WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:     | 1 |   ...   | 3 | 4 || 6 | 7 |   ...   | 18 |

«IOM is committed to the principle that humane and orderly migration benefits migrants and society. As an intergovernmental organization, IOM acts ...»

-- [ Page 5 ] --

Culturally appropriate communication requires adjusting one’s practice and identifying appropriate resources, such as interpreters, to ensure that the patient can communicate needs and have those needs understood. Select interpreters carefully. Do not use casual bystanders, minors or those who have accompanied the trafficked person as interpreters (see action sheets 3, 6 and 10).

RequIRed ACTIonS To provide care that is culturally responsive • Provide access to interpreters if there are language barriers (see action sheet 3). Have a system for identifying a patient’s language needs, including in-person or telephone access to interpreters.

• Assess an individual’s literacy level to ensure that information is conveyed in understandable ways. Some people respond well to information conveyed using visual aids.

• Don’t make rapid or negative assumptions about individuals’ reactions or behaviour. Consider possible cultural, social or personal reasons for individual reactions.

CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERS

• Identify current social stressors, including housing, legal and financial constraints, and making appropriate and timely referrals to social services (see action sheet 10).

• Explore the patient’s own understanding of their illness. See section on the explanatory model, below.

• Ensure that the patient’s wishes for a provider of the same sex is respected when possible, as well as the patient’s choices about whom they would permit to examine them.

• Recognize the importance of religious beliefs in a patient’s recovery, as well as their understanding of the trafficking experience in the context of their religion and cultural beliefs.

Explanatory model (EM)

Exploring the patient’s meaning of illness is important, particularly while evaluating the range of symptoms. The ‘explanatory model’ is a practical approach to assessing this that can help providers avoid cultural stereotyping.

Because it is not possible to know everything about every culture, it is important to learn how to ask trafficked persons about their expectations for care. Suggested questions for eliciting the patient’s perspective on their

symptoms include:

1. What is the problem? How do you describe what is going on?

2. What do you think has caused your problem? How?

3. Why do you think the problem started when it did?

4. How does it affect you?

5. What worries you most? (Severity? Duration?)

6. What kind of treatment do you think you should receive?

(Expectations?) Provider-patient negotiation Once you have explored the patient’s concerns and elicited the patient’s perspectives on their illness (their explanatory model), utilizing the support of interpreters and visual aids as necessary, work with the patient to develop a treatment plan that is understandable, feasible and sustainable.

Creating a mutually acceptable plan that acknowledges the background and individuality of each patient for next steps requires shifting paradigms from ‘making a patient comply with treatment’ to ‘supporting patients in their healing and recovery’. Planning treatment in cooperation with the trafficked person conveys responsive support and a sense of empowerment: it is a signal to the patient that you have listened and understood the patient’s concerns.

44 CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERS

A mutually acceptable treatment plan is more likely to be embraced by the patient and result in improved outcomes. Such negotiations may be constrained when clinical encounters are brief (e.g., if the patient is in detention or in transit) or by a patient’s lack of health insurance or resources to pay for care.19 While you may be concerned about the additional time involved in communicating and negotiating with patients, particularly those from diverse backgrounds, evidence suggests that using these strategies actually shortens the amount of time ultimately required to diagnose and treat. Patients are more engaged and open to communication when providers offer culturally responsive care. Using these techniques to take medical histories from those who may express their illnesses differently and to plan treatment for individuals familiar with other medical practices is likely to take less time and be more effective than guessing, missing diagnoses and failing to get adherence to care.

–  –  –

Health is a recognized human right and many countries strive to provide universal access to health care for victims of violence, those in need of emergency care and vulnerable groups. However, in reality it can be very complicated to provide the necessary medical and mental health care for a victim of trafficking who cannot pay and may not have the identity documents required to access existing social services. Coordination with other service providers, particularly those with experience in meeting the many non-health needs of trafficked persons, is essential (see action sheet 10).

CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERS

–  –  –

Denoba, D. L. et al.





1998 “Reducing health disparities through cultural competence”, American Journal of Health Education, vol. 29 (5 Suppl.), pp.

S47–S58.

