Understanding the Experiences of Health Care–Seeking Migrants in Delhi: Trajectories and Challenges

Many studies have reported on issues of accessibility and quality of health care among the different vulnerable subgroups in urban locations. To date, no study has been done on the challenges faced by health care–seeking migrants (those traveling to cities for health reasons). This qualitative study used in-depth interviews and nonparticipant observation to examine the health problems, health care–seeking trajectories, and challenges faced by health care–seeking migrants in Delhi, India. Participants described long courses of health care seeking, typically from the district to the state capital to the national capital. There were variegated paths to health care seeking characterized by delays in service utilization, progression of disease, and cost escalation. The challenge relating to the delay in receiving health care was exacerbated by the residency status of health care–seeking migrants. In conclusion, health-related migration is associated with shared but also unique barriers to health care seeking. India’s urban health care reform agenda needs to cater to the needs of this population.

Determinants of Therapeutic Routes for Malaria Patients in Ivory Coast

Malaria patients in Ivory Coast pursue a wide variety of treatment routes, depending upon how they understand the aetiology of their illness, their association of illness with supernatural causes, their ability to afford standard consultation fees, their access to conventional health care facilities, and their confidence in traditional African therapies. This research took place in the context of the government’s policy of providing free management of ‘simple malaria’ for all. Working with four conventional doctors and four traditional African medical practitioners, treatment choices of 161 malaria patients were analysed at Kennedy-Clouétcha, a busy urban health care centre in Abidjan. Almost half (77) of the patients in the study cited mosquito bites, general poor health, and stagnant water sources as the causes of their malaria. A greater number of patients (84) indicated fatigue, sun exposure, mysticism, and diet as the cause. The scope of therapies sought by these patients covered conventional biomedical treatment, traditional African medicine, and prayer. When patients were not cured through methods of their first resort, they pursued second options for care. Despite the availability of free care in centrally located public health systems, the therapeutic trajectory of many patients diverted away from conventional treatment. The data suggests that a patient’s orientation away from the conventional biomedical model may be best explained by confusions surrounding the diagnostic label ‘simple malaria’.