that of the White population in the United Kingdom of completed suicide and 1.6 times more likely to attempt suicide(Hicks & Bhugra, 2003). Hicks and Bhugra examined perceived causes of suicide attempts in 180 ethnic South Asian women living in the London area. The three factors endorsed most frequently and strongly as causes of suicide attempts in South Asian women were violence by the husband, being trapped in an unhappy family situation, and depression. South Asian women are also two and a half times more likely to attempt suicide that South Asian men.

Barriers to accessing services

Recent New Zealand research has found that barriers for Chinese people accessing services include a lack of English language proficiency leading to communication difficulties and knowledge gaps, for example, being unaware of what services are available; the important role of primary healthy care and General Practitioners in particular as a first point of contact and a lack of awareness of the health and civil rights of citizens in New Zealand (Ruth DeSouza & Garrett, 2005). The research identified regional differences in terms of the place of birth of respondents and, in particularly, it was noted that Chinese-born respondents experienced more communication difficulties than those born in Hong Kong or Taiwan. Some of the strategies recommended in the report which are pertinent here include: encouraging cultural competence in health services (clinical, systemic and organisational), staff training and workforce development, developing partnerships with ethnic communities and community organisations, involving ethnic communities in strategic planning and linguistic competence. The latter involves not only ensuring that resources are available in several languages but also that interpreting and translation services are available.

Accessing mental health services

There are issues in attempting to access mental health services as well which are compounded by stigma within ethnic communities and anxiety from the mental health workforce. Increasingly mental health services are being called on to provide culturally appropriate care, but little is known about what that constitutes. Such a call cannot be answered if mental health professionals are not prepared for working in ways that are culturally competent. Despite the emphasis on cultural safety as part of the curricula of undergraduate health professional preparation, it has largely been concerned with Treaty obligations to Tangata whenua rather than evolving to meet the needs of ethnic communities (R. DeSouza, 2004). Burman, 2003, p.106) found in a research project investigating suicide and self-harm in the United Kingdom among South Asians that staff working with the women were caught in ‘race anxiety’ whereby white staff were hesitant and silent around issues to do with race, gender and mental health and were concerned that their actions were not misinterpreted. Their responses were to pass on issues to their South Asian counterparts or to avoid them. For the South Asian workers there was concern that discussing issues like this would reinforce or add to the existing stereotypes. This culture of silence within mainstream services was viewed as frustrating and annoying.

Ruth DeSouza Centre Co-ordinator/Senior Research Fellow Centre for Asian and Migrant Health Research Faculty of Health & Environmental Science Auckland University of Technology Address: Private Bag 92006, Auckland 1020

Ethnicity data collection

There is a need for improvements in quality ethnicity data collection so as to more clearly ascertain health needs and dispraities (Aspinall, 2003; British Medical Journal, 1996; Klajakovic, 1993; Latimer, 2003; McLeod et al., 2000; Ministry of Health, 2001, 2003, nd-a, nd-b; New Zealand Health Information System, 1996; Pringle & Rothera, 1996; Senior & Bhopal, 1994; Statistics New Zealand, 1996; Thiru, Hassey, & Sullivan, 2003; D. R. Thomas, 2000; S. B. Thomas, 2001). Several reports and research findings confirm that ethnicity data collection is poorly conducted by staff. A Waitemata District Health Board review found that staff were unaware of national guidelines for collecting data, had not received training on why and how ethnicity data was collected and consequently collected it inconsistently (Latimer, 2003). An internal paper for the Ministry of Health based on interviews with key stakeholders and a literature review found that there was inconsistency in the way in which data was collected and that what was collected was inaccurate and incomplete and that the concept of ethnicity was misunderstood (Ministry of Health, nd-a). These factors point to the need for support and training to facilitate accurate data collection. In order that ethnicity data is collected consistently and accurately ethnicity questions need to be aligned with Statistics New Zealand Census question for 2001 so that they are standardised. Variation exists across health providers around the method of ethnicity data collection, ranging from not asking and using previous admission information, to asking verbally to postal or using a show card. Furthermore, in secondary care, staff rely on information from GP’s which has been found to be problematic. A national survey of 1,062 members of the Royal New Zealand College of General Practitioners (RNZCGP) found that only 20% of practices collected ethnicity data. A recent study of 12 South Island practices found ethnicity was recorded for only 5% of patients (McLeod et al., 2000). Other problematic areas include the assumption of ethnicity by a provider.

Recommendations

• Further research and exploration of factors is needed in clinical and epidemiological studies of suicidality in South Asian women which might then contribute to prevention and intervention strategies.

