“When I was working in psychiatry, a patient cancelled his appointment with me three times because he didn’t want to be treated by a ‘foreign doctor’,” 30-year-old practitioner Navid Ghan told AFP.
“In the end he didn’t have any choice, I was the only doctor available.
During the appointment, even though he saw that I spoke Swedish without an accent, he told me ‘you foreigners, you don’t understand anything’,” Ghan said.
Ghan, whose name has been changed at his request to protect his identity, is not even a ‘foreigner’: he was raised and earned his medical degree in Sweden.
“Now my colleagues and I joke about it in the lunch room. The nurses arrive and say ‘they cancelled again when they saw your name’.”
Since 2010, as part of a broader reform to Sweden’s universal healthcare system that opened up primary healthcare to private actors, patients have been allowed to choose their own doctor and clinic.
Prior to the reform, Swedes were assigned a clinic based on where they lived.
But as tensions smoulder over rising immigration in traditionally homogeneous Sweden, the reform has made it possible for patients to refuse to be treated by non-ethnic Swedes.
Sweden has seen its immigrant population double in the past two decades, statistics show, and support for the far-right Sweden Democrats has surged to 20 percent to make it the third-biggest party.
Lars Arrhenius is the head of Sweden’s Equality Ombudsman, a government agency that promotes equal rights and combats discrimination.
He said that choosing a doctor based on ethnicity is a “worrying development”.
At the end of March, 1,011 doctors and medical students signed an appeal in daily newspaper Expressen calling on “the responsible authorities to act against racism” in their field.
In July, the country’s largest broadsheet Dagens Nyheter published an investigative series exposing the scope of the problem.
Journalists posing as patients who had recently moved to a new city or town called 120 healthcare clinics and asked that their new doctor be an ethnic Swede.
A total of 51 clinics agreed to the request, 40 refused. Only a handful explicitly said the request was unacceptable.
“We have Maria, Sanna and Elsa. Three fair-skinned women,” one medical secretary told a journalist.
Gender Equality Minister Marta Stenevi, whose brief includes the fight against discrimination, told AFP the practice was “totally unacceptable”, after meeting various actors in the healthcare sector to address the issue.
The head of the Swedish Junior Doctors’ Association, Madeleine Liljegren, said clinics often consented to the requests because of “competition between healthcare clinics over patients.”
The more patients a clinic has, the more state funding it gets.
Lack of support
“The nurses likely think ‘I’ll agree to their request’ — as shocking and horrible as it is — just to keep the patient,” said Liljegren, noting that some clinics do not have enough patients to stay afloat financially.
Makih Fatelahi, a hospital doctor in the southern Swedish county of Kronoberg whose name has also been changed, says some patients are concerned about communication issues.
“The problem is that they only see your name when the appointment is made.
You don’t get a chance to establish an in-person contact before you get rejected,” the 28-year-old tells told AFP.
The number of cases of discrimination against doctors of foreign origin is not known.
In 2020, more than 3,500 general discrimination complaints were filed to the Equality Ombudsman, 1,146 of which concerned “ethnicity”.
Sweden’s health care system relies heavily on immigrant workers, who are often employed as nursing assistants. In 2020, 2,401 doctors received medical licences in Sweden, almost half of whom earned their degrees abroad.
Navid Ghan said he doe not feel supported by his superiors, even though they have seen the discrimination he has faced.
Many doctors with foreign names complain about a lack of internal procedures at their workplaces for how to respond in such situations.
“You end up not paying any attention to (the discrimination). I use an algorithm to not let my emotions get the better of me: Does this patient really need my help? If yes, I take care of the patient and ignore the comments. If not, I ask a colleague to take my place,” Ghan said.
OPINION: France’s Australian submarine row shows that Macron was right about NATO
First, which country is immediately west of Australia? Second, which country is immediately east of Australia? Thirdly, which country sprawls most widely over the globe?
The answer to all of these questions is the same: France.
The nasty row which has broken out between Paris, Washington, Canberra and (to an extent) London, is about more than a €60bn French contract to build 12 submarines for the Australian navy.
It is about France as a Pacific and Indian ocean nation; it is about France’s desire to play an important role in Indian-Pacific affairs, containing China without antagonising China; it is about America’s willingness to treat allies as allies, not vassals; it is about honesty and openness in international affairs.
