Available online at www.sciencedirect.

com

ScienceDirect
Procedia - Social and Behavioral Sciences 237 (2017) 70 – 76

7th International Conference on Intercultural Education “Education, Health and ICT for a
Transcultural World”, EDUHEM 2016, 15-17 June 2016, Almeria, Spain

Perception of health and healthcare amongst Senegalese immigrants

in Andalusia
Encarnación Sorianoa, Diego Ruíz & Verónica C. Calaa*
Universidad de Almería, Spain

Abstract

Immigrant healthcare boundaries are one of the most important indicators of health inequality. If health institutions want to take
action against barriers and difficulties, it would be necessary to identify immigrant perceptions of health and their views of the
Healthcare System. In the Spanish context, earlier studies show that sub-Saharan immigrants find it more difficult to gain access
to the public health system.
The aim of this study is to describe the health perceptions and views on the healthcare system of Senegalese population, in
Andalusia through 61 in-depth interviews.
The results indicated processes of deterioration in the immigrant health status and their health behaviours with regard to their
arrival, as well as a pathogenic and utilitarian conception of health, linked to their work occupation. In their health speeches we
observed a dialectical relationship between the hegemonic health model and the model of traditional Senegalese health. Regarding
the quality of the Andalusian Healthcare Service, participants positively emphasize its universality, its infrastructure and easy
access to information while, at the same time, they demand reduction of waiting time for care or cultural adaptation of certain
service, criticizing discriminatory attitudes from professionals.
It would necessary to implement transcultural advisory services in health and to promote intercultural mediators to eliminate some
of the barriers to access and health communication.
© 2017
© 2016TheTheAuthors.
Authors. Published
Published by by Elsevier
Elsevier Ltd.Ltd.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the organizing committee of EDUHEM 2016.
Peer-review under responsibility of the organizing committee of EDUHEM 2016.
Keywords: Health perception; Health assistance; Senegalese; immigrants; Andalusia

* Corresponding author: E-mail address: esoriano@ual.es; vcc284@ual.es

1877-0428 © 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the organizing committee of EDUHEM 2016.
doi:10.1016/j.sbspro.2017.02.028
 Encarnación Soriano et al. / Procedia - Social and Behavioral Sciences 237 (2017) 70 – 76 71

1. Introduction

The immigration increase has led to a revolution in social and health disciplines, which must now deal with the
different ways of understanding health and healthcare (Porthé, Amable, & Benach, 2006). This brings about a need
to analyse the perceptions of health amongst immigrant populations in order to determine the way in which people
understand, reflect upon and value their own health (Sholkamy, 1996) and how this is influenced by their social
context, their knowledge, values and cultural norms (Mahasned, 2001). These perceptions are closely related to how
this people access health services (Kornblit & Mendes Diz., 2000).
The relevance of studying the perception of the Senegalese population who migrated to Spain lies in their actual
size as a group. According to the Spanish census (INE, 2015) there are 61,798 Senegalese citizens living in Spain, of
which 10,306 live in Andalusia. This is the largest sub-Saharan population in the south of Spain, and the second largest
African community in the country.

1.1. A brief history of Senegalese migration. The origin and features of the migration to Spain

The Senegalese migration to Europe in the 20th Century is influenced by French colonial policies, responsible for
introducing and promoting an image of international success amongst Senegalese urban elites. After Senegal’s
independence in 1960 there was a massive rural oxodus caused by the abandonment of farming systems and the surge
of the “urban civilisation” (Kleidermacher, 2011). From the 70s the worsening living conditions of the peasant
population, the demographic boom, the country’s climate and the European neo-liberal policies led to an important
wave of migration to France. When the French government closed the borders in the 80s, migrants began to disperse
(Italy and later Spain) and a new migration flow began known as móodou-móodou and based on street selling networks
(Mboup, 2001). The first significant arrivals in Spain started the 80s, settling in Catalonia’s Maresme region and
finding their labour niche in agriculture (Vazquez-Silva, 2011). Later destinations would include other areas with high
economic activity and employment opportunities (the Mediterranean coast, Andalusia,…).
Most of the Senegalese migrants who arrived in Spain have economic migrants; they are predominantly men from
rural areas, they belong to the Wolof ethnic group and have Islam as their main religion. This economy-based mobility
gives rise to a “selection” of the migrant population according to their likelihood of success abroad: healthy, young
men (the so-called “healthy migrant” effect), with social skills and with a certain socio-economic capacity in their
home country (Kaplan, 2004)).

