Jenny’s Pennies

(My post for Bloggers Unite for Human Rights)

Today, bloggers all over the world are joining together to blog for human rights. And there is certainly no shortage of subjects to chose from when it comes to this issue - there are huge human rights problems in the world today. But today I’ve decided to keep blogging about an issue closer to (my) home: the treatment of undocumented migrants in Sweden when it comes to health care. For background information, you should read this post from a few days ago.

PICUM, the Platform for International Cooperation on Undocumented Migrants, wrote in their report “Access to health care for undocumented migrants in Europe” (2007):

The absolute lack of entitlements as well as the inexistence of any publicly funded reimbursement scheme to cover expenses incurred by hospitals for providing health care to undocumented migrants has led to numerous and serious consequences for undocumented migrants’ health. Similarly, it has put enormous pressure on health care providers and civil society organizations. Undocumented migrants constitute one of the most vulnerable groups in Sweden and failure by the Swedish government to recognize their presence and their very basic health needs contributes largely to their stigmatization and discrimination. Very few undocumented migrants attempt to approach health services in Sweden and most of them find numerous barriers against accessing appropriate health care. In the framework of a survey conducted by Médecins Sans Frontières in Stockholm from July to September 2005, 82% of undocumented migrants who had sought health care reported to have encountered barriers against access. They reported barriers such as being turned away by administrative staff at health care centers as well as indirect obstacles like the high costs of consultations and medication, the feeling that they were not entitled to access health care and the fear of approaching the services and being reported to the authorities.

The whole report in pdf-format is available at PICUM’s website.

According to Tobias Billström, Sweden’s minister for migration, the proposed new legislation seeks to address the issue of lack of regulation of health care rights for asylums seekers. In a reply to Maceij Zaremba’s article (referenced in the post a few days ago), he writes that the new legislation won’t limit the rights to health care to undocumented or “hidden” migrants and refugees any more than it does today: they will still be able to receive immediate and emergency care. (What he fails to mention is that they have to pay full price for that care.)

To formalize and regulate what rights asylum seekers have is all fine and well, but after that Billström’s reasoning starts to get really shady. It becomes all too clear that the government really wants to send a signal, and that being refused health care is seen as a proper punishment for being in the country without the correct papers. He writes (my translation):

It is not so easy as to say that everyone, no matter if they have the right to be in Sweden or not, should have the same rights. The person who comes here as an asylum seeker but is denied asylum after a due process shall return to their home country. The person who has never been interested in applying for asylum but comes to work illegally, hasn’t followed the laws and rules which applies to everyone else in Sweden. Should they then have the same rights as those who follows laws and rules and pays taxes?

Maceij Zaremba puts is perfectly in his reply, where he writes:

I don’t know if it is populism or ingenuousness that guides his pencil when he asks why those who doesn’t obey the law should have the same rights as the law-abiding. Doesn’t he know that in two areas (health care and judicature), blind equal treatment is necessary for our view of humans not to go rotten. Or does he mean that those who cheat on their taxes forfeit their right to a fair trial?

The example isn’t mine, but UN special rapporteur Paul Hunt’s, who tried to teach the government the principal difference between the right to housing allowance and the right to health and justice. If the latter are conditional, then democracy is corrupted.

(emphasis mine)

That my government wants to sort people at the hospital entrance is shameful. Even more shameful is that they expect the doctors and nurses to stand there at the door and send those not worthy away. When someone without the correct paperwork comes in to a health care clinic, my government expects the doctors and nurses to betray their profession and the medical ethics, and show them the door. Luckily, the medical community is fighting back. In the face of a law which expects them to break UN conventions and their medical oaths, medical personnel and health care civil servants are coming up with new and creative ways to ensure that undocumented migrants and hidden refugees are given access to a most basic human right: the right to life and health. And that right, Tobias Billström, cannot be forfeited by being here without the correct papers.

More information in Swedish:
Rätt till vård-initiativet
Vård för alla
The Facebook group Rätt till vård had about 30 members when I joined after reading Zaremba’s article May 11th. Now there are more than 2000 members! On Sunday May 18th at 2pm there is a protest outside the parliament building in Stockholm in support of equal right to health care. Read more here.

