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National Working groups
have been organized in Portugal in order to provide the adequate
exchange context between public and private spheres, gathering together
experts from health fields, Roma issues, and public administrations.
This
isl contributing to the identification of good practices and health
indicators, which are a good tool for health professionals and health
agents in their understanding of the day to day work with the Roma
Community. Since REAPN during the last years (since 1995) is
participating together with FSG and other organisations in Europe in
different activities related with Roma issues, we had already a stable
working group on Roma issues (related generally with Poverty and Social
Exclusion).
In
the context of the Sastipen Project, we had to enlarge this
inter-institutional group and to mobilize particularly institutions
coming from the Health sector. As we’ve said previously, taking in
consideration the political national context, this was not an easy task.
Between April and September, parallel with gathering of information for
the data-base we held different contacts and informal meetings with
different organisations trying to involve them in this project. In
September the first meeting of a more formal group took place.
The
Working Group meetings are important moments of debate and exchange of
experiences and planning the activities. As the national working group
had a previous existence we had had the opportunity and in the scope of
its general activities to develop specific activities where we
introduced the theme of the Sastipen Project. For example, we held
specific thematic meetings about Roma Communities, also trying to
disseminate the information we gathered but also different materials
coming from other projects and initiatives. Nowadays, and after the
first national meeting, this group (now enlarged) will be the main tool
for developing all the actions previewed in the project.
Some
of the activities will be developed (and were agreed) with the active
participation of the different members of the group (for instance the
structure of the training and the contents of the manual which will be
produced during the national working group meetings). During this first
meeting a calendar of activities was defined as follows:
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The main conclusions of the meeting were:
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Lack of information (health indicators) about this minority;
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Some recent researches reveals that the Roma Communities are the
target of health inequalities and are the most disfavoured group in
this domain. Some of the authors make reference to the difficulties
in the access to the information, more specially information related
with the vaccination of the children, the prevention and the
treatment of some diseases;
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The
access of these communities to the health services is incipient
(very little). A Roma population seems to be not very concern with
health an have few preventive habits of health. This is because
Health for Roma Communities is just (is similarly) absence of
disease. Roma population only appeals to health services in case of
extreme necessity, that is, when they are sick and need to be
treated;
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The poor or inadequate nutrition makes them more exposed to serious
illnesses; some of them were almost eradicated from the majority of
society. At this level there are still many gaps and deficiencies,
such as: excess of grease and sugars, absence of schedules and
healthy alimentary habits;
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In what concerns drug addiction and drug traffic, the tradition on
marketing selling, the contact with marginalised sectors of the
society, its social and economical conditions and the difficult on
the access to the information, seem to explain the vulnerability and
the spread/enlargement of this practice within Roma Community. These
practices within Roma Community contribute for the vulnerability of
the gypsy’s families and for the worsening of its situation of
exclusion and poverty;
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Gypsies’ communities present high levels of premature maternity and
few (or none) medical assistance on pregnancy or childbirth and they
present also a high average number of children. The contraception
(birth control) is not current practice; even so it starts to be
more frequent among the youngest women;
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the standardized functioning of health services it’s an obstacle in
the access to theses minority groups and they enhance repressive
behaviours quitting them to take some attitudes and increasing the
mutual diffidence. Gypsies have proper cultural characteristics that
need to be respected or take in consideration in the
interaction/intervention with these communities. It’s clear the
existence of a mutual ignorance between gypsies communities and
health services. This ignorance leads to a hostility resulted of a
series of stigmas and fears. Gypsies are characterized as being
insubordinate, demand and undisciplined in relation to the
functioning of the services and to the medical prescriptions because
they don’t believe in medical professionals and in health services.
The different perspectives and expectations in relation to the
health cares by gypsies and medical professionals, it’s an obstacle
to the communication and the interaction between them. It’s the lack
of knowledge about gypsy culture and it’s characteristics that
difficult the use of the services that could improve its quality of
life. By this way the health problems of these communities became
worse because of some of their traditions, customs and beliefs. Many
of the diseases are related to the supernatural, and so they apply
to healers and alternative medicines.