President Emmanuel Macron has withdrawn the French ambassadors to Washington and Canberra after the US, Australia and Britain announced a new security pact, called AUKUS, after 18 months of secret talks. As part of the pact France’s 2016 deal to supply 12 diesel-powered, Barracuda-class submarines to Australia has been replaced by a US-UK promise (not yet a deal) to supply nuclear-powered, but not nuclear armed, subs.
France accuses the three English-speaking nations of a “stab in the back”. But it has not withdrawn its ambassador from London. Some commentators suggest that is because France has so many important interests in common with the UK, Brexit or no Brexit.
Other commentators and French officials suggest that, au contraire, it is because Paris regards the UK involvement in AUKUS as something “opportunistic” and irrelevant.
French officials told Le Monde that NOT withdrawing the French ambassador from London was a way of expressing contempt for Boris Johnson’s role as a “stowaway” in a US-Australian submarine.
But why is France so furious? Arms deals are a murky business. The bigger they are, the murkier they become. One friendly nation beating another to a huge arms deal is hardly new.
Let’s return to our pub quiz question. Australia’s nearest significant neighbour directly to the west is the island of Réunion in the Indian Ocean. To the east it is the archipelago of New Caledonia. These islands are constitutionally and legally not French colonies: they are as much part of France as Corsica or Calais.
The torpedoed submarine deal was commercially important to France but also politically important as the cornerstone of a new Pacific and Indian Ocean security partnership with Australia agreed in 2016 and re-asserted this year. That, in turn, was crucial to France’s hopes of building an Indo-Pacific strategy which would make it the most important European player in the region.
The commitment to both was restated by Paris and Canberra as recently as June 15th when the Australian Prime Minister, Scott Morrison, visited Macron in the Elysée.
“Every element of our partnership is about reinforcing the values and beliefs that we hold dearly,” Morrison said at the time. He gave Macron no hint that the submarine deal was in trouble. Problems with cost over-runs and design details appeared to have been resolved.
In fact, it now emerges, the US has been involved in talks with Australia and the UK to blow both the French deal and the Franco-OZ pact out of the water for 18 months. In other words, the secret talks began under President Donald Trump and continued and were completed under President Joe Biden.
“And we thought we were mates,” the departing French ambassador Jean-Pierre Thebault said in interview with Australian newspapers today. “This is not what you do a partner and even less to a friend.”
Which was more important to the United States? Stealing the submarine deal? Or destroying French hopes of playing an allied role with the US , Japan and others in Indo-Pacific affairs and coping with an increasingly aggressive and confident China?
Some people suggest that AUKUS is just a vulgar arms deal dressed up as a security pact. The US and Australia already have a security agreement. Why do they need another one? And what can Britain do to help with a tiny Royal Navy and an Army that can’t fill Wembley stadium?
Others commentators suggest that Washington was too ignorant or too inward-looking to grasp that AUKUS would humiliate and infuriate the French. Australia, they say, grew unhappy with the conventionally-powered French subs. It secretly approached Washington – even though France had offered to upgrade its own deal to nuclear-powered submarines.
One of the many oddities of this affair is that US arms companies already stood to earn more from the French deal than French ones. Only €8bn of the €60bn was to be spent in France (for the submarine hulls mostly). The rest was to be spent on US armaments and high-tech equipment and Australian labour.
The suspicion in the Elysée Palace is that AUKUS is a deliberate and well-planned hit on French ambitions in the Pacific (which precede Macron but have been emphasised since he came to power) Hence the extreme, though symbolic, measure taken by Macron to withdraw ambassadors from allied countries (and the first time ever from the US).
Macron finds himself in a strange place – both vindicated by what has happened and humiliated by it. He has been saying for almost four years that Nato is “brain dead” and Europe can no longer rely on the United States to defend, or even consider, European interests.
He wanted to strengthen France’s role in the Pacific partly because he feared that Washington – whichever President might be in power – would stumble into a confrontational approach to China. He wanted Europe to have its own voice in western-Chinese relations.
Arguably, he over-reached himself. The US has now, in effect, slapped him down.
There is nothing much he can do about it. Germany is preoccupied by its election. Most other European countries are reluctant to face the consequences of quarrelling with Uncle Sam. None of them have islands in the Pacific or Indian Oceans.
All the same, the AUKUS affair, coming so soon after the debacle of America’s withdrawal from Afghanistan, proves that Macron is right. Nato is brain dead. Washington doesn’t have allies, only junior partners. Britain has willingly accepted that role. It is time that for the European Union to consider how (to coin a phrase) it can take back control of its own security and prosperity.
