Latin Americans Living in London and Access to Health Care Jasmine Gideon Birbkeck College, University of London

Migrant health and vulnerability Dynamic process – from ‘healthy migrant’ to ‘exhausted migrant’ Bollini (1995) High levels of stress related conditions found among migrant pop in Europe compared to host population Range of factors can contribute to this change: Temporal Different vulnerabilities associated with diff points in migration process Spatial Inhospitable terrain in transit Spatial dislocation from social and economic opportunities Socio-cultural Norms, values, cultures constituting local ‘constructions’ of migrants Cross cut with gender, race, legal status Socio-political Institutional constraints: political commitment of destination govt. (Sabates-Wheeler and Waite, 2003)

Gender, migration and health Gendered nature of migration Women often seen as dependents of men vis-a-vis immigration status Changing gender relations Gender division of labour in informal health care provision Women responsible for transmission of health knowledge Women’s role as carers reinforced

Latin Americans living in London ‘new’ migrant population Rising numbers – 2001 census 46, 325; 2007 FCO report estimates up to 1 million ‘Hidden’ population – not officially monitored Diverse population vis-á-vis migration status Majority living marginal existences – concentrated in cleaning and catering sectors Limited political representation from Lat AM community

Formal barriers to health care access Lack of rights and entitlements associated with immigration status Administration of entitlements confusion at point of delivery - Rules seen only as guidelines Hospital overseas visitors managers – no real accountability structure at present NHS is only system – no fall back system GP surgery managers make (ad hoc) decisions over access to primary care

Informal barriers Language Feelings of exclusion and discrimination Lack of interpreters or service not offered; users depend on friends, relatives; Feelings of exclusion and discrimination I could feel that I was having contractions and I was in a lot of pain. They asked me for my mobile number but I couldn’t remember it – you know what it is like when you are nervous. I could see that they were laughing at me’ (interview, June 3rd 09). Cultural values and expectations Latin American health systems heavily medicalised in contrast to NHS

Lack of knowledge of NHS Dependence on other individuals to help negotiate access ‘I have a friend who lives in Nottingham and has lived here for 5 years so she helps me. When I needed to find out about vaccinations for my daughter I asked her to ring the surgery and speak to them and then I asked her to sort out the appointment...I don’t really know what I would do if she couldn’t help me, if she went back home’

Transnational health seeking strategies Self medicating using drugs from Latin America Phone (female) relatives for advice in Latin America ‘In Bolivia they give you a specific antibiotic for tonsillitis, I know because I used to have it a lot. Each time I went to the walk in centre they gave me a different antibiotic, they said you only need to take it for five days but I know that especially for children you have to give it to them for seven days to make sure they don’t get ill again. I kept asking for the one I wanted and finally when we went to the hospital I saw a doctor who prescribed it but by then I had already phoned my mum (in Bolivia) and she sent me the drugs. I will just keep them now in case we need them and next time I will just ring her immediately’

Return to Latin American health system ‘I still pay my health insurance in Argentina, because I have had it for a long time the premiums are not that high and then each time I go home I know that I can see my doctor’ ‘I had some gynaecological problems and have seen the doctor here several times. He keeps telling me that there is nothing wrong, but if there is not a problem why am I in pain. My friend in the US has given me some money so that I can go back to Ecuador and see my doctor there as I know that he will give me a proper examination’

Seek telephone consultation with Latin American doctor from the UK ‘ I felt really frustrated after I had seen the GP and been to the hospital, each time you go you see someone else and they don’t really try to understand your situation. When I get upset about the treatment or want to make sure that what they have given me here I ring my doctor at home as he is always really helpful and I have his home number and he doesn’t mind me ringing him’ Buy alternative remedies in Latin American shops in London Use of unregulated Latin doctors in UK

The way forward?