“They Treat us Like Pests:” Undocumented Immigrant Experiences Obtaining Health Care in the Wake of a “Crackdown” Ordinance

This article presents findings from a qualitative study of Latino immigrant experiences seeking health care services in the wake of an anti-immigrant “crackdown” ordinance similar to Arizona's SB 1070. Prince William County, Virginia's 2007 “Rule of Law” ordinance escalated law enforcement efforts that targeted this population for deportation and ordered staff to ensure that no one receive social services other than those required by federal law. This article sought to answer the questions: (1) Were undocumented immigrants able to obtain health care? (2) How do immigrants characterize their experiences with health providers? Data were gathered via semi-structured interviews (n = 57) with Latinos in a low-income neighborhood. Analysis of Spanish-language narratives found that many were dissuaded from seeking care because of high costs as well as lack of familiarity with the health care system. Others perceived that they were treated with insensitivity or outright hostility—and believed this treatment was a deliberate effort to discourage them from seeking help.     

Navigating labels,seeking recognition for victimhood: Diaspora activism after mass-atrocities

This article analyses diaspora mobilization for transitional justice as efforts to gain recognition for victim-based identities. Building on research among diaspora groups from Rwanda and Sri Lanka in North America and Europe, the article investigates how diaspora actors in their quest for victimhood recognition navigate, make use of and challenge labels such as “victim”, “perpetrator”, “genocide”, “survivor” and “terrorist”. The article uses Jacoby's theory of victimhood to draw attention to the diasporic space as particularly conducive for recognition struggles, and discuss the different stages through which victim-based identities are constructed. The empirical examples reveal how serveral competing and interrelated processes towards victimhood recognition are simultaneously at work, and how diaspora actors both refute and creatively make use of categories that assign blame or signal victimhood and resilience.     

The Migration–Development Nexus: Sri Lanka Case Study

This paper explores the relationship between migration and development in Sri Lanka, a country that has been the source of large numbers of migrants and the recipient of much development assistance. Commissioned as part of a wider study conducted by the Centre for Development Research, Denmark, this case study seeks to answer a set of specific questions about the nature and extent of links between development assistance and migration flows. The paper surveys the socio–economic context in which both migration and development have taken place in Sri Lanka, describing the causes, scale, and features of migration flows from Sri Lanka in recent decades. Two main streams of migration flows are identified: labour migration and political migration. The flows are distinguished by ethnic characteristics (the former is mostly Sinhalese and the latter pre–dominantly Tamil) and destination (the former to the Middle East and the latter to the West). Both flows have intensified during a time of protracted conflict and in the context of waraffected economic development since the early 1980s.
The importance of remittances from migrants to the Sri Lankan economy and the extent to which diaspora activities impact Sri Lanka are also discussed. Despite the lack of statistics, especially on informal remittances from the Tamil diaspora, it is suggested that the remittances have been and will continue to be a sizeable component of foreign exchange receipts in Sri Lanka. The paper concludes that the complex interactions between migration, development assistance, remittances, and conflict are important for the prospects for peace and reconstruction in Sri Lanka. The challenge in Sri Lanka will be to move from a vicious cycle of conflict, underdevelopment and migration to a more virtuous one. In this process, it is suggested that the diaspora will be a key player in the shift towards peace and remittances will be an integral part of reconstruction.     

Working a Third Shift: Physical Activity and Embodied Motherhood

In their conception of the “third shift,” Dworkin and Wachs argue that working mothers engage in fitness and bodywork in addition to the first shift of professional work and the second shift of household labor and childcare. Within this third shift, the goal for women is to “erase physical evidence of motherhood” and return to the pre-pregnancy self. The cultivation of a body socially defined as “good” and “attractive” thus serves as a visible illustration of an embodied subjectivity anchored in morality and neoliberal personal responsibility, signifying a strong woman who has her body and her life under control. Utilizing thematic analysis to examine dominant constructions of embodied motherhood in popular texts and products, this article offers five conceptual categories to explore why and how women in engage in bodywork. Understanding how women operationalize the third shift of fitness and bodywork is important because it helps to unpack the struggles of contemporary motherhood and the competing realities of home, work, and self-care.     

Motherhood Motivations: African Refugee Women Resettled in Australia and Return Visits to a Country of First Asylum

This article expands on conceptualizations of refugee “return” by examining why African women resettled as refugees in Australia return to visit the country of first asylum from which they were previously resettled. I show that their return visits do not relate to attachment to place, but are motivated by social obligations to practise “motherhood” to family members who, due to conflict‐induced displacement, remain in a country of first asylum. I argue that the phenomenon of refugee “return” cannot be conflated exclusively with return to country of origin but is, for African women in particular, centred on the reinvigoration of care relationships across diasporic settings of asylum in which family remain. Building on an emergent focus on feminization in migration studies, I show how these gendered dynamics of refugee “return” are an entry point from which to re‐consider how scholarship and policy take into account “family” in contexts of forced migration.     

