Preparación y respuesta ante emergencias sensibles a poblaciones migrantes en Chile: perspectivas postpandémicas / Emergency preparedness and response sensitive of migrant populations in Chile: post-pandemic perspectives

El 31 de agosto de 2023, el Gobierno de Chile puso fin a la alerta sanitaria por COVID-19. Este hito invita a reflexionar sobre lecciones aprendidas respecto a la preparación y respuesta ante emergencias, que sean sensibles e informadas sobre la experiencia de la población migrante de nuestro país. En este marco, se presentan tres perspectivas. La primera se centra en evitar la responsabilización individual en el incumplimiento de las medidas de prevención del contagio, ya que este enfoque ignora las inequidades estructurales e históricas. Las recomendaciones de emergencia se deben construir bajo un abordaje colectivo y con la consideración de los diversos contextos socioculturales y políticos. La segunda perspectiva llama a tomar en cuenta y abordar la migración como determinante social de la salud de la población en la preparación y respuesta ante emergencias. Durante la pandemia, los cambios en la gobernanza de la migración en todo el mundo precarizaron los procesos migratorios, con riesgos para la salud física y mental de las personas que migran. Esto requiere una mejor planificación y decisiones informadas en evidencia científica para futuras pandemias. La tercera perspectiva se enfoca en promover la interculturalidad, dado que la comunicación de los riesgos de contagio y de las medidas preventivas se vio dificultada entre poblaciones migrantes con diversas cosmovisiones e interpretaciones de los procesos de salud y enfermedad. Asimismo, el responder a las necesidades de aquellas comunidades históricamente marginadas, requiere establecer modos de vida que respeten la diversidad en las narrativas y las prácticas cotidianas. Los gobiernos y sistemas sanitarios deben incorporar la migración a sus estrategias de preparación y respuesta ante emergencias, con la construcción de las condiciones para su cumplimiento óptimo.

On August 31, 2023, the Chilean government ended the health alert for COVID-19. This milestone invites us to reflect on lessons learned in emergency preparedness and response regarding migrant populations in the country. In this context, three perspectives are presented. The first focuses on avoiding pointing to individual responsibility for non-compliance with prevention measures, as this approach ignores structural and historical inequities. Emergency recommendations should be constructed considering a collective approach and diverse sociocultural and political contexts. The second perspective calls for considering and addressing migration as a social determinant of health. During the pandemic, changes in the governance of migration around the world made migration processes more precarious, with risks to the physical and mental health of migrants, which needs better planning and evidence-based decision-making in future pandemics. The third perspective focuses on promoting intercultural health, as effective communication of contagion risks and preventive measures were hampered among migrant populations with diverse worldviews and interpretations of health and disease processes. Responding to the needs of historically marginalized communities requires establishing ways of life that respect diversity in narratives and everyday practices. Governments and health systems must incorporate migration into their emergency preparedness and response strategies, creating the conditions for optimal compliance.

Emergency preparedness and response sensitive of migrant populations in Chile: post-pandemic perspectives. / Preparación y respuesta ante emergencias sensibles a poblaciones migrantes en Chile: perspectivas postpandémicas.

On August 31, 2023, the Chilean government ended the health alert for COVID-19. This milestone invites us to reflect on lessons learned in emergency preparedness and response regarding migrant populations in the country. In this context, three perspectives are presented. The first focuses on avoiding pointing to individual responsibility for non-compliance with prevention measures, as this approach ignores structural and historical inequities. Emergency recommendations should be constructed considering a collective approach and diverse sociocultural and political contexts. The second perspective calls for considering and addressing migration as a social determinant of health. During the pandemic, changes in the governance of migration around the world made migration processes more precarious, with risks to the physical and mental health of migrants, which needs better planning and evidence-based decision-making in future pandemics. The third perspective focuses on promoting intercultural health, as effective communication of contagion risks and preventive measures were hampered among migrant populations with diverse worldviews and interpretations of health and disease processes. Responding to the needs of historically marginalized communities requires establishing ways of life that respect diversity in narratives and everyday practices. Governments and health systems must incorporate migration into their emergency preparedness and response strategies, creating the conditions for optimal compliance.

