Immigrant Visions & VoicesA Photovoice Exploration of Health in Santiago, ChileJustin Trop and Professor Mellissa Withers

IntroductionProject

Development

Photovoice

Results

Conclusions

Keck School of Medicine of USC, August 2017

Introduction• Migrant vs. immigrant

• Immigration in Chile

• Research need

• Project objectives

Background

Our Aims

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Source: Google Maps2

Background• In June 2015, the estimated number of

immigrants in Chile was 441,529 (1).

• The majority are from Latin American countries (1).

• Approximately 2/3 live in the Metropolitan Region of Santiago (MRS), the location of Chile’s capital (1).

• Recoleta is the district with the 3rd largest number of immigrants in the MRS, after Central Santiago and Independencia (2).

(1) International Organization for Migration (2015). Migrant Life in Santiago de Chile: IOM Study. https://www.iom.int/news/migrant-life-santiago-de-chile-iom-study. (2) Centro Latinoamericano para el desarrollo Rural (2014). Estudio y Diagnóstico del colectivo de Migrantes de la comuna de Santiago.(3) Departamento de Extranjería y Migración en Chile (2016). Migración en Chile 2005-2014.

(3)

(Percentageofthetotalpopulation) (Totalforeignresidents)

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Our Aims

Upon arriving in a country of reception, immigrants may experience a particular vulnerability that when compounded by a series of immigration-associated challenges can negatively affect their health and well-being.

Explore the immigrant experience as a social determinant of health.

Identify the health needs of a specific immigrant community in Santiago, Chile.

Contribute to raising awareness and sensitivity among community stakeholders regarding immigrant health and well-being.

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Specific Objectives

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Development• Collaboration among

academic institutions,

local government, and

community members

Timeline

OurParticipants

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Timeline PROPOSAL, ETHICS APPROVAL, REACHING OUT

PLANNING AND REVISION

EXECUTION OF PHOTOVOICE

May 2016 October 2016 February 2017 July 2017

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Our Participants

• 11 immigrants living in Recoleta: 8 women, 3 men

• Between 18 and 48 years old

• Time living in Chile: from 9 months to 17 years

• Countries of origin: Peru, Colombia, Bolivia, Ecuador, Haiti, and the Dominican Republic

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Photovoice• Participatory research

method• Community members

express their voices through their own photography and narrative

• Representation of and reflection upon important and relevant themes

• Often used among vulnerable populations

Process Overview

Workshop Preview

Individual and Group Meetings

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Origin of Photovoice

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• Developed by Caroline C. Wang and Mary Ann Burris for a study of reproductive health needs of women in rural China.

• The women participating presented through their photography and narratives much broader perspectives regarding their needs and concerns than those only limited to reproductive health.

• These results demonstrated that photovoiceplaces the power in the hands of the participants, allowing them to define and represent what they feel is important.

Why Photovoice?

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• A VOICE FOR COMMUNITIES: this method is often used among marginalized and/or vulnerable populations that otherwise may not have a chance to express their voice

• EMPOWERMENT: participants are protagonists, their knowledge and experience lying at the center of the process

• INSIDER ACCESS: because participants have their cameras 24/7, they are able capture unique moments that we would never be able to access as researchers, for example, conducting an interview

• COMMUNITY CONVERSATION: during the process of taking photos, participants talk with their neighbors, friends, family, etc., stimulating conversation about themes related to project

• ARTICULATION OF NEEDS: participants develop their capacity to use photography and narrative to identify and advocate for community needs

• ABILITY TO REACH STAKEHOLDERS: the sharing of photos and narratives can sensitize and impact stakeholders in a profound way

Process Overview

WORKSHOPProject introduction,

learning about photovoice, and review of basic photography

techniques.

PHOTOGRAPHYCarried out in the

field, i.e.,in the community, by participants.

NARRATIVESSelection of photos and writing of narratives, participants together

with the facilitators in individual meetings.

MEETINGSReflection upon and

analysis of photos and narratives through

individual and group discussion.