–  –  –

RATIonAle Accurate communication is essential to providing quality, rightsbased health care to trafficked persons. Due to the nature of trafficking, many trafficked persons are offered care when they are away from their home country by health care providers who do not speak their language.

(Persons trafficked within a country may also face language barriers.) In these situations, care is often facilitated by interpreters. This action sheet focuses on communication via interpreters, while acknowledging that there are also cultural, gender, age-related and other sensitivities (e.g., literacy, disability, culture or capacity) that may affect communication with trafficked persons.

(See action sheets 1, 2, 5, 9, and 10 for more information on other topics related to communication.) Working with interpreters in health care settings can be enjoyable as well as challenging. Such topics as abuse and psychiatric symptoms may be more difficult to discuss through interpreters. Some health care providers report greater detachment from their patients and feel less effective in their work or frustrated because treatments take longer. However, in many cases, care strategies can be enhanced by working with an interpreter who fosters better communication and engagement with the trafficked person, and who helps the provider obtain accurate information within a cultural understanding of the individual (see action sheet 2).

Interpreters in health care settings can have various roles. When working with an interpreter it is worth considering the potential roles that he or she might take. This role will depend on the care setting, the patient’s needs and the professional experience of the interpreter and the clinician. The following

roles have been identified for interpreters:

50 CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERS

• Interpreter who provides a neutral and impartial service.

• Cultural broker who explains and gives cultural and contextual understanding to the health care provider and the client.

• Advocate who represents the patient’s interests.

• Intermediary or conciliator who resolves conflicts between the patient and the health care provider.

• link worker who helps the clinician identify unmet needs of the patients and provides support to the patient.

• Bilingual co-worker who takes on a more involved therapeutic role in addition to providing translation.

RequIRed ACTIonS Before beginning work with an interpreter there are some preparations that you might wish to consider to facilitate your work with the trafficked person and the interpreter.

Selecting an interpreter Selecting an interpreter is an extremely important step that is crucial to the safety and well-being of the trafficked person as well as that of the health

provider. The following basic cautionary notes should be followed:

–  –  –

For the patient encounter • Find out the trafficked person’s first language and dialect and if he or she speaks any other languages.

• Take into account the nationality, religion and gender of the patient (see action sheet 2).

• Book longer sessions that will allow time for interpretation.

• Try to find a way to explain to the trafficked person that you are seeking interpreting services.

• Try to find a way to encourage the trafficked person to let you know if he or she becomes uncomfortable with the selected interpreter for any reason.

For the interpreter

• Notify the interpreter or his or her agency of the subject matter (e.g., confidential medical discussions that may cover violence, rape, etc.). Be aware that if you don’t do that you might find that the interpreter is reluctant or feels uncomfortable with the subject matter.

• Because confidentially is extremely important when working with trafficked persons (see action sheets 7 and 9), you may want to consider establishing a formal mechanism which makes clear the role of the interpreter and their responsibilities to maintain confidentiality. An example of this could be a standard operating procedure agreed to with the agency or individual.

• In order to establish a relationship in which the trafficked person feels safe working with you and the interpreter, it is important to carry out all consultations with the same interpreter if more than one meeting is possible. When arranging for an interpreter it is important to ensure that the agency and the individual interpreter know that you are planning to use the same interpreter in your future sessions.

• Warn the interpreter not to give out personal contact details and against disclosing any information to others about the trafficked person.

52 CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERS

During the consultation

–  –  –

• If you have serious doubts about the interpreter's conduct, discuss this with the interpreter. If the individual is employed by a service, provide feedback to the employer.

• Reflect on how to maintain good working alliances with interpreters who have demonstrated that they can be trusted.

RefeRenCeS And ReSouRCeS Raval, H.

2005 “Being heard and understood in the context of seeking asylum and refuge: communicating with the help of bilingual coworkers”, Clinical Child Psychology and Psychiatry, vol. 10, no. 2, 1 April 2005, pp. 197–216.

Tribe, R. and H. Raval (Eds.) 2003 Working with Interpreters in Mental Health, Brunner-Routledge, Hove, United Kingdom and New York, NY, USA, 2003.

