Minor Field Studies – MFS – Sida 3 – Malmö University's MFS students' blogs!

30 april, 202230 april, 2022 av Elin och Hanna - Inga kommentarer

Week 5: Transcribing

At the beginning of this week we temporarily said goodbye to the staff at APLE for a two week transcription period away.

We decided to go to a quiet and calm island, Koh Rong Samloem, to transcribe. Phnom Penh has been very crowded and noisy which has affected our sleep. The environment here is not too bad!

The transcription process has been surprisingly valuable to us; it included a lot of information that got lost during the interviews. Due to a great amount of new information and some difficulties hearing, we were not able to apprehend all details at the time of the interviews.

A story from the interviews that touched us this week:

Next week we will continue to write and transcribe!

21 april, 202230 april, 2022 av Elin och Hanna - Inga kommentarer

Week 3 & 4: A Supreme Court Trial

During week 3, we had the opportunity to interview two more respondents at APLE. We experienced some difficulties in terms of language barriers, yet, we received valuable information about APLE’s work! We also finished writing the compulsory parts of the thesis, as the deadline was closing in.

This week, we were invited by APLE to join a Supreme Court Trial.

Their case included a 39 year old British offender, previously convicted with “indecent assault” (e.g. sexual touching) of a 13 year old Cambodian girl (his sister in law’s daughter). He had spent 2 out of 2,5 years in prison and appealed his conviction with the wish to be freed of the allegations and return to teaching in Cambodia.

Unfortunately, the victim and her mother was not present as they decided to terminate their participation in the case. Therefore, we were only able to really understand the offender’s perspective.

The process of the trial differed a lot from the Swedish legal process that we know and, in contrast to Sweden, all offenders can appeal to The Supreme Court (the highest level of court) in Cambodia. The Supreme Court does not only handle specific praxis or evidence cases. There were 5 judges, one court clerk, one prosecutor, one child/victim lawyer, and one or several defence lawyers. There was about 15 people on trial, over only 4 hours, that were standing outside, in the doorways or sitting amongst the visitors. There were guards multiple seats behind the offenders, of which some were sleeping. Some offenders/people were on trial, or appealed their convictions, for murder and sex crimes. The hearings were short and we discussed the legal security/certainty (rättssäkerhet) of the proceedings.

We are by no means making any assumptions about the guilt or innocence of the British offender. However, we were quite surprised by the lack of legal security/certainty, e.g. in terms of the translator’s translation of the judges’ and prosecutors’ questions. The english was at times hard to understand and the offender claimed that previous translators had been even worse, at times even drunk. We were lucky to have APLE staff translating the parts in Khmer and the parts in english that we could not understand. The offender also claimed that a 6h trial in The First Instance Court only generated a 2 page court report and that the written report from the initial police interrogation was not translated correctly and excluded major parts of his statement. We also noticed that neither witnesses nor charged offenders swore under oath before witnessing in front of the judges.

An interesting question was raised in regard to cultural differences. The victim was living with her sister in the house of the offender, his wife (the victims aunty) and their own children. One part of the conviction was based on the acts of kissing the child’s cheek and forehead to comfort her when she was sad. Such acts are not considered as appropriate comforting acts by fathers in Cambodia, in contrast to western countries. This observation does not exclude the allegations of sexual touching of private parts, but, solely points out differences in cultural norms.

As a defence, the wife witnessed to her husband’s benefit, by describing the girl victim as a bad daughter, involved in ‘bad’ activities, and being outdoors until midnight. This is a recurring argument that we face in our research about stigmatisation and assigning a complete and legitimate status of being a victim of sexual exploitation and abuse in Cambodia. Daughters are seen as bad or blamed for their own victimisation because they are outdoors at late hours which is far from the western values and perceptions of victimhood.

Next week: last interview!

11 april, 202212 april, 2022 av Elin och Hanna - Inga kommentarer

Week 2: Interviews and Celebrating Khmer New Year

This week we finished our interview guide and consent letter. We started to spread information about our thesis and the APLE organisation on social media and will start a fundraising for the organisation over the coming days.

We interviewed 5 team leaders this week and we have 2 left for next week. It went great, they were very informative and would tell us a lot about their work and experiences! There were some heartbreaking stories and we are amazed about how positive and happy they seem to remain considering their work.