• Better collection of ethnicity data (McKenzie, Serfaty, & Crawford, 2003). • Access to information in commonly used languages. • Encouraging cultural competence in health services (clinical, systemic and

organisational). • Staff training and workforce development. • Developing partnerships with ethnic communities and community

organisations. • Involving ethnic communities in the design of services.

References

Aspinall, P. J. (2003). Who is Asian? A Category that Remains Contrived in Population and Health Research. Journal of Public Health Medicine, 25(2), 91-97.

Batsleer, J., Chantler, K., & Burman, E. (2003). Responses of health and social care staff top South Asian women who attempt suicide and/or self-harm. Journal of Social Work Practice, 17(1), 103-114.

Bhugra, D., & Desai, M. (2002). Attempted suicide in South Asian women. Adv Psychiatr Treat, 8(6), 418-423.

Bhugra, D., & Hicks, M. H.-R. (2004). Effect of an Educational Pamphlet on Help- Seeking Attitudes for Depression Among British South Asian Women. Psychiatric Services, 55(7), 827-829.

British Medical Journal. (1996). Style Matters: Ethnicity, race, and culture: guidelines for research, audit, and publication. British Medical Journal, 312, 1094. Burr, J. (2002). Cultural stereotypes of women from South Asian communities: mental health care professionals’ explanations for patterns of suicide anddepression. Social Science & Medicine, 55(5), 835-845.

DeSouza, R. (2004). Working with refugees and migrants. In D. Wepa (Ed.), Culturalsafety (pp. 122-133). Auckland: Pearson Education New Zealand.

DeSouza, R., & Garrett, N. (2005). Access Issues for Chinese People in New Zealand(draft). Auckland: Accident Compensation Corporation.

Henare, K., & Ehrhardt, P. (2004). Support for Maori, Pacific and Asian Family,Whanau, and Significant Others who have been bereaved by suicide: Findings of a literature search. Wellington: Ministry of Youth Development.

Hicks, M. H. R., & Bhugra, D. ( 2003). Perceived Causes of Suicide Attempts by U.K. South Asian Women. American Journal of Orthopsychiatry, 73(4), 455-462.

Klajakovic, M. (1993). Is it easy collecting ethnicity data in general practice? NewZealand Medical Journal, 106, 103-104.

Latimer, S. (2003). Waitemata District Health Board: Ethnicity Data Collection Baseline Review. Auckland: Waitemata District Health Board.

McKenzie, K., Serfaty, M., & Crawford, M. (2003). Suicide in ethnic minoritygroups. British Journal of Psychiatry, 183(2), 100-101.

McLeod, D., Harris, R., Bailey, T., Dowell, A., Robson, B., & Reid, P. (2000). The collection of patient ethnicity data: a challenge for general practice. New Zealand Family Physician, 27(3), 51-57.

Ministry of Health. (2001). Monitoring Ethnic Inequalities in Health. Wellington:

Ministry of Health. Ministry of Health. (2003). Health and disability sector ethnicity data protocols. Wellington:

Ministry of Health. Ministry of Health. (2005). Suicide Facts: Provisional 2002 All-Ages Statistics. Wellington: Ministry of Health. Ministry of Health. (nd-a). Environmental scan: Ethnicity data collection issues.Wellington: Ministry of Health.

Ministry of Health. (nd-b). Submission on the review of the measurement of ethnicity. New Zealand Health Information System. (1996). Recording patient information:Ethnicity. Wellington: New Zealand Health Information System.

Pringle, M., & Rothera, I. (1996). Practicality of recording patient ethnicity in general practice: descriptive intervention study and attitude survey. Retrieved 8th February, 2004, from http://bmj.bmjjournals.com/cgi/content/full/312/7038/1080

Senior, P., & Bhopal, R. (1994). Ethnicity as a variable in epidemiological research. British Medical Journal, 309, 327-330.

Statistics New Zealand. (1996). Ethnicity – Standard Classification 1996. Retrieved 8th February, 2003, from http://www.stats.govt.nz/domino/external/web/carsweb.nsf/Classifications/Ethnicity+-+Standard+Classification+1996

Thiru, K., Hassey, A., & Sullivan, F. (2003). Systematic review of scope and quality of electronic patient record data in primary care. BMJ, 326(7398), 1070-1070.

Thomas, D. R. (2000). Assessing Ethnicity in New Zealand Health Research. New Zealand Medical Journal, 114, 12-14.

Thomas, S. B. (2001). The color line: Race matters in the elimination of health disparities. American Journal of Public Health, 91(7), 1046-1049.

