'There are millions of people who remain invisible to us,' says Muhammad Zaman in new book. wait for a miracle.
The miracle he is referring to is access to health care.
He writes about different types of refugees. Refugees, people crossing borders. Internally displaced persons who leave their homes but remain within the country. and stateless persons without proof of citizenship or national ID cards.
/ Johns Hopkins University Press
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Johns Hopkins University Press
Citing a term coined by George Orwell, Zaman says they are “non-humans”, displaced by conflict, climate change, persecution and political change.
In the book, ZamanA biomedical engineer and director of the Center for Forced Migration at Boston University, he tells the stories of people from four countries: Colombia, Pakistan, South Sudan, and Uganda. They seek care from friends and family in the community.
The following has been edited for length and clarity.
I know this question is terrible, but why should someone who has no connection to the community you're writing about care about or worry about people's health?
This is a really good question and an important question. If you have five things to do and you only have time and money for one, why should you do this one thing?
There are several reasons. One reason is basic human rights. What does it mean for you and me to have a sense of social responsibility towards others? Is not it. It should be a socially responsible position, not a sympathetic position.
Second, positive experiences for refugees are important for any community. They can contribute to society economically and can bring new culture, new ideas, and intellectual energy.
Also, I do not agree with this, but for the sake of argument let me say that displaced and disaffected people are more likely to fall into danger of radicalism and extremism. [a group might] Exploit that vulnerability for malicious purposes. So it's the same argument that we say, “Why should we invest in peace? Why should we invest in the education of others?” It is good for everyone when people have the opportunity to live a decent, dignified and prosperous life.
And finally, new diseases emerge when people live in complex, difficult, and environmentally unstable spaces. By denying people access to clean water or forcing them to live in crowded areas, there is always a risk that new diseases will emerge that will affect others.
Can I ask about the title of the book? We wait for a miracle. I thought the title was interesting because it talks about the clear reasons why displaced people don't have access to medical care, and that there are clear ways to solve these problems. So why this title?
About a third of the book is about Pakistan's stateless communities. Saida, for example, is not a citizen of Pakistan, but was born there and has lived there all her life.
You described her as one of a group of Bengalis living in what is now Pakistan. After the 1971 civil war split the country into Pakistan and Bangladesh, Bengalis in Pakistan found themselves stranded without any papers.
They were mainly from disadvantaged communities. There is no evidence that they came, and they were not given any documentation at birth.
One person seemed so frustrated and stubborn that only a miracle could get him out of his predicament. There are no policies to deal with them because nothing seems to have changed.
So it comes out of a sense of frustration. [to believe] that only a miracle could resolve their legitimate and rational desire for adequate and quality medical care.
As you write in your book, Saida has to support her son, take care of her mother, and receive health care for her mentally disabled brother. She has to do her job and visit the law clinic many times to get her national ID card.
It's understandable that many people in her situation believe they need a miracle. But some say it is easy to access medical care for these displaced groups. Just throw money at them, donate to the Red Cross, pay for their hospital bills. Your book suggests otherwise.
I don't think we should underestimate the importance of financial resources. I think that's absolutely important. But even if you had the financial resources, imagine a hospital for a group of refugees. It is very difficult to staff a hospital with unbiased personnel.
Or you might have a hard time staffing that hospital because no one wants to work there. Or your doctor may only come once a month. Therefore, just having a hospital will not solve the problem.
And, of course, there's the idea of making sure we understand the complex needs of refugees. We tend to focus on infectious diseases. However, this does not erase the fact that refugees face challenges such as mental health, diabetes, cancer, and cardiovascular disease.
So how do you fix it?
First of all, we must ensure that we remove the dehumanization often associated with refugees. Treat them with dignity, respect and a sense of basic human rights. that's it. That's the core starting point.
Then, build a system that incorporates these types of challenges that come with being a displaced person. You have to really pay attention to the context, so whether it's climate, whether it's conflict, whether it's persecution, medicine is agile and responsive to that.
Third, and I think it's absolutely important, we have to provide incentives to train new doctors and nurses. Healthcare workers want to work at the best hospitals and receive training and career development.Working in a place like this [for the displaced] Even if you're socially conscious, it's a career dead end.What you hope is that the country recognizes this effort and it becomes an opportunity to continue to grow. [professionally]. Pay is part of it, and creating a research community to share and learn from these experiences is important for everyone's health. These are not very expensive.
What surprised you most about writing this book?
There are also communities that we don't think about. For example, people coming back. [after being displaced].
Our assumption is that when people go home, everything is fine and everything is perfect. But in South Sudan, former refugees are returning and the situation there is actually worse than when they left.If you really want to solve [getting displaced people health care]I think it's possible, but we need to really understand the nuances and shades of this.
And you realize that many of the medical needs of displaced people are being ignored.
The broader issue I felt was the shortsightedness of thinking about health in silos. We do not believe that displaced or stateless people have cancer or diabetes or need palliative care. We consider that their health needs are different and have caricatures of what their health is like, including malaria, disease outbreaks, and injuries. We have created these barriers that create more problems than solutions.Thinking about internally displaced persons [internally displaced people] Refugees from Gaza – We may not think they have diabetes. But where do you go to get your blood sugar tested in such a situation?
You talk a lot about trust in your book. Can you talk about what that means in terms of health care?
By trust, I mean that displaced communities may or may not seek medical care. Not because healthcare is not always available, but because there are good reasons not to trust the system. So, as you can imagine, if there's a sense that hospital care is going to be influenced by xenophobic people, or that there's going to be someone who's going to report them to the police or try to deport them; They won't necessarily make demands. That resource.
You and I go to a doctor who believes we will get better. Healthcare is so intimate and so personal that we really want this to be something that is built on individual trust and organizational trust.
Can you give an example of the role trust plays in healthcare?
Let's take Henry. [a clergyman and health-care worker in South Sudan]. His congregation trusted him. In the midst of the coronavirus, it was he who gave them information on what to do and how to get through it. You may not hear government instructions or messages over the phone, but the people you trust will play a big role in how you respond.
Personally, I was touched when Henry himself suffered a stroke. He was quite connected and it was very difficult to get treatment. [He did eventually get the resources to get treatment in Khartoum, Sudan.] However, what struck me was that [displaced] people can help [each other] However, only if you are healthy. When they get sick or retire, whatever thin system they've worked under begins to crumble.
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