Enumah Zachary Obinna
Center for Global Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States of America.
Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, United States of America.
PLOS Glob Public Health. 2023 Jun 8;3(6):e0001655. doi: 10.1371/journal.pgph.0001655. eCollection 2023.
Globally, refugees number over 25 million. Yet, little attention has been paid to how refugees access referral health care in host countries. By referral, I mean the process by which a patient deemed too sick to be managed at a lower-level health facility is transferred to a higher-level facility with more resources to provide care. In this article, I provide reflections on referral health care from the perspective of refugees living in exile in Tanzania. Through qualitative methods of interviews, participant observation, and clinical record review, I trace how global refugee policy on referral health care manifests itself in the lives of refugees locally in a country like Tanzania that has strict policies and limitations on freedom of movement. In this space, refugees experience complex medical problems, many of which began prior to or during their flight to Tanzania. Many refugees indeed are approved to be referred to a Tanzanian hospital for further treatment. Others are denied care or pursue other therapeutic itineraries outside the formal system. But, all are subject to policies of Tanzania that restrict freedom of movement and almost all experience delays on several levels (e.g., waiting for a referral, waiting at the referral hospital, waiting for follow-up appointments). In the end, refugees in this context emerge not simply as passive beings upon which biopower is enacted, but also as active agents, sometimes circumventing a system of power in their pursuit of their right to health, all in the context of strict policy that seeks to enforce state security over one's right to health. In the process, refugee experiences with referral health care become a window into the larger politics of refugee hosting in Tanzania in the present day.
全球范围内，难民人数超过2500万。然而，对于难民在东道国如何获得转诊医疗服务，却很少有人关注。所谓转诊，是指一个被认为病情过重、无法在较低级别医疗机构得到治疗的患者，被转至资源更丰富的较高级别医疗机构接受治疗的过程。在本文中，我从流亡在坦桑尼亚的难民的视角，对转诊医疗服务进行了思考。通过访谈、参与观察和临床记录审查等定性研究方法，我探寻了全球难民转诊医疗政策在坦桑尼亚这样一个对行动自由有着严格政策和限制的国家，是如何在当地难民的生活中体现出来的。在这个环境中，难民面临着复杂的医疗问题，其中许多问题在他们逃往坦桑尼亚之前或期间就已出现。许多难民确实被批准转诊到坦桑尼亚医院接受进一步治疗。其他人则被拒绝治疗，或者在正规医疗体系之外寻求其他治疗途径。但是，所有人都受到坦桑尼亚限制行动自由政策的影响，几乎所有人都在多个层面经历延误（例如，等待转诊、在转诊医院等待、等待后续预约）。最终，在这种情况下的难民不仅仅是被动接受生物权力作用的个体，也是积极的行动者，有时会在追求健康权的过程中规避权力体系，而这一切都发生在一个试图将国家安全凌驾于健康权之上的严格政策背景下。在此过程中，难民的转诊医疗经历成为洞察当今坦桑尼亚难民收容更大政治问题的一个窗口。