April 7, 2008/by ruth

Cultural safety, Inequalities, Mental health, Migration, Racism, Women

Pregnant with possibility: Migrant motherhood in New Zealand

First published in Mindnet Issue 6 – Winter 2006

When my family arrived in New Zealand in 1975 there were very few people from Goa living here. We quickly got know every Goan in the country and, in hindsight, this connection provided me with an early interest in and focus on both maternal mental health and migrant mental health. Two Goan women we knew developed mental health problems that were devastating for themselves and their families. For one, it led to suicide and for another a lifelong history of mental illness and loss. Hardly good outcomes! This was a time when it was hard to maintain our culture. Thankfully, the more recent shift in focus to encompass settlement rather than just immigration will further enhance the well-being of ethnic communities in New Zealand.

There are still large research, policy and practice gaps in the area of migrant motherhood, which I’d like to address in this article. I’d like to start by highlighting the significance of migrant motherhood, which has potentially long term and wide ranging impacts on members of a family. I’ll then talk about the changing demographics of New Zealand society and suggest that health workers need to broaden their focus for working with New Zealand’s increasing diversity and develop culturally safe ways of working with migrants and their families. Lastly, I’ll share my experiences of research with migrant mothers from different ethno-cultural communities.

When migrants “cross borders they also cross emotional and behavioural boundaries. Becoming a member of a new society stretches the boundaries of what is possible because one’s life and roles change, and with them, identities change as well. Boundaries are crossed when new identities and roles are incorporated into life” (Espín, 1997, p.445). Border crossing can involve trauma related to migration and a psychic split (Mohamed & Smith, 1999).

Migration policies favour women (and families) of childbearing age, so it is no surprise that having a baby is a common aspect of a woman’s settlement experience. Motherhood and migration are both major life events. They present opportunities but incur the risk of mental health problems, more so when they are combined. Many cultures and societies have developed special perinatal customs that can include diet, isolation, rest and household help. But these traditional and specific practices and beliefs that assist in the maintenance of mental health can be lost in migration (Kruckman, 1992). Women are separated from their social networks through migration and must find new ways to recreate these rituals or lose them (DeSouza, 2002). Research suggests that the loss of support, protective rituals and supportive networks compounded by a move to a nuclear family-model can result in isolation and postnatal depression (PND) (Barclay & Kent, 1998; Liamputtong, 1994).

Access to help and support can be impeded if the mother has language and communication problems.

Migrant mothers sometimes face additional cultural and social demands and losses that include the loss of lifestyle, control, sense of self and independence, family and friends, familiar birthing practices and care providers.

Women are more likely to develop emotional problems after childbirth than at any other time in their lives and the life time prevalence of major depression in women is almost twice that of men (Kohen, 2001). According to Lumley et al. (2004), one out of every six women experiences a depressive illness in the first year after giving birth. Thirty per cent of those women will still be depressed when their child is two years old. Of those women, 94% report experiencing a related health problem. Women who experience problems in the early stages of motherhood also report problems with their relationships, their own physical health and well-being. Women report that a lack of support, isolation, and exhaustion are common experiences.

In a study of 119 pregnant immigrant women in Canada, Zelkowitz et al., (2004) found that the transitions associated with migration placed women at higher risk of depression. Forty-two percent of participants scored above the cut-off for depression. Depressive symptoms were associated with poorer functional status and more somatic symptoms. Depressed women reported a lack of social support, more stressful life events and poorer marital adjustment. In Australia, Liamputtong and Naksook (2003) found that Thai women who became mothers in Australia had several main concerns, including social isolation, different childrearing and child disciplinary practices, and the desire to preserve their culture. Findings of isolation, loneliness and negotiating between traditional and Western childbirth rituals are common in these studies and were significant issues in my own New Zealand research (DeSouza, 2006c). This research strongly suggests that migrant mothers, regardless of origin, benefit significantly from effective and familiar social support networks.

Psychiatric illness occurring at this time can have an adverse effect not only on the woman herself but also on her relationships, family, and the future development of her infant. The impact on a child of a mother’s depression can include behavioural problems, relationship problems and cognitive deficits. Research shows that infants who had a mother who was depressed in its first year of life are more likely to develop cognitive deficits and behavioural problems than infants whose mothers were not depressed in that first year (Beck, 1998).
A review by Goodman (2004) of literature from 1980 to 2002 found 20 research studies that included incidence rates of paternal depression during the first year postpartum. During the first postpartum year, the incidence of paternal depression ranged from 1.2% to 25.5% in community samples, and from 24% to 50% among men whose partners were experiencing postpartum depression. Maternal depression was identified as the strongest predictor of paternal depression during the postpartum period.

