Tag: migrants

We need more than diversity in nursing.

I wrote a piece for the Spring 2018 edition (Issue 23) of the Hive (the Australian College of Nursing’s quarterly publication). Cite as:DeSouza, R. (2018). Is it enough? :Why we need more than diversity in nursing. The Hive (23, 14-15). You can also download a pdf of the article for your own personal use.

Diversity is a hopeful, positive and celebratory idea, it generates more happiness than words like inequity, racism and privilege. It feels good for a large number of people precisely because it is depoliticized (Hall & Fields, 2013). It does not demand accountability. It does not demand transformational change of our minds or our environment, but requests that we continue to put up with difference or to tolerate it (Bell & Hartmann, 2007). What does it mean for our profession to be diverse? And is it enough?

Is it enough, when we have a yawning chasm of health inequity and disparity, of deaths in custody, of punitive policy aimed at Aboriginal Australians? Is it enough, in an era of devastating Islamophobia and racism enabled by nationalist right wing xenophobia? Is it enough, when politicians challenge group-based rights and argue that they undermine social cohesion and “our way of life”, maligning and scapegoating already vulnerable groups like African youth. Is it enough, when media only catapult the spectacular and exceptional into our view. Is it enough, when the entire world is condemning Australia’s abhorrent offshore policy of deterrence and detention. Yes, we need to recognise difference, but we must also understand how differences are connected to inequalities. As Mohanty observes: “diversity by passes power as well as history to suggest a harmonious and empty pluralism” (Mohanty, 2003, p. 193).

We might be ticking the diversity boxes and celebrating diversity — whether in University brochures and websites or on Harmony Day — but do our combined activities address health disparities? The problems of inequity and disparity are bigger than us but we can be accountable for the parts we play in larger political struggles. For a politics of equity, we also need to consider race, disability, ethnicity, class, gender, sexuality, and religion and integrate these into our analyses of our social world. We need to expand the frames we use to look beyond individual behaviour and to consider social and systemic issues, and call for systematic interventions to address inequity. ‘Celebrating’ cultural difference isn’t the same as action, as fighting for justice. As (Perron, 2013) notes, nurses can be both caring for individuals and advocating for the collective rights to equitable care, they aren’t mutually exclusive.

Diversity assumes that care is still a neutral technical activity
As nursing emerged from being a class of handmaidens to the medical system to the dynamic profession it is today, we have understood it to become an intellectual, cultural and contextual activity. This means it is also a political activity (De Souza, 2014). Nursing is connected to systems of power and privilege. Nurses and clients bring multiple ways of being in the world into the world of care and yet we only privilege some of these ways of being. Iris Marion Young describes oppression as being “the disadvantage and injustice some people suffer not because of a tyrannical power coerces them but because of the everyday practices of a well-intentioned liberal society…” (Young, 1990, p. 41). There continue to be clear links between institutional bias in health care systems and health disparities (Hall & Fields, 2013). Let’s ask ourselves what practices we enact every day that contribute to inequity?

Diversity maintains whiteness at its core
In diversity talk in nursing there’s an assumed white centre with difference added. White people are conceived as the hosts and people of color viewed as guests and the perspectives of Indigenous people are erased. Allen (2006, pp. 1–2) calls this the ‘white supremacy’ of nursing education: an assimilationist agenda that converts diverse groups people into a singular kind of nurse, which can then add ‘others’ into the mainstream to create a multicultural environment. But, this addition reinforces rather than displaces whiteness from the centre of structures and processes of educational or clinical institutions (p.66). It’s important that we focus on whether nurses reflect the communities that they serve. But representation in the workforce doesn’t mean that the people who are culturally different have a voice in the corridors of power. There are questions also about “who’s at the decision-making table and who’s not. And what’s on the agenda and what’s not” (Brian Raymond, 2016).

Diversity focuses on sensitivity and respect rather than on the social and historical
Race and racism are determinants of health inequities (Krieger, 2014) therefore it follows that a key area where nurses could intervene is to address discrimination. It is inadequate for us to provide individualised sensitive and respectful care while ignoring the historical and structural conditions that shape health and healthcare. As nurses, we understand more than most that life is an uneven playing field – we need to bring this knowledge to the way we work as a profession. Cultural sensitivity and awareness tend to assume that racism is “out there”, rather than something that is also enacted within healthcare systems. Our claims to colorblindness reinforce the problem, as” treating people the same” doesn’t take into account their differing needs, which is one definition of what care is.

