Hong Soo Jung
Department of Communication Arts and Sciences, 234 Sparks Building, The Pennsylvania State University State College, University Park, PA, 16802, USA,
J Immigr Minor Health. 2015 Jun;17(3):867-84. doi: 10.1007/s10903-014-0008-9.
By focusing on North Korean defectors' medical experiences in South Korea and their medical providers' experiences treating the defectors, this article considers the differences between the views of these two groups in regard to the causes of prescription non-adherence. The results suggest that (a) whereas the defectors tended to see their symptoms as being physical in nature, the medical providers often ascribed symptoms to psychological/socio-cultural influence; (b) whereas the defectors tended to trust in their ability to self-diagnose and in their belief systems established in North Korea, the medical providers tended not to place trust in these aspects; (c) whereas the defectors tended to view the available medical treatment as inappropriate for them, the medical providers often noted the presence of tolerant bacterial strains as causes of treatment failure; and (d) whereas the defectors felt that the treatment they received was slow and ineffective and attributed this to capitalism, the medical providers felt that the defectors failed to understand the concept of staged treatments. Based on the findings, some solutions are suggested to address the complex issue of North Korean defectors' prescription non-adherence in terms of subjective/objective health assessments and patient-centered care. North Korean defectors' established health beliefs/lack of medical knowledge based on their previous medical and cultural experiences gave rise to beliefs and practices associated with medicine that differ significantly from those of the health providers and that have the potential to severely compromise the defectors' health. Therefore, therapy negotiation and appropriate education are suggested as possible solutions, and as an agenda, the notion of civic friendship is addressed. Implications for medical practice, prevention, and intervention are also discussed.
通过关注朝鲜叛逃者在韩国的就医经历以及他们的医疗服务提供者治疗这些叛逃者的经历，本文探讨了这两组人在处方不依从原因方面的观点差异。结果表明：（a）叛逃者倾向于将自己的症状视为身体上的，而医疗服务提供者往往将症状归因于心理/社会文化影响；（b）叛逃者倾向于相信自己的自我诊断能力以及在朝鲜建立的信仰体系，而医疗服务提供者则往往不相信这些方面；（c）叛逃者倾向于认为现有的医疗治疗对他们不合适，而医疗服务提供者经常指出存在耐药菌株是治疗失败的原因；（d）叛逃者觉得他们接受的治疗缓慢且无效，并将此归因于资本主义，而医疗服务提供者则认为叛逃者不理解分阶段治疗的概念。基于这些发现，本文提出了一些解决方案，以从主观/客观健康评估和以患者为中心的护理方面解决朝鲜叛逃者处方不依从这一复杂问题。朝鲜叛逃者基于他们以前的医疗和文化经历所形成的既定健康观念/缺乏医学知识，产生了与医疗服务提供者截然不同的与医学相关的信念和做法，这有可能严重损害叛逃者的健康。因此，建议将治疗协商和适当教育作为可能的解决方案，并将公民友谊的概念作为一个议程来探讨。本文还讨论了对医疗实践、预防和干预的影响。
