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Road of Hope

Research aims to contribute to equity in the healthcare system in The Netherlands

Canva’s photo, only illustrative.

The Road of Hope Foundation, partnering with the GGD Amsterdam, Nisa for Nisa and SomAstel, have been conducting a research about the experiences of women from four different nationalities (Somalia, Eritrea, Morocco and Syria) and the healthcare professionals regarding pregnancy and childcare during the first 1.000 days. The project, coordinated by Valerie Chin, has been conducting 37 in-depth interviews over the course of a year. She interviewed women and, simultaneously, healthcare professionals who are in frequent contact with these women throughout their pregnancy and the first few years of their children who are born in Amsterdam.

"By working on bettering the experiences of newcomer mothers, we strengthen the whole healthcare system", says Valerie.

The project’s goal is to build a bridge between these different cultures, and enhance cooperation between the two sides, thus contributing to equity. To better understand the difficulties faced by the women and healthcare workers, we talked to Valérie about her findings and experiences leading the research.

ROH – Before we talk about the finds and your experience with this project, could you please elaborate on the goals of this initiative?

Valárie – The main goal is to gain a deeper understanding of the different cultural perspectives, of the women and the healthcare professionals, to achieve a better collaboration. By working on bettering the experiences of newcomer mothers, we strengthen the whole healthcare system. There has not been a lot of research done in this exact area, and I am very happy to contribute to recognizing what could be the obstacles to building trust between medical professionals and their patients. I have seen what an important role trust plays, and many times I have seen that these women find it hard to give complete trust at their appointments. My perspective also changed: before, I never noticed how easy it was for me to confide my doctors in. There are no barriers between us, in terms of language, and I have known the system my whole life. By conducting this research, I understand the newcomer ladies’ position a lot better.

ROH – Overall, Collective Cultural Research have conducted 37 interviews over the course of a year. Can you highlight some common patterns you have seen from the data? 

Valárie – It is visible that the healthcare professionals are struggling to make a connection with some of the women, as they might be more ‘closed off’ than what they are used to when dealing with Dutch patients. What is really important to highlight is that different cultures have different way of communicating: the way one expresses their emotions can vary to a great extent, and often, also due to the language barrier, they are expressed in a non-verbal way. While the Dutch are famous for their directness, some women find it harder to share their concerns and ask questions, which in turn can make the medical professionals feel as though they are failing to make a connection and thus can not help them accurately. 

The target groups were women from Somalia, Eritrea, Morocco and Syria, and the research showed that they have a very community-based perspective. For example, the grandmother can play a very important role in influencing the decisions being made. Families can also have their own culturally rooted traditions regarding pregnancy and newborns, which sometimes may clash with the Dutch healthcare system’s standards. This is a fine line to walk because women should be able to practice their traditions, which make them feel at home, and they honor their heritage and families through them. At the same time, medical professionals need to make sure this is done in the safest way for the mothers and their children. 

New mothers can also struggle with the pressures of expectations of high independence, coming from places where for example, it is customary to allow women 40 days of rest after giving birth. This is possible because of the extended support network, and while some women have partners and some family here, those who do not face extreme difficulties and oftentimes, loneliness. No matter how good the healthcare professionals are, they cannot replace family.

ROH – How was for you conducting this research? Did you have any expectations before you started? 

Valérie – I did not have a lot of expectations, but I thought that working with a translator would be easier. At times, these women have not yet learnt Dutch, as they have arrived in the Netherlands recently as refugees or migrants, and the way for us to have a conversation was through a translator. I am used to having conversations where we directly respond to each other, and it was very different from having to wait for the translation. Sometimes it was challenging, but it has shown me what being on the other side is like. It made me understand their position a bit better, as sometimes it can be confusing, and you spend a lot of time thinking whether the message is getting across correctly or there is a misunderstanding.

ROH – You also interviewed healthcare professionals. Do they also feel challenged by the language barrier and using translators?

Valérie – From the side of the healthcare workers, what I have seen from the data is that sometimes they feel insecure because they might have doubts about whether the translator delivers all the information precisely as it was said. Especially when we are talking about topics concerning mental health, in many cultures, there is a lot of shame around acknowledging these struggles to people outside of their inner circle. For the ladies with these cultural backgrounds, they often only share things around this subject if they are really trusted and close to somebody rather than doctors, nurses, midwives, or whoever they are in contact with. 

Another component here is the time constraints, these medical professionals are extremely busy trying to provide the best care for each patient, so instead of waiting for a translator, sometimes they prefer to do it themselves. They are trying to bridge the language barrier by non-verbal communication, writing, drawing, and using tools such as Google translate. Sometimes it works, but there is a lot of room for misunderstanding, which can create insecurity and the feeling of not being able to connect with each other. 

ROH – What are your hopes for the research and the people you have met?

Valérie – I am really honoured to have heard first-hand accounts of the journeys some of these women had to make. I realized that refugees are extremely strong people, who have a lot of perseverance. It is always a challenge to not victimize them, but at the same time acknowledge their difficulties. 

The main point of the research was to create more understanding and lessen the distrust, and I am really hoping that the results will make a significant impact on the healthcare system as a whole. 

 I did not just want to write research but collect experiences and stories, that is why the idea of creating a theatre play came up. The performance would highlight the different backgrounds and challenges, as to help medical professionals to put their empathy in the right place. Creating awareness around how to work in a culturally sensitive way will support both the women in getting the best care and the professionals in doing their job. 

Another step in achieving equity in healthcare and supporting both groups is making an Ebook with illustrations for the medical professionals. Highlighting the needs of mothers and their children, this book will serve as an even more tangible version of the research, to make sure that what these conversations have shown are not forgotten and are implemented too.