Transcultural communication

On my last full day in Stockholm I managed to fit in an impromptu visit to the Transkulturellt Centrum (Transcultural Centre), thanks to a couple of leads from Ingrid. The Centre, funded by the Stockholm County Council, exists to provide support to health professionals (including GPs) and dental care staff concerning issues of culture, migration, and refugee status.

The Centre also provides health communication for newly arrived refugees and migrants on a wide range of subjects, including: the impact of migration on health; healthy eating; sexual health; and parenting. The programme is delivered by a team of Health Communicators: bilingual health advisors with professional medical backgrounds and, crucially, personal experience of migrating to Sweden. I had the opportunity to meet one of the Health Communicators, Susan Sami, during my visit; Susan’s enthusiasm for her role was palpable. The image below is taken from an English-language pamphlet about the Centre’s work.

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The Health Communicators are uniquely placed to empathise with new arrivals to the city and help them to get to grips with their entitlements and how to navigate the health system, but also to develop an understanding of the ‘medical culture’ in Sweden. Often this differs significantly from the medical culture of their homeland. The Centre has its roots in Transcultural Psychiatry which, as I learnt from Karima Assel (the Centre’s Child and Adolescent Psychiatrist), is a branch of psychiatry concerned with the cultural context of mental health problems.

As well as working with newly arrived refugees and immigrants, much of the Centre’s work involves educating health and dental care staff about the specific health challenges patients from these backgrounds experience via training and a consultancy service that provides advice to health staff. In the spirit of Transcultural Psychiatry, the Centre encourages health staff to reflect on their own cultural position and how it interacts with the cultural positions of their patients; the Centre emphasises the importance of communication over ‘education’. I left the Centre with lots to think about over my last kaffe and kanelbulle in Stockholm. Next stop: Gothenburg.

 

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Experiencing election time in Stockholm

I had no idea, when I booked my flight to Stockholm a few months ago, that I would be arriving in the final days of campaigning before the country’s election. Given immigration has featured so prominently in the campaigning, it is an interesting backdrop to my research into how GPs are meeting the needs of refugees and asylum seekers.

Arriving in the city, pre-election anticipation – and perhaps tension – was clear. There was a notable police presence, gatherings of protestors, and organised groups of campaigners. The parties’ posters line the walls of the Metro stations, including this one from the controversial, far-right party the Sweden Democrats which had been daubed with ‘blood’.

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On my first evening in the city I found myself sat, two tables down in a Middle Eastern café, from a very senior politician from the Moderate party with his two minders looking on from nearby. I’d spotted the minders doing a recce of the small square, where the café had tables, a few minutes before and my intrigue was piqued… it felt like a scene from a Nordic Noir. I had to find out who he was and two Swedish diners were happy to fill me in, discreetly.

On election day, I took a boat to Fjaderholmarna: a small, picturesque island 30 minutes from Stockholm. In the tourist bubble of artisans’ workshops and a craft brewery, the close-run elections taking place on the mainland felt very distant.

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Back in Stockholm, later in the day I met up with Ingrid Eckerman: a retired GP, campaigner for human rights, and editor of a Swedish journal for General Practice. Ingrid took me to see her local polling station; as well as getting to see the proceedings, I enjoyed my first coffee and apple cake (the famous fika) from a stall outside the polling station, run by school children raising money for a trip. Afterwards, Ingrid gave me a tour of her co-house; run by a housing association, it offers private flats combined with communal living. Residents take turns to cook and clean for one another and take shared responsibility for looking after the lovely gardens and orchard. Amongst her roles, Ingrid campaigns for the rights of young Afghan asylum seekers; whilst I was at her flat, one of the young people she is supporting dropped by for a chat.

Ingrid told me that she and her neighbours would gather in the shared lounge at 9pm for the election results but that she predicted quite a long a period of wrangling before a new government is formed. She was right: as of this morning, the make-up of the new Swedish government is unclear but with results showing a growth in nationalist influence. As I look forward to moving on to Gothenburg to get stuck into my research proper, I will be interested to explore what influence the national political context has on policy and practice amongst health professionals at the local level.

 

Migration and Health: My Churchill Fellowship

It’s six months since I found out I had been successful in securing funding from the Winston Churchill Memorial Trust to travel to Sweden, Germany, and Italy to explore how GPs are meeting the health needs of refugees and asylum seekers.

My project will try to go some way in answering the question: What can the UK learn from how general practice in Sweden, Germany, and Italy has responded to the needs of refugees and asylum seekers?

The project topic brings together my interest in refugee and asylum seeker issues, having previously volunteered for a number of years at a weekly ‘drop-in’ for refugees and asylum seekers in Stockport, and how public services can best meet their needs. In 2010 I had the opportunity to travel to Copenhagen to undertake research into how the local authority and partner agencies were ‘managing’ ethnic diversity, including responding to the needs of refugees and asylum seekers, in the city. A great opportunity that whet my appetite for researching overseas…

More recently, in my role as Analyst Team Leader at the Care Quality Commission, where I lead qualitative analysis for the Primary Medical Services (PMS) sector, I have developed an interest in and appreciation of the challenges GPs face in meeting the needs of people whose circumstances make them vulnerable. Leading the qualitative research and analysis to inform CQC’s report The State of Care in General Practice 2014-17 and, in particular, interviewing inspection colleagues, gave me new insight into the variation in quality of care received by different patient groups and the difficult context in which GPs are working.

Through the fantastic opportunity that the Winston Churchill Memorial Trust Fellowship presents, I hope to increase my own understanding of the health and social care needs of refugees and asylum seekers and learn how these needs are being met by GPs abroad with a view to translating learning to the UK. After months of Googling, planning, emailing, and pestering(!) contacts across Europe, I’m on the cusp of starting my research and excited to be dusting off my Dictaphone.