Why did you decide to study only Punjabi immigrants and health issues related to this particular community?
In my opinion, Indian immigrants can be classified into three categories. Those on short term visit, on long term or student visas, and Punjabis. Amongst undocumented immigrants Punjabis form the major bulk. In fact, the biggest stumbling blocking in studying these Punjabi migrants has been their undocumented status and constant fear of being unmasked and deported. I am not even referring to the migrants who moved west after the 1984 riots. These people are officially not allowed to work but they clandestinely work for the government and some other private employers. They bridge a gap in the socio-economic system in Germany. Typically they end up with jobs that are classified as 3D – dangerous, degrading and dirty. Also, since I was pursuing my course from South Asia Institute, I had to choose a topic relevant to the South Asian community.
What were your major findings during the course of your study?
A surprising find was, contrary to popular belief, most Punjabi immigrants have not come to Germany for security reasons. They have come to earn money; if possible to find a local who will marry them and provide them with a legal status. This population has not been studied in the past. They maintain good ties with the local Gurudwara. During emergencies, they are able to arrange funds. Their network in the Gurudwara is the key to their life’s success
What measures would you suggest the German government should adopt to address the issues you observed among the Punjabi immigrant population?
Health legislation should be less stringent and less restrictive. The medical community is in two minds about treating undocumented immigrants. Doctors and health care workers should have more freedom to treat these immigrants who should also have anonymous health insurance cards. Medical facilities on a cash basis should be encouraged and the government could also assist NGOs who work with immigrants and provide free annual health check ups.
As a community, how are Punjabis different from other regional groups in India with respect to their health and hygiene practices? Do they have particular habits / deficiencies in their diet which makes them particularly vulnerable to certain diseases?
The Punjabi immigrants in Germany are not a very educated lot. They are mostly from a rural and agrarian background. They have a very casual approach to health and consume huge amounts of alcohol. They also expose themselves to dangerous conditions to earn quick money. Since these people undergo forced and prolonged sexual abstinence from being isolated due to their illegal status, instances of homosexuality and excessive consumption of libido enhancing pills have been observed. It is also shocking that some of these undocumented Punjabi migrants have admitted to a previous STD diagnosis, particularly those who have visited Russia and other former Soviet Unions states. After such a diagnosis, most of these migrants entering Germany and other EU countries have remained deprived of further medical care treatment due to their undocumented status. When these infected Punjabi migrants come into contact with new migrants in extremely unhygienic living conditions and consistently fail to use prophylactics, prevalence of STDs among this population has assumed dangerous proportions.
Whilst it is true that some of the young migrants hold the view that sex without a condom is more adventurous and satisfying, there are others who have engaged in unprotected sex either because they were in a state of inebriation or too frustrated to think about such measures and saw their lives in illegality as worthless. Medical care givers interviewed during my research also confirmed that such tendencies of casualness and frustration leading to neglect of safety measures exist among this population. In fact, many of the STD infected migrants failed to show up or follow up with the treating doctor due to fear of arrest and deportation. This urgently needs to be addressed before it snowballs into a major threat to other migrants and the host population at large.
How do the illegal immigrants access healthcare, if at all? If not. How are they treating their diseases?
Since they are illegal immigrants, they mostly resort to self medication to avoid hospitalization. The live in fear of being deported and avoid any kind of contact with ‘the authorities’. When they do visit a doctor, it would be a doctor of South Asian descent who has been recommended by a fellow immigrant. Medical students, traditional healers like Ayurvedic or Homeopathic physicians, pharmacists and some self-styled therapists from their own community are also approached by these migrants during the time of their illness.
Germany does not require immigrants to undergo HIV screening. Do you have any inputs on if there are immigrants living with HIV but without access to treatment drugs?
There are no statistics on HIV/STD occurrences amongst immigrants. I had interviewed a small sample population of 30 people. They are not very comfortable speaking with strangers. In my opinion, about 60-70 % of the immigrants would have some sexually transmitted diseases either in early or advanced stage. Their condition is aggravated since they cannot access regular treatment.
Please give us some excerpts from you thesis which highlights the plight of Punjabi immigrants in Germany.
"It is true that these undocumented migrants access to healthcare is so limited that the quality of treatment cannot be ensured even if immigrants are willing to pay cash as also observed by Pross (2007). Cholewinski’s (2005:49) view, too, heightens this notion when he describes the plight of this population in trying to have minimum access to social rights including medical care facilities. However, it is also important to note here that some of the doctors and even patients during my research admitted that the quality of their treatment suffered due to irregularity in visiting the treating physician. Money was not the issue in that situation and irregularity of course was due to their prolonged confinement in hideouts for fear of being caught."
"In respect of the types of health disorders among these Punjabi undocumented migrants, my observations about the element of homosexuality, the use of life-threatening libido-enhancing pills and unsafe sexual practices presented new findings."
"Health issues of these immigrants are primarily mental and psychological in nature. Almost everyone complained of deep depression and anxiety characterised by sleep disorders and alcohol abuse. It is not so difficult to comprehend that these mental disorders are result of an isolated lifestyle and dire living conditions, where the fear of being unmasked constantly hovers over the heads of these people."
"Iqbal Singh, another undocumented immigrant, contends that the problem of anxiety has also to do with a high level of jealousy among the housemates. He explains that every time someone from their group informs others about even the possibility of finding an escape route from illegality, the others go into their shells. Almost all interviewed migrants admitted to some sort of rivalry among housemates as to who will be first to obtain a legal status."
"There is a conflict between suspicion and trust on the minds of these undocumented immigrants. They do not easily trust anyone, not even the people they are sharing a room with, and prefer to be mute about their plans and personal matters due to the fear of having their identity disclosed. There have been a few instances where people from within the same group secretly informed the police about a specific hideout or an individual working illegally at a certain place.”