AC

Action Sheet 4:

TION Comprehensive health assessment

–  –  –

RATIonAle A comprehensive health assessment is important because many trafficked persons will experience a range of abuses and other health risks that result in co-occurring conditions.20 Although patients may present with specific symptoms that seem to be the focus of the clinical encounter, patients are likely to require a comprehensive medical and mental health assessment because the high likelihood of co-occurring disorders. Knowing the multiple health problems that trafficked persons face may assist you in using a systematic care approach to address patients whose medical problems are often complex. Depending on the trafficking context, trafficked persons may have experienced a range of abuse, violence and other health risks. For example, a child exploited sexually will also likely have experienced physical abuse, poor nutrition and sleep deprivation. Careful ‘head-to-toe’ assessments should be developmentally appropriate. Examination of children should be conducted by providers who are comfortable with the care of abused children and with forensic examination whenever possible (see action sheets 5 and 12). Infectious diseases are discussed in detail in action sheet 15.

Many trafficked persons may have had poor health prior to being trafficked, because factors such as poverty and poor living conditions, which increase susceptibility to being trafficked, also predict baseline poor health.21,22 Many patients may have additional multiple active medical problems (e.g., asthma, diabetes, anaemia and parasitosis) that are likely to have been exacerbated in the context of trafficking. Living in overcrowded This action sheet assumes that health care providers are aware of the basic principles of trauma-informed care (see action sheet 1) and cross-cultural care (see action sheet 2), appropriate identification and safety assessments have been conducted (see action sheet 7), and referral options for legal advocacy and social services have been identified (see action sheet 10).

Beyrer, C., “Is trafficking a health issue?” The Lancet, vol. 363, no. 9408, 14 February 2004, p. 564.

Zimmerman, C. et al. (2003).

58 CARING FOR TRAFFICKED PERSONS: GUIDANCE FOR HEALTH PROVIDERS

situations, with poor nutrition, restricted lifestyles, and limited access to health care all contribute to poor health and greater severity of symptoms.23 Providers should try to learn about the local epidemiology of disease patterns in a patient’s country of origin, the transit environment and the trafficking destination to ensure that such common disease conditions as dengue, malaria, tuberculosis and others are not missed.



Pages:     | 1 |   ...   | 3 | 4 || 6 | 7 |   ...   | 18 |


Similar works:

«MINUTES FLORIDA BARBERS’ BOARD CROWNE PLAZA HOTEL 200 E. GREGORY STREET PENSACOLA, FLORIDA 32501 Monday, August 4, 2014 The Florida Barbers’ Board meeting was called to order at approximately 9:00 a.m., by Mr. Herman White, Chair. Board Members Present Board Members Absent Herman White, Chair Monica Smith Thomas Vaughn, Vice Chair Edwin Stewart Bill Gilbert Julie Rivera Other Persons Present Robyn Barineau, Executive Director, Department of Business and Professional Regulation (DBPR)...»

«Operational Plan Document 2014-16 Operational Plan Document for 2014-16 University Hospital of South Manchester NHS Foundation Trust Operational Plan Document 2014-16 1.1 Operational Plan for y/e 31 March 2015 and 2016 This document completed by (and Monitor queries to be directed to): Name Dr. Attila Vegh Job Title Chief Executive e-mail address attila.vegh@uhsm.nhs.uk Tel. no. for contact 0161 291 2023 Date 31 March 2014 The attached Operational Plan is intended to reflect the Trust’s...»

«Volatility of Short Term Capital Flows, Financial Anarchy and Private Investment in Emerging Markets Fırat Demir* Department of Economics, Hester Hall, 729 Elm Avenue, Room 324A, University of Oklahoma Norman, Oklahoma, USA 73019 Tel: 405 325 5844, Fax: 405 325 5842 E-mail: fdemir@ou.edu In Journal of Development Studies 45(5): 672-692, 2009 *Acknowledgments: I thank Jaime Ros, Amitava K. Dutt, Kwan S. Kim, Kajal Mukhopadhyay, participants at the Eastern Economic Association 2007 annual...»

