Working With Diversity, Northern Ireland Section 75 Equality Scheme Advice

Case 2

Mei Lee

Mei Lee, aged 25 who is 6 months pregnant who originally came from mainland China, moved to live in Northern Ireland from July of last year. Her husband, Ming works in a Chinese restaurant in South Belfast. The couple shared their accommodation with other workers above the restaurant. All their families are in China and they have very few friends here. Mei and Ming arrived at X health centre for an appointment (Mei is suffering from the flu). Mei Lee and Ming speak very little English. The receptionist managed to find out that they were not registered with any GP.

This case illustrates the following :

Learning how the structure of the system works can be one of the biggest barriers to access
This especially happens when people are without family in NI and are not guided by an institution such as their place of study or work
The need to register with a GP on arrival in Northern Ireland.
The provision of maternity services and general health check would have been made available at the registration medical with the GP. (GP is the gateway to services.)
Shows the need for multilingual materials such as 'First Steps in Using Health and Social Services in Northern Ireland' which can provide necessary information for new arrivals.
Demonstrates the lack of awareness of how the system works.
A separate issue is that of the provision of interpreters. Practitioners and service users alike are often unaware of their right to an interpreter if they are not speakers of English
Contact with organisations Northern Ireland Council for Ethnic Minorities and the MultiCultural Resource Centre is essential contact for new arrivals.

Case 3

Krishna and Sumatra are from India and are a married couple with a young son. They came to Northern Ireland to undertake Ph.D. studies at the University of Ulster as part of a work/study programme. Both of them arrived with a limited understanding of English.
Because Krishna is a student they use the University Medical Centre. Despite their limited English, they had never been offered an interpreter. They recall a negative experience with a doctor. Their five-year-old son got very ill. He started with a high fever and then with some vomiting; they were afraid it was meningitis, as there had been some cases in their neighbourhood. They took him to the doctor and got very upset because the GP didn't examine the child in the way they were expecting. Also Sumatra had problems getting a smear test. In general they were not happy with their GP, they found out that they could change and they did it; their current GP is more caring and more supportive.

This case illustrates the following:

Issues regarding interpreters.
In addition there is often a high rate of awareness among the general public regarding health, medicine and well-being meaning patients often expect a dialogue
For all the interviewees, building a relationship of trust with their GP was felt to be a very important component in receiving care.

Case 4

A second generation Pakistani woman related the post-natal depression she suffered after the birth of her first child.
'I didn't talk about how I feel because it's not the norm here, especially in our culture. Especially since I'd given birth to a boy, people couldn't understand what was wrong with me, so I had to cover it up. I would shout at my brothers and get it out that way - they didn't know what was happening.

Language barriers do not present a problem in this case.
This case shows a lack of knowledge of the support services available
It emphasises that problems of access to health care are not solely restricted to first generation women.

Case 5
Cermak is a young man from Croatia. He is single and living in Northern Ireland for the last 2 years. He arrived at the end of the summer and at that time felt healthy and didn't need a doctor. In November he started to feel ill. He felt very tired and homesick. He later developed a chest infection and became very ill. His main concern was his inability to go work. He visited the pharmacy and tried to buy antibiotics, as he would normally do in his own country but found that it was not possible. The chemist explained to him that to sell him antibiotics he need an 'order' (prescription) from the doctor and for that he would need to be registered with a GP. Cermak was very surprised to find out that he needed to fill out an application form to register with a doctor. Before he had fallen ill he had not done anything to find out how to register with a doctor, now being ill it was difficult to go out and fill in the forms.
His problems didn't finish once he got a GP. His English is good enough to communicate his ideas and talk with people but not good enough to explain his symptoms to the GP. He found it very frustrating the fact that he couldn't tell how he felt. He needed an interpreter but he didn't know he could ask for one nor did his GP offer.

His problems didn't finish once he got a GP. His English is good enough to communicate his ideas and talk with people but not good enough to explain his symptoms to the GP. He found it very frustrating the fact that he couldn't tell how he felt. He needed an interpreter but he didn't know he could ask for one nor did his GP offer.

