Pedagogia e cuomunicazione interculturale in ambito sanitario.Interazioni fra personale medico e donne migranti in un ambulatorio della gravidanza.

The theoretic premises of this work lie in the Intercultural Education approach. In the Seventies of the last century in Europe, and later in Italy, the problems faced by the teachers in the schools with the sons of immigrant people gave a start to the reflection on the linguistic and cultural diversity. From the Seventies to the Nineties the reflection on the educational strategies changed its approach from a multicultural one to the intercultural one. As Portera and other scholars state in their works , whereas the multicultural approach gives evidence to the similarities and differences between cultures, which are considered static and definite entities, the intercultural one stresses the importance of the inter-action between people, which is the necessary condition for an equal and constructive dialogue which may enrich each person involved. According to this approach the culture and the personal identity are considered as dynamic processes changing all-time. The Intercultural Education entails the ability to communicate with persons who don’t share our cultural background and this issue leads us to the other main pillar of the work: the Intercultural Communication studies. According to Giaccardi the intercultural communication is an interaction, a dialogue, a process of negotiation between different frames, where negotiation is intended as a bidirectional process in which different interests face each other and, step by step, increase the mutual comprehension; this process, which is not definitive but continual, may require a partial loss of integrity of the individual points of view in order to give value to all the instances involved and to reach an agreement on some points. In order to become able to communicate interculturally, it is necessary to acquire some knowledge, attitudes and skills. E.g., knowledge of social groups and their products and practices, and of the general processes of societal and individual interaction; curiosity and openness, readiness to suspend disbelief about other cultures and belief about one’s own; skills of interpreting and relating, of discovery and interaction, and critical cultural awareness; listening skills and creative conflicts’ management. Starting from these premises the research work focuses on the relationship between doctors (in most cases female student doctors) and immigrant patients in a Pregnancy Outpatients’ Clinic, heading to the Obstetrics Department in the G. Rossi Hospital in Verona. In order to analyse the subject from an emic point of view, an ethnographic approach has been adopted: I took a period of participant observation (from January to July, 2009) during which I dressed a doctor coat and I attended the Department’s daily life, especially the doctors’ meetings and the visits to the admitted patients, both in the morning time. After about a month I got the possibility to attend also the Pregnancy Outpatients’ Clinic, a public service of the hospital addressed to the external women in order to keep in check their pregnancy. The largest number of women who enter the Clinic are immigrants (they can’t afford private and expensive check visits as the greater part of Italians do). So, I was in the right place to observe the plans arranged by the hospital to address the needs of such a population and the communication strategies adopted by the doctors to conduct the visits. The questions with which I started the participant observation is the following: what are the features of the doctor-patient interaction in the specific context of the Clinic? Besides the participant observation, I made 6 semi-structured interviews in order to understand the feelings and the problems faced by the participants: - 3 group-interviews with women coming from Marocco, Sri Lanka and China; - 2 individual-interviews with linguistic mediators (two women from Sri Lanka and China); - 1 individual-interview with a female student doctor. Data analysis revealed that, from the practitioner point of view, the construction and analysis of case histories is more important than the relationship with the person. Furthermore, the efficiency value, which pervades the hospital setting, often steals time to the interaction with patients. The hospital has arranged a Cultural-Linguistic Mediation Service which helps doctor to communicate with immigrant women. Anyway the cultural and personal dimensions are not addressed in the relationship with patients and the mediator serves as an interpreter. Women report a lack of attention to their needs and a lack of information on their pregnancy, their baby, ect.. Doctors find it difficult to give complete information, in understanding problems and facing conflicts. Doctors’ communicative competence is poor and requires more training and self-consciousness. On the basis of this findings, I suggest a reflection on different levels: 1. Management and organization policies. 2. Culture transmitted by medical training. 3. Working practices. Specifically about the medical education, more training on the intercultural relational competence is required for practitioners who in everyday working life face cultural diversity and take care of immigrant pregnant women.