1.2. Health-related studies with Senegalese population in Spain

Health studies using Senegalese population in Spain can be grouped in two categories, namely anthropological
studies, which have analysed cultural, religious and identity elements that have an influence on health, and
sociological/epidemiological studies, focusing more on social factors and how they relate to health.

a. Anthropological studies show how the health-related conceptions and representations of the Senegalese
population maintain some of the main principles of traditional African medicine. Therefore, two orders seem to
influence their conceptions (Goldberg, 2010, 2003): a physical order, where disease or malaise is understood as a
physiological issue which manifests through a series of physical symptoms and which must be treated by the marabout
in foods
and medicinal plants (Ellena, Quave, & Pieroni, 2012). And a supra-physical order, of magical and spiritual nature.
This dimension often associates ailments and pathologies to curses and bad spirits taking over people or to the effects
of witchcraft.
Disease is understood as an event that breaks an individual’s balance and can reach a group of people, ultimately
affecting an entire community (Gungui, 2010).
On the other hand, the “biomedical” health system is perceived as something belonging to the white man, and
historically associated with Christianity as throughout the French colonisation churches, schools and health centres
were used as spaces for social control and as “civilisation” and evangelisation centres (Goldberg, 2010).
72 Encarnación Soriano et al. / Procedia - Social and Behavioral Sciences 237 (2017) 70 – 76

The Senegalese associations in Spain provide certain public services such as severe illness treatment and
repatriation of the deceased (Giró Miranda & Mata Romeu, 2013).
b. Studies of living conditions highlight the importance of a person’s employment situation and their role in health
as a transnational family member. The performance of their job, essentially centred around street selling/móodou-
móodou (Sow, 2004) and in the agricultural-farming sector (González Pérez & López Trigal, 1999), is characterised
by its precariousness, temporariness and instability. These working conditions have a negative impact on health
(Agedelo-Suárez, et al., 2009). In a survey conducted in the Basque Country, the Senegalese community reported
greater health disadvantages than the other migrant communities (Orayen García, 2013). Other studies have associated
sub-Saharan migrants to worse levels of mental health and to a higher risk of anxiety/depression and other
psychosomatic disorders (18) (19).
At the family level, Senegalese immigrants maintain transnational ties and responsibilities, including sending
remittances and looking after the wellbeing, health and nutrition of their relatives in their home country (Achotegui,
et al., 2010; Gailly, 1991).

2. Aim

To describe the perception of health and the perception of the healthcare system amongst the Senegalese immigrant
community living in Andalusia.

3. Method

This report presents a qualitative research conducted in Andalusia amongst the HUM665 Research Group, the
ACIIA association and ADESEAN.

3.1. Participants

There were a total of 61 persons of Senegalese origin and living in different towns in Almeria, Seville, Malaga,
Huelva and Granada. 54 of them were men (88.5%) and 7 were women (11.5%), a figure representative of the sex
distribution of the Senegalese population in Andalusia. 63.9% of participants declared being married, 26.2% single
and 9.8% separated. The age of the respondents ranges between 16 and 67 years, with an average of 37.5 years +/-
11.7 years. With regard to the nationality of their partners, only one female respondent claimed having had a Spanish
partner.
The number of children ranges from 0 to 9. The highest percentage is between 1 and 2 children, albeit 8 participants
claimed that they had between 5 and 9 children. Only two of the respondents with children (5.7%) have their children
with them in Spain. The vast majority of respondents claimed to be Muslim (96%).

3.2. Procedure

The participants were recruited through the Andalusian Association of Senegalese Immigrants (ADESEAN). Data
collection techniques consisted of 45 in-depth personal interviews and two discussion groups, one made up by 7 men
and one woman, and the other made up exclusively by women. Both formats followed an open interview script
including aspects related to the respondents’ living conditions, their conception and their adaptation to the education
and health systems.