Spotted at my local market

Creating a meaningful diverse and multicultural nursing profession
in an era where both patient populations and the nursing workforce are becoming more diverse, where are the spaces for nurses to talk about both institutional and societal racism and how they impact on care? How can nurses broaden their focus from the micro-level to see the big picture, especially when they labor in unstable and under-resourced working environments (Allan, 2017)? Nurse educators must confront our own resistance to teaching about race and racism (Bond & Others, 2017) – the recent debates about the inclusion of cultural safety into the Nursing and Midwifery Codes of Conduct reflect now far we have to go. Our curricula must more explicitly embed anticolonial and intersectional perspectives into learning experiences in order to prepare nurses for not only understanding how structural inequities affect health but also for the skills to counter them (Blanchet Garneau, Browne, & Varcoe, 2016; Thorne, 2017; Varcoe, Browne, & Cender, 2014). In Australia, the Indigenous Health Curriculum Framework developed by the Committee of Deans of Australian Medical Schools, recognised the critical need to teach students about racism. In particular, it asks us to see the connection between history and current health outcomes; to be able to identify features of overt, subtle and structural racism or discrimination and to be able to address and help resolve these occurrences.

Viewing nursing as a neutral, universal activity where appreciation, sensitivity and respect are adequate, prevents us from considering nursing as a political activity where power is at play. Conversely, embedding an understanding of the historical, structural and systemic factors that shape health, into our practice will allow us to create a meaningfully inclusive – and more caring – profession. This however, requires courage, commitment and accountability. Do we have it?

References

Allan, H. (2017). Editorial: Ethnocentrism and racism in nursing: reflections on the Brexit vote. Journal of Clinical Nursing, 26(9-10), 1149–1151.
Allen, D. G. (2006). Whiteness and difference in nursing. Nursing Philosophy: An International Journal for Healthcare Professionals, 7(2), 65–78.
Bell, J. M., & Hartmann, D. (2007). Diversity in Everyday Discourse: The Cultural Ambiguities and Consequences of “Happy Talk.” American Sociological Review, 72(6), 895–914.
Blanchet Garneau, A., Browne, A. J., & Varcoe, C. (2016). Integrating social justice in health care curriculum: Drawing on antiracist approaches toward a critical antidiscriminatory pedagogy for nursing. Sydney: International Critical Perspectives in Nursing and Healthcare. Google Scholar. Retrieved from http://sydney.edu.au/nursing/pdfs/critical-perspectives/blanchet-garneau-browne-varcoe-integrating-social-justice-2.pdf
Bond, C., & Others. (2017). Race and racism: Keynote presentation: Race is real and so is racism-making the case for teaching race in indigenous health curriculum. LIME Good Practice Case Studies Volume 4, 5.
Brian Raymond, M. P. H. (2016, August 2). How Racism Makes People Sick: A Conversation with Camara Phyllis Jones, MD, MPH, PhD | Kaiser Permanente Institute for Health Policy. Retrieved August 17, 2018, from https://www.kpihp.org/how-racism-makes-people-sick-a-conversation-with-camara-phyllis-jones-md-mph-phd/
De Souza, R. (2014). What does it mean to be political? Retrieved August 21, 2018, from http://www.ruthdesouza.com/2014/08/03/what-does-it-mean-to-be-political/
Hall, J. M., & Fields, B. (2013). Continuing the conversation in nursing on race and racism. Nursing Outlook, 61(3), 164–173.
Krieger, N. (2014). Discrimination and health inequities. International Journal of Health Services: Planning, Administration, Evaluation, 44(4), 643–710.
Mohanty, C. T. (2003). “Under Western Eyes” Revisited: Feminist Solidarity through Anticapitalist Struggles. Signs: Journal of Women in Culture and Society, 28(2), 499–535.
Perron, A. (2013). Nursing as “disobedient” practice: care of the nurse’s self, parrhesia, and the dismantling of a baseless paradox. Nursing Philosophy: An International Journal for Healthcare Professionals, 14(3), 154–167.
Thorne, S. (2017). Isn’t it high time we talked openly about racism? Nursing Inquiry, 24(4). https://doi.org/10.1111/nin.12219
Varcoe, C., Browne, A., & Cender, L. (2014). Promoting social justice and equity by practicing nursing to address structural inequities and structural violence. Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis, Eds PN Kagan, MC Smith and PL Chinn, 266–285.
Young, I. M. (1990). Throwing Like a Girl and Other Essays in Feminist Philosophy and Social Theory. Monograph Collection (Matt – Pseudo).

