Medicine and Migration in Rome

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Presented in Tokyo at IMA in 2008

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Medicine and Migration in Rome

  1. 1. Medicine and Migration<br />1983-2008 Romeexperience:<br />From a Clinic to a <br />Network ofServices and Rights<br />Dr. Riccardo Colasanti<br />
  2. 2. Acknowledgments: <br />To Dr. Salvatore Geraci e to Dr. Alberto Colajacomo who so kindly gave me the possibility to publish some slides of their collection<br />Paintings by WebMuseum<br />Cc creative commons license Share alike<br />http://creativecommons.org/licenses/by-sa/3.0<br />
  3. 3. Total Migrant Stock 1960 - 2005<br />Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, Trends in Total Migrant Stock: The 2005 Revision <br />
  4. 4. Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, Trends in Total Migrant Stock: The 2005 Revision <br />
  5. 5. Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, Trends in Total Migrant Stock: The 2005 Revision <br />
  6. 6. Source: Colajacomo modified<br />
  7. 7. Source: S.Geraci-modified<br />Migrationto Italy<br />5 Immigrationlaw<br />2002: L. Bossi Fini<br />1998: L. Turco Napolitano<br />1990: L. Martelli<br />1995: dec. Dini<br />1986<br />
  8. 8. Philosophies behind the<br />Migrations Laws<br />Migrants“Arms” <br />Migrants “Workers”<br />Migrants “New Citizens”<br />Safety<br />Migrants“hazard” <br />Source: S.Geraci-modified<br />
  9. 9. Migrazione in Italia:<br />Health Policies<br />ExclusionPhase:<br />DeniedRights<br />HiddenRights<br />AdmissionPhase<br />Acknowledged Right<br />Source: S.Geraci-modified<br />
  10. 10. ItalianConstitution<br />Paragraph 32 ofItalianConstitution:<br />“Healthis a Fundamental right of the individual” notof the citizen<br />“La Repubblica tutela la salute come fondamentale diritto dell’individuo e interesse della collettività, e garantisce cure gratuite agli indigenti.<br />Nessuno può essere obbligato a un determinato trattamento sanitario se non per disposizione di legge.<br />La legge non può in nessun caso violare i limiti imposti dal rispetto della persona umana”.<br />Source: S.Geraci-modified<br />
  11. 11. Why<br />Assistanceforall the migrants<br /><ul><li>Ethicalreason
  12. 12. Health Policy</li></ul>ProtectionofIndividualHealthtoprotectcollectivehealth<br /><ul><li>Economical Interest</li></ul>Source: S.Geraci-modified<br />
  13. 13. OurHistory<br />Startingpoint<br />Renovation<br />S.I.M.M.<br />Car Service forGypsies<br />New Center<br />Gr.I.S.<br />Source: S.Geraci-modified<br />Area sanitaria Caritas Roma 2008<br />
  14. 14. New Patients Poliambulatorio Caritas 1983 -2008<br />Direzione Area sanitaria e Servizio Banca Dati Medica Caritas Roma, 2008<br />
  15. 15. Stone-age 1983 - 1989<br />
  16. 16.
  17. 17.
  18. 18. Modern-age 2000- today<br />
  19. 19.
  20. 20. Italian Doctors - Migrant Patients: <br />a mutual misunderstanding<br />Italian doctors: All the migrants are affected by tropical or infectious diseases or depend on the different culture<br />Migrant patients: European (Italian Medicine ) is high-tech<br />
  21. 21. Salgari’s Syndrome<br />
  22. 22. Healthy Migrant Effect<br />CriticalAreas<br />Mother-child, Accident at work, InfectiousDiseases<br />
  23. 23. Tbc and migration<br />
  24. 24. Italy<br />Source: EuroTB Report on tuberculosis cases notified in 2006 <br />
  25. 25. France<br />Source: EuroTB Report on tuberculosis cases notified in 2006 <br />
  26. 26. Germany<br />Source: EuroTB Report on tuberculosis cases notified in 2006 <br />
  27. 27. El<br />Hamad<br />, Centro Patologia del Migrante, Brescia. 2002<br />Tempo medio di latenza = 35,7 mesi<br />L<br />’<br />83,4% dei casi <br />è<br />stato diagnosticato<br />entro 5 annidall<br />’<br />arrivo in Italia<br />(n=169)<br />Latency from the arrival in Italy and TB diagnosis<br />
