Ajay Bailey

A Life Course Approach to High-skilled Migration: Lived Experiences of Indians in the Netherlands

This article presents a framework which applies life course approach to high-skilled migration. By using the lens of the life course, migration behaviour is viewed not only in response to labour market triggers, but also in relation to other life domains such as education, employment and household. The data presented in this article are drawn from 22 in-depth interviews and visualisations of parallel careers. The results illustrate how highly skilled Indian migrants in the Netherlands shape their life course and highlight the parallel careers that structure their migration trajectories. Parents, spouse and social networks inform the life course decisions of these migrants through the linked lives mechanism to a large extent. Our findings challenge the notion of ‘trailing wives’ and suggest that, despite of gender differences in the life course patterns, the joining spouses play an active role in the family migration decisions of the highly skilled. Life course approach enables us to understand the migration process through the lives of the highly skilled and reveals how—the often culturally conditioned—life course interdependencies frame their migration decisions.

“We have become doctors for ourselves”: motives for malaria self-care among adults in southeastern Tanzania

BackgroundPrompt and appropriate treatment of malaria with effective medicines remains necessary if malaria control goals are to be achieved. The theoretical concepts from self-care and the health belief model were used to examine the motivations for malaria self-care among the adult population.MethodsA qualitative study was conducted through eight focus group discussions with adult community members to explore their general opinions, views and perceptions of malaria and of its treatments. These groups were followed by 15 in-depth interviews of participants with a recent malaria experience to allow for an in-depth exploration of their self-care practices. The analysis followed principles of grounded theory and was conducted using Nvivo 9 qualitative data management software.ResultsThe self-treatment of malaria at home was found to be a common practice among the study participants. The majority of the participants practiced self-medication with a painkiller as an initial response. The persistence and the worsening of the disease symptoms prompted participants to consider other self-care options. Perceptions that many malaria symptoms are suggestive of other conditions motivated participants to self-refer for malaria test. The accessibility of private laboratory facilities and drug shops motivated their use for malaria tests and for obtaining anti-malarial medicines, respectively. Self-treatment with anti-malarial monotherapy was common, motivated by their perceived effectiveness and availability. The perceived barriers to using the recommended combination treatment, artemether-lumefantrine, were related to the possible side-effects and to uncertainty about their effectiveness, and these doubts motivated some participants to consider self-medication with local herbs. Several factors were mentioned as motivating people for self-care practices. These included poor patient provider relationship, unavailability of medicine and the costs associated with accessing treatments from the health facilities.ConclusionsMalaria self-care and self-treatment with anti-malarial monotherapy are common among adults, and are motivated by both individual characteristics and the limitations of the existing health care facilities. There is a need for public health interventions to take into account community perceptions and cultural schemas on malaria self-care practices.

Negotiating between patriarchy and emancipation: rural-to-urban migrant women in Albania

It is essential to explore the role of gender while analysing internal migration in Albania to account for the differing experiences of men and women. Quantitative studies suggest that Albanian internal migration is pioneered by men, with women merely acceding to their wishes. This article addresses the undervalued role of women in the academic discourse concerning migration in Albania. Utilizing ethnographic research techniques, it explores the role of women migrating from rural to urban areas as part of a larger household and examines the coping and negotiating strategies used for survival in the city. Our findings reveal that women actively participate in the rural-to-urban migration process, including the initial decision to migrate and the choice of destination. Womens narratives provide evidence of specific emancipation strategies through which they express themselves and their new ways of living. Women adjust to and challenge their new urban environment through gaining paid employment and expanding their social networks, as well as experience emancipation through daughters and by changing their appearance, achieving varying degrees of personal and social prosperity.

Highly skilled migration between the Global North and South: gender, life courses and institutions

Highly skilled migration is emerging as the new wave in the migration flows between countries both in the Global North and in the Global South. Skilled migration1 is seen as one of the key elements...

