Presented in Tokyo at IMA in 2008

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

6. Source: Colajacomo modified

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

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

15. Stone-age 1983 - 1989

18. Modern-age 2000- today

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

21. Salgari’s Syndrome

22. Healthy Migrant Effect CriticalAreas Mother-child, Accident at work, InfectiousDiseases

23. Tbc and migration

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

30. Advocacy

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

33. Source: S.Geraci-modified

35. 06.5809764 studiemigrazione@cser.it www.cser.it Idos - ottobre 2007: 512 pagine 18 euro tel.06.66514345 idos@dossierimmigrazione.it

36. Transcultural Medicine: Medical Hermeneutics

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

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

49. GrammaticalSyntactical and LexicalIncompleteness:

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

55. Ear: false friends in Italian and Spanish Me duele el oido Mi fa male l’orecchio

57. Different cultural customs

58. Different Symbolic values