Person: Obach, Alexandra
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Obach
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Alexandra
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Alexandra Obach
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Publication The social and health protection of migrants in Chile: qualitative analysis of civil society proposals for constitutional change(2023) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Esnouf, Sophie; Mezones, Edward; Espinoza, Manuel; DeJong, JocelynBackground: A sustained period of social, economic, and political unrest took place during October of 2019 in Chile. As an institutional solution, the "Agreement for Social Peace and the New Constitution" was signed. In this document, most political parties committed to reestablishing peace and public order in Chile, agreeing on the initiation of a constitutional process. To promote participation of civil society actors, the "Popular Initiative for Norms" was enabled. This was a platform where civilians could submit proposals for constitutional norms to be discussed by the Constitutional Convention. We aimed to analyze proposals related to migrants and migrant health. Methods: We conducted a qualitative thematic analysis of the proposals. Sixteen of them were related to migrants, and we analyzed their association to health. We also evaluated their link to the Health Goals 2030 set out by the Chilean Ministry of Health and the Global Action Plan 2019-2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Results: Four main thematic categories were identified: 1) Humans rights of migrants, refugees, and asylum seekers; 2) Nationality and regularization of migrants and refugees; 3) Political participation and cultural integration of migrants and refugees; and 4) Specific regulations on slavery and human trafficking. These resonated with broader frameworks established in the Health Goals 2030 (Chile) and the Global Action Plan 2019-2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. Conclusions: The 'Popular Initiative for Norms' was a non-binding participatory mechanism. Although the proposals sent through were not guaranteed to be included in the constitutional draft-and despite the final draft being rejected last September 2022-the platform allowed to gain insights into civilian opinions. Our findings showed that there is an incipient yet weak recognition of the rights and situation of migrants in Chile. There was no direct mention of health nor an explicit contemplation of social determinants of health. Despite there being an urgent need to define strategies for migrants' health in Chile, this study demonstrated that civil awareness and interest are still insufficient.Publication "Healthcare should be the same for everyone": perceived inequities in therapeutic trajectories of adult patients with lung cancer in Chile, a qualitative study(2023) Cabieses, Báltica; Obach, Alexandra; Campaña, Carla; Vezzani, FranciscaBackground: Globally, it has been reported that different social determinants of health affect health outcomes in lung cancer (LC). Research on the therapeutic trajectories of patients (TTP) is a novel field for identifying barriers and facilitators in health. The objective of this study was to reveal perceived differences in TTP with LC in Chile according to selected social determinants of health (SDH) and the experiences of patients, health professionals, and civil society leaders. Methods: This is a qualitative paradigm, one case-study design. Online semi-structured interviews were conducted with patients with LC, health professionals, and civil society leaders. The strategies for the recruitment process included social networks, civil society organizations, health professionals, and the snowball technique. A thematic analysis was carried out. Results: Selected SDH impact LC's TTP in Chile, particularly concerning health system access, health services, information, and patient navigation experiences. The analysis of the experiences of the participants allowed us to identify barriers related to the selected SDH in three stages of the TTP: initiation, examinations, and diagnosis and treatment. Individuals with limited education, those residing outside the capital, women, and those in the public health system encountered more barriers throughout their TTP. Discussion: Study findings suggest that being a woman with low education, from the public health system, and not from the capital might represent one of the most powerful intersections for experiencing barriers to effective healthcare in LC in Chile. It is necessary to monitor the TTP from an SDH perspective to guarantee the rights of access, opportunity, quality, and financial protection.Publication Quemaduras: ¿por qué prestarles especial atención a los adolescentes en América Latina y El Caribe desde un enfoque de prevención primaria en salud?(2023) Blukacz, Alice; Cabieses, Báltica; Obach, Alexandra; Fuentes, Rodrigo; Carmina, Domic; Peredes, Carola; Saavedra, Rolando; Rojas, JorgeLa evidencia existente en materia de quemaduras en población menor de edad a nivel global se ha enfocado principalmente en niños y niñas menores de 10 años, dejando atrás al grupo etario definido como "adolescente" por la Organización Mundial de la Salud. Sin embargo, la etapa de la adolescencia presenta características propias que la diferencian de los rangos etarios menores con respecto a las quemaduras. Estas diferencias son relevantes desde una perspectiva de prevención primaria, la cual se centra en evitar la enfermedad o lesión. En este contexto, el presente artículo reflexiona en torno a los motivos por los cuales es necesario prestarles especial atención a las y los adolescentes en el marco de la prevención primaria de las quemaduras, con relevancia para Latinoamérica y El Caribe. Primero, los escenarios de quemaduras en adolescentes muchas veces se vinculan con la participación en actividades de riesgo por presión, deseabilidad social o baja percepción de los riesgos asociados. Segundo, es importante recalcar que los adolescentes pueden experimentar