Fortin Sylvie, Gauthier Annie, Gomez Liliana, Faure Christophe, Bibeau Gilles, Rasquin Andrée
a Anthropology Department , Université de Montréal , Montreal , Quebec , Canada.
Anthropol Med. 2013;20(3):311-23. doi: 10.