3.3. Data analysis

Interviews and discussion groups were transcribed and analysed using the AQUAD 6 qualitative data analysis
program.
 Encarnación Soriano et al. / Procedia - Social and Behavioral Sciences 237 (2017) 70 – 76 73

4. Results

4.1. Perception of health

The perception of health amongst Senegalese people shows different trends. Some respondents consider that their
migrant project has had a positive impact on their health as they feel they are in better off than they were in their
country of origin Here I am much better than when I was there.” V. A. 43. Only one respondent replied that they had
migrated to Spain due to a health condition (healthcare migration)“… I came because I had a health problem…” V.
RM (A) 16.
On the other hand, more than 80% of respondents claimed that their living and health habits had worsened compared
to the conditions prior to migration “I was young then, I didn’t have any problem.” V. RM (A) 67. This type of
statement is in line with the hypotheses of the “healthy migrant” effect, which claims that it is the healthy persons who
decide to migrate (Tarnutzer & Bopp, 2012; Domnich, Panatto, Gasparini, & Amicizia, 2012; Abraído-Lanza,
Dohrenwend, Ng-Mak, & Turner, 1999). The negative effects of their adaptation include weight gain due to the change
in eating habits: “Yes, I have put on weight.” V. A 36 “Yes, I feel I am much heavier, I think it’s my eating.” V. A. 38
They also mentioned psycho-emotional unrest associated with the shift in lifestyle after the migration (eating habits,
working conditions, separation from the family, change of climate): “…well. What affects me is having to live away
from my family and I can feel that. Apart from that I am very anxious, I move a lot, I worry too much, and of course
this has to do with what I eat, even though I cook myself it’s not the same environment or the same food. Then you
spend most of your time working” V. S. 43.
There was also a group of respondents who believe that migration did not affect their health based on the fact that
they did not suffer any illness requiring a medical treatment. Medical treatment is placed at the point where the illness
starts.

4.2. Conceptualisation of health and healthy lifestyles

Health is perceived as the lack of illness, pain or medical treatment “Being healthy, not feeling any pain” V. SI (A)
32.
Very few respondents associated health with living habits such as good nutrition or physical exercise “Not having
pain, eating properly and sleeping well.” V. CA (A). 32, “I know nutrition and sport are essential to enjoy good
health.” V. G. 23 Some participants did recognise the importance of early detection and treatment of problems “In
Senegal we have the bad habit of enduring many things and only see the doctor when we cannot bear it any longer”.
V. M. 35. “The truth is that I, like many of my fellow countrymen and women, when we feel pain we say to ourselves
that it will go away and it is hard to break this habit. We go to the hospital as a very last resort.” V. S. 43
Few are those who claimed they had a healthy lifestyle as a mechanism to improve their health. “I care about what
I eat, I don’t drink or smoke…” V. G. 45 And their answers are somewhat influenced by Islam as they identify some
religious practices as healthy.
Health is not perceived as a purely physical issue but its definition also takes into account the psychological
dimension “... having a healthy mind and body.” V. RM (A) 3 , the functional dimension “Being healthy to perform
my activities.” V. EE. (A) 55 and, importantly, the social/labour dimension “If I am able to work, then it’s ok.” V. SI
(A) 25 “It’s clearly a question of having the means.” V. M. 30

4.3. The clash between the traditional and biomedical models

The discourse on health shows a shift in traditional health-related habits, a transition towards a greater use of drugs.
“Now I have to take some pills every day for the rest of my life.” V. RM (A) 67 and the abandonment of the use of
medicinal herbs to fight mild symptoms “Before I used to take some tree leaves to control my blood pressure…” V.
RM (A) 43
However, despite the impact of western medicine, they still recognise the role of traditional medicine.
“Conventional is better” V. RM. (A). 26 “I also believe in the benefits of traditional medicine” V. A. 46; “African
medicine is also valuable” V. SI. (A) 43.
74 Encarnación Soriano et al. / Procedia - Social and Behavioral Sciences 237 (2017) 70 – 76

They maintain certain traditional practices such as the use of natural foods and herbs with curative purposes
“Sometimes they send me herbs to improve my health but I’m not sure if that could be done in a hospital.” V. A. 43.
In many cases, these products are shipped from Senegal.
Some respondents continue to use protective amulets (gri-gri or gris-gris) as well as potions made with herbs, barks,
roots (safara) “In my case I still maintain the tradition, my mother still sends me safara, gris-gris, amulets. Sometimes
I use it, sometimes I don’t” V. S. 43

