3rd Australian Conference on Quality of Life

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3rd Australian Conference on Quality of Life

• Stonnington House, Deakin University,
• 16th Nov 2001
• Session 3 (B) Conceptual Issues in QOL
• Liz Eckermann Violent scatterings and QOL

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Research project 2001-4

• Perceptions of violence in two groups of war
  refugees -the Hmong (from Laos) and the Nuer
  (from Southern Sudan)
• Similarity and Diversity within and between these
  two groups.
• Continuity between collective violence and
  domestic violence?
• Produced by war experience and poverty or other
  political, social religious, economic or cultural
  factors?

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Research team

• Professor Bruce Wiegand, University of Wisconsin,
  Whitewater (deceased)
• Assoc Prof Sharon Hutchinson, University of
  Wisconsin, Madison
• Assoc Prof Pranee Liamputtong Rice, La Trobe
  University
• Assoc Prof Liz Eckermann, Deakin University

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Policy and implementation implications

• How appropriate are health services in the host
  countries, Australia US, to meet the needs of
  these two groups of refugees?
• Tension between universalism and cultural
  relativity, or universalism and economic and
  social relativity?
• Challenges for cross-cultural measurement of
  quality of life.
• Implications for Afghani, Iraqi and Iranian
  asylum seekers currently on Nauru?
• Violence against refugees??

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Key Concepts 1.Universalism

• Universality of human/health rights is one of the
  guiding principles of new public health yet at
  times the principle of universalism, as applied
  to specific public health programmes, can work
  against the interests of minority groups.

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Key concepts 2.Diversity

• The need to take account of diversity in
  peoples understandings of their bodies peoples
  attitudes to public/private responsibilities
  peoples cultural, spiritual, political and
  personal belief systems, has been hotly debated.
  Violence is a classic example.

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3.Problematizing/pathologizing culture and
ethnicity

• problematizing/pathologizing ethnicity and
  culture
• culture as the inherited solution to vital
  problems
• ethnicity as resource vs ethnicity as a
  liability

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Culture independent variable?

• interplay between class, gender, generation and
  culture/ethnicity
• cultural explanations may mask economic,
  political,survival issues
• need to tease out cultural issues from other
  factors
• Implications for measuring QOL?

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Diversity within Diversity

• cultural groups not homogenous
• e.g. for Nuer host country diffs between
  Australia and US
• Nuer Hmong migration experiences vary with
  socioeconomic circumstances
• e.g. generational differences for Hmong -young
  Hmong webpage Hmongonline -hardly primitive
  and traditional!

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Culture as Negotiation

• cultural norms, themselves contested and
  changing, represent flexible guidelines within
  which behaviour is negotiated, rather than an
  independent variable which is solely responsible
  for determining behaviour
• Ahmad, 1996 in D. Kelleher S. Hillier (eds)
  Researching Cultural Difference in Health

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Adaptation QOL equivalents?

• There is an urgent need to disentangle the
  specific experience of those who are critically
  involved in the process of adaptation to new
  worlds ways of life.
• Most ... hope to retain their original culture
  and lifestyle ..to some extent but find that the
  exigencies of being migrants/refugees forces them
  to examine their preconceptions and to adopt
  roles, both social and economic, which they would
  have rejected at home. (Buijs, 1993)

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Remaking the self plus and minus

• This remaking of self is often a traumatic
  experience with serious repercussions on their
  relationships with their menfolk.
• On the other hand, for some women, emigration
  also provided a spur to ambition and progress, a
  means of achieving a social and economic mobility
  that they would have been denied at home (Buijs,
  1993)
• How to measure trauma or opportunity?

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Violence negotiable?

• It is generally agreed that acts of violence in
  civil society are non-negotiable and to be
  condemned.
• Yet violence in times of war is seen as
  inevitable and in many cases is condoned. Photos
  in Melbourne newspapers yesterday, of the
  aftermath of violence against the Taliban, attest
  to this.

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Hmong and Nuer

• What happens when groups of war refugees such as
  the Hmong (from Lao PDR) or the Nuer (from Sudan)
  or Afghanis and Iraqis arrive on Australias
  shores (with attitudes to violence generated in
  their war-torn home countries) and face laws and
  services geared to the host countrys
  non-negotiable principles on violence?

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Nuer

• Hutchinson domestic violence amongst Nuer
  culturally ingrained or response to social
  tension civil unrest?
• Civil war in Sudan altered ethics and tactics
  of intertribal feuding and domestic conflict
• spear replaces club in domestic violence
• girls and women bring war? Move from cattle to
  women as subject of dispute.

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Nuer-womens rights

• Denial of womens rights endorsed by courts
  rather than culture (changed over time) in Sudan
• by 1980s women permitted to sue for divorce in
  Sudan
• Nuer women in US major users of 911 crisis line -
  men hide behind cultural rights

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Hmong spirit damage

• Liamputtong Rice research Hmong post natal
  symptoms after Caesarian
• cutting of body seen as violence to soul
• Response of health system soul calling ceremony
• similar issues in domestic violence?
• violence as survival in war same dimension as
  domestic violence?

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Parallels with PTSD

• psychological effects of domestic violence in
  Cambodia resemble the symptoms of post traumatic
  stress disorder experienced by Cambodian refugees
  after the Khmer Rouge period. (Zimmerman (199494

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Shared DV/PTSD symptoms

• hopelessness
• feeling that you are going crazy
• no future
• forgetting things easily
• feeling ashamed
• difficulty concentrating

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cont Shared DV/PTSD symptoms

• low energy
• difficulty performing daily activities
• Depression, anxiety, weight loss, lethargy,
  memory loss, disorientation, inability to
  concentrate, mental illness, suicide attempts.
• Shame and humiliation

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Spiritual harmnot exclusive to traditional
societies

• In fact the body mends soon enough. Only the
  scars remainBut the wounds inflicted upon the
  soul take much longer to heal. And each time I
  re-live these moments, they start bleeding all
  over again. The broken spirit has taken the
  longest to mend the damage to the personality
  the most difficult to overcome. (Domestic
  violence survivor quoted in WHO, 1996b)

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Challenges for QOL measurement

• Universality vs diversity
• Generalisability to current Afghani, Iraqi and
  Iranian asylum seekers
• Security, safety, trust , new social
  connectedness vs response of host country (esp.
  social, economic racial discrimination), loss
  of the familiar, loss of culture and former
  social connections
• Can QOL measures reflect the soul?