Language, perceived discrimination and barriers to complaint use: sub-Saharan African immigrants' healthcare experiences in Oslo, a qualitative interview study
This qualitative study of sub-Saharan African immigrants in Oslo reveals that while many perceive discriminatory healthcare encounters, barriers such as anticipated futility, emotional conservation, and procedural uncertainty prevent them from filing formal complaints, thereby masking systemic inequities and highlighting language accessibility as a critical determinant of accountability.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
Imagine a healthcare system where everyone has the same legal right to see a doctor, where the government pays the bills, and where the law promises that no one will be treated unfairly because of their skin color or where they were born. In such a place, you might assume that if a person walks into a clinic and leaves with a prescription, the system has worked. But access to care is not just about walking through the door; it is about whether you feel safe, understood, and respected while you are inside. When a patient feels ignored, spoken down to, or treated as if they do not belong, the experience changes. They may still return for their next appointment because they are sick and have no other choice, but the trust that holds the relationship between patient and doctor begins to crack. This is the quiet gap between having rights on paper and feeling those rights in practice, a space where the true measure of a health system's fairness is often hidden.
A recent study in Oslo, Norway, set out to explore this gap by listening to the stories of fifteen first-generation immigrants from sub-Saharan Africa. The researchers, Peter Kofi Taadi and Bill Derman, wanted to understand what happens after these individuals experience what they feel is unfair treatment. They asked: How do these patients interpret the moment they feel discriminated against? Does the language barrier make them feel like outsiders? And most importantly, if they feel wronged, do they try to fix it by filing a complaint, or do they simply stay silent? The study involved in-depth conversations with people from Ghana, Nigeria, Cameroon, Uganda, and The Gambia, all of whom had used Norwegian healthcare services. The goal was not to prove that racism occurred in every case, but to understand how these experiences shaped the patients' future choices and their belief in the system.
The researchers found that the way a patient is spoken to, or the lack of a shared language, often felt like a signal that they were not fully welcome. Ten of the fifteen participants described encounters they interpreted as discriminatory. These were not always loud or obvious acts of hate. Sometimes, it was a doctor who put on two pairs of gloves before taking a blood sample, making the patient feel as though they were carrying a dangerous disease. Other times, it was a midwife speaking only Norwegian to a woman in labor, or a doctor dismissing a request for sick leave by saying that Africans are too strong to get sick. Even when the treatment was technically correct, the feeling of being treated as "less than" or as a stereotype left a mark. In contrast, the five participants who did not report such negative experiences all shared one key feature: they were able to communicate with their providers in a language they both understood well, either Norwegian or English. This suggested that being able to speak and be understood might be the first step in feeling recognized as a legitimate patient.
When these troubling encounters happened, the patients did not all react in the same way, but their reactions revealed a difficult reality. Some continued to visit the clinic, not because they were happy with the care, but because they had no other option. They had families to support or illnesses to manage, so they swallowed their anger and kept going. Others, however, began to avoid the system entirely. One woman described giving up on the health services after repeated struggles with language, choosing instead to rely on friends to bring her medicine from abroad. This behavior highlights a crucial point: simply counting how many people visit a doctor does not tell the whole story. A high number of visits can hide a deep sense of dissatisfaction and fear, while a drop in visits might signal that people are suffering in silence because they feel the system is not for them.
Perhaps the most striking finding was that despite knowing that discrimination is against the law, none of the participants said they had ever filed a formal complaint. When asked about their rights, they agreed that unfair treatment was a violation of human rights. Yet, when it came to taking action, they held back. The researchers identified five main reasons for this silence. First, many felt that complaining would be a waste of time, expecting that the bureaucracy would be too long and the outcome would be nothing. Second, they wanted to protect their emotional energy, avoiding the stress of recounting a painful event. Third, they had grown used to these experiences, viewing them as something to endure rather than fight. Fourth, they were unsure of the actual steps to take, lacking clear information on how to file a report. Finally, and perhaps most fearfully, they worried that speaking up would put their future care at risk. They feared that if they complained, the doctors might treat them even worse next time.
The study does not claim to have solved the problem of racism in healthcare, nor does it say that every negative experience was legally discriminatory. Instead, it offers a clear picture of how these experiences play out in real life. It shows that language is more than just a tool for exchanging medical information; it is a way of showing respect and establishing trust. When that trust is broken, patients may stay in the system out of necessity, but they do so with their backs turned, waiting for the next visit to go better, or they leave the system entirely. The findings suggest that for a healthcare system to be truly fair, it must do more than offer services; it must ensure that every patient feels seen, heard, and safe enough to speak up if something goes wrong. Until then, the silence of those who do not complain will continue to look like a system that is working perfectly, even when it is not.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.