Transforming the Boundaries of Health Care: Insights from Somali Migrants

Abstract

Despite its growing practice, transnational medical care has not yet been embedded as a critical component of health research, professional practice, or analyses of changes in the social determinants of health. Biomedical practitioners in Finland have failed to take into account the transformative role of transnational health care. Consequently, Somali migrants do not receive informed advice on how to incorporate distant practices into physical and mental health plans. By connecting here-and-there (Finland and Somaliland) studies involving outlooks on and experiences of illness, healing, and interactions among Somali migrants and their medical providers, we show how transnational connections augment personal resilience.

Key Words:

• indigenous healers
• medical education
• mental health
• Somalis
• transnational health care

ACKNOWLEDGMENTS

Marja Tiilikainen's postdoctoral research, “Suffering, Healing and Health-care: The Transnational Lives of Somalis in Exile,” has been funded by the Academy of Finland. She is also grateful for the financial support provided by the Nordic Africa Institute and the Ella and Georg Ehrnrooth foundation. A Fulbright New Century Scholar award supported Peter Koehn's research. He is also grateful to his Finnish hosts at Joensuu University. The manuscript was improved by helpful comments and suggestions from three anonymous reviewers and the editor.

Notes

Note. Values displayed are percents. N are in parentheses. PAP = principal attending physician.

Note. Values displayed are percents. N are in parentheses. PAP = principal attending physician.

The small number of missing or “don't know” values indicates that study participants had little difficulty understanding the mental health status questions presented in the interview. When questions arose, one of the principal investigators was available for clarification. A number of studies have shown that “although refugees may exhibit distress through somatic channels, they are also capable of discussing their problems in psychological terms” (Bemak et al. 2003:24–25).

For further evidence of in-Finland stressors, see Pitkänen and Kouki (2002), Alitolppa-Niitamo (2000:49–50), and Virtanen (2001:120, 122). These are “common post-migration psychosocial adjustment issues for refugees” (Bemak et al. 2003:33, 37, 42–43).

On the importance of advocacy in migrant-health care, see Koehn (2006a) and Koehn and Rosenau (2010:107–108).

Trust in the country of origin's health care system also features prominently in one investigation into why Finns living abroad decide to return to Finland for medical attention (Gashi 2009:32–34, 41).

Steven Vertovec (2009:54–61) concluded that “nothing has facilitated processes of global linkage more than the boom in ordinary, cheap international telephone calls. This is especially the case among non-elite social groups such as migrants.”

We recognize that the ability to advise is complicated by the difficulty of ascertaining the effect of a single indigenous treatment when considered in isolation from the full range of recommended remedies (see Parker-Pope 2008:D5).

Including micro-level exchanges of medical “recipes” among people from diverse places in the world (see Hiebert 2002:210).

Although the “theoretical state of the art in anthropology … emphasizes the interweaving of culturally constructed beliefs and structurally influenced access to services and living conditions” (Hirsch 2003:236), prevailing cultural competence curricula in medical schools fail to treat effectively intracultural variation and the multidimensional interaction of culture with class, gender, power, structural barriers, and discrimination (Gregg and Saha 2006:546; Koehn and Rosenau 2010:7, chapter 10; Jacobs et al. 2003:350).

That is “the total medical resources that are available to, and might be utilized by, a community and society including its biomedical and traditional forms of therapy” (Verwey and Crystal 2002:83).

Additional information

Notes on contributors

Marja Tiilikainen

MARJA TIILIKAINEN is a postdoctoral researcher who has worked on suffering, healing, and health care among Somalis in the Diaspora with funding from the Academy of Finland. A list of her publications can be found at http://blogs.helsinki.fi/mtiilika/. She is currently affiliated with the Department of Social Research, University of Helsinki, Helsinki, Finland.

Peter H. Koehn

PETER H. KOEHN is Professor of Political Science, the University of Montana's Distinguished Scholar for 2005, and a Fulbright New Century Scholar. His recent work on medical education is published in Academic Medicine and in Globalization & Health. A full CV and list of publications can be found at www.cas.umt.edu/polsci/faculty/koehn.htm. He is currently affiliated with the Department of Political Science, University of Montana, Missoula, Montana, USA.