El 31 de agosto de 2023, el Gobierno de Chile puso fin a la alerta sanitaria por COVID-19. Este hito invita a reflexionar sobre lecciones aprendidas respecto a la preparación y respuesta ante emergencias, que sean sensibles e informadas sobre la experiencia de la población migrante de nuestro país. En este marco, se presentan tres perspectivas. La primera se centra en evitar la responsabilización individual en el incumplimiento de las medidas de prevención del contagio, ya que este enfoque ignora las inequidades estructurales e históricas. Las recomendaciones de emergencia se deben construir bajo un abordaje colectivo y con la consideración de los diversos contextos socioculturales y políticos. La segunda perspectiva llama a tomar en cuenta y abordar la migración como determinante social de la salud de la población en la preparación y respuesta ante emergencias. Durante la pandemia, los cambios en la gobernanza de la migración en todo el mundo precarizaron los procesos migratorios, con riesgos para la salud física y mental de las personas que migran. Esto requiere una mejor planificación y decisiones informadas en evidencia científica para futuras pandemias. La tercera perspectiva se enfoca en promover la interculturalidad, dado que la comunicación de los riesgos de contagio y de las medidas preventivas se vio dificultada entre poblaciones migrantes con diversas cosmovisiones e interpretaciones de los procesos de salud y enfermedad. Asimismo, el responder a las necesidades de aquellas comunidades históricamente marginadas, requiere establecer modos de vida que respeten la diversidad en las narrativas y las prácticas cotidianas. Los gobiernos y sistemas sanitarios deben incorporar la migración a sus estrategias de preparación y respuesta ante emergencias, con la construcción de las condiciones para su cumplimiento óptimo.

Access to health services for international migrants during the COVID-19 pandemic: a qualitative study.

OBJECTIVE: To explore the experience and perception of international migrants in Chile regarding access to health services during the pandemic. METHOD: Collective case study following the qualitative paradigm. Forty semi-structured interviews were carried out with 30 migrants from different countries in Latin America and the Caribbean and 10 key actors from the health or social sector in November and December 2020. The interviews were analyzed thematically. RESULTS: Perceived facilitators for general access to health services are related to formal work, support networks, and good treatment, while barriers are linked to immigration status, information gaps, discrimination, lack of cross-cultural skills, and personal limits of the system. In the context of access to COVID-19 diagnosis and treatment, the main barriers identified are: cultural approach to the disease, communication gaps, experiences of discrimination, costs, and lack of support networks. CONCLUSION: Access to health services is related to social vulnerability and violation of international migrants rights.

Access to health services for international migrants during the COVID-19 pandemic: a qualitative study / Acesso a serviços de saúde para migrantes internacionais durante a pandemia de COVID-19: estudo qualitativo / Acceso a servicios de salud para personas migrantes internacionales durante la pandemia por COVID-19: estudio cualitativo

ABSTRACT Objective: To explore the experience and perception of international migrants in Chile regarding access to health services during the pandemic. Method: Collective case study following the qualitative paradigm. Forty semi-structured interviews were carried out with 30 migrants from different countries in Latin America and the Caribbean and 10 key actors from the health or social sector in November and December 2020. The interviews were analyzed thematically. Results: Perceived facilitators for general access to health services are related to formal work, support networks, and good treatment, while barriers are linked to immigration status, information gaps, discrimination, lack of cross-cultural skills, and personal limits of the system. In the context of access to COVID-19 diagnosis and treatment, the main barriers identified are: cultural approach to the disease, communication gaps, experiences of discrimination, costs, and lack of support networks. Conclusion: Access to health services is related to social vulnerability and violation of international migrants rights.

RESUMO Objetivo: Explorar a experiência e a percepção dos migrantes internacionais no Chile sobre o acesso aos serviços de saúde durante a pandemia. Método: Estudo de caso coletivo sob o paradigma qualitativo. Foram realizadas 40 entrevistas semiestruturadas com 30 migrantes de diferentes países da América Latina e Caribe e 10 atores-chave do setor de saúde ou social em novembro e dezembro de 2020. As entrevistas foram analisadas tematicamente. Resultados: Os facilitadores percebidos para o acesso geral aos serviços de saúde estão relacionados ao trabalho formal, redes de apoio e bom tratamento, enquanto as barreiras estão ligadas ao status de imigração, lacunas de informação, discriminação, falta de habilidades interculturais e limites próprios do sistema. No contexto do acesso ao diagnóstico e tratamento da COVID-19, identificam-se principalmente barreiras: abordagem cultural da doença, lacunas de comunicação, vivências de discriminação, custos e falta de redes de apoio. Conclusão: O acesso aos serviços de saúde está vinculado à vulnerabilidade social e à violação dos direitos dos migrantes internacionais.