‘No country for working parents’
Even before the pandemic, childcare was one of the biggest challenges facing young families. “It cripples families financially,” says Lucia Ryan, a school principal and parent of three-year-old twins.
Covid-19 has intensified the pressure on parents and providers, launching them into a new world of regulations, “play pods” and resulting staffing pressures.
“Our creche couldn’t find staff. So they reduced their hours to finish at 4pm,” Ryan, the principal of Hartstown Community School in Dublin, tells The Irish Times.
She was left trying to “run a school from home in the afternoons” and look after two-year-old twins, Matilda and John, though they are now enrolled in the State’s Early Childhood and Childcare Scheme, along with an afternoon childminder.
But she worries about the pressure facing parents and the “absolute heroes” who are the country’s childcare workers. Her third child is due in three weeks. She’s trying not to think about what happens when her maternity leave ends. “I don’t know what I’ll do.”
For many, the complications of the post-pandemic world of work and childcare are only beginning. A new era of flexibility is supposed to free people but, in practice, things could get worse, not better.
Up to 200,000 children are in early years services, with parents paying €800 per month for a creche place, and up to €1,200 a month in some areas. Now, some are discovering that their needs do not always align with either a childcare provider or their employer.
Michelle Walsh, who works with the Health Service Executive, recently returned to work after maternity leave with her second child, and considered herself lucky to get a place for the baby in the only creche in her rural town, where her three year old already attends. “On my first day back at work, the creche called to say they had to cut hours for my one year old and could only provide childcare until 1pm.”
The three-year-old could still stay full days. Walsh runs clinics in primary care four days a week, so “it is impossible to change hours to facilitate this. I’ve now had to find a childminder for the afternoons and start settling in again. To say the situation has been stressful is an understatement.”
The combination of a creche in the mornings and childminder in the afternoons is proving more expensive than full days in the creche would be. But it is her last option and she may have to take a career break if arrangements falter.
Other parents have similar stories, telling of the difficulty of juggling the same hours at work with reduced hours in childcare, the fees which haven’t changed and the dread felt that a child could be sent home with a sniffle.
“Our creche has reduced its hours. They haven’t reduced fees,” says Olivia, who doesn’t want to use her real name because she does not want to be perceived as critical of her creche or her employer, when she’s just frustrated by the system. “It used to be 7.30am to 6pm. Now it’s 8.00am to 5.30pm, which can be challenging . . . I know management are keen not to raise fees, but they say with the pod system, it’s impossible to have the staff for longer hours.”
Consequently, she has to finish work at 5pm. “Right now I’m still WFH [working from home] but it will be even more challenging once I go back to the office in a couple of weeks. In the old days, I used to drop three kids to creche for 7.45am, where they got breakfast and two were brought to school from there. Then I could work from 8am to 5.30pm. Now, we need to split drop-off for school and creche, make it to work for 9am and rush out of work at 5pm for pick-up.”
Her employer is understanding, but the hours have to be made up. “It’s just back to the same old juggling – logging in early morning or after kids go to bed.”
So what exactly is going on to put Ireland’s already-struggling childcare infrastructure under such additional strain? “The pre-Covid pressures are back with a bang,” says Frances Byrne, policy director with Early Childcare Ireland, which represents 3,900 childcare providers providing care for 120,000 children.
Irish parents already pay the third-highest proportion of their income on childcare of OECD countries, due, provider say, to the lack of spending over generations by successive governments.
According to the OECD, Ireland was spending just 0.1 per cent of gross domestic product on early years prior to Covid, the lowest investment of any developed country. During Covid, additional government funding “kept the show on the road” and meant that creches were able to keep staff employed and stay open, Byrne says. But as the world returns to normal, there’s no certainty over how long that funding will be available.
Meanwhile, although the pod system is supposed to offer some flexibility – allowing staff to move between pods to cover breaks for each other for example – in practice many creches feel they’ve been left with a choice of hiring more staff or reducing hours. Regina Bushell, who is the managing director of Grovelands, which operates six childcare centres in the midlands and runs the Seas Suas group representing independent childcare providers, explains how it has reduced the places available to babies.
“The regulations require a ratio of three [babies] to one [staff member]. But realistically for governance, I need a three to two ratio, because that one person has to have annual leave, lunch breaks, their comfort breaks, they may go out sick. I require those three babies to be in on a full-time basis to cover the cost.”
“Service providers would love to be able to provide as much flexibility as required. But there is a sustainability problem if parents only want to do five hours, but there are staff there who need to be paid for 10 hours.”
