Urgent Research

When a great number of refugees came to Germany in fall 2015, it was necessary to create vital infrastructures, including healthcare services. A cultural anthropologist, a psychologist, and a doctor had to put their initially theoretical ideas on this issue rapidly into practice.

When a great number of people came to Germany in fall 2015, it was necessary to create vital infrastructures, including healthcare services.
Photo: Jonathan Stutz/stock.adobe.com

What do humanities researchers mean when they say “narration”? What about medical researchers or psychologists? This is one of the questions Anne-Maria Müller had to ask herself when she initiated a scholarly exchange on migration with her colleagues: “We spent a lot of time clarifying our vocabulary in the beginning. The term narration is very important for all of us, but we use it differently,” says the psychologist from the Medical Center – University of Freiburg. Medical researcher Dr. Berit Lange, who also works at the university medical center, adds: “It can be the core of research or also a tool.”

Lange and Müller were members of the “Tracing Narratives of Flight and Migration” project group at the Freiburg Institute for Advanced Studies (FRIAS) of the University of Freiburg. This project ran from 2016 to 2018 and emerged from the Freiburg Network for Migration and Integration Research (FREINEM). The exchange of knowledge and experience was already a part of the research in FREINEM; in addition, the group organized several events on the topic, disseminated information, and shared experience with initiatives from Freiburg and the surrounding area. Both the network, which has been in existence since 2011, and the project group were composed of researchers from various disciplines, including medicine, psychology and social work, European ethnology, political science, and geography. The topic of the FRIAS project gained a special urgency and relevance for society in the fall of 2015, when a great number of people came to Germany in the course of heightened global migration flows. This necessitated the creation of various infrastructures, including healthcare services for refugees at the reception centers.

Different Narratives

Prof. Dr. Anna Lipphardt from the University of Freiburg’s Institute of Cultural Anthropology and European Ethnology, who served both as director of FREINEM and as co-organizer of the project group, always considers the communication situations of narratives. They are not always communicated from a neutral standpoint, as she illustrates by means of the following example: While visiting the exhibition “Stories of Survival from A to Z: Refugees’ Things” at the Baden-Württemberg House of History in Stuttgart, she was struck by an exhibit showing a young Gambian’s smartphone, including a contract. “In fall 2015, there was a lot of discussion concerning the fact that all of the migrants owned smartphones,” she says. It was a debate that was not entirely free of resentment, because how could someone who had lost everything afford something as expensive as a smartphone? In reality, however, the exhibit represents a technology that enabled the refugees to navigate, make emergency telephone calls, and stay in contact with their families back home, says the Freiburg researcher. In a word, it is part of a completely different narrative.

Important technical tool: Refugees use their smartphones to navigate, make emergency telephone calls, and stay in contact with their families back home.
Photo: Emiliano Vittoriosi/Unsplash

The anthropologist knows from her work with Holocaust survivors that victims of violent events are often traumatized and that there are experiences people are incapable talking about explicitly but nevertheless reveal information about involuntarily through their body language, changes in syntax, and mental leaps in their narrative. All of this can also apply to refugees. According to Lipphardt, the narratives of people fleeing their homelands differ depending on whether they are addressed to social workers, volunteers, or border police.

Healthcare Services for Refugees

Lange and Müller started bringing together theory and practice when they got involved in organizing healthcare services for refugees at a Freiburg refugee reception center. The assignment was coordinated by the Department for Infectious Diseases at the Medical Center – University of Freiburg. A team from the medical center deliberated on how to design healthcare research on this issue as early as late 2014, reports Lange, who specializes in tuberculosis research. “We needed more than just medical output,” recalls the doctor. “A lot of social issues were involved,” adds Müller. “You need to know the legal situation,” not least because entitlement to medical services depends on asylum status. It was thus only natural to cooperate with other disciplines.

Healthcare services at the reception center initially included a general medical clinic with regular psychological, pediatric, and gynecological consultation hours. They differed from other similar facilities only in that they were offered by doctors from the university medical center rather than by registered doctors working in an honorary capacity. Although the general medical problems of refugees are often similar in nature to those of other patients, the interaction between doctor and patient is generally completely different. This is primarily due to communication problems: If an interpreter is present or connected by video conference, the meeting is no longer private. In addition, many patients are not aware of their rights. Moreover, refugees sometimes ask for a medical certificate, because they know that it can have a positive effect on their asylum procedure. Furthermore, the special vulnerability of refugees – which Lipphardt also names as an essential factor for irregular migration ‒ is also significant for Lange and Müller’s practical work.

Familiar examination in an unfamiliar situation: The special vulnerability of the refugees was significant for the doctors’ practical work.
Foto: absolutimages/stock.adobe.com

A Temporary Arrangement Becomes Permanent

“We grappled a lot from the start with ethical questions. Everyone who lives at a reception center is under strain, because they are in a precarious situation. The people are trying to get a foothold and deal with their past here. At the same time, some of them are in danger of being deported to Italy or to the Maghreb countries,” says Müller. Sleep disorders, general indisposition, and pain are typical symptoms that manifest in response to stressful situations. Sometimes the doctors also diagnose depression or anxiety disorders. When necessary, Müller could refer patients to a psychiatric clinic. What the government had originally intended to serve as a temporary arrangement for several weeks became permanent in practice. “It’s not good for your health to live for more than twelve weeks at a reception center of this kind,” believes Lange, who, like her colleagues, feels it would make sense to provide the refugees decentralized accommodations after this period. In an paper the two published with further colleagues, they describe the dilemma in which the responsible doctors are caught up: The conflict of aims between medical treatment and the demands of the asylum procedure sometimes gives the doctors the impression that their work serves to perpetuate a system whose principles they in reality longer support.

The problem has its origins in the history or the Federal Republic of Germany, sums up Lipphardt, because migration research was long understood as integration research. The study of deportations and population shifts during and after the Second World War was conducted primarily by historians who did not see themselves as migration researchers. The empirical social sciences, on the other hand, concentrated on state-mandated labor migration and integration. Whereas today many people who do not have the “right” papers endure chaotic and dangerous journeys, labor migrants entered the country with the proper visa by airplane or train and found a job upon their arrival.

The Freiburg doctors drew their conclusions from this scientific vacuum: When they began to set up the clinic in 2014, they found it more helpful to visit comparable facilities than to read the international research literature. And that is why they have now begun to publish their own findings.

Annette Hoffmann