The implications of being an international medical graduate (IMG) in Canadian society : a qualitative study of foreign-trained physicians' resettlement, sense of identity and health status

This qualitative research study used grounded theory methodology to explore the settlement experiences and changes in professional identity, self esteem and health status of foreign-trained physicians (FTPs) who resettled in Canada and were not able to practice their profession. Seventeen foreign-trained physicians completed a pre-survey and rated their health status, quality of life, self esteem and stress before and after coming to Canada. They also rated changes in their experiences of violence and trauma, inclusion and belonging, and racism and discrimination. Eight FTPs from the survey sample were interviewed in semi-structured qualitative interviews to explore their experiences with the loss of their professional medical identities and attempts to regain them during resettlement. This study found that without their medical license and identity, this group of FTPs could not fully restore their professional, social, and economic status and this affected their self esteem and health status. The core theme of the loss of professional identity and attempts to regain it while being underemployed were connected with the multifaceted challenges of resettlement which created experiences of lowered selfesteem, and increased stress, anxiety and depression. They identified the re-licensing process (cost, time, energy, few residency positions, and low success rate) as the major barrier to a full and successful settlement and re-establishment of their identities. Grounded research was used to develop General Resettlement Process Model and a Physician Re-licensing Model outlining the tasks and steps for the successfiil general resettlement of all newcomers to Canada with additional process steps to be accomplished by foreign-trained physicians. Maslow's Theory of Needs was expanded to include the re-establishment of professional identity for this group to re-establish levels of safety, security, belonging, self-esteem and self-actualization. Foreign-trained physicians had established prior professional medical identities, self-esteem, recognition, social status, purpose and meaning and bring needed human capital and skills to Canada. However, without identifying and addressing the barriers to their full inclusion in Canadian society, the health of this population may deteriorate and the health system of the host country may miss out on their needed contributions.

Le rapport Displaced Persons and Their Resettlement in the United States et le début des politiques d’accueil aux États-Unis

RÉSUMÉ : Avec le dénouement de la Deuxième Guerre mondiale, le problème des réfugiés en Europe devient un enjeu international. Plusieurs millions de personnes, que l’on nomme les Displaced Persons (DP), sont sans refuge et doivent recevoir une aide immédiate pour survivre. Même si la majorité de ces gens retourneront dans leurs pays d’origine, il reste encore des centaines de milliers de réfugiés en 1948. La seule solution concrète pour régler cette problématique est l’émigration des réfugiés dans des pays prêts à les accepter. Les Américains jouent un rôle crucial en acceptant 415 000 DP entre 1948 et 1952 grâce au Displaced Persons Act de 1948 et ses amendements en 1950 et 1951. Après d’âpres discussions entre les restrictionnistes et ceux qui défendent la libéralisation des lois d’immigration, naîtra le Displaced Persons Act (DP Act) signé avec beaucoup de réticence, le 25 juin 1948, par le président Harry S. Truman. Cette loi qui prévoit la venue de 202 000 DP en deux ans, contient des mesures jugées discriminatoires à l'endroit de certaines ethnies. Afin d'améliorer le DP Act, le Congrès effectue des recherches sur la situation des réfugiés toujours dans les camps en 1949 tout en étudiant l’impact de la venue des DP aux États-Unis entre 1948 et 1950. Cette étude est soumise sous forme de rapport, le Displaced Persons and Their Resettlement in the United States, le 20 janvier 1950. Ce mémoire propose une analyse minutieuse du rapport et de son contexte politique afin de démontrer le rôle important de cette étude dans le processus décisionnel du Congrès américain visant à accueillir un plus grand nombre de DP tout en posant les bases pour une politique d’accueil en matière de refugiés.

'To move or not to move': Reflections on the resettlement of artisanal miners in the western region of Ghana

This article critically reflects upon the shortcomings of the 'Prestea Action Plan', an ambitious initiative undertaken to facilitate the resettlement of artisanal miners operating in the Western Region of Ghana. The aim of the exercise was to identify viable areas for the thousands of operators who were working illegally in the town of Prestea, an area under concession to the US-based multinational, Golden Star Resources Ltd. At the time of its launch, it was one of the few support initiatives to target artisanal miners, whose claims to land are generally not recognized by governments. It was a particularly significant exercise in Ghana because it suggested that the authorities, who traditionally have exercised a policy of non-negotiation with such groups, had finally recognized that dialogue was needed if the growing rift between the country's indigenous artisanal miners, foreign mining companies and government bodies was to be bridged. It soon emerged, however, that despite its commendable policy objectives, the Plan was fundamentally flawed-problems which would undermine the entire exercise.

