Anne Dempsey outlines the thrust of an ambitious study focusing on appropriate healthcare for religious minorities
While migrants are proving to be a hot election issue in the UK, we don't need an election for Irish tempers to flare when it comes to migrant deportation, migrant workers and equal pay, and the rights of migrant children born here - the woes of a migrant family are even featuring in RTÉ's crime thriller, Proof 2.
There are at least 160 different nationalities living in Ireland today with up to 200,000 people of non-EU nationality registered in the State. While publicity has centred around legal rights, the health needs of these new citizens pose particular questions for health professionals.
So the creation by the Irish School of Ecumenics (ISE) of a research fellow post, funded by the Health Research Council, to examine health policy and delivery is timely.
The "Health Policy Formation in a Christian Culture with Religious Minorities" will examine the challenges religious minorities meet when accessing our healthcare system, and review and analyse policies in three other countries. It aims to provide a focus for informed public debate.
The ISE is a graduate institute of Trinity College Dublin. Established in 1970 to study peace and reconciliation, it has a tradition of interfaith dialogue. This new project represents an expansion of its existing base. The crucial point which the project acknowledges is one which many Irish Catholics will understand. It is the deep link - for good and for ill - between our religious tradition and the way we relate to our own bodies.
Lecturer in ethics Dr Linda Hogan will supervise the research. "Much of the discussion on the nature of change has focused on immigrants as workers. But migrants bring their families, so rather than seeing them only as individuals, we need to view them as people with families with whom they share very deeply held values. We would also be defining health to include mental health and, given the stressful nature of many migrants' lives, this could be relevant."
Some of the research will involve interviewing staff and outpatients at The Adelaide & Meath Hospital, Tallaght with whom the ISE has a working partnership. "These are the people working at the coalface. If you talk to medical practitioners, including healthcare chaplains, many have a clear idea of what is needed."
The new patient profile has implications too, she says, for ethics committees and hospital boards. A number of medical dilemmas have already hit the headlines such as, whether the circumcision of baby boys - as required by some religions - should be regulated. In other jurisdictions, medics have been asked for reinfibulation (recircumcision) of the mother after childbirth.
Anecdotally there are stories of husbands conveying a wife's symptoms to the doctor while denying access to a physical examination of the patient. While some of these tales may be apocryphal, the question of minority women's obstetric and gynaecological health is significant.
As is access. "Issues of equity and access to the health service are particularly complicated when one takes into account the particular needs of certain religious minorities, the degree to which a culture encourages its people to go outside to look for help, problems with language and understanding. I think we need to examine if the way in which we traditionally deliver our services is suitable for a religious minority or how the services could be available in other forms and via other routes."
For example, a UK study on access found the idea that a health visitor could knock on the door of a woman of the Islamic faith and that she would be happy to open it to discuss her health needs with a stranger was simply out of the question. "As a result, a system of peer training and peer support was set up in the UK which has been very successful. They have the numbers in the minority population to provide such a service, we are a long way from that as yet," Dr Hogan explains.
When it comes to male health, while it is well known that many Irish men will avoid their GP unless pain drives them there, it remains to be seen whether men in minority populations have a similar attitude. Also, while the study is not primarily concerned with HIV/Aids, it may amplify whether immigrants with HIV/Aids have access to proper testing and treatment.
Representative groups from religious minority communities such as the Islamic Cultural Centre, Council of Christians and Jews, the Russian Orthodox Church and African Independent churches, who already have a rich vein of experience and anecdotal evidence to offer, will contribute to the research. There will be liaison also with NGOs working with minorities.
"The real challenge of this study is to get a snapshot of what is happening now. We feel these organisations will be very helpful in this regard," says Hogan.
The study is the first of its type for the ISE and part of a broader ambition to look at religious education and minority religions. Dr Hogan is on the board of the Crisis Pregnancy Agency, currently examining the provision of sex education in schools.
"I would like to see sex education taught in a way that would engage with religious diversities and cultures. We need a discussion which is responsive to the changes taken place in Irish society," she says.
The second strand of the ISE research will examine how health policies in Britain, Canada and France have adapted to multiculturalism, pluralism and secularism.
"France's approach is one of integration into the predominant secular culture with religion a private matter as the recent head scarf/school debate showed," she says.
"Canada's approach is very different, allowing as much diversity as is possible. Britain, with a long tradition of multiculturalism, is somewhat in the middle with a flourishing minority religion healthcare system. We know that simple multicultural policies in many countries are now coming under strain, the result of failure to take religion sufficiently seriously."
The report will be made available to policymakers, health boards, professional associations, NGOs and the Department of Health and Children. The study does not take place in a vacuum as a current pilot project in the Adelaide & Meath Hospital examines health needs and ethnicity. "We see our research as complementary to this. Underneath issues of identity are religious values, so if we concentrate on ethnicity alone, we may be missing those very intimate and significant questions regarding birth, death, sex, precisely the point at which particular religious beliefs are expressed," Dr Hogan adds.
"If we omit this broader religious context, we miss the obstacles and road blocks which can surface. Also, different religious minorities have different interpretations, so there may be many answers to the same question. Our quest is to help people to find other ways of being true to their religion by being more open and flexible with our practices. This is not a statistical piece of work, not a representative sample, not one snapshot, but a number of different snapshots."