Placing the lived experience(s) of TB in a refugee community in Auckland, New Zealand

Abstract

Although rates of tuberculosis (TB) in much of the western world have steadily declined since the Second World War, this infectious disease remains a leading cause of death among those living in impoverished circumstances. Social science perspectives have argued that TB is as much a reflection of socio-economic inequality and the uneven distribution of power and resources as it is about biological processes. In this thesis I explore the lived experience of TB within the Somali refugee community in Auckland, New Zealand. While migrants and refugees are frequently blamed for the resurgence in TB in Western countries, very little is known about the determinants that underlie this manifestation of the disease. The present research addresses this gap in the literature by employing a transdisciplinary social science approach that considers the determinants of health and illness that range across the social, cultural economic and political domains of human experience. The geographical underpinnings of the work are borne out in the fundamental goal: to (literally and metaphorically) place the lived experience of health, disease (and particularly TB) within the Somali refugee community in the wider context of migration and resettlement. Employing qualitative methods I draw upon participants’ narratives to highlight the different ways in which Somali health beliefs and experiences have been shaped by wider structural forces. I demonstrate that within Auckland, Somalis encounter multiple and overlapping layers of disadvantage. The combined impacts of this disadvantage have a profound influence on their health and illness experience, particularly in terms of the development and ongoing occurrence of TB. Respondents with TB recounted widespread stigma that exacerbated the harm incurred by the illness itself. Although Somalis are highly marginalised, the thesis acknowledges the agency and creativity exerted by people in fashioning the course of their life within the context of considerable structural constraints.