poster - humanosta ne poznava razliki - enMutual negative attitudes, rejections and isolated opinions create multiple discrimination and/or obstacles in the communication between doctors and Roma patients that often are based on stereotypes and prejudice, and directly affect the way the treatment and attitude towards health is realized.

    In order to investigate the key factors that influence the situation, formative research was conducted in the period from February to June 2015 by the association ROMA S.O.S. from Prilep in partnership with three other associations: LIL from Skopje, SONCE from Tetovo and ROMANO AVAZI from Skopje. Therefore, health workers from the primary health care were covered, which represents the initial phase of the request/providing health services (dentists, gynecologists and general practitioners) in the municipalities of Prilep, Karpos – Gorce Petrov, Cair, Tetovo and Roma communities Trizla 2 Zlokukani and Dame Gruev, Topaana and Potok.

For the needs of the research the following activities have been conducted:

  • 48 pre-tests with doctors,
  • 22 in-depth interviews with doctors,
  • focus groups in Roma communities, which were attended by 96 Roma,
  • 10 stories that were personal experience of Roma patients were documented about their treatment in the health facilities.

and they resulted in the following key findings:

  • Poor living conditions for Roma contribute to low level of hygiene and untidy appearance,
  • Lack of finances contributes to irregular examinations and asking for medical care at the final stage of the disease,
  • Lack of personal documentation of Roma contributes to untimely monitoring of the administrative procedures and inappropriate use of prescribed therapy and services from secondary health care,
  • Low level of health education of Roma contributes to not practicing preventive measures in maintaining health, with a special focus on oral health,
  • Health workers pay less attention to Roma patients because of the low level of hygiene,
  • Health care workers do not trust Roma patients and thus they are inferior to their complaints that they are not able to cover financially their future health services and therapies,
  • Prejudices towards Roma patients are more visible and more serious in the secondary health care because of more complex administrative procedures and protocols that have to be followed, and the perception of health workers that are not responsible in supplying appropriate documentation,
  • Nurses have more negative attitudes about Roma patients than the doctors because of their task to establish order and discipline in the infirmaries and the impression that they are loud and present in large numbers,
  • Health care workers are not familiar with the culture of the Roma, but the ones that have more experience or a greater number of patients in typically Roma communities are more sensitized to work with Roma without any negative perceptions about them,
  • Health care workers, do not register the ethnicity of Roma and consider that segregated data collection for certain ethnic groups, is discrimination against other ethnic groups,
  • Taking into consideration cultural values and lifestyle, Roma go to an examination in bigger group with more family members, but respect the rules of medical facilities,
  • Health workers agree that Roma live in isolated areas in one part of the town, but it is because of practical aspect, their relatives are nearby, they are familiar with the surrounding and thus they feel secure in their environment,
  • General attitude of both, health workers and Roma is that the media promote negative image of Roma, especially when poverty and begging are emphasized, and very often children are abused in these articles.

In the period from September to December 2015 by overtaking creative and innovative field activities, the associations aimed to create conditions for mutual interaction and education that would contribute to more efficient access of Roma to health services, while respecting diversity and rights as well as the need for active participation in the health system that should be opened for all.

  1. Community Forum

Community forum was formed in the four municipalities separately and included 10 Roma from various parts, the ones who managed to articulate the needs and obstacles in the most concrete way during the focus groups.

This activity contributed to a complete coverage of the population with information about the purpose and activities of the project. The involved parties through the three monthly coordinative meetings discussed about the results of the survey, conveyed the information in the community, defined activities aimed at overcoming the key findings and participated directly in the implementation of field activities taking over different roles and tasks.

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  1. Preparation of a poster

In order to present the purpose of the project and the key findings in a more picturesque way, and thus to provide greater visibility, public promotion and recognition of the condition, a Poster that emphasizes humanity of the health activity and the need for equal treatment of patients regardless the appearance, clothing and lifestyle was created.

The model was a Roma woman from the municipality of Prilep who was actively involved in the research activities and the Community forum, and the poster was distributed in Roma communities and healthcare facilities as a call for mutual respect and understanding.