RESUMEN Objetivo: Explorar la experiencia y percepción de las personas migrantes internacionales en Chile en torno al acceso a servicios de salud durante la pandemia. Método: Estudio de caso colectivo bajo el paradigma cualitativo. Se llevaron a cabo 40 entrevistas semi-estructuradas con 30 personas migrantes provenientes de diferentes países de América Latina y el Caribe y 10 actores clave del sector salud o social en noviembre y diciembre 2020. Se analizaron las entrevistas temáticamente. Resultados: Los facilitadores percibidos para el acceso general a servicios de salud se relacionan con el trabajo formal, las redes de apoyo y el buen trato, mientras que las barreras se vinculan con situación migratoria, brechas de información, discriminación, falta de competencias interculturales y límites propios del sistema. En contexto de acceso a diagnóstico y tratamiento de COVID-19, se identifican principalmente barreras: abordaje cultural de la enfermedad, brechas comunicacionales, experiencias de discriminación, costos y faltas de redes de apoyo. Conclusión: El acceso a servicios de salud se vincula con vulnerabilidad social y vulneración de derechos de las personas migrantes internacionales.

"If I get sick here, I will never see my children again": The mental health of international migrants during the COVID-19 pandemic in Chile.

BACKGROUND: The COVID-19 pandemic has had an impact on the mental health of international migrants globally. Chile has managed its response to the pandemic in an ongoing context of social unrest and combined regional migratory and humanitarian crisis. The country's population presents a high prevalence of common mental disorders and a high suicide rate, with limited access to mental healthcare. International migrants in Chile represent 8% of the total population, and although a socioeconomically heterogenous group, they face social vulnerability, a range of mental health stressors and additional barriers to access mental healthcare. This study describes the mental health outcomes, stressors, response, and coping strategies perceived by international migrants during the COVID-19 pandemic in Chile. METHODS AND FINDINGS: A qualitative case study was carried out through individual online interviews to 30 international migrants living in Chile during the pandemic and 10 experts of the social and health care sectors. An inductive content analysis was carried out, a process during which the researchers sought to identify patterns and themes derived from the data. Participants experienced mainly negative mental health outcomes, including anxiety and depression symptomatology. Stressors included the virus itself, work, living and socioeconomic conditions, discrimination, fear for their family and distance caring. Institutional responses to address the mental health of international migrants during the pandemic in Chile were limited and participants relied mainly on individual coping strategies. CONCLUSIONS: The pandemic can represent an important opportunity to strengthen mental health systems for the general population as well as for population groups experiencing social vulnerability, if the issues identified and the lessons learned are translated into action at national, regional, and international level. Promoting the mental health of international migrants means recognising migration as a social determinant of mental health and adopting a cross-cultural as well as a Human Rights approach.

Latin American Youths' Migration Journeys and Settlement in the Tarapacá Region in Chile: Implications for Sexual and Reproductive Health.

The sexual and reproductive health of young migrants has not been sufficiently addressed in mobility studies. In this article, we dwell on some aspects of this issue in the migration process of Latin American youth. We conducted a qualitative study in the region of Tarapacá, Chile, carrying out in-depth interviews with key informants, health staff and young migrants between 18 and 25 years old. The results show some motivations to migrate related to sexual and reproductive health: young pregnant women, LGBTQI+ and HIV-positive people seeking access to health care and social contexts of reduced gender discrimination. During the migration process, young people are exposed to various kinds of sexual violence, and in their settlement in Chile, to situations of racism, stigma and discrimination in society as a whole and in access to and during sexual and reproductive health care. Health care for young migrants is mainly focused on maternal care and reproductive issues, while sexual health as a whole is disregarded. We argue that sexual health must be addressed as a central dimension of the lived experiences of young migrants, and that the social, cultural and structural factors that undermine their sexual and reproductive health must be addressed in order to provide culturally competent health services.

[Towards ethical care in nursing homes during the COVID-19 pandemic: a qualitative study with international migrants in Chile]. / Hacia un cuidado ético en residencias sanitarias durante la pandemia de COVID-19: estudio cualitativo con migrantes internacionales en Chile.

International migrants have been recognized as a population at risk in the context of the COVID-19 pandemic. Worldwide, various strategies have been deployed for the protection of this population, such as the establishment of reception and quarantine or isolation centers. This article reports the results of a study that explored the experiences of international migrants in nursing homes in Chile created to ensure a safe quarantine during the COVID-19 pandemic, from an approach of ethical conditions for care. A qualitative study was carried out in 2020-2021. Thirty individual semi-structured online interviews were conducted in the cities of Arica, Iquique, Antofagasta and Santiago with international migrants with experience of using nursing homes; health teams of nursing homes; managers of nursing homes; local authorities; and national experts. Thematic analysis of the information was carried out. The study concludes that for international migrants, although the experience in nursing homes has meant significant health support, it is essential that the care provided, in addition to the requirement that it be framed in an approach of rights and respect for the dignity of each person, incorporate the perspective of interculturality in its work, that is, ensuring the right to culturally relevant health services, respectful of the culture of individuals, minorities, peoples and communities.

