Tag Archive for: migration

Why write/read book chapters? Community, connection, and creativity.

“…the neo-liberal academy has compelled me to compete and compare, to work on my own, to overwork, and to count narrowly. At various times, neoliberal ideologies have crept into my mind/writing/body, breaking me down. The academy’s “finite games” of winners and losers, the demands to prove I am a “credible academic”, the narrow counting and the changing and hardening rules of entry have kept me running on the production treadmill, frequently distracting me from what matters most” (Harré et al., 2017, pp. 5, 9).

I am a serial book chapter reader and writer. If you check out this link, you’ll see I have written a fair few. Writing a book chapter seems less daunting than trying to write a whole book, and less prescriptive and intimidating than journal articles because I can more easily imagine the reader. It may be a student or someone from my academic or professional community, but I have a sense of their ethical and political commitments. In quantified academia, research activity and impact are crucial to academic promotion/tenure and research funding. In my field of health, peer-reviewed journal articles are the gold standard. When I think like a ‘professional’ academic I sometimes wonder if book chapters are ‘worth’ writing. So much of “successful” knowledge production depends on your discipline, your structural location (not only whether you are tenured or precarious, but also whether you have a marginalised identity/ies or work in a marginalised field), your preferences for dissemination or contribution in terms of who you write for, and how ambitious you are, so it’s political as well. None of this is helped by the ways in which academia is still predicated on being an exceptional competitive individual which can preclude more contemplative kinds of collaboration (Black, 2022). In the Gigiversity, there’s also what Mark Carrigan calls temporal budgeting which can be a barrier to writing as a creative process. Writing becomes calculated, something that has to be accounted for, and made time for.

I am not immune from living a calculated life. I recently said no to an invitation to write an academic book chapter (and I am still ambivalent about this) because of the opportunity cost, not because of wanting it published in a journal where it would “count” more, but because my career is now based on consulting, so the time I spend writing without payment means not getting paid. You can read more about the reasons not to write book chapters in this blog by Adam Chapnick. I have also co-edited a book Researching with Communities: Grounded perspectives on engaging communities in research, supposedly a huge no-no, but that’s for another blog. Rasmus Nielsen’s conceptualization of the value of the book chapter genre is helpful (1) argumentative chapters, (2) trailer chapters, and (3) review chapters. In the first category, a book chapter can help to think through an argument in an interpretive and personal way; and the second category where you operationalize the underlying concerns for another project is where my work has typically landed. I save the third for journal articles. So why even write book chapters? Here are some of my reasons.

As a reader and scholar, anthologies have saved me as a person of color. This Bridge called my Back and later Black British Feminism edited by Heidi Mirza, which I devoured avidly in a largely monocultural academic New Zealand are just two examples. As an author Sara Ahmed, says that the Mirza book was pivotal to a broader political identity and that being part of “a collection can be to become a collective” (Ahmed, 2012, p.13). Younger me would have been so thrilled to get my hands on Towards a Grammar of Race In Aotearoa New Zealand edited by Arcia Tecun, Lana Lopesi and Anisha Sankar. Covering all the things younger me was living through but had no vocabulary for, things like racial capitalism, colonialism, white supremacy, and anti-Blackness.

More elegantly and evocatively, my friend and podcast guest extraordinaire Alice Te Punga Somerville writing from Musqueam whenua, offers many metaphors for the collectivity of edited books, as food, as gathering, as connected across time and space, tantalising and replenishing. She adds (in discussing a new edited book by Kiri Piahana-Wong and Vaughan Rapatahana) “Māori have always been collective with our writing: so many anthologies, collections, joint readings, festivals, hui, organisations, writing groups, one-off collectives, roopu… this one draws consciously on the Into the World of Light/ Te Ao Mārama anthologies called into being by Ihimaera and others… but all of these Māori literary awa are part of a massive network of tributaries and streams and gorges and brooks and braided rivers and underwater culverts and, yes, all the way out to open ocean…she concludes “slurping down this awa which is replenishing and exciting me… and loving this hui with writers known by my heart, writers I have long admired from afar, and writers I have yet to meet.”

These relationships and collaborations are such a good reason for writing book chapters. Helen Kara who I enjoy for their interest in creative methods values the sense of community or social network that can accompany an edited book when there is a clear theme and the authors richly complement each other, which cannot be achieved with a single or co-authored book. It’s what Debra Brian says is a plus for the reader — “they often capture an important moment in the history of the discipline, or an opportunity to bring together multidisciplinary takes on a central theme.” I have recently had a chapter on racism and care published in No longer silent: Voices of 21st Century Nurses edited by Lesley Potter with support from the Australian College of Nursing. It is envisioned as a snapshot of contemporary nursing in Australia. Here’s a short excerpt:

There is trepidation and vulnerability that accompanies naming racism, rather than the more palatable good feeling word diversity (De Souza, 2018). Discourses of diversity and inclusion are what Ahmed (2012) describes as ‘non-performative institutional speech acts’ meaning that just their use as words do not necessarily change what it is they are naming Ahmed, 2012, p. 119). Racism is so direct, so harsh in the text as opposed to toned down with my good humor or the self-effacing charm I have cultivated as a bolster. I am a nurse who migrated to Australia post PhD for work in academia. As a person of color or brown settler, I occupy a position of unease and anxiety, uninvited living on stolen land, in a country where relationships between Indigenous people, settlers and migrants are contested. I am also privileged to be a mobile, highly educated researcher working in the prestigious context of a University. As (Moreton-Robinson, 2007, 2015) quips, the White nation-space of so-called Australia, excludes both Indigenous people and non-British people. However, I invoke this process of critical reflexivity and locate my own positionality to account for myself and for my writing. A person with ancestral heritage in Goa, India but whose personal and familiar multiple migrations, have been shaped by colonization. I provide these histories and geographies to account for how I write, they provide me with a specific set of ethical and political commitments that aim to contribute to making nursing a profession that is less discriminatory and more equitable for both those who follow me and those we purport to serve. I care about nurses and nursing and am troubled by the paradox that a profession that claims to care could be implicated in perpetuating inequities for some populations. This stance of critique and the desire for accountability may make what I write seem particularly critical, however, it also reflects a deep investment in the nursing profession.

