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Identification and Support: Refugees with Health Problems in Refugee Homes

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Abstract

Social Workers in refugee homes have a key position in identifying and supporting refugees with health problems. But helping in this field is a highly paradoxical challenge: On the one hand many refugees struggle with health problems, illness, chronical diseases and/or mental health problems. On the other hand, they are discriminated against by a very restrictive legislation, administrative barriers and a nearly total lack of accessible and appropriate supply. The research focused on the question how Social Workers handle this dilemma situation, with which professional roles they identify themselves what this means for the perception of health problems and their task to help. The results of the qualitative study reflect the ambivalent situation of Social Workers in refugee homes. On the one hand, Social Workers are neither medical nor therapeutical experts and therefor see their role in forwarding clients to specialists or to appropriate services. On the other hand, their intermediate position forces them to diagnose the needs of their clients before acting. In matters of health this often means that they judge about the severity or even the seriousness of reported health problems. At the same time Social Workers feel obliged to help those who cannot communicate their problems (lack of knowledge, taboo, feelings of shame or fear of stigmatization). In this case they take the role of explorers who try to discover hidden problems. Another challenging moment could be found on the level of emotions. While ill clients are unquestionable vulnerable and therefor need more attention and support than others they could also be perceived as a threat to other clients or the Social Workers themselves (aggressive behavior of mentally ill clients or highly infectious diseases). To improve the health care situation for refugees it could be a first step to address these challenges and paradoxes in advanced training courses for Social Workers and to discuss solutions and best practices.
Being at risk and needing protection themselves
Social work in refugee homes is also narrated as a risky job. Social workers feel threatened when clients
have unknown but highly infectious diseases or when they show aggressive and violating behaviour. They
talk about drastic experiences that “leave a cut in the skin” and have the feeling that their working experience is
“formative” for their biography.
Discovering hidden health
problems
Some health problems of clients are complex,
unspecific, sometimes hidden and not easily
perceptible at the first glance. Then it is necessary
to have a deeper look and do some research. This
research is rarely conducted using scientific
methods. It is either realised by just being more
conscious in daily interaction and communication
situations. Or it is part of a programme like a
clearing interview in which the social workers ask
purposefully in this direction.
Seeing and recognizing obvious
health problems
Health problems can often be perceived easily by
professionals when clients show visible symp-
toms. The visibility can be an “abnormality in the
appearance of a client, but it can also be a
change, for example in his/her behaviour.
Therefore “seeing” clients daily, looking at them
carefully and also observing them are important
professional skills to identify health problems and
also to make the initial diagnosis.
Caring for and
educating clients with psychological problems
This role of parenthood highlights the emotional side of social work. Social workers take care for their clients and also
perform an educating role when they admonish clients to fulfil their obligations or correct “wrong” behaviour. One
important aim of this education is cultural integration or assimilation and preparation for an independent life outside
the refugee home. In the case of clients with psychological problems that are caused by the depriving living conditions
in refugee homes, the parental advice has two functions: It is therapy and goal at the same time.
Carrying the burden of
clients’ disabilities
Refugees are described as clients who live in an unbearable
situation and are therefore burdened with a heavy rucksack
full of problems. In contrast refugees with disability or severe
disease carry a burden that is part of themselves and cannot
be removed like a rucksack. That burden is narrated as a heavy
weight that can not be carried alone and so they need
someone to lean on. Such support demands a lot of power
and effort and can not be performed on the regular base of
daily work in refugee homes.
Activating immobile clients
and providing access
Some diseases are associated with a lack of activity
(depression), the inability to follow the path of life (posttrau-
matic disorders) or loosing orientation. Disabilities like severe
physical handicaps are mainly seen as the inability to move
independently or in the “normal” way. In those cases, the role
of the Social Workers is on the one hand to motivate clients to
set themselves targets and to move forward. On the other
hand they have to develop possibilities to enable activity and
access.
Finding appropriate places
for “disturbing” clients
In a half-total organisation with routine procedures and
inflexible structures, ill and disabled refugees are perceived as
non-fitting and therefor disturbing elements. So, the main task
of social workers is to find appropriate “places” for them
outside the refugee home to where clients are sent. These
places can be accessible accommodation or nursing homes but
also people or organisations that provide culturally sensitive
treatment, accommodated therapy or professional counselling.
