Nabi Fatahi

Factors Beyond the Language Barrier in Providing Health Care to Immigrant Patients

Background: Due to the enormous migration as the result of war and disasters during the last decades, health systems in Europe are faced with various cultural traditions and both healthcare systems and healthcare professionals are challenged by human rights and values. In order to minimize difficulties in providing healthcare services to patients with different cultural backgrounds, cultural competence healthcare professionals are needed. Material and Methods: Four focus group interviews, were conducted with Kurdish immigrants in Scandinavian countries (N=26). The majority were males (n=18) aged between 33-61 years (M= 51.6 years) and a few were (n=8) females aged 41-63 years (M=50.7 years). The data were analyzed by using qualitative content analysis method. Results: According to the study results participants experienced that diversities both in culture and healthcare routines create a number of difficulties regarding contact with healthcare services. Though culture related aspects influenced the process of all contact with health care services, the obstacles were more obvious in the case of psychological issues. The results of the study showed that cultural diversities were an obvious reason for immigrants’ attitudes regarding healthcare services in resettlement countries. Conclusion: The results of the study revealed a number of difficulties beyond linguistic problems regarding immigrants’ contact with healthcare services in Scandinavian countries. Problems were rooted both in diversities in healthcare services and cultural aspects. Immigrants’ views of healthcare systems and healthcare professionals’ approach in providing healthcare were some of the problems mentioned.

Being Immigrant in their Own Country: Experiences of Bosnians Immigrants in Contact with Health Care System in Bosnia and Herzegovina.

Background: Bosnia and Herzegovina became an independent state (6th April 1992) after referendum for the independence of Bosnia and Herzegovina which was held on 29 February and 1 March 1992. On the referendum voted total 2,073,568 voters (63.6% turnout) and 99.7% were in favor of independence, and 0.3% against. According to the provisions of the peace agreement, particularly in Annex IV of the Constitution of Bosnia and Herzegovina, the country continues to exist as an independent state. Like all others institutions, even the health-care system was separated between Federation and the other part of Bosnia and Herzegovina. The right to social and medical services in Bosnia and Herzegovina is realized entities level and regulated by entity laws on social and health-care. Aims: The aim was to explore how immigrants born in Bosnia and Herzegovina and living as refugees in their own country experience different institutions in Bosnia and Herzegovina with the special focus on the health-care system. We also investigated the mental health of those immigrants. Patients and Methods: Focus-group interviews, with 21 respondents born in Bosnia and Herzegovina and living as refugees in their own country, were carried out. Content analysis was used for interpretation of the data. Results: The analysis resulted in two categories: the health-care in pre-war period and the health-care system in post-war period. The health-care organization, insurance system, language differences, health-care professional’s attitude and corruption in health-care system were experienced as negative by all respondents. None of the participants saw a way out of this difficult situation and saw no glimmer of light in the tunnel. None of the participants could see any bright future in the health-care system. Conclusion: Health-care system should be adjusted according to the needs of both the local population born as well as the immigrants. Health-care professionals must be aware of the difficulties of living as immigrants in one’s own country. In order to provide health-care on a high level of quality, health-care professionals must meet all the expectations of the patients, and not to expect that patients should fulfil the expectations of the health-care professionals. Different educational activities, such as lectures, seminars and conferences, are needed with the purpose of the optimal use of the health-care system for people that have been forced to become refuges in their own country.

From immigrant to patient: experiences of bosnian immigrants in the Swedish healthcare system.

Background: We aimed to explore the background of refugees emigrating to Sweden and their situation in the new country with special focus on their contacts with the Swedish healthcare system. Material and methods: Our study has a qualitative design. Data was collected between January and October 2013 during face-to-face interviews using open-ended questions. A qualitative content analysis was carried out in accordance with the Graneheim and Lundman method (2004). The participants were 8 women and 7 men, aged between 65 and 86 years who had emigrated from Bosnia and Herzegovina. They had lived in Sweden between 13 and 21 years. Results: The findings revealed that the participants themselves experienced that change of scenery, culture and language influenced their own well-being. The most important finding was that language and communication difficulties are experienced as the major problems. These difficulties implied that all informants were forced to seek help from their children or to use an interpreter when they visited various healthcare institutions. Conclusions: Health care professionals need to be aware of the diverse needs of various ethnic groups in Sweden, some of whom may carry traumatic experiences that could influence their health. In order to provide trans cultural care, a professional staff needs to know that historical, political and socioeconomic factors may influence ethnic minorities. Health care staff needs to recognize that social problems might be medicalized. In particular this article emphasizes the problems associated with language.

