Sick migrants from Central Asia often arrive at hospital already in a critical condition, having neglected the disease. This is a result of obstructed access to medication. And this is not only about lack of time and money for therapy. The lack of medical aid is largely a result of several factors including social isolation, their living conditions, the lack of a residency permit, registration, and, most importantly, medical insurance. In addition to all of these, some migrants are poorly informed as to the medical aid on offer. Foreigners also sometimes face discrimination in clinics and hospitals.
Under such conditions, foreigners from post-Soviet countries are forced to invent non-standard solutions: from medical consultations by phone to treatment actually in situ at the workplace (for example, on construction site or at a market), or visiting so-called ‘Kirgiz clinics’ – private medical centres aimed at Central Asian migrants.
Daniil Kashnitsky studied the problems of medical care among migrants from Kirgizstan and Uzbekistan in detail. The results of his research were presented in a paper ‘Medical aid to migrants from Central Asian countries in Moscow: the choice of strategies and the available infrastructure’.
As part of the research, 100 citizens of Kirgizstan and Uzbekistan were surveyed; 60 semi-formal interviews with migrants were conducted, as well as 23 in-depth interviews with staff from Moscow medical institutions (the private ones among them included only ‘Kirgiz’ clinics). The study was carried out as part of the project ‘Transformation of urban space: detecting social infrastructure of migrant communities’, HSE ISDS, 2013-2014.
Employers share a pragmatic assumption that migration involves healthy people who are capable of hard labour and can stand a high workload. ‘There’s no place for sick people in migration’, the researcher quotes a popular idea. One of the arguments in its favour is the migrants’ age. Most of them are men and women under 40.
This belief in the myth of ‘the healthy migrant’ (‘I’ve never been sick and I’ve never been treated’) is mirrored by foreigners themselves, who, due to various reasons, are not careful enough about their health. In most ordinary cases, Central Asian migrants confine themselves to self-treatment. They ask for consultations at pharmacies, and as a result, the therapy is limited to treating symptoms of the sickness with the cheapest medication available. Many of them have no time and opportunity to look for the cause of the illness (only a few of the migrants have medical insurance). Their previous experience can also influence such an approach, since many of them have never had serious diseases before.
Nevertheless, it is clear that with such ‘control’ of people’s conditions, sicknesses may become chronic.
Emergency treatment of migrants usually happens through calling for an ambulance. It usually takes place in the case of sharp pain, when a migrant can’t see any other solution. For men, this is usually caused by industrial accidents and for women by gynecological disorders, pregnancy, and neuralgia, Kashnitsky noticed. Other diagnoses include chronic fatigue syndrome, panic attacks, as well as such serious contagious diseases as tuberculosis.
Migrants know that in cases of serious diseases or injuries, Moscow hospitals will treat them for free for three days. ‘If a migrant has to stay in the hospital, in most cases they try to leave it as soon as possible, since after three days of treatment they have to pay for it’, the researcher explains.
At the same time, there is no evidence of segregation by hospitals (or injury care centres) and treatment conditions, Kashnitsky emphasized.
If a migrant is sick but doesn’t need emergency care, they often go to those medical centres or individuals who understand them well and, literally, speak their language. Such doctors, according to foreign labourers, can treat them properly: taking into account their financial capabilities and the cultural specifics of their countries.
Such medical centres imply ‘Kirgiz clinics’, and most of migrants in the Russian capital have heard of these places.
Migrants believe that these institutions were founded in Moscow specially for them. Even those who have never been to ‘Kirgiz clinics’ know about their existence and if necessary are prepared to only go to these places. Trust in these institutions is related to the fact that the information is distributed among ‘fellow’ migrants (friends, coworkers, diaspora newspapers).
The second strategy is related to informal aid. When symptoms appear, foreigners start to look for doctors among their friends, migrants such as themselves, who have medical education of any level (In Moscow they may be working as janitors or cleaners). Such an approach includes consultations by phone, or with a ‘neighbour’, who used to be a nurse, or with a friend ‘who had a similar disease’. Sometimes migrants call their home country to talk to doctors they know. The reasons for requesting this informal assistance include drinking problems, pregnancy, gynecological diseases etc.
In case of pregnancy, migrants often try to work until late in the thrird trimester (7-8 months), before returning to give birth in their home country.
If the disease leaves no opportunity to work, migrants also go home. This is usually the case of chronic or acute contagious diseases, such as tuberculosis.
The doctors see migrants as a separate type of patients with a clear set of features, mostly related to social status, the researcher states. Essentially, the attitude of doctors from public hospitals and ambulance crews is ambiguous.
On one hand, they, one way or another, appeal to stereotypes ‘we’ (norm) versus ‘they’ (alien, unusual). Though, they often use the caveat that those migrants who have lived in Moscow for a long time have adjusted to life here and ‘start living as we do’.
On the other hand, the doctors declare that they as professionals make no difference with regards to who they treat, fellow citizens or migrants. The researcher sees such arguments (‘We are doing our job… We’ve seen many things, and not only among migrants…’) as a ‘warning against their own visible stereotype’.
Generally, doctors see migrants as calm and unaggressive patients. In this context, they usually mention their hard living conditions: many people living in one apartment etc. And for medics these features are more social than ethnic.
Daniil Kashnitsky also wrote about medical aid in private clinics aimed at migrants (there are about 20 ‘Kirgiz clinics’ in Moscow). They are attended by Kirgizs, Uzbeks, Tajiks, and occasionally Moldavians, as well as elderly Muscovites who live nearby. Large clinics are supported by the embassy and charity organizations and employ doctors in all the key specializations.
Such clinics help remove the psychological, social and cultural barriers that divide migrants and medical aid in Moscow. These medical centres employ doctors, citizens of Kirgizstan, graduates of medical institutes in Bishkek and Osh (the strongest medical school in Central Asia is in Bishkek). It’s important that the staff in such institutions speak Kirgiz, Uzbek and sometimes Tajik languages.
The price policy of ‘Kirgiz clinics’ is also important for migrants. The prices there are 20-30% lower than in other private medical centres, and repeat visits for the same problem are free.
‘Phone-a-friend’ is also often used as a treatment strategy. It involves the search for ‘fellow’ doctors. Such doctors can work in private and public clinics. Informal contacts with other doctors in municipal and corporate clinics are also possible.
But often the contacts are limited to simple phone consultation. For example, there is a medical hot line in Tajik and Russian languages. It offers such options as an initial diagnosis by a therapist over the phone and free consultations from volunteers (23 doctors). Some migrants find doctors from advertisements.
The ‘Doctor at hand’ strategy is important on construction sites
Another type of informal medical aid is a ‘doctor in the workplace’. This is especially important on construction sites, where the risks of injury are high, as well as at large markets.
For example, there is an emergency unit on the ‘Sadovod’ market. Essentially, this is an alternative ambulance team consisting of two medical assistants on duty, the researcher said.
Social, cultural and psychological barriers, together with cases of discrimination, force migrants to use self-treatment and ask for belated medical help, when it’s harder to treat the disease. As a result, some of them are admitted to hospital.
In non-emergency cases, migrants have to look for ‘fellow’ doctors and clinics that understand their problems, including psychological ones. Such choice rids them of possible discrimination. Some of foreigners try to get treatment ‘by phone’ (or ‘through the internet’). The use of such alternative strategies negatively influences the quality and timing of medical aid, the speaker concluded.