Usually I’m glad to be Swedish. Not proud, because I don’t understand why I should be proud of a coincidence, but yeah, glad. And we have a pretty good reputation around the world. It’s the inheritance of the Olof Palme years - that solidarity with the poor, the oppressed, the hungry and the exploited. Many still view Sweden as a country which stands for those values.

And among our own population, many still believe that we are the good-hearted, although they don’t see it as a good thing. “We can’t take care of everyone!” they whine. But those of us who are based in reality, we know that we aren’t taking care of everyone. We aren’t even taking care of those who we are obliged to take care of.

But for those who still lives with the delusion that Sweden is a compassionate country who cares about the less fortunate, we are getting ready to “send out new signals” and take that belief out of them. This is one of those times when I’m not happy to be Swedish. I’m ashamed and sad.

The subject is health care for asylum seekers and undocumented migrants. New proposed legislation says that the only health care they have a right to is emergency treatment, maternal care, abortion care and contraceptive advice. (Unless they are under 18, in which case they have the same rights as Swedish citizens does). And even if they have a “right” to this health care, they still have to pay full price for it: a delivery will cost 21.000 SEK, a broken leg 63.000. In the future, your rights as a patient will depend on what criteria you fulfill. Some will be able to get maternal care, some don’t. If you fall under paragraph four you will get your heart medication, otherwise you’re on your own.

Maciej Zaremba writes about this shameful legislation in today’s Dagens Nyheter. It’s a long article, and for once, I’m completely with him - every single word along the way. A piece (my translation):

In August 1920, my father stood in a tent outside Warsaw. He stitched abdomens together, applied bandages and amputated legs. Narcosis was unheard of, so both doctors and patients had to do with alcohol. The summer was hot, flies were feasting in the open wounds, corpses turned black before they were buried.
It was, you need to say, horrible sights. But in one respect less offensive than what is going on in Rosenbad*.
Most of the bodies that my father tended to were illegally in the country. They had neither visa, nor the four digits**. Soldiers in an invading army are as undocumented as anyone can be. But they were tended to in the same way as those people that they had just tried to kill.
Because for a doctor, meant my father, there are no fellow countrymen or enemies, legals or illegals. There are only patients.

That is the principle that minister for migration Tobias Billström now wants to change. It is impractical, according to Billström. “Sends the wrong signals”, he has said. By which he means that if a pregnant Iranian who has been denied asylum are given maternal care, she will immediately start to think that she is welcome to Sweden. Wrong signal! But if she is denied help and has a miscarriage, the voice of Sweden will sound clearly. Won’t be able to misunderstand. Same thing with a hidden Afghan who will see his cancer grow freely. The tumour becomes the right signal: that a no from the Migration Board really is a no.

Read read read!

Sweden is, together with Austria, the worst offender in Europe when it comes to equal treatment in health care. This according to PICUM, The Platform for International Cooperation on Undocumented Migrants. No other countries have come up with the idea of using illness and injuries as a political signal, of thinking that sickness and maybe death is a proper punishment for failing to adhere to the authorities’ request that you should leave the country.

But there is opposition. To treat people differently depending on their legal status is not in adherence with the medical oath, and the Swedish Association of Health Professionals have said that their members will act according to the UN Convention: they will do their job no matter what background the patient has. A spokesperson for the Swedish Medical Association has called the law “disgraceful” and states that doctors won’t be able to adhere to it. And Region Skåne (the region in southern Sweden) decided almost unanimously (only xenophobic party Sverigedemokraterna were against) that asylum seekers who are hiding and other undocumented/uninsured patients have a right to health care, no matter their ability to pay for it.

The “Right to health care“-initiative is started by a large number of organizations who thinks that Sweden shouldn’t break the human rights conventions that we have signed by denying health care to undocumented immigrants.
There is also a Facebook group for the initiative (requires login).

The proposed law is supported by the Moderates, the Social Democrats and the Center Party. The Left Party and the Greens are against it, the Christian Democrats and the Liberals are undecided. On the regional/local level, Sverigedemokraterna (populist xenophobes) are of course for it - they also think that undocumented children should be denied health care, unless they have some contagious disease that could affect a real Swede.

If this goes through, it shatters the last shivering remains of the image of Sweden as a just society, where people are of equal value. But what does that matter, as long as we are sending out strong signals, right?

It’s truly sickening. Luckily, I’m a citizen with all my papers in order, so I can go see a doctor for my nausea.

