Friday, September 30, 2011

Cultural approach to illness and pain - conception differences between the occidental model and the Melanesian and Aboriginal traditional model

Recently, I have been participating to a lecture about indigenous people. The lecturer described aboriginal culture and their language of pain and barriers with health care professionals but all along the lecture I felt there were a real connection between Aboriginal and Melanesian people. There were multitude similarities regarding their culture and behaviors. There were also similar stereotypes from Health care professionals and the community.

I then realized that Melanesian people may face similar barriers with health professional in New Caledonia. Unfortunately not much research about this issue has been done and I am not even sure if anything has been considered to assist them. However, this would be essential to facilitate treatment managements and processes.

I am currently writing an article listing similarities found between aboriginal and Melanesian cultures and beliefs. My goal would be to examine these similarities to find out if the Melanesian community face same obstacles and share same feelings regarding pain management as aboriginal people and if anything can be done to remove these barriers.

From the research I have done at the moment, I found that they face similar language barriers (no equivalent words in English or French in their own language, and they have a word that covers everything from pain to any type of injury and illness with the differentiation made by the context in which the word is use, "pika" for western Australia aboriginal communities and "aketr" in drehu language for Lifou Melanesian communities).

Melanesian people also have similar beliefs towards illness and pain as aboriginal people. Illness is physical, social and mystical. They believe there are 3 different type of illness: natural, caused by spirit ancestors, caused by a "boucan" (evil spell from a jealous person through a sorcerer) and to be treated they need their own traditional medicine and family.

Both do not verbally complain about pain because they do not want to be seen as weak, or be ashamed of saying the wrong things. They often hide their symptoms from others, delaying diagnosis or not pursuing treatment because they can feel ashamed of "wrong doing" (Melanesian and aboriginal people have this notion of being sung, it's basically a bad magic put on somebody because of breaking a "taboo" or law).

Both communities suffer from stereotypes (i.e. "they don't feel pain", "they don't understand or get what I am trying to explain", "they don't care of pursuing treatments", "they cannot explain in details") and communication barriers with health care professional: they speak a different language, have different time concept, respect concept, silence time, body language (averting gaze, shrugging eyebrows for example are forms of respect and humility in the Melanesian society). They are shy because their culture reinforce humility and respect especially with older people. Silence and listening are parts of their entire childhood, during this time they cannot say whatever they want to say to anyone they want, it is inappropriate to express their opinions to people older than them.

These concepts and cultural differences are often not all well understood and some behaviors can sometimes be seen as "rude" for the health professional. But aboriginal and Melanesian people may also feel that HP are not interested about their beliefs, tragic past events, traditional medicine and culture and both can feel HP are not listening to them, do not believe in them or do not care.

We need to develop better communication techniques that build trust and consideration,we need to be culturally sensitive and respectful for better treatment management and process and equality towards all communities.



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