1. Cultural mediation Training the health-care providers T.Antypas, M.Meliou NGO PRAKSIS Training the health-care providers T.Antypas, M.Meliou NGO PRAKSIS

2. The term foreigners includes: Immigrants with legal documents Immigrants without legal documents (sans papiers) Asylum seekers refugees Immigrants with legal documents Immigrants without legal documents (sans papiers) Asylum seekers refugees

3. The migration issue in Greece Even since 2006 foreign population in Greece exceeded 850.000 (Eurostat) Without legal documents >30% Even since 2006 foreign population in Greece exceeded 850.000 (Eurostat) Without legal documents >30%

4. Country of Origin Albania Bulgaria Georgia Afghanistan Pakistan Bangladesh Somalia Albania Bulgaria Georgia Afghanistan Pakistan Bangladesh Somalia

5. Profile of migrants 15-64 yo (53,5% 25-54yo) Male (if they originate from Asia and north Africa) Female (if they originate from Ukraine, Philippines and Moldavia) Live in urban areas Majority is occupied in construction,housekeeping,trade Low educational level 15-64 yo (53,5% 25-54yo) Male (if they originate from Asia and north Africa) Female (if they originate from Ukraine, Philippines and Moldavia) Live in urban areas Majority is occupied in construction,housekeeping,trade Low educational level

6. Migrants and healthcare Only 4% of their income goes to health (7%in Greek households) 13% lack any kind of insurance policy Only 4% of their income goes to health (7%in Greek households) 13% lack any kind of insurance policy

7. National Healthcare System Combined model (state-health insurance bodies-private sector) Primary healthcare Secondary healthcare Combined model (state-health insurance bodies-private sector) Primary healthcare Secondary healthcare

8. Access to public healthcare Important for the successful social integration Migrants with no legal documents are excluded According to the Ministry of Health migrants with no legal documents are not eligible to access the public hospitals unless it is an emergency. In every other case admission of a foreigner with no legal documents is strictly forbidden and the patient is threatened with immediate deportation. Important for the successful social integration Migrants with no legal documents are excluded According to the Ministry of Health migrants with no legal documents are not eligible to access the public hospitals unless it is an emergency. In every other case admission of a foreigner with no legal documents is strictly forbidden and the patient is threatened with immediate deportation.

9. Problems of foreigners in healthcare Language barrier Different beliefs Fear of deportation Insecurity Lower status of female migrant racism Language barrier Different beliefs Fear of deportation Insecurity Lower status of female migrant racism

10. Health care providers Common problems Language barrier Low educational level of migrants Migrants do not follow orders because of : financial issues religious beliefs (t.ex. During Ramadan muslims do not take medication during day time) Common problems Language barrier Low educational level of migrants Migrants do not follow orders because of : financial issues religious beliefs (t.ex. During Ramadan muslims do not take medication during day time)

11. Health providers Common problems Lack of time (do not have the luxury of the extra time a migrant need in order to explain) Suspicion by the migrants Violent acts from migrants Common problems Lack of time (do not have the luxury of the extra time a migrant need in order to explain) Suspicion by the migrants Violent acts from migrants

12. Cultural mediator He/she is called to create the connection between the two sides

13. Cultural mediators Never are supposed to judge each other Is responsible to make sure that the conditions are appropriate for the translation Is aiming at a full translation of the information the migrant and the healthcare provider need to communicate Never are supposed to judge each other Is responsible to make sure that the conditions are appropriate for the translation Is aiming at a full translation of the information the migrant and the healthcare provider need to communicate

14. Cultural mediators Never express their personal opinion (neither verbally nor non-verbally) Have to built a level of trust between the two sides Never express their personal opinion (neither verbally nor non-verbally) Have to built a level of trust between the two sides

15. Cultural mediators More complex than translation Has to be based in other cultural elements as well Must be people in good knowledge of both the language and the cultural background of the country More complex than translation Has to be based in other cultural elements as well Must be people in good knowledge of both the language and the cultural background of the country

16. Health providers- cultural mediators From the good cooperation between healthcare providers and cultural mediators, medical practice benefits since less malpractice takes place that was due to the cultural differences

17. The healthcare providers have to: Trust the cultural mediator Keep the relationship strictly professional Never let the mediator express personal opinions (it could cloud judgment) Absorb all the information the mediator can extract from the patient Trust the cultural mediator Keep the relationship strictly professional Never let the mediator express personal opinions (it could cloud judgment) Absorb all the information the mediator can extract from the patient

