Kyoto University1
The notion of 'context' has been central to geographers' conceptualization of health and place in manners focusing on place determinants of health dynamics, behaviors and health related outcomes (Cummins et.al 2007, Jones and Moon 1993, Kearns 1993). 'Context' evokes two interrelated geographical constructs of 'space' and 'place.' Kearns and Joseph (1993: 712, citing Griffiths and Johnson 1991) argued that whereas people's lives are shaped and influenced by processes that occur over geometric space, it is in places that '...people become what they are.' The question then is what happens when individuals who have developed in one place and space contexts attempt to re-establish their lives in another context? We used existing data on these issues to compare what have changed or persisted regarding the knowledge and practices of, for instance, sanitation and hygiene, diseases of the Ibibio (Nigeria) migrants in the UK. We framed the research around medical pluralism and health belief model, while data collection techniques were based on in-depth interviews and structured questionnaires.By our findings, not much has significantly changed in the medical worldview of the respondents. Most WASH behaviors such as hand washing after toilet with or without soap, regular bath, dental care, etc were linked to social habits. While in Nigeria, 57.5% of the respondents said they used to wash their hands after the use of toilet. In the UK, there was a progressive improvement as 83.3% of the respondents said they often wash their hands after every use of the toilet facilities. But when asked whether they wash hands with soap after every use of the toilet facilities, only 16.7% claimed they used to wash hands with soap after every use of the toilet facilities in Nigeria. A little higher number of same respondents (20.8%) claimed they wash their hands with soap after every use of the toilet facility in the UK. Standard WASH infrastructure in the UK probably could explain migrants' significant adjustment in the form of improved sanitary practices. It is also possible that respondents who claimed the habit of regular hand washing/hand washing with soap while in Nigeria had some level of improved living condition which enabled the use of modern toilet system. For respondents who hardly adjust their habits in response to improved sanitary system, this may have to do with poor socio-economic background which limits their exposure to messages and knowledge of standard practices. For bodily hygiene, about 83.3% claimed they never failed to take bath at least once in a day while in Nigeria but the percentage dropped significantly to 53% as some respondents claimed they do not follow such regularity while in the UK. Seasonal changes in the UK weather system especially in the winter were the commonest explanation for the slight adjustment in such habit. Most respondents agreed that regular bath, for them, is still the normal routine except in the winter, '... but whatever is the case one must bath at least once in a day...' argued a male respondent in his late 50s. The symbolic notion of beauty linked to cleanliness is the underlying reason, which is in line with the general belief in the Ibibio tradition (expressed in a local proverb) that cleanliness is beauty (translated in local dialect as Nsana-idem ado uyai) (Akpabio 2012). For dental care, the use of chewing stick for tooth brush was highlighted with specific reference to its impact on dental health. Our questionnaire information showed that while in Nigeria, 95.8% of the respondents would clean their teeth first thing in the morning before meal, but in the UK, all the respondents (100%) said they clean their teeth first thing before meal. A follow-up question produced 70.8% in favour of those who claimed they had regularly been using chewing stick for tooth brush while in Nigeria, and 33.4% of the respondents who still continue in the same habit (though not on regular basis) while in the UK. Using chewing stick for dental care carries some health implications for many who believe in it as one man observed, '...I always bring them each time I travel home...I can also buy them here...' Respondents who often bring chewing sticks back to the UK make careful selection of the type depending on the medical and health values particular specie of plant offers to the teeth and the body system in general. A combination of health experiences and histories both at home country and the UK deprive respondents from developing a culture of visiting the dentist while in the UK. This is true as the statistics showed that only 16.6% said they engaged in regular dental care beyond the use of chewing stick as against 45.8% who did not while in Nigeria. While in the UK only 12.5% claimed they engaged in regular dental care beyond self-management while 75% claimed they did not.We used many other informal health care behaviors and practices to understand how the hegemonic norms embodied in the UK society and its health care institutions has helped in opening up alternative spaces of health care and healing practices among migrants. As a highly organized system, the UK medical field represents and symbolizes everything about the western medical ideology which hardly conforms to migrants' medical worldview. The emerging contradictory relationship facilitates the emergence of alternative medical spaces which are not within the scope and regulatory surveillance of the UK medical institutions. Health belief, attitudes and complex processes associated with the UK medical institution and its immigration laws limit migrants' full participation in the system. These are the basis for the sustenance of alternative spaces of medical practice. Business and religious settings and such tactics as 'code buying of products', circulation of illegal products, and other forms of dangerous self-medication and health management are survivalist behaviors among migrants, which make regulation difficult. References Akpabio, E. M. (2012). Water Meanings, Sanitation Practices and Hygiene Bahaviours in the Cultural Mirror: a Perspective from Nigeria. Journal of Water, Sanitation and Hygiene for Development 02 (3): 168-181. Cummins S, S. Curtis, AV Diez-Roux and Macintyre (2007). Understanding and representing ‘place’ in health research: a relational approach. Social Science and Medicine 65: 1825-1838. Griffiths MJ and Johnson RJ (1991). What is in a place? An approach to the concept of place, as illustrated by the British National Union of Mineworkers’s strike, 1984-5. Antipode 23, 185-213. Jones K and Moon G (1993). Medical geography: taking space seriously. Progress in Human Geography 17: 515-524 Kearn RA (1993). Place and health: towards a reformed medical geography. Professional Geographer 45, 139-147 Kearns RA and AE Joseph (1993). Space in its place: developing the link in medical geography. Social Sci Med 37 (6): 711-717