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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.