Changes in models of publishing have also made writing book chapters more worthwhile Patrick Dunleavy says in an LSE blog. Dorothy Bishop admits her best writing is in book chapters where she has had the freedom to integrate broad perspectives, but argued in the past that writing a book chapter was like burying your work because of difficulties in trying to access and cite work. However, now that e-book chapters are becoming as discoverable, and more affordable, the reader or potential citer no longer has to pay massive prices for books that are just as easy to find as journal articles. Individual chapters have become easier to use in teaching, as they can be added to reading lists on learning management systems (LMS). I have added a book chapter on Cultural Safety I co-wrote for the book The Relationship is the Project for a lovely intensive course I’ve been teaching in the School of Art with Alan Hill and Jody Haines at RMIT University called Creative Practice in Place: Working on Unceded Lands. Interestingly the chapter has been reprinted online in two different contexts, in Arts Hub as Taking action for Cultural Safety and republished in Spotlight, the Arts Wellbeing Collective magazine which makes it more accessible. However, access does not equal citations, so even if they are used in essays or theses, they may not show up in citation metrics.

Book chapters open up different formats and creative options compared to journal articles, which is why one of my favorite academic bloggers Pat Thomson who blogs at Patter writes them. Another favorite blogger Agnes Bosanquet writes In defence of book chapters that book chapters let you publish “something experimental, fun and adventurous” and you can take more “risks with style, structure and method”. Concluding that “when I want to write in the company of others, flex my writing muscles in new ways, and find pleasure in the craft of writing, then book chapters are a gift”. Historian Zora Simic says “I find them a more liberating form than a journal article and some of that is because of the way I think – journal articles typically demand an argument that is pursued in coherent fashion whereas I prefer ambiguity, open and loose ends, experimentation, and exploration for the sake of it.” This desire to write playfully and creatively resonates with me. There’s also a pragmatic freedom that Thomson identifies. Firstly, because your chapter is part of a collection, you do not have to do as much prefacing and situating as you would in a journal article. and secondly, you do not have to convince people to read the chapter because the editors have already done that work for you.

Viewing a field through a different lens is another reason to write a book chapter, providing a way in which students or practitioners can get a feel for a topic, its scope and debates. Elaine Swan adds “I recommend them to students as they can see how a topic can be understood through different concepts and methods.” Scholars like Carol D’Cruz find the breadth of the approaches to tackling the same issue appealing: “I love variety in the perspective and approach in edited collections, especially when all answering the same/similar problem.” Some writers also appreciate the opportunity to learn, to use their experience in another context, like Zora Simic who says “Once I responded to a call for contributions to a book called Fat Sex. I’d always wanted to know more about the history of fat activism/feminism and this was the perfect opportunity. It had nothing whatsoever to do with my other research, apart from being about feminism. But I loved writing and researching it.”

Leaving your mark in a field is another drawcard. Debra Brian contends saying yes to a book chapter “can signal your commitment and standing in the field, your academic social capital, etc — and it can bring other opportunities. Sometimes it is worth doing for the sake of collaboration and relationships and the opportunity to find a home for something that needs to be said but doesn’t really ‘fit’ in another format.” This really rang true for me in my contribution to Jessica Dillard-Wright’s book Nursing a Radical Imagination: Moving from Theory and History to Action and Alternate Futures co-edited with Jane Hopkins-Walsh and Brandon Brown where I wrote about creative methods in nursing education. We’ve subsequently collaborated on a number of other projects, Jess (and Jane) contributed an artwork for our exhibition and course for The Big Anxiety Festival, and did a Zoom guest lecture to art students. We have also just cowritten No as an act of care A glossary for kinship, care praxis, and nursing’s radical imagination Jessica Dillard-Wright, Favorite Iradukunda, Ruth De Souza, and Claire Valderama-Wallace in the tome Routledge Handbook of Philosophy and Nursing Edited By Martin Lipscomb. I feel deep gratitude for the friendship that has evolved between us in the process of talking and writing (a non-academic benefit (Tom Pepinsky) of writing book chapters)! Here’s the abstract:

Radical imagination and the transformations that ensue are fundamentally collaborative, connected, and conscious. In an effort to first imagine and then co-create a more just, equitable present/future for nursing and those with whom we care in the spirit of radical imagination, this chapter examines nursing care as praxis and the shifts that occur in embracing kinship as a reciprocal model for nursing. In so doing, we challenge embedded power structures within the healthcare-industrial complex – and thus nursing – as we currently know it. Using feminist, queer, anti-colonial, anti-imperialist, and abolitionist insights, we imagine a present/future for nursing liberated from the capitalist political economy entrenched in a boundless society of control. This speculative vision is urgent, encompassing, and material, bursting open the boundaries of nursing as we consider with whom we align and how we build toward a future on a deteriorating planet.

Obviously, academics have to be strategic about writing but I also write because writing helps me make sense of things. I write to think, just as I speak to think. The former is far more laborious for me but I am getting better at it. Book chapters allow me to play, to experiment, and to feel part of a community, a collective and that is hard to beat.

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We need more than diversity in nursing.

I wrote a piece for the Spring 2018 edition (Issue 23) of the Hive (the Australian College of Nursing’s quarterly publication). Cite as:DeSouza, R. (2018). Is it enough? :Why we need more than diversity in nursing. The Hive (23, 14-15). You can also download a pdf of the article for your own personal use.

Diversity is a hopeful, positive and celebratory idea, it generates more happiness than words like inequity, racism and privilege. It feels good for a large number of people precisely because it is depoliticized (Hall & Fields, 2013). It does not demand accountability. It does not demand transformational change of our minds or our environment, but requests that we continue to put up with difference or to tolerate it (Bell & Hartmann, 2007). What does it mean for our profession to be diverse? And is it enough?