Are we there yet?

This piece was originally published at Tangatawhenua.com http://news.tangatawhenua.com/archives/14051

On October 3rd 2011 as part of the series: Are we there yet? These articles are being written as a prelude to the election in November, and focus on the ‘wish list’ of Generation Xers; their hopes, dreams, aspirations and vision for New Zealand society.

I have two enduring memories of arriving in New Zealand with my family in June 1975. On the drive to our new home from Mangere, I was stuck by two sights, the first were the abundant citrus trees, promising sweetness and growth in this new life and the second, the Blockhouse Bay Foodtown supermarket where we shopped for our first meal before it closed (and no I don’t remember what that was!).

The supermarket too represented abundance but the shopping trip was a portent of the self-reliance my family would need to develop to survive in this country. A marked contrast to the hospitality of home cooking that we might have expected as newcomers from the other side of the world. Later, I found out that Tom Ah Chee a New Zealand-born Chinese, was one of the three small business owners to invest in the Foodtown, New Zealand’s first American-style supermarket.

The neoliberal narrative of migration is that my family came to New Zealand (like other migrants) for a better life. Another explanation is that we were pulled to New Zealand as a result of the unevenness of life chances created by colonial capitalism. As South Asians in East Africa we were what Avtar Brah calls the filling in the colonial sandwich. Occupying a precarious uneasy place that had neither the imperial support of the British coloniser nor the entitled weight of indigeneity. Migration to New Zealand offered an escape from the colonial sandwich to maybe a liberal pizza, a place of equal footing, a safe haven, replete with economic and academic opportunities. “New Zealand has no ‘colour bar’” I remember my Mother proudly telling friends. Unfortunately, like the settler colony we’d left, the dynamic was the same but the nuances were different. In East Africa Asians had a symbiotic relationship with Africans and were understood (a checklist of some of the popular foods in Kenya, shows how our culinary destinies were interwoven despite the imminent exclusionary nationalist future: kachumbar, chapati, pilau, chai, samosa to name a few). In New Zealand, food provided an entry point in a different way. I sold Maori cookbooks to raise funds for the Hoani Waititi marae in Henderson.

The migrant’s new life is characterised by a delicate dance between preservation and hope. Treasuring a past that might never be retrieved while hoping to succeed and make good on the sacrifices that have been incurred. But other kinds of reconciliation are also necessary; requiring that migrants develop what Ghassan Hage calls an ethical relationship with the history of colonial capitalism/colonisation in which they are implicated. The narrative of migration as an individual choice framed by the desire for betterment must be considered against the collusive role of migrants in usurping the indigenous. As must being subsumed into larger stories of ethnic communities as uninvited foreign guests, in need of careful management and modernisation so as not to lower the cultural standards of the receiving society (“our way of life”).

Reckoning with a colonial history requires coming to terms with New Zealand’s history of racism. Knowing that anti-Chinese and anti-Indian sentiment has been evident since the arrival of these groups in the 1800s, where they represented the largest groups of migrants and refugees, and were viewed as threats to jobs, morals and sexuality. Chinese particularly were the targets of exclusionary immigration legislation through the 1881 Chinese Immigration Act, which exacted a poll tax of £10 from all Chinese arriving in Aotearoa/New Zealand. Indians, as British subjects were not exempt from hostility nor restrictive legislative practices despite their status. The 1899 Immigration Restriction Act restricted Indian and other Asian immigration and the formation of the White New Zealand League, in 1926 epitomised this hostility. The latter formed to counter the potential for contamination of bloodline, values and lifestyle posed by Chinese and Indian men. The introduction of the 1920 ‘permit system’ reflected demands for increasing prohibitions and excluding and/or repatriating Asian migrants.

