Medals: A Knowledge Base for Transcultural Health and

MedicineDr. Riccardo Colasanti

Rielo Institute for Integral Developmentcolasanti@rieloinstitute.org

Transcendental Direction and Meaning

Integral Health

Linguistical-Anthropological

CustomsCommunicationHealth LiteracyTraditionalConcept of Life

PsychologicalFearHopeDesireIntention

Clinico-Biological

DiagnosisTheraphyTechnologyInfrastructure

Integral Health

What is Integral health?

1.Communicative competence2.Anthropological competence3.Clinical competence4.Psychological competence

Four competences are defined:

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 patientEur J Public Health. 2002 Mar;12(1):63-8.Intercultural communication in general practice.Van Wieringen JC, Harmsen JA, Bruijnzeels MA.

Communication in Transcultural Medicine

The lack of comprehension may imply, medical misdiagnosis (false positive or false negative), erroneous prescriptions, a possible death toll

Outcomes of poor comprehension in medicine

We need to know:Cultural medical models of the patientHis cultural expectativeHow he/she communicates with linguistical and not-linguistical skills his/her problems How the doctor can communicate to her/him

To improve medical comprehension

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 ChicagoTirodkar,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

Models of Health and Disease in different cultures

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 )

The medical incomprehension is a multilayer issue:

Patient

Sickness

Doctor

Intercultural communication is very complex

objectifying

objectifying

subjectifying

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 tipical issue in Crosscultural Communication

in Medicine in

Some examples

The lungs, liver, spleen, and other viscera ஈரல் : irel

இரத்தக்கஇரத்தக்கவி�ச்சுவி�ச்சு, , (irattacavic(irattacavicciù) ciù)

Tamil terms related to health :

Offensive smell of blood.

The anatomical terms define the sameanatomical areas in different languages?

1.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

30.

32.

33.

34.

31.

2.

3.

29.

LifeART Collection Images Copyright © 1989-2001 by Lippincott Williams & Wilkins, Baltimore, MD

No!

Arabic

Bangla-desh

Turkish

Persian

Tamil

Malayalam

Pashto

Sinhala

Manda-rine

Foot Riğl Qadam

Pā Ayak

Pā Kal (more common)

Padam

Kal Kh-pā

Kakula

Jiao

Leg Riğl,Sāq

Pā Bacak(Ayak)

Pā Sāq-e pā (parte inferiore, dal tallone in sù)

Kal Kal Kh-pā KakulaGaataya

Tui

Foot/Leg Diversity in language

(De Blasio, Colasanti 2009)

Foot-Leg

Romanian

Moldovan

LingalaCongo Bandundu

PularGuinea

EweTogo

AmharicEthiopia

Foot Picior Picior,Talpà

Likolo Thépéré

Afo Egher

Leg Picior Picior Likolo Coȉghal Ata Egher

(De Blasio, Colasanti 2009)

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

The reduction of the cultural gap in Health is a two-way path

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

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

Basic Problem: Huge Dimension of the Data Base

I we the number of cultural groups is proportional to the number of linguistic differences:

How many cultures in the world?

How many cultures in the world?

Peoples Defined By

Resulting List Examples Totals

Language Linguistic peoples Ethnologue ~7,000

Language / Dialect Linguistic peoples

(Particularly supports language based ministry)

ROPAL (Registry of Peoples and Lang) ~11,000

Language / DialectEthnicity

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

~ 13,00

0Language / DialectEthnicityReligionCaste Culture

Ethnic peoples

(Particularly supports church planting outreaches)

Joshua Project Registry of Peoples (ROP)

~ 16,60

0Language / DialectEthnicity ReligionCaste CultureEducationPoliticsIdeologyHistorical enmityCustomsBehavior

Unimax peoples

(Particularly supports church planting and all types of evangelistic / discipleship outreaches)

World Christian Encyclopedia estimates US Center for World Mission estimates

~ 27,00

0

Modificato da http://www.joshuaproject.net/how-many-people-groups.php

How many people clusters in the world?

Africa

2,110 =30.5%

Europe

234 =

3.4%

Asia

2,322 =

33.6%Australia& New Zealand1,250 = 18.1%

6,909 Known Living Languages of the World

Americas

993 = 14.4%

http:// www.ethnologue.com/ ethno_docs/ distribution.asp?by=area

Broad Up-to-date Scientific But open to Social Network of Healthcare

Professionals

The Knowledge Base has to be

3 Structural Blocks of the Knowledge Base

1 2 3

Ontologies inMedicine and

Culture (OWL)

Web 2.0 to bepromoted

Web 2.0 alreadyrunning

Non peer-Reviewed

Non Medical(Anthropological or

Etnnological)

MedicalPeer-Reviewed

(PubMed)

KB in Medicineand Culture

Scientifical Data

Data innon-scientific Web

pages

Radio

Literature

Movies

Media

Social Forum

Generic Web pages

Define the taxonomical tree in Medical Anthropology and in Transcultural Medicine

1. Taxonomy Ontology Based

From the scientific literature peer reviewed Medical (Medline) Non Medical

From the social Network of Health Care Professional

2. Cultural Data Collection

A data base to be consulted via web Interface user friendly A IT Social Network platform

3. IT database

3. IT database: Zentity 2.0

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.

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.

Publish v 0.1

InformationTechnology

Populating KBfrom Literature

Assessment

PrototypingMEDALS

Build Ontologies

Activate SocialNetwork

DefineRequirements

Prototyping

Define a Model ofKB

Test

Prototyping

Connect to KB

Create Platform

Assessment

Categorize withOntologies

Search Non PubMe Journalsd

Search Pub MedJournals

Define Standardsand Procedures

Search Books

Assessment

Create Ontologies

Training HR

Define Procedureof Approval

Define Standard

Number Task Resource Start End Duration%

Complete

2011 2012 2013

September October November December January February March April May June July August September October November December January

1 Define Requirements 1/9/2011 30/9/2011 22

2 Activate Social Network 1/10/2011 31/12/2012 326

2.1 Create Platform 28/4/2012 19/10/2012 125

2.2 Connect to KB 17/10/2012 31/12/2012 54

2.3 Test 27/10/2012 28/12/2012 45

2.4 Prototyping 1/10/2011 8/8/2012 223

3 Build Ontologies 1/10/2011 27/4/2012 150

3.1 Define Standard 1/10/2011 2/11/2011 23

3.2 Define Procedure of Approval 3/11/2011 10/11/2011 6

3.3 Training HR 11/11/2011 23/12/2011 31

3.4 Create Ontologies 24/12/2011 10/2/2012 35

3.5 Assessment 11/2/2012 27/4/2012 55

4 Populating KB from Literature 10/10/2011 28/12/2012 320

4.1 Define Standards and Procedures 10/10/2011 8/12/2011 44

4.2 Search Pub Med Journals 9/12/2011 11/6/2012 132

4.3 Search Non Pub Me Journalsd 9/12/2011 11/6/2012 132

4.4 Search Books 9/12/2011 11/6/2012 132

4.5 Categorize with Ontologies 28/4/2012 26/11/2012 151

4.6 Assessment 27/11/2012 28/12/2012 24

5 Information Technology 1/10/2011 12/7/2012 204

5.1 Define a Model of KB 1/10/2011 12/7/2012 204

5.2 Prototyping 1/10/2011 12/7/2012 204

6 Publish v 0.1 12/6/2012 28/12/2012 144

6.1 Assessment 12/6/2012 28/12/2012 144