One mother in a different part of the country, Sinead, said her daughter used to attend after-school care from 2.30pm to 5.30pm five days a week. She had been hoping to use the care for two days, not five because of Covid-prompted changes to her work, but the provider can only do all or nothing.
Sinead is understandably annoyed, but, explains Byrne, “It’s not an inflexibility by choice; it’s an inflexibility imposed by the funding models.”
Funding is tied to attendance, says Byrne. So the National Childcare Scheme is the most flexible, but it can only offer flexibility “for up to eight weeks”, says Byrne. “If someone is saying I’m not going to need care on a Wednesday because I’m working from home or I reduced my hours, it’s really difficult for providers to offer that flexibility. Over time, their public funding will be withdrawn.”
The answer, believes Early Childhood Ireland, is more money and more flexibility. The Government has committed to doubling spending by 2028, but a five-year budget is needed, says Byrne.
And the models must adapt to post-Covid working. In Scandinavian counties, the provider is not “punished” if a parent is in a position to reduce their child’s hours. “We need to move to a Scandinavian model, where everybody pays something, but the richest pay more – but even the richest only pay up to a certain amount.”
As things stand, says Olivia, Ireland is no country for working parents and “definitely no country for working mothers.”
France recalls ambassadors from US, Australia over submarines row
President Emmanuel Macron ordered the recalling of the envoys after Canberra ditched a deal to buy French submarines in favour of US vessels, Foreign Minister Jean-Yves Le Drian said.
Le Drian said in a statement that the decision was made to “immediately” recall the two French ambassadors due to “the exceptional seriousness of the announcements made on September 15th by Australia and the United States.”
The abandonment of the ocean-class submarine project that Australia and France had been working on since 2016 constituted “unacceptable behaviour among allies and partners,” the minister said.
“Their consequences affect the very concept we have of our alliances, our partnerships, and the importance of the Indo-Pacific for Europe”
US President Joe Biden announced the new Australia-US-Britain defence alliance on Wednesday, extending US nuclear submarine technology to Australia as well as cyber defence, applied artificial intelligence and undersea capabilities.
The pact is widely seen as aimed at countering the rise of China.
The move infuriated France, which lost a contract to supply conventional submarines to Australia that was worth Aus$50 billion (€31 billion, $36.5 billion) when signed in 2016.
The French ambassador recalls from the United States and Australia, key allies of France, are unprecedented.
At request of @EmmanuelMacron, @Ph_Etienne & his colleague appointed in Canberra are being recalled to Paris for consultations. This reflects exceptional seriousness of announcements made on Sept 15 that constitute unacceptable behavior for allies/partnershttps://t.co/o75Lnte9I8
— French Embassy U.S. (@franceintheus) September 17, 2021
France has made no effort to disguise its fury and on Thursday accused Australia of back-stabbing and Washington of Donald Trump-era behaviour over the submarines deal.
“It’s really a stab in the back,” Le Drian said Thursday. “We had established a relationship of trust with Australia, this trust has been
France has also called off a gala at its ambassador’s house in Washington scheduled for Friday. The event was supposed to celebrate the anniversary of a decisive naval battle in the American Revolution, in which France played a key role.
Australia earlier shrugged off Chinese anger over its decision to acquire US nuclear-powered submarines, while vowing to defend the rule of law in airspace and waters where Beijing has staked hotly contested claims.
Beijing described the new alliance as an “extremely irresponsible” threat to regional stability, questioning Australia’s commitment to nuclear non-proliferation and warning the Western allies that they risked “shooting themselves in the foot”.
China has its own “very substantive programme of nuclear submarine building”, Australian Prime Minister Scott Morrison argued Friday in an interview with radio station 2GB.
China claims almost all of the resource-rich South China Sea, through which trillions of dollars in shipping trade passes annually, rejecting competing claims from Brunei, Malaysia, the Philippines, Taiwan and Vietnam.
Beijing has been accused of deploying a range of military hardware including anti-ship missiles and surface-to-air missiles there, and ignored a 2016 international tribunal decision that declared its historical claim over most of the waters to be without basis.
France’s European Affairs Minister Clement Beaune said on Friday that Paris was unable to trust Canberra in ongoing European Union trade deal talks following the decision, before the ambassadors were recalled.
Australian Foreign Minister Marise Payne, in Washington, said she understood the “disappointment” in Paris and hoped to work with France to ensure it understands “the value we place on the bilateral relationship and the work that we want to continue to do together”.
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