The end of an unofficial White New Zealand migration policy was not brought about by a desire for equity or fairness. Economics was central to this policy shift, and the 1986 review of immigration was a response to a ‘brain drain’ and decreased immigration to New Zealand. Consequently migrant selection shifted from preferred source countries (largely European) to being skills based in the Immigration Act of 1987, whereby a points system was introduced. The introduction of the Business Immigration Policy and  ‘Family reunification’ and ‘Humanitarian/refugee’ categories plus the growth of a thriving export education market consolidated this long-term trend to diversity. Consequently Asians grew in number and became more visible and central to the national economy and the number of people from Middle Eastern, Latin American and African communities (MELAA) increased. However, the residue of the old attitudes and fears remains, migrants and refugees are held with great ambivalence- disadvantaged in the employment stakes but welcomed for the spice and innovation their presence adds.

I began this piece by talking about my family’s welcome to New Zealand through consumer capitalism at Foodtown. On reflection, the supermarket is an apt metaphor for migration, both for the visibility and promise of its products and for the invisibility of its processes. Neoliberal narratives of individualism and ‘choice’ render invisible both the dispossession of the local and indigenous and the economic imbalance necessary for the movement of goods and people to the West in order for capitalism to flourish. Yet if these two aspects of migration were made visible, in the same way that more ethical consumptive practices are becoming a feature of contemporary life then other kinds of relationships might be made possible. In the case of ethnic communities, direct negotiation with Maori for a space where indigenous Maori claims for tino rangatiratanga, sovereignty and authority are supported while the mana of newcomers to Aotearoa is upheld hold promise.

So, I close this piece with an alternative story of welcome. Two years ago we had a Refugee conference at AUT University, where Tainui, Refugee Services and a group of refugees talked about the powhiri process they had instituted as part of the orientation of newly resettled refugees in Hamilton. Their presentation included a powhiri during which a refugee participant delivered his mihi in Swahili. Much to his astonishment when he came to sing his Swahili waiata I joined in. It was a moving experience. In his korero he said that the original powhiri in Hamilton had helped him to stand tall and regain his mana after the dehumanising experiences of his refugee journey. On a larger scale, Maori King Tuheitia, invited ethnic communities members to a special powhiri during the 5th Koroneihana (Coronation) celebration at Turangawaewae marae in August this year. Isn’t this the kind of Aotearoa we want? Where standing tall is possible for all of us?

Ruth DeSouza
Are we there yet? Contributor


Footnote

The process of direct negotiation with Maori has already begun and there are many resources available.

New spaces and possibilities: The adjustment to parenthood for new migrant mothers

DeSouza, R. (2006). New spaces and possibilities: The adjustment to parenthood for new migrant mothers. Wellington, New Zealand.

I recently completed a report for the Families Commission about migrant maternity, based on interviews with new mothers in Auckland and with the help of Plunket and many colleagues (see the acknowledgements in the report).

Parenthood and migration are both major life events which, while stressful, can be mediated effectively with appropriate support. International research indicates that parenting in a new country without support, networks or access to information creates additional stressors.

There is a paucity of research about the transition to parenthood in New Zealand for migrant families and this research project explores the maternity experiences of women from five different migrant backgrounds. It is a starting point for further research about migrant families and the development of a migrant family life-cycle research agenda.

Forty migrant women were interviewed about their experiences of the adjustment to parenthood in a new country in order to ascertain their support needs. Early motherhood was chosen as a focus because migration policy selects healthy women and therefore the maternity experience is often when many migrant women are first initiated into the New Zealand health system. In consultation with Plunket, five groups were chosen for the study; three were from the largest Asian communities, Chinese, Indian and Korean (Chinese make up 44 percent of all Asians, Indians 26 percent and Koreans 8 percent). Two other new migrant groups were also selected for inclusion for different reasons. European migrant women were chosen because they are the largest migrant group yet little is known about their needs. These are assumed to be similar to those of other Pa-keha- because of their familiarity with language and systems. Arab Muslim women were chosen because their faith and cultural needs are not well understood. One focus group was undertaken for each group. AUT University’s Centre for Asian and Migrant Health Research and the Royal New Zealand Plunket Society conducted the research together in March 2006.

