Health Care: Risk

Question:

Critically discuss strategies in place for the provision of health care to address the identified risk factors.

Answer:

Introduction

The clocks had never stopped ticking, the stories of past have been told over and over again and life just seems to go on, unquestioned. From the days when women were squeezed into corsets to the day when they could now walk liberally with a dignity of their own, time sure has changed the mortal souls and their opinions. But the question however is, have we completely destroyed the evil of this world from its roots or have given another name to the cruelty that has been prevailing for years? 

Slavery had been one of the worst cruel acts committed by the elite ones over 100 years ago, great men and women rose to the call of humanity and strove to abolish it forever. They condemned the violation of the rights of fellow humans and fought until every other soul could enjoy its rightful pleasure. Years have passed by, slavery sure has become a term that is extinct, but is this world an absolute free world in reality? 

Cruel and unfair acts still prevail in all corners of the world. The modern unjust practices include gender discrimination, racial discrimination, denial of fundamental rights, inaccessibility to health care etc. Out of all the unjust practices, racial discrimination happens to be the most prevalent and cruel practices to be practiced even today by prejudiced men and women which affects all the other spheres of the victim’s lives. 

Health care means different things to varying societies, each nation has its social determinants of health. As stated by WHO, social determinants of health refer to the conditions in which people are born, grow, work, live and age. Although, the determinants of health are stated clearly, and the strategies are set in place, many aren’t aware of their fundamental rights in regards to healthcare in different nations. 

Furthermore, with the prevalence of globalization, trade liberalization and migration from one country to other in search of a better opportunity to be employed, access to SDH and their distribution require a deeper outlook as the determinants have changed rapidly. Research does reveal that there are several changes in the healthcare systems in the global marketplace (Susilo, n.d.)

This essay has been written focusing on the health status of two cultural groups in Hong Kong, by exclusively selecting the Indonesian and Pakistani cultural groups. The essay will begin with a case study which will be followed with analyzation and discussion. The essay will then conclude by drawing out an ultimate solution to the issue at hand and will state the observations. 

Hong Kong 

Hong Kong is one of the world’s most populated cities with over a population of 7 million with 93% of the population being Chinese and the rest are migrant workers. The city is densely populated and vibrant as it is one of the most prominent trade centers of the world. 

Though the city is termed as the business hub, the international human rights agencies have condemned the treatment of foreign workers extensively. The workers are humiliated to an extent that the treatment is considered to be a modern form of slavery. 

Health care in Hong Kong seems to be excellent if one looks at the apparent excellence of the population of health, however this does not mean that the city possesses excellent health care system. Most of the population in Hong Kong rely on private practitioners for primary care, and the number of people who access primary care are absolutely meagre when compared to other megacities (Labonte & Schrecker, 2007) . About only 30% of the population hold employer based health insurance, which places many of them in a stance to pay from their own pockets. Due to lack of any primary care for health conditions, major avoidable diseases have become prevalent.

Health is commonly assumed to be the state of our mind and body in general, but from the perspective of anthropologists and sociologists, health seems to take a more cultural and societal approach. At a particular point of time, the opinions of people in regards to health dwindles (Fanany, n.d.; Kaur, 2016). The diseases like measles which were common and normal a few decades ago, is now considered to be fatal and children are required to take vaccines for prevention. The health status of the constituents of an area largely depends on the approach of the society (Rodwin, 2011).

The case study stated below of two emigrant workers in Hong Kong will help the readers understand the stance of health in different cultural groups. 

Miss S, a 23 year old Indonesian female had been admitted to the medical ward for haemoptysis, Sputum for AFB smear +++.  After the initial admission, she was transferred to the infectious diseases unit and started her anti-TB treatment immediately. After three sputum specimen for AFB –ve, she was then taken over to the respiratory ward to proceed with her treatment. 

Miss S had come to Hong Kong as a domestic helper six months ago. With her limited knowledge about the city and inability to speak Cantonese fluently, she had to struggle immensely. Back in Indonesia, her family consists of her parents and three younger brothers. Her only older sister works as a domestic helper in Singapore and both her sister and Miss S are the prime financial supports of the family. Her father is a farmer, hence he is unable to generate enough income from his crops. 

In Hong Kong, she works for a family of four members. A couple along with two children, a five year old boy and a three year old girl. As per the laws of Hong Kong, domestic helpers are deemed to live with their employers. Miss S led a very tough life in the employer’s place. She had to wake at 7am every day and work herself off until night 9pm. She didn’t have any formal breaks except for a day off every week. Lonely and distraught, she had managed to find two friends in Hong Kong. 