Changing demographics

Many societies are grappling with issues of citizenship and participation in the context of globalisation, increased migration and increasing diversity. In Europe, one in every fifteen people was born overseas, in the US it rises to one in eight and in New Zealand it is one in five (DeSouza, 2006a). This presents unique challenges and opportunities for service providers to develop skills and competence for working with this diversity, especially as migration is going to be a key source of population increase. Census projections to 2021 suggest that Māori, Pacific and Asian populations will grow at faster rates than the European population but for different reasons. The Asian population is expected to more than double mainly due to net migration gains while Māori and Pacific people’s increases will be due to their higher fertility rates (Statistics New Zealand, 2005).

The Asian community has the highest proportion of women (54%), followed by Māori and Pacific (53% each) and European (52%) (Scragg & Maitra, 2005). Asian women are most highly concentrated in the working age group of 15-64 years compared to other ethnic groups and to some degree this is a reflection of migration policy with Asian women using the opportunity to study or work. It is thought that 23% of New Zealand females were born overseas, predominantly in the UK and Ireland, Asia and the Pacific Islands (Statistics New Zealand, 2005). The 2001 Census revealed growing numbers of Māori (14.5%), Pacific Island people (5.6%), Chinese (2.2%) and Indian (1.2%), despite the dominance of the European/Pākehā who make up 79.6% of the population. In the period between 1991-2001, women originating from the Republic of Korea have increased 23 times from 408 to 9,354, women from China have quadrupled from 4,620 to 20,457 and women from South Asia have doubled in the same time period. Women from Africa (primarily South Africa, Zimbabwe and Somalia) have quadrupled in number (Statistics New Zealand, 2005). This has significant implications for the development and delivery of health services to women.

Cultural competence?

Working on a postnatal ward of a women’s hospital several years ago led me to question whether cultural safety had prepared the nursing and midwifery workforce for working with ethnic diversity1. Cultural safety, which refers to the experiences of the client, and cultural competence, which focuses on the practitioner and their capacity to improve health status by integrating culture into the clinical context, have been gaining prominence, but what do they actually mean?

The introduction of the Health Practitioners Competence Assurance Act 2003 has meant an additional responsibility to ensure the cultural competence of health practitioners. Cultural competence can be defined as “the ability of systems to provide care to patients with diverse values, beliefs and behaviours, including tailoring delivery to meet patients’ social, cultural, and linguistic needs (Betancourt, Green, & Carrillo, 2002). Cultural competence includes not only the interpersonal relationship (for example, training and client education) but also the organisational (for example, involving community representatives) and the systemic (for example, providing health information in the appropriate language, collecting ethnicity data).

The New Zealand Medical Council recently consulted its members on cultural competence (The New Zealand Medical Council, 2005). The consultation document includes a proposed framework and says that cross-cultural doctor-patient interactions are common, and doctors need to be competent in dealing with patients whose cultures differ from their own.

It cites the benefits of cultural competence as:

Developing a trusting relationship;
helping to get more information from patients;
improving communication with patients;
helping to resolve any differences;
increasing concordance with treatment and ensuring better patient outcomes; and
improved patient satisfaction.

For cultural competence to occur there is a need for the voices of ethnic communities to be considered in service development, policy and research. Despite the long histories of migration to New Zealand, ethnic communities have been absent from discussions of nation building and health care policy (DeSouza, 2006b). This has in part been due to the relatively small numbers of migrants from non-traditional source countries until the early 1990s, which meant that that the concerns of a relatively homogenous Pākehā people were reflected in policy (Bartley & Spoonley, 2004). This monoculturalism continues to be challenged by the increased prominence of Māori concerns since the 1970’s and increasing attention to biculturalism and health outcomes for Māori. Developments have also occurred with regard to Pacific peoples, largely around health disparities, but this concern has not been extended to ethnic communities despite their increasing visibility in long and short-term migration statistics. This is partly due to an assumption of a ‘health advantage’ of immigrants on the basis of current migration policy, which selects healthy people. However, evidence is growing that this advantage declines with increasing length of residence in a receiving country (Johnstone & Kanitsaki, 2005).

Cultural safety

When Britain assumed governance of its new colony in 1840, it signed a treaty with Māori tribes. Te Tiriti O Waitangi/The Treaty of Waitangi is today recognised as New Zealand’s founding document and its importance is strongly evident in health care and social policy. As an historical accord between the Crown and Māori, the treaty defines the relationship between Māori and Pākehā (non-Māori) and forms the basis for biculturalism.

