Archive for November, 2009

Children as gatekeepers

I (now not so) recently attended a research seminar at Swansea University organized by the Centre for Migration Policy Research called Methodological issues in capturing and understanding experiences of migration. This text is based on my presentation at the seminar titled: Getting to know ‘hidden’* rejected asylum seekers in Sweden – Children as gatekeepers

As part of my research aiming to understand the everyday experiences of undocumented migrants, I am doing participatory observation in a monastery that is a sanctuary for anyone in need of protection. Around 35 undocumented migrants stay there at any given time, mainly families with children that have been denied asylum. At my first visit there, I offered my assistance to the three nuns, and was accepted as child minder, factotum and researcher, and over the last year and half, I have spent longer and shorter periods there amounting to about 50 days.

I got to know the children in the immediate way that one often does, and with time I have also come know the grown-ups. During this time, I have realized how important my relations with the children are for my relations with the parents. Not only as a natural subject of discussion and possible conflict, but also for me to show trustworthy. Families that arrived during the time I have been there have soon adopted me as their friend and discussion partner, actually saying straight out that “well we see that the children like you very much, we see that they trust you, then we do too!”

One case where my relations with children have reflected extra visibly in relations with parents is in the case of a family with an autistic son. For a year, he didn’t show any interest in me, my efforts to come closer to him and his parents were fruitless. This summer then, after a year of repeated visits and a couple of longer stays at the monastery, the boy finally befriended me an evening on the trampoline, and, surely I know that it is not this simple, but I know our new friendship was significant when I the same evening and the coming days had a couple of intimate discussions with his mother. Since then, she is one of the women I speak most often to when I’m there.

I have thought of this in terms of a gatekeeperhood of children. They give me a playful route to their parents, and in that, the children’s trust is key. There are several positive but also problematic implications of this modus operandi. Being the factotum and child minder gave me an opportunity to stay in the monastery and slowly let us get used to each other. The children know that I’m writing a “book” about the monastery and I have had formal drawing and interview-sessions with some of them, but what do I do with the things children tell me about their parents? It has happened several times that children have told me things about what their parents think of other parents or children, or things that have happened to them that are or are not related to my research. One conclusion I can take without revealing things I should not reveal is that the children to a rather high degree are aware of what is going on among the grown-ups and have good idea of why they are there.

Another issue that constantly arises is that of which ‘side’ to be on in conflicts between parents and children. When staying in the monastery for longer periods of time I come very close to their everyday conflicts, as a bystander, as a witness –of the act to be punished, the conflict or both – or even as the object of conflict. It is fair to say that I often don’t agree with the nuns’ and parents’ methods of rearing children and I often whish to object, but I cannot interfere with their rules and undermine their authority, that’s not why I’m there. I have not yet faced a really difficult situation (although I can picture several potential such), and my decision to have ‘my rules’ in ‘my games’, but let parents have their way when present has functioned this far. It is mainly an internal conflict in me than something affecting children, parents or nuns.

Finally, and this may be the most difficult question, what is my responsibility for our relationships? During my time there we have had time to build strong relationships and especially the children wonder why I am not coming more often and staying longer. But what next? Will l leave and never come back when my thesis is written? Hopefully these families have moved out with residence permits and probably others have moved in. But I do believe that I will continue to know some of these children for a long time.

* a lot can be said about the therm ‘hidden’, but this is not the time


A post in Swedish om landstingens riktlinjer angående vård för papperslösa

Update: Sammanställningen är nu uppdaterad med information om lokala riktlinjer vid Varbergs sjukhus.

De flesta av Sveriges landsting har tagit upp frågan om vård för papperslösa, och en stor andel av dessa har antagit någon form av lokal policy i frågan. Många landsting har samarbetat på olika sätt och hämtat inspiration från andras riktlinjer, men ändå är bilden ganska fragmenterad. En del av mitt avhandlingsarbete handlar just om hur landstingen har hanterat frågan, administrativt och politiskt, men även praktiskt, och för att få en tydligare bild av hur det ser ut i de olika landstingen har jag gjort en sammanställning av de riktlinjer och tillämpningsanvisningar som landstingen antagit såhär långt. Det ska påpekas att flera landsting just nu är i begrepp att ta beslut om policyer och en del av denna information kan därför komma att ändras relativt snart.

Sammanställningen baseras på läsning av policydokument, landstingsstyrelse- och landstingsfullmäktigeprotokoll samt främst telefonintervjuer men även mailkontakt med utredare av frågan, men i de fall frågan inte utretts, landstingsråd med ansvar för sjukvårdsfrågor, samt personer med ansvar för asylsjukvård, vårdval eller ekonomi och patientavgifter. De frågor som ställts handlar främst om vad man har för policy, om man tagit fram praktiska tillämpningsanvisningar, hur information om dessa kommunicerats till verksamheterna, och var man inhämtat information i frågan.

Sammanfattningsvis kan sägas att alla landsting utom Jämtland och Gotland tagit upp frågan, och av de som tagit upp frågan har alla utom Kalmar och Västmanland formulerat något slags dokument angående papperslösas tillgång till vård. Dessa dokument kan utifrån sitt innehåll delas upp i tre grupper: de som ”förtydligat lagen”, de som har utvidgat akut vård till att också omfatta ”omedelbart nödvändig vård” samt de som inkorporerat papperslösa i gruppen asylsökande. Den sista gruppen kan vidare delas upp i två grupper där den ena skiljer på ”gömda” och ”andra papperslösa”. Kartan nedan ger en överblick över situationen i de olika landstingen.

landstingens riktlinjer

Landstingen indelade utifrån riktlinjer angående vård för papperslösa, per oktober 2009

Utöver skillnaderna i policy skiljer sig landstingen åt i hur detaljerad man varit i tillämpningsanvisningar samt hur kommunicerat beslutet till verksamheterna. Vissa landsting har tagit fram mycket detaljerade tillämpningsanvisningar för att säkerställa att man inrättat fungerande rutiner och att personalen har kunskap om dessa. På några håll har man ordnat utbildningar för berörd personal eller tagit upp frågan inom ramen för befintlig vidareutbildning trots att ingen policy antagits.

Sammanställningen finns att ladda ned här:

Vård för papperslösa i Sverige

Alla befintliga riktlinjer och tillämpningsanvisningar om vård för papperslösa finns att ladda ned här:

Västragötalandsregionen riktlinjer
Västernorrland protokollutdrag
Västerbotten tillämpningsanvisningar
Stockholm riktlinjer
Sörmland riktlinjer
Skåne Tillämpningsanvisningar
Skåne policy
Sahlgrenska riktlinjer
Norrbotten protokollutdrag
Östergötland riktlinjer

Update: OBS!! Fler riktlinjer finns här!


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