Is it enough, when we have a yawning chasm of health inequity and disparity, of deaths in custody, of punitive policy aimed at Aboriginal Australians? Is it enough, in an era of devastating Islamophobia and racism enabled by nationalist right wing xenophobia? Is it enough, when politicians challenge group-based rights and argue that they undermine social cohesion and “our way of life”, maligning and scapegoating already vulnerable groups like African youth. Is it enough, when media only catapult the spectacular and exceptional into our view. Is it enough, when the entire world is condemning Australia’s abhorrent offshore policy of deterrence and detention. Yes, we need to recognise difference, but we must also understand how differences are connected to inequalities. As Mohanty observes: “diversity by passes power as well as history to suggest a harmonious and empty pluralism” (Mohanty, 2003, p. 193).

We might be ticking the diversity boxes and celebrating diversity — whether in University brochures and websites or on Harmony Day — but do our combined activities address health disparities? The problems of inequity and disparity are bigger than us but we can be accountable for the parts we play in larger political struggles. For a politics of equity, we also need to consider race, disability, ethnicity, class, gender, sexuality, and religion and integrate these into our analyses of our social world. We need to expand the frames we use to look beyond individual behaviour and to consider social and systemic issues, and call for systematic interventions to address inequity. ‘Celebrating’ cultural difference isn’t the same as action, as fighting for justice. As (Perron, 2013) notes, nurses can be both caring for individuals and advocating for the collective rights to equitable care, they aren’t mutually exclusive.

Diversity assumes that care is still a neutral technical activity
As nursing emerged from being a class of handmaidens to the medical system to the dynamic profession it is today, we have understood it to become an intellectual, cultural and contextual activity. This means it is also a political activity (De Souza, 2014). Nursing is connected to systems of power and privilege. Nurses and clients bring multiple ways of being in the world into the world of care and yet we only privilege some of these ways of being. Iris Marion Young describes oppression as being “the disadvantage and injustice some people suffer not because of a tyrannical power coerces them but because of the everyday practices of a well-intentioned liberal society…” (Young, 1990, p. 41). There continue to be clear links between institutional bias in health care systems and health disparities (Hall & Fields, 2013). Let’s ask ourselves what practices we enact every day that contribute to inequity?

Diversity maintains whiteness at its core
In diversity talk in nursing there’s an assumed white centre with difference added. White people are conceived as the hosts and people of color viewed as guests and the perspectives of Indigenous people are erased. Allen (2006, pp. 1–2) calls this the ‘white supremacy’ of nursing education: an assimilationist agenda that converts diverse groups people into a singular kind of nurse, which can then add ‘others’ into the mainstream to create a multicultural environment. But, this addition reinforces rather than displaces whiteness from the centre of structures and processes of educational or clinical institutions (p.66). It’s important that we focus on whether nurses reflect the communities that they serve. But representation in the workforce doesn’t mean that the people who are culturally different have a voice in the corridors of power. There are questions also about “who’s at the decision-making table and who’s not. And what’s on the agenda and what’s not” (Brian Raymond, 2016).

Diversity focuses on sensitivity and respect rather than on the social and historical
Race and racism are determinants of health inequities (Krieger, 2014) therefore it follows that a key area where nurses could intervene is to address discrimination. It is inadequate for us to provide individualised sensitive and respectful care while ignoring the historical and structural conditions that shape health and healthcare. As nurses, we understand more than most that life is an uneven playing field – we need to bring this knowledge to the way we work as a profession. Cultural sensitivity and awareness tend to assume that racism is “out there”, rather than something that is also enacted within healthcare systems. Our claims to colorblindness reinforce the problem, as” treating people the same” doesn’t take into account their differing needs, which is one definition of what care is.

Spotted at my local market

Creating a meaningful diverse and multicultural nursing profession
in an era where both patient populations and the nursing workforce are becoming more diverse, where are the spaces for nurses to talk about both institutional and societal racism and how they impact on care? How can nurses broaden their focus from the micro-level to see the big picture, especially when they labor in unstable and under-resourced working environments (Allan, 2017)? Nurse educators must confront our own resistance to teaching about race and racism (Bond & Others, 2017) – the recent debates about the inclusion of cultural safety into the Nursing and Midwifery Codes of Conduct reflect now far we have to go. Our curricula must more explicitly embed anticolonial and intersectional perspectives into learning experiences in order to prepare nurses for not only understanding how structural inequities affect health but also for the skills to counter them (Blanchet Garneau, Browne, & Varcoe, 2016; Thorne, 2017; Varcoe, Browne, & Cender, 2014). In Australia, the Indigenous Health Curriculum Framework developed by the Committee of Deans of Australian Medical Schools, recognised the critical need to teach students about racism. In particular, it asks us to see the connection between history and current health outcomes; to be able to identify features of overt, subtle and structural racism or discrimination and to be able to address and help resolve these occurrences.

Viewing nursing as a neutral, universal activity where appreciation, sensitivity and respect are adequate, prevents us from considering nursing as a political activity where power is at play. Conversely, embedding an understanding of the historical, structural and systemic factors that shape health, into our practice will allow us to create a meaningfully inclusive – and more caring – profession. This however, requires courage, commitment and accountability. Do we have it?