Durie (1994) suggests that the contemporary application of the Treaty of Waitangi involves the concepts of biculturalism and cultural safety, which are at the forefront of delivery of mental health services. This means incorporating “principles of partnership, participation, protection and equity” (Cooney, 1994, p.9) into the care that is delivered. There is an expectation that mental health staff in New Zealand ensure care is culturally safe for Māori (Mental Health Commission, 2001). Simply put, “unsafe practitioners diminish, demean or disempower those of other cultures, whilst safe practitioners recognise, respect and acknowledge the rights of others” (Cooney, 1994, p.6). The support and strengthening of identity are seen as crucial for recovery for Māori along with ensuring services meet Māori needs and expectations (Mental Health Commission, 2001). Cultural safety goes beyond learning about such things as the dietary or religious needs of different ethnic groups; it also involves engaging with the socio-political context (DeSouza, 2004; McPherson, Harwood, & McNaughton, 2003). However, critics suggest that cultural safety needs to encompass new and growing ethnic communities. Whilst in theory cultural safety has been expanded to apply to any person or group of people who may differ from the health professionals because of socio-economic status, age, gender, sexual orientation, ethnic origin, migrant/refugee status, religious belief or disability (Ramsden, 1997), in practice the focus remains on the relationship between Pākehā and Māori, rather than migrants (DeSouza, 2004) and other communities (Giddings, 2005).

Expanding the bicultural to a multi-cultural framework is necessary without removing the special status of tangata whenua. New Zealand’s reluctance to encompass multiculturalism as a social policy framework has been shaped by two key factors, according to Bartley and Spoonley (2004). The first is the location of historical migration source countries such as the United Kingdom and Ireland, which shaped the development of activities and concerns (as they argue, racist and Anglo centric assumptions of a colonial New Zealand) and, secondly the rise in concerns over indigenous rights and the Treaty of Waitangi, which have precluded discussion around nation and nationality. Thus while countries such as Canada and Australia were developing multicultural policies, New Zealand was debating issues of indigeneity and the relationship with tangata whenua. As a result, New Zealand has yet to develop a locally relevant response to cultural diversity (multiculturalism) that complements or expands on bicultural and Treaty of Waitangi initiatives (Bartley & Spoonley, 2004).

Need for a migrant health agenda

It is, I hope, clear by now that there is a need to develop a migrant mental health agenda, yet much of the previous New Zealand research has omitted the experiences of migrant mothers. The Centre for Asian and Migrant Health Research at AUT University and Plunket have begun a collaborative project with funding from the Families Commission and Plunket volunteers to understand the experiences of migrant mothers from the United Kingdom, the United States, South Africa, Palestine, Iraq, China, India and Korea, which it is hoped will assist in the development of services and policy.

There is a misguided view that migrants do not experience compromises in their health status despite the changes in income and social support and the new stressors they encounter, which can lead to cumulative negative effects and the need to access mental health services. The neo-liberal trajectory that our society has taken has precluded an interest in the wellbeing of migrants who often face culture-related barriers in using mental health care services. Other than a literature review produced by the Mental Health Commission (Mental Health Commission, 2003), which recommended that mental health services become more responsive to Asian people, there has been little in the way of strategic or long term planning with most of the developments in this area coming from the community and voluntary sector.

Conclusion

Migrants face additional stressors that can increase their need for mental health services. Migration can be a traumatic life event. Becoming a mother in an unfamiliar country adds to this already traumatic event, leading migrant mothers to be more at risk of experiencing depression or other mental health issues. Yet, research on the migrant experience in New Zealand is limited and studies on postnatal depression have excluded migrants in the past.

As the number and diversity of migrants increase, their well-being becomes an increasingly important issue for policy makers and health professionals. The time is right to begin a dialogue about how mental health services can work effectively with this diversity. Migrant mothers hold the key to a family’s future well-being and so are an important group for us to understand and support. In the absence of policy there is a need to advocate for migrant mental health service development, building on the many grassroots initiatives that are already occurring. Beyond this, further discussion is needed as to how cultural competency and cultural safety can be applied to migrant populations.

1. ‘Ethnic’ is a term devised by the Department of Ethnic Affairs and refers to people who are neither Pakeha, Maori or Pacific).

References

Barclay, L., & Kent, D. (1998). Recent immigration and the misery of motherhood: a discussion of pertinent issues. Midwifery, 14, 4-9.

Bartley, A., & Spoonley, P. (2004). Constructing a workable multiculturalism in a bicultural society. In M. Belgrave, M. Kawharu & D.V. Williams (Eds.), Waitangi revisited: perspectives on the Treaty of Waitangi (2nd ed., pp. 136-148). Auckland, N.Z.: Oxford University Press.

Beck, C. T. (1998). A checklist to identify women at risk for developing postpartum depression. Journal of Obstetric, Gynecologic and Neonatal Nursing, 27(1), 43-44.

Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2002). Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches. Retrieved 27th April, 2005, from www.cmwf.org/usr_doc/betancourt_culturalcompetence_576.pdf

Cooney, C. (1994). A comparative analysis of transcultural nursing and cultural safety. Nursing Praxis in New Zealand, 9(1), 6-12.

DeSouza, R. (2002). Walking upright here: Countering prevailing discourses through reflexivity and methodological pluralism. Massey University, Albany, New Zealand.

DeSouza, R. (2004). Working with refugees and migrants. In D. Wepa (Ed.), Cultural safety (pp. 122-133). Auckland: Pearson Education New Zealand.

DeSouza, R. (2006a, May 26th). Cultural Diversity and Context: Responding to the needs of ‘This Child” in “This Family”. Paper presented at the 5th Annual Child Law Conference, Lexis Nexis, Auckland.

DeSouza, R. (2006b). Researching the health needs of elderly Indian migrants in New Zealand. Indian Journal of Gerontology, In press.

DeSouza, R. (2006c). Walking upright here: Countering prevailing discourses through reflexivity and methodological pluralism. Auckland, NZ: Muddy Creek Press.

Durie, M. (1994). Whaiora: Maori health development. Auckland; Oxford: Oxford University Press.

Espin, O. M. (1997). The role of gender and emotion in women’s experience of migration. Innovation: The European Journal of Social Sciences, 10(4), 445-455.

Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1), 2-35.

Johnstone, M.-J., & Kanitsaki, O. (2005). Cultural safety and cultural competence in health care and nursing: An Australian study. Melbourne: RMIT University.

Kohen, D. (2001). Psychiatric services for women. Advances in Psychiatric Treatment, 7, 328-334.

Kruckman, L. D. (1992). Rituals and support: An anthropological view of postpartum depression. In J. A. Hamilton & P. N. Harberger (Eds.), Postpartum psychiatric illness: a picture puzzle (pp. 137-148). Philadelphia: University of Pennsylvania Press.

Liamputtong, P. (1994). Asian mothers, Australian birth: pregnancy, childbirth, and childrearing: the Asian experience in an English-speaking country. Melbourne: Ausmed Publications.

Liamputtong, P., & Naksook, C. (2003). Life as mothers in a new land: The experience of motherhood among Thai women in Australia. Health Care Women International, 24(7), 650-668.

McPherson, K. M., Harwood, M., & McNaughton, H. K. (2003). Ethnicity, equity and quality: Lessons from New Zealand. Quality & Safety in Health Care, 12(4), 237-238.

Mental Health Commission. (2001). Cultural Assessment Processes for Maori – Guidance for Mainstream Health Services. Wellington: Mental health commission.

Mental Health Commission. (2003). Mental Health Issues for Asians in New Zealand: A Literature Review. Wellington: Mental health commission.

Mohamed, C., & Smith, R. (1999). Race in the therapy relationship. In M. Lawrence, M. Maguire & J. Campling (Eds.), Psychotherapy with women: feminist perspectives (pp. 134-159). New York: Routledge.

Ramsden, I. (1997). Cultural Safety: Implementing the concept – The Social Force of Nursing and Midwifery. In P. T. Whaiti, M. McCarthy & A. Durie (Eds.), Mai i rangiatea (pp. 113-125). Auckland, NZ: Auckland University Press and Bridget Williams Books.

Statistics New Zealand. (2005). Focusing on women. Retrieved 25th January, 2005, from www.stats.govt.nz/analytical-reports/children-in-nz/growing-ethnic-diversity.htm

The New Zealand Medical Council. (2005). Assuring Medical Practitioners’ Cultural Competence (draft document for consultation). Retrieved 3rd May, 2005, from www.mcnz.org.nz/portals/1/news/culturalcompetence.pdf

Zelkowitz, P., Schinazi, J., Katofsky, L., Saucier, J. F., Valenzuela, M., Westreich, R., et al. (2004). Factors Associated with Depression in Pregnant Immigrant Women. Transcultural Psychiatry, 41(4), 445-464.

June 11, 2006/by ruth

Indigenous, Migration, Multiculturalism, Racism, Te Tiriti o Waitangi/Treaty of Waitangi

My World, Diversity and New Zealand

Plenary presentation at the New Zealand Diversity Forum, August 22, 2006. Te Papa Tongarewa, Wellington.

Thank you for inviting me to speak at this plenary session of the Diversity Forum. I’ve been asked to talk about my world, diversity and New Zealand from an ‘ethnic’1 point of view. The theme of my talk is to ‘Get lost’. There is something about going out of town to conferences and meetings that is very liberating. I feel like I am much more open to new experiences and meeting people because I am not stuck in my routines, tasks and schedules. Getting lost means stepping out of your comfort zone, and being open to expanding your internal and external boundaries.