«Part 1: The Lean Fulfillment Stream What is a Fulfillment Stream? In today’s world, most products move across many companies and through many departments within each company on their way to the final customer. Because the movement of material is so complex, businesses struggle to understand the progression of their products as they move from their suppliers through their own organization into distribution and on to the customer. Certainly work is done by others somewhere, but managers in each...»

«Modigliani-Miller On Capital Structure: A Post-Keynesian Critique Murray Glickman* * Department of Economics, University of East London, Longbridge Road, Dagenham, Essex, RM8 2AS, UK. An earlier version of this paper was presented at the Fourth International Conference of the International Trade and Finance Association, held at the University of Reading, UK, in July 1994. UEL Department of Economics Working Paper, No. 8 December 1996 Modigliani and Miller on Capital Structure: A Post Keynesian...»

«Janus Capital Management LLC 151 Detroit Street Denver, CO 80206 303.333.3863 www.janus.com March 28, 2016 This Brochure provides information about Janus Capital Management LLC’s (“Janus”) qualifications and business practices for Janus’ advisory clients. If you have any questions about the contents of this Brochure, please contact us at 303.333.3863. The information in this Brochure has not been approved or verified by the United States Securities and Exchange Commission (the...»

«blic Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Editors during the Trade Finance Great Trade 63264 Collapse Trade Finance during the Great Trade Collapse Trade Finance during the Great Trade Collapse Jean-Pierre Chauffour and Mariem Malouche Editors © 2011 The International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org All rights...»

«1 Choice Architecture Authors Adrian R. Camilleri, PhD. Richard P. Larrick, PhD. Lecturer Professor School of Economics, Finance, and Marketing Fuqua School of Business RMIT University Duke University 124 La Trobe Street 100 Fuqua Drive Melbourne, Victoria 3000 Durham, NC, 27708 Australia USA E: ac11ca@gmail.com E: rick.larrick@duke.edu P: +1 919 660 4076 2 Abstract “Choice architecture” is a metaphor capturing the idea that all choices occur within a structure of contextual and task...»

«Trg J. F. Kennedya 6 10000 Zagreb, Croatia Tel +385(0)1 238 3333 http://www.efzg.hr/wps wps@efzg.hr WORKING PAPER SERIES Paper No. 11-03 Tomislav Hernaus Business Trends and Tendencies in Organization Design and Work Design Practice: Identifying Cause-and-Effect Relationships FEB – WORKING PAPER SERIES 11-03 Business Trends and Tendencies in Organization Design and Work Design Practice: Identifying Cause-and-Effect Relationships Tomislav Hernaus thernaus@efzg.hr Faculty of Economics and...»

«Case 1:09-cv-00861-REB Document 1-2 Filed 04/13/2009 Page 1 of 34 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO IN THE MATTER OF THE TAX ) LIABILITIES OF: ) ) JOHN DOES, United States Merchants who ) have established Merchant Sales ) Civil No. Agreements with First Data Corporation ) or any of its subsidiaries or affiliates, to ) process debit card, credit card, charge ) card, or other payment card transactions ) pursuant to a referral or any other business ) arrangement...»

«Economic Issues, Vol. 19, Part 1, 2014 Aspects of Macroeconomic Policy Combinations and Their Effects on Financial Markets Muhammad Ali Nasir1,5 and Alaa M. Soliman2,5 ABSTRACT This paper analyses the implications of macroeconomic policy interactions for financial stability, proxied by financial assets prices (equity and bonds). The empirical analysis applies a Vector Autoregressive (VAR) model and our findings suggest that an accommodating monetary, and disciplined fiscal, stance has been...»

«File: Meyer Macro Final.doc Created on: 9/23/2005 8:09:00 AM Last Printed: 10/27/2005 3:47:00 PM CURRENT ARTICLE 9 ISSUES AND AGRICULTURAL CREDIT Keith G. Meyer * I. Introduction II. Scope of Article 9 A. Agricultural Liens B. Sale of Farm Products Subject to an Agricultural Lien or Security Interest 1. Proceeds from the Sale of Farm Products 2. Recent Cases Dealing with Sale of Farm Products and Cash Leases III. Attachment A. In General B. Security Agreements and Bankruptcy Exception to...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.