Migrantes internacionales han sido reconocidos como población de riesgo en el contexto de la pandemia de COVID-19. A nivel mundial se han desplegado diversas estrategias para la protección de esta población, como la habilitación de centros de recepción y cuarentena o aislamiento. El artículo da cuenta de los resultados de un estudio que exploró las experiencias de migrantes internacionales en residencias sanitarias dispuestas en Chile para la realización de cuarentenas seguras en el marco de la pandemia COVID-19, desde un enfoque de condiciones éticas para el cuidado. Se realizó un estudio cualitativo entre los años 2020-2021. Se efectuaron 30 entrevistas individuales semi-estructuradas en línea en las ciudades de Arica, Iquique, Antofagasta y Santiago a migrantes internacionales con experiencia de uso de residencias sanitarias; equipos de salud de residencias sanitarias; mánagers de dichos recintos; autoridades locales; y expertos nacionales. Se realizó análisis temático de la información. El estudio concluye que para migrantes internacionales, si bien la experiencia en residencias sanitarias ha significado un apoyo sanitario significativo, es imprescindible que el cuidado proporcionado, además de la exigencia que se enmarque en un enfoque de derechos y de respeto a la dignidad de cada persona, incorpore la perspectiva de la interculturalidad en su quehacer, es decir, asegurando el derecho a servicios de salud culturalmente pertinentes, respetuosos de la cultura de las personas, las minorías, los pueblos y las comunidades.

Migrantes internacionais foram reconhecidos como uma população de risco no contexto da pandemia de COVID-19. Em todo o mundo, várias estratégias têm sido implantadas para a proteção dessa população, como o estabelecimento de centros de acolhimento e quarentena ou isolamento. Este artigo relata os resultados de um estudo que explorou as experiências de migrantes internacionais em residências de saúde organizadas no Chile para quarentena segura no âmbito da pandemia de COVID-19, a partir de uma abordagem de condições éticas para o atendimento. Foi realizado um estudo qualitativo entre os anos de 2020-2021. Foram realizadas 30 entrevistas individuais semiestruturadas online nas cidades de Arica, Iquique, Antofagasta e Santiago com migrantes internacionais com experiência de uso de residências de saúde; equipes de saúde das residências de saúde; gestores dos referidos locais; autoridades locais; e especialistas nacionais. Foi realizada análise temática das informações. O estudo conclui que para os migrantes internacionais, embora a experiência em residências de saúde tenha significado significativo apoio à saúde, é imprescindível que os cuidados prestados, além da exigência de que sejam enquadrados em uma abordagem de direitos e respeito à dignidade de cada pessoa, incorporar a perspectiva da interculturalidade em seu trabalho, ou seja, garantir o direito a serviços de saúde culturalmente relevantes, que respeitem a cultura dos indivíduos, minorias, povos e comunidades.

Recursos y vulnerabilidades de comunidades migrantes en Chile para enfrentar la pandemia SARS-CoV-2

Objetivo Conocer, en contexto de la pandemia por SARS-CoV-2, las vulnerabilidades psicosociales y socioeconómicas de la población migrante internacional en Chile y los recursos y capitales sociales reportados desde la propia comunidad. Métodos Estudio cualitativo descriptivo. Se realizaron 40 entrevistas semiestructuradas a migrantes (N=30) e informantes claves (N=10), ejecutadas virtualmente durante el 2020. El material fue analizado mediante análisis temático. El proyecto fue aprobado por el Comité de Ética Científico de la Facultad de Medicina de la Universidad del Desarrollo. Resultados Como principales vulnerabilidades enfrentadas por parte de personas migrantes en pandemia se identifican: hacinamiento, precariedad laboral y necesidades económicas, uso del transporte público, desinformación y creencias en torno al COVID-19, discriminación, falta de redes de apoyo, y estatus migratorio. Como recursos se reconocen: contar con redes de apoyo, posibilidad de teletrabajo o salir a trabajar, acceso a información y a la red asistencial y municipal, apoyo gubernamental y de la sociedad civil. Adicionalmente, se reportan experiencias de diagnóstico de COVID-19, identificando dificultades en acceso a PCR y adaptaciones familiares y laborales como cambios en los hábitos de vida dentro y fuera del hogar. Discusión El estudio entrega información relevante e inédita para la construcción de políticas en salud para migrantes internacionales con foco en crisis sanitarias. Se destaca la necesidad de fortalecer adecuaciones interculturales en las estrategias de prevención del contagio y de promoción de la salud y aumentar la disponibilidad de respuesta en el acceso a salud en el marco de la pandemia, mitigando así la vulnerabilidad social en migrantes y potenciando sus recursos de afrontamiento.

