Aims

This chapter explores the health and social care needs of Ethiopian refugees in the UK, looking specifically at how their experience of migration impacted upon their health. The chapter looks closely at the migration histories of Ethiopians in the UK, their social networks, lifestyles, health and sickness beliefs, mental and physical health, health-seeking behaviours and self-care practices.

Methodology

The data were derived from a study based mostly in London, but also Leeds and Liverpool conducted between 1999-2001. The research methodology involved members of the Ethiopian community closely, in activities such as interviewing, translating, transcribing, report writing and dissemination. Semi-structured, in-depth interviews were held with 106 Ethiopians including eight Ethiopian professionals providing services to Ethiopian refugees. Qualitative data were analysed thematically and using the constant comparative process, defining and redefining themes as new evidence comes to light. All participants also completed a semi-structured questionnaire in order to collect supplementary data relating to personal details; this quantitative data were analysed using SPSS software. Participants were located through quota and snowball sampling, primarily through personal contacts, the Ethiopian Community Centre in the UK [ECCUK] and through adverts broadcast on an Ethiopian radio station.

Key findings

Some findings of note are as follows. Although some participants aimed to integrate fully into British society, trying to adapt to the culture was seen by many as a source of stress, depression and poor health. Factors that were seen to aid integration were information about health and social systems, material and emotional support and support in developing skills and finding employment, among others. A wealth of practical problems were reported, such as barriers to suitable employment, inappropriate housing arrangements and social isolation, which were all seen as barriers to their acculturation. Regarding the respondents' health beliefs, the research found that healthiness was an indication of happiness, that is: fulfilling dreams and ambitions, not feeling stressed or worried and being physically fit and mentally well. Sources of ‘sickness' were identified; they included: eating contaminated food, the climate and environment, poor socio-economic conditions, depression and stress, behaviours such as unprotected sex and smoking and social isolation. This list indicates that the respondents were aware of the threat social circumstances pose to well-being. These were combined with supernatural causes and more physical causes. Mental health was seen to have supernatural causes such as spirit possession, and held stigma which was likely to discourage people from seeking mental health services. The most common types of health problems however were mental health related. Almost all the participants were registered with a GP [97%] and 78% found UK health services easy to use. Some however were shocked at the length of waiting times, and others reported difficulties communicating with healthcare practitioners due to a lack of interpreters.

Conclusions

Ethiopian refugees face numerous barriers to successful integration into British society. The report highlights a number of factors that facilitate integration, such as positive socio-economic circumstances, achieving refugee status and access to training and education; the desire to integrate was found to be high. With regards to health beliefs, the informants stressed the importance of happiness and living harmoniously with the community. They described their health holistically, and did not separate concepts of physical health from those of mental or spiritual health. The healthcare practices of the refugees had changed slightly as a result of their migration experience: they were more likely to access western medicine in the UK. There is a tendency however to use traditional medicine, and often, traditional practices and beliefs are revived in the context of exile due to a desire to take on the identities of the homeland. Negative experiences of the healthcare system in the UK is likely to deter refugees from seeking further help. This can often be an effect of racism and inappropriate medical care. Health professionals should address their own ‘cultural competence' and ensure that they are sensitive to the particular cultural beliefs and practices of their client groups.