By Simon Fern | OMC 2024
Fanon wrote that doctors in colonial contexts operate as both technicians and colonisers, while Césaire called attention to how colonisation necessarily ferments brutality in the colonial core. Thinking of Fanon and Césaire, I am interested in how the practice of medicine in colonising countries directs violence towards people who have migrated from postcolonial contexts. This means thinking about how medical culture, knowledge, and care delivery reproduces and reinforces deeply rooted processes of harm.
I conducted interviews with 121 immigrants in Spain, with approximately a third coming from more privileged countries in Europe and North America, and two thirds were largely from the Philippines, Latin America, and the Caribbean. I do not want to suggest a binary where the first group had only positive experiences, and the second were massively disadvantaged and maltreated by comparison. However, the forms of mistreatment differed, and their access to good and dignifying treatment was differently bordered.
Coming to the doctor’s office, respondents from North America frequently shared stories of being confused by foreign administrative systems, struggling to express themselves in Spanish, and feeling that the doctors they encountered were more direct, abrupt, and rude than they were used to. These respondents would also talk about how much harder it was to access stronger medications which were more freely prescribed in the United States and Canada. Respondents spoke about recognising that being read as American by healthcare professionals granted them better treatment and more respect. For example, Black American respondents spoke about the difference between the treatment they received from what they knew Black people moving from Africa and the Caribbean experienced.
By comparison, respondents moving from Latin America spoke about feeling disrespected, talked down to, and at times entirely ignored by chauvinistic healthcare professionals. They relayed stories of having to advocate for themselves to have their health complaints taken seriously, being told that the Spanish they spoke was incorrect or incomprehensible and receiving inappropriate comments about their skin colour and features. Respondents from the Philippines described practitioners relying on pseudo-scientific tropes about their bodies being essentially different and therefore harder to treat, having their health complaints dismissed as being the result of eating a ‘foreign’ diet, and being accused of being entitled foreigners burdening the healthcare system.
One respondent, a Filipina woman, described visiting her doctor for a checkup only to be insulted about her Spanish proficiency and lectured about the fact that not only should she speak the language better because of colonisation, but that Filipinos should be grateful for this legacy. Another Filipina woman reported presenting to her dermatologist with severe atopic dermatitis, only to be dismissed and told that her darker skin was not only the cause of her problem, but entirely beyond her ability to treat. Other cases of mistreatment reported by people who had migrated from countries colonised by Spain included being deprioritised or entirely ignored during emergency hospital visits, having their pain dismissed during procedures and examinations, and instances of obstetric violence. Respondents consistently pointed to differences in the culture of care experienced in their countries of origin, as opposed to the rudeness and lack of empathy they encountered as foreign patients – relating this difference to their racial, ethnic, and national otherness.
Doctors enjoy great social status and are frequently treated as respectable, compassionate, and learned members of society. The harms that doctors perpetrate are often explained away as the result of organisational stress, being a skilled technician rather than a natural carer, or having their brisk and rude behaviour outbalanced by their competency as a physician. Patients, particularly those of immigrant backgrounds, may be uncertain about how to complain and unwilling to jeopardise their future care by seeming to be a ‘difficult’ patient. Because of these protective vagaries, it can take a long time before patients even come to terms with the fact that they were mistreated or harmed.
Thinking about doctors as technicians and colonisers and confronting the brutality that has fermented in the colonial core, means unpacking how medical practice continues the epistemic and practical projects of enforcing difference and shoring up supremacy. Naming and understanding this offers a path forward for developing accountability, restitution, and reversing the co-option of healthcare workers in the state violence of bordering.
Simon Fern is a PhD candidate in the Department of Sociology at Rice University in Houston, Texas. He previously studied for an MA (cand.mag.) in Advanced Migration Studies at Copenhagen University, and an MA (hons.) in English Literature and History at Edinburgh University. His dissertation research addresses the health and medical experiences of immigrants in Spain, drawing on feminist and postcolonial approaches to the social construction of health.