4.4. Perception, use and assessment of the Andalusian health service

The assessment of the Andalusian healthcare system is generally positive: “Here social security is a great
advantage especially for us migrants, it offers a lot of support and it makes many things easier for us.” V. EE. (A) 55”
“I am satisfied with what they do” M. RM. (A). 17
The advantages they recognised include the free nature of care, the open access and the quality of the healthcare
provided “There are advantages, we have a health card that gives us free access to the healthcare services.” V. M. 40,
“They help us a lot because we don’t have papers or anything and they don’t charge us a single cent. “ V. RM. (A).
26.
They believe that the health services have adapted effectively to the healthcare needs Yes, they are effective, and I
think they generally respond to the needs of the people as a whole. “ V. TM. 44. Some appreciate the respect towards
cultural diversity shown by the healthcare professionals “They do respect us as persons and they respect our cultural
identity.” V. EE. (A) 55 “Yes, I honestly feel satisfied with them, they pick up on every detail, your religion, your
culture…” V. A. 43
On the issue of access to information, they shared a positive vision. They believed that the information they received
in Senegal was insufficient or nonexistent “In Senegal the information hardly reaches the population.” V. EE. (A) 55;
“Almost nonexistent, too difficult to access.” V. G. 45, although some respondents did say that they had accessed
“Information on HIV, sexually transmitted diseases, public hygiene, contagious diseases.” V. A. 36b. With regard to
information in Spain, they claimed that “Information is better here in Europe than in Senegal.” M. M. 45, and it can
also be accessed through the general media, “On the television and on the radio” V. SI. (A) 37 “The TV and in the
hospital with my doctor” V. SI (A) 32. They insisted on how easy it was to discuss directly about health and on their
confidence in the professionals.
The areas of major criticism include:

1. Waiting times. They negatively valued the long waiting lists, queues and the slow pace in the provision of
healthcare services (medical appointments, consultations, etc.) “The appointment was very long.” V. RM (A) 49;
“I think it’s ok, I don’t miss anything except more specialists because the appointments at the practice are too long.”
V. G. 23 “Yes, they could get their job done more quickly” V. SI. (A) 37.
2. Emergencies. They called for improvements in the service that is most widely used by migrants “The emergency
services must improve.” M. M. 17, “They should improve healthcare services like emergencies, they treat us a bit
negligently.” V. M. 52
3. Lack of cultural adaptation of certain services such as gynaecology “The gynaecology service is not adapted to
our religion.” M. M. 45. One of the most common requests among women is that such job should be performed by
women “No, as a Muslim woman I need a female gynaecologist.” M. RM. (A). 42.
4. Poor sensitivity and cultural competence of certain professionals, with disrespectful or even discriminatory
attitudes “The system is alright but the staff don’t respect us. “V. A. 53 “The measures are correct but doctors are
not good, they treat us badly” V. SI. (A) 43

Some of their statements reflect the kind of use they make of the healthcare services: they mostly go to hospitals,
with virtually no contact with health centres. In addition, their health-related activities do not include preventive
checks, which means that they only go to the hospital in severe situations and with advanced pathologies.
Some of the measures that the participants suggested in order to adapt and improve the healthcare services include
promoting activities in the area of health to reach the lower classes “Create local community groups to inform those
 Encarnación Soriano et al. / Procedia - Social and Behavioral Sciences 237 (2017) 70 – 76 75

who are more vulnerable.” V. A. 36b , and also promoting the figure of the cultural mediator in health, something
which seems particularly relevant, “If we could have foreign staff, I think it would help us communicate better.” V.
G. 23

