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Illness: A Risky And Costly Affair For Punjabi Migrants (Part 2)


1947-2014 (Archived)
Jun 17, 2004
Illness - A risky and costly affair for Punjabi migrants (Part 2)

By Rajiv Kunwar

( The following write-up is a summary of the original Master´s thesis titled “ Undocumented migrants’ access to health care in Germany: Limitations and strategies”)

There are several impediments and constraints undocumented Punjabi migrants have to encounter in a desperate effort to seek medical care in Germany and Sikh migrants, who form more than 90 percent of this population additionally endure the self-humiliation of shaving off their hair thereby flouting the religious tenet of maintaining the Sikh identity. These migrants are caught up in a situation where they have to bite the bullet to minimise the risk of being identified, caught and deported to their home country especially when their deteriorating health forces them to access medical care facilities against all odds.

During my research about this population for the South Asia Institute, Ruprecht-Karls-Universität Heidelberg, none of these Sikh migrants interviewed could conceal his grimace with regard to shaving off their hair. However, most of them also accepted that such compromises were part and parcel of a life in illegality wherein one’s real identity was definitely a big stumbling block in accessing medical care options during the time of illness. However, the most obvious handicap named by almost everyone during this study was their undocumented status. With a ‘no paper identity’ - a term used by the respondents to describe their illegal status – these Punjabi migrants adopt a ‘once bitten, twice shy’ kind of approach vis-à-vis seeking medical help.

Another important aspect which often keeps this population from seeking medical care is their shortage of money. These financial straits stem from the fact that undocumented residents are legally not allowed to work in Germany. Illegal types of employment are limited and full of risks. Henceforth, financial constraints are a big hindrance in seeking medical care. With the cost of treatment being so high in Germany, proper medical attention is usually beyond their reach. Dara, who recently went to see a practitioner because of severe chest pain reveals: “The doctor was kind enough to waive off his consultation fee, but I had to borrow an amount of 180 Euros from a friend to buy medicines”. Yet another migrant interviewed discloses that whatever little money he earns by taking the risk of doing some dirty and degrading work, it is hardly enough for his own meals and his small family back home in Punjab.

Anonymity is another interference factor in availing of health care. Since these people do not want to divulge any information about their identities and avoid giving any contact details for fear of jeopardising their stay, it sometimes becomes very difficult for healthcare centres and clinics to start the treatment because it is often not possible to stay in contact with such patients and therefore no proper record of their treatment can be maintained. In many cases, long-term therapies cannot be carried out successfully due to this problem.

For all those undocumented migrants who somehow manage to see a doctor, the lack of German language skills is no small issue. “If I can’t speak German or even English and I am not accompanied by anyone who can help me with the communication, I feel like a deaf-and-dumb person”, one of the immigrants expresses his helplessness. For someone like Dalbir, who speaks some German, understanding a German doctor is the toughest thing he has to encounter when he goes to a clinic. “For me, they speak too fast and I hardly understand anything. And whatever little German I can speak is not good enough for them to understand my health problem”, he explains his dilemma. So, he generally prefers Russian- or English-speaking doctors because he spent a long time in Russia and can understand English better than German.

Another equally important factor which discourages them from visiting a doctor is their general lack of trust in others. Even their everyday lives and relationships with closer acquaintances are marked by suspicion and distrust. Almost all undocumented migrants interviewed during this fieldwork agreed on the view that doctors in Germany were under some sort of obligation to report the presence of an illegally residing person to the police or to the Foreigners’ Registration Office. This impression is even justified to an extent as there have been instances of undocumented migrants being caught at healthcare centres. Among undocumented migrants, German practitioners have a different image in comparison to doctors of other nationalities. Barring a few, most interviewees believed that, being very law-abiding by nature, German doctors were less reliable for them. This also explains why some of these immigrants prefer to see either a doctor of their own nationality or someone who is known to them through a person of confidence.

Undocumented migrant Sukhi speaks in defence of German doctors. According to him, even German physicians are not too happy about their restricted freedom in serving undocumented migrants. “If German doctors were too tough to deal with, they would not be part of several NGOs which are committed to treating people without papers”, he argues and further explains: “The undocumented migrants’ lack of trust in German doctors is a result of their own fears and suspicious behaviour”.

Although in spite of above mentioned constraints and hurdles in accessing health care, these migrants do not refrain from resorting to certain methods, tactics and ploys to avail of medical facilities but not without certain precautions. During all those free-wheeling conversations with some migrants, one thing which was more than evident was the fact that all of them are extremely anxious to avoid hospitalisation at any rate. A hospital stay is considered an enormous risk. Therefore, these undocumented migrants try to find alternative options.

Self-medication obviously is the most realistic option whenever these people encounter any health problems. All the respondents confirmed that they have stocked up with various basic medicines and tablets which can be used to stabilise their condition. New supplies are commonly arranged through friends. Gurudwaras (Sikh temple) frequently serve as collecting points for these medicines. From there, they might be picked up or delivered to the buyer’s home. According to the interviewees, there are also some pharmacy and medicine students who provide the Gurudwaras and other social organisations with medicines which they obtain for free through visiting medical representatives at their university clinics and hospitals. Paracetamol, Crocin, Combiflame, and several other pain killers and tranquilisers were adduced as instances of medications which are popularly used in case of body pains, fever, headaches and colds. The use of antidepressants is also quite common among this population.

In case of serious physical injuries, mental issues, cardiac disorders or other grievous complaints where self-medication is not applicable, undocumented migrants prefer to see a doctor who is known to them through a person of confidence In this context, the importance of social networks such as community-based get-togethers at Gurudwaras cannot be neglected as they enable their members, including undocumented migrants, to share useful information like recommendations regarding certain doctors.

The migrants interviewed revealed that using other people’s health insurance cards is a common practice among undocumented residents. If cash payment is not possible, they in many cases choose to borrow a friend’s insurance card, preferably without the picture of the original card holder. In reply to the question about how exactly misusing someone else’s card at a medical practice or hospital works, one migrant gives an interesting explanation:

One Punjabi migrant who lived in illegality for more than ten years before obtaining a legal status describes his own experiences regarding the misuse of health insurance cards: “The passport is actually never needed when you want to see a doctor and so, if there is no picture on the medical insurance card you are carrying… It worked eight out of ten times in my case”. And on the remaining two occasions, the lack of German-speaking skills (pretended or otherwise) usually covered up his failed ploy, he discloses.

In cities like Heidelberg, Berlin and Cologne, illegal residents sometimes approach medicine and pharmacy students for medical help. Further, there are some South Asian Ayurvedic doctors that are frequently contacted by these people. NGOs and private initiatives like Medinetz, Café 104 etc. are also approached when the patients are sure about getting free treatment for their ailments, especially sexually transmitted diseases and other contagious diseases with the sole exception of HIV.

And then there are self-styled therapists like Jagjeet Singh from Frankenthal, who claims to provide a massage therapy which brings physical and mental relief. He especially attends to undocumented migrants to help them cope with depression, anxiety and emotional traumata. Jagjeet laments that his therapy remains ineffective for some patients who cannot visit him regularly due to their illegality. He himself spent 15 years as an illegal immigrant in and around Germany before finally obtaining a legal status only recently. With no formal training in massage therapy, Jagjeet, who hails from the Indian state of Punjab, learnt the finer points of this technique by reading a book. Initially based on a hit-and-trial method of learning, he acquired some sort of expertise after five to seven years of hard work. He does not charge any service fee from his undocumented patients, but the ones with a legal status pay seven Euros for a session of 45 minutes.

The case of these Punjabi undocumented migrants indicates that they heavily rely on illegal means and methods when crossing the borders of a foreign country. As they do not shy away from using fake documents to travel from one country to another, one might be inclined to assume that these people may as well have forged medical fitness certificates without actually undergoing the procedure. This is where undocumented migrants’ access to healthcare in Germany needs to be facilitated in order to minimise the risk of contagious diseases spreading throughout the nation.

P.S. Names of the all the migrants in the above text have been changed due to interviewees’ request.




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