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Political Ecology of Health of South Sudanese Immigrants and Refugees in Ottawa

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Political Ecology of Health of South Sudanese Immigrants and Refugees in Ottawa Political Ecology of Health of South Sudanese Immigrants and Refugees in Ottawa by Katie MacPherson A thesis submitted to the Faculty of Graduate and Postdoctoral Affairs in partial fulfillment of the requirements for the degree of Master of Arts in Geography and Environmental Studies Carleton University Ottawa, Ontario © 2017, Katie MacPherson Abstract Emerging research suggests that despite access to health care, South Sudanese in Canada experience dismal health. Applying political ecology of health (PEH) framework, this qualitative study builds on literature, to examine factors underlying this health decline. Focus groups and in-depth interviews with South Sudanese in Ottawa (n=31) reveal multiple factors acting alone or in interaction with processes at multiple temporal and spatial scales. Specifically, findings show that trauma suffered before arrival and from ongoing conflict in South Sudan affects everyday health. The findings also show that a deep political and moral sentiment of solidarity with the motherland mediates household decisions about health. In addition, fierce intra-ethnic rivalry stirred by war in South Sudan greatly affects South Sudanese, eroding social and psychological resources necessary for health. Furthermore, the findings indicate that weak integration of South Sudanese men in Canada breeds feelings of loss of social status, triggering family instability and gendered health impacts. Key words: Immigrant, refugee, migration, relocation, South Sudanese, health experience, gender, ethnicity, political ecology. ii Acknowledgements First, I would like to acknowledge the members of the South Sudanese communities in Ottawa who participated in this study. Without your kindness, generosity and participation, this study would not have happened. Thank you. Second, thank you to my supervisor, Professor Paul Mkandawire. Thank you for your tremendous amount of support and guidance. You have believed in me since day one, and helped me become more confident as an academic and person in general. You have been a great mentor and friend throughout this entire process. I could not have done this without you. Also thank you to my committee member Professor Jennifer Ridgley, for your extremely helpful comments and support throughout my degree. I would like to also thank Professors Kon Madut of Ottawa University and Odwa Atari of Nipissing University for their help in organizing meetings within the South Sudanese communities in Ottawa. Thank you to my friends in the Geography Graduate Department. Your constant support and friendship helped me through the stressful times. I am forever grateful for all of you, and look forward to continuing our friendships. I would also like to extend this thank you to the staff and faculty for their support, especially Erin. Finally, I would like to thank my family for their emotional and financial support throughout my time at Carleton University. I would specifically like to thank my Mom, Dad, brothers Ben and Curtis, Aunt Patty, and Grandparents Ed and Linda. And finally, thank you to my Step-dad Bruce Murphy, for motivating me to complete this degree. I have enjoyed our equally intellectual conversations up until this point, and I must admit that I will miss them very much. iii Table of Contents Abstract ......................................................................................................................... ii Acknowledgements ...................................................................................................... iii List of Appendices ...................................................................................................... vii 1 Chapter: Introduction..................................................................................................... 1 1.1 Research Background ................................................................................................ 1 1.2 Health and Wellbeing as Lived Experience ................................................................ 6 1.3 Immigrant and Refugee Experience ......................................................................... 11 1.4 Research Objectives and Questions.......................................................................... 12 1.5 Thesis Structure ....................................................................................................... 13 2 Chapter: Research Background ................................................................................... 16 2.1 Introduction ............................................................................................................. 16 2.2 Colonial History of South Sudan: The Creation of Division between the North and South. ............................................................................................................................... 17 2.3 Colonial Legacies: An Ethno-Regional Divide ......................................................... 21 2.4 The Post-Independence and Civil War Eras: Colonial Legacies Leading to Secession… ...................................................................................................................... 22 2.5 Geographies of Exile and Refugee Movement ......................................................... 27 2.6 Post-Migration Experiences ..................................................................................... 32 3 Chapter: Political Ecology of Health Framework and Feminist Political Ecology ..... 40 3.1 Introduction ............................................................................................................. 40 3.2 Political Ecology (PE) ............................................................................................. 40 3.3 Applications of Political Ecology of Health Framework (PEH) ................................ 41 3.4 A Feminist Political Ecology of Health (FPEH) ....................................................... 45 4 Chapter: Research Methodologies and Methods ......................................................... 49 iv 4.1 Introduction ............................................................................................................. 49 4.2 Qualitative Research Methodology .......................................................................... 49 4.3 Post-Colonial and Feminist Methodologies .............................................................. 53 4.4 Recruitment ............................................................................................................. 59 4.5 Research Methods: FGD’s and IDI’s ....................................................................... 62 4.6 Data Analysis: Grounded Theory ............................................................................. 68 5 Chapter: Research Findings ......................................................................................... 71 5.1 Introduction ............................................................................................................. 71 5.2 Theme 1: Transnational Caring ................................................................................ 71 5.3 Theme 2: Interaction with the Healthcare System: Attitudes and Experiences .......... 76 5.4 Theme 3: “Fitting the System”: Changing Gender Dynamics in Canada ................... 83 5.5 Theme 4: Ethnic, Tribal and Political Tensions ........................................................ 90 5.6 Theme 5: Generational Differences in Experience Health and Wellbeing ................. 94 6 Chapter: Discussion .................................................................................................... 103 6.1 Introduction ........................................................................................................... 103 6.2 Transnational Caring and Health Decision Making ................................................ 104 6.3 Changing Gender Dynamics .................................................................................. 108 6.4 The Conflict-Generated Diaspora: Ethnic and Political Tensions ............................ 111 6.5 Generational Identities and what this means for Health .......................................... 113 7 Chapter: Conclusions .................................................................................................. 115 7.1 Introduction into my Final Thoughts ...................................................................... 115 7.2 Conclusions and Future Directions for Research .................................................... 115 7.3 Concluding with Advice for Future Health Geographers at Carleton: Make Time and Make Friends .................................................................................................................. 118 Appendices ................................................................................................................. 120 v References .................................................................................................................. 133 vi List of Appendices Appendix A – Certificate of Ethics Clearance………………………………………….120 Appendix B – Letter of Introduction…………………………………………………...122 Appendix C – Invitation for Interview….………....…………………………………....124 Appendix D – Invitation for Focus Group………………………………..….…………126 Appendix E – Interview Guide and Checklist for Interview………..……….…………127 Appendix F - Interview Guide and Checklist for Focus Group………..……………….130 Appendix G – Codes to Theory Model…………………………………………………132 vii 1 Chapter: Introduction 1.1 Research Background A few
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