EMERGING TRENDS IN THE PROVISION AND CONSUMPTION OF HEALTH SERVICES

Health services are examined in terms of emerging trends for the new millennium. On the one hand, centralization is increasing as payers tighten control over disbursements through managed care and more restrictive health insurance. On the other hand, health services are decentralizing as patients acquire more information and take more control of some aspects of treatment. Health services markets now also show signs of becoming global in nature, possibly benefiting both bulk purchasers of care and individual consumers. Any tendencies toward increased patient control are likely to be ephemeral, however: In the absence of reforms sparked by yet-to-be-experienced crises, advances in technology, particularly in medical informatics, will likely be used to strengthen the profit positions of insurance providers, not to provide more comprehensive health care services for patients.     

Child sexual abuse in Sri Lanka: the current state of affairs and recommendations for the future

This article focuses on child sexual abuse in Sri Lanka. The background of child sexual abuse in the country and its current status are discussed. The role of the National Child Protection Authority, the primary governmental body concerned with child protection, is also explored. The article also brings to light various cultural dimensions that serve to call attention to the issue of sexual abuse of children in Sri Lanka. These are explored and illustrated with case vignettes from the author's clinical experience. Finally, the article elucidates the main issues and barriers in Sri Lanka that need to be surmounted in order to have an integrated service delivery in the care of the sexually abused child.     

Healthcare Use in the Heartland: How Health Care Selection Varies Between Rural,Retirement‐Age Migrants and Long‐Term Residents

One increasingly important problem affecting rural health care selection is the tendency of older residents to bypass local health care providers. This research investigates how the effects of community characteristics and attachment on health care bypass behavior vary between rural retirement‐age migrants and retirement‐age long‐term residents. Non‐health‐related behaviors, such as purchasing goods and services outside one's community during a health care trip, that is, “outshopping,” could influence bypass if individuals combine trips for their medical care with other consumer needs. Basing our work on the outshopping theory, we argue that bypass behavior is one facet of consumer consumption patterns for both rural retirement‐age migrants and long‐term residents. In addition, dissatisfaction with local health care and services like shopping can “push” rural residents to bypass local health care and travel greater distances for primary health care. We further contend that strong community attachment has an opposite “pull” effect that can help to negate the push of outshopping and reduce the likelihood of bypass. Our results reveal retirement‐age migrants are significantly more likely to bypass local primary health care providers than retirement‐age long‐term residents. Furthermore, our analysis bridges the rural health care and retirement community development literature to suggest that outshopping theory can now be applied to rural primary health care bypass behavior.     

Indian Ocean Tsunami and its influence on the resurgence of social work as an academic discipline in Sri Lanka

ABSTRACT

In December 2004, the massive Indian Ocean Tsunami hit the coastal areas of Sri Lanka causing a devastating impact on the lives of people. National and International humanitarian aid received in the aftermath was unprecedented. Among this was a team of professors and students from the faculty of Social Work, University of Ljubljana, Slovenia, who conducted a summer camp as a social work practice project together with Sri Lankan undergraduates. The objective was to initiate a project for support based on an action research model adopting a short-term design built upon a needs assessment. While critically looking at the process of international support in the context of country’s long history of state welfare and community support systems, the paper also focuses on one major lapse among others, negligence of people’s needs during disaster interventions. The paper attempts to view this situation in relation to the absence of an established social work profession in the country and examines the applicability of an international framework and concepts of social work in developing academic and professional social work in a context as diverse as Sri Lanka.     

WITHIN‐MOTHER ESTIMATES OF THE EFFECTS OF WIC ON BIRTH OUTCOMES IN NEW YORK CITY

There is a large literature suggesting that “WIC works” to improve birth outcomes. However, methodological limitations related to selection into the Women, Infants, and Children (WIC) program have left room for doubt about this conclusion. This article uses birth records from New York City to address some limitations of the previous literature. We estimate models with mother fixed effects to control for fixed characteristics of mothers and we directly investigate the way that time‐varying characteristics of mothers affect selection into the WIC program. We find that WIC is associated with reductions in low birth weight, even among full‐term infants, and with reductions in the probability that a child is “small for dates.” These improvements are associated with a reduction in the probability that the mother gained too little weight during pregnancy. Improvements tend to be largest for first born children. We also find that women on WIC are more likely to be diagnosed with chronic conditions, and receive more intensive medical services, a finding that may reflect improved access to medical care. (JEL I12, H42)     

Delivering LGBT-sensitive substance use treatment to sexual minority women

Abstract

Epidemiologic studies have consistently found elevated rates of alcohol and other substance use among sexual minority women (SMW), and despite calls for “lesbian, gay, bisexual, and transgender (LGBT)-specific” services and culturally tailored interventions, few such services exist. This study involved qualitative interviews with directors from substance use treatment programs (N?=?10) about how they addressed the needs of SMW. Strategies implemented primarily focused on creating a safe and welcoming environment for sexual minority clients. Findings highlight challenges involved in meeting the treatment needs of SMW and provide guidance to researchers and service providers on how to improve the quality of care for them.     