Objective To know, in the context of the SARS-CoV-2 pandemic, the psychosocial and socioeconomic vulnerabilities experienced by the international migrant population in Chile, as well as the resources and social capital reported from the community itself and its support networks, and to analyze the reception and implementation of the measures recommended by the health authorities in the different stages of the pandemic in the country. Methods Descriptive qualitative study. The information was collected through 40 semi-structured individual interviews with migrants (N=30) and key informants (N=10), carried out through online communication platforms during 2020. A thematic analysis of the material was carried out. The project was approved by the Scientific Ethics Committee of the Faculty of Medicine of the Universidad del Desarrollo. Results The main vulnerabilities experienced by migrants in the context of the pandemic include overcrowding, job insecurity and economic needs, use of public transport, misinformation and beliefs about COVID-19, experiences of discrimination and xenophobia, lack of support networks, and migratory status. The main resources are support networks, the possibility of working remotely or going out to work, access to information, access to the assistance and municipal network, and government support and civil society. In addition, experiences of diagnosis of COVID-19 are reported, identifying difficulties in accessing PCR testing, and family and work adaptations such as changes in lifestyle habits inside and outside the home. Discussion The study provides relevant and unpublished information for the construction of health policies for international migrants with a focus on sanitary crises. It highlights the need to strengthen cross-cultural strategies for the prevention of infection and health promotion, and to improve access to health in the context of the pandemic and beyond, thereby mitigating the social vulnerability experienced by migrants and enhancing their coping resources.

Características fonológicas en población escolar con dislexia: Un modelo de ecuaciones estructurales / Phonological features in a school population with dyslexia: A structural equation model

Resumen Introducción: El trastorno específico del aprendizaje es una entidad nosológica del neurodesarrollo, las manifestaciones clínicas se hacen evidentes en la etapa escolar y son persistentes en el transcurso de la vida. La dislexia (DS) se caracteriza por una afectación en la comprensión y fluidez del proceso lector, asociada a déficits neurocognitivos. Objetivo: Analizar. la relación existente entre fluidez fonológica, repetición, denominación y comprensión verbal en niños con diagnóstico de DS. Método: Se empleó una muestra de N=114 personas con diagnóstico de DS escolarizados, en edades entre 7 y 16 años y un. muestreo no probabilístico. Construimos un modelo de ecuaciones estructurales (MEE) en el software RCran 4.0.4, para analizar la relación entre las variables latentes (fluidez fonológica, fluidez semántica, repetición de pseudopalabras, repetición de frases, denominación y comprensión verbal), a través de los resultados de pruebas psicométricas estandarizadas; Test de Fluencia Verbal, Test de Boston, Evaluación Neuropsicológica Infantil y Escala Weschler IV de Inteligencia. Resultados: Las covarianzas entre fluidez fonológica y todos los componentes del lenguaje (LG) fueron positivas; fluidez semántica (σxy=0,55), repetición de pseudopalabras (σxz=0,53), repetición de frases (σxw=0,64), denominación del LG (σxv=0,60), comprensión verbal (σxy=0,57), lo que indica una relación directa. En las personas con DS, a menor fluidez fonológica mayores deficiencias del LG. Conclusión: En la DS la fluidez fonológica y semántica es limitada y se relaciona de manera directa con las manifestaciones clínicas de este trastorno del neurodesarrollo (TN).

Abstract Introduction: The specific learning disorder is a nosological entity of neurodevelopment, the clinical manifestations become evident in the school stage and are persistent throughout life. Dyslexia (DS) is characterized by an impairment in the comprehension and fluency of the reading process, associated with neurocognitive deficits. Objective: To analyze the relationship between phonological fluency, repetition, naming and verbal comprehension in children diagnosed with dyslexia (DS). Method: A sample of (N=114) school patients with DS diagnosis between the ages of 7 and 16 years, selected by non-probability sampling, was used. We built a structural equation model (MEE) in RCran 4.0.4 software, to analyze the relationship between the latent variables (phonological fluency, semantic fluency, pseudoword repetition, sentence repetition, naming and verbal comprehension), through the results of standardized psychometric tests; Verbal Fluency Test, Boston Test, Child Neuropsychological Assessment and Weschler Intelligence Scale IV. Results: Covariances between phonological fluency and all language (LG) components were positive; semantic fluency (σxy=0.55), pseudoword repetition (σxz=0.53), sentence repetition (σxw=0.64), LG naming (σxv=0.60), verbal comprehension (σxy=0.57), indicating a direct relationship. In people with DS, the lower the phonological fluency the greater the language deficits. Conclusion: In DS, phonological and semantic fluency is limited and is directly related to the clinical manifestations of this neurodevelopmental disorder (TN).

