Access to Health Care for Non Citizens is a Universal Struggle

Francis Adaikalam.V

[Teaches in Department of Social Work, Loyola College, Chennai]

Almost 30,000 people in the USA are currently held in administrative detention for alleged violations of immigration law. The detainees are accommodated across more than 500 facilities, mostly state and county jails, often for periods of months or years.

The health of women in custodial facilities raises specific challenges. The USA has the highest rate of immigration in the developed world. Many migrants entering the country are extremely vulnerable, face poor working and living conditions, and have limited, if any, entitlement to health care even after their status has been declared legal. Obama announced a welcome law change: that legal immigrant pregnant women and children who have been in the country fewer than 5 years will be able to receive health benefits through the State Children's Health Insurance Program and Medicaid.

One of the major barriers to adequate health care for migrants to the USA is a lack of understanding of their specific health needs. Data for disease prevalence are rarely disaggregated by country of birth or length of residence in the USA, so American-born ethnic minorities are not distinguished from foreign-born migrants. This knowledge is crucial for targeting vulnerable communities with tailored disease-prevention programmes and treatment strategies.

The Lancet has previously praised the USA on its contribution to global health. The country's efforts to improve the health of vulnerable people in resource-poor countries around the world is immensely important, but the fact that the USA largely ignores the needs of migrants on its own doorstep is shameful. Issuing guidelines is not enough—they must be enforced through data transparency, staff training, and continuous monitoring of standards. America's failure to provide adequate health care for its migrant population risks seriously undermining President Obama's commitment to improve global health.

Full text of this editorial in the latest Lancet (Volume 373, Issue 9669, 28 March 2009-3 April 2009, Page 1053 )

Immigrants’ Choice of Place Residence: Canadian Perspective

Geetisha Dasgupta

In an intriguing news piece, the argument that whether a state should try and regulate immigrant settlement in other ways than is natural and guided by market forces, comes through. Are migrants to Canada showing tendencies of skipping past the traditional stops at the heart of big cities and in stead opting for smaller hamlets and suburban areas? “New data from the Canadian Federation of Municipalities (CFM) suggests they might be. The CFM measures social indicators in 24 of Canada's largest communities, ranging in size from Toronto and Montreal down to Regina and Sudbury. These urban centres took in 90% of all immigrants in 2002. In 2006, the figure was 83%. Most of the change was ascribable to economic-class immigrants, who make up around half of Canada's intake; the flow of refugees and family-class immigrants into the cities remained largely unchanged over the period.” What happens in the bargain is that, in stead of larger cities, which need them most, the skilled immigrants choose to settle in the outskirts, whereas, the less self sufficient ones opt for the former. The smaller municipalities are also less equipped to offer “up-front help and on-the-ground social services” that are required to attract aspiring citizens to maximize their contribution to the development of the country. “In the CFM's big-24 communities, nearly 70% of recent immigrant households are in rented accommodation. Outside them, the figure is less than 50% -- meaning that if they skip the cities, immigrants to Canada have a better-than-even chance of becoming homeowners almost immediately.” This continues to be the puzzle because, no matter what the municipalities think to be serving their own purposes, they cannot peremptorily tell the immigrants where to live and where not. The municipalities would like to have a bigger share of the tax money and also a greater say in immigration policies, but once the migrants arrive, they must be allowed to make free, informed choices of that support maximization of their own benefits.

The Representative of the UN Secretary-General on the Human Rights of Internally Displaced Persons, Walter Kalin, has called for more attention to be paid to some of the world's most serious displacement crises. He cited a number of the worst-affected countries, including Somalia (1.3 million IDPs), Sudan (2.7 million IDPs) and Sri Lanka, where IDPs are struggling to survive and many find themselves in a life-threatening situation due to lack of water, food and medical assistance. He also expressed concern about the Government of Sudan's recent decision to expel 13 major international humanitarian organizations and feared that the Sudanese Government would be unable to provide enough food, drinking water or basic healthcare for an extremely vulnerable population.

Tenth Session of the Human Rights Council

Shiva Dhungana

[Works at Search For Common Ground, Kathmandu]

Mr. Kalin called upon both parties to conflict in Sri Lanka to do their utmost to prevent civilian casualties and to allow for the safe evacuation of those trapped in the conflict zone. He expressed serious concern about the news regarding the use of human shields by the rebels in Sri Lanka and reminded States and armed groups to respect their obligations under human rights law and international humanitarian law, including the obligation not to arbitrarily prevent international humanitarian assistance from being delivered to those in need.
Mr. Kalin also expressed concern about impact of climate change which is expected to increase the frequency and magnitude of natural disasters and lead to more displacement. He called governments to make a greater effort to prepare for natural disasters and in particular to protect disaster-affected populations, including the displaced.