The APLE staff were very sweet to invite us to their yearly Khmer New Years celebrations and we were so happy to join! It gave us a chance to get to know the staff outside of the office and they were as warm and inviting, just like they were during the first meeting. It turned out to be a boat get-together with plenty of Cambodian food!

APLE have clear equality principles in all respects and the staff has really inspired us both. One of the employees travels a total of 4 hours every day to get to APLE’s office. There is no shortage of ambition amongst APLE’s employees!

11 april, 202211 april, 2022 av Elin och Hanna - Inga kommentarer

Week 1: Arrived in Cambodia

We arrived in Phnom Penh! It is warm and people are very friendly. We stepped into our pretty decent hotel lobby where we had booked a room for one month and were instantly reminded of why we are here. The sign on the counter says “no sex trafficking”.

After battling our jetlag, we started off with some deep diving into ProQuest to gain a better understanding of Cambodia’s history and its effect on sexual exploitation and abuse (SEA). We also worked our way through prior research to discuss and identify gaps. We noticed that there were plenty of research on the phenomenon SEA along with counter actions and preventions means; yet, very little about victim stigmatisation and the absence of a complete and legitimate status of being a victim. With that, we had found our main focus area and started to put research questions into writing. We realised that both Christie’s “The ideal victim theory” and Goffman’s theory about stigmatisation were great guidelines for our research.

We consider ourselves very lucky to collaborate with the APLE organisation. They gave us a warm welcome as they invited us to a meeting at their office with the team leaders within the organisation. Five hardworking and busy professionals set off an hour of their day to introduce themselves to us and to tell us about their work and ambitions. We are inspired by their drive and commitment to put an end to SEA of children! They also seemed to be very keen to learn from us in exchange which made us feel valued and important too.

Through our own research, we have gained a deeper understanding of the country’s history and context that allows continued exploitation of children, through e.g. prostitution. The Cold War and the US peacekeeping troops, corruption, and poverty are emphasised factors. Later, tourism became a strong contributing factor along with the Internet, which has become an increasingly popular platform for SEA. As a result, the street-based vulnerability has to some extent received less attention, says APLE’s ED. During the meeting with APLE, we also learned that the family and society play a major role in victims’ rehabilitation and reintegration into society as shaming and distancing from abused children is common. Exposure to sexual crimes is “taboo” and victims are facing the risk of being rejected by their families and the society.

Next week, interviews!

22 december, 202119 januari, 2022 av Glenn Möllergren - Inga kommentarer

Weeks 8 & 9

The final interviews: residential care in Moldova

This project is coming to an end. In order to fully understand Moldova’s elderly care, I visited a residential care home in a village in the estern part of the country. Interviews were carried out with a number of residents, aged between just under 60 and over 90.

Interview with one of the residents of the elderly care home in eastern Moldova.

Residential care is a complicated part of the Moldovan elderly care. Principally, residency is granted only to people who pay for themselves, or who have relatives that pay for them. In all other cases, the process of ageing takes place in each person’s home. There are, however, exceptions. Occasionally, residency will be granted to a person of age whose condition urgently calls for a more permanent form of support than may be offered by home care which, as has been highlighted in previous posts, typically arrives every second day. Such exceptions also require the existance of a free slot, which is becoming rarer as Moldova’s population ages far quicker than the number of residential care places increases.

Residents typically pay 60% of their pension as a fee for a place in a residential care home. Residency includes a bed in a shared room – the room may contain from two to six beds, or even more, and is gender separated. Residency also grants access to a dining room, where cooked meals are offered several times a day. At this particular home, the cook took great pride in serving well-cooked, healthy food which is also offered to staff. I had a lunch together with a group of employees and the food quality was indeed very high. Residents are said to “always put on weight”, according to staff.

Apart from a bed in a shared sleeping room and access to the dining hall, there is a communal area with books, games, a TV-set, as well as some smaller rooms with gym, bathroom and hobby area. When outdoor temperatures permit (which they do about nine months per year in Moldova), residents spend most of their daytime hours outdoors. This center has a garden, some alotment for agriculture, outdoor furniture, a grill, etc.