vulnerabilidad social, la cual los puede exponer al riesgo de sufrir una quemadura intencional o no. Tercero, el riesgo de quemaduras en adolescentes se puede asociar con la salud mental y escenarios de autolesión. Se requiere indagar en estos aspectos, tanto a través de estudios cuantitativos epidemiológicos como de estudios cualitativos, para poder diseñar e implementar estrategias de prevención primarias relevantes para este grupo de población en la región.Publication Acceso a salud de migrantes internacionales en pandemia en Chile: resultados de encuesta cuantitativa(2023) Cabieses, Báltica; Blukacz, Alice; Obach, Alexandra; CARREÑO CALDERON, ALEJANDRA; Oyarte, Marcela; Alvarez, Maria; Osse, Claudio; Mezones, EdwardEl objetivo del estudio fue analizar barreras de acceso a la atención de salud en Chile reportadas por migrantes internacionales residentes en la región metropolitana del país y factores asociados. Para ello, se aplicó una encuesta en formato digital sobre vulnerabilidades y recursos de comunidades migrantes en Chile para enfrentar la pandemia SARS-CoV-2. Se realizó análisis descriptivo y estratificado por variables demográficas, socioeconómicas, tipo de previsión de salud y estatus migratorio. Como resultados, inmigrantes provenientes de Haití reportaron el mayor porcentaje de barreras de acceso a la atención en salud, esto tras ajustar por variables sociodemográficas y estatus migratorio. The objective of the study was to analyze barriers to access to health care in Chile reported by international migrants residing in the metropolitan region of the country and associated factors. For this purpose, a digital survey on vulnerabilities and resources of migrant communities in Chile to face the SARS-CoV-2 pandemic was applied. A descriptive and stratified analysis was performed by demographic and socioeconomic variables, type of health provision and migratory status. As results, immigrants from Haiti reported the highest percentage of barriers to health care access, after adjusting for socio-demographic variables and migratory status.Publication “Viajar para estar mejor”: trayectorias migratorias de niños, niñas y adolescentes que han ingresado por paso no habilitado a Chile durante la crisis por COVID-19(2023) CARREÑO CALDERON, ALEJANDRA; Obach, Alexandra; Correa, ElianaChile ha experimentado un importante aumento de población migrante y refugiada en los últimos años. A pesar de su invisibilidad, muchos de los recién llegados son niños, niñas y adolescentes (NNA), la mayor parte provenientes de países latinoamericanos. El artículo se basa en una investigación cualitativa en curso que se propone comprender las experiencias, significados y prácticas que han desarrollado en torno a la salud y enfermedad los núcleos con NNA que han cruzado la frontera norte de Chile, durante el periodo de crisis sanitaria por COVID-19. En el artículo nos interrogamos sobre sus experiencias y trayectorias de migración, así como sobre el impacto que éstas generan sobre su salud, reconociendo la importancia de visibilizar las rupturas y continuidades que la niñez y la adolescencia enfrentan en este momento del ciclo vital, destacando a su vez la capacidad que tienen los NNA de repensarse desde sus pertenencias múltiples en el contexto migratorio.Publication Desafíos para el abordaje de la salud de los migrantes en Chile durante la pandemia por Covid-19: una revisión de alcance(2023) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Rada, Isabel; CARREÑO CALDERON, ALEJANDRA; Mezones, EdwardObjetivo.Indagar sobre los principales desafíos reportados en el marco de la emergencia sanitaria de SARS-CoV-2 según la evidencia científica disponible a la fecha en esta materia en Chile. Material y métodos. Revisión de alcance con base en tres búsquedas en Web of Science, PubMed y Google Scholar de publicaciones en inglés y español publicadas entre 2020 y 2023. Resultados. Se identificaron tres áreas clave: desafíos de acceso y uso efectivo del sistema de salud, desafíos más allá del sistema de salud, incluyendo aquellas relaciones con determinantes sociales de la salud, autocuidado e información y, finalmente, desafíos de integración de los enfoques de interculturalidad, género y cooperación internacional. Conclusiones. Se evidencian oportunidades de mejorar el abordaje de la salud de personas migrantes internacionales en Chile a raíz de la pandemia por Covid-19, de cara a futuras crisis sanitarias y para reducir brechas e inequidades que impactan la salud poblacional. Objective. To investigate the main challenges in the context of the SARS-CoV-2 health emergency according to the scientific evidence available to date in this area in Chile. Materials and methods. Scoping review based on three searches in Web of Science, PubMed and Google Scholar of publications in English and Spanish published between 2020 and 2023. Results. Three key areas were identified: the challenges of access and effective use of the health system, the challenges beyond the health system, including those related to social determinants of health, self-care and information, and finally, the challenges of integrating intercultural, gender and international cooperation approaches. Conclusions. There are opportunities to better address the health of international migrants in Chile in the wake of the Covid-19 pandemic, anticipating future health crises and to reduce gaps and inequities that impact population health.Publication El rol de nuevas organizaciones de la sociedad civil en la promoción de salud sexual en Chile(2023) Obach, Alexandra; Sadle, Michelle; Roberts, Antonia; Marín, MatíasEl artículo que da cuenta de los resultados de dos investigaciones cualitativas ejecutadas entre 2020 y 2022, tiene como propósito, desde un enfoque de salud global, salud colectiva y vulnerabilidad estructural, reflexionar en torno al rol que juegan nuevos actores de la sociedad civil en la promoción de la salud sexual, de derechos sexuales y en la prevención y detección del VIH en Chile. Estos actores son organizaciones de la sociedad civil conformadas por jóvenes profesionales de