2. the advent of the patient as expert ? The benefits of a hospital structure for cultural mediation in the care of immigrant patients with chronic pain or

4. This consultation involves   The patient and his/her relatives   The referring physician   The cultural mediator   The physician trained in clinical ethnopsychiatry

5. This structure was offered to   first- and second- generation immigrants consulting the pain center   with a long history of chronic pain   whose treatment posed a problem for the medical team.

6. Who were these patients? All of them are of working age : the great majority are from the working class. All patients have founded families Fifteen patients are first generation immigrants, two were born in metropolitan France

8. The medical problems are varied and complex  For twelve patients, pain has obviously become chronic, and dates back over five years.  Among the psychological problems, depression is in the forefront.  These pains were caused or aggravated by a surgical or medical procedure in almost half of the group.

9. Reasons for referral Mentioned in (nb. of cases) depression, mental suffering 9 threatened or attempted suicide 2 unexplained symptomatology 7 cultural obstacle to understanding, need for cultural explanation 5. patient angry, rebellious. 5 non-compliance with treatment or totally unreceptive 3 passivity, continuing complaints 2 -addressed to the structure at the request of a relative already treated - hysterical paralysis 2 - nocturnal visions, - fabulation - self-mutilation - medication addiction 1

10. First observation   Previous or current recourse to a parallel therapeutic system occurred in nearly 60% of the cases

11. Etiologies suggested by the patients Attack by witchcraft subsequent to: a conflict about inheritance a conflict with in-laws the jealousy of a deserted woman jealousy of success in business by an unidentified relative 9 times 2 1 2 curse on the family5 possession by invisible beings (jnouns, jinnas,) or breach of a pact with invisible beings 6 problem of parents’ forced marriage3 problem linked to a break in transmission in the paternal or maternal lineage 4 failure to practice a supernatural gift2 discord in the family1 none1

12. Actions carried out or planned

13. Summary of changes observed in 17 cases

14. Impact on the strategy of treatment Modifications observedNumber of cases surgical procedure not required2 hospitalization not required3 return to the urologist to clarify misunderstandings2

15. Prospects   Widen our approach to include other types of chronic pathologies   Experiment this approach on “native” French patients   Set up a system of collaboration with other European teams to establish a tool of evaluation of intercultural mediation in medicine.

16. Contact IPAOS Association - Paris - Dr Serge Bouznah  sbouznah@free.fr