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Cultural mediationCultural mediationTraining the health-care providers
T.Antypas , M.Meliou NGO PRAKSIS
Training the health-care providersT.Antypas , M.Meliou
NGO PRAKSIS
The term foreigners includes:
The term foreigners includes:
• Immigrants with legal documents
• Immigrants without legal documents (sans papiers)
• Asylum seekers• refugees
• Immigrants with legal documents
• Immigrants without legal documents (sans papiers)
• Asylum seekers• refugees
The migration issue in GreeceThe migration
issue in Greece• Even since 2006 foreign population in Greece exceeded 850.000 (Eurostat)
• Without legal documents >30%
• Even since 2006 foreign population in Greece exceeded 850.000 (Eurostat)
• Without legal documents >30%
Country of OriginCountry of Origin
• Albania• Bulgaria• Georgia• Afghanistan• Pakistan• Bangladesh• Somalia
• Albania• Bulgaria• Georgia• Afghanistan• Pakistan• Bangladesh• Somalia
Profile of migrants
Profile of migrants
• 15-64 yo (53,5% 25-54yo)• Male (if they originate from Asia and north Africa)
• Female (if they originate from Ukraine, Philippines and Moldavia)
• Live in urban areas• Majority is occupied in construction,housekeeping,trade
• Low educational level
• 15-64 yo (53,5% 25-54yo)• Male (if they originate from Asia and north Africa)
• Female (if they originate from Ukraine, Philippines and Moldavia)
• Live in urban areas• Majority is occupied in construction,housekeeping,trade
• Low educational level
Migrants and healthcare
Migrants and healthcare
• Only 4% of their income goes to health
(7%in Greek households)• 13% lack any kind of insurance policy
• Only 4% of their income goes to health
(7%in Greek households)• 13% lack any kind of insurance policy
National Healthcare System
National Healthcare System
• Combined model (state-health insurance bodies-private sector)
• Primary healthcare• Secondary healthcare
• Combined model (state-health insurance bodies-private sector)
• Primary healthcare• Secondary healthcare
Access to public healthcare
Access to public healthcare
• Important for the successful social integration• Migrants with no legal documents are excluded• According to the Ministry of Health migrants with
no legal documents are not eligible to access the public hospitals unless it is an emergency. In every other case admission of a foreigner with no legal documents is strictly forbidden and the patient is threatened with immediate deportation.
• Important for the successful social integration• Migrants with no legal documents are excluded• According to the Ministry of Health migrants with
no legal documents are not eligible to access the public hospitals unless it is an emergency. In every other case admission of a foreigner with no legal documents is strictly forbidden and the patient is threatened with immediate deportation.
Problems of foreigners in healthcare
Problems of foreigners in healthcare
• Language barrier• Different beliefs• Fear of deportation• Insecurity• Lower status of female migrant• racism
• Language barrier• Different beliefs• Fear of deportation• Insecurity• Lower status of female migrant• racism
Health care providers
Health care providers
Common problems• Language barrier• Low educational level of migrants• Migrants do not follow orders because of :
financial issues religious beliefs (t.ex. During Ramadan muslims do not take medication during day time)
Common problems• Language barrier• Low educational level of migrants• Migrants do not follow orders because of :
financial issues religious beliefs (t.ex. During Ramadan muslims do not take medication during day time)
Health providersHealth providers
Common problems• Lack of time (do not have the luxury of the extra time a migrant need in order to explain)
• Suspicion by the migrants• Violent acts from migrants
Common problems• Lack of time (do not have the luxury of the extra time a migrant need in order to explain)
• Suspicion by the migrants• Violent acts from migrants
Cultural mediatorCultural mediator
• He/she is called to create the connection between the two sides
• He/she is called to create the connection between the two sides
Cultural mediatorsCultural mediators
• Never are supposed to judge each other• Is responsible to make sure that the conditions are appropriate for the translation
• Is aiming at a full translation of the information the migrant and the healthcare provider need to communicate
• Never are supposed to judge each other• Is responsible to make sure that the conditions are appropriate for the translation
• Is aiming at a full translation of the information the migrant and the healthcare provider need to communicate
Cultural mediatorsCultural mediators
• Never express their personal opinion (neither verbally nor non-verbally)
• Have to built a level of trust between the two sides
• Never express their personal opinion (neither verbally nor non-verbally)
• Have to built a level of trust between the two sides
Cultural mediatorsCultural mediators
• More complex than translation• Has to be based in other cultural elements as well
• Must be people in good knowledge of both the language and the cultural background of the country
• More complex than translation• Has to be based in other cultural elements as well
• Must be people in good knowledge of both the language and the cultural background of the country
Health providers-cultural mediatorsHealth providers-cultural mediators
From the good cooperation between healthcare providers and cultural mediators , medical practice benefits since less malpractice takes place that was due to the cultural differences
From the good cooperation between healthcare providers and cultural mediators , medical practice benefits since less malpractice takes place that was due to the cultural differences
The healthcare providers have to:
The healthcare providers have to:
• Trust the cultural mediator• Keep the relationship strictly professional
• Never let the mediator express personal opinions (it could cloud judgment)
• Absorb all the information the mediator can extract from the patient
• Trust the cultural mediator• Keep the relationship strictly professional
• Never let the mediator express personal opinions (it could cloud judgment)
• Absorb all the information the mediator can extract from the patient
Healthcare providers
Healthcare providers
• Need to assist the mediators in order for them to be able to translate successfully
In other words:• Do not use difficult medical terms• Keep questions short• Ask for explanation if some information does not
seem to satisfy you• Ask for possible cultural elements that may be
interfering with the medical condition (t.ex. Afrikaners use to believe they are victims of black magic when they have abdominal pains-it doesn’t mean they are psychiatric patients)
• Need to assist the mediators in order for them to be able to translate successfully
In other words:• Do not use difficult medical terms• Keep questions short• Ask for explanation if some information does not
seem to satisfy you• Ask for possible cultural elements that may be
interfering with the medical condition (t.ex. Afrikaners use to believe they are victims of black magic when they have abdominal pains-it doesn’t mean they are psychiatric patients)
Health care providers when examining a foreigner should:
Health care providers when examining a foreigner should:
• Respect the sexuality of patients• Respect their religious beliefs• Take into consideration their financial status• Take into consideration their nutritional habits• Take into consideration their living conditions
The above should be followed by cultural mediators as well
• Respect the sexuality of patients• Respect their religious beliefs• Take into consideration their financial status• Take into consideration their nutritional habits• Take into consideration their living conditions
The above should be followed by cultural mediators as well
Trust Trust
If you achieve all that, the cultural mediator will be able to communicate this to the patient and this way a level of trust between the medical professional and the patient is built.