Barriers and challenges around the mental health of refugees and asylum seekers in Chile. / Barreras y desafíos en salud mental de refugiados y solicitantes de asilo en Chile.

Asylum and refuge in Chile h¬ave received limited attention in policymaking and academia, and there is scarce evidence on their mental health needs and outcomes. Studies on mental healthcare access for international migrants suggest systemic barriers linked to costs and coverage, administrative issues, and adequacy of services. Today, we see that asylum and refuge is an emerging topic in Chile, which opens up the challenges around the mental health of refugees and asylum seekers. This topic is gaining visibility due to increased asylum claims over the past ten years, making it an urgent topic at a policy level. An exploratory qualitative study was conducted in 2018 on the health and social needs of asylum seekers and refugees from Latin America in Chile. This study indicated a general lack of knowledge on the mental health needs of refugees and asylum seekers and Chile and a lack of training in mental health professionals to address specific needs. Consequently, the health needs of these people remain largely unaddressed in terms of the number of available services and the relevance and pertinence of the services delivered. As Chile is positioning itself as a receiving country of refugees and asylum seekers in Latin America and the Caribbean, there is an opportunity to "do better" and adequately address the mental health of these marginalized populations.

Las temáticas de asilo y refugio han recibido escasa atención por parte de los decidores públicos y de la academia, existiendo poca evidencia respecto a las necesidades de salud mental, índices y acceso a atención de salud de refugiados y solicitantes de asilo. La literatura en temas de acceso a salud mental de migrantes internacionales en general sugiere la existencia de múltiples barreras vinculadas a costos y cobertura, temas administrativos y de adecuación de servicios. Los desafíos en términos de salud mental de estas poblaciones aumentan en la medida en que es un problema emergente en el país, que ha ganado visibilidad debido al importante incremento de las solicitudes de refugio en los últimos diez años. Un estudio cualitativo exploratorio fue conducido durante el año 2018 sobre las necesidades sociales y de salud de refugiados y solicitantes de refugio de origen latinoamericano presentes en Chile. Los resultados indican que existe falta de disponibilidad y de competencias por parte de los profesionales de salud mental para abordar las necesidades de esta población. En consecuencia, la salud mental de esta población está quedando desatendida tanto en términos cuantitativos debido a la falta de disponibilidad de servicios, cuanto en términos cualitativos por falta de adecuación y aceptabilidad de los servicios ofrecidos. Debido a que Chile se está posicionando como país de acogida de migrantes en la región Latinoamérica y Caribe, incluyendo a refugiados, es necesario acoger la oportunidad de hacer “mejor las cosas” respecto a la salud mental de poblaciones particularmente emarginadas, como son solicitantes de asilo y refugiados.

Hacia un cuidado ético en residencias sanitarias durante la pandemia de COVID-19: estudio cualitativo con migrantes internacionales en Chile / Towards ethical care in nursing homes during the COVID-19 pandemic: a qualitative study with international migrants in Chile / Rumo ao cuidado ético em residências de saúde durante a pandemia de COVID-19: um estudo qualitativo com migrantes internacionais no Chile

Migrantes internacionales han sido reconocidos como población de riesgo en el contexto de la pandemia de COVID-19. A nivel mundial se han desplegado diversas estrategias para la protección de esta población, como la habilitación de centros de recepción y cuarentena o aislamiento. El artículo da cuenta de los resultados de un estudio que exploró las experiencias de migrantes internacionales en residencias sanitarias dispuestas en Chile para la realización de cuarentenas seguras en el marco de la pandemia COVID-19, desde un enfoque de condiciones éticas para el cuidado. Se realizó un estudio cualitativo entre los años 2020-2021. Se efectuaron 30 entrevistas individuales semi-estructuradas en línea en las ciudades de Arica, Iquique, Antofagasta y Santiago a migrantes internacionales con experiencia de uso de residencias sanitarias; equipos de salud de residencias sanitarias; mánagers de dichos recintos; autoridades locales; y expertos nacionales. Se realizó análisis temático de la información. El estudio concluye que para migrantes internacionales, si bien la experiencia en residencias sanitarias ha significado un apoyo sanitario significativo, es imprescindible que el cuidado proporcionado, además de la exigencia que se enmarque en un enfoque de derechos y de respeto a la dignidad de cada persona, incorpore la perspectiva de la interculturalidad en su quehacer, es decir, asegurando el derecho a servicios de salud culturalmente pertinentes, respetuosos de la cultura de las personas, las minorías, los pueblos y las comunidades.