Getting lost isn’t really that difficult, some of us do it without trying! I always get lost in Wellington! My family has had a habit of getting lost. From my great grandfathers’ who both went to Burma (who said that astronaut families are a new trendy kind of thing!). Then my grandparents got lost in Tanzania and so did my parents. I was born in a place called Tabora, which was founded by Arab slave traders in 1852, captured by the Germans in 1891 and a prosperous, thriving town. It was the administrative centre of German East Africa. From 1852 to 1891, Tabora was the slave capital of East Africa, ivory and humans were traded for guns, beads and cloth. Tabora is also famous as a base for many great explorers, it was the place where Stanley uttered those unforgettable words “Dr Livingstone, I presume.”

In 1975, my parents decided to get lost again, this time in New Zealand and I have made it a habit to get lost regularly ever since! Migration forces you to ‘get lost’. Disorientation and the loss of reference points mean that some people never survive while others thrive. Migration leads us to develop new reference points, networks, rituals and experiences. Depending on the kind of pre- migration experiences we’ve had we might be traumatised, grieving and exhausted. When we arrive, the reception of the receiving country can influence how happy we are about the experience and, equally, if our expectations are met. If not, we can lose heart and face. Yet, if we allow ourselves to get lost in the experience of resettling and be open to new ways of doing things we can benefit enormously.

There is an expectation that migrants need to find their feet. They are the ones who are lost and need to discover our reference points so they can become just like the receiving community. But, I would like to argue that all of us need to ‘get lost’ and on a regular basis! What I mean by this is that we all need to be willing to take a trip to a place we’ve never been. A new New Zealand where there are wonderful adventures to be had. We don’t have to go around the world to get lost, as TV host Phil Keoghan says “just put yourself in a situation that is removed from your everyday life and become immersed in it. Go with the flow – it expands your horizons, opens you up to new influences, and tests your resourcefulness and adaptability’. Unless you prefer to hark back to the dark days of assimilation. I think this is the gift of migration. For migrants but also for the receiving community, who are given an opportunity to re-evaluate what they consider valuable and important without leaving home.

The opportunity to expand our internal and external boundaries is going to increase with the continuing demographic changes that are occurring in New Zealand. These changes are not only an increase in ethnic diversity, but also linguistic and religious diversity. They pose opportunities and challenges for not only receiving communities, but also for long term settled communities, like Chinese and Indian communities who have been here since the late 1800s. There are opportunities and challenges ahead for Māori and Pacific peoples who fear that their needs and aspirations might be lost among the competing claims that newcomers bring.

We’ve had very few conversations about how we are all going to live together; the only ones I’ve heard are about the Treaty partners, and those leave the rest of us out. There are additional issues for us to get lost in, such as moving from models of deficits to models of strength and resourcefulness. Examining multiple and intersecting identities, moving beyond what is a fashionable cause and hierarchies of deserving. I am thinking of a research project I’ve just completed which showed that white migrants struggle with being lost too. Their needs go unconsidered as it is assumed that they will ‘fit in’ and are a close match to people already here. How do we go about actively embracing the people around us, building bridges not walls or silos? Passive acceptance means we don’t have to get lost; we don’t even have to try. But we can then idealise or demonise the people around us because we’ve partaken in the highly consumable aspects of their culture, the food and the festivals. Trouble is we can enjoy the food without caring about the cooks.

I’d like to suggest some ways forward, moving beyond discussions of bicultural and multicultural to consider how we can all live together and what vision can guide us. I want to draw on some ideas from Ghassan Hage about multi-cultural co-existence versus multicultural interaction. I then want to say something about how we become inter-cultural by, accepting the ‘other’ in ourselves. I think it is easier to identify the problems than come up with solutions so I’d also like to give an example of a successful initiative.

Hage says that coexistence involves existing alongside one another. We acknowledge each other’s existence but this existence operates on the premise that we can respect one another as long as we do not rub up against each other. In effect we live in silos right next to each other but watch out if there is any seepage into the public arena. Interaction requires more effort because engagement and irritation are a necessary part of the process, it means getting to know each other as a living multiculturalism where we don’t glorify or demonise ‘others’. To move from coexistence to interaction requires all of the people who live in New Zealand to literally get lost, to step out of our comfort zones and to start getting to know each other. Messy, untidy, unpleasant bits included. This is harder than it sounds, very easy for the liberal middle classes who have the benefit of distance, harder when you are fighting for the same piece of socio-economic pie. Vin D’Cruz tells us for this to happen we must make some internal shifts and embrace the ‘other’ in ourselves. Lorde agrees, urging “each one of us here to reach down into that deep place of knowledge inside herself and touch that terror and loathing of any difference that lives there.” Only through a process of empathy and transformation can we live with difference. Going deep into ourselves to embrace our own loathing of difference requires us to get lost.