Qualitative to Quantitative: linked trajectory of method triangulation in a study on HIV/AIDS in Goa, India

Abstract With 3.1 million people estimated to be living with HIV/AIDS in India and 39.5 million people globally, the epidemic has posed academics the challenge of identifying behaviours and their underlying beliefs in the effort to reduce the risk of HIV transmission. The Health Belief Model (HBM) is frequently used to identify risk behaviours and adherence behaviour in the field of HIV/AIDS. Risk behaviour studies that apply HBM have been largely quantitative and use of qualitative methodology is rare. The marriage of qualitative and quantitative methods has never been easy. The challenge is in triangulating the methods. Method triangulation has been largely used to combine insights from the qualitative and quantitative methods but not to link both the methods. In this paper we suggest a linked trajectory of method triangulation (LTMT). The linked trajectory aims to first gather individual level information through in-depth interviews and then to present the information as vignettes in focus group discussions. We thus validate information obtained from in-depth interviews and gather emic concepts that arise from the interaction. We thus capture both the interpretation and the interaction angles of the qualitative method. Further, using the qualitative information gained, a survey is designed. In doing so, the survey questions are grounded and contextualized. We employed this linked trajectory of method triangulation in a study on the risk assessment of HIV/AIDS among migrant and mobile men. Fieldwork was carried out in Goa, India. Data come from two waves of studies, first an explorative qualitative study (2003), second a larger study (2004–2005), including in-depth interviews (25), focus group discussions (21) and a survey (n=1259). By employing the qualitative to quantitative LTMT we can not only contextualize the existing concepts of the HBM, but also validate new concepts and identify new risk groups.

Remittances and household expenditure patterns in India and selected states

Using the nationally representative data drawn from NSSO 64th round, this paper investigates the impact of remittances both internal and international on the expenditure patterns of households in India, with special focus on Uttar Pradesh and Kerala and Karnataka. To control for selectivity bias and to assess the average impact of remittances on household expenditure items, the present paper applies propensity score matching technique. The estimates reveal that compared to non-recipient households, households receiving remittances spend less on food and more on education and health care. Increasing expenditure with remittance flow on these critical variables signifies the positive impact of remittances on household development. The impact of international remittances on these indicators weighs more than internal. In line with the optimistic view, the findings of the present study show that remittances enhance household well-being.

‘For the sake of the family and future’: the linked lives of highly skilled Indian migrants

ABSTRACT While in Western literature, migration is generally considered an individual or (nuclear) household phenomenon, Indian context adds the strong presence of parents and extended family to the constellation. This paper addresses how significant others shape the life course events and the migration trajectories of highly skilled Indian migrants to the Netherlands and UK. We employ a qualitative approach to the life course framework to highlight the linked lives that can alter the migration decisions. Our findings are drawn from 47 semi-structured biographic interviews. The results underscore how further migration decisions are often informed by the implications of the different life stages of the linked lives, the key elements being care-giving by and for the parents. Furthermore, we also illustrate how migration provides space for negotiating social norms and expectations: due to the geographical distance between migrants and their parents, the local (non-Indian) context plays a bigger role and thus the need for and timing of conformity with norms can be postponed. The understanding of family life in transnational settings will be enriched when individuals are embedded within the cultural background and linked lives are extended beyond the immediate nuclear family.

Health Seeking Behaviour and Treatment Intentions of Dengue and Fever: A Household Survey of Children and Adults in Venezuela

