wealthy citizens take advantage of immigrants and refugees for cheap labor

 wealthy citizens take advantage of immigrants and refugees for cheap labor

The margin can be described as “an area, state, or condition excluded from or existing outside the mainstream” – Merriam-Webster dictionary. To live on the margin means to live in conditions of extreme poverty and on the margin of society with limited access to employment and health care. These people live outside of the socially accepted norm and lack social power.

Migration is a fundamental innate human characteristic, and it occurs within national boundaries as well as across international territories (Castañeda, 2010a, 2019; Castaneda, 2009; RAZAK & NORDIN, 2018; Hartwig & Mason, 2016). Health care is significant need for all people, and the migrants are particularly in need of health care because of the recent changes they have just gone through (Carballo & Nerukar, 2001; Castaneda, 2009; Ansar, Johansson, Vásquez, Schulze, & Vaughn, 2017; Asaduzzaman, 2019; O’Mahony, Donnelly, Bouchal, & Este, 2012). However, there are some countries in which the political systems systematically weaponize health care as a tool of discrimination and deterrence to prevent migrants from entering their countries(Ansar et al., 2017; Castañeda, 2010a, 2019).

The United States is frequently being described as a nation of immigrants, judging from the historical description of the country and the references that lawmakers and politicians make on the televisions. As one of the highly industrialized nations {often described as first world country or developed country}, the U.S. occupies a highly exemplary position among other nations in global affairs. America does not have a guaranteed health care system. Though some of the wealthy citizens take advantage of immigrants and refugees for cheap labor(Castañeda, 2010b)

Literature Review:

There are various barriers to health care access that were identified for unauthorized migrants. According to Castaneda (2010); these include linguistic barriers, lack of insurance, lack of transportation, lack of knowledge about the availability of (affordable) health services, lack of familiarity with the U.S. health system, avoidance because of fear of deportation, experiences of liminality. The migrants’ receiving context and class insertion into the host society. All these factors have been described as a “web of effects”(Castañeda, 2010b)

In another study of the post-resettlement health realities of Rohingya refugees in Atlanta, Georgia, Asaduzzaman (2019) identified that these groups of migrants face a similar set of barriers, which in his study include language illiteracy, transportation access, and health insurance complexities (Asaduzzaman, 2019). This study found that the inability to speak English well affect people’s satisfaction with the health care system. They were found to report the failure to understand medication prescriptions well, and even unable to explain their illness well to their provider.

Parajuli and Horey (2019) in Australia conducted systematic reviews of more than two hundred published articles. They observed that three broad barriers were found to refugee health care access: those relating to refugees, those relating to health services, and those relating to the context of resettlement. Again, in a similar finding to the previous reference studies. The common refugee-related barriers were language, cultural and health beliefs, low literacy, refugee experiences, financial constrains, employment, and physical issues. (O’Mahony et al., 2012; Colucci, Szwarc, Minas, Paxton, & Guerra, 2014; Hadgkiss & Renzaho, 2014). Health service-related barriers included lack of cultural competency, lack of knowledge about refugee health issues, difficulties working with interpreters, and time constraints (Robertshaw, Dhesi, & Jones, 2017). The final barrier which is in the context of resettlement included the type of health system and its flexibility; the location of services; and transport accessibility (Robertshaw et al., 2017)

In Calgary, Alberta Canada, O’Mahony et al. in studying the Barriers and Facilitators of social supports to immigrant and refugee women coping with Postpartum Depression reported that immigrant and refugee women were divided on whether health care services supported their situations. The challenges reported were difficulties in accessing health care services, lack of information on PPD, poor relationships with health care providers, discouragement from health care providers attempts to normalize their depressing feelings, downgrading the seriousness of their condition. These lead to despair in seeking help for PPD. Language difficulties, lack of familiarity with health care services and unawareness of the existence of health care services were also reported (O’Mahony et al., 2012)

In a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017, Brandenberger et al. found the 3C model to give a comprehensive, patient-centered summary of critical challenges in health care delivery for refugees and migrants. The 3Cs include a. Communication, b. Confidence, and c. Continuity of care (Julia Brandenberger, Thorkild Tylleskär, Katrin Sontag, Bernadette Peterhans, & Nicole Ritz, 2019). The World Health Organization (WHO), in their details on how to improve health care delivery for migrants and refugees, includes the need for patient-centered and intercultural approaches.