Flooding, resettlement and change in livelihoods: evidence from rural Mozambique

Post-disaster development policies, such as resettlement, can have major impacts on communities. This article concerns how and why people's livelihoods change as a result of resettlement, and what relocated people's views of such changes are, in the context of natural disasters. It presents two historically-grounded, comparative case studies of post-flood resettlement in rural Mozambique. The studies show a movement away from rain-fed subsistence agriculture towards commercial agriculture and non-agricultural activities. Ability to secure a viable livelihood was a major determinant of whether resettlers remained in their new locations or returned to the river valleys despite the risks that floods posed. The findings suggest that more research is required into 1) understanding why resettlers choose to stay in or abandon designated resettlement areas; 2) what is meant by 'voluntary' and 'involuntary' resettlement in the context of post-disaster reconstruction; and 3) what the policy drivers for resettlement are in developing countries.

A climate of control: flooding, displacement and planned resettlement in the Lower Zambezi River valley, Mozambique

In recent years, the potential role of planned, internal resettlement as a climate change adaptation measure has been highlighted by national governments and the international policy community. However, in many developing countries, resettlement is a deeply political process that often results in an unequal distribution of costs and benefits amongst relocated persons. This paper examines these tensions in Mozambique, drawing on a case study of flood-affected communities in the Lower Zambezi River valley. It takes a political ecology approach – focusing on discourses of human-environment interaction, as well as the power relationships that are supported by such discourses – to show how a dominant narrative of climate change-induced hazards for small-scale farmers is contributing to their involuntary resettlement to higher-altitude, less fertile areas of land. These forced relocations are buttressed by a series of wider economic and political interests in the Lower Zambezi River region, such dam construction for hydroelectric power generation and the extension of control over rural populations, from which resettled people derive little direct benefit. Rather than engaging with these challenging issues, most international donors present in the country accept the ‘inevitability’ of extreme weather impacts and view resettlement as an unfortunate and, in some cases, necessary step to increase people’s ‘resilience’, thus rationalising the top-down imposition of unpopular social policies. The findings add weight to the argument that a depoliticised interpretation of climate change can deflect attention away from underlying drivers of vulnerability and poverty, as well as obscure the interests of governments that are intent on reordering poor and vulnerable populations.

Resilience as transformative capacity: exploring the quadripartite cycle of structuration in a Mozambican resettlement programme

The concept of resilience has emerged out of a complex literature that has sought to make sense of an increasingly interconnected world that appears ever more beset by crises. Resilience’s appeal is reflected by the burgeoning mass of literature that has appeared on the subject in the past five years. However, there is ongoing debate surrounding its usage, with some commentators claiming that the term is inherently too conservative a one to be usefully applied to situations of vulnerability in which more radical social change is required. This article extends existing efforts to formulate more transformative notions of resilience by reframing it as a double-edged outcome of the pre-reflective and critical ways in which actors draw upon their internal structures following the occurrence of a negative event, thus reproducing or changing the external structural context that gave rise to the event in the first place. By employing a structuration-inspired analysis to the study of small-scale farmer responses to a flood-induced resettlement programme in central Mozambique, the article presents a systematic approach to the examination of resilience in light of this reframing. The case study findings suggest that more attention should be paid to the facilitative, as well as constraining, nature of structures if vulnerable populations are to be assisted in their efforts to exert transformative capacity over the wider conditions that give rise to their difficulties.

Refugees from Myanmar and their health care needs in the US: A qualitative study at a refugee-resettlement agency

In response to the recent rapid influx of refugees from Myanmar, Interfaith Ministries for Greater Houston (IM), a refugee resettlement agency, started to support them in June 2007. The study looked at the refugees' perspectives and identified the gaps in their understanding on US health care system, health seeking behaviors and challenges in utilizing health care in United States. The major issues identified were non-compliance with tuberculosis prevention medication due to barriers in obtaining medication refills, barriers in accessing specialty care services, transportation issues, written and oral language barrier, difficulties in the application for and use of Medicaid and Gold Card, misunderstanding of emergency health services, lack of resources for health education, self-treatment with Western medicine and income too low to buy private health insurance. In order to transform them to healthy citizens able to contribute to the US workforce, several multi-faceted and comprehensive approaches and better coordination among agencies are recommended. ^

Capacity-building through English language training to improve long-term resettlement success: A case study of the refugees along the Thailand-Burma border

Achieving long-term resettlement success is a challenge for many refugees seeking to restart their lives after displacement and being uprooted from their lives. Refugees must deal with finding employment, integrating into a society immensely different from what they have known their whole lives, and starting over from scratch. Learning a new language enables refugees to progress towards integration and long-term resettlement success, however, resettled refugees face a multitude of barriers in the U.S. to accessing language classes and attaining English proficiency. This study seeks to bridge this problem by exploring the possibilities of implementing a standardized language training program in the refugee camps to better prepare refugees for resettlement. A case study of the refugees along the Thai-Burma border demonstrated the significance of learning English in the camps on eventual English proficiency as well as the need for increased partnerships to overcome the barriers of lack of motivation and lack of funding. The author explores the possibilities of implementing a language training program in the camps by determining need, interest, barriers, and perceptions through the use of interviews, surveys, and focus groups of camp refugees, resettled refugees, and key organizational representatives. The significance of these results offers the possibility of leveraging and unlocking resettlement as a durable solution for more of the world's refugees in protracted situations.