KEY FINDINGS

It is hoped that the research findings will inform policy, the development of appropriate resources and other research in this area, and will assist both health professionals and migrant communities in New Zealand. The key findings of the research were that:

  • migrant women lose access to information resources, such as family and friends, in the process of migrating and come to depend on their husbands, health professionals and other authoritative sources. Importantly, the expectations from their country of origin come to inform their experiences of pregnancy, labour and delivery in a new country
  • migration has an impact on women’s and their partners’ roles in relation to childbirth and parenting. The loss of supportive networks incurred in migration results in husbands and partners taking more active roles in the perinatal period
  • coming to a new country can result in the loss of knowledge resources, peer and family support and protective rituals. These losses can lead to isolation for many women.

RECOMMENDATIONS

The findings of the research suggest that:

  • support services for women who have a baby in a new country need to be developed and services also need to be ‘father-friendly’
  • the information needs of migrant women from all backgrounds need to be considered in planning service delivery (including European migrant women)
  • services need to develop linguistic competence to better support migrant mothers, for example by providing written information in their own language
  • those developing antenatal resources must consider the needs of migrant mothers; for example, by having antenatal classes available in a number of common languages, eg Korean
  • workforce development occurs among health professionals to expand existing cultural safety training to incorporate cultural competence
  • health and social services staff must become better informed as to the resources that are available if they are to provide effective support for migrant mothers.

FUTURE RESEARCH

Further research is required to:

  • explore the experiences of New Zealand-born women to identify whether the issues raised in this report are peculiar to migrant women or to women in general
  • explore the information needs of migrant parents through the family life-cycle
  • identify the factors that support breastfeeding in the absence of social support
  • understand the experiences of migrant father
  • understand the needs of additional migrant groups, including African, Middle-Eastern and Latin American communities
  • review the effectiveness of cultural safety for migrant women by focusing on outcomes.

The Art of Walking Upright Here: Realising a Multicultural Society

Background paper for the Asia:NZ Foundation’s Kiwi India Seminar Series. Auckland and Wellington, October 2004

The title of this paper is drawn from a line in a Glenn Colquhoun poem. He draws inspiration from a poem by Allen Curnow, himself inspired by the site of a skeleton of a long extinct Moa in a museum. Whilst Colquhoun’s words are undoubtedly a profound metaphor for the migrant experience, Curnow’s are, perhaps, a metaphor for our failure to adapt to change, whether as a migrant or a member of the host community:
Not I, some child born in a marvellous year, Will learn the trick of standing upright here (Curnow, 1997, p.220).

Aotearoa/New Zealand has seen a significant increase in new migrants over the last ten years. Drawn here from across the world and facing the challenges of settlement, they face another unique challenge, finding their place within a country that embraces the notion of biculturalism, where Māori are positioned as partners with the Crown. As New Zealand society becomes increasingly multi-cultural, it is still required to negotiate the bi-cultural discourses of Māori which some argue positions migrants from places such as India as outsiders. In this presentation I will introduce myself briefly and outline the challenges facing Indian communities in New Zealand by drawing together the history of migration to New Zealand and outlining some possibilities for the future.

Migrants in Aotearoa/New Zealand
New Zealand is viewed as a nation of immigrants, and immigration has been an important factor in economic growth and social development. One in five New Zealand residents was born overseas and this rises to one in three people in the Auckland region (Statistics New Zealand, 2003). The Treaty of Waitangi/Te Tiriti o Waitangi is the founding document of the nation state, recognising Māori as ‘tangata whenua’ (Roscoe, 1999). Te Tiriti defines “principles of partnership, participation, protection and equity” (Cooney, 1994, p.9). Yet this benign notion of ‘settlerhood’ contrasts sharply with the end result of a process that has led to the traumatic colonisation and dispossession of Māori. Favourable policies resulted in subsequent waves of migrants of European descent, resulting in a dominance of this group such that Māori became the ‘other’ in their own land (Du Plessis & Alice, 1998).
The visibly different migrant, such as Indians, Chinese and Pacific Islanders, became ‘others’ because of their physical appearance, religion or culture but without the status of the indigenous Māori (Du Plessis & Alice, 1998). Most Indians migrated to New Zealand from Gujarat and Punjab then from Fiji and. About 200 came from Uganda as refuges in 1971. One of the first Indians to arrive in New Zealand was thought to be a Goan nicknamed “Black Peter” (Edward Peters) in 1853 (Leckie, 1995). The first Chinese arrived in 1866 (Roscoe, 1999). A fear of the impact of foreigners led to restrictive laws being introduced between 1870 and 1899 and these were only repealed later when new sources of labour were required.