There exist a much full range of barriers to access to health care for undocumented immigrants. Not only are these barriers legal in nature, but they also surround problems immanent in undocumented or illegal status. They are inclusive of policy hindrances, lack of financial and social assets as well as fear of disclosure (Ansar et al., 2017). Given the contemporary level of undocumented immigrants in the world, these barriers continue to bring forth repercussions in human health. Additional studies are essential in the field to aid in determining the impact of installed policies in health care on undocumented immigrants as well as choices to move. Above a billion individuals in the world are immigrants according to population statistics. This number has been on the rise, especially in developed countries (Julia Brandenberger, Thorkild Tylleskär, Katrin Sontag, Bernadette Peterhans, & Nicole Ritz, 2019). National immigrant support and hosting services that provide hosting and support to immigrants have noted this rise over the years in many of these countries. Such states are inclusive of the United States, Portugal, and the United Kingdom, among many others (Brandenberger et al., 2019).

The managing of immigrant health care is an essential challenge. The world health organization views the right to access to health care as a fundamental right. However, access and utilization of healthcare may vary for immigrants and residents. The entrance to healthcare needs may be impacted by their unfavorable working and living conditions, discrimination, as well as minimized social-economic opportunities (Brandenberger et al., 2019). Additionally, immigrants are under the risk of contracting various diseases than residents of a particular state or the host population. An example of such a scenario is seen in the proportion of tuberculosis cases among refugees or immigrants in numerous European countries. These cases have increased to above fifty percent. Data from Portugal, for instance, indicates that 15.9 percent of tuberculosis cases were immigrants, which was much higher than that of the general population.

The literature presents multiple levels and categories of barriers to healthcare for undocumented immigrants. Such restrictions are evident in the policy arena, at the individual level, and in the health care system (O’Mahony et al., 2012). The policy arena, to begin with, focuses on issues such concerning both policy and law. Such problems include access to insurance covers for immigrants and the limitations to the healthcare type they can use. The health care system focuses on capacity, bureaucracy, and discriminatory acts that are present in the community. Finally, the individual level focuses on the stigma, fears, and lack of capital socially or financially, which, as a result, creates barriers to healthcare.

Policy

National policies that do not include immigrants or refugees in receiving healthcare are the most common barriers to health care. Numerous studies have described legal restrictions, including the denial of insurance access. Some states have active surveillance of providers who lead to the refutation of care as providers feared to lose their licenses or undergo criminal procedures (Brandenberger et al., 2019). A usually pointed mechanism for excluding immigrants from health care are laws that limit them from accessing insurance. Due to the ability of insurance to provide them with access to affordable care or receive any care services, these laws were used to hinder them from access to healthcare. Medical deportation, as allowed in many countries (O’Mahony et al., 2012). Deporting sick immigrants to their country of origin against their will for medical care purposes led to avoidance of care by developed countries. It is unfortunate to have to use such measures, mainly because the immigrants’ countries of origin did not have sufficient health care services. Also, the documents that are required to access health care services were a significant barrier for these minority groups. This documentation mostly spread and affected authorized children of immigrant parents who failed to seek care for them due to the inability to provide documentation themselves (Carballo & Nerukar, 2001).

Health system

Barriers in the health system include costs to the immigrants, external resource restrictions, discrimination, as well as high bureaucratic needs (O’Mahony et al., 2012). External resource restrictions or work conflict constraints can, for example, be offering healthcare during work hours and fears of losing employment because of time are taken off for health care. Others include lack of transport access and limited health care, such as fund cuts, translation services, and cultural competencies present in health facilities. Limited capacity was seen to be dominant in the mental health care for immigrants. Research reveals discrimination based on nativity status, and some subpopulations experienced the same but with other forms of discrimination, such as that of sexual, which limited them to accessing care (Brandenberger et al., 2019). Complex bureaucracies created unconquerable hindrances that were not only present among immigrants but also providers who wanted to provide care to them. On most occasions, bureaucratic regulations resulted in extensive paperwork requirements, which were so complicated and expensive to complete.

Individual

Individual barriers consist of deportation fears, communication ability, shame and stigma, financial resources, as well as understanding healthcare systems (Ansar et al., 2017). Fear of deportation by immigrants has been seen by various studies to lead them to avoid health care and waiting until they got to critical conditions to seek attention. This happens due to their concern about being reported to authorities. Countries such as Denmark, the United States, as well as France, were seen to have this (Carballo & Nerukar, 2001). The communication barrier which consists not only of the inability to speak the dialect of the immigrant but also the cultural discomfort, which involves how the dominant culture communicated. Most immigrants have been noted to fail to know how to express their medical issues to care providers, or some were misunderstood (Carballo & Nerukar, 2001).

