The Big Society idea that the coalition government in the UK has launched may seem vague and woolly but to many minority groups and newly arrived migrants, it is an idea that through necessity is second nature. The entrepreneurial spirit, a creative instinct for survival, has ensured that many of these groups are not only able to help their own communities but are also ensure that wider society also benefits from their skills. These are groups of people who have often learnt to flourish in the most difficult of circumstances through sheer force of will and determination.
It was practical examples of these qualities that were discussed at the inaugural Cities of Migration conference in the Hague last month. For example the MiMi (With Migrants for Migrants) programme developed by the Ethno-Medizinisches Zentrum in Hanover recruits, trains and supports individuals from within immigrant communities to become cultural mediators who can help navigate new and different ways of dealing with traditions of health, illness and the body. The goal is to make the German health system more accessible to immigrants by increasing their health literacy while simultaneously empowering migrant communities by prompting their direct participation in the process. Or the San Francisco Welcome Back Initiative which builds a bridge between the pool of internationally trained health workers who are living in the US and the need for linguistically and culturally competent health services to diverse migrant communities.
Similar creativity, good communication and empathy form the foundation the work at Maslaha, an organisation that tackles the health inequalities that occur within Muslim communities in the UK by producing interactive websites, DVDS, and posters that combine medical information with faith advice. These resources tackle diabetes, cardio-vascular disease and perinatal mortality. For instance a nurse or doctor may find it hard to convince a Muslim patient not to fast during Ramadan solely on medical grounds (the number of diabetics who are admitted to hospital as a result of fasting soars during Ramadan). Maslaha's website and DVDs contain a short clip with an imam quoting a verse from the Qur'an which forbids fasting if it harms one’s health. There is also advice to feed the homeless as one way of compensating for not fasting during Ramadan.
Using the language of faith helps to widen the language around health which is no longer fenced by medical textbook language. The language of faith is a vital ingredient in these resources as it resonates both with newly arrived migrants, and with families who have been in the UK for a couple of generations. So examples of how the Prophet Muhammad did not overeat and exercised regularly, coupled with the healthy foods mentioned in the Qur'an such as ginger, garlic, lentils, and fish, help to support medical advice around a healthy diet. The fact that our films feature an imam and doctor giving this advice together helps to make the message more powerful.
In each local community both Muslim and public services - such as health practitioners or libraries - are integral to producing the website content and films. Members of the local communities share their stories or appear in our films – imams, mothers, doctors, breast-feeding counsellors, fitness experts – to name just a few. The emphasis is on listening to patients and finding out what information is useful to them. Community centres, council one stop service centres, schools and religious centres all become hubs through which the information gathered is disseminated and the migrants experiences are collected.
It is this public ownership that is a constant throughout our work and it is an idea that can be found all over the world and across many centuries. Take Gaudi’s iconic church in Barcelona, the Sagrada Familia, built “for the people by the people”, its first stone laid down in 1882. Made possible by the donations of worshippers, the church remains unfinished and still relies on public donations. It continues to be built in the public gaze, as generations of visitors marvel at its construction, they too become a part of the Sagrada Familia’s story. There is a kind of vulnerability in watching this artistic and religious endeavour continue to evolve and take shape. Once you have visited the church and seen the bulldozers inside, and heard the sound of hammering and drilling, you can’t help but feel a part of its history.
This sense of community ownership is vital to tackling health inequalities. Health issues should not just be a concern in the GP’s surgery but a part of everyday life that is led by communities themselves. As one young Bangladeshi female patient said to us after watching our films: “My dad has diabetes, and I think it’s really useful that it’s in Sylheti. It would be really good if you could do another project for depression in different languages, especially in Bengali, but also other minority languages as well, because that’s a real problem here in the community.”
Patients send Maslaha emails: “Assalamualikum, I think that this is a great website, especially when it is coming from an Islamic point of view. As this a website for the benefit of people health and well being, I would urge someone to research on brown rice versus white rice and if the findings show that the actual brown rice is healthier option."
Research conducted by Professor Trisha Greenhalgh at Queen Mary, University of London strongly supports the power of narrative based healthcare and the way in which stories told by other members of the community play a powerful role in changing behaviour whereas a doctor’s advice may not result in behavioural change. Greenhalgh’s research with focus groups also confirmed the strong alignment of the teachings of the Quran and diabetes self-management behaviours. “Successful management of diabetes requires attention not just to observable behaviour but to the underlying attitudes and belief systems which drive that behaviour. Bangladeshi culture is neither seamless nor static, but some widely held beliefs and behaviours have been identified. Some of these have a potentially beneficial effect on health and should be used as the starting point for culturally sensitive diabetes education.”
An article in the British Medical Journal demonstrates how knowledge of faith and culture helped healthcare practitioners working with British Bangladeshis with type 2 diabetes: "Seeking knowledge is an important aspect of the Islamic way of life, and both lay participants and religious scholars believed that education about faith was one mechanism through which preventive messages (especially those linked to misinterpretations of religious teachings) could be conveyed. Faith was seen as linked to individuals’ confidence and motivation to change behaviour. Religious leaders were seen as trusted sources of information and support...They were enthusiastic about working in partnership with health professionals for mutual education and with a view to developing initiatives within the community for diabetes prevention."
The idea of working in collaboration with communities to produce online resources is spreading in other countries. The communities are an immense source of knowledge, creativity and courage. Through the internet, film, and empathetic communication, these invaluable resources can travel across borders and tackle some of the most pressing social issues we face today.
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