In the last few decades other trends have impacted on migration patterns. The first being an initial increase in migration from the Pacific Islands in the second half of the 1970s and again following the Fiji coup in 1987. Pacific Islands migration decreased in the 1990s with a shrinkage in manufacturing jobs and the closure of factories as tariffs on imported goods were removed. An increase in Asian migration was the second immigration trend and was related to the encouragement of foreign investment in New Zealand. Refugees also arrived from Cambodia and Vietnam and migration from Hong Kong related to the return of the colony to China. The third was the increase in migration from Africa and the Middle East, predominantly from South Africa. The above trends led to an increase in the number of migrants from non-traditional source areas. Compounding these trends, there has been the noticeable increase in tension between Māori and Pākehā, particularly around grievances and claims relating to the Treaty (Pawson et al., 1996) and land issues.

Government Policy
Following World War Two, the notion of assimilation dominated. ‘Invisible’ migrants were seen as desirable and the goal was for migrants to ‘fit in’ rather than change the society they had entered. For many, therefore, change, was one-way. There was a philosophical shift in this policy when Canada and Australia embraced multiculturalism during the 1960s, which held that people had the right to retain their culture and have access to society and services without being disadvantaged (Fletcher, 1999). This transformed the notion of settlement into a two way process whereby change was required by both migrants and the host society. New Zealand policy made a strategic move towards multiculturalism in the 1986 review and subsequent 1987 Immigration Act. This Act eased access into New Zealand from non-traditional source countries and replaced entry criteria based on nationality and culture to one initially based on skills and subsequently through the introduction of a points system (Roscoe, 1999). This policy emphasis on attracting highly qualified immigrants was similar to policy changes in North America and Australia (Pernice, Trlin, Henderson, & North, 2000). The adoption of the points system in 1991 led to immigrants who had experience, skills, qualifications and money being selected for business investment in New Zealand (Ho, Cheung, Bedford, & Leung, 2000).

Implications
Changes in migration policy and the resulting increase in migration have led to much public debate fuelled also by a renaissance in Māori sovereignty, itself related to the global rise in indigenous movements since the 1970s. This has seen the re-positioning of Māori as indigenous to New Zealand and the evolution of a bicultural nationalism (Roscoe, 1999). Many vociferous opponents of increased migration argue that the ideology of multiculturalism is problematic as it negates the primacy of Māori and biculturalism. This, some argue, is problematic because Māori are indigenous, whilst migrants (and refugees) have other places that maintain and preserve their culture. Many argue that because the Treaty has not been honoured, other ethnic groups have had no other option but to relate only to the Crown.

By calling Māori ‘the first immigrants’, it is argued that the rights of Māori as first nation people are negated and their claim for special status as tangata whenua countered (Walker, 1995). The argument continues that the preamble of Te Tiriti o Waitangi allowed immigration to New Zealand from Europe, Australia and the United Kingdom and for any variation to occur, consultation with Māori is required as descendants of the Crown’s treaty partner. Walker concluded that the government consultation process with Māori was flawed because some Māori leaders were not representative and dissenting voices were ignored. Some have also argued that the points system of immigration and active encouragement of migration from non-traditional source countries was
a quick fix for rising unemployment and a stagnant economy driven by the partnership between corporate business interests and the government.

Within this debate between Pākehā and Māori, many visibly different migrants felt marginalised on two levels; firstly as outsiders to Māori and secondly as outsiders and cultural ‘other’ to Pākehā (Jaber, 1998). The process of ‘othering’ of Asian immigrants2 differs from that of Māori. Firstly, Asians are considered to be contributing to the economy even if they are ‘too successful’ by virtue of their skills and working attributes and secondly, elements of Asian culture can be commodified for consumption in the form of food and restaurants (Pawson et al., 1996). In particular this packaging absolves the consumer from caring about “the authenticity of the product, its cultural meaning, its technical sophistication or its historical origin” (Yuan, 2001, p.79). This process of consumption fetishises, foods, clothing and rituals into a decontextualised barren image. Sari material, yoga, ayurvedic medicine and Eastern spirituality have joined the list of consumables that many New Zealanders enjoy without understanding their social, political, cultural and spiritual significance. Despite the consumption of ‘Indianness’, little emphasis has been accorded to visibly different migrants in the debates over citizenship.
Roscoe (1999) sees two ways in which citizenship can be viewed; the first is civic nationalism, underpinning the discourse of multiculturalism, when a national identity is shared equally by citizens regardless of origin. Secondly, citizenship can be viewed as ‘ethnic nationalism,’ when greater standing is given to members of the dominant group.