THE INFLUENCE OF INFORMATION AND RELIGION ON ORGAN DONATION, AS SEEN BY SCHOOL TEACHERS IN BOSNIA AND HERZEGOVINA

Introduction: Transplantation of organs is the treatment of choice for severe organ failure worldwide. Aim: The aims of the present study were to determine the influence of religion on attitudes towards organ donation among staff at schools in Tuzla. Material and Methods: In the Tuzla region there are 42 schools and 1580 school staff. A total of 21 schools were selected randomly, which were stratified by geographical location. 499 employees were invited to participate in the study, and 475 agreed to participate. According to the definition of their attitude towards religion the subjects were divided into three groups: non-religious, only religious and practical believers. Results: None of the subjects possesses a donor card. To the question whether the subjects support the idea of organ transplantation, most replied that they support the idea of donating organs both during life and after death. Regarding this question there is a significant difference between the groups (p = 0.0063). To the question whether they are prepared to donate an organ of a deceased family member, most replied that they would consent to donating an organ, whilst a significant number also replied that they were not sure. The results show that there is no significant difference between the replies given by the groups (p = 0.7694). To the question regarding to whom they were prepared to donate an organ, most said they were prepared to donate one to a member of their family, then to a close relative, whilst the least would donate to a stranger. The results show that there is a significant difference between the groups (p = 0.0002). Conclusion: In order to reduce the wide disparity between the need and organ donation amongst other things a more active relationship is necessary between health workers, religious officials and school staff.

Migrant General Practitioners' Experiences of Using Interpreters in Health-care: a Qualitative Explorative Study

Background: According to the UNHCR, 250 million people currently live outside their country of birth. The growing multicultural population poses a major challenge to healthcare professionals who aim to provide individualized, holistic care, which respects the individual’s autonomy. To ensure basic rights, healthcare interventions should be guided by the value of benefiting others; individuals should be treated honestly, equally, and impartially. Objective: To investigate immigrant doctors’ experiences of using interpreters in the Swedish health-care system. Material and Methods: Twenty-eight doctors, 12 men and 16 women from Bosnia and Herzegovina, Croatia, Macedonia and Serbia participated in four focus group interviews (FGI). The interviews were audio recorded, transcribed and analyzed using content analysis method. Results: The best results in the present study were achieved in situations where a professional interpreter was involved. In some cases, the doctors were forced to use relatives or a colleague to interpret, which in many cases proved to be a mistake. The consequences of poor interpretation routines included payment by mistake, a patient paying an interpreter who refused to interpret, time spent waiting for another interpreter, as well as disturbances to the daily work schedule. Finding someone who could replace an interpreter who did not show up caused time shortage and increased stress. Conclusions: Improved routines and more effective cooperation between interpreting services and health-care centers are needed in order to ensure that using professional interpreters guarantees appropriate, high quality care. Improvements are needed to provide satisfactory health-care to people with limited language skills. In order to achieve this, better education of interpreters is needed, especially regarding cultural diversity and medical terminology. These improvements present complex challenges, deserving empirical and critical reflection in order to improve the work situation for doctors.

CONTACT WITH HEALTH-CARE SERVICE EXPECTATION AND REALITY OF SITUATION EXPERIENCED BY IMMIGRANTS SEEKING SWEDISH HEALTH-CARE.

Aim: The aim of the study was to investigate how immigrants from Bosnia and Herzegovina, Somalia and Kosovo experienced contact with Swedish health-care regarding meeting with health-care professionals. Material and Methods: Eighteen participants, nine men and nine women from Bosnia and Herzegovina, Somalia and Kosovo participated in focus group interviews (FGI). Data were collected from April 2013 to April 2014 through three group interviews using open-ended questions. A qualitative approach, incorporating a critical incident technique (CIT) was used. Results: The findings highlighted patient’s negative experiences regarding the Swedish health care system. Their main complaints concerned delayed ambulances, lack of doctors in outpatient clinics, long journeys to the hospital and long waiting time at the emergency department. Lack of information about the disease, difficulties seeing a doctor in the department, poor language skills and insufficient interpreters were some of other difficulties that mentioned by participants. Conclusions: In order to provide satisfactory health care to patient with different ethnic backgrounds, it is important to be aware of their vulnerable situation and their limit capacity to express their needs. This research could be a starting point in developing strategies for reducing ethnicity-based misunderstandings and inequalities in the health-care system.

Communication with Health Care Services-Experiences of Kurdish Refugees in Scandinavian Countries

Background: According to recent statistics, the number of people who had fled their own home by 2015 was 59.5 million. In this context, the number of people who need a third person as a language link in communication with health care services has increased dramatically. This issue has led to a major challenge to healthcare providers to fulfill immigrants’ needs in communication with health care services in resettlement countries. Aim: To study Kurdish refugees’ experiences concerning communication with health care services in resettlement countries. Methods: Focus group interviews carried out with five groups of Kurdish refugees (N=21). The group interviews were transcribed, interpreted, analyzed and the text was categorized according to the content analysis method. Results: A number of difficulties regarding communication with health care services with the use of an interpreter, as well as with immigrants’ independent communication, were highlighted by the present study. Participants’ dissatisfaction with interpreters, and their competence in communication through an interpreter were reasons why some of them avoided using an interpreter although their language knowledge was limited. The other group finally had to use interpreters following their exaggeration of their language ability, meanwhile the third group waited until their language skills were good enough for independent communication. Conclusion: A number of difficulties concerning the Kurdish refugees’ communication with health care services in Scandinavian countries were revealed by the present study. Interpreters’ linguistic incompetence, their relatives’ impartially and lack of language knowledge in communication through interpreters were problems mentioned by participants. Dissatisfaction with professional interpreters’ competence, exaggeration of their own language ability by some of the participants and sufficient language knowledge were motives for Kurdish refugees’ tendency to make independent communication with health care services.