USPSTF recommends screening for illicit drug use in adults

Last week, the United States Preventive Services Task Force (USPSTF) recommended screening for “unhealthy drug use” by asking questions — not by drug tests — in adults. There is a proviso: “Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.”     

What do we really know about usual care child protective services?

The term “usual care” is often used in clinical research to refer to a comparison or control group that is receiving whatever normal services an organization may provide. In the US child protection system, “usual care” is the practice from the point of screening in a report, to assessment and possible in-home services or a decision to place a child in out of home care. Policy and practice variations across states and counties, as well as changes in policy over time, make research on normative child welfare practice services challenging but necessary. The service delivery mechanism in child protection is understudied, limiting our ability to inform decision-making at the local, state and federal levels. Gaps in knowledge also confound intervention research because a clear understanding of a given service platform is key when interpreting effect sizes against usual care controls. This article overviews what is known about “usual care” in child protective services and seeks to encourage more research in this area by reviewing six key factors related to measuring the impact of usual care from the point of initial report through the provision of services.     

A Certain Gesture: Reflections on the Murder of Sivaram

In the late 1970s and early 1980s, a generation of young Tamils in Sri Lanka joined one or other of the militant separatist groups that sprang up in opposition to the Sinhala-dominated government of Sri Lanka. This paper examines the life of one member of this generation, the journalist and intellectual, Sivaram Dharmaratnam, who was abducted and murdered in Colombo in 2005. Sivaram's death provoked a flood of reflections from his peers and these are used to ask questions about the relationship between personal biography, intellectual trajectory and political commitment in a post-colony in long-term crisis. The subsequent appearance of a biography of Sivaram, written by his friend the anthropologist Mark Whitaker, provides an opportunity for further reflection on ethnography, friendship and the limits of biography.     

Barriers and facilitators to delivering effective mental health practice strategies for youth and families served by the child welfare system

While the gap between need for and access to mental health services is well documented among children of color in foster care, little is known about why they are sustained. To illuminate barriers of service delivery, thirty-six caseworkers participated in one of five focus group meetings in a large urban Mid-Atlantic City. Ground Theory Methods revealed that there are barriers and facilitators at the macro, meso, and micro practice orientations. At the macro-level, development of effective practice strategies and proximity to effective services are likely to influence dissemination of effective practices. Secondly, at the meso-level, job support is needed to facilitate awareness, but for case managers to feel supported, they need effective training and opportunities to facilitate interagency collaboration. Finally, at the micro-level, cultural competence largely impacts implementation of effective practices. However, increased awareness around the social ills of stigma and the salience of “insider work” are needed to increase cultural competence. A “downstream” effect in which there are numerous barriers identified at the macro level has a direct negative impact on organizational capacity and readiness to deliver and engage youth and families in mental health services served by the child welfare system. Findings underscore the need for child welfare agencies to build supports at the macro, meso, and micro practice levels to ameliorate mental health service disparities.     

Motherhood and “Moral Career”: Discourses of Good Motherhood Among Southeast Asian Immigrant Women in Australia

In this paper, I examine the lived experience of motherhood among Cambodian, Lao and Vietnamese immigrant women in Australia. The women in this study felt a profound change through the process of becoming a mother; they experience the “transformation of self.” The results reveal several discourses of good motherhood. Becoming a mother was experienced as a moral transformation of self and women were urged to perform their moral career. The representation of mothers as the “keepers of morality” is prominent. Women's moral career is influenced by an ethic of care and responsibility for others, particularly their children. The paradoxical discourse of motherhood is profound in the women's narratives of their lived experiences of motherhood. It is clear that motherhood is not an easy task. When this is combined with difficulties resulting from migration, motherhood becomes double burdens. Lack of sufficient English, financial difficulties and support network in a homeland make the task of good motherhood difficult to achieve. Social and health care services need to take women's experiences into account if sensitive care for immigrant women is to be achieved.     

NEW TRENDS IN THE DOCTOR-PATIENT RELATIONSHIP: IMPACTS OF MANAGED CARE ON THE GROWTH OF A CONSUMER PROTECTIONS MODEL

Managed care is prompting a large revision not only in the ways doctors are employed and paid but also in the essence of the relationship between doctors and patients. In medical sociology, a discipline with a long-standing focus on scrutinizing the role of both the physician and the patient, there has already been discussion of a shift from the doctor as more all knowing to a less dominant position vis-a-vis both the patient and delivery of care. Patients are aware of shifts that place physicians in an environment characterized by new roles and responsibilities, such as acting as a gatekeeper. Limitations on health care coverage and the rethinking of roles have led to a depiction of the patient as the consumer of care and the managed care plan's becoming the commercial enterprise from which a service is obtained. The model of the patient as consumer of medically related goods and services appears to be growing, as does a model of the physician as one who contracts for a specified range of services for specific patients. In this article, trends in and problems with contemporary managed care are raised. Calls for patients' rights legislation may be among the health trends of the new millennium.