Enabling Better Health Care Professional-Roma Interactions in Macedonia


Interactions between Health Care Professionals (HCP) and the Roma in Macedonia are unhealthy, with each side blaming the other for the situation. Many HCP consider the Roma dirty, lazy, and lacking a prevention-based healthcare culture, their behavior rude, loud, and demanding, their presence odorous, and their tendency to come to the facilities in groups unethical. The Roma in turn believe that HCP use abusive and arrogant speech, engage in difficult to understand medical-speak, are corrupt treating better those who can/will bribe them even if these patients lack requisite health care documents, and take no cognition of the structural conditions of Roma life, rooted in centuries of marginalization, and leaving the Roma with little access to clean water, hygienic neighborhoods, quality schools, and employment opportunities. Interestingly, while the Roma acknowledge the need to change their attitudes and behaviors, HCP rarely do so.

The above observations are derived both from secondary research and from findings of primary formative research, using in-depth interviews and focus group discussions with HCP, and one FGD with the Roma, conducted by Ramaprasad and (doctoral student) Zhou in Macedonia in 2014, under funding from Open Society Foundations (OSF). The long-term aim of the research is to have the findings inform a communication intervention to foster more efficacious HCP-Roma interactions. The structural problems the Roma or, for that matter, the HCP face (e.g., complicated regulations) require long-term, systemic solutions; but other problems can be addressed in short-term stages.

The communication intervention is a video, that deals with two issues: 1) HCP views of the administrative problems they face and therefore the need for patients to respect appointment schedules, and 2) Roma beliefs about the importance of family support during visits to the HCP. Footage for the video has been shot and edited. This version of the video will be subjected to a pilot evaluation in Macedonia to assess its effectiveness in changing knowledge and short-term attitude but also in creating understanding and intent to dialogue. Findings from this evaluation will be used to do a second edit. This second version will also be evaluated and  then distributed to NGOs in Macedonia to use as an educational tool in dialogic educational settings with health care providers and the Roma to create understanding and dialogue. The funding for the creation of the video and for its evaluation came from the Center for Communication, Culture and Change in the School of Communication, University of Miami, and from OSF.