January 29, 2018 maHp News 0 Comments

40 000 words completed: My MA journey with maHp

My MA studies in Migration and Displacement came to a happy ending when I submitted my thesis in March 2017, after one good year of reading, writing and fieldwork.

When I decided to register in 2016, I knew that I wanted to study the relationship between policy and practice in South Africa. But I had no idea that I would be working on South African health systems as my case study. Anyway, as fate would have it, I was granted a scholarship and research funding by the Migration and Health Project in Southern Africa (maHp) courtesy of the Wellcome Trust. I was interested in looking at the experiences and practices of frontline healthcare providers who deal with migrant HIV/AIDS patients in public healthcare facilities. Through my background research and consultation with my supervisor Prof Jo Vearey, I discovered that South Africa had not approved or ratified the Southern African Development Community (SADC) Framework for the Control of Population Mobility and Communicable Diseases. This, coupled with a lack of nationally coordinated strategies to ensure treatment continuity for chronic conditions creates a gap in clear policy, standardized guidelines and systems of patient referral to harmonize and better coordinate HIV treatment (antiretroviral treatment (ART)) in South Africa and the SADC region as a whole.

This became my entry point. I was intrigued by what this meant for mobile populations in South Africa. So I chose two research sites, Johannesburg and Musina. I also created a blog titled 40 000 Words To Go which was meant to serve as a platform for me to share my experiences and interim findings. I conducted qualitative research in which I observed and interviewed providers working in primary health care facilities at these two sites. I wanted to hear what they had to say on their own terms and to complement the literature on migration and health, which has, to a large extent, focused on the perspectives and experiences of patients. While this is indeed laudable, the unfortunate result is that the voices of providers get lost in the emerging narratives. For example, because of this bias, we know more about the idea that providers are xenophobic than we do about the work structure and environment of providers, and how it influences the practices they resort to when dealing with patients. This creates a parochial concept of medical xenophobia that does not give due diligence to the fact that the public health care system is in itself struggling. This thesis is quick to discount the reality that we should also try to move towards a conceptualization of migration and health that acknowledges the symbolic violence that users and providers experience as a result of a state that has not adequately responded to migration. In other words, a systems approach may enhance our interventions, than simplistic ones that are merely aimed at addressing attitudes.

What is also missed in the extant literature, I found, with a few notable exceptions, is the fact that providers in both contexts have come up with innovative practices to make up for the state’s failures to address incompatible and unharmonious systems. For example, providers register patients using their date of birth if they are undocumented. The current patient registration system does not make a provision for such circumstances. They also come up with all sorts of lingua franca in order to address communication barriers related to differences in language because South Africa currently has no formal on-site interpretation services. Where they are to be found, they are often sponsored by NGOs who, due to the precarious nature of their funding, can only do so much over a particular period of time. These are just a few examples that came from my study.

…For the rest of this post visit Kuda’s blog: 40 000 Word To Go.

About Kuda Vanyoro

Kudakwashe Vanyoro is a Postdoctoral Research Fellow at the African Centre for Migration & Society (ACMS), University of the Witwatersrand, in South Africa interested in migration, temporality, borders, humanitarianism and governance in Africa. His doctoral research explored how temporal disruptions at international borders shape (im) mobile bodies’ experiences and modes of waiting by focusing on irregular Zimbabwean migrant men at the Zimbabwe-South Africa border who have arrived in South Africa but are restricted in moving further into the interior. Through this inquiry, his work reveals how waiting is a component of both governing Zimbabwean migrants as well as seeking agency through the relationship between time, space, and humanitarianism in the Zimbabwe-South Africa border regime. He has also been conducting research uptake work for ACMS since 2014. As part of this role, Kudakwashe is responsible for stakeholder engagement in South Africa and is regularly called upon to brief decision-makers in government and civil society, including the creation of synthesis documents and other communication products to make evidence more accessible and applicable.