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Medicine and Migration 1983-2008 Romeexperience: From a Clinic to a  Network ofServices and Rights Dr. Riccardo Colasanti
Acknowledgments:  To Dr. Salvatore Geraci e to Dr. Alberto Colajacomo who so kindly  gave me the possibility to publish some slides of their collection Paintings by WebMuseum Cc creative commons license Share alike http://creativecommons.org/licenses/by-sa/3.0
Total Migrant Stock 1960 - 2005 Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, Trends in Total Migrant Stock: The 2005 Revision
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, Trends in Total Migrant Stock: The 2005 Revision
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, Trends in Total Migrant Stock: The 2005 Revision
Source: Colajacomo modified
Source: S.Geraci-modified Migrationto Italy 5 Immigrationlaw 2002: L. Bossi Fini 1998: L. Turco Napolitano 1990: L. Martelli 1995: dec. Dini 1986
Philosophies behind the Migrations Laws Migrants“Arms”   Migrants “Workers” Migrants “New Citizens” Safety Migrants“hazard”   Source: S.Geraci-modified
Migrazione in Italia: Health Policies ExclusionPhase: DeniedRights HiddenRights AdmissionPhase Acknowledged Right Source: S.Geraci-modified
ItalianConstitution Paragraph 32 ofItalianConstitution: “Healthis a Fundamental right of the individual” notof the citizen “La Repubblica tutela la salute come fondamentale diritto dell’individuo e interesse della collettività, e garantisce cure gratuite agli indigenti. Nessuno può essere obbligato a un determinato trattamento sanitario se non per disposizione di legge. La legge non può in nessun caso violare i limiti imposti dal rispetto della persona umana”. Source: S.Geraci-modified
Why Assistanceforall the migrants ,[object Object]
Health PolicyProtectionofIndividualHealthtoprotectcollectivehealth ,[object Object],Source: S.Geraci-modified
OurHistory Startingpoint Renovation S.I.M.M. Car Service forGypsies New Center Gr.I.S. Source: S.Geraci-modified Area sanitaria Caritas Roma 2008
New Patients Poliambulatorio Caritas 1983 -2008 Direzione Area sanitaria e Servizio Banca Dati Medica Caritas Roma, 2008
Stone-age 1983 - 1989
Modern-age 2000- today
Italian Doctors - Migrant Patients:  a mutual misunderstanding Italian doctors: All the migrants are affected by tropical or infectious diseases or depend on the different culture Migrant patients: European (Italian Medicine ) is high-tech
Salgari’s Syndrome
Healthy Migrant Effect CriticalAreas Mother-child, Accident at work, InfectiousDiseases
Tbc and migration
Italy Source: EuroTB Report on tuberculosis cases notified in 2006
France Source: EuroTB Report on tuberculosis cases notified in 2006
Germany Source: EuroTB Report on tuberculosis cases notified in 2006
El Hamad , Centro Patologia del Migrante, Brescia. 2002 Tempo medio di latenza = 35,7 mesi L ’ 83,4% dei casi  è stato diagnosticato entro 5 annidall ’ arrivo in Italia (n=169) Latency from the arrival in Italy and TB diagnosis
TBC e /HIV and migrants: Nederlands HIV prevalence among TB patients in The Netherlands, 1993-2001: trends and risk factors  Haar, C.H.; Cobelens, F.G.J.; Kalisvaart, N.A.;Van der Have, J.J.; Van Gerven, P.J.H.J.; Van Deutekom, H. 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). CONCLUSION: Although the prevalence of HIV among TB patients in The Netherlands remained stable between 1993 and 2001, the distribution of risk groups changed over this period.  Int. J. Tuberc. Lung Dis., 2006, 10 (7)
Rome experience  Main Areas: Medical Assistance Advocacy  Transcultural medicine Postraumatic Stress Disorders and Migration
Advocacy
La “società civile” ed il mondo scientifico denunciano alto rischio di “clandestinità sanitaria” Violazione dei diritti Danno per la salute individuale e collettiva Source: S:Geraci- modified
12 settembre 2008 Source: S.Geraci-modified
Source: S.Geraci-modified
06.5809764 studiemigrazione@cser.it www.cser.it Idos - ottobre 2007: 512 pagine 18 euro tel.06.66514345 idos@dossierimmigrazione.it
Transcultural Medicine: Medical Hermeneutics
Mutual Understanding in doctor-patient relationship 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
Patient objectifying subjectifying Doctor Intercultural communication in medicine objectifying Sickness
Communication: IntentioAuctoris: What you want to tell me (your intention) IntentioOperis: What really means, what you are telling me  Intentiolectoris: What I want to understand  (my intention)
Levels of misunderstanding Pre-linguistical Linguistical Cultural Philosopical and religious
Prelinguistical 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) We can explain how much we suffer but not what we are suffering.
Non verballanguage Gestures ambiguity (nodding  and shaking head)
Linguistical: in different languages  there are different  referents for the same word The lungs, liver, spleen, and other viscera ஈரல் : irel இரத்தக்கவிச்சு, (irattacavicciù)        offensive smellofblood.
Foot/Leg Source: R. Colasanti- E .De Blasio
Foot-Leg Source: R. Colasanti- E .De Blasio
GrammaticalSyntactical and LexicalIncompleteness:
Cognitive Frames Minsky’s  concept of cognitive frames: “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.”