References

Allan, H. (2017). Editorial: Ethnocentrism and racism in nursing: reflections on the Brexit vote. Journal of Clinical Nursing, 26(9-10), 1149–1151.
Allen, D. G. (2006). Whiteness and difference in nursing. Nursing Philosophy: An International Journal for Healthcare Professionals, 7(2), 65–78.
Bell, J. M., & Hartmann, D. (2007). Diversity in Everyday Discourse: The Cultural Ambiguities and Consequences of “Happy Talk.” American Sociological Review, 72(6), 895–914.
Blanchet Garneau, A., Browne, A. J., & Varcoe, C. (2016). Integrating social justice in health care curriculum: Drawing on antiracist approaches toward a critical antidiscriminatory pedagogy for nursing. Sydney: International Critical Perspectives in Nursing and Healthcare. Google Scholar. Retrieved from http://sydney.edu.au/nursing/pdfs/critical-perspectives/blanchet-garneau-browne-varcoe-integrating-social-justice-2.pdf
Bond, C., & Others. (2017). Race and racism: Keynote presentation: Race is real and so is racism-making the case for teaching race in indigenous health curriculum. LIME Good Practice Case Studies Volume 4, 5.
Brian Raymond, M. P. H. (2016, August 2). How Racism Makes People Sick: A Conversation with Camara Phyllis Jones, MD, MPH, PhD | Kaiser Permanente Institute for Health Policy. Retrieved August 17, 2018, from https://www.kpihp.org/how-racism-makes-people-sick-a-conversation-with-camara-phyllis-jones-md-mph-phd/
De Souza, R. (2014). What does it mean to be political? Retrieved August 21, 2018, from http://ruthdesouza.dreamhosters.com/2014/08/03/what-does-it-mean-to-be-political/
Hall, J. M., & Fields, B. (2013). Continuing the conversation in nursing on race and racism. Nursing Outlook, 61(3), 164–173.
Krieger, N. (2014). Discrimination and health inequities. International Journal of Health Services: Planning, Administration, Evaluation, 44(4), 643–710.
Mohanty, C. T. (2003). “Under Western Eyes” Revisited: Feminist Solidarity through Anticapitalist Struggles. Signs: Journal of Women in Culture and Society, 28(2), 499–535.
Perron, A. (2013). Nursing as “disobedient” practice: care of the nurse’s self, parrhesia, and the dismantling of a baseless paradox. Nursing Philosophy: An International Journal for Healthcare Professionals, 14(3), 154–167.
Thorne, S. (2017). Isn’t it high time we talked openly about racism? Nursing Inquiry, 24(4). https://doi.org/10.1111/nin.12219
Varcoe, C., Browne, A., & Cender, L. (2014). Promoting social justice and equity by practicing nursing to address structural inequities and structural violence. Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis, Eds PN Kagan, MC Smith and PL Chinn, 266–285.
Young, I. M. (1990). Throwing Like a Girl and Other Essays in Feminist Philosophy and Social Theory. Monograph Collection (Matt – Pseudo).

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A level playing field? Sport and racism

At the weekend it was my parents’ wedding anniversary. They got married in Dar es Salaam and one of the distinguishing features of their wedding was the hockey stick “guard of honour” that their friends created for them outside the church after the service (my Mum played hockey for Tanzania). The family capability and Goan cultural propensity to excel at sport (take Seraphino Antao the first Kenyan athlete to win a gold medal at the 1962 Commonwealth Games) skipped right past me. Mostly I enjoy the social, political and cultural issues in relation to sport like the national anthems, the medals and the underdog winning. The recent completion of a PhD (yes really) has also given me some confidence and time to begin to explore questions like the neocolonial exploitation of African players by European football clubs and how raw materials in the form of players are sourced, refined and exported for consumption and wealth generation in Europe leaving the African periphery impoverished. But that’s another blogpost. This post is about racism and sport, but I needed to do a geneaological manouevre and trace my own relationship with sport through my experience of being a Goan via East Africa now resident in Aotearo New Zealand. I’ve mapped some of the ways in which sport has been mobilised such as the re-shaping of personhood for colonised peoples and in turn the ways in which western sport has been appropriated by diasporic and marginalised communities as a form of resistance. I then talk about the prevalence of racism in sport, the contributing factors and what can be done.

Photo of Goans in Dar es Salaam via Jo Birkmeyer-submitted to Mervyn A Lobo’s blog 

The establishment of sport in colonial contexts was linked with Western Christian church activity and colonialism. Sports were introduced to meet both the needs of churches and colonial governments in transforming bodies into desirable shapes and capabilities so imperial reform could be undertaken by locals thereby creating physical and moral reform against existing less palatable indigenous norms. Games like cricket and football were intended to reinforce the superiority of colonial culture and transmit a particular moral order and values that were seen lacking in the colonised group such as team spirit, commitment, the sacrifice of individual aspirations to the group, bravery and so forth. Particular versions of masculinity were also being promulgated in a context where many Asian men were seen as effeminate.

In the diaspora, Goans formed clubs and institutions replicating village ties and loyalties back home which helped to allay loneliness, cultural alienation and the challenges of navigating a new country. In 1921 it was estimated that almost half a million Goans lived in Goa, Dama and Diu and that up to 200,000 Goans lived in British India, East Africa or Mesopotamia (James Mills, 2002). One quarter of that number lived in Bombay. Expatriate sports confirmed ties with the homeland, created a sense of community and provided an oasis from the demands of navigating belonging in racially stratified communities. Every Saturday after mass at the Holy Family Cathedral in Nairobi my parents would make their way with us to the Railway Goan Institute founded in 1909 which later became the Railway Institute in 1967. I have great memories of hurtling around (we seemed to do a lot of running along those wooden floors) and being spoiled rotten by my parent’s friends who would provide us with bottomless supplies of coke and crisps. Goans in Kenya also formed other clubs like The Goan Institute Mombasa in 1901, Goan Institute Nairobi in 1905 and the Goan Gymkhana in 1936 with sports an important focus of diasporic life.

Closer to where I live now in New Zealand, Indians in Wellington formed their own hockey team in 1936, which also marked the year that the Auckland Indian Sports Club (AISC) was established.