For instance, a study revealed that immigrants felt that physicians based in the emergency rooms did not believe their symptoms. Lack of financial resources for immigrants has also become a significant barrier. Countries that excluded immigrants from accessing healthcare services or lacking access to healthcare insurance prove this to be true. Shem and stigma were also reported to be barriers hat hindered immigrants from accessing health care in these countries. Immigrants felt that they could undergo shame or did not want to be a burden in these countries where services were available (Ansar et al., 2017). The final individual barrier is that of a lack of understanding or knowledge of the health care system. Immigrants in normal circumstances failed to know which services were available to them or their healthcare rights in general. Additionally, they were unable to understand how to utilize the healthcare system, especially when additional requirements were needed (Hadgkiss & Renzaho, 2014).

Most European countries restrict healthcare access to refugees. Although legal restrictions may be limited once refuge has been granted, they continue facing barriers to health care and preventative services. The structural barriers consist of the language and the availability of interpreters. Countries such as Switzerland found the lack of interpreters in the healthcare system affecting significantly the use of these services, which in turn lead to high follow-up costs (Carballo & Nerukar, 2001). Adequate language similarity was associated considerably with top reports of severe psychological symptoms. Language barriers have made refugees or immigrants make low use of health care services, especially cancer screening and vaccine use. High follow-up costs are brought about by such actions for tertiary and secondary care, and administrative and fundamental expenses (O’Mahony et al., 2012). Immigrants and refugees, in general, display high rates of emergency room use and hospitalization according to studies. This exceeds the number of individuals that are native-born in these European states.

Financial hindrances have also ben seen to associate with hidden and direct health care expenses. These include coverage costs, transportation costs as well as lack of accessibility of health care institutions. Also, there could be inadequate assessments of lack of support for mental health problems. Underfinanced health care systems often result in knowledge gaps, and insufficient information flows among healthcare providers and immigrants or refugees (O’Mahony et al., 2012). This can lead to a sustained lack of familiarity with health care services. Inadequate literacy levels, as well as matters such as social exclusion, can also lead to these repercussions. The limited availability of specialized health care centers, particularly in the rural areas and their financial and geographic inaccessibility and their inflexible scheduling of appointments due to opening hour’s restrictions, can also act as barriers (Robertshaw, Dhesi & Jones, 2017).

Cultural differences, inferred biases, as well as discrimination also play a significant role. Countries such as the Netherlands have depicted the medical consultations with such marginalized groups are shorter than that of natives. Medical practitioners have also been noted to be verbally dominant when attending to marginalized groups individuals (Robertshaw, Dhesi & Jones, 2017). They fear deportation or the adverse effects on asylum applications, which may hinder mental illness seekers under subsidiary protection to approach health care treatment services (Colucci et al., 2014). This arises from the fear of being denied. Socio-cultural barriers of mental disorders and religious contingent interpretation of physical symptoms can also contribute to health care access restrictions. This is seen particularly in preventive and psychotherapy treatments (Hadgkiss & Renzaho, 2014).

Immigrants seen in the Middle East and the African continent may have their health symptoms misread or misunderstood as somatic symptoms. Such acts lead to misdiagnosis by health practitioners. The existing mental health flexibility may be impacted negatively by extended asylum application processes in many European countries (Colucci et al., 2014). The healthy migrant effect can also dictate the use of health care and preventative services by refugees. Migrants involved in works of labor, according to studies, have depicted healthy statuses than the general population both in the host and sending countries. This is because of the self-selection bias among immigrants (Hadgkiss & Renzaho, 2014). Also, refugees have been observed to display higher symptom prevalence of anxiety and depression conditions regardless of the state’s economic health. Self-selection bias in terms of qualifications and knowledge also exists.

Insurance

Inflated health care costs, as well as the erosion of health insurance covers, are significant long-term issues that present themselves to Americans (Hadgkiss & Renzaho, 2014). These issues are specifically acute for immigrants residing in the United States who possess meager rates of insurance coverage as well as poor access to the services. Almost half of the immigrants are seen to be uninsured. This is a level that exceeds that of native-born citizens three times. So many immigrants lack insurance hence facing severe barriers to health care access (Carballo & Nerukar, 2001). This results in them paying more out –of –pocket when they decide to receive care.