The
National Working group is an important moment because it’s a space of
meeting, debate and exchange of experiences and planning of activities.
In the scope of this working group we have developed the diagnosis on
the current situation of the roma communities, in what concerns health
and, at this moment, we are gathering the difficulties and
recommendations.
This work is being done taking in consideration 4 levels of analysis: 1
1)
The main difficulties at public health system level are:
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health inequalities within the population and lack information
concerning roma health indicators;
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the functioning of health system is usually rigid and close;
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lack of a real work of prevention and awareness of these
communities in what concerns health issues;
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lack of information about cultural diversity;
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marginalization and exclusion of these members on health public
programmes and campaigns
Facing these difficulties, the participants had presented the following
recommendations and suggestion:
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activities of information and awareness raising promoting the
credibility of these services - visits of study;
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development of studies and researches, at micro level, on health
needs;
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health must be a permanent issue in Project applications and
reports
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construction of a network of health professionals in order to
better conduct roma to health services
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inter-sectoral co-ordination and collaboration with Roma
mediator's and health/social professionals;
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identification of rigid protocols that usually contribute for
exclusion and establishment protocols and rules more flexible
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specific training involving members of gypsies communities in
order to better understood theses communities and adapt the
services to their needs and characteristics
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Prevention Campaigns addressed to these communities and
developed with their help
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development of partnerships with different organisations
2)
The main difficulties at Roma Communities level are:
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distance between the Roma Communities and health services;
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less conscience about the importance of education to health;
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high levels of poverty and low levels of education have a
negative influence on the roma health standards;
Facing these difficulties, the participants had presented the following
recommendations and suggestions:
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information/training of the roma communities about the
functioning of services;
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teach the functioning of the diverse services of health, what
they can wait of it, how they work and what are the procedures
to access to them;
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cooperation between health services and associations – share
experience that can facilitate the relation with the roma
population;
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decentralization of the services of primary heath (mobile
units);
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sessions on health education;
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implement programmes/strategies to promote quality of life
(accomplish basic conditions)
3) The main difficulties at health services and specific health areas
are:
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the functioning of health centres (lack of evaluation and
planning and insufficient information);
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distant relationship between roma communities and health
centres;
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phase of reception (when Gypsies persons arrive to services
sometimes they are not very well welcome)
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lack of family planning
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question of gender
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premature maternity (youth pregnancy)
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lack information about paediatrics issues
Facing these difficulties, the participants had presented the following
recommendations and suggestions:
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planning and evaluation on the level of satisfaction and
information of the users and the professionals ;
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alternative ways of communication (audiovisual, training of
pairs, collaboration with partners of the community);
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develop communicative skills in the professionals (adapt
language and the level of information to give);
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promote networking (cooperation with local agents – civil
society);
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existence of key professionals for the members of the roma
community, in order to get a more close proximity and
confidence between them;
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training
in interpersonal relationship and cultural diversity issues;
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individual accompaniment of Roma Community members;
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informative leaflets and placards;
4)
The main difficulties at health-care level professionals are:
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the prevalence of prejudices and stereotypes – attribution by
the all society of a negative image
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racism and intolerance (prejudices, stigmatization and
discrimination)
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communications barriers
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lack of information about the characteristics and culture of
this minority among health-care professionals
Facing these difficulties, the participants had presented the following
recommendations and suggestions:
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adaptation of the attendance procedures to the characteristics of
the roma population;
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it is important that the gypsies know the professionals and that
these ones work in order to gain it’s confidence;
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it is necessary to make an effort for knowing this population and
thinking about exchange strategies;
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to prevent technical language and look for on accessible language;
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the professionals must have in special consideration the gypsies
cultural characteristics (initial training);
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the base education of health professionals must contemplate the
questions of cultural diversity;
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