This case illustrates the following:

In the first instance Cermak is unaware the GP is the first point of contact for Health Services. He is used to the pharmacist playing that role for minor ailments

Secondly he is unaware of the process (or need) for registering with a GP and, as do many, waits until he is ill and can't cope with the paperwork.

Provision of multilingual materials such as the resource First Steps in Using the Health and Social Services in Northern Ireland (produced by SEBT and MCRC) can provide necessary information to new arrivals.

It is important to note that a service user may not just need an interpreter if they have no English at all, but also if they have only a basic or even intermediate level of English.

Case 6

Catalina is a Portuguese person who lives in the countryside. She arrived in Northern Ireland seven years ago. When she arrived she hardly spoke English and language has always been a barrier for her. She recalls that during her first years she couldn't even understand her in-laws.
The first time she used the health system was when she found out that she was pregnant. Her sister-in-law took her to the local clinic, introduced her to the staff and helped her fill in the forms. It was very simple as it is a small family friendly clinic.
Once they registered they asked her questions regarding her medical history, she told them only what she was able to remember, something she feels is not very appropriate because as a patient she really didn't have all the information in her previous clinical history.
“I keep telling my GP that I have a headache, he doesn't try to find the cause, he just gives me some paracetamol…I know is not a simple headache.”
Catalina finds it extremely hard to explain her symptoms and she feels that her GP gets impatient once she starts. She is aware that GP's don't have much time to spare but she wants them to listen. She is considering the possibility of using an interpreter, but she is not sure from whom she should request this service.
Catalina recalls that all medical staff were very helpful while she was pregnant. She had all her appointments on time and they were very careful with all routine tests: blood test, urine test, etc. After her son was born the health visitor and the GP had a good follow up care for about a year, but after this period there was no further after care.
Catalina thinks that getting an appointment with a specialist is like winning the lottery. Her son had some sort of eczema and his GP sent him to see a specialist. They had to wait one year for an appointment, which was finally set for August 2001, and latterly rescheduled for March 2002.

This case illustrates the following:

Clinical histories from countries of origin are not always requested and many patients do feel this is important and are willing to chase them up.
There may be a perception that some minority ethnic users are transient and therefore there is no need, rather than seeing many minority ethnic people as part of the established settled community.
See cases 1,2,3, and 5 for information on accessing interpreters.
The above two issues are questions of differences of expectations of the system due to structure.
There is a feeling of abandonment as postnatal support dries up, and an expectation of follow up rather than having to approach the GP.
There is the question of waiting for a specialist. Whilst long waiting times for specialists are an experience for all, in other systems specialists are not accessed via a GP but are done directly.

Case 7

Mrs Justina Morales is 58 and married to a language teacher from a South American country. Following her husband receiving death threats from state sponsored paramilitaries they left the country on a flight to London and claimed political asylum on arrival. They then flew to Northern Ireland as they had a family friend in Belfast.
Mrs Morales has had a medical condition for the last ten years, as soon as they arrived in Northern Ireland she had to request medical treatment. Despite the fact that she had very little English she was never offered an interpreter. Her husband was asked to interpret but it was too complicated for him leading to severe frustration and worry in case he got things wrong on such a serious issue, in the end they had to bring their own interpreter.
Mrs Morales health condition got worse and she eventually had to return to her country of origin for specialist treatment, her husband had to stay behind due to the threat on his life.

This case illustrates the following:

This case illustrates lack of provision of interpreters having serious consequences on people's lives. In addition refugees often have differing patterns of health to the general population and may be physically or psychologically unwell due to both the experiences in their home countries and experiences of the lengthy asylum process and minimal support system here.

''I came to Northern Ireland in 1993 and I have had no problems living here so far. I like Northern Ireland, the people are very friendly and the countryside is so green and beautiful''

''As an ethnic minority, it is difficult to adjust to our own culture. We try to maintain our own culture by speaking mother tongue to our children and cooking our traditional dishes on Sunday. If I had a choice, I would move out of here because I would like to bring up my children in the Sudanese way of life.''

''People look at minorities as immigrants, that they are just here temporarily. This happens throughout the world not just in Northern Ireland. They do not appreciate that people were born here, they live here and will die here. This is their home!''

(Source ' Diversity on Display' An exhibition on the lives and culture of Northern Ireland's ethnic minorities.)

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