18. Healthcare providers Need to assist the mediators in order for them to be able to translate successfully In other words: Do not use difficult medical terms Keep questions short Ask for explanation if some information does not seem to satisfy you Ask for possible cultural elements that may be interfering with the medical condition (t.ex. Afrikaners use to believe they are victims of black magic when they have abdominal pains-it doesn’t mean they are psychiatric patients) Need to assist the mediators in order for them to be able to translate successfully In other words: Do not use difficult medical terms Keep questions short Ask for explanation if some information does not seem to satisfy you Ask for possible cultural elements that may be interfering with the medical condition (t.ex. Afrikaners use to believe they are victims of black magic when they have abdominal pains-it doesn’t mean they are psychiatric patients)

19. Health care providers when examining a foreigner should: Respect the sexuality of patients Respect their religious beliefs Take into consideration their financial status Take into consideration their nutritional habits Take into consideration their living conditions The above should be followed by cultural mediators as well Respect the sexuality of patients Respect their religious beliefs Take into consideration their financial status Take into consideration their nutritional habits Take into consideration their living conditions The above should be followed by cultural mediators as well

20. Trust If you achieve all that, the cultural mediator will be able to communicate this to the patient and this way a level of trust between the medical professional and the patient is built. Trust is fundamental for the avoidance of medical malpractice If you achieve all that, the cultural mediator will be able to communicate this to the patient and this way a level of trust between the medical professional and the patient is built. Trust is fundamental for the avoidance of medical malpractice

21. Cultural mediation Role in current healthcare is indisputable All healthcare providers need to be open to the interference of cultural mediators during medical practice Role in current healthcare is indisputable All healthcare providers need to be open to the interference of cultural mediators during medical practice

22. Possible dangers The cultural mediator may become the centre of attention Mixing of roles Cultural mediator gains “power” and “status” among migrant communities The cultural mediator may become the centre of attention Mixing of roles Cultural mediator gains “power” and “status” among migrant communities

23. Possible dangers Mediator does not agree (politically, sexually, religiously etc) with the object to be translated (written or oral) Mediator does not respect privacy of the patient Mediator does not understand what he has to translate Mediator does not agree (politically, sexually, religiously etc) with the object to be translated (written or oral) Mediator does not respect privacy of the patient Mediator does not understand what he has to translate

24. Possible dangers clue elements to avoid them Always keep in mind that cultural mediators are also migrants themselves Always explain that his role is limited to translation Never encourage him to explain sth the patient did not understand the first time by his own initiative Always keep in mind that cultural mediators are also migrants themselves Always explain that his role is limited to translation Never encourage him to explain sth the patient did not understand the first time by his own initiative

25. Always explain to the patient who is the healthworker and who is the translator Always be aware - there are numerous non- verbal clues that will reveal if the mediator is transmitting information he is not supposed to Always explain to the patient who is the healthworker and who is the translator Always be aware - there are numerous non- verbal clues that will reveal if the mediator is transmitting information he is not supposed to Possible dangers clue elements to avoid them

26. Keep speech simple Always get in touch with the mediator previously (when this is possible) Be reluctant to use a mediator who is anyway closely related to the patient Keep speech simple Always get in touch with the mediator previously (when this is possible) Be reluctant to use a mediator who is anyway closely related to the patient

27. Possible dangers clue elements to avoid them At the beginning of the mediation always explain the role of each party and encourage the mediator to communicate it to the patient Take the time to explain to the mediator his mistakes afterwards If you are aware that the mediator does not respect the privacy of the session make sure that he/she is relieved from duty At the beginning of the mediation always explain the role of each party and encourage the mediator to communicate it to the patient Take the time to explain to the mediator his mistakes afterwards If you are aware that the mediator does not respect the privacy of the session make sure that he/she is relieved from duty

28. Cultural mediation Conducted under the right conditions can be useful Conducted by trained professionals can be a powerful tool against medical malpractice Conducted under the right conditions can be useful Conducted by trained professionals can be a powerful tool against medical malpractice

29. Thank you Questions? Source: Training material created in the context of the program «Cultural mediation in selected hospitals of Athens and Thessaloniki» Action 1.6–2009 Priority 1 «Materialization of actions towards the insurance of 5 basic principles for the political integration of migrants in European Union» Coordinators: ΚΕΚ Diastasi – National School of Public Health. Antypas Tzanetos Social worker MSc Health Management Questions? Source: Training material created in the context of the program «Cultural mediation in selected hospitals of Athens and Thessaloniki» Action 1.6–2009 Priority 1 «Materialization of actions towards the insurance of 5 basic principles for the political integration of migrants in European Union» Coordinators: ΚΕΚ Diastasi – National School of Public Health. Antypas Tzanetos Social worker MSc Health Management