Q&A: Author Muhammad Zaman On Why Health Care Is An Impossible Dream For 'unpersons'

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Muhammad Zaman, author of We Expect Miracles , in his laboratory at Boston University. Jackie Ricciardi/Boston University Hide caption

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“There are millions of people who are invisible to us,” says Muhammad Zaman in his new book, We Expect a Miracle .

The miracle he talks about is access to health care.

He writes about various immigrants. Refugees. Persons crossing international borders; They were forced to leave their homes, but remained in the country; and stateless persons without proof of nationality or nationality.

Johns Hopkins University Press

They are “non-human,” Zaman says, referring to a term coined by George Orwell.

Zaman, a biomedical engineer and director of Boston University's Center on Forced Displacement, tells the stories of people in four countries — Colombia, Pakistan, South Sudan and Uganda — trying to care for their friends and family. Communities. .

The following has been edited for length and clarity.

Goats and soda

Comment: Refugees are particularly vulnerable to COVID-19. Don't ignore their needs

This seems like a scary question, but if someone has no connection to the communities you're writing about, why would they care or worry about people's health?

This is a good and very important question. If I have five things to do and only one time and money, why does it have to be one?

there are many reasons. The first is the fundamental reason for respecting human rights. What does feeling socially responsible towards others mean for you and me? How do we think about our role towards those who have gone through difficult times or are experiencing difficulties? This should not be a pity, but a social responsibility.

Second, a positive immigrant experience is important for any society. They can make an economic contribution to society and bring new culture, new ideas and intellectual energy.

Moreover, I don't believe it, but let's assume, for the sake of argument, that the displaced and desperate are victims of systemic risks, or that there is a group exploiting their vulnerability for nefarious purposes. This is the argument we are making. Why should we invest in peace or why should we invest in educating others? It is good for everyone that people have the opportunity to live dignified, dignified and prosperous lives.

Finally, when people live in complex, challenging, and environmentally unstable environments, new diseases emerge. By depriving them of access to clean water or forcing them to live in cramped spaces, there is always the possibility that new diseases will affect everyone.

Let me ask about the title of the book: Waiting for a Miracle. I thought this article was interesting because you wrote that there are clear reasons why displaced people do not have access to health care, and there are clear ways to solve these problems. So why this topic?

About a third of the book focuses on stateless communities in Pakistan. For example, Saeed is not a citizen of Pakistan, where he was born and has lived all his life.

She explained that he belonged to the Bengali ethnic group living in what is now Pakistan. After a year of civil war that divided the country into Pakistan and Bangladesh in 1971, Pakistani Bengalis found themselves imprisoned and undocumented.

These were mostly people from poor communities. There is no evidence of their arrival, and their birth documents have not been received.

It seemed so frustrating and difficult that only a miracle could get one of the men out of this predicament. Since nothing seems to change, no policy can take care of it.

Hence, [the belief] that only a miracle will solve their legitimate and reasonable need for adequate, high-quality health care stems from a feeling of disappointment.

As she writes in the book, Saeeda must provide for her son, care for her mother, and nurse her mentally ill brother until he recovers. To obtain a national ID card, he must work hard and attend a legal clinic.

In his case, many believe they need a miracle. But some say these displaced people have an easier time getting medical care. All you have to do is throw money to them, donate to the Red Cross, or pay the hospital. Your book suggests no.

I think we should not ignore the importance of finances. I think this is absolutely necessary. But even if you had the financial resources to think about starting a hospital for a group of refugees, it would be difficult to fill it with people who have not suffered.

Or you may have trouble hiring staff at that hospital because no one wants to work there. Or in some cases, doctors come only once a month. So just having a hospital will not solve this problem.

Of course, the idea is to make sure you really understand the complex needs of refugees. We often focus on infectious diseases. However, this does not change the fact that immigrants face problems related to mental health, diabetes, cancer or cardiovascular diseases.

So how do we fix this?

First, you must ensure that the dehumanization associated with refugees is addressed. Treat them with dignity, respect and respect for basic human rights. no more. This is an important starting point.

Then you build a system that includes movement problems. You really need to look at its context, so whether it's climate, conflict or migration, public health is prepared to address this issue.

The third thing that I think is very important is that we need to create incentives to train new doctors and nurses. Healthcare professionals want to work in the best hospitals and benefit from training or career advancement. Working in these places [for displaced people] is a never-ending task, even if the person is socially conscious. You want the country to appreciate this work and give him the opportunity to continue [professional] development. Part of this is recruitment, but also creating a research community that will engage and learn from this experience, which is important for everyone's health. These are not expensive things.

What surprised you most while writing this book?

There are societies we don't even think about. People, for example, return to their country [after displacement].

We assume that when people go home, they are fine and everything is fine. But the man who was a refugee in South Sudan came back and the situation was worse than when he left. I think if we really want to solve what we can (access to health care for displaced people), we need to understand the complexities and nuances of this issue.

She believes that many of the medical needs of evacuees are being ignored.

The broader issue that fascinates me is the short-sightedness of our individualistic approach to health. We do not think of displaced or stateless people as people with cancer, diabetes or palliative care. We have cartoons that think their health condition, malaria, epidemics, injuries, and their health needs are different. We have created obstacles that cause more problems than solutions. Think of the displaced or refugees from Gaza. For example, we may not think they have diabetes. But where can you check your blood sugar levels in such situations?

You talk a lot in your book about authenticity. Can you tell us what this means for healthcare?

Through trust, displaced communities may often seek or not seek health care, not because it is not always available, but because they have very good reasons to distrust the system. So you can imagine that if xenophobic people book treatment in hospital, or if someone reports them to the police or is about to be deported, they won't necessarily be able to turn to that resource.

You and I will go to the doctor, and we are sure that everything will be fine. Health care is a very intimate and personal thing, so it must be based on individual trust and institutional trust.

Can you give an example of how faith impacts healthcare?

Take Henry [a spiritual and health practitioner from South Sudan] for example. So the believers believed him. He was the one who gave them information on what to do and how to travel during Covid. You may not hear a government regulation or message on your phone, but the people you trust play a big role in your response.

I was personally affected by this when Henry himself had a stroke. He had insufficient contacts and it was very difficult to get treatment. [He was finally able to get treatment in Khartoum, Sudan.] But I am amazed that (displaced) people can only help each other if they are healthy. When you get sick or die, the system you worked with begins to break down.

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