University of California, Berkeley, USA.
Soc Sci Med. 2012 Mar;74(6):873-81. doi: 10.1016/j.socscimed.2011.06.067. Epub 2011 Sep 8.
This paper utilizes eighteen months of ethnographic and interview research undertaken in 2003 and 2004 as well as follow-up fieldwork from 2005 to 2007 to explore the sociocultural factors affecting the interactions and barriers between U.S. biomedical professionals and their unauthorized Mexican migrant patients. The participants include unauthorized indigenous Triqui migrants along a transnational circuit from the mountains of Oaxaca, Mexico, to central California, to northwest Washington State and the physicians and nurses staffing the clinics serving Triqui people in these locations. The data show that social and economic structures in health care and subtle cultural factors in biomedicine keep medical professionals from seeing the social determinants of suffering of their unauthorized migrant patients. These barriers lead clinicians inadvertently to blame their patients--specifically their biology or behavior--for their suffering. This paper challenges the focus of mainstream cultural competency training by showing that it is not the culture of the patient, but rather the structure and culture of biomedicine that form the primary barriers to effective multicultural health care.
本文利用 2003 年至 2004 年进行的为期十八个月的民族志和访谈研究，以及 2005 年至 2007 年的后续实地调查，探讨了影响美国生物医学专业人员与其无证墨西哥移民患者之间互动和障碍的社会文化因素。参与者包括来自墨西哥瓦哈卡州山区的无证土着 Triqui 移民，以及在这些地方为 Triqui 人服务的诊所工作的医生和护士。数据显示，医疗保健中的社会和经济结构以及生物医学中的微妙文化因素使医务人员无法看到无证移民患者痛苦的社会决定因素。这些障碍导致临床医生无意中将他们的无证移民患者的痛苦归咎于他们的生物学或行为。本文通过展示主流文化能力培训的重点不是患者的文化，而是生物医学的结构和文化，从而对有效多元文化医疗保健构成了主要障碍。