The employer eventually got to know that Miss S was afflicted with TB, which made the employer restless. They wanted to get rid of her and send her back to Indonesia. Miss S had been extremely distressed fearing her health condition and the state of her employment. She wanted help, but didn’t know where to look for it. As her health condition had been stabilized, her employer got her air tickets and sent her back to Indonesia just a day after her discharge. 

However, the act of the employer wasn’t right since the Hong Kong law states that domestic helpers can stay two weeks longer after losing their initial job to find another job. But Miss S wasn’t ever aware of this right and she simply had to fly back. 

Mr. X is a 45 year old Pakistani male who was born in Hong Kong. As he had been here throughout his life, he could speak fluent Cantonese. Mr. X is a construction site worker and is also a chronic smoker. Recently he was admitted for performing Bronchoscopy. He had been married and is a father to three children aged 5, 7 and 9. As a construction site worker, he earned around $12000 per month which isn’t a large amount at all in Hong Kong. His wage is based on daily rate and he does not have any saving.

 He works for about 10 hours per day. During his admission in the hospital, he couldn’t work for a few days, therefore he didn’t earn any income. He lives in a shared apartment, the size of which is 150 square feet with a monthly rental around $5000, and takes a great portion of his daily wages. Mr. X had been extremely distressed about his health condition, he had been helpless and clueless as to what had to be done.  Just as the bronchoscopy was done, he had been diagnosed with Adenocarcinoma. A few of his friends visited him and suggested that he should seek help from a medical social worker. 

Discussion and Analyzation 

The aforementioned case studies talk about members of two cultural groups belonging to different professions working for the dwellers of Hong Kong. Although both of them do not actually belong to the nation, the approach of one member had been different from the other. Primarily, they both had access to healthcare system and reflection of Hong Kong’s SDH can be clearly seen. 

Miss S migrated from Indonesia, it is said that out of the 320,000 foreign domestic helpers in Hong Kong, about 49% of them are Indonesians. Being a new emigrant and her inability to speak Cantonese fluently had a great impact on her losing the job due to her illness. Her condition clearly portrays that cultural groups do have different approaches towards health. 

Miss S had been completely unaware of her inherent rights and being exhausted and mentally drained due to lack of support from her employers and those around her, she couldn’t look for any other sources or claim for her rights. Sociologists suggest that not everyone accepts foreigners into their land easily, the ability to accept foreigners into their own land as one among them takes a harder turn in many cultures (Rodwin, 2011). 

In case of Miss S, she was still an outsider with language barriers and apparently unfamiliar to the norms and values of Hong Kong, her employers naturally couldn’t accept her as one among them. In some cultures, it is always about family and friends first, and they value their own culture a lot (Centre for Civil Society and Governance, 2012). In the same way, the manner in which some people look at illnesses differ highly, some think diseases are caused by germs, while others due to their sin and others think of it as an evil omen. The household in which Miss S had worked in could have disregarded her for a plethora of reasons, and they hadn’t really considered her to be integrated well to empathize with her. She was after all one of the thousands of other Indonesian domestic helpers who couldn’t afford to save her own skin.

In studies done by anthropologists, South Asian countries like Thailand simply choose ‘not’ to integrate foreigners into their own nation (Centre for Civil Society and Governance, 2012).

A Different Approach

On the other hand, the case of Mr. X looks towards a more positive approach. He had been offered help from his friends and they even suggested him to seek help from a professional medical social worker. The fact that he could claim his rights does not owe to the fact the he is a Pakistani, rather it highlights the level of acceptance by the people of Hong Kong. As Mr. X had grown in the city and could communicate in a better manner, he could build connections and also seek help.

 Even though he wasn’t aware of all the laws that could help him, he could look out for a solution unlike Ms. S who had to flee the country. This also clearly highlights the influence of SDH. As Mr. X was born, had grown and worked in Hong Kong, he had better access to healthcare system and also look towards other options to assist himself. 

Although Mr. X is a Pakistani, he has been exposed to the social determinants of Hong Kong since his childhood, which makes him more capable to access the healthcare system of Hong Kong than Ms. S who had been lost and couldn’t figure as to what must be done (Susilo, n.d.).

Appreciable Medical Treatment

The positivity shown by both the cultural groups is that the medical treatment for both the members regardless of their ethnicity or race had been provided in full measure, but on a later stage. This shows the impact of implementation of culturally competent care in Hong Kong by which the medical professionals such as the doctors and nurses are trained to treat patients from varying cultures equally (Omeri & Raymond, n.d.) . Although, this had required a lot of learning to do on behalf of the healthcare professionals about different cultures, the results had certainly paid off (Kaur, 2016). 