Interviews and observations brought forward a couple of recurring themes. Firstly, residents consider themselves happy to have arrived at this particular home, which is considered a very good one. They also expressed huge gratitude for not living alone, in their own house, anymore. Being left alone in an otherwise empty house was frequently describes in terms of a disaster, a terrible fate.
Secondly, the power balance between staff and residents appeared quite patronising. Residents were simply told to participate in interviews, although several of them showed hesitation (and I reacted by asking the staff to ask another resident). Staff described residents in terms of “child-like” individuals, persons that need a lot of attention, confirmation, moral support – but with very low own agency. It was clear that being part of the staff means to know what should be done, and being a resident means to accept things as they are, and relax and be peaceful. Staff repeatedly underlined that a large part of their job consists of showing warmth, consideration, emotional proximity, reliability, and build trust. These and similar terms have been repeated also by home care staff that I have interviewed during the previous weeks.

Since my thesis will not focus on residential care, I will not bring a comparison with Swedish residential care into this post. However, several findings during this visit align with what I have found and reflected about in the home care interviews and observation. One thing diverges quite abruptly: the sheer horror with which the residential care interviewees described the lonelyness of an old person living in their own home.

With this post, the academic part of this blogg is coming to an end. A suggestion for future collaboration between students & professors in Moldova and Sweden will be the theme of the last post – stay tuned for that, and please leave a comment below this one.

Glenn Möllergren

29 november, 202129 november, 2021 av Glenn Möllergren - Inga kommentarer

Weeks 5-7: Empirics & theory

Interview with home care staff in northern Moldova.

The last couple of weeks have been intense and full of fascinating input. This blog update will try to highlight some of them. The picture shows an interview with three home care workers in a village in Northern Moldova; for pandemic-related reasons the interview was performed outdoors.

While carrying out a number of interviews and observations, one thing has become a lot clearer: Elderly care workers in Moldova do spend considerable time supporting care-takers emotionally. As previously stated, talks (“convoribiri”) amount to the most commonly performed intervention during care work, but this is also regarded the most important of them all, both from care-takers and staff’s perspective. They may have considerable duration in time and occur every second day. This contrasts sharply with Swedish home care practice, characterized by short but frequent interventions.

As a Moldovan care-taker is admitted home care, a number of hours is assigned and a schedule established. Typically, the schedule (“grafic”) allows for a two-hour visit every second day, by one care-giver. Together, the care receiver (“beneficiar/a”) and the staff agrees on what needs to be done. While shopping for food, taking care of the house, helping out with preparing food, and making errands at the postal office or the pharmacy are frequently occuring task; talks & consultation takes place at almost every visit. In case a care receiver needs more time on a specific day, staff may call to the person next on the list to announce a later arrival. It’s however not feasible, or at least not sustainable, to reoccuringly spend more than the assigned number of hours, or to come at a more frequent pace – like every day or several times per day (although some staff admit to that they occasionally step out of their work schedule to make additional visits at care receivers who are in especially dire need).

This order of things differs radically from how Swedish home care is designed. There, the normality could be described as consisting of a number of very short visits per day. Care takers may be admitted help with getting out of bed, making breakfast, performing intimate care, etc – all of which may be divided into a number of short interventions. Since actions related to food, intimate hygiene, movement, and getting dressed and undressed occur in large numbers in Sweden, one may wonder why they are not mentioned in the Moldovan home care. Interviewees have given two explanations:

Few people have this sort of needs. Most can get out of bed, put coffee on the table, or take care of their intime hygiene by themselves.
Those that are in such an advanced state of ageing that they can not manage this any more, will anyway not have too many more months left to live, so that when those things occur, this type of interventions will not have to last for very long.

Alternatively, it may be possible that a lot of people feel uncomfortable to ask for this kind of help, because they know it’s unusual, or they’re too proud to admit to incapabilities of this kind, or out of knowledge that it may anyway not be provided.
Whichever comes closer to the truth – or if they all have some truth in them – a theory coined by James Holstein (1992; full reference below) may here be employed. Holstein applies a micro perspectiv to social interaction in public sector organisations and finds that whenever an instituion, authority or welfare organisation sets up formal criteria, such as diagnoses, it tends to “squeeze” its clients/patients into that scheme. It “produces” the clients/patients it is set up to deal with. Out of a person with certain conditions, it produces a patient with a specific diagnose – or a care receiver with a number of needs, neatly lined up in a list, corresponding with interventions lined up equally neatly.