  1. Local Action Plans were created and implemented within the three municipalities according to local findings and context
  • Prilep: based on the conclusion that maintaining hygiene in the Roma community is a factor which mainly affects the relationship with healthcare workers and it is directly related to the living conditions of Roma, an action for setting water supply in order to access clean water for drinking was initiated and maintenance of hygiene in two settlements which are not part of the urban plan of the municipality of Prilep, Tri Bagremi and Debarca where more than 200 families live.

Support from the Public Company “Water Supply and Sanitation” and Local Government was obtained in a form of material contribution i.e. investment in setting up a drainage and supply in both settlements, supply of faucets and taps, supply of hose and engaging workers, and it ended with the construction of a street dredging and a tap by the association ROMA S.O.S. that will practically help residents to access water and maintain hygiene.

Formal commissioning under the slogan “Hygiene is half health” was organized on 02.12.2015 – outdoor event supported by Dr. Dafina Bogeska, a dentist who at the same time held a Lecture on hygiene for the attendees. The need for the lecture was the reason that oral health is identified area that is least known and people do not pay much attention to, and is also directly related to the maintenance of hygiene. Dr. Dafina practically demonstrated proper brushing, and the children who were attending were given toothpaste and toothbrushes in order to acquire the habit in their use.

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  • Karpos-Gorce Petrov: based on the conclusion that preventive measures for preserving the health are not practiced by the Roma patients which contributes to non-timely detection of certain illnesses, and often results in chronic diseases such as diabetes and hypertension, that reproductive health care for women is neglected and nobody pays attention to the oral health, an action was initiated in order to create conditions for mutual education of primary care physicians and Roma patients and their greater interaction would contribute to increase their confidence and overcome the current

On 17.11.2015 in the premises of the local community Dame Gruev, Mini Conference was held entitled as “Prevention is better than cure” and the attendees that were identified as critical in collaboration with the family doctors in specific areas were divided in three working groups for which  GP Dr. Emil Petrovski, gynecologist Dr. Bojan Mitanoski and the dentist Dr. Milosav Markovic gave lectures on the topics: “Prevention of diabetes and hypertension”, “Reproductive health” and “Children’s oral health”.

Local Government – Gorce Petrov also contributed organization of the event by providing free space and refreshments for the attendees.

Use of devices for measuring pressure and sugar, toothpaste and toothbrush as well as contraceptives, as a precautionary measure to preserve the health were presented by the doctors to Roma patients, and after the lecture they were given to them in order to use them at home.

  • Cair-Topaana: based on the conclusion that Roma have a low level of health culture that contributes to not practicing preventive measures in preserving health, while regular physical activity and sports reduce the risk of cardiovascular and other chronic diseases, in the settlement Topaana an action about reconstruction of a sports field was initiated in order to promote the habit and conditions for practicing physical activity among the Roma community.

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Municipality of Cair also supported and contributed the action specifically in terms of cleaning the ground, supplying flashlights, benches and trash bins.

On 28.12.2015 the event under the motto “In a healthy body, healthy mind” was organized and the playground was officially put into use, and the importance of physical activity and sport was emphasized by the lecture given by Dr. Katerina Dimitrieska, a general practitioner and by Dr. Mirela Omerovikj, a dentist, while afterwards a football match was played between the members of the Forum.

  1. Organizing “Friendly evenings” between health workers and the Roma community

Doctors who were involved in the research and the members of the Community forum at a joint meeting on 29.12.2015 discussed the key findings of the research. At the same time the fact that the meeting was conducted in a friendly atmosphere provided conditions for their better acquaintance as persons who belong to different nationalities with their own customs, traditions and culture.

Thereby, potential future opportunities/activities for overcoming stereotypes and prejudices were considered as well as some general directions for approaching Roma patients by the doctors were suggested. This activity was organized simultaneously by all four associations in their municipalities.

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* The project is supported by Open Society Foundations through Media and Health Program from New York and was realized in the period from January to December 2015.