International migrants have been recognized as a population at risk in the context of the COVID-19 pandemic. Worldwide, various strategies have been deployed for the protection of this population, such as the establishment of reception and quarantine or isolation centers. This article reports the results of a study that explored the experiences of international migrants in nursing homes in Chile created to ensure a safe quarantine during the COVID-19 pandemic, from an approach of ethical conditions for care. A qualitative study was carried out in 2020-2021. Thirty individual semi-structured online interviews were conducted in the cities of Arica, Iquique, Antofagasta and Santiago with international migrants with experience of using nursing homes; health teams of nursing homes; managers of nursing homes; local authorities; and national experts. Thematic analysis of the information was carried out. The study concludes that for international migrants, although the experience in nursing homes has meant significant health support, it is essential that the care provided, in addition to the requirement that it be framed in an approach of rights and respect for the dignity of each person, incorporate the perspective of interculturality in its work, that is, ensuring the right to culturally relevant health services, respectful of the culture of individuals, minorities, peoples and communities.

Migrantes internacionais foram reconhecidos como uma população de risco no contexto da pandemia de COVID-19. Em todo o mundo, várias estratégias têm sido implantadas para a proteção dessa população, como o estabelecimento de centros de acolhimento e quarentena ou isolamento. Este artigo relata os resultados de um estudo que explorou as experiências de migrantes internacionais em residências de saúde organizadas no Chile para quarentena segura no âmbito da pandemia de COVID-19, a partir de uma abordagem de condições éticas para o atendimento. Foi realizado um estudo qualitativo entre os anos de 2020-2021. Foram realizadas 30 entrevistas individuais semiestruturadas online nas cidades de Arica, Iquique, Antofagasta e Santiago com migrantes internacionais com experiência de uso de residências de saúde; equipes de saúde das residências de saúde; gestores dos referidos locais; autoridades locais; e especialistas nacionais. Foi realizada análise temática das informações. O estudo conclui que para os migrantes internacionais, embora a experiência em residências de saúde tenha significado significativo apoio à saúde, é imprescindível que os cuidados prestados, além da exigência de que sejam enquadrados em uma abordagem de direitos e respeito à dignidade de cada pessoa, incorporar a perspectiva da interculturalidade em seu trabalho, ou seja, garantir o direito a serviços de saúde culturalmente relevantes, que respeitem a cultura dos indivíduos, minorias, povos e comunidades.

["No one seems ready to hear what I've seen:" Mental health care for refugees and asylum seekers in Chile]. / "Nadie está preparado para escuchar lo que vi": atención de salud mental de refugiados y solicitantes de asilo en Chile.

This article analyzes the results of a descriptive, qualitative study carried out in 2018 on the mental healthcare needs of Latin American refugees and asylum seekers in Chile, through the perspectives of refugees and asylum applicants (n=8), healthcare professionals responsible for delivery of care (n=4), and members of civil society organisations involved in this area (n=2). Our findings indicate that despite Chile's commitment to international treaties in this regard, little has been achieved in safeguarding the right to access to mental health care, understood as part of the universal right to health care access. This article documents barriers to mental health care access for migrants applying for asylum and refugee status. Post-migration stress factors may also increase the risk of emotional disorders within this group of people. Mental healthcare providers and teams are often not equipped with the tools to deal with the psychological consequences arising from the situations of violence and persecution associated with forced migration. Our study discusses the need to strengthen the link between mental health care - as a fundamental human right - and the right to international protection.

