How do Filipino au pairs mobilize a support system when becoming ill and undergoing treatment for tuberculosis (TB) in Norway? The story of their rights, relations and illness experience.

Abstract

Background: There has been an increase in au pairs from the Philippines with TB registered in Norway. The study’s objective is to investigate 1) how this patient group is managing their TB treatment, 2) how the disease influences the host families they live with and 3) the relationship between au pairs and host families. Design/Methods: The study is conducted over a two-year period. Methods include qualitative research methods in the form of semi-structured in-depth interviews, participant observation, questionnaires, group discussions, focus-groups and informal conversations. Results: The study follows 5 au pairs undergoing TB treatment, their host families, health care workers, and NGOs. The au pair visa requires that they live with a host family as a culture exchange and perform household choirs and child care for housing, food and a small salary. They are particularly vulnerable because their visa, social network in Norway, living arrangements and salary are all connected to their host family and the role they have as an au pair. Au pairs draw on multiple resources and negotiate their health and legal status in a precarious situation. They are followed up closely by health care workers, but cultural differences and misunderstanding when communicating seem to influence illness management. Middle class host families and au pairs often have diverging expectations to each other regarding the au pairs role and they often face social stigma around TB. While the stigma and illness management may strengthen ties between them, some au pairs also have their contract terminated due to the diagnosis. Conclusions: The immigration status of au pairs determines their rights. Findings indicate that legal rights and status could be strengthened to ensure successful treatment. The information given to host families can be improved to avoid tensions, and to au pairs so that they understand and manage their illness better. Thus, the combination of this disease and au pair regulations has serious consequences for the au pairs, but also impacts on their host families and the relationship between them.

Background: There has been an increase in au pairs from the Philippines with TB registered in Norway. The study’s objective is to investigate 1) how this patient group is managing their TB treatment, 2) how the disease influences the host families they live with and 3) the relationship between au pairs and host families. Design/Methods: The study is conducted over a two-year period. Methods include qualitative research methods in the form of semi-structured in-depth interviews, participant observation, questionnaires, group discussions, focus-groups and informal conversations. Results: The study follows 5 au pairs undergoing TB treatment, their host families, health care workers, and NGOs. The au pair visa requires that they live with a host family as a culture exchange and perform household choirs and child care for housing, food and a small salary. They are particularly vulnerable because their visa, social network in Norway, living arrangements and salary are all connected to their host family and the role they have as an au pair. Au pairs draw on multiple resources and negotiate their health and legal status in a precarious situation. They are followed up closely by health care workers, but cultural differences and misunderstanding when communicating seem to influence illness management. Middle class host families and au pairs often have diverging expectations to each other regarding the au pairs role and they often face social stigma around TB. While the stigma and illness management may strengthen ties between them, some au pairs also have their contract terminated due to the diagnosis. Conclusions: The immigration status of au pairs determines their rights. Findings indicate that legal rights and status could be strengthened to ensure successful treatment. The information given to host families can be improved to avoid tensions, and to au pairs so that they understand and manage their illness better. Thus, the combination of this disease and au pair regulations has serious consequences for the au pairs, but also impacts on their host families and the relationship between them.