Ethical and Epistemological Implications of Conducting Ethnographic Fieldwork as a Researcher-cum-Clinician in Brussels, Belgium.

We draw on ethnographic fieldwork conducted in Brussels (Belgium) on the health care experiences of undocumented migrants. We explore the implications of the double position of the ethnographer, who is both a researcher and a practicing doctor. We describe how the intimate knowledge the ethnographer-cum-clinician holds about the health care system influenced and shaped the data collection, analysis and subsequent policy recommendations. We examine the ethical dilemmas in conducting research from an engaged position about care practices toward vulnerable populations in one's own professional field. We conclude with recommendations on how to challenge and interrupt complexities faced by multi-positioned ethnographers.

Between Sympathy, Fascination, and Powerlessness. The Experiences of Health Professionals During the Medical Monitoring of a Hunger Strike Among Undocumented Migrants.

In 2014, a group of undocumented migrants started a hunger strike in Brussels. The medical monitoring was mainly done by young, committed health professionals with no prior experience of medical monitoring of people on hunger strike. Following the hunger strike, two focus groups were organized to assess the experiences of the health professionals during the medical monitoring of the hunger strike. Their main motivation for assisting was wanting to help the people on hunger strike but they were also curious about the living conditions among undocumented migrants and the reasons behind starting the strike. They were puzzled by the paradox of hunger strikers putting their life at risk in order to get a better life and obtain a residence permit. They felt conflicted about their own role as a caregiver: they did not know how to deal with patients who did not comply with medical advice, they struggled to build a relationship of mutual trust and feared that they would end up being instrumentalized by the hunger strikers or their environment. Afterwards, some of the health professionals were deeply touched by the experience and there were reports of symptoms of secondary traumatic stress such as re-experiencing and avoidance. During the focus group's discussions, the respondents made suggestions on how to improve the medical monitoring in the event of any future hunger strikes.

Beyond biopolitics: the importance of the later work of Foucault to understand care practices of healthcare workers caring for undocumented migrants.

BACKGROUND: Undocumented migrants experience multiple institutional and legal barriers when trying to access healthcare services. Due to such limitations, healthcare workers often experience ethical dilemmas when caring for undocumented migrants. This article aims to understand how individual healthcare workers who regularly take care of undocumented migrants deal with these dilemmas in practice. So far, the role of healthcare workers in this context has mainly been theorized through the lens of biopolitics, conceiving of healthcare workers as merely obedient instruments of humanitarian government or gatekeeping. METHODS: Based on semi-structured, in-depth interviews and ethnographic observations with healthcare workers in Belgium, we explore how they ascribe meaning, reflect upon and give shape to care practices in relation to undocumented migrants. We use Foucault's later work on care of the self to interpret the accounts given by the healthcare workers. RESULTS: Healthcare workers in clinical roles exercise a certain degree of freedom in relation to the existing limitations to healthcare access of undocumented migrants. They developed techniques such as purposefully being inattentive to the undocumented status of the migrants. They also try to master their affective responses and transform their bodily attitude towards undocumented patients. They perform practical mental exercises to remind themselves of their role or position in the wider healthcare system and about their commitment to treat all patients equally. These techniques and exercises are inspired by colleagues who function as role models, inspiring them to relate in an ethical way to limitations in healthcare access. The developed care practices sometimes reproduce, sometimes transform the legal and institutional limitations to care for undocumented migrants. CONCLUSIONS: The findings nuance the biopolitical analysis regarding the role of healthcare workers in healthcare delivery to undocumented migrants that has been dominant so far. Theoretically this article provides a reconceptualization of healthcare ethics as care of the self, an ethical practice that is somewhat independent of the traditional professional ethics. Trial Registration Medical ethics committee UZ Jette, Brussels, Belgium - Registration date: 18/05/2016 - Registration number: B.U.N. 143201628279.

Counting the non-existing: causes of death of undocumented migrants in Brussels-Capital Region (Belgium), 2005-2010.

BACKGROUND: So far knowledge about undocumented migrant health status is poor. The objective of this study is to compare patterns in causes of death between undocumented migrants and legal residents, of both migrant and non-migrant origin. METHOD: Using cause-of-death data, we compared undocumented migrants with Belgian residents and documented migrants through logistic regression analyses.. RESULTS: This study shows that male undocumented migrants have a significantly higher risk of death from cardiovascular diseases compared to male Belgian residents (OR: 1.37) and documented migrants (OR: 2.17). Male undocumented migrants also have an increased risk of dying from external causes of death compared to documented migrants (OR: 1.93). Furthermore, we found a lower risk of suicidal death in undocumented migrants compared to Belgian residents (OR men: 0.29, OR women: 0.15). CONCLUSIONS: We found important differences in underlying causes of death between undocumented migrants and residents in Belgium. These findings urge us to claim improved healthcare provision for undocumented migrants in Belgium. TRIAL REGISTRATION: Medical ethics committee UZ Jette, Brussels, Belgium - Registration date: 18/05/2016 - Registration number: B.U.N. 143201628279.