El presente artículo analiza las necesidades de atención de salud mental de refugiados y solicitantes de asilo de origen latinoamericano en Chile, por medio de un estudio cualitativo descriptivo, realizado en 2018, desde la voz de las personas solicitantes de refugio y asilo (n=8), profesionales de salud que los atienden (n=4), y miembros de organismos e instituciones dedicados en la temática (n=2). Los hallazgos evidencian que las obligaciones asumidas por Chile, a través de la adhesión a tratados internacionales, no han logrado garantizar el ejercicio del derecho a la salud mental, entendida como parte del derecho universal de acceso a la salud. En lo particular, el artículo documenta la presencia tanto de barreras de acceso a la salud mental en migrantes solicitantes de refugio y asilo, como de factores de estrés posmigratorios que pueden acentuar el riesgo de estos grupos a sufrir trastornos emotivos. También se reporta la insuficiente instalación de capacidades de atención en los equipos de salud mental para abordar las consecuencias psíquicas de los episodios de violencia y persecución que están a la base de la migración forzada. Finalmente, el artículo discute la necesidad de estrechar la vinculación entre la salud mental ­como derecho humano fundamental­ y el derecho a la protección internacional.

Experts by Experience: Qualitative Evaluation of Adolescent Participation in the Development of a Technological Intervention to Prevent Youth Suicide in Chile.

Adolescent suicide is a pressing problem in Chile that has not yet been sufficiently addressed, as suicide rates have stagnated in recent years. One possible explanation could be linked to the adult-centered paradigm that continues to prevail in relation to adolescent health initiatives. In light of this, programs that seek to promote youth mental health should consider incorporating adolescents in the design process using participatory methodologies, to ensure that these initiatives are well-suited for the population. In line with this recommendation, a group of seven adolescents, 13 to 20 years of age, were incorporated into a research team to actively guide the design, development, and validation of a technology-based intervention, known as Project Clan, which was piloted to reduce adolescent suicide in schools in Chile. This group was known as the "Group of Experts," in acknowledgment of their role as experts by experience on adolescence. A qualitative case study was conducted to explore their lived experiences, through semistructured individual in-depth interviews with six members of the group. Results showed that the adolescents had a high level of interest in mental health and had experienced problems of their own or accompanied friends who were struggling, which motivated their participation in the study. They had a critical view of the previous interventions they had received through educational institutions and valued their role in the promotion of their peers' mental health through the Group of Experts. They also highlighted the importance of creating tools that complement their daily lives and provide an alternative to existing social networks, by respecting their anonymity, providing a secure place for divulgation and self-expression, and facilitating access to professional support. We conclude that programs that address issues that affect adolescents should incorporate adolescents in the decision-making and design processes to ensure the acceptability and effectivity of their interventions.

"Nadie está preparado para escuchar lo que vi": atención de salud mental de refugiados y solicitantes de asilo en Chile / "No one seems ready to hear what I've seen": Mental health care for refugees and asylum seekers in Chile

RESUMEN El presente artículo analiza las necesidades de atención de salud mental de refugiados y solicitantes de asilo de origen latinoamericano en Chile, por medio de un estudio cualitativo descriptivo, realizado en 2018, desde la voz de las personas solicitantes de refugio y asilo (n=8), profesionales de salud que los atienden (n=4), y miembros de organismos e instituciones dedicados en la temática (n=2). Los hallazgos evidencian que las obligaciones asumidas por Chile, a través de la adhesión a tratados internacionales, no han logrado garantizar el ejercicio del derecho a la salud mental, entendida como parte del derecho universal de acceso a la salud. En lo particular, el artículo documenta la presencia tanto de barreras de acceso a la salud mental en migrantes solicitantes de refugio y asilo, como de factores de estrés posmigratorios que pueden acentuar el riesgo de estos grupos a sufrir trastornos emotivos. También se reporta la insuficiente instalación de capacidades de atención en los equipos de salud mental para abordar las consecuencias psíquicas de los episodios de violencia y persecución que están a la base de la migración forzada. Finalmente, el artículo discute la necesidad de estrechar la vinculación entre la salud mental -como derecho humano fundamental- y el derecho a la protección internacional.

ABSTRACT This article analyzes the results of a descriptive, qualitative study carried out in 2018 on the mental healthcare needs of Latin American refugees and asylum seekers in Chile, through the perspectives of refugees and asylum applicants (n=8), healthcare professionals responsible for delivery of care (n=4), and members of civil society organisations involved in this area (n=2). Our findings indicate that despite Chile's commitment to international treaties in this regard, little has been achieved in safeguarding the right to access to mental health care, understood as part of the universal right to health care access. This article documents barriers to mental health care access for migrants applying for asylum and refugee status. Post-migration stress factors may also increase the risk of emotional disorders within this group of people. Mental healthcare providers and teams are often not equipped with the tools to deal with the psychological consequences arising from the situations of violence and persecution associated with forced migration. Our study discusses the need to strengthen the link between mental health care - as a fundamental human right - and the right to international protection.