Photo reproduced with permission from Te Ara. Original article: Nancy Swarbrick. ‘Indians’, Te Ara – the Encyclopedia of New Zealand, updated 1-Sep-11
URL: http://www.TeAra.govt.nz/en/indians/5/5

Many other communities also made sport a focus of their activities, for example the New Zealand Chinese Association Annual Sports Tournament (AKA Easter Tournament) started in 1947 and runs every Easter Weekend. It consists of a sports tournament and cultural event for Chinese members and competitive sports like basketball, volley ball, touch rugby, netball, lawn bowls and golf are enjoyed. Similarly pan-ethnic events like the Ethnic Soccer Cup at the Auckland International Cultural festival are eagerly awaited and full of good natured fun and tough competition.

Photo by the Localist

Sport seemingly offers a transcendent space, where cohesion and connection is possible not only within and across diasporic communities, but also across dominant and minority communities. A phrase bandied around frequently last year was the way in which hosting the Rugby World cup in New Zealand “brought us together as a nation”.  Who of us will ever forget the ferocious and irrepressible passion of the Tongan community in New Zealand supporting their team? I love the ideal that sport can be a place where people with diverse interests, histories and values can be unified in one setting. I’ve watched with growing feelings of warmth the ways in which our Pacific players have infused “the game” of rugby with flair and energy and increased the ratio of tattoos, dreadlocks and eye-liner.

This illusion that sport can be a connecting force is challenged in Sara Ahmed‘s critique of the “happy” multicultural film Bend it Like Beckham. Directed by Kenyan-born, Punjabi British filmmaker Gurinder Chadha, Ahmed suggests that the central message of the film is that “the would-be- citizen who embraces the national game is rewarded with happiness”. The feel good vibe of this film ignores the negative affects surrounding racism and unproblematically represents visibly different migrants as patriarchal, closed, traditional, fixed and unchanging. White people can be inspired and warmed by Jess’ migrant success, as she bends the ball (a metaphor for disrupting cultural barriers) without needing to feel guilty about racism. The film plays into the notion that success is the reward for integration and is also proof that racism can be overcome.

My fantasy that the arrival of the first Asian All Black will give Asians more street cred and admiration has taken a battering with the racist responses to the “Linsanity” phenomenon. Jeremy Lin, the Asian American son of Taiwanese immigrants and graduate of Harvard has experienced spectacular NBA basketball success but the headline “Chink in the Armor,” or the tweet by Jason Whitlock referring to “two inches of pain” have deeply hurt many Asian Americans. Understandable, given the limited representation of Asian Americans in mainstream media and because the blatant racism provided a barometer reading of how this group are viewed in a racially charged landscape. But as Long, Tongue, Spracklen and others have noted, we live in a racist society so why should there not be racism in sport? Racist taunts and chants at matches and the throwing of banana skins at players have been supplemented by attacks via social media adding a new viciousness. A Welsh student was recently been imprisoned for using twitter to spread racist rants about acritically ill footballer Fabrice Muamba and locally, unhappy fans took to twitter to racially denigrate Blues coach Pat Lam.

Sport media coverage contributes to inequity by not reflecting social and cultural diversity. The MARS – Media against racism in sport programme– developed by The Council of Europe and the European Union recognises the following inequalities in representation in sports news stories:

  • Gender under-representation -where women comprise only one quarter of all stories despite making up half the population.
  • Migrants making up around 10% of the EU population but representing less than 5% of the main actors in the news in Europe.
  • Lesbian, Gay, Bisexual and Transgender (LGBT) people representing roughly 6% of the population of the United Kingdom but accounting for less than 1% of the population seen on TV.
  • 20% of the British population has an impairment or disability but less than 1% are represented on British TV.

These inequalities in sports media coverage reflect broader societal inequalities. The New Zealand Human Rights Commission’s annual review of race relations Tūi Tūi Tuituiā, Race Relations in 2011 released in March 2012 noted a “continuing degree of racial prejudice, significant racial inequalities, and the exclusion of minorities from full participation in all aspects of society”. The Commission identified racial prejudice in the form of: “negative attitudes to the Treaty, to indigenous rights, to Māori, Pacific peoples, Asians, migrants and refugees”. The report noted that these prejudices were implicated in discrimination, marginalisation, and inequalities, ultimately proving a barrier to the realisation of the social and economic benefits of diversity.

The racist soup of Pakeha media culture not only excludes particular groups but it also reproduces pathological, deficient and destructive representations of groups that are already discrimiinated against and marginalised. Take the “common sense” racism of Paul Henry, Michael Laws and Paul Holmes who all compete for New Zealand’s top racist.Take the comments by the former All Black and World cup Rugby Ambassador Andy Haden, who referred to a “three darkies”selection policy by rugby franchise The Crusaders. When Haden made an apology it was “to anyone who was offended” by the comments. He received a smack on the hand with a wet hanky from our Prime Minister John Key despite the outrage and I don’t think he had to resign. Key defended Haden’s actions as having a precedent in Paul Holmes‘ “cheeky darkie” comments in 2003. The gutless and useless Broadcasting Standards Authority refused to uphold 10 complaints over the  comments on Radio station Newstalk ZB. They acknowledged that the comments went beyond the limits of acceptability and breached broadcast standards, but they were happy that the actions taken internally by broadcaster were adequate. Thank goodness for writers with a conscience like Tapu Misa who is my only reason for continuing to purchase the morning newspaper and the long missed Karlo Mila from the Dom Post who can still remind us through her poetry that words scar.

Poster by Dudley Benson (2012)

Where there is power, there is resistance (Thanks Foucault). Racism (and anti-Semitism) in sport have also provided a space for protest and resistance. American sprinters Sam Stoller and Marty Glickman who were the only two Jews on the USA Olympic team, were pulled from their relay team on the day of the competition in the 1936 Berlin Olympics,. There was speculation that the American Olympic committee did not want two Jews to win gold medals in the context of Nazi Germany and Hitler’s Aryan pride. These are the same games where Jesse Owens won four gold medals.  Fast forward to the 1968 Olympics when Tommy Smith and John Carlos powerfully raised their fists on the podium in a Black power salute. The symbolism of this gesture referenced the black American community (black gloves); black American poverty (black socks, no shoes), black American lynching (Smith wore a scarf and Carlos a bead necklace).