5. Discussion and conclusions

Cultural and social adaptation to Spain involves changes in lifestyle and in health perceptions. These changes often
lead to a gradual worsening of health (Pardo Moreno, Engel Gómez, & Agudo Polo, 2007) linked to weight gain due
to changes in eating habits, a feeling of isolation, a decline in psycho-emotional wellbeing due to hard working
conditions (Agedelo-Suárez, et al., 2009) and to the separation from their loved ones.
The migrants’ opinions on health reflect a multi-dimensional view with a physical, psychological, social, spiritual
and functional dimension. Their ability to perform their job (complying with their migration project) becomes a good
subjective health indicator (Pardo Moreno, Engel Gómez, & Agudo Polo, 2006), whereas unemployment is considered
a source of unhealthiness. On the other hand, they maintain a pathogenic view on health, whereby health ends where
a perceptible illness or ailment begins (health as the absence of disease). This translates in low recognition of the value
of education and the promotion of health, and in a belated use of medical centres as they only visit them in severe or
advanced cases.
The contradictions between the biomedical and traditional African models are also part of the health discourse.
They recognise the importance of traditional medicine (Kaplan, 1998) as a symbolic space for resistance and identity.
The relevance of Senegalese medicine can be observed in their use of medicinal plants and foods, amulets and potions
(Goldberg, 2010), most of which are sent from Senegal. Nevertheless, those spaces for “resistance” in health are not
incompatible with the slow but unforgiving influence of the dominant western model, which transforms their lifestyles
and health trends slowly but constantly, leading to an increasingly medicated life and to greater dependence on the
State for the provision of care as opposed to self-care practices (Menéndez, 1992).
As far as the quality of healthcare of the Andalusian health system is concerned, they identify its universality,
infrastructure capacity, equipment and professionals, and easy access to information as positive aspects. Still, they call
for a reduction in waiting times for consultation, the improvement of certain services such as emergencies and
gynaecology, and they criticise the discriminatory attitudes of some professionals. Regarding the use of basic
healthcare services, they record a low use of specialised services (Regidor, et al., 2009), only resorting to the
emergency service in cases of dire need or when faced with an advanced health condition.
Finally, they demand a more active role in decision making, better cultural adaptation of the healthcare system in
questions related to their religion and traditions, and the implementation of the figure of the intercultural mediator,
“well trained people who can understand us better” for better intercultural communication and a closer relationship
with the healthcare professionals.

References

Abraído-Lanza, A. F., Dohrenwend, B. P., Ng-Mak, D. S., & Turner, J. B. (1999). The Latino mortality paradox: a test of the "salmon bias" and
healthy migrant hypotheses. American Journal of Public Health, 89(10), 1543-1548.
Achotegui, J. (2004). Emigrar en situación extrema. El Síndrome del inmigrante con estrés crónico y múltiple (Síndrome de Ulises). Revista Norte
de salud mental de la Sociedad Española de Neuropsiquiatría., V(21), 39-53.
Achotegui, J., Morales, M. M., Cervera, P., Quirós, C., Pérez, J. V., Gimeno, N., . . . Borrell, C. (2010). Características de los inmigrantes con
sindrome de estrés crónico del inmigrante o síndrome de Ulises. Norte de salud mental, 37, 23-30.
Agedelo-Suárez, A., Gil-González, D., Ronda-Pérez, E., Porthé, V., Paramio-Pérez, G., García, A. M., & Garí, A. (2009). Discrimination, work
and health in immigrant populations in Spain. Social Science & Medicine, 68, 1866–1874.
Domnich, A., Panatto, D., Gasparini, R., & Amicizia, D. (2012). The “healthy immigrant” effect: does it exist in Europe today? Italian Journal of
Public Health, 9(3), 1-7.
Ellena, R., Quave, C. L., & Pieroni, A. (2012). Comparative Medical Ethnobotany of the Senegalese Community Living in Turin (Northwestern
Italy) and in Adeane (Southern Senegal). Evidence-Based Complementary and Alternative Medicine, 1-30.
Gailly, A. (1991). Simbolique de la plante en le culture. La Cahiers du Germ, 4-19.
Giró Miranda, J., & Mata Romeu, A. (2013). La estructura asociativa de los senegaleses en España. Revista Internacional de Sociología (RIS),
71(1), 91-115.
76 Encarnación Soriano et al. / Procedia - Social and Behavioral Sciences 237 (2017) 70 – 76