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RESULTS

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ResultsCategories

Photos and

Narratives

• Analysis of the photos and narratives

• Includes the following: • Selection process• Writing of narratives• Categorization• Discussion

Key Points

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Categories 1. Health Care2. Basic Needs3. Adaptation as a Migrant and Social

Integration4. Social Relationships and Support

Networks5. Stigma and Discrimination6. Social Vulnerability7. Environment8. Aspirations

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Photos and Narratives

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Some time ago, my daughter got sick, and we received thenecessary medical care for her recovery. I felt good, becauseregardless of our insurance status and financial situation, shereceived treatment. This was a huge relief and made me feelthat health professionals care about saving lives and are notsolely interested in money. I was worried that they would nottake care of her, and we were very distressed by her symptoms.My wife and I had to ask what to do, because her papersweren’t complete. I hadn’t registered her in the publichealthcare system at the local clinic, because initially I didn’thave the necessary information, and once I did, I still didn’t doso. Thus, when she got sick, I was extremely worried, but itgave me peace of mind to see the good care that she received.

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One night there was a fire in a building where many familieslive together, and it made me reflect upon the fact that not allof us are fortunate enough to be able to have our own house.Generally, we must share a room with someone whom wedon’t know, as it’s our only option. Usually as migrants, wehave to look for cheaper places, and many take advantage ofour lack of familiarity with the currency and living conditions,because we are new here. The houses generally aren’t in goodcondition, and the rooms that the landlords construct insideare of poor quality. Where I live, there are five families in thehouse. It’s not very pleasant to be among so many people,because we all need some personal space and comfort. I havebeen looking for a more comfortable place, searching for otherhouses, but I haven’t found one. They are very expensive, sowe don’t have any other choice but to stay where we are.

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I want to show the long trips that I have to takealmost every day in the metro. I carry mybackpack with me, and it’s very heavy. Often, Ihave to set it down to rest a bit, but doing soworries me. If I were to lose it, I don’t knowwhat I would do, because everything that I ownis in there. The yellow line in this photosymbolizes the sensation of restriction that wefeel as migrants in Chile. There are so manyrules and regulations that we must complywith, and if you don’t, there is a price to pay. Inthis situation, the bureaucracy’s monetaryinterest, for example in collecting fines,supersedes any attempt to understand thereasons behind a failure to comply (the highcost of documentation procedures, theexcessive paperwork and red tape involved inthe process, etc.). This situation makes me feelalways like an “outsider”, “not a citizen”, andalso “vulnerable”, because I can neithercomplain nor demand that they respect myrights. If I were to do so, I could bereprimanded by the authorities. They treatforeigners differently than Chilean citizens.

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Seeing my room like this fillsme with positive feelings,making my days happier,because every small detailhas meaning. They are giftsfrom my friends and family.When I left my country andarrived in Chile, I began tomiss them. Obviously, I wasmissing them a lot, but atthe same, each word orexpression of support thatthey shared with me gaveme the strength to continuemy life in Chile and not bebrought down by thesadness.

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Skin color at times limits not only employmentopportunities, but also affects you when you areout in public. Many people don’t know how it is,how people treat you in the street: some insultyou, they get angry...It’s difficult to hear “youdirty black” or “what are you doing here stealingwork from the Chileans”. It hurts. It makes youwant to cry, and you feel like they kicked you.You feel like garbage. When this happens, youask yourself, “What am I doing in a place where Iam not wanted?” It would be good if everyonerealized that our social environment candramatically affect our health too. Not everyonediscriminates like this. There are also people inthis country who are sincere and compassionate,caring about fellow human beings regardless ofwhere they’re from. People should realize that ifthere wasn’t a need, we wouldn’t leave ourcountries to come to Chile. Right now, there is alot of migration, and thus racial and culturalmixing will inevitably occur.

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This photo deals with the theme of intimatepartner violence, rape being the specificword in this case. It happened to her, andinitially she avoided talking about it,because at the time, her parents were veryconservative. Eventually, she had thecourage to face what had happened, toovercome her pain, and to move forwardwith her life. I took this photo, because Iwant people to understand that it is verydifficult psychologically to recover fromsomething like this. You say “it happened along time ago”, but in reality, something likethis marks you and stays with you for life.Not any woman can recover and moveforward with her life. One has to continuefighting. She decided to move from anothercountry, recover, become a parent, and dealwith her pain once and for all. In thisprocess, you have to go out and make a lifefor yourself. Never isolate yourself, andactively look for ways to recover. Migrationmade her stronger and was part of thisjourney.