Source Jonny Weeks:The Guardian

Closer to home, look at the stand many New Zealanders took against the Springbok rugby tour of 1981. 150,000 people took part in over 200 demonstrations in 28 centres and 1500 people were charged with protest related offences. The protests were in response to New Zealand opposition to the apartheid and segregation practiced in South Africa. These apartheid policies had impacted on team selection for the All Blacks, and Māori players had been excluded from touring South Africa by the New Zealand Rugby Football Union (NZRFU) until 1970. I take my inspiration from this event that “New Zealanders” might take their history into account and challenge the unacceptable comments against Pat Lam and show leadership over such behaviour.

So what are we to do about racism in sport? How can we use the values of sport, ostensibly fairness, teamwork, a fair go, equal opportunity, respect and care for each other to help us create a real level playing field, locally and globally? We can protest the sponsorship of the London Olympics by Dow (Union Carbide was merged into Dow and responsible for the tragedy at Bhopal not least 25,000 deaths and much much suffering). We can ask much more of our junk food media and not consume it as Jennifer Sybel suggests.  We can ask that the groups in our communities that are under-represented (disabled, women, LGBTQ, visibly different) get a fairer go and that  stories that purport to represent them contribute positively to our cultural and social diversity. We can take more responsibility for the actions of racist tweeters and taunters and recognise their actions come from consuming the same junk food media that we do. Rather than individualising their behaviour we can ask questions about what kind of playing field we have created and whether we want to put any effort into creating an alternative.

Illustration by Jim Sillavan for the Guardian

 

 

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Celebrating African women in Aotearoa New Zealand

I was honoured to be invited by the African Community Forum Incorporated to attend and speak at an event on March 10th 2012 to celebrate International Women’s Day. I have written elsewhere about my links with East Africa. Briefly, I was born in Tabora Tanzania and lived in Nairobi, Kenya until the age of ten, when my family migrated to New Zealand. Originating from Goa, India, both sets of grandparents moved to Tanzania in the late 19th Century and both my parents were born there. Until moving to New Zealand I was fluent in both Swahili and Maragoli.  The African part of my identity rarely gets the opportunity to play, so I was thrilled to attend the event.

 

Indians in Africa

Many people might be surprised to know that the Indian connection to Africa goes back three thousand years. Indians were traders and later sojourners. The British indentured labour scheme which replaced slave labour, ushered a new era of cheap and reliable labour for plantations and the building of railways. The construction of the great railway from Mombasa to Lake Victoria in Uganda in the late nineteenth century brought fifteen thousand (of the sixteen thousand) workers or ‘coolies’ from India. Tragically one quarter of them died or returned disabled (Sowell, 1996). Indians (especially Goans) were also recruited to run the railways after they were built (as my grandparents were) and Goans came to dominate the colonial civil services.

Africans in New Zealand

The history of African migration to New Zealand is much more recent. Te Ara online encyclopedia notes that the first black African in New Zealand was travelling on James Cook’s second voyage as a servant (no name is provided) and later killed by Maori in 1773. The 1871 New Zealand census recorded 34 people who were born in ‘British African Possessions’ and another 31 from other African countries. The 1911 census recorded 92 African-born people. However, these African born people were likely to have been white given the mobility of white settlers through the then British Empire. The 1916 census recorded 95 “Negroes” referring to African Americans and six African born people, four Abyssinians (Ethiopians) and two Egyptians. The Colombo Plan saw the arrival of Black Africans as students in the 1960s, some of whom remained in New Zealand and had families. During the 1970s two groups of Africans arrived in New Zealand. White Rhodesians who were escaping from the war and two hundred Ugandans (not sure if they were all Asian Ugandans) who were ejected by Idi Amin. The number of African born residents (mainly from Commonwealth countries) increased to 3,939 Africans by 1986, but again were mainly white. It was not until the changes in migration policy of 1987 that there were significant demographic changes as a result of the development of a formal refugee quota  which saw arrivals especially from Ethiopia (1991-3), Somalia (1992-4), Rwanda (1994) and the shift to a migration points policy which saw a greater number of African people coming New Zealand as migrants. The 2006 Census 10,647 or 0.3% of the population identified as African. 4,806  Africans reside in Auckland and 5,841 outside of Auckland. In the 10 years between 1991 and 2001 the number of women from African countries increased considerably with numbers of women from South Africa, Zimbabwe and Somalia more than quadrupling in that time (Statistics New Zealand, 2005).

The growth of the African community is an exciting development and the event organised by ACOFI was a fantastic celebration of Pan-African culture and the vitality and energy of the community. I look forward to taking part in more events and improving my now very rusty Swahili! By the way, the art work is from a drawing competition run on the night. My big thanks to all the organisers especially Carlos Carl, Boubacar Coulibaly and Sharon Sandra Paulus and all the people that worked hard to make the event happen.

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How is your Central Helping System?

First published in Mindnet Issue 11 – Spring 2007
Recently I’ve come through a series of life changing stresses and learned what true love; friendship and personal strength were about. In particular the words of wise Rabbi Hillel, a Jewish scholar & theologian who lived from 30 BC – 9 AD have been a source of inspiration for a previously uncharted journey: “If I am not for myself, who will be for me? If I am not for others, what am I? And if not now, when?” Dan Baker and Cathy Greenberg suggest using these questions to prompt you on a daily basis. Despite being written so long ago, these words have stood the test of time and got me thinking about how we can maintain good mental health amidst transition and change. Two transitions that have occupied a great deal of my energy and interest have been the transition to parenthood and the transition to living in a new country.

If I am not for myself, who will be for me?

