Pediatrics

“Intercultural pediatrics” at Sainte-Justine

According to a study conducted in 2002 by Annie Gauthier, an anthropology student at Université de Montréal, more than 40% of patients who present at the emergency room of Sainte-Justine Hospital are first generation immigrants. “In order to get a better handle on things, the hospital has put forward the concept of “Intercultural Pediatrics.” “During our medical training, not much attention was paid to the differences between the people to whom we were providing health care,” explains Dr. Fernando Alvarez, Director of the Pediatrics Department at the university’s hospital for children. Given the cultural diversity we have to face nowadays, our diagnostics, our therapeutic methods, and how we talk to people are no longer appropriate.”

To help develop new skills, the physicians asked medical anthropologists to come to the hospital and look into the matter, given the new context. A dozen anthropology students were paired with pediatricians in order to examine the relationships between physicians and foreign-born patients. And according to the partners in this “therapeutic alliance,” as they call it, the language barrier is not the main obstacle. “When a Haitian mother tells you that her 45 day old baby has bad blood, you have to know how to interpret what she is saying,” the physician explains. She could mean that she herself is distressed and that breast-feeding is causing problems.”

Dr. Alvarez, who was born in Argentina , knows something of the immigrant experience, because he lived in France and the United States before coming to Québec in 1992. He is therefore very sensitive to these questions. “When a mother entrusts her child to us, we can’t act the same if she came from Latin America , Africa or the Beauce in Québec. We have to learn to adapt our approach to each case.” When anthropologist Gilles Bibeau suggested that they collaborate, two years ago, he leapt at the invitation. “The therapeutic alliance,” he explains, “seeks to put the parent, child and physician on the same wavelength. We practice a profoundly humanistic medicine. That’s why the viewpoint the anthropologist can bring is so precious for us.” The 150 specialists in the Pediatrics Department at Université de Montréal have been invited to learn about Intercultural Pediatrics, and 10 of them are taking part in the research into medical anthropology as co-directors. Dr. Alvarez, for example, who is a specialist in liver transplants, is supervising a study of children who undergo this kind of operation. A good example of what Intercultural Pediatrics can accomplish is the collaboration set up with the Cree community. Three times, when parents were not cooperating well with caregivers, they had to ask to meet the band chief. He came from Northern Québec to talk to the physician and his staff. “We told him how important it was for the success of the treatment to follow the drug instructions. By becoming responsible for the child, he took his work very seriously and talked to the parents. The results were positive every time.”

 

Researcher: Fernando Alvarez
Email: fernando.alvarez@umontreal.ca
Telephone: (514) 345-4626
Funding: Fonds de la recherche en Santé du Québec
 


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