*The Swedish government building in Stockholm.
** The four unique digits in the personal number given to every Swedish citizen.

People who say that if we outlaw abortion, it just goes away and a lot of lives are saved, should really, really read this:

Figures show that 10,000 women die every year in Nigeria from unsafe abortions, carried out by untrained people in unsanitary conditions.

That is 27 deaths every day.

According to the US-based Guttmacher Institute, that is one sixth of the total number of women who die worldwide from such procedures.

In Nigeria abortion is illegal unless the life of the woman would be at risk if she were to give birth.

But the Guttmacher Institute estimates that more than 456,000 unsafe abortions are done in Nigeria every year.

Some women go to traditional healers to terminate their pregnancies.

Methods include trying to break the amniotic sack inside the womb with a sharp stick. This causes infection and in extreme cases the tissue inside the body can start to die.

“They’re pulling out intestines,” says gynaecologist Dr Ejike Oji, of Ipas, an international organisation working to secure reproductive rights for women.

Another method is to pump a toxic mixture of fiercely hot Alligator chilli peppers and chemicals like alum into their bodies.

“The women go into toxic shock and die,” Dr Oji said.

Pro-life my ass.

Via Feministe.

Very interesting product which may help solve some of the problems raised in the previous post!

A Swedish company called Peepoople (cute name!) has developed a self-santizing single use biodegradable toilet - the “peepoo bag”. The concept is simple: you do your business in the bag, seal it, and it will be odourless. The contents of the bag are hygienized within a period of 2-4 weeks by a mix of chemicals which inactivates the dangerous pathogens (i.e. the bacteria which spreads stuff like cholera and dysentery). The bag can be thrown away or the contents used as fertilizer, which makes the bag have economic value and opens up the possibility of small business systems to develop. Trials are on their way in Kibera, a giant shanty-town in Nairobi, Kenya. Very cool innovation and a great idea!

Peepoople website (in English).

(Quote in title from Gil Stern)

Tomorrow, March 22nd is World Water Day. Water is one of those things you often don’t reflect over, if you live like me. It’s just there, when you turn on the faucet. You bathe, wash your clothes, do dishes, water your lawn or plants, flush the toilet… it’s just there. But for about one in six people in the world, getting water is not that easy. Water is one of the most pressing issues when it comes to global environment and climate change, and water shortage and water access disparities can lead to mass migration, epidemics and conflicts in the future.

The world market price for water has never been as high as it is now. To collect, clean and distribute water takes a lot of investments. Before, it was taken for granted that the government would handle the water. Water is, after all, a public good and something that everyone should have the right to. But today, water distribution is increasingly privatized by multinational corporations like Suez, Veolia and RWE, although not to the extent that was believed in the 90s. Today, 5-10 percent of the world’s population buy their water from private companies. Some private corporations even own the rights to the rain falling from the sky. As I said above, it is expensive to collect, clean and distribute water. And I don’t trust private corporations, whose foremost goal is to make profit, will build the infrastructure necessary to distribute water in very arid and poor areas - there is not enough money to be made from that. Therefore local, public, democratic solutions are needed.

In El Salvador, privatization of the water distribution has lead to that many poor people doesn’t have access to clean drinking water. The pipes are there, but the water is not on. Therefore, many have to buy their water from tank trucks, without knowing where the water comes from. A woman who works seven days a week selling vegetables at the market lay up to half of their salary on buying water. Of course, some people can’t afford that, so they are stuck with polluted water from rivers and lakes. The child mortality rate in El Salvador is 30 percent, most of those from water related diseases such as diarrhea. It is estimated that by drinking water, a person in El Salvador consumes one cup of human faeces per year (yes, that is gross, but it’s the reality). Last year, many people demonstrated against the water privatizations, but the demonstrations were brutally cracked down and some participants were accused of terrorism.

In China, a 50 year old dream of Mao’s are now being realized - to build a gigantic pipeline system to lead water from the Yangtzee river in the south to the arid areas in the north. Of course, Beijing needs reliable water supply for the Olympics (to give the Olympics to China seems like a worse and worse idea every day), so villages in the south, who themselves doesn’t have enough water to sustain industries like wheat farming and fishing, are forced to send their water up north. One in four people in China are lacking access to clean water.

Two thirds of the world’s population is expected to run short of clean drinking water by the year 2025! And the thing is, there is really is enough water. Mismanagement, waste, pollution and uneven distribution is the problem, not supply. We in the rich countries can’t keep watering our golf courses or waste liter upon liter doing dishes in running water (I confess to being guilty of that). I’ve been for extended periods in countries with water shortages (Venezuela and Israel), and being able to shower in hot, clean, constantly running water when I got home was a delight. I don’t want to loose that, but then we need to find solutions to the world’s escalating water crises and that probably means giving up some of our unreflecting attitudes towards water usage.

To learn more:
Food and Water Watch
Water Partners International
Vattenportalen (Swedish)
UN Water
Stockholm International Water Institute

Outsourcing is normal in today’s globalized economy. But now the global south are not only offering services such as customer support and low skilled assembly work to their wealthier counterparts. From the New York Times:

An enterprise known as reproductive outsourcing is a new but rapidly expanding business in India. Clinics that provide surrogate mothers for foreigners say they have recently been inundated with requests from the United States and Europe, as word spreads of India’s mix of skilled medical professionals, relatively liberal laws and low prices.

Yes, it’s wombs for rent. For about 25.000 US dollars, you get payments for the surrogate mother, medical procedures, plus plane tickets and hotel nights for two trips to India, one for the fertilization and one for collecting the baby. The egg donor and the surrogate are different women, as it is said to be less likely for the surrogate to bond with the baby if there is no genetic connection.

The surrogacy business in India has made a sharp upturn in the last years, and people in the business are afraid that less scrupulous providers will smell the money and leave ethics aside.

The Ministry of Women and Child Development said in February that it was weighing recommending legislation to govern surrogacy, but it is not imminent.

An article published in The Times of India in February questioned how such a law would be enforced: “In a country crippled by abject poverty,” it asked, “how will the government body guarantee that women will not agree to surrogacy just to be able to eat two square meals a day?”

Some people might argue that we should view this as any business transaction, but I’m not at all comfortable with the idea of viewing reproduction as a commodity, especially when there is such huge power differentials in play.

“Surrogates do it to give their children a better education, to buy a home, to start up a small business, a shop,” Dr. Kadam said. “This is as much money as they could earn in maybe three years. I really don’t think that this is exploiting the women. I feel it is two people who are helping out each other.”

Mr. Gher agreed. “You cannot ignore the discrepancies between Indian poverty and Western wealth,” he said. “We try our best not to abuse this power. Part of our choice to come here was the idea that there was an opportunity to help someone in India.”

In the Mumbai clinic, it is clear that an exchange between rich and poor is under way. On some contracts, the thumbprint of an illiterate surrogate stands out against the clients’ signature.

This kind of globalization makes me very uncomfortable, and I think the practice should be examined with a critical eye. That does not mean that we should pass judgment on the persons on either side of the transaction - the couple who can’t conceive for whatever reason (Mr. Gher and his partner who are featured in the article are gay), and the woman who by carrying someone else’s baby can make a lot more money than she would on a normal job.

But there are so many issues here: what if the surrogate changes her mind? What if the couple changes their mind? What if the surrogate mother wants out? In India, this is regulated with contracts, but once again we have to look at the wealth and power differential here. As far as I can tell from quickly researching the subject, in the US, while surrogacy may not be illegal, contracts relating to it have been declared unenforceable. In Sweden, surrogacy is illegal, while in neighboring Finland, it’s legal. However, no money is allowed - the surrogate is doing it for altruistic reasons.

One thing which also makes me uncomfortable about the whole thing is that one reason why Indian surrogates are increasingly popular (besides the relatively cheap costs, good medical professionals and favorable legislation) is that Indian women are easier to “police”. As it says in the article:

Dr. Naina Patel, who runs the Anand clinic, said that even Americans who could afford to hire surrogates at home were coming to her for women “free of vices like alcohol, smoking and drugs.” She said she gets about 10 e-mailed inquiries a day from couples abroad.

Just how much say should the couple using the surrogate have to say over what the surrogate mother does to her body? You’re using her womb, yes, but the whole body is affected by the pregnancy, and so is the mind. No drinking, smoking or drugs during pregnancy - perfectly fine and reasonable of course, but what else can you compel the surrogate to do? I think with this international reproductive outsourcing there is more potential for abuse and for using the power/money leverage to make unreasonable demands.