In Swedish elderly care, the possible conditions for which an elderly person may receive home care are listed in a code guide consisting of almost 200 pages, an international functionality standard called ICF. Every possible vulnerability, urgent human need, every requirement has to be linked to one or several of the codes in the ICF. The assistance officer, investigating the conditions for home service admittance, performs an assessment interview and is required by the National Bureau of Social and Medical Services to tic all the boxes corresponding to the catalogue of codes in the ICF. Following Holstein, we may observe how the care receiver is reformed into fitting the form – the “care-taker” is thus produced. If reocurring help requirements such as getting out of bed, getting dressed or putting food on the table are expected to turn up during the interview, they’re much more likely to be asked for by the care receiver – compared to if they are not mentioned and barely possible to even pronounce. In short, while Moldova may be “producing” care-takers that are in apparent need of having a longer talk every time the care giver shows up, Sweden may be producing care receivers who require frequent visits in order to just survive each day.

The empirical study is, however, not coming to an end quite yet, and new findings may put Holstein down the list of theory providers. Please return for updates, and please do leave comments below.

Holstein, J.A. 1992. “Producing People: Descriptive Practice in Human Service Work.” Current Research on Occupations and Professions 6:23-39.

9 november, 20219 november, 2021 av Glenn Möllergren - Inga kommentarer

Fourth week: Corona-restrictions… but the work gets done

Social workers' office in a Moldovan village.

Halfways into the project, covid-infection rates start reaching alarming levels. Among others have all of my colleagues/informants in Chisinau city administration been ordered to self-quarantine (and many of them are ill with covid, but currently recovering). The impact is quite noticeble from the point of view of my research, since it’s impossible to collect empirical data without meeting people. Hence I decided to go to outlying villages with lower infection levels where restrictions and quarantine is not (yet) in function.

Thus I came to interview care staff and assistance officers in a village in northern Moldova. I met with them in their work office, appearing at the photo. Interviews were carried out individually and recorded, resulting in audio files that will further on be transcribed and translated into English. Following previous findings, my questions this time focused on how decision making about service provision takes the needs of each individual into consideration, since it appeared to me as if decision texts were rather vague and tended to end in a paragraph stating the admission of home service of a certain number of hours per week, without too many details as of which kind of help, how often and for how long per day had been agreed upon.

Interviewees explained that needs would typically vary from day to day, and that it’s therefore more fair, and better for everyone, to set a number hours of home service as an outcome of the assessment – without stating too detailedly exactly what sort of service or help would be provided at each visit. Thereby, money would be allocated from the regional healt & social care board to the assigned social worker in the village, and they could start working almost instantly. From that moment on, the interventions would be decided by the care-taker and the home care worker together, with a priority to what the beneficiary wishes for at each visit. As the interventions would commence, the social worker would report in a summary what had been performed at each visit, based on a 15-point-scheme of possible intervention. Of all the possible interventions, the two most common ones referred to 1) bringing groceries to the beneficiary, and 2) carrying out small talk and listen to what the beneficiary wanted to say, an activity named convorbiri. From a Swedish point of view, this last intervention appear almost unthinkable, since Swedish care staff seldomly have any time for talking to the care-taker. Reflecting on this, both interviewees stated that the need for convorbiri was more or less the corner stone of elderly care in Moldova, since beneficiearies are all too often very lonely. Looking at reports from recent weeks’ work, it was beyond doubt that the code for convorbiri appeared at almost every visit, whereas other interventions, such as bringing groceries or water, cleaning the living areas, performing personal care, or securing house heating, appeared sporadically.

20 oktober, 202127 oktober, 2021 av Glenn Möllergren - Inga kommentarer

Third week: a clearer picture of the assessment process

Halfways through the third week I’m happy to find that I’ve got a reasonable grip on the assessment process in Moldova’s elderly care. Findings emanate from formal documents, interviews with social assistants, care workers and their managers, as well as a sociology scholar, and, most importantly, several care-takers.