For the detailed report of the tenth session of the Human Rights Council click here
http://www2.ohchr.org/english/bodies/hrcouncil/10session/reports.htm

In Jammu's Camps, No Relief

Aditi Bhaduri

[Is a freelance journalist based in Kolkata]
[This article was first published in www.kashmirtimes.com]

Usha Pandita, 45, feels tired even after the smallest of chores. But that's not unusual for her. She suffers from Pelvic Inflammatory Disease (PID). For her, it all began with abdominal pain, which she initially disregarded as routine until it steadily increased. Usha then started to notice a heavy discharge and the feeling of being perpetually run down. That was when she visited the doctor. Tests confirmed she was suffering from PID - the inflammation of the organs in the pelvic region because of infection. It is during menstruation particularly that the uterus becomes more susceptible to this condition caused by unhygienic conditions.

Usha is one of the 10,000 residents of the Purkhoo migrant camp, one of the several camps set up on the outskirts of Jammu for the Kashmiri Pandit community forced to flee the Kashmir Valley when militancy gained ground in the 1990s. From Kupwara, Usha and her family made their way to Purkhoo, which they have called home since 1990. Years have gone by and even militancy is on the wane, yet time seems to have stood still for the inhabitants of the camps. Living in a one-room pigeon hole with a family of four can be trying in itself but the lack of sanitation has only added to the woes. For women, in particular, it is horrifying.

The Purkhoo camp has four phases and each phase has around 300 to 500 rooms. There are 10 toilets each for men and women. So there is one toilet per 150 men/women. The water supply lasts only an hour each day. Every time Usha, who lives in Phase I, goes to the toilet, she walks about 150 metres. What's more, she has to carry her wash water along. But there is only that much water she can carry. On numerous occasions the water is found insufficient to keep both herself and her surroundings clean.. It is because of these abysmal facilities that she ended up with PID.

Veena Pandita, 40, also lives in the same deplorable environs of Purkhoo. She too has acute PID. Dr Indu Kaul, a well-known Jammu-based gynaecologist treating these women, explains that the symptoms for PID include abdominal pain accompanied by heavy discharge and backache. She finds that in the case of women like Usha and Veena, PID continues for years. Usha, for instance, has been suffering from it for the last four years. The medicines don't really help, as the toilet she visits roughly four times a day continues to be poorly equipped.

Unfortunately, even the medication includes heavy doses of antibiotics, the intake of which has major side effects. When PID is deep rooted then surgery is usually the final recourse. Usha has been recommended surgery but her financial condition doesn't permit the procedure. "We still have four 'kanals' (one kanal equals 605 sq. yards) left in Kupwara. We had our own 'chashm' (well) there," she recalls wistfully. She adds, "I did not have to go to a toilet that was used by hundreds of others there."

Purkhoo's water supply, too, is contaminated. Residents complain that they have to replace their utensils every few months as they get coated with a white sediment. The pipes leak at multiple locations and so germs and dirt merge with the water. Near the toilets at Phase I, there is a water hole from which people draw out water to flush. But not only is the water filthy, it is even difficult to draw it out, especially when there is a long line of people waiting for their turn to use the toilet. Although help has been hired to clean the facilities once every two days, because of insufficient water and the sheer number of users, it is impossible to maintain a basic level of hygience. Moreover, there is no electricity in the toilets, so going after dark is another hazard, especially for the women.

That's why the maximum number of cases of PID in the city come from these camps. In fact, according to Dr Kaul, while the national average of PID is six to eight per cent, the cases reported from the camps can be 15 to 20 per cent, which is extremely high. The most affected age groups are the adolescents and those above 35 years. In adolescents, chronic PID can lead to a loss of fertility, so the increasing trend is cause for alarm.

Sarla Kaul, 28, who lives in the Mishriwalla camp, a kilometre from Purkhoo, suffers from Urinary Tract Infection (UTI). The sanitation situation at Mishriwalla is worse than at Purkhoo as toilets for both men and women are common here and no one comes to clean them. Many toilets are simply holes in the ground. Sarla has UTI, caused by poor hygiene and unsanitary conditions that make her vulnerable to other infections too. Lately, she has been suffering from menstrual dysfunction, with heavy blood loss and pain around her abdominal area.

Expectant women are particularly vulnerable to UTI, as pregnancy causes hormonal changes that lead to the relaxation of the urethra, which if exposed to poor sanitary conditions is quick to contract infection. UTI leads to anaemia, itching and swelling, which could eventually endanger the life of the child. It also often retards the growth of the foetus and results in stunted babies or those with low birth weight. That was the case of the baby Rajni Raina, who is in her mid-twenties and lives in Purkhoo Camp's Phase II, gave birth too. Not surprisingly, Rajni had chronic UTI during her pregnancy. Once again, Dr Kaul points out that while the national average of UTI is about 10 to 15 per cent, it is about 20 to 30 per cent in these camps.

Besides this there are other water-borne diseases prevalent here. Shetu Pandita, 17, of Purkhoo, has been ailing from a recurring hepatitis for the last five years. As has Puneet Bhatt, 16, of Mishriwalla - since he was 10, in fact. According to the World Health Organization, 80 per cent of such cases are caused by lack of safe water and sanitation. Five of the 10 top diseases of children are also related to water and sanitation. According to Dr K.L. Chowdhury, of Jammu, Hepatitis A and E are common in the camps. Again, in pregnant women, Hepatitis is particularly dangerous as it can put the lives of both the mother and child at risk.

The Third South Asian Conference on Sanitation held in New Delhi recently called for according priority to sanitation and reiterated that sanitation and safe drinking water are basic rights. Such declarations need to be translated into a reality if life is to improve for women like Usha and Veena, who are rendered without proper homes because of the politics of division and hate.

Parreñas, Rhacel Salazar. 2001. Servants of Globalisation. Women, Migration, and Domestic Work. California: Stanford University Press

Ishita Dey

The focus of this work is on migrant Filipina domestic workers through a comparative understanding of their migration and settlement in two highly populated and most popular destinations of Filipino Migrants; Rome and Los Angeles. Philippines share a common colonial history with both these places and these cities in their own way had a strong economic and cultural influence on the life of Philippines. This study departs from the other ethnographic works on Filipina domestic workers in Hong Kong and Saudi Arabia because as Parreñas (2001) points out “ the movements of domestic workers into these two countries are for the most part informal streams that are not monitored by the state” (Parreñas 2001: 2). The processes and experiences of Filipina domestic workers are explored through four key institutions of migration- the nation-state, family, labour market and the migrant community. The findings of the study suggest similarities in “dislocations” in different “contexts of receptions”. Such similarity lies in their shared role as low wage labourers in global capitalism (ibid: 3).

There are historical differences in migration patterns of Filipina domestic workers to Rome and Los Angeles. Filipino migration to Los Angeles began in 1920s compared to their counterparts in Italy who started migrating in 1970s. This comparative study sets out to argue through experiences of dislocation in the context of labour diaspora as the particular result of global restructuring vis-à-vis Philippines. Global restructuring according to the author implies “economic reconstitution” influenced by the transnational corporatism and postnational finance capitalism. This resulted in restructuring of the global service sector and increase in the demand of the low wage service labour in areas of highly specialized professionals. “… Global restructuring engenders multiple migration flows of female workers entering domestic work and results in globalisation of this occupation” (ibid: 9). Restructuring of economies has produced economies of migrant populations particularly engaged in low-skilled work. In some cases the sending countries, control train and regulate the process of migration and in some cases it is based on familial and other networks. Whatever be the pattern of migration there exist a notion of “Filipina” in the labour migration map. The Filipina migrants are bound to share similar experiences of dislocations across geographical boundaries and most of this experience centers on “partial citizenship”.

The book is divided into seven chapters. The first chapter puts forth the theoretical perspective; and the dislocations of Migrant Filipina Domestic Workers. The second and third chapter addresses the experiences of the migrant Filipina Domestic workers. The second chapter puts forward the partial citizenship Filipina domestic workers shares vis-a vis the nation state. The third chapter is titled “International division of reproductive labour” – where she highlights that “migrant Filipina domestic workers are in the middle of the three –tier hierarchy of the international transfer of caretaking”(ibid: 73). She argues that Filipina domestic workers are in the middle of the three-tier hierarchy. On one hand, migration enables the women to escape traditional gender roles in Philippines and on the other hand, it is interesting to examine how the “gender roles” shift and transfer between the women posited at two poles of global capitalism. A unique relationship is created between the migrant women and the women of greater resources which redefines the relationship between the “care” and the commodified reproductive labour. The following chapters i.e., Chapter 4 and 5 explores how migration produces and recreates structures in the context of transnational family. Chapter 6 interrogates the power relations between the domestics and employers followed by the concluding chapter on experiences of dislocations of migrant workers in Rome and Los Angeles.

This book is an interesting account of the restructuring of the lives of the Filipina domestic workers in the context of global capitalism. The study reveals the multiple variables that control their experiences and inform the process of subject formation in Rome and Los Angeles.