Transcript Nila Heredia - People`s Health Movement

Medals: A Knowledge Base for
Transcultural Health and Medicine
Dr. Riccardo Colasanti
Rielo Institute for Integral Development
[email protected]
What is Integral health?
Four competences are defined:
1. Communicative competence
2. Anthropological competence
3. Clinical competence
4. Psychological competence
Communication in Transcultural
Medicine
 According Van Wieregen et al. (2002) in
medical consultation in general practice
mutual understanding was poor in 33% of
consultations with ethnic-minority patient
versus 13% with native-born patient
Eur J Public Health. 2002 Mar;12(1):63-8.
Intercultural communication in general practice.
Van Wieringen JC, Harmsen JA, Bruijnzeels MA.
Outcomes of poor
comprehension in medicine
The lack of comprehension may
imply, medical misdiagnosis (false
positive or false negative),
erroneous prescriptions, a possible
death toll
To improve medical
comprehension
We need to know:
 Cultural medical models of the patient
 His cultural expectative
 How he/she communicates with linguistical and notlinguistical skills his/her problems
 How the doctor can communicate to her/him
Models of Health and Disease in different
cultures
 According to Tirodkar et al. (2011) …physician’s
explanatory models of illness are still largely
biomedical in that they emphasize the biological and
physical aspects of disease etiology . However,
patients or individuals who are experiencing illness
may have different explanatory models.
Explanatory models of health and disease among South Asian immigrants in Chicago
Tirodkar,M.A.; Baker,D.W. ; Makoul,G.T.; Khurana,N.; Paracha,M.W.; Kandula,N.R.
J.Immigr Minor.Health., 2011, 13, 2, 385-394, United States
The medical incomprehension
is a multilayer issue:
 Pre-linguistic
 Linguistic
 Cultural (Different Customs in Food,
Habits etc)
 Philosophical and Religious
(Explanatory Model of Health and
Disease, Existential meaning of Life
and Disease )
Intercultural communication is very complex
Patient
objecti
fying
subjectifying
Doctor
objectifying
Sickness
Some tipical issue in Crosscultural
Communication in Medicine in
 Gesture Ambiguity (ex.: nodding and shaking head)
 Lack of grammatical precision
 Hyperbolic use of deictical terms (ex. that, this) that hides the meaning in case of
lack of context
 Lexical Differences (Ethnoanatomy)
 False Friends in the Vocabulary
 The Rethorical use of Medical Language
 Differences in Conceptual Schemas (Frames di Minsky)
 Difference in the medical encyclopedia
 Difference in Health Customs
 Difference in Symbolic Values
 Difference in philosophical and religious values
Some
examples
Tamil terms related to health :
ஈரல் : irel
இரத்தக்க
விச்சு,
(irattacavicciù)
The lungs, liver, spleen, and other
viscera
Offensive smell of blood.
No!
Foot/Leg Diversity in language
Arabic Bangla Turki Persian Tamil Malayala Pasht Sinhala Manda-desh sh
m
o
rine
Foot
Riğl
Pā
Ayak Pā
Kal Kal
(mor
e
com
mon
)
Qada
m
Kh-pā Kakula Jiao
Pada
m
Leg
Riğl,
Sāq
Pā
Bacak Pā
(Ayak) Sāq-e pā
(parte
inferiore,
dal
tallone in
sù)
Kal
Kal
Kh-pā
(De Blasio, Colasanti 2009)
Kakula
Gaataya
Tui
Foot-Leg
Romanian Moldovan Lingala
Pular
Congo
Guinea
Bandund
u
Ewe
Togo
Amharic
Ethiopia
Foot
Picior
Picior,
Talpà
Likolo
Thépéré
Afo
Egher
Leg
Picior
Picior
Likolo
Coȉghal
Ata
Egher
(De Blasio, Colasanti 2009)
The reduction of the cultural
gap in Health is a two-way path
Improve health
literacy of
patiente
Improve Cultureal
competence of
doctor
Patient-Physician Relationship and Racial Disparities in the
Quality of Health Care
Saha et al. American Journal of Public Health October 2003 Vol 93 n. 10
It is really necessary to constitute a
knowledge base of alle the medical
observations related to cultural and
linguistically topics in all the culture ion
the world
Basic Problem: Huge Dimension
of the Data Base
 Pub Med (NLM Bethesda) for “cultural diversity”
return 10.000 articles
 Non medical scientific literature: indetermined
number
 Google Video looking for “traditional medicine”
return 19.700 clips.
 Slideshare (presentations) for “traditional medicine ”
return 28000 Powerpoint presentation.
 + i social forum, le news etc
Terabyte di data
How many cultures in the world?
I we the number of cultural groups is proportional to
the number of linguistic differences:
In the World 2011
Languages
Dialects
According to
Ethnologue
6,909
11,779
(http://www.ethnologue.com/)
According Stephen
Anderson
Secondo World
ChristianDatabase
http://www.worldchristiandatabase.
org
33,000
Difference in
Grammar
How many people clusters in the
world?
Peoples Defined By
Resulting List
Examples
Language
Linguistic peoples

Ethnologue
Language / Dialect
Linguistic peoples

ROPAL (Registry of Peoples and Lang)
(Particularly supports language
based ministry)
Totals
~7,000
~11,000
Language / Dialect
Ethnicity
Ethno-linguistic peoples
(Particularly supports language
based evangelistic / discipleship
outreaches)





Integrated Strategic Planning Database
World Christian Encyclopedia
Operation World peoples lists
Original Joshua Project list
PeopleGroups.org
~
13,000
Language / Dialect
Ethnicity
Religion
Caste
Culture
Ethnic peoples


Joshua Project
Registry of Peoples (ROP)
~
16,600
Language / Dialect
Ethnicity
Religion
Caste
Culture
Education
Politics
Ideology
Historical enmity
Customs
Behavior
Unimax peoples


World Christian Encyclopedia estimates
US Center for World Mission estimates
~
27,000
(Particularly supports church
planting outreaches)
(Particularly supports church
planting and all types of
evangelistic / discipleship
outreaches)
Modificato da http://www.joshuaproject.net/how-many-people-groups.php
The Knowledge Base has to be




Broad
Up-to-date
Scientific
But open to Social Network of Healthcare
Professionals
•Taxonomy
•Ontology/based
1
IT
Data
Taxonomy
3 Structural Blocks of the
Knowledge Base
•Cultural and
Antropologicsl
Data
•From scientific
literature
(Medical and
non medical)
•From Social
Network
2
•Data Base
•Social Network
3
1. Taxonomy Ontology Based
 Define the taxonomical tree in Medical Anthropology
and in Transcultural Medicine
2. Cultural Data Collection
 From the scientific literature peer reviewed
 Medical (Medline)
 Non Medical
 From the social Network of Health Care Professional
3. IT database
 A data base to be consulted via web
 Interface user friendly
 A IT Social Network platform
3. IT database: Zentity 2.0
Integrating Literacy, Culture, and Language to
Improve Health Care Quality for Diverse Populations
Dennis P Andrulis, Cindy Brach. American Journal of
Health Behavior. : Sep/Oct 2007.
 This vision for an integrated approach is intended to
serve as a catalyst for transforming the health care
system to meet the needs of limited-literacy,
culturally diverse, and limited English proficiency
patients. Clinicians and health care staff have an
important role to play, but the responsibility for
achieving real progress for patients facing
challenges related to literacy, culture, and language
must extend to organizations that support them.