Fighting for the rights of ill and disabled clients
Social workers often fight against administrative authorities that regularly
curtail the already marginalized rights of refugees especially in the field of
health, medical treatment and social support. They veto against
discriminating administrative decisions, but they perceive themselves in a
powerless position. Especially in the case of benefits, aids and treatments
for disabled refugees they report a lot of exhausting struggles, time
consuming processes and lost fights.
Identification and Support:
Refugees with Health Problems in Refugee Homes
DORIS GRÄBER, INSTITUT FÜR REHABILITATIONSWISSENSCHAFTEN
INSTITUTE OF REHABILITATION SCIENCES
4th FlüGe Symposium Center for Interdisciplinary Research (ZiF), Bielefeld University February 21-22, 2019
WORKING
as a Social Worker
… for integration, autonomy, and human rights
according to the ethics of the profession of social work
… in a total organisation
with the “rational plan” (Goffman1) to monitor and control the
inhabitants and being part of a system of structural exclusion
… with
systematically
discriminated
clients
refugees in the procedure
for granting the right of
asylum or living with the
status of Duldung(ex-
ceptional leave to remain)
LIVING
as a Refugee
… under unhealthy conditions
that are either the reason of physical or psychological health problems
or lead to a manifestation due to lack of treatment and supply
… with severe
disease or
disability
and without the right to
get support, treatment,
therapy, assistance, care
and supply makes these
refugees especially vul-
nerable
… without being seen or heard
because the perception and interpretation of health-related problems are connected to culture
because of the lacking intersectionality of help and support systems and organisations
How do social workers
perceive health
problems of their
clients? Distributing
limited resources
for health care
Social workers are not only respon-
sible to organise supply but also have to
distribute the very limited resources to
clients. Questions of equal treatment
and legitimacy of support arise, and
social workers have to decide about the
appropriateness of benefits and also the
legacy of needs. In their daily work they
often judge about the severity of
reported pain and the urgency of health
problems. Especially in the field of psy-
chological disorders there is a high level
of distrust against requests for help.
ANSWERS
from 9 episodical interviews with social workers in refugee
homes before and after the increase of refugee numbers in
Germany in 2015/2016
Analysed with the integrative, reconstructive analysis
method by Kruse2with a strong focus on metaphorical
concepts (Schmitt3)
CONCLUSIONS
Social workers in refugee homes have a key position for identifying refugees with health problems and organising support for them.
Helping vulnerable people to (re-) gain autonomy and integration goes along with the ethical principles of the profession. But in the daily work in refugee homes, social workers face multiple challenges that also
influence the perception of health problems of their clients.
All refugees here are ill” traumatizing experiences, unhealthy living conditions, discriminating legal status -> sensitivity for all kind of health problems
Those who are really ill” estimations about the severity and seriousness of reported (invisible) health problems -> decisions about the necessity of support and treatment
“Disabled refugees – that is not possible here” assumption of disabled refugees as difficult and time-consuming clients due to special needs -> transferring disabled clients to specialists/other organisations.
These experiences leave their mark on you” feelings of threat through infectious diseases or violent behavior -> selfless help against need of self-protection
The paradoxical working situation leads to ambivalent perceptions and attitudes of social workers towards refugees with health problems.
Providing
Support for
clients in need
First and foremost, refugees are
seen as people in need of everything.
As the state shows up as a bad provider
that strongly discriminates refugees as
non-citizens, social workers have to
organise the necessary supply and
economical support. In the field of
health care social workers take over the
public discourse that has a strong
deficit orientation and marks refugees
with health problems as a high cost
factor and a group that is not assumed
to provide any benefits for the host
country.
References:
1) Goffman, Erving (1990): Asylums: essays on the social situation of mental patients and other inmates. Repr. of
1961 ed. New York, NY: Doubleday
2) Kruse, Jan (2011): Einführung in die Qualitative Interviewforschung. Reader. Freiburg
3) Schmitt, Rudolf (2014): Systematische Metaphernanalyse als Methode der qualitativen Sozialforschung.
Wiesbaden: Springer VS
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