Furthermore, the apparent health and humanitarian issues relating to poor health care access, other social and financial reasons, cause concern. Unresolved health issues can lead to limiting the ability of immigrants and associated marginalized groups in society to maintain productivity in employment, especially when given strenuous jobs or jobs that have high incidents of occupational injuries. Due to the existence of many immigrants lacking medical insurance covers the cost of hospitalization can lead them into debt or financial bankruptcy. The institute of medicine in the United States has estimated the lack of insurance costs to approximately sixty-five to one hundred thirty billion dollars every year. This occurs due to health impairments as well as the years of productive life that is lost of all individuals who are uninsured and not just immigrants.

Both legal and unauthorized immigrants and refugees usually depend on a patchwork system of safety-net clinics as well as hospitals (Carballo & Nerukar, 2001). Such platforms offer health services to them at reduced prices, including the state and county facilities and also charitable and religious ones. Their dependence on these systems has had many developed states and communities concerned about uncompensated health care expenses that arise from uninsured immigrants as well as the local and state financial burdens that they have as outcomes (Carballo & Nerukar, 2001).

The goals of this paper are to actualize an opportunity for the practical application of the theoretical knowledge gain from the applied anthropological class. To utilize the tools and skills gained from the academic discussions of socio-cultural problems to highlight the contribution of ordinary citizens who volunteer and are responding to some of the significant human challenges; health care needs for people with unique requirements for them. Also, to develop a possible functional resource mapping created as a product of brief ethnographic fieldwork at this Clinic. This is in part to fulfill the need of semester classwork of demonstrating a participatory action research project with a need base organization, also to provide a pilot for the foundation of a future theses project.

Background Story:

The Grace Village Medical Clinic is in the Clarkston community area in Georgia. Based on the information on their website, it is Clinic that was started in October 2017, as a State of Georgia certified Clinic operating under the oversite of the Georgia Volunteer Health Care Program (GVHCP) of the Department of Health (DPH). The Clinic serves operates in partners with Christian Medical and Dental Association (CMDA); colleges and universities including Emory, Mercer, Morehouse School of Medicine, Georgia State University and Philadelphia College of Osteopathic Medicine (PCOM); in addition to contributions from individuals and organizations with interest in serving refugee and underserved population. The city of Clarkston, a city in Dekalb County, Georgia, United States, website information and Wikipedia, shows that the town is noted for its ethnic diversity; often referred to as “the most the most diver square mile in America” and “the Ellis Island of the South.” A non-profit organization that provides free healthcare services for people with no health insurance and immigrants to the United States.

Research Methodology:

The bulk of this paper includes a literature search using the university library and google scholar. It is to e a theoretical

I plan to speak with some of the volunteers at this Clinic, and some of the patients that attend who may be willing to share with me some of their experiences using the Clinic and getting their health care needs in America met, I would like to focus on some of the obstacles they encounter and how much knowledge in terms of the resources that they think they can use to meet their health needs since they have been living in the United States; what do they know that is available to them, where can they get it and what challenges do they have in getting health care in the united states.

I also would like to research some of the options available to someone who does not have health insurance or who is an immigrant or refugee in this community.

Challenges/Limitations:

Several problems surfaced during this ethnographic work. Institutional Review Board (IRB) approval; since this population is considered people at the margin, they have to be well protected; therefore, I will need a proper IRB approval. Ethical considerations are also another essential component of the research proposal that is essential. Health Insurance Portability and Accountability Act (HIPAA) is another very crucial aspect that has to be followed; the patient’s information and the medical record have to well-protected. Researchers positionality; as an immigrant myself and a foreign-trained physician and a candidate of the United State Medical license examination (USMLE) the board with a prospect of gaining residency training to practice as a physician in the U.S. I have to develop special reflexivity during my data collection

Time limitation; this is an ongoing study, and actual data collection is about to begin. I have mainly done the initial clinic visitation, the building of rapport. Since this report must be given over a semester, this report has to be generated.

Clinic source; to obtain more data, it will be necessary to include more clinics that provide services to underserved populations and immigrants. Also, since this is a free clinic and volunteers provide all services, there is a limitation to the detail of information that can be obtained from the patients.

Initial Submissions;

There is relatively less literature on this topic in the U.S. compared with other countries like Australia and Germany.

This may be a pointer to the much far behind health care quality in the U.S.

There is a need for more studies in this line.