1. Faces of Truth Perspectives on Health Care for Female Muslim Allochtonen in Amsterdam Emily Sands and Lauren Sterling University of Washington University of Amsterdam Summer Institute

2. Allochtonen In the Netherlands, refers to immigrants and their children in the sense that they are outsiders. One is an allochtoon if one or both parents were not born in the Netherlands. http://lh3.ggpht.com/_Tbarytmj7CA/R6JJ9K1o_oI/AAAAAAAACnY/OQHzdpVjqwA/2008-01- 25T145733Z_01_FSA05_RTRMDNP_3_TURKEY-HEADSCARF-PRESIDENT.jpg

3. Amsterdam Demographics 55% 13% 19% 13%

4. Background: Health Care in the Netherlands Focus on primary care Patient’s main contact is General Practitioner (GP) ‏ Universal, mandatory, private health insurance as of 2006 The government is responsible for the accessibility and quality of the healthcare.

5. Research Question What are the greatest barriers to health care for female Muslim allochtonen? What are the differences in beliefs about those barriers between patients and their providers?

6. Literature Review Immigrant women have higher fertility and child/maternal mortality than native Dutch (Nordbeckk 1985, nigz.nl) ‏ Migrant health educators improved quality of health care (Johnston 2004) ‏ Older Moroccan and Turkish females report more serious communication problems (GG&GD 2001) ‏

7. Conceptual Framework Cultural Diversity: Culture is beliefs, values and traditions which form the basis for shared social action and which are transmitted and reinforced within a group. Cultural Competence: refers to an ability to interact effectively with people of different cultures. http://blogs.reuters.com/faithworld/files/2008/02/turkish-headscarf-wearers.jpg

8. Research Methods Surveys of professionals (n=5) ‏ Surveys of women (n=4) ‏ Interviews (n=3) ‏ Site visits Library/Online Research http://www.miller.k12.ga.us/images/MPj03995750000%5B1%5D.jpg

9. Map of Locations

10. Two faces Of a doctor: “What do you think is the most important issue that prevents Muslim women from receiving the best health care possible?” “Primarily, their spouses, and secondly, the language barrier.”

11. Survey of Women: Question and Response “Have you ever chosen to not attend an appointment?” “Yes. I made an appointment because my back hurts. When I heard that a male doctor would examine me I didn’t go.” “What do you think is the most important issue that prevents you from receiving the best health care possible?” “Sometimes I have problems explaining where it hurts in Dutch. The doctor gets frustrated about that.”

12. Results: Interviews Male Muslim Student Organizer: “The child cannot come.” Segregation (re-pillarization) of communities Trust issues Female Native-Dutch Citizen: “Problem is not being “non-native,’ problem is that doctors blame the problem on the ‘non- native-ness.’” Female Non-Dutch Health Care Provider: Cultural understanding/specialization important

13. Discussion: Differences in Perspectives Don’t want to see male doctors Spouses interfere with care Cultural differences Drs. Impatient, language hard Understaffing, other issues Not enough time to explain Turkish, Arabic, etc. DutchLanguage Women’s Perspective Doctor’s Perspective Barriers to Care

14. Conclusion: The purpose of our research was too: Illuminate barriers Show differing viewpoints Recommendations Increase Cultural Competency Training for doctors Specialized migrant health workers Increase Dialogue

15. Future Questions/ Continuing Research Questions Desegregation of schools? Language vs. Cultural barriers? Research More data Cultural competency educators Spouse issues Comparative Studies