Jane was invited to Jack’s Birthday Party.  She wondered if he would like a kite
Expression Deixis. Use of deictical  (that, this, other, who, which..) may obscure the meaning if I do not know the context ,[object Object],[object Object]
Ear:  false friends in Italian and Spanish Me duele el oido Mi fa male l’orecchio
Other issues: Rhetoric of medical dialogue ,[object Object]
Different cultural customs

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Medicine and Migration in Rome

  • 1. Medicine and Migration 1983-2008 Romeexperience: From a Clinic to a Network ofServices and Rights Dr. Riccardo Colasanti
  • 2. Acknowledgments: To Dr. Salvatore Geraci e to Dr. Alberto Colajacomo who so kindly gave me the possibility to publish some slides of their collection Paintings by WebMuseum Cc creative commons license Share alike http://creativecommons.org/licenses/by-sa/3.0
  • 3. Total Migrant Stock 1960 - 2005 Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, Trends in Total Migrant Stock: The 2005 Revision
  • 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
  • 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
  • 7. Source: S.Geraci-modified Migrationto Italy 5 Immigrationlaw 2002: L. Bossi Fini 1998: L. Turco Napolitano 1990: L. Martelli 1995: dec. Dini 1986
  • 8. Philosophies behind the Migrations Laws Migrants“Arms” Migrants “Workers” Migrants “New Citizens” Safety Migrants“hazard” Source: S.Geraci-modified
  • 9. Migrazione in Italia: Health Policies ExclusionPhase: DeniedRights HiddenRights AdmissionPhase Acknowledged Right Source: S.Geraci-modified
  • 10. ItalianConstitution Paragraph 32 ofItalianConstitution: “Healthis a Fundamental right of the individual” notof the citizen “La Repubblica tutela la salute come fondamentale diritto dell’individuo e interesse della collettività, e garantisce cure gratuite agli indigenti. Nessuno può essere obbligato a un determinato trattamento sanitario se non per disposizione di legge. La legge non può in nessun caso violare i limiti imposti dal rispetto della persona umana”. Source: S.Geraci-modified
  • 11.
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  • 13. OurHistory Startingpoint Renovation S.I.M.M. Car Service forGypsies New Center Gr.I.S. Source: S.Geraci-modified Area sanitaria Caritas Roma 2008
  • 14. New Patients Poliambulatorio Caritas 1983 -2008 Direzione Area sanitaria e Servizio Banca Dati Medica Caritas Roma, 2008
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  • 20. Italian Doctors - Migrant Patients: a mutual misunderstanding Italian doctors: All the migrants are affected by tropical or infectious diseases or depend on the different culture Migrant patients: European (Italian Medicine ) is high-tech
  • 22. Healthy Migrant Effect CriticalAreas Mother-child, Accident at work, InfectiousDiseases
  • 24. Italy Source: EuroTB Report on tuberculosis cases notified in 2006
  • 25. France Source: EuroTB Report on tuberculosis cases notified in 2006
  • 26. Germany Source: EuroTB Report on tuberculosis cases notified in 2006
  • 27. El Hamad , Centro Patologia del Migrante, Brescia. 2002 Tempo medio di latenza = 35,7 mesi L ’ 83,4% dei casi è stato diagnosticato entro 5 annidall ’ arrivo in Italia (n=169) Latency from the arrival in Italy and TB diagnosis
  • 28. TBC e /HIV and migrants: Nederlands HIV prevalence among TB patients in The Netherlands, 1993-2001: trends and risk factors Haar, C.H.; Cobelens, F.G.J.; Kalisvaart, N.A.;Van der Have, J.J.; Van Gerven, P.J.H.J.; Van Deutekom, H. 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). CONCLUSION: Although the prevalence of HIV among TB patients in The Netherlands remained stable between 1993 and 2001, the distribution of risk groups changed over this period. Int. J. Tuberc. Lung Dis., 2006, 10 (7)
  • 29. Rome experience Main Areas: Medical Assistance Advocacy Transcultural medicine Postraumatic Stress Disorders and Migration
  • 31. La “società civile” ed il mondo scientifico denunciano alto rischio di “clandestinità sanitaria” Violazione dei diritti Danno per la salute individuale e collettiva Source: S:Geraci- modified
  • 32. 12 settembre 2008 Source: S.Geraci-modified
  • 34.
  • 35. 06.5809764 studiemigrazione@cser.it www.cser.it Idos - ottobre 2007: 512 pagine 18 euro tel.06.66514345 idos@dossierimmigrazione.it
  • 37. Mutual Understanding in doctor-patient relationship 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
  • 38. Patient objectifying subjectifying Doctor Intercultural communication in medicine objectifying Sickness
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  • 42. Communication: IntentioAuctoris: What you want to tell me (your intention) IntentioOperis: What really means, what you are telling me Intentiolectoris: What I want to understand (my intention)
  • 43. Levels of misunderstanding Pre-linguistical Linguistical Cultural Philosopical and religious
  • 44. Prelinguistical 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) We can explain how much we suffer but not what we are suffering.
  • 45. Non verballanguage Gestures ambiguity (nodding and shaking head)
  • 46. Linguistical: in different languages there are different referents for the same word The lungs, liver, spleen, and other viscera ஈரல் : irel இரத்தக்கவிச்சு, (irattacavicciù) offensive smellofblood.
  • 47. Foot/Leg Source: R. Colasanti- E .De Blasio
  • 48. Foot-Leg Source: R. Colasanti- E .De Blasio
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  • 52. Cognitive Frames Minsky’s concept of cognitive frames: “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.”
  • 53. Jane was invited to Jack’s Birthday Party. She wondered if he would like a kite
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  • 55. Ear: false friends in Italian and Spanish Me duele el oido Mi fa male l’orecchio
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