Medals: A Knowledge Base for Transcultural Health and Medicine

1. Medals: A Knowledge Base for Transcultural Health and Medicine Dr. Riccardo Colasanti Rielo Institute for Integral Development colasanti@rieloinstitute.org

2. What is Integral health?

3. Four competences are defined: • Communicative competence • Anthropological competence • Clinical competence • Psychological competence

4. 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.

5. 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

6. To improve medical comprehension We need to know: Cultural medical models of the patient His cultural expectative How he/she communicates with linguistical and not-linguistical skills his/her problems How the doctor can communicate to her/him

7. 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.ImmigrMinor.Health., 2011, 13, 2, 385-394, United States

8. 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 )

9. Intercultural communication is very complex Judgment Patient fears objectifying subjectifying Doctor objectifying Sickness

10. 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

11. Some examples

12. ஈரல் : irel Tamil terms related to health : Offensive smell of blood. இரத்தக்கவிச்சு, (irattacavicciù) The lungs, liver, spleen, and other viscera

14. No!

15. Foot/Leg Diversity in language (De Blasio, Colasanti 2009)

16. Foot-Leg (De Blasio, Colasanti 2009)

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

18. 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

19. 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 “traditionalmedicine” return 19.700 clips. Slideshare (presentations) for “traditionalmedicine ”return 28000 Powerpointpresentation. + i social forum, le news etc Terabytedi data

20. How many cultures in the world? How many cultures in the world? I we the number of cultural groups is proportional to the number of linguistic differences:

21. How many people clusters in the world? Modificato da http://www.joshuaproject.net/how-many-people-groups.php

24. The Knowledge Base has to be Broad Up-to-date Scientific But open to Social Network of Healthcare Professionals

25. 3 Structural Blocks of the Knowledge Base 1 2 3

27. 1. Taxonomy Ontology Based Define the taxonomical tree in Medical Anthropology and in Transcultural Medicine

29. 2. Cultural Data Collection • From the scientific literature peer reviewed • Medical (Medline) • Non Medical • From the social Network of Health Care Professional

30. 3. IT database A data base to be consulted via web Interface user friendly A IT Social Network platform

31. 3. IT database: Zentity 2.0

32. Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse PopulationsDennis 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.