The difficult communication for a multiethnic pathway in hospitals.
prof. Maria Giovanna Ruberto
Our society is rapidly changing in composition. Migratory fluxes, on the one hand, and cultural globalisation, on the other, have contributed to create a situation in which the traditional geographical and social confines which we are used to are being rapidly decreasing.
In a professional context like that of the health sector, where the interaction between user and professional is perhaps the most intimate ever created and has indeed become an unquestionable and fundamental part of the therapeutic process, it is necessary to reflect impartially and in depth on what are, in practice, the difficulties which these social changes project on the patient-professional relationship.
Communication with people from different cultures to ours is complex and governed by processes which include a wide range of vastly different communicative environments. Firstly, there are needs which are codified differently in each culture. Once expressed, this need must be received, re-elaborated by the receiver and, finally, satisfied. What are, along the lines of general principles, the critical areas for a multiethnic pathway in hospitals? Above all, the need for security typical of a subject who is living outside their socio-cultural context. This need includes the implicit necessity to express yourself and your religious beliefs in absolute freedom, without the removal from your cultural context becoming a limit or obstacle. Only at this point, finally, can we concentrate on the course of treatment, which represents the point of arrival and not a presupposed approach to the patient which is completely different from the traditional approach. In more detail, I have pinpointed four fundamental areas in which we can subdivide the complex situation of a patient who is from outside the professional’s socio-cultural context.
Here the first:
The need for security and communication – A foreign patient has difficulty communicating their needs, their history and their personal experience, in a language which is largely unknown to them, like the nuances which are often fundamental in giving colour to the patient/professional dialogue. There are in fact two difficulties: the first contained within the linguistic significance of the words, the second in the meaning of the emotional content and value applied to the experience of being ill. Arthur Kleinman’s work is particularly significant in this regard, as it separates the concept of illness into two very different nuances: an “illness” represented by the illness as it is lived by the patient and a “disease” as seen through objective reality. When a health care professional and patient come from the same cultural background they will have a similar perception of “illness” and this will make it easier to build a relationship of dialogue. On the other hand, coming from a different cultural background will highen the risk of a misunderstanding between them on the subjective value of the illness, in such a way that there is the possibility that the patient determines the illness in a emotive manner which the health care professional cannot fully comprehend. What are the possible consequences of such a situation? Failure to comply on the part of the patient, which will put them in the position of not be ablt to fully take advantage of the health care available.
Professionals often hide behind presumed or real cultural differences believing them to be insurmountable barriers in the communicative process. In reality, the use of plain, simple language, the support of non verbal communication and help from members of the patient’s culture are sufficient instruments to overcome the cultural difference or communication divide between the professional and the patient. Where this is not the case, however, a cultural mediator may be necessary, who is able to act on three levels: practical, to give explanations of the course of treatment, linguistic-communicative, and thus guides the reciprocal communication, to reclaim the psycho-social concept of cultural identity related to the migratory experience.