Trust is fundamental for the avoidance of medical malpractice
If you achieve all that, the cultural mediator will be able to communicate this to the patient and this way a level of trust between the medical professional and the patient is built.
Trust is fundamental for the avoidance of medical malpractice
Cultural mediationCultural mediation
• Role in current healthcare is indisputable
• All healthcare providers need to be open to the interference of cultural mediators during medical practice
• Role in current healthcare is indisputable
• All healthcare providers need to be open to the interference of cultural mediators during medical practice
Possible dangersPossible dangers
• The cultural mediator may become the centre of attention
• Mixing of roles• Cultural mediator gains “power” and “status” among migrant communities
• The cultural mediator may become the centre of attention
• Mixing of roles• Cultural mediator gains “power” and “status” among migrant communities
Possible dangersPossible dangers
• Mediator does not agree (politically, sexually, religiously etc) with the object to be translated (written or oral)
• Mediator does not respect privacy of the patient
• Mediator does not understand what he has to translate
• Mediator does not agree (politically, sexually, religiously etc) with the object to be translated (written or oral)
• Mediator does not respect privacy of the patient
• Mediator does not understand what he has to translate
Possible dangersclue elements to avoid
them
Possible dangersclue elements to avoid
them• Always keep in mind that cultural mediators are also migrants themselves
• Always explain that his role is limited to translation
• Never encourage him to explain sth the patient did not understand the first time by his own initiative
• Always keep in mind that cultural mediators are also migrants themselves
• Always explain that his role is limited to translation
• Never encourage him to explain sth the patient did not understand the first time by his own initiative
• Always explain to the patient who is the healthworker and who is the translator
• Always be aware - there are numerous non-verbal clues that will reveal if the mediator is transmitting information he is not supposed to
• Always explain to the patient who is the healthworker and who is the translator
• Always be aware - there are numerous non-verbal clues that will reveal if the mediator is transmitting information he is not supposed to
Possible dangersclue elements to
avoid them
Possible dangersclue elements to
avoid them
Possible dangersclue elements to avoid
them
Possible dangersclue elements to avoid
them• Keep speech simple• Always get in touch with the mediator previously (when this is possible)
• Be reluctant to use a mediator who is anyway closely related to the patient
• Keep speech simple• Always get in touch with the mediator previously (when this is possible)
• Be reluctant to use a mediator who is anyway closely related to the patient
Possible dangersclue elements to avoid
them
Possible dangersclue elements to avoid
them• At the beginning of the mediation always explain the role of each party and encourage the mediator to communicate it to the patient
• Take the time to explain to the mediator his mistakes afterwards
• If you are aware that the mediator does not respect the privacy of the session make sure that he/she is relieved from duty
• At the beginning of the mediation always explain the role of each party and encourage the mediator to communicate it to the patient
• Take the time to explain to the mediator his mistakes afterwards
• If you are aware that the mediator does not respect the privacy of the session make sure that he/she is relieved from duty
Cultural mediationCultural mediation
• Conducted under the right conditions can be useful
• Conducted by trained professionals can be a powerful tool against medical malpractice
• Conducted under the right conditions can be useful
• Conducted by trained professionals can be a powerful tool against medical malpractice
Thank youThank youQuestions?
Source:Training material created in the context of the program «Cultural mediation in selected hospitals of Athens and Thessaloniki»Action 1.6–2009 Priority 1 «Materialization of actions towards the insurance of 5 basic principles for the political integration of migrants in European Union»Coordinators: ΚΕΚ Diastasi – National School of Public Health.Antypas TzanetosSocial workerMSc Health Management
Questions?
Source:Training material created in the context of the program «Cultural mediation in selected hospitals of Athens and Thessaloniki»Action 1.6–2009 Priority 1 «Materialization of actions towards the insurance of 5 basic principles for the political integration of migrants in European Union»Coordinators: ΚΕΚ Diastasi – National School of Public Health.Antypas TzanetosSocial workerMSc Health Management