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I decided to take this photo since itshows how people living in the streetsor even those who have their ownhomes don’t put out their garbageproperly. The piles of trash don’t lookgood, and when the people living inthe area open their doors or windows,the smell is very unpleasant. Thissituation creates tension amongcommunity members. Additionally, onecan note a lack of solidarity and prideamong them for the place where theylive. There are people, both migrantsand Chileans, who are homeless andlive in the streets, and some of what isthrown out could in some way beuseful to them. I think that thereshould be greater consciousnessregarding the things that we decide tothrow in the street. There could beanother solution, for example givingthe reusable things to people whoneed them most; in this way, we couldavoid this situation.

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All of us have goals ashuman beings. As migrants,upon arriving in thiscountry, we want to have abetter life. When we have agoal, it doesn’t matter if thejourney is difficult. We can’tgive up. We have tocontinue looking forhappiness. Many migrantscome, because they seek agood job and a place to live.At the beginning, it’s verydifficult – the form ofspeaking, the environment,the culture. It’s hard for allof us to get accustomed tothese things, but it is alwayspossible to take the rightpath and continue movingforward. A better life is alsoa life without violence andin which money is not aproblem.

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Key Points• Many immigrants come with the dream of

a better life for themselves and their families, and although difficulties exist, one perseveres.

• Support networks facilitate the process of integration and adaptation to life in Chile. These networks help individuals to find work and housing and obtain valuable information in addition to providing emotional support. Without such networks, the experience of loneliness can be very potent.

• When an immigrant arrives in Chie, he/she may find it difficult to satisfy basic needssuch as work and housing due to social, legal, and economic barriers.

• Discrimination manifests itself in various forms (insults, exclusion, physical violence) and contexts (public areas, workplace, housing).

• The experience of discrimination has a profoundly negative impact on mental health.

• In terms of health care, there is variability in experiences. Although some immigrants have received good medical care, others report bad experiences.

• Some key factors which influence access to health care include economic situation, ability to communicate in Spanish, support networks, information, and documentation status.

RESULTS

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Conclusions

Initial Recommendations

• Immigrant experience as a social determinant of health

• Dependent on what conditions are encountered in the country of reception

• Psychosocial stress, especially chronically, can be harmful to health and well-being

Acknowledgements

Next Steps

Challenges

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Initial Recommendations

Implement strategies to promote the fulfillment of immigrant rights in the realm of work and housing.

1 2Establish and fortify support networks for immigrants, especially at the community level (local government, organizations, religious institutions).

3Enhance information dissemination to immigrants regarding their rights and offer basic orientation regarding establishing oneself in Chile.

4Create immigrant offices at the local government level, with the goal of facilitating immigrant integration and adaptation.

5Implement educational programs in schools that are sensitive to language and cultural differences and promote an inclusive society.

6Consider multiculturality and include community members in the development and implementation of relevant policies and programs.

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Challenges

RESOURCE INTENSIVE

COORDINATION

AVAILABILITY RECRUITMENT

COMMUNITY CONNECTIONS

ETHICS CONSIDERATIONS

ADAPTABILITY

MANAGING CONFLICT

UNFAMILIAR TERRITORY

Acknowledgements

Professor Lourdes Baezconde-GarbanatiYaneth RodriguezRosa Barahona

Jacqueline Cerda CórdovaGina Milena Correa AtenciaDr. Óscar Arteaga HerreraProfessor Fanny BerlagosckyProfessor Ana María OyarceProfessor Leonel ValdiviaThe Administration

Department of Health: Dr. María Eugenia Chadwick, Ynga VillenaMigrant and Refugee Program: Delia Rosaura Curahua Huerta,

Luis Valenzuela, Jaime Encina, Rodrigo AdasmeThe Migrant Organization of Recoleta

Dean’s Research Scholar ProgramLarissa Puro (USC Institute for Global Health)

Participants:• Shirley Haydee Rodriguez Landaveri• Rebeca Iris Huerta Campoblanco• Marita Yoana Valverde Sanchez• Elizabeth Espinosa Lastra• Filomena Valer Lopez• Jhonatan David Villarroel Ojeda• Sandra Patricia Campaz Vergara• Yessica Rivas• Teresa Lorenzo Maldonado• Saúl Arroyo Languidey• Vincent Emmanuel Jean Clemaque

Advisory Board:• Joseph Reynol

Duperval• Elena Morote

Durand• María Natividad

Rivera Flores

Volunteers:• Geraldine Alejandra

Ortiz Padilla• Danny Andrés Durán

Allende• Vanessa Muñoz

Villanueva• Ignacio Esteban

Martinez• Leonardo Jose

Somana Diaz• Isaías Gad Sarmiento

Padilla• Victoria Patricia

Sevilla

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