Ndlovu - FINAL - Feb 19 20 Correspondence Address: Duduzile Ndlovu, African Centre for Migration & Society, University of the Witwatersrand, P.O. Box 76, Wits 2050, Johannesburg, South Africa; Email: duduzile.ndlovu@gmail.com ISSN: 1911-4788 Volume 14, Issue 1, 166-168, 2020 Creative Intervention The Migrant Nurse Dilemma DUDUZILE SAKHELENE NDLOVU University of the Witwatersrand, South Africa ⁠I am a nurse1 I work with pregnant women I moved here in August2 ⁠ I just wanted exposure There we are still behind It’s a challenge with foreigners Check the passport Proof of residence In case she has a problem I take them even if it’s not valid They are pregnant Send her away? She collapses? Last week this other lady came She could see, we could see it’s not her It’s your sister’s passport? Now your sister is on ARVs ⁠3 Another one’s passport expired in 2012 I just said, “Hey, go to Home Affairs, You’ll come back on Wednesday” I know she won’t 1 Poetic transcription of an interview conducted by Becky Walker in 2015 with a professional nurse as part of a study funded by MRC/DFID/ESRC/Wellcome Trust Health Systems Research Initiative (MR/M002160/1) through a Wellcome Trust Investigator Award. I was involved in the fieldwork for the study. 2 From another province in South Africa. 3 Anti-retroviral therapy for HIV infection. The Migrant Nurse Dilemma Studies in Social Justice, Volume 14, Issue 1, 166-168, 2020 167 I go home I sleep stressed End up in a dilemma What do I do with this person? Someone who is pregnant I even asked from Home Affairs ⁠4 Give me something so that I am safe Nothing… Even if there was a protocol, Human Rights are not specifically for South Africans I don’t even know the policy I am looking for How should I treat the foreigner? If she doesn’t have a valid passport She’s a human being Context I wrote this poem based on the transcript of an interview between a researcher and a nurse at a primary health care center in Johannesburg, South Africa. I assigned the anonymised transcript to a graduate research methods course for students to practice qualitative analysis. All the students presented in their analysis the conclusion that the nurse was xenophobic, and none engaged with how the nurse grappled with mixed feelings over her xenophobic actions. The poem emerged initially with the intention to reflect on the health care encounter from the perspective of the nurse: a migrant, black, South African woman providing care for migrant, black, non-South African women. The poem brings out the nurse’s mixed feelings and how she experiences her location. As a nurse she has “power” to decide to grant or bar people’s access to health care, but this choice is not without complexity. She finds herself torn between her professional role as a nurse representing institutional policies and regulations (which are not always clear) and her position as a fellow human being providing health care to others with whom the caring relationship is structured by national borders. The nurse expresses a sense of powerlessness regarding the legal provisions that are not clearly spelt out, and a moral dilemma as she recognizes that despite nationality the patients are equally human. On the other end of these ambiguously interpreted regulations and the nurse’s moral dilemma, migrants are forced to develop different strategies to navigate difficult challenges accessing health care, even though the World Health Organization (WHO) considers health care a right for all, and international law provides for migrants’ access to health care (Hanefeld et al., 4 The South African Department of Home Affairs. Duduzile Sakhelene Ndlovu Studies in Social Justice, Volume 14, Issue 1, 166-168, 2020 168 2017). This right is protected in the South African constitution, but is not clearly outlined in either the National Health Act or the Immigration Act (Ncumisa, 2018). The result is a grey area in which many migrants experience challenges accessing health care, while health workers may also experience frustration over the lack of guidelines for how to deal with non- South African patients. This grey area in the legislation has also sometimes led to some government officials issuing unconstitutional circulars to health centers, for example, incorrectly directing migrants to pay for services, which presents a huge barrier for many who cannot afford to pay (e.g., see Vearey, 2014). The situation in South Africa is also underscored by widespread xenophobic perceptions of migrants who are often seen as a burden to the health care system (see Clifford & Hazvineyi, 2019; Crush & Tawodzera, 2014). References Clifford, C., & Hazvineyi, L. (2019, January 29). ANALYSIS: Are South Africa’s public hospitals ‘overburdened’ by foreign patients? Retrieved 25 October 2019, from Africa Check website: https://africacheck.org/2019/01/29/analysis-are-south-africas-public- hospitals-overburdened-by-foreign-patients/ Crush, J., & Tawodzera, G. (2014). Medical xenophobia and Zimbabwean migrant access to public health services in South Africa. Journal of Ethnic and Migration Studies, 40(4), 655–670. Hanefeld, J., Vearey, J., Lunt, N., Bell, S., Blanchet, K., Duclos, D., … Adams, J. H. (2017). A global research agenda on migration, mobility, and health. The Lancet, 389(10087), 2358– 2359. Ncumisa, W. (2018, January 7). Ensuring health and access to health care for migrants: A right and good public health practice. Retrieved 25 October 2019, from https://www.sahrc.org.za/index.php/sahrc-media/opinion-pieces/item/1422-ensuring- health-and-access-to-health-care-for-migrants-a-right-and-good-public-health-practice Vearey, J. (2014). Healthy migration: a public health and development imperative for south (ern) Africa. SAMJ: South African Medical Journal, 104(10), 663–664.