Me with Chief Human Rights Commissioner Roslyn Noonan

Richard Brecknock talks about moving from the multicultural, where we acknowledge and celebrate our differing cultures, to the intercultural where we focus on what we can do together as diverse cultures in shared space to create wellbeing and prosperity. An assumption of an intercultural vision is the recognition that diverse societies are more innovative, productive and competitive. Immigrants and ethnic communities have a greater facility to move within and between communities and high intercultural networking capacity. However, this capacity isn’t always well optimised especially when there is no vision and where socio-economic inequalities exist and ethnic community groups are siloed, the challenge then is to enhance the abundance of talent and entrepreneurship in ethnic communities.

The Aotearoa Ethnic Network is a partner in the Human Rights Commission’s New Zealand Diversity Action Programme, and aims to contribute to the dialogue on how we can all live together. An inter-cultural, inter-sectoral network with over 300 members from all over New Zealand, it provides a space for discussion and debate for those interested in ethnic issues. The AEN Journal, launched in July this year, promotes critical debate on issues facing migrants and refugees, ethnic, diasporic and religious communities. Race Relations Commissioner Joris de Bres writes about the genesis of the Diversity Action Programme in the July issue and the need to have “networks and spaces where people were able to meet across ethnicities or cultures, and that while many people ‘wanted to do something’ there were no readily available mechanisms through which to do so in concert with others”. AEN goes some way to achieving this.

To conclude, thanks for a wonderful two days at this Forum. I know that we have identified problems and we have a way to go, but look how far we have come and how far we can go!

Migrant Populations

DeSouza, R. (2004). Working with refugees and migrants. In D. Wepa (Ed.), Cultural safety (pp. 122-133). Auckland: Pearson Education New Zealand.

The art of walking upright here

Is the art of using both feet.

One is for holding on.

One is for letting go. (Colquhoun, 1999, p.32)

Glenn Colquhoun’s poetry captures the challenge dislocation from home and family. The migrant or refugee has to somehow hold on to their legacy and their heritage whilst simultaneously letting go of those things that cannot be maintained in a new country. They must let go to create new lives, so they can stake a new claim of belonging; a new place to stand.

One in five New Zealanders was born overseas. This rises to one in three in Auckland. For many, migration is seen as a way of obtaining a better life, particular for ones children. Whilst many migrants make informed decisions, this needs to be seen as a continuum between full choice and no choice. This can been viewed as a ‘pull’ effect (migrants are drawn to a new country for the opportunities available) or a ‘push’ effect (the motivation is simply to leave where they are). Migrants can be defined as people who were born in one country and then move to another under an immigration programme. In New Zealand this consists of three main streams:

Skilled/Business: Which relates to attracting migrants with qualifications and skills, or the potential to create business opportunities in New Zealand.
Family sponsored: Where New Zealand citizens or permanent residents can sponsor family members to the country.
Humanitarian: This includes refugees and allows for family members to be granted residence if there are serious humanitarian concerns.

Refugees that have resettled in New Zealand mostly originate from Africa, the Middle East, South East Asia and Eastern Europe. Refugees differ from voluntary migrants because they were forced to leave their home and have little if any choice in selecting their destination. They are at the extreme end of the ‘push’ effect, often having fled from situations of conflict and human right abuses. This has important implications for the provision of health care, as they might not have had access to preventative and treatment services. Most refugees arriving in New Zealand will spend six weeks at the Mangere Refugee Reception Centre (MRRC) in South Auckland. There are estimated to be 20.6 million refugees and displaced people in need of protection and help (UNHCR, 2003). Currently New Zealand accepts a United Nations-mandated quota of 750 refugees per year, plus approximately the same number again of asylum seekers. Asylum seekers are people seeking refugee status without legal documentation. They often experience depression, hopelessness and helplessness related to stress and socio-economic deprivation. Even where migration is an informed choice, the result can still be isolation and loss of financial independence. Before migration, one often only considers the positives; it can be difficult to understand the adjustment that is required and to come to terms with the losses of family, friends, culture and familiarity.

In this chapter I present a view of cultural safety and how it is relevant to health from the perspective of a migrant with a view to informing those who will be caring for the needs of migrants and refugees. I will briefly review the history and tensions around migration and migrants. Anecdotes from my clinical experience are woven through the text to present multiple layers to reflect the complexity of the experience and reflective questions are posed to increase self-awareness. I conclude by offering a range of strategies for working with diversity.

April 7, 2004/by ruth