Far from being the welcoming immigrant nation New Zealand purports to be, the paradigm of ethnic nationalism is more representative of the reality and is based around Pākehā notions of New Zealand. So, there remains a tension between the universalist, egalitarian notion of equal treatment of citizens and the need for recognition of cultural specificity. Docker and Fischer (2000) suggest that there needs to be a recognition of the politics of universalism and the politics of difference and conclude:

Thus, we experience a plethora of overlapping, competing and unresolved contradictions: colonial versus post-colonial, old settlers versus new settlers, indigenous people versus invaders, majority versus innumerable minorities, white against black or coloured, the search for a collective, inclusive or ‘national’ identity…vis-á-vis the search for individual and personal or group identity based on ethnicity, language, country of origin, or religion. All these struggles are played out on the same but rather less-than-level-playing field: social antagonisms, class and gender differences continue to play decisive roles in the game of identity recognition (Docker & Fischer, 2000, p.6).

Critics such as Thakur (1995) argue that the official rhetoric of biculturalism recognises the legitimacy of Māori and Pakeha but excludes migrant cultures that are non-white and non- indigenous. These ‘others’ are excluded from the debate on the identity and future of the country in which they live, leading writers such as Mohanram (1998, p.21) to ask “what place does the visibly different coloured immigrant occupy within the discourse of biculturalism?” This tension exists for many other groups as well, for example Wittman (1998, p.39) has commented “on the exclusionary effect of any others by the ideology of biculturalism” for Jewish people in New Zealand. Many Chinese argue that in New Zealand, a bicultural society, migrant cultures are not even relegated to the margins of society “our place is nowhere” (Yuan, 2001, p.121).

Conclusion
As the global marketplace shrinks, countries compete for people with skills and wealth creating potential. Gone are the days of relying on migrants from the traditional source countries. This transformation in migration means that there is now an urgent need for settlement focussed- resources for new migrants and refugees. New migrants need to be resourced to recognise, understand and value the special position of tangata whenua and to be able to examine their role in relation to the Treaty of Waitangi. Equally, it is necessary for immigration policy and settlement policy to be inclusive of those already here. This means not only Pākehā (represented by government) but also Māori.

Can biculturalism and multiculturalism co-exist or are they mutually exclusive? I would argue that one need not preclude the other. Recognising and celebrating the ethnic diversity of modern day New Zealand need not diminish the rights of Māori. Perhaps we can all work together to create a social and political milieu that is both universal and egalitarian: ironically something many Pakeha New Zealander’s assume already exists. In this model we treat citizens equally, celebrating their diversity but valuing as a central tenet of our society the position of the Treaty of Waitangi and its guiding principles. This ensures a unique position for Māori to be recognised as the guardians of this special land. By doing this we create a dynamic and vibrant society leaving behind a past based on fear (for loss of whiteness), grievance (for abuse of Māori rights) and invisibility (of others arriving in an already formed land).

References
Colquhoun, G. (1999). The art of walking upright. Auckland, NZ: Steele Roberts.

Cooney, C. (1994). A comparative analysis of transcultural nursing and cultural safety. Nursing Praxis in New Zealand, 9(1), 6-12.

Curnow, A. (1997). Early days yet: New and collected poems 1941 – 1997. Auckland: AUP.

Docker, J., & Fischer, G. (2000). Adventures of identity. In J. Docker & G. Fischer (Eds.), Race, Colour and Identity in Australia and New Zealand. Sydney: UNSW Press.

Du Plessis, R., & Alice, L. (Eds.). (1998). Feminist thought in Aotearoa/New Zealand. Auckland: OUP. Fletcher, M. (1999). Migrant settlement; a review of the literature and its relevance to New Zealand.Wellington: New Zealand Immigration Service, Department of Labour.

Ho, E., Cheung, E., Bedford, C., & Leung, P. (2000). Settlement assistance needs of recent migrants (Commissioned by the NZIS). Waikato: University of Waikato.

