3rd Australian Conference on Quality of Life

1. 3rd Australian Conference on Quality of Life Stonnington House, Deakin University, 16th Nov 2001 Session 3 (B) Conceptual Issues in QOL Liz Eckermann: “Violent scatterings and QOL”

2. Research project; 2001-4 • Perceptions of violence in two groups of war refugees -the Hmong (from Laos) and the Nuer (from Southern Sudan) • Similarity and Diversity within and between these two groups. • Continuity between collective violence and domestic violence? • Produced by war experience and poverty or other political, social religious, economic or cultural factors?

3. Research team • Professor Bruce Wiegand, University of Wisconsin, Whitewater (deceased) • Assoc Prof Sharon Hutchinson, University of Wisconsin, Madison • Assoc Prof Pranee Liamputtong Rice, La Trobe University • Assoc Prof Liz Eckermann, Deakin University

4. Policy and implementation implications • How appropriate are health services in the host countries, Australia & US, to meet the needs of these two groups of refugees? • Tension between universalism and cultural relativity, or universalism and economic and social relativity? • Challenges for cross-cultural measurement of quality of life. • Implications for Afghani, Iraqi and Iranian asylum seekers currently on Nauru? • Violence against refugees??

5. Key Concepts: 1.Universalism • Universality of human/health rights is one of the guiding principles of new public health yet at times the principle of universalism, as applied to specific public health programmes, can work against the interests of minority groups.

6. Key concepts: 2.Diversity • The need to take account of diversity in: people’s understandings of their bodies; people’s attitudes to public/private responsibilities; people’s cultural, spiritual, political and personal belief systems, has been hotly debated. Violence is a classic example.

7. 3.Problematizing/pathologizing culture and ethnicity • problematizing/pathologizing ethnicity and culture • culture as ‘the inherited solution to vital problems’ • ethnicity as ‘resource’ vs ethnicity as a ‘liability’

8. Culture: independent variable? • interplay between class, gender, generation and culture/ethnicity • cultural explanations may mask economic, political,’survival’ issues • need to tease out cultural issues from other factors • Implications for measuring QOL?

9. Diversity within Diversity • cultural groups not homogenous • e.g. for Nuer host country diffs between Australia and US • Nuer & Hmong migration experiences vary with socioeconomic circumstances • e.g. generational differences for Hmong -young Hmong webpage: Hmongonline -hardly ‘primitive’ and ‘traditional’!

11. Culture as Negotiation • ‘cultural norms, themselves contested and changing, represent flexible guidelines within which behaviour is negotiated, rather than an independent variable which is solely responsible for determining behaviour’ • [Ahmad, 1996 in D. Kelleher & S. Hillier (eds) Researching Cultural Difference in Health]

12. Adaptation: QOL equivalents? • There is an urgent need to disentangle the specific experience of those who are critically involved in the process of adaptation to new worlds & ways of life. • Most ... hope to retain their original culture and lifestyle ..to some extent but find that the exigencies of being migrants/refugees forces them to examine their preconceptions and to adopt roles, both social and economic, which theywould have rejected at home. (Buijs, 1993)

13. Remaking the self: plus and minus • This remaking of self is often a traumatic experience with serious repercussions on their relationships with their menfolk. • On the other hand, for some women, emigration also provided a spur to ambition and progress, a means of achieving a social and economic mobility that they would have been denied at home (Buijs, 1993) • How to measure: trauma or opportunity?

14. Violence: negotiable? • It is generally agreed that acts of violence in civil society are non-negotiable and to be condemned. • Yet violence in times of war is seen as inevitable and in many cases is condoned. Photos in Melbourne newspapers yesterday, of the aftermath of violence against the Taliban, attest to this.

15. Hmong and Nuer • What happens when groups of war refugees such as the Hmong (from Lao PDR) or the Nuer (from Sudan) or Afghanis and Iraqis arrive on Australia’s shores (with attitudes to violence generated in their war-torn home countries) and face laws and services geared to the host country’s non-negotiable principles on violence?

16. Nuer • Hutchinson: domestic violence amongst Nuer culturally ingrained or response to social tension & civil unrest? • Civil war in Sudan ‘altered ethics and tactics’ of intertribal feuding and domestic conflict • spear replaces club in domestic violence • ‘girls and women bring war’? Move from cattle to women as subject of dispute.

17. Nuer-women’s rights • Denial of women’s rights endorsed by courts rather than culture (changed over time) in Sudan • by 1980s women permitted to sue for divorce in Sudan • Nuer women in US major users of 911 crisis line - men hide behind ‘cultural rights’

18. Hmong : spirit damage • Liamputtong Rice research: Hmong post natal symptoms after Caesarian • cutting of body seen as violence to soul • Response of health system: soul calling ceremony • similar issues in domestic violence? • ‘violence as survival’ in war: same dimension as domestic violence?

19. Parallels with PTSD • psychological effects of domestic violence in Cambodia resemble the symptoms of post traumatic stress disorder experienced by Cambodian refugees after the Khmer Rouge period. (Zimmerman (1994:94

20. Shared DV/PTSD symptoms • hopelessness • feeling that you are going crazy • no future • forgetting things easily • feeling ashamed • difficulty concentrating

21. cont: Shared DV/PTSD symptoms • low energy • difficulty performing daily activities’ • Depression, anxiety, weight loss, lethargy, memory loss, disorientation, inability to concentrate, mental illness, suicide attempts. • Shame and humiliation

22. Spiritual harm:not exclusive to ‘traditional’ societies • “In fact the body mends soon enough. Only the scars remain…But the wounds inflicted upon the soul take much longer to heal. And each time I re-live these moments, they start bleeding all over again. The broken spirit has taken the longest to mend; the damage to the personality the most difficult to overcome.” (Domestic violence survivor quoted in WHO, 1996b)

23. Challenges for QOL measurement • Universality vs diversity • Generalisability to current Afghani, Iraqi and Iranian asylum seekers • Security, safety, trust , new social connectedness vs response of host country (esp. social, economic & racial discrimination), loss of the familiar, loss of culture and former social connections • Can QOL measures reflect the ‘soul’?