Starting with question one, If I am not for myself, who will be for me? Baker argues that we have to take good care of ourselves and begin by having a good relationship with ourselves and being our own best friend. There are some things that only we can do for ourselves and some things that we can delegate. They recommend asking yourself further questions every day: such as what I have done to take care of my body, mind and spirit today? Both new parents and new migrants experience the loss of otherwise familiar reference points. New mothers face the demands of an unpredictable gamut of demands for a baby whose needs are all-consuming and leave little time or energy for focusing on oneself. For a migrant, the loss of a “village” and familiar things, places and processes often leads to a quest for belonging and clarification of values and purpose. Both transitions offer the potential of transformation provided resources and support are in place, but accessing them can often be difficult.

If I am not for others, what am I?

Question two leads us from taking care of ourselves to taking care of others. If I am not for others, what am I? Research evidence is growing that social support is critical to successful coping through enhancing resilience, buffering the impact of stress and assisting in the maintenance of positive mental health. Social support encompasses four key attributes emotional (e.g. providing empathy, caring, love, and trust), instrumental (e.g. aid in kind, money, labour, time, and modifying environment), informational (e.g. advice, suggestions, directives, and information) and appraisal (e.g. affirmation, feedback (Toljamo & Hentinen, 2001) and results in improved mental health (Finfgeld-Connett, 2005 ). Often support starts with one’s immediate family and then to friendships termed ‘central helping system’ by (Canavan & Dolan 2000 cited in (Pinkerton & Dolan, 2007)) and often it is only when this support is exhausted, weak or unavailable that people approach more formal sources of support.

In terms of my two professional interests, I have found that when people migrate they frequently lose their support networks and when people welcome a new baby into their family they frequently have to develop alternative support networks. Social support is characterised by reciprocity and mutuality and involves the exchange of resources between people that enhance the well-being of both. When we are supported and become part of a network of communication and mutual obligation we can begin to believe that we are cared for, loved and valued (Hupcey, 1998).

If not now, then when?

Question three asks us “if not now, then when?” This is where a focus on the present moment becomes highlighted. For so many of us the focus is on the future. For the new migrant it can be about “when I get the job that recognises my qualifications and worth then I can start enjoying my life in this new country”. For a new parent it might be “when I can sleep through the night I’ll start enjoying being a parent”. How can we feel good in ourselves, when things feel out of control, unresolved and unresolvable? Mindfulness, a Buddhist concept based on becoming aware of the moment and living fully in it regardless of how pleasant or unpleasant it is can lead to transforming that reality and your relationship to it (Kabat-Zinn, 1993). Ultimately there is very little we can do about what has already happened or determine the future, but the likelihood of a wonderful future is enhanced by thoroughly enjoying the present.

Mental health awareness week

Which leads me to the theme of this year’s mental health awareness week, good mental wellbeing can come from:

  • Celebrating our uniqueness
  • Connecting with each other
  • Supporting others in their journey
  • Sharing our stories

So how can we celebrate our uniqueness when there is little to support our identity? How can we connect with each other, when we are isolated? How can we supporting others in their journey, when we ourselves are un-resourced? How can we share our stories if there is no one to listen?

Key points to consider for mental health and health promotion workers and organisations.

There is a need for mental health service providers to both safeguard quality care and ensure continual improvement of the quality of their services by creating an environment where they, their colleagues, their clients and family members can flourish. One of my own favourite strategies is supervision which helps me both with my self-care, self-development and ensuring I get the support that I need. It also helps me develop and increase my knowledge, understanding and skills. Again I’d like to reiterate Rabbi Hillel’s first question. How can we truly care for others if we don’t care for ourselves? Self-care is so under-rated, but if you are a mental health worker ask yourself: How do we I look after myself and cultivate my own wellness? And how can I practice what I preach?

In terms of your own support network. How can you avoid working in isolation? How can you get the support that you need? If you aren’t thinking about this it can be difficult to consider the needs of people and groups that require support to remain socially included. How do you encourage clients/tangata whai ora to use and enhance their own personal support networks? In reflecting on Hillel’s third question, consider how can you be fully present with your mahi. How can you be so fully engaged in your work that it provides a well of energy that is renewable and deeply satisfying so that you don’t get burned out. How can you ensure that your work and efforts are sustainable? For me it goes back to attending to myself regularly, meeting my own needs, considering my own health and well being.

My central helping system undergoes continuous refinement but what I have realised is that it requires me to first have a relationship with myself. Only then can I have an effective relationship with anyone else. Then ensuring that I have a support network in which reciprocity reigns and lastly being fully present with myself (not always easy). Rabbi Hillel’s questions provide a useful starting point for considering our own mental health and of those who are part of our lives personal and professional. Attending to these three questions provides us with accessible resources for mental well being.

REFERENCES

Finfgeld-Connett, D. (2005 ). Clarification of social support. Journal of Nursing Scholarship 37(1 4).

Hupcey, J. E. (1998). Clarifying the social support theory-research linkage. Journal of Advanced Nursing 27(6), 1231.

Kabat-Zinn, J. (1993). Mindfulness meditation: Health benefits of an ancient Buddhist practice. In D. Goleman & J. Gurin (Eds.), Mind, body medicine : how to use your mind for better health (pp. 259–276). Yonkers, N.Y.: Consumer Reports Books.

Pinkerton, J., & Dolan, P. (2007). Family support, social capital, resilience and adolescent coping. Child & Family Social Work, 12(3), 219.

Toljamo, M., & Hentinen, M. (2001). Adherence to self-care and social support. Journal of Clinical Nursing 10(5), 618.

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The ultimate engagement of life: Being mentally healthy

Published in (2007) Asian Magazine, 4.

I came across a wonderful definition of health by Jesse Williams in 1928 the other day in a book that I was reading. Williams defines health as being “the optimal condition of being that allows for the ultimate engagement of life.” To me this is what being healthy is about, being in the best condition to fully take part in life. I have had a long passion in the issue of migration and settlement and in particular the impact on health and specifically mental health. We know that migration is a risky business that also has the potential to transform, so how can we maintain our mental health and go beyond maintenance to optimal health and engaging fully with life? What are the factors that help or hinder being ultimately engaged with life and what can we do about them? In this article I’d like to share my professional, personal and research findings with you from work I did with Goan women living in Auckland some years ago [1].

