the advent of the patient the advent of the patient as expert as expert ??

The benefits of a hospital structure The benefits of a hospital structure

for cultural mediation in the care of for cultural mediation in the care of

immigrant patients with chronic painimmigrant patients with chronic pain

oror

This consultation involves

The patient and his/her relatives

The referring physician

The cultural mediator

The physician trained in clinical ethnopsychiatry

This structure was offered to

first- and second- generation immigrants consulting the pain center

with a long history of chronic pain

whose treatment posed a problem for the medical team.

Who were these patientsWho were these patients ??

• All of them are of working age : the great majority are from the working class.

• All patients have founded families

• Fifteen patients are first generation immigrants, two were born in metropolitan France

Country of birth

6

33

1

2

2

North Africa Western Africa South Europ

Madagascar French Antilles Metropolitain France

The medical problems are varied and complex

For twelve patients, pain has obviously become chronic, and dates back over five years.

Among the psychological problems, depression is in the forefront.

These pains were caused or aggravated by a surgical or medical procedure in almost half of the group.

Reasons for referralReasons for referralMentioned

in (nb. of

cases)

depression, mental suffering 9

threatened or attempted suicide 2

unexplained symptomatology 7cultural obstacle to understanding, need forcultural explanation 5

patient angry, rebellious.. 5non-compliance with treatment ortotally unreceptive 3

passivity, continuing complaints 2

- addressed to the structure at the request of a relative already treated

- hysterical paralysis 2

- nocturnal visions, - fabulation - self-mutilation- medication addiction

1

First observation

Previous or current recourse to aparallel therapeutic system occurredin nearly 60% of the cases

Etiologies suggested by the patients

Attack by witchcraft subsequent to:

a conflict about inheritance a conflict with in-lawsthe jealousy of a deserted womanjealousy of success in business by an unidentified relative

9 times

22212

curse on the family 5

possession by invisible beings (jnouns, jinnas,)

or breach of a pact with invisible beings

6

problem of parents’ forced marriage 3

problem linked to a break in transmission in the

paternal or maternal lineage

4

failure to practice a supernatural gift 2

discord in the family 1

none 1

Actions carried out or plannedActions carried out or planned

0 1 2 3 4

mentioned in (nb of cases)

to go on a pilgrimage

traditional healer

resolution of a problemof inheritance

protective ritual

ritual to purify the home

resumption of religiousrituals

Summary of changes observedSummary of changes observed in 17 cases in 17 cases

0 4 8 12 16

positive impact in nb of cases

in general understanding

in the reasons for referral

in the problem of pain

in the handicap

in use of medication

in the relationship with themedical worldin receptivity to treatment

in strategy for treatment

Impact on the strategy of Impact on the strategy of treatmenttreatment

Modifications observed Number of cases

surgical procedure not required 2

hospitalization not required 3

return to the urologist to clarifymisunderstandings 2

Prospects

Widen our approach to include other types of chronic pathologies

Experiment this approach on “native” French patients

Set up a system of collaboration with other European teams to establish a tool of evaluation of intercultural mediation in medicine.

Contact

IPAOS Association - Paris -

Dr Serge Bouznah sbouznah@free.fr