Goldberg, A. (2003). Ser inmigrante no es una enfermedad. Inmigración, condiciones de vida y de trabajo. El proceso de salud/ enfermedad/
atención de migrantes senegaleses en Barcelona. Departamento de antropología, filosofía y trabajo social. Tarragona: Universitat Rovira i
Virgili.
Goldberg, A. (2010). Exploración antropológica sobre la salud/enfermedad/atención en migrantes senegaleses de Barcelona. Cuicuilco, 49, 139-
156.
González Pérez, V., & López Trigal, L. (1999). Jornaleros extranjeros en el campo español. Eria, 49, 213-229.
Gungui, R. (2010). Autoatención y estructuras sanitarias en inmigrantes senegaleses en Cagliari. En J. M. Comelles, X. Allué, M. Bernal, J.
Fernández-Rufete, & L. Mascarella, Migraciones y Salud (págs. 316-330). Tarragona: Publicaciones URV.
Kaplan, A. (1998). De Senegambia a Cataluña. Procesos de aculturación e integración social. Barcelona: Fundación La Caixa.
Kaplan, A. (2004). Procesos migratorios: transformaciones culturales e identitarias. Revista Electrónica de Ciencias Sociales, 1-16.
Kleidermacher, G. (2011). Migración subsahariana a la argentina: un análisis desde el concepto de ciudadanía. XI Jornadas Argentinas de Estudios
de Población, (págs. 1-21). Neuquén.
Kornblit, A. L., & Mendes Diz., A. M. (2000). La Salud y la Enfermedad:Aspectos biológicos y sociales. Contenidos curriculares. Buenos Aires:
Grupo Editorial Aique.
Mahasned, S. M. (2001). Health perceptions and health behaviours of poor urban Jordanian women. Issues anpracticed innovations in nursing,
36(1), 56-68.
Mboup, M. (2001). Les Sénégalais d´Italie. Émigrés, agents du changement social. Paris: L´Harmattan.
Menéndez, E. (1992). Modelo hegemónico, modelo alternativo subordinado, modelo de autoatención. Caracteres estructurales. En R. Campos
Navarro, La antropología médica en México (págs. 97-114). México: Instituto Mora/Universidad Autónoma Metropolitana.
Orayen García, E. (2013). Desigualdades en salud en los grupos de inmigrantes viviendo en la Comunidad Autónoma del País Vasco. Departamento
de Enfermería y fisioterapia. Madrid: Universidad de Alcalá de Henares.
Pardo Moreno, G., Engel Gómez, J. L., & Agudo Polo, S. (2006). Percepción de la salud en población inmigrante procedente de África subsahariana
I. Semergen, 10, 484-493.
Pardo Moreno, G., Engel Gómez, J. L., & Agudo Polo, S. (2007). Factores condicionantes de salud en población inmigrante procedente de África
subsahariana. Semergen, 33(1), 3-8.
Porthé, V., Amable, M., & Benach, J. (2006). La precariedad laboral y la salud de los inmigrantes en España ¿qué sabemos y qué deberíamos saber?
Archivos de prevención de riergos laborales, 10(1), 34-30.
Regidor, E., Sanz, B., Pascual, C., Lostao, L., Sánchez, E., & Díaz Olalla, J. M. (2009). Health services utilization by the immigrant population in
Spain. Gaceta Sanitaria, 4–11.
Sholkamy, H. (1996). Women's health perceptions: A necessary approach to an Understanding of Health and Well Being. Giza, Egypt: The
Population Council.
Sow, P. (2004). Prácticas comerciales transnacionales y espacios de acción de los senegaleses en España. En A. Escrivá, & N. Ribas, Migración y
Desarrollo. Córdoba: CSIC.
Tarnutzer, S., & Bopp, M. (2012). Healthy migrants but unhealthy offspring? A retrospective cohort study among Italians in Switzerland. BMC
Public Health, 1104-1112.
Vazquez Silva, I. (2006). La inmigración senegalesa en Galicia: las redes transnacionales. VI Congresso Português de sociologia. Mundos Sociais:
Saberes e prácticas, (págs. 1-14). Lisboa.
Vazquez Silva, I. (2011). The stadistical challenge of being a senegalese emigrant in Spain: A comparative survey of secondary sources in origin
and destination regarding senegalese immigration in Spain. Migraciones, 29, 127-155.