Migration offers the potential of a new and better life, otherwise why would anyone migrate for a worse life? Yet sometimes this is what unexpectedly happens. We are so focussed on the wonderful future and the leaving, but not so much on the arrival. Without our usual “soft places to fall” as Dr Phil terms it, our support networks, our fulfilling work, migrants can end up with migrant’s remorse!

It was the first time we had been on our own before, in Bombay you’ve always got family to help you and you’ve got everything ready made, so you never know what hardship is until you come here (Flora).

When there is a big gap between our hopes and expectations and the reality the disillusionment can be too much to bear. When the job that is going to be the foundation of the new life doesn’t materialise and the income doesn’t match the sacrifices, it can seem like things are going down hill fast. There is a cumulative impact of all these disappointments that can result in feeling overwhelmed and worn out. So when do ups and downs become something you should pay attention to? In my experience, it is best to ask for help from those around you when you feel like you are not coping and managing as well as you would like to be or know that you usually can. Help-seeking is something that many of us find difficult to do. Whether it is pride or the shame of admitting we cannot manage on our own. What I know for sure though is that when we have exhausted our own resources we should ask for help because things don’t tend to get better by themselves and sometimes they get worse when we do nothing. So start by talking to people that you trust, family or friends and keep talking and asking until you get what you need. If you have a faith community tap into its resources. Talk to your General Practitioner and ask for referral to a counsellor or mental health service. I remember talking to a man with a gambling problem that had become depressed, he said “what is the point of going to talk about my problems, I need financial help!” The answer is that there are a range of things that have contributed to how you feel and equally there are a range of things that will help, from going for a walk to talking to someone to getting budgetary advice. There is not going to be just one magical solution.

So what if you are reading this and thinking, I am fine, I just get down sometimes. Here are four strategies that Goan women used to help them maintain their mental health.

Developing a new support network New Zealand researchers [2] have found that support is one of four important factors for successful settlement. Support makes coping with daily living, acquiring language and employment (the three other factors) easier to acquire. Support also helps you manage stress by reducing how big you see the stress and helping to reduce the severity of your reaction to it [3]. Participants in my research study found that having contact with family, friends and other migrants was crucial and that by volunteering, joining their faith community and having access to support through e-mail the stresses of migration and settlement were minimised. It is important to make sure that you connect with people outside your faith or ethnic group too.

Having a “can do” attitude The term ‘pioneer spirit’ is often used to refer to migrants. The attitude of coping with things in the present because they will get better in the future if you make it work is part of the migrant dream. T some degree pragmatism and philosophical acceptance are necessary for survival and essential:

You just couldn’t pick a flight and go, you’ve resigned your job, you’ve spent half your savings to come here and you know there’s no turning back so you have to make the most of this. So it’s like there’s no turning back, but you think, ‘God what have I done’ (Flora).

As Arisaka says [4] “This almost non-negotiable drive for upward mobility requires diligent assimilation. Self-pity, victim consciousness, and separationist self-consciousness are deadly to the process towards success. Not only are they excessively self-indulgent, but they are also a waste of time and energy, and therefore not allowed”. I think that this can also be a trap and that again it is important to ask for help when you need it. You don’t get extra points at the end of your life for having done it the hard way!

Learning There are two ways of learning that assist with settlement one is the  ‘culture learning approach’ where you adapt  by overcoming every day cross-cultural problems by learning new culture specific skills that assist you to navigate the new cultural environment [5]and the other is by inoculation or anticipatory preparation [6, 7] which helps the transition experience , where a previous visit or some similar kind of preparation where you gain culturally specific knowledge and skills prior to migration can be a great help.

Lastly, maintaining cultural links was used to make sense of the migration and settlement experience and maintaining wellbeing. The loss and separation that can occur with migration can be lessened to some degree by holding on to familiar and trusted values and keeping ties [8]. Keeping a connection with ‘the familiar’ helps lessen the dislocation and challenges that resulted from being in ‘the unfamiliar”. This can be done by attending community events or even going back to the place of origin, for the benefit of children as well:

It’s important not to get carried away by the western thing, to keep taking them back to their roots if you can afford it because I think that priority has really made the difference for us (Sheila).

There are many ways to manage a new life in a new country. Each one of us has to find a combination of ways that are going to work for us. I hope this has give you some ideas about how you can not only survive the transition to life in a new country but thrive as well so that you can be in optimal condition to enjoy your new life fully.

References

  1. DeSouza, R., Walking upright here: Countering prevailing discourses through reflexivity and methodological pluralism. 2006, Auckland, NZ: Muddy Creek Press.
  2. Ho, E., et al., Settlement assistance needs of recent migrants. 2000, University of Waikato: Waikato.
  3. Kearns, R.A., et al., Social support and psychological distress before and after childbirth. Health and Social Care in the Community, 1997. 5(5): p. 296-308.
  4. Arisaka, Y., Asian women: Invisibility, locations, and claims to philosophy, in Women of color and philosophy: A critical reader, N. Zack, Editor. 2000, Blackwell Publishers: Malden, Mas. p. 219-223.
  5. Ward, C., S. Bochner, and A. Furnham, The psychology of culture shock. Second edition ed. 2001, Hove, East Sussex: Routledge.
  6. Meleis, A.I., et al., Experiencing transitions: an emerging middle-range theory. Advances in Nursing Science, 2000. 23(1): p. 12-28.
  7. Weaver, G., Understanding and coping with cross-cultural adjustment stress, in Culture, communication and conflict: readings in intercultural relations, G. Weaver, Editor. 1994, Gin Press: USA. p. 169-191.
  8. Vasta, E., Gender, class and ethnic relations: the domestic and work experiences of Italian migrant women in Australia, in Intersexions; gender, class, culture, ethnicity, G. Bottomley, M.D. Lepervanche, and J. Martin, Editors. 1991, Allen and Unwin: Sydney.
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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).

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