la salud que han construido espacios de información, promoción y atención en salud sexual y reproductiva fuera del sistema formal de salud; y organizaciones lideradas por jóvenes LGBTIQA+ en torno a información en sexualidades en general, y a acceso a prevención y detección del VIH en particular. El artículo contribuye en mostrar la importancia que tienen estos nuevos actores en las trayectorias terapéuticas en materia de salud sexual de jóvenes en Chile, y la relevancia aún mayor que han adquirido desde el inicio de la pandemia de Covid-19 The article which gives an account of the results of two qualitative investigations carried out between 2020 and 2022, has the purpose, from a global health, collective health and structural vulnerability approach, to reflect on the role played by new civil society actors in the promotion of sexual health, sexual rights and in the prevention and detection of HIV in Chile. These actors are civil society organizations led by young health professionals who have built spaces for information, promotion, and care in sexual and reproductive health outside the formal health system; and organizations led by LGBTIQA+ youth around information on sexualities in general, and access to HIV prevention and detection in particular. The article contributes to show the importance that these new civil society actors have in therapeutic trajectories in the field of sexual health of young people in Chile, and the even greater relevance that they have acquired since the beginning of the Covid-19 pandemic.Publication Trenzando las antropologías de la salud en Chile: temas, diálogos y desafíos(2023) CARREÑO CALDERON, ALEJANDRA; Obach, Alexandra; Leyton, Daniela; Sadler, MichelleLa formación del campo de la antropología de la salud (o antropología médica) en Chile es paralela al desarrollo de la disciplina en el país. Actualmente observamos la consolidación de distintos temas y el surgimiento de nuevos diálogos y desafíos. El artículo reflexiona sobre el pasado, el presente y el futuro del campo, y propone una caracterización de las distintas etapas de esta subdisciplina basada en una revisión de investigaciones nacionales y de tesis de pregrado y postgrado dedicadas al tema. Se destacan los aportes y las limitaciones de cada período y se reflexiona en torno a los desafíos que la subdisciplina enfrenta actualmente considerando el arribo a un momento histórico de mayor reconocimiento y de implicación en el debate nacional sobre los procesos de salud/enfermedad/atención/cuidado. The development of the field of anthropology of health (or medical anthropology) in Chile has taken similar pathways as local social anthropology. We can currently observe the consolidation of different topics and the development of new dialogues and issues. The article reflects on the field’s past, present, and future directions, putting forward a proposal to describe the different stages of the subdiscipline in Chile based on a review of the local research, as well as under- and post-graduate dissertations and theses. The contributions and limitations of each stage are highlighted, and we reflect on the challenges the subdiscipline currently faces as it gains further recognition and involvement in the national debate on health/disease/attention/care processes.Publication Barriers and facilitators to access sexual and reproductive health services among young migrants in Tarapacá, Chile: a qualitative study(2024) Obach, Alexandra; Blukacz, Alice; Sadler, Michelle; CARREÑO CALDERON, ALEJANDRA; Cabieses, Báltica; Carolina DíazBackground: Chile has become a destination country for immigrants from Latin America, including youth. Guaranteeing access and use of sexual and reproductive health services for young migrants is crucial because of their overlapping experiences of transitioning to a new country and to adulthood. However, the existing evidence shows barriers to accessing sexual and reproductive healthcare among young migrant populations. In this context, the main objective of this article is to identify the barriers and facilitators that young migrants experience to access sexual and reproductive healthcare in the Tarapacá region of Chile. Methods: A qualitative study was conducted in the Tarapacá region of Chile. Semi-structured interviews with 25 young migrants from Venezuela, Colombia, and Ecuador, as well as 10 health workers, were carried out. The interviews were transcribed and thematically analysed. The study was approved by the Ethics Committee of the Universidad del Desarrollo (#2019-22). Results: Young migrants face barriers linked to structural shortcomings within the healthcare system, which may be similar to those faced by the local population. Barriers are also derived from reductionist sexual and reproductive health approaches, which prioritise the prevention of pregnancy, sexually transmitted infections, and HIV, with a predominantly heteronormative focus. The prevailing narratives from the health system are those of risk and lack of control and self-care among young people, and they are exacerbated in the case of migrants. Young migrants, especially from the Caribbean, are stereotyped as over-sexualised and liberal in comparison to the local population and believed to be engaging in riskier sexual behaviours that should be kept under check. This may translate into experiences of discrimination and mistreatment when receiving care. Facilitators include good-quality information and community-level interventions. Conclusions: This study shows a limited approach to the sexual and reproductive health of young migrants in Chile, severely hampering their reproductive and sexual rights. Policies and initiatives must work towards removing structural barriers, changing narratives, and empowering young migrants regarding their sexual and reproductive health.Publication Emergency preparedness and response sensitive of migrant populations in Chile: postpandemic perspectives(2024) Blukacz, Alice; Cabieses, Báltica; Obach, Alexandra; CARREÑO CALDERON, ALEJANDRA; Mezones, EdwardOn 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.