  28. 28. TBC e /HIV and migrants: Nederlands<br />HIV prevalence among TB patients in The Netherlands, 1993-2001: trends and risk factors <br />Haar, C.H.; Cobelens, F.G.J.; Kalisvaart, N.A.;Van der Have, J.J.; Van Gerven, P.J.H.J.; Van Deutekom, H.<br />Of 13269 patients diagnosed with TB, 542 were HIV-positive (4.1%). Prevalence was 4.1% in 1993-1995, 3.8% in 1996-1998 and 4.4% in 1999-2001. The highest prevalence was observed among drug users (29.2%), homeless patients (20.1%) and patients residing illegally in the country (9.1%). Compared with the period 1993-1995, the relative risk of HIV infection in the periods 1996-1998 and 1999-2001 decreased significantly for drug using patients (P = 0.006), and increased for patients from African countries (P < 0.001).<br />CONCLUSION: Although the prevalence of HIV among TB patients in The Netherlands remained stable<br />between 1993 and 2001, the distribution of risk groups changed over this period. <br />Int. J. Tuberc. Lung Dis., 2006, 10 (7)<br />
  29. 29. Rome experience Main Areas:<br />Medical Assistance<br />Advocacy <br />Transcultural medicine<br />Postraumatic Stress Disorders and Migration<br />
  30. 30. Advocacy<br />
  31. 31. La “società civile”<br />ed il mondo scientifico<br />denunciano alto rischio di<br />“clandestinità sanitaria”<br />Violazione dei diritti<br />Danno per la salute<br />individuale e collettiva<br />Source: S:Geraci- modified<br />
  32. 32. 12 settembre 2008<br />Source: S.Geraci-modified<br />
  33. 33. Source: S.Geraci-modified<br />
  34. 34.
  35. 35. 06.5809764<br />studiemigrazione@cser.it<br />www.cser.it<br />Idos - ottobre 2007:<br />512 pagine 18 euro<br />tel.06.66514345<br />idos@dossierimmigrazione.it<br />
  36. 36. Transcultural Medicine:<br />Medical Hermeneutics<br />
  37. 37. Mutual Understanding in doctor-patient relationship<br />According Van Wieregen et al. (2002) in medical consultation in general practice mutual understanding was poor in 33% of consultations with etnic-minority patient versus 13% with native-born patient<br />
  38. 38. Patient<br />objectifying<br />subjectifying<br />Doctor<br />Intercultural communication in medicine<br />objectifying<br />Sickness<br />
  39. 39.
  40. 40.
  41. 41.
  42. 42. Communication:<br />IntentioAuctoris: What you want to tell me (your intention)<br />IntentioOperis: What really means, what you are telling me <br />Intentiolectoris: What I want to understand (my intention)<br />
  43. 43. Levels of misunderstanding<br />Pre-linguistical<br />Linguistical<br />Cultural<br />Philosopical and religious<br />
  44. 44. Prelinguistical<br />Private experience: impossibility to point to and to share with the others the same experience (by the way an experience shared is not equal to another lived alone)<br />We can explain how much we suffer but not what we are suffering.<br />
  45. 45. Non verballanguage<br />Gestures ambiguity (nodding and shaking head)<br />
  46. 46. Linguistical: in different languages <br />there are different <br />referents for the same word<br />The lungs, liver, spleen, and other viscera<br />ஈரல் : irel<br />இரத்தக்கவிச்சு, (irattacavicciù) <br /> offensive smellofblood.<br />
  47. 47. Foot/Leg<br />Source: R. Colasanti- E .De Blasio<br />
  48. 48. Foot-Leg<br />Source: R. Colasanti- E .De Blasio<br />
  49. 49. GrammaticalSyntactical and LexicalIncompleteness:<br />
  50. 50.
  51. 51.
  52. 52. Cognitive Frames<br />Minsky’s concept of cognitive frames:<br />“When one encounters a new situation (or makes a substantial change in one's view of the present problem) one selects from memory a structure called a Frame. This is a remembered framework to be adapted to fit reality by changing details as necessary.”<br />
  53. 53. Jane was invited to Jack’s Birthday Party. <br />She wondered if he would like a kite<br />
  54. 54. Expression<br />Deixis. Use of deictical (that, this, other, who, which..) may obscure the meaning if I do not know the context<br /><ul><li>Lack of grammar precision (another instead of the other)</li></li></ul><li>Referent / Expression<br />Differences between the lexical material used for the dissimilarity in the two languages of the denotation-connotation and signifier-signified <br />false friends<br />
  55. 55. Ear: false friends in Italian and Spanish<br />Me duele el oido<br />Mi fa male l’orecchio<br />
  56. 56. Other issues:<br />Rhetoric of medical dialogue<br /><ul><li>Different medical encyclopedia
  57. 57. Different cultural customs
  58. 58. Different Symbolic values
  59. 59. Different Religious and philosophical outlook</li></li></ul><li>The hope to see beyond the prejudice<br />Thank you!<br />

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