Rudolf Virchow once famously said, “Medicine is a social science and politics is nothing else but medicine on a large scale. Medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution; the politician, the practical anthropologist, must find the means for their actual solution”.
That close intertwining between politics and medicine is a huge interest of mine, and in part, contributing to my study visit in Sweden. Not only am I interested in learning about quality improvement but also the policy levers which can improve the lives of patients powerfully.
Last week, I had the opportunity to work closely at that intersection with one of Jonkoping Region’s newest nurse-led teams called the Health School. This team works solely with asylum seekers in the region by providing onsite group education at Asylum Centres on:
- Accessing the Swedish healthcare system
- Self-care at home
- Coping with stress, sleeping, anxiety, and PTSD in a new country while waiting for a decision regarding a claim
- Having an opportunity for group or one on one counseling with a kurator. Kurators provide mental health support and counseling and are part of the health and wellness circle of mental health care.
- Healthy behaviour training such as smoking cessation, reducing alcohol intake, exercise training, and appropriate nutrition.
Since the members of the team are trained nurses and a translator, the Health School visits also function as an opportunity for asylum seekers to start a conversation with a healthcare professional about any individual health concern following the session. I witnessed patients bringing forward their medical concerns and receiving an assessment onsite, or getting their care coordinated so they could be seen by an appropriate professional (e.g. GP for getting a diabetes medication assessment) the same or next day. Thanks to a shared EMR, electronic medical records and consultation requests can be filed right on site from the asylum centre using a laptop.
From the political side, Europe is in the midst of a large influx of refugees and asylum seekers fleeing conflict. Sweden has historically been one of the shining examples of acceptance in this regard, taking in more refugees and asylum seekers per capita than almost any other country in Europe.
So from what I saw, how are asylum seekers treated in Sweden? If you’re unfamiliar with the term, asylum seeker refers to an individual who has fled to another country, but is not a refugee and therefore has not been officially accepted into the country. However, they are able to stay in the country until a decision is made regarding their status – either they will be able to immigrate or they will be sent elsewhere. Sometimes these claims can take over a year.
While I was with the Asylum Health School team, we visited two asylum centres. These are often repurposed buildings that provide food, lodging, and shelter to asylum seekers as they wait for their claims to be processed. The facilities can vary but generally they are private facilities that contract their services to the government, and are inspected by the Immigration authorities in Sweden.
Asylum seekers receive certain healthcare coverage while in Sweden. All emergency or acute care services will be provided to them if needed, including access to a primary care physician. However something that is not as medically urgent will not be covered such as rehabilitation services until they receive a permit to stay. Schooling to teach children English and Swedish is provided as well, but until the claim is processed they cannot register in a formal schooling program. There are still user fees for asylum seekers but they are less than the Swedish population. It costs approximately 50kr ($7.50 CAD) for an asylum seeker to receive primary care for example.
The issues surrounding migration, refugees, and asylum seekers is one of deep personal significance to me. As a young child my mother and her entire family fled Uganda as refugees under the regime of Idi Amin. They were accepted as refugees in the UK and eventually emigrated from there to Canada where I have had the privilege of growing up. Without accepting policies, it’s quite possible I would not be writing this blog today.
In an era with unfortunately, an escalating rhetoric of misconceptions, fear, hatred and bitterness towards refugees and asylum seekers who are forced into challenging situations due to political circumstances beyond their control, I was proud to see the acceptance and support that Sweden has extended to its asylum seekers, even though its system is becoming increasingly overstretched. It is reflected in the actions of people too: ordinary retired citizens in Sweden volunteer their time to help asylum seekers learn Swedish for example.
I was utterly impressed by the Asylum Team’s novel work too, which is making people feel welcome in a new and strange and different country with a very different healthcare system.
Most inspiring however, was an encounter at one Asylum Centre and its manager. The manager was living in a facility like this himself and after becoming a permanent resident returned to work at the centre. There, he runs program for the asylum centre residents, sometimes using his own money to pay for additional dinners or outings for the residents if the budget has been used up. He also runs activities for them such as a football (Soccer for my North American friends) league that provides a familiar pastime. When I asked him why he was doing this, he responded simply that he remembered when he was in their shoes, and knows these small things make such a big difference.
“So what if it costs a bit of money for me, it is worth it to make them feel welcome in this country while they are dealing with so much stress.”
As my study visit winds down and I prepare to head back to Canada this week, it was this moment of compassion that reminds me why I decided to engage in this work in the first place. Quality improvement and policy are levers, and medicine is an art and science, but they are fuelled by compassion and a love for humanity. No matter the pressures, we mustn’t lose sight of that love and the ties that connect us with one another. And that gives me strength to continue to improve my system and care for my future patients when I get back home.
Till next time,