Jaber, N. (1998). Postcoloniality, identity and the politics of location. In R. D. Plessis & L. Alice (Eds.),Feminist thought in Aotearoa, New Zealand (pp. 37-43). Auckland: Oxford Press.

Leckie, J. (1995). South Asians: Old and new migrations. In S. W. Greif (Ed.), Immigration and national identity in New Zealand (pp. 133-160). Palmerston North: Dunmore Press.

Mohanram, R. (1998). (In)visible bodies? Immigrant bodies and constructions of nationhood in Aotearoa/New Zealand. In R. D. Plessis & L. Alice (Eds.), Feminist thought in Aotearoa, New Zealand (pp. 21-29). Auckland: Oxford Press.

Pawson, E., Bedford, R., Palmer, E., Stokes, E., Friesen, W., Cocklin, C., et al. (1996). Senses of place. In R.L. Heron & E. Pawson (Eds.), Changing places: New Zealand in the nineties. Auckland: Longman

Paul. Pernice, R., Trlin, A., Henderson, A., & North, N. (2000). Employment and mental health of three groups of Immigrants to New Zealand. New Zealand Journal of Psychology, 29(1), 24-29.

Roscoe, J. (1999). Documentary in New Zealand: an immigrant nation. Palmerston North: Dunmore Press.

Statistics New Zealand. (2003). New Zealand in profile 2003. Wellington: Statistics New Zealand, Ministry of Foreign Affairs and Trade, New Zealand Immigration Service.

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Migrant Populations

DeSouza, R. (2004). Working with refugees and migrants. In D. Wepa (Ed.), Cultural safety (pp. 122-133). Auckland: Pearson Education New Zealand.

The art of walking upright here

Is the art of using both feet.

One is for holding on.

One is for letting go. (Colquhoun, 1999, p.32)

Glenn Colquhoun’s poetry captures the challenge dislocation from home and family. The migrant or refugee has to somehow hold on to their legacy and their heritage whilst simultaneously letting go of those things that cannot be maintained in a new country. They must let go to create new lives, so they can stake a new claim of belonging; a new place to stand.

One in five New Zealanders was born overseas. This rises to one in three in Auckland. For many, migration is seen as a way of obtaining a better life, particular for ones children. Whilst many migrants make informed decisions, this needs to be seen as a continuum between full choice and no choice. This can been viewed as a ‘pull’ effect (migrants are drawn to a new country for the opportunities available) or a ‘push’ effect (the motivation is simply to leave where they are). Migrants can be defined as people who were born in one country and then move to another under an immigration programme. In New Zealand this consists of three main streams:

  •  Skilled/Business: Which relates to attracting migrants with qualifications and skills, or the potential to create business opportunities in New Zealand.
  • Family sponsored: Where New Zealand citizens or permanent residents can sponsor family members to the country.
  • Humanitarian: This includes refugees and allows for family members to be granted residence if there are serious humanitarian concerns.

Refugees that have resettled in New Zealand mostly originate from Africa, the Middle East, South East Asia and Eastern Europe. Refugees differ from voluntary migrants because they were forced to leave their home and have little if any choice in selecting their destination. They are at the extreme end of the ‘push’ effect, often having fled from situations of conflict and human right abuses. This has important implications for the provision of  health care, as they might not have had access to preventative and treatment services. Most refugees arriving in New Zealand will spend six weeks at the Mangere Refugee Reception Centre (MRRC) in South Auckland. There are estimated to be 20.6 million refugees and displaced people in need of protection and help (UNHCR, 2003). Currently New Zealand accepts a United Nations-mandated quota of 750 refugees per year, plus approximately the same number again of asylum seekers. Asylum seekers are people seeking refugee status without legal documentation. They often experience depression, hopelessness and helplessness related to stress and socio-economic deprivation. Even where migration is an informed choice, the result can still be isolation and loss of financial independence. Before migration, one often only considers the positives; it can be difficult to understand the adjustment that is required and to come to terms with the losses of family, friends, culture and familiarity.

In this chapter I present a view of cultural safety and how it is relevant to health from the perspective of a migrant with a view to informing those who will be caring for the needs of migrants and refugees. I will briefly review the history and tensions around migration and migrants. Anecdotes from my clinical experience are woven through the text to present multiple layers to reflect the complexity of the experience and reflective questions are posed to increase self-awareness. I conclude by offering a range of strategies for working with diversity.