A brief summary:
When a person of age – a pensioner, basically – experiences difficulties in everyday life, they can turn to the local social care and ask for help. Initially, an assistance officer will evaluate their needs and gather the documentation required. This includes personal documents as well as medical certificates proving disabilities and, which makes Moldova very different from Sweden, a set of papers showing that the applicant lacks any form of close relative, who would otherwise be required by law to help their kid. That’s the portal paragraph in one of the documents photographed here.
When all due documents are in place, the assistance officer formulates a decision about providing help, and a schedule for its provision. The schedule, called a grafic, basically states at what days help will be provided, and what it will consist of. Formalities include registering data about the beneficiary in several different administrative systems, that appear to mean a lot of unnecessary job for the social secretary. The formal requirements – including a form with specific questions about living standard, disabilities, needs, and other personal data about the applicant – are stated in national law, which makes Moldova a different case from Sweden, where such a form (albeit a much more detailed one) is recommended, though not juridically enforced, by the National Social Board.

As soon as formalities are in place, a social worker will be assigned to start providing the help. After three months, an evaluation of the services is required by law, but in practice, this may take a lot longer, since the beneficiary is anyway free to make a phone call to the assistance officer at any moment, should the services not match expectations. Re-evaluations – including a visit to the beneficiary’s home – will then take place roughly once per year.

If the administrative process is not carried out according to the detailed regulation, the assistance officer will be held responsible. One of my informers has had their salary reduced twice because of formal mistakes. Considering the overwhelming amount of formal requirements involved in the assessment process, one may wonder if there is anyone who can actually perform this job to perfection.

From the beneficiaries’ point of view, the system seems to provide a set of security measures, aimed at preventing ignorance, poor quality care, or mistreatment. Apart from directing themselves to the care staff – which typically is one care giver specifically for one beneficiary – or to the assistance officer, a receiver of elderly care in Moldova may also address the local administration manager, or turn directly to the National Inspection of Social Care. Considering that a substantial part of the collective of beneficiaries may suffer from dementia – a majority, according to some informants – there seems to be quite a requirement for frequent check-ups. At the same time, informers are stating that the experts from the National Inspection tend to ask beneficiaries about data that they may have a hard time remembering, like on what day a certain service was provided. “They usually don’t even know what day it is”, said one care worker.

15 oktober, 202115 oktober, 2021 av Glenn Möllergren - Inga kommentarer

First impressions of Moldovan elderly care

During the second week of MFS I’ve had the great privilege of meeting the managers of elderly care in the central district of Moldovas capital, Chisinau. In a brief summary of what we’ve talked about, one may conclude a couple of crucial matters. Here are some of the highlights:
1 Moldovan elderly care mainly covers the need of people who don’t have a family, or whose families are unable of caring for them when they reach their old age. By law, family is obliged to care for their kin, and the assessment authority – the Directia Generala Asistenta Sociala si Sanatate, the administration for social assistance and health care – will duly investigate an applicant’s possibility to obtain help from their children or spouse. Hence, in this district, numbering about 100 000 inhabitants, a mere 300 are beneficiaries from elderly care, meaning 0,3% of the population receive elderly care. In Sweden, this figure is about ten times higher.
2 Once the assessment process has considered the applicant’s right to receive social help, a formal decision stating the amount of help admitted is issued. This amount may range from one to several hours a couple of days per week, and the help is delivered by a social worker which, as a general rule, will be the same person from day to day. In other words, a beneficiary of Moldovan elderly care will normally have to get aquainted with just one single person from the care provider. A Swedish home care receiver sees on average 15 different people per week.
3 The contents of the home care is decided upon by the care receiver and their social worker for each day. In this aspect, Moldovan elderly care differs widely from the Swedish one, where care provision is formulated in a set of interventions, scheduled in a detailed plan for each home care staff’s visit. Flexibility is minimal in Swedish home care, and appears to be rather wide in Moldova.
4 Public elderly care in Moldova takes place in the beneficiarie’s home. There are no publicly funded asylums, residential care homes or other units of that kind. Only those who can pay for residential care may recieve it. Regardless of how ill the care receiver is, help will only be provided in their home. In Sweden, approximately one out of five care receiver lives in a residential care home, and those that do, have been found to have explicitly severe disabilities or health conditions, motivating their move into a residential care unit.

During the upcoming week, my hope is to meet some of the social workers who provide care, and carry out at least one formal interview.