Rivista per le Medical Humanities

Ilario Rossi
rMH 17, 2011, 11-17

Mondialisation and plural societies or how to think the relationship between migration and health

 Sickness is a personal thing, experienced subjectively by the person concerned, while health has a more collective connotation and is today an important financial element of society and a social indicator which is situated right at the heart of any anthropological debate. Health has become a reference value, and can be defined as a socially – and politically – developed entity whose limits are constantly changing and being redefined. This process has transformed the logic of supply and demand, notably in the problems associated with health and migration. In this aspect, the health management of asylum-seekers has also to include an analysis of the situation and the solutions which can be found in the various health-care systems.

Fabrice Althaus
Patricia Hudelson
Dagmar Domenig
Alexander R. Green
Patrick Bodenmann
rMH 17, 2011, 18-23

Transcultural clinical competence and medical praxis

 The care of immigrant patients can be particularly challenging due to epidemiological, cultural and linguistic differences, as well as patients’ immigration-specific and socioeconomic problems. Cultural competence is usually defined as the knowledge, attitudes and skills necessary for ensuring quality health care to socially, culturally and linguistically diverse patient populations. Cultural competence training is considered important not only for reducing inequalities in health and health care for immigrant patients, but for improving care for all patients, regardless of their social and cultural origins.

Alexander Bischoff
rMH 17, 2011, 24-29

Staying in the middle, teaching the culture and being a shoulder to cry on for the patients

 In this age of migration, many societies are characterized by linguistic and cultural diversity. Public institutions in general, and health care systems in particular, face the challenge of integrating new arrivals, immigrants, refugees or asylum seekers, into the host society. The present study was part of larger project titled: “Intercultural mediation: Does it contribute to inclusion? Comparing policies and practices in the sectors of health, education, social and legal services”. Its purpose was to examine how interpreters see their work within the context of the integration of immigrants in Switzerland in general, and into the local health system in particular. We investigated the roles that interpreters working in a Women’s Hospital in Switzerland take on and are aware of in their work. The interpreters described four main roles: “linguistic mediation”, “cultural mediation”, “conflict mediation” and “accompanying mediation”. Interpreters who take on and juggle the different roles related to integration have the potential to be important actors in health care services that cater for patient populations that are increasingly linguistically and culturally diverse.

rMH 17, 2011, 30-34

Interpreting and cultural mediation. SOS Ticino's Derman project

 The “Derman” project of SOS Ticino (Soccorso Operaio Svizzero sezione Canton Ticino) presides to the training, the assistance and the supervision of the work of the interpreter/ mediator in the social, educational and medical services of the canton. The interpreters/mediators intervene in case of problems of linguistic/cultural understanding between native operators (physicians, nurses, welfare officers, educators, teachers, etc.) and immigrants. The aim is to make a correct and adequate communication possible, as well as to prevent and sustain the solution of possible conflicts. The translation is to be understood not simply as a “technical” act, but as a sort of “transfer”, and transposing a discourse from a linguistic world into another implies translating everything the (spoken) language stands for, i.e. culture: habits, beliefs, values, etc. Therefore intercultural interpreting also becomes a encounter/collision between different habits, beliefs and values, which the interpreter has to “mediate”.

Maria C. Terreri Vitagliano
rMH 17, 2011, 35-40

Intercultural aspects of care

 In a multicultural society, a basic knowledge of the concepts of life, birth, health, illness and care of different cultural contexts is very important, as it allows a cultural mediation between health care professionals and their patients. The article provides a critical overview of the fallowing topics: language and comprehension, ways of addressing the patient, assessment of attitudes, different roles, the “Gastarbeitersyndrom” (guest worker syndrome), illness explanation, body fluids, the liver in Oriental cultures, the navel, religious references, healers, newborns, eating, body, clothing, facial expressions.

Giovanna Ciano
rMH 17, 2011, 41-45

When "nobody" is perfect

 In the encounter with other cultures the caregiver can be faced with several relational problems (language, understanding of the disease, recognition of supporting devices for therapy, etc.). In order to be more available to the intercultural encounter, the caregiver is required to be less self-referred, i.e. to question and modify his/her usual professional and behavioural schemes and to resort to external professionals, such as interpreters and mediators. Here some general guidelines are proposed for the implementation of personalised models of intervention. The article ends with a concrete psychiatric case study, testifying to the effectiveness of the approach.

Bernice S. Elger
rMH 17, 2011, 69-78

Humanitarian Medicine in places of detention

 The author invites a reflection on humanitarian medicine in contexts of detention, insisting on the importance and urgency of an adequate training of all the professionals exposed to contact with convicts, and therefore to the problem of respect, and the risk of violation, of human rights. The respect of human rights is all the more important in the case of vulnerable subjects. Healthcare professionals operating in the field of penitentiary medicine play an important role in preventing and detecting potential threats to human dignity. A reflection on the rights of the detainees and on the ethical principles that must inform their care is instructive non only for physicians working in prison, but for all healthcare workers.

rMH 17, 2011, 79-87

Medicine in a prison environment. A multidisciplinary challenge

Penitentiary medicine is the medicine practiced in prison, to the benefit of inmate patients. This apparently simple and clear definition, however, is questioned by a closer inspection to the specificities and aims of this professional activity. That is what the author, himself a prison physician, proposes. Whereas national and international guidelines require to treat inmates as any other patient, abiding by the principle of equity, in a prison environment, the practice of medicine and the implementation of deontological rules are difficult and problematic. It is the medic’s own position, at once as doctor of the inmates and doctor of the jail, what makes his/her job so hard.

Nicola Grignoli
rMH 17, 2011, 88-92

Medical secret between trust and duty

The paper reports the discussion following the contributions of Bernice Elger and Damiano Castelli during the Comec Seminar 2010 “Reflections on penitentiary medicine” held on September 22, 2010 in Lugano. The discussion panel was composed by the attorney general Bruno Balestra, Fabrizio Comandini, director of the penitentiary system, and the chief of the Cantonal Police, Romano Piazzini. The debate was moderated by Comec members Brenno Balestra and Mattia Lepori. The issues debated range from the respect of confidentiality and professional secret in special occasions in which the “sacredness of the secret” is challenged, to the conditions of compatibility between an adequate psychological and psychiatric treatment of the detainees and public security exigencies.