THE RIGHT TO THE RIGHT TO CULTURALLY CULTURALLY

SENSITIVE HEALTH SENSITIVE HEALTH SERVICES FOR SERVICES FOR

REFUGEES AND IDPSREFUGEES AND IDPS

JANAKA JAYAWICKRAMAJANAKA JAYAWICKRAMACOMMUNITY WELLBEING COMMUNITY WELLBEING

PROGRAMMEPROGRAMME

HEALTHHEALTH

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Preamble to the Constitution of the World Health Organization, 1946

RIGHT TO HEALTHRIGHT TO HEALTHEveryone has the right to health, as recognised in a number of international legal instruments:

Universal Declaration of Human Rights (1948)Constitution of the World Health Organization (1946)International Covenant on Economic, Social, and Cultural Rights (1966)

RIGHT TO HEALTHRIGHT TO HEALTH

This embraces not only the right to equal access to health care but also to the underlying determinants of health, such as: access to safe water and adequate sanitation; adequate supply of safe food, nutrition and housing;healthy environmental conditions; access to health-related education and information; non-discrimination; and human dignity and the affirmation of individual self-worth.

(Minimum Standards in Health Services, Sphere Project, 2008)

RIGHT TO HEALTH RIGHT TO HEALTH SERVICESSERVICES

International Covenant on Economic, Social, and Cultural Rights (1966):

“right of everyone to the enjoyment of the highest attainable standard of physical and mental health”

WHY CULTURE? WHY CULTURE? Culture = Cult + Ure Social Political Economic Geography Language Food Religions Attitudes and values And many more,…

WHY CULTURE? WHY CULTURE? Different communities from different

countries, regions and continents have different value systems and world views.

These value systems and world views are the set of rules that help people make sense of their lives and make them feel safe.

Not that one culture is better than the other.

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THE CULTURAL THE CULTURAL DIFFERENCEDIFFERENCE

Existing health services are mainly based on western medical scientific culture.

The mainstream medical system treat other medical systems as ‘alternative’.

But most indigenous medical systems such as Ayurveda or Chinese Medicine are more than 5,000 years old.

For non-western communities, the western medicine then become ‘alternative’.

THE WESTERN MEDICAL THE WESTERN MEDICAL CULTURECULTURE

Reductionist world view: specialisation and separation of the body from nature.

War against disease – distrust of nature. Ignorance of uncertainty and dangers of

life. Scientific explanation: logical. Drugs: conquering nature and nature as a

machine. Service delivery by scientifically trained

medical elites.

This is not to This is not to undermine the positive undermine the positive contributions of contributions of western medicine. western medicine.

Non-western Cultures - Non-western Cultures - GeneralGeneral Broader world view: nature, cosmologies,

internal and external environments and dead ancestors.

Harmonious relationships with the natural world.

Acceptance of uncertainty and dangers of life: illnesses and death are part of life!

Non-western Cultures - Non-western Cultures - GeneralGeneral

Social, political, cultural, economic and environmental aspects of health.

Faith in healing than logical understanding. Caring and intuition play a major role of

healing.

Not all the aspects of non-Not all the aspects of non-western medical systems western medical systems

are positive. are positive.

REFUGEES AND IDPSREFUGEES AND IDPS

Apart from coming from non-western cultures, refugees and IDPs carry baggage of experiences: TortureRapeDestructionLosses of loved ones and propertiesLiving in unfamiliar environments

REFUGEES AND IDPS IN REFUGEES AND IDPS IN WESTERN HEALTH CAREWESTERN HEALTH CARE

Re-experience torture. Explaining personal and horror narration

to an unknown stranger. Lack of space for beliefs, attitudes, values

and rituals. Indifference to diverse health perceptions. Problems in communication and language. Different ethics and morals.

DISCUSSIONDISCUSSION

Respect for different health perspectives and practices.

Culturally informed care delivery. Culturally tailored health promotion,

disease prevention and disease support. Institutional and community-based cultural

support staff.

SOME SUGGESTIONSSOME SUGGESTIONS

To care for someone, I must know who I am.To care for someone, I must know who the other is.To care for someone, I must be able to bridge the gapbetween myself and the other.

Jean Watson(Cited by J. Anderson, RN, PhD, 1987)

SOME SUGGESTIONSSOME SUGGESTIONS Re-validate the current policy and practice

for cultural understanding: know who I know who I amam

Incorporate different health perceptions and care practices in to medical education: know who the other isknow who the other is

Involvement of refugees and IDPs in to health service decision making processes: bridge the gapbridge the gap

MSC – COMMUNITY MSC – COMMUNITY WELLBEINGWELLBEING Appreciate and investigate uncertainty and

dangers in life Collaborating with communities to

retrieve traditional knowledge systems Combining traditional and new knowledge

systems for effective and quality processes with communities as equal partners

www.northumbria.ac.uk/communitywellbeing

THANK THANK YOU. YOU.