Background Dengue in Venezuela is a major public health problem with an increasing incidence of severe cases. Early diagnosis and timely treatment influences the outcome of dengue illness, as delay in care-seeking is significantly associated with complications leading to severe dengue. We aimed to understand patterns of health seeking behaviour (HSB) in individuals exposed to high dengue incidence in order to improve early attendance to health centres. Methods Between September 2013 and February 2014 a cross-sectional household survey was performed in Maracay, Venezuela. Intended HSB of adults and children’s parents/guardians was assessed with respect to fever or suspected dengue. Data was collected through structured questionnaires from 105 individuals. Results Most individuals felt at risk of dengue and believed it could be a deadly disease. In the case of suspected dengue, the majority (60%) would choose to first seek medical help versus first treating at home, in contrast to 11% in the case of fever. Amongst those who decided to visit a doctor, a suspected dengue infection would prompt them to search medical help earlier than if having only fever (p<0.001). Multivariate analysis modelling showed that the independent factors associated with the intention to firstly visit a doctor versus treating at home in the case of dengue were feeling at risk (OR = 3.29; p = 0.042) and being an adult (as opposed to caring for a child as a parent/guardian; OR = 3.33, p = 0.021), while having had a previous dengue infection (OR = 0.29; p = 0.031) and living in the neighbourhood Caña de Azúcar (OR = 0.28, p = 0.038) were negatively associated with seeking medical care as their first action. Conclusion Knowledge of HSB related to dengue is scarce in the Americas, our study attempts to contribute to a better understanding of HSB in this region. Improving early dengue disease recognition and awareness may enhance prompt attendance to medical care in affected populations and thereby reduce mortality and severity of dengue. Especially for those with a previous dengue infection, efforts have to be made to promote prompt health centre attendance.

Food, faith and community : social well-being of Ghanaian migrants in the Netherlands

This article explores how Ghanaian migrants in the Netherlands enhance their gendered social well-being. We provide an in-depth view of gender-specific places and relations that shape the social well-being of migrants, focusing on place-based lived experiences, by conducting in-depth interviews and observations. Our results demonstrate that social well-being is enhanced by social networks, wherein the participants recreate feelings of self-esteem, belonging and recognition. Furthermore, the special meaning of food and faith also contributes to the social well-being of the participants. Food and faith serve as commemorations of traditions in their home country and alleviate the transition to new traditions in the host country. We also found that specific places, such as shops and churches, contribute to the social well-being of participants in the study. Men and women in our study use different strategies to construct their well-being, and they interpret places and social relations differently, but they all showed to be active agents in enhancing their social well-being. Our female participants in particular look for opportunities in the host country to independently enhance their social well-being, for instance through establishing their own small businesses and social groups. Through its focus on the social well-being of migrants, the study contributes to increase understanding between different cultural groups.

It is the medicines that keep us alive : lived experiences of diabetes medication use and continuity among adults in Southeastern Tanzania

BackgroundDiabetes is a chronic condition which requires many patients to use medications for the remainder of their lives. While this regimen is demanding, little research has been done on the experiences individuals have with diabetes medication use and the continuity of use, especially patients from rural areas of Tanzania. This study explores the lived experiences of diabetes medication use and the continuity of use among adult diabetes patients from rural communities with limited access to diabetes medicines.MethodsWe conducted 19 in-depth interviews to explore patients’ experiences with diabetes medication use and the continuity of use. We employed the 5As of access to care to situate the behavioral practices surrounding diabetes medication use in the study settings. The data analysis followed grounded theory principles, and was conducted with the help of NVivo 9.ResultsStudy participants expressed positive attitudes toward the use of diabetes medicines, but also concerns about affordability. The patients employed two main strategies for dealing with the cost. The first was to increase their available funds by spending less money on family needs, selling household property, asking family and friends for money, or borrowing cash. They also reported sourcing medicines from pharmacies to save on consultation and laboratory costs. Second, participants reported using less than the recommended dosage or skipping doses, and sharing medicines. The geographic accessibility of diabetes service providers, the availability of medication, and the organization of the diabetes services were also cited as barriers to taking medications and to using them continuously.ConclusionsThe strategies employed by the people in this study illustrate their resilience in the face of poverty and failing health care systems. More comprehensive strategies are therefore needed to encourage consistent medication use among people with chronic conditions. These strategies could include the reduction of prices by pharmaceuticals, the strengthening of community risk-pooling mechanisms and sustained health campaigns aimed at patients and the community.