Alioune –fictitious name– was found among the crowd in the port of Arguineguín in 2020. Pediatricians from the Canary Islands Health Service found him in a corner, in shock and with the reflection in the gaze of the 16 people he had seen die in his boat. Post-traumatic stress is one of the conditions that migrant minors who arrive to the Canary Islands by sea can present. But health workers can also come across boys and girls with hepatitis, malaria, or who show signs of having undergone female genital mutilation. This year, to improve care for this group, the Ministry of Health has launched an action guide aimed at health professionals: Recommendations for the care of the asymptomatic African migrant under 15 years of age. This manual, which has not been updated since 2006, dedicates much of its content to mental health and stressors, such as fear of failure, the struggle to survive and integrate or loneliness.
Four migrants prove they are minors and avoid Las Raices camp after months in an adult center
Although minors have special protection and cannot be expelled, the fear of arrest and deportation appears among them. Especially in those who do not have documentation to prove their age and are filmed as adults. When stress is multiple and becomes chronic, Ulysses syndrome can appear. Odysseus left Ithaca, the world he knew so far, to participate in the Trojan War. He moved away from his language, his culture and his customs to suffer hundreds of adversities far from his family and home, and during his return home he saw many of his friends die on the journey. Those who suffer from this syndrome see how their migratory grief lasts over time and becomes extreme. “It is so problematic that it exceeds the adaptive capacities of the subject,” the guide explains.
The symptoms of this syndrome “have a disabling effect.” Loneliness, the lack of a support network, the struggle to have food and decent housing, fear of the dangers of the journey and the fear of being detained and expelled are aggravating factors. Health sources consulted by this writing point out that in recent months this syndrome has not occurred in any minor, but it has occurred in adults who arrived in the Archipelago by sea.
This multidisciplinary guide for the initial care of migrant minors (in a period of less than or equal to twelve months) “aims to standardize the actions to be carried out, avoid unnecessary complementary tests and guarantee the diagnosis of potentially serious entities.” according to its special characteristics and adequate integration into the Health System “, underlines the Primary Care pediatrician Mercedes Mateos Durán. The health company also recalls that this document favors coordination between the different entities involved in the care of this group and create information circuits that “facilitate the continuity of health care for this vulnerable population.”
Mateos, member of the Intervention Team of the Management of Primary Care of Gran Canaria, defends that in Primary Care falls the greatest responsibility and effort for the recruitment of minors, taking into account the right of all people to access the National Health System in conditions of equity and universality. “The foreign population forms a large group within our population, so health personnel must be trained and kept up-to-date on aspects related to imported diseases and the risks associated with international travel.”
Free Healing from prejudices
The new guide of the Government of the Canary Islands considers that health care marked by prejudice or racism also hinders the recovery and treatment of patients. Thus, it states that professionals must also have cultural competencies. “The first step is to identify and avoid ethnocentrism, the thought that one’s own culture is better. Eliminate prejudices in order to understand different cultures “, reads the text.
Pediatrician Martín Castillo, who has participated together with dozens of health workers from different specialties in the preparation of this document, highlights the comprehensive nature of this protocol, which has a multidisciplinary approach. In addition, a large part of its recommendations are designed to address the particularities of children who arrive in boats and cayucos. In order for the service to be efficient, the protocol advises the presence of translators and cultural mediators during appointments. The presence of social workers will also be decisive when it comes to people in exclusion, victims of mistreatment, abuse or genital mutilation.
Female genital mutilation: a crime and not a custom
Female genital mutilation must be valued as a crime and not as a custom. The guide for health workers explains in a blunt way how a professional should act when identifying that a girl has undergone ablation. After informing the family, the injury report is sent to the Guard Court and the notification letter to the Juvenile Prosecutor’s Office. It should also be communicated to the social worker of the Health Center. Martín Castillo insists that it is a delicate matter, since many of the women and girls who arrive in the Canary Islands in boats and cayucos have been fleeing this practice.
In other cases, families living in Spain travel to the country of origin to practice genital mutilation on minors. The health workers must, in these cases, warn that the ablation is considered a crime in the Spanish Penal Code even if it has been carried out outside the national territory. It is punishable by imprisonment from 6 to 12 years for parents, guardians or guardians and disqualification from four to ten years for the exercise of parental authority, guardianship, custody or foster care. “We have the obligation to summon the families when they return from the trip. This point is more important than prosecuting,” Castillo explains.