But as we see, both Ms. S and Mr. X have been diagnosed with their severe health conditions on a later term. This clearly highlights the fact that access to primary healthcare in Hong Kong lags behind considerably due to lack of a firm support system for the workers in Hong Kong. This is especially the case of Ms. S who had been denied any form of further employment in the city.

The difference between two of the cultural groups could also have risen due to the fact that they perhaps have grown in different societies. The individualistic societies are prone to look after oneself while collectivist societies takes a more united approach where ‘I’ is replaced with ‘we’ (Julian, n.d). While Ms. S would have been forced to adapt to an individualistic society where her employer wouldn’t care about her health conditions, Mr. X was fortuned enough to have met people belonging to a collective society where people looked out for one another. 

However if we look at the theories of postmodernists, they suggest that the world around us is simply how we invent it. Hence, both the members might have had a number of cultural influences, but fundamentally some are more open to learning than the others and some are prone to communicating and demanding than other members (Tonsing, 2013; Rodwin, 2011).

Conclusion: 

Analyzing and discussing the case studies aforementioned, it can be concluded that different cultural groups have varying approaches towards healthcare. However, the influences may not be always the same for different individuals. 

As a person comes out of his/her own confines, he/she is exposed to a wide world which consists of its personalized opinions and views of different elements of the society. Health might seem to be the state of mind or body to a layman, but as we view it from a sociological perspective, health has more to do with what the society presumes it to be. Various cultural groups have an opinion about healthcare and treatment, while some would seek immediate help, others wouldn’t care much. Also, the extent of mutual love prevailing in a society largely influences the state of health in a particular society (Labonte, & Schrecker, 2007). These factors are what inherently comprises the social determinants of health as suggested by WHO.

Hong Kong has been termed as a city that reduces its domestic helpers to slaves, to some extent it has been proven true as the level of intolerance is exorbitantly high. The inability to integrate is also horridly unacceptable. In case of Mr. X and Ms. S, we have seen two different approaches, while the former was guided to seek help, the latter was asked to leave. Both the cases had happened in the same society with people belonging to different cultural groups and different professions. 

To build a positive approach towards all the groups regardless of race or ethnicity, awareness must be raised from within the roots of the society. The society must be taught to look beyond the conventions and accept foreigners wholeheartedly and be able to empathize with them. As we trudge towards a more globalized world, accepting differences is the only key to build a better nation (Susilo, n.d). Conventionalized and narrow minded approach will not help at any cost. Racial discrimination should be condemned strongly and eliminated. 

Access to healthcare is a fundamental right of every human born into this earth. Mr. X and Ms. S have come from different cultures that have their own social determinants of health, for instance, one of the most prevalent diseases in Indonesia is tuberculosis (TB), with which Ms. S had been affected. Although she might have come from a different culture, at the moment as she belongs to the megacity of Hong Kong, it is only right for her to live an inclusive life with the citizens. The world isn’t going to get smaller to discriminate between people based on nationality or color, it is only going to grow bigger as time will evolve.  

References

Centre for Civil Society and Governance (2012), Study on Racial Encounters and Discrimination Experienced by South Asians, Report. (2012).  The University of Hong Kong and Policy 21 Limited, 1-25.

Fanany, R. (n.d.). Language, culture, and health. Social Determinants of Health, Illness, and Well-being, Part 2, 14th Chapter, 229-242.

Julian, R. (n.d). Ethnicity, health, and multi cuturealism. the social production and distribution of health and illness, Part 2, 09th Chapter., 164-184.

Kaur, B. (2016, February 2). Cultural Competent Care in Hong Kong. International Journal of Social Science and Humanity,, 6(2), 136-140.

Labonte, R., & Schrecker, T. (2007, June 19). Globalization and social determinants of health: The role of the global marketplace (part 2 of 3).Globalization and Health, 3/6. Retrieved from http://globalizationandhealth.biomedcentral.com/articles/10.1186/1744-8603-3-6

Omeri, A., & Raymond, L. (n.d.). Diversity in the context of Multicultural Australia: Implications for nursing practice. Contexts of Nursing: An Introduction, 19, 287-300.

Rodwin, V. G. (2011, November). Health in Hong Kong: An International Urban Perspective. Retrieved from https://lsecities.net/media/objects/articles/health-in-hong-kong-an-international-urban-perspective/en-gb/

Susilo, D. (n.d.). Social Determinants of Health in Indonesia [Publication].

Tonsing, K. N. (2013, January 22). Predictors of psychological adaptation of South Asian immigrants in Hong Kong. International Journal of Intercultural Relations,238-246.