"Vaikus augina alachas": pabėgėlių ir prieglobsčio prašytojų moterų reprodukcinės sveikatos kultūriniai skirtumai

LTGlobaliame pasaulyje vykstantys politiniai ir ekonominiai konfliktai sukelia karinius veiksmus įvairiose pasaulio regionuose, dėl to vis auga pabėgėlių ir prieglobsčio prašytojų skaičius. Žmonės, gyvenantys konfliktinių neramumų zonose, dėl patiriamo religinio, etninio, rasistinio, seksualinio persekiojimo, prievartos, epidemijų protrūkio bei nuolatinio Žmogaus teisių nepaisymo yra priversti palikti savo tautą, namus ir prašytis prieglobsčio sąlyginai saugesniuose pasaulio regionuose. Dažnai atvykstama ne tik į kultūriškai, bet ir tipologiškai skirtingas visuomenes, kuriose susiduriama su skirtinga sveikatos priežiūros sistema, skirtinga gydytojo ir paciento santykių tradicija bei apskritai skirtinga ligos ir sveikatos sampratos filosofija. Statistiškai į Lietuvą daugiausia atvyksta islamiškosios kultūros atstovų, kurių tapimas pacientais mūsų sveikatos priežiūros sistemoje tampa nemažu iššūkiu tiek jiems patiems, tiek medikams. Dėl giliai įsitvirtinusios patriarchalinės visuomenės standartų musulmonės moters statusas šeimoje, bendruomenėje ir visuomenėje tiesiogiai priklauso nuo jos turimų vaikų skaičiaus. Taigi gera reprodukcinė moters sveikata yra ne tik aukštesnio statuso garantas, bet ir jos saviraiškos bei orumo realizavimo šaltinis. Lietuvoje musulmonės moterys turi žymiai geresnes sąlygas rūpintis savo ir šeimos reprodukcine sveikata dėl, jų manymu, ypač aukšto vietinių medikų profesionalumo lygio. Tačiau ypač ryškūs kultūriniai skirtumai susiję su moterų reprodukcinės sveikatos priežiūra sukelia įtampas terapinio proceso metu tarp etniškai skirtingų pacientų ir vietinių medikų. Dalį jų siekiama atskleisti šiame straipsnyje.

ENThis article deals with the issue of cultural differences of refugee and asylum seekers women's reproductive health care. According to the statistics the majority population of refugees and asylum seekers living in Lithuania are from Islamic culture. Immigrants and refugees are diverse groups of people with unique health care needs. When refugees and asylum seekers become patients of a totally different health care system this phenomenon throw down the challenge not only for aliens themselves but also for native therapists and physicians Patients bring their own beliefs and notions to the medical visit. Finding asylum is not the end of their difficult journey. In a host country, refugees face the challenging task of reconstructing their material lives and cultural identities as they adjust to their new environment (Heidi Ellis, Kia-Keating, Aden Yusuf, Lincoln, Nur 2007). Health care system is only one part of the social life that needs to be learned by refugees. Case studies in medical anthropology demonstrates how often doctors face the question: how do they have to learn to be culturally competitive to ethnic patients' needs and still stay loyal to their own profession with a western-style point of view. Doctors assume they treat each patient objectively, viewing their ailments through what they believe to be impartial lenses of the medical model. But theory and research shows their assumptions are often unrealistic and naive. Because of the high domination of patriarchal standards in Islamic culture, Muslim women and their social status is tight related to maternity and the quantity of children. More children means higher position in a family, community and society. Therefore, well reproductive health is so coveted because it leads women to self-expression, dignity and ensures high social status.This is the standard of Islamic society and culture, say informants. Refugees and asylum women claim Lithuania being as beneficial country for reproductive health care because of it's professionals stuff and high biotechnological equipment. However existing cultural differences related to women reproductive health care raise many tensions during consultations and therapies among native doctors and Muslim women. There are many specific areas in medicine where every therapeutic process is sort of negotiation between two different cultures: doctor and patient. Gynecology - midwifery or more scientifically to say - reproductive health care service is one of them, and which is discussed in this paper. Collected data demonstrates reproductive health care (RHC) is being the area where nearly every consultation is negation between doctor and Muslim woman. The main purpose of the article is to reveal cultural differences of refugees and asylum seekers women's reproductive health care. Goals of the article are as follows: demonstrate cultural differences of refugees and asylum seekers women reproductive health care related to (in) fertility notions, breastfeeding, gender role and decision making about family sexual and reproductive health care, also child care in early childhood from doctors' perspective. Discuss how do existing cultural differences influence their ordinary professional behavior, attitudes and therapeutic processes. Secondly author pursues to find out what are the main cultural differences in Lithuanian health care system that faces refugees and asylum seekers solving their reproductive health care problems and what are the limits of tolerating these differences. The ethnographic data analyzed in this paper is just a small part of future dissertation while the anthropological fieldwork is still going on.Data was collected applying participant observation, in-depth interview, illness narrative and field notes methods. Later on interviews were transcribed, coded and themes blocs where sorted. Theoretical insights are used from the perspective of medical anthropology. Summarizing the article it might be claimed that the initial attempts to grasp the first encounter with new reproductive health care mode is a great challenge for both: Muslim women and native doctors. Data shows how initial doctors' attempts to treat each patient in a cultural competitive spirit are not always a part of real existing everyday practice. However it must be recognized that refugees and asylum seekers must also assume responsibility for their better state of health. Aliens should realize that doctor's recommendations, following appointed time for consultations, valid needs and other factors determine not only the better health state but also efficient doctor-patient communication. Reproductive health care is one of the most culturally and socially constructed health care area in medicine. Women's reproductive health care and body is very high medicalized in Western world countries while Islamic culture demonstrates wholly different attitudes and beliefs of reproductive health cares. The limits how far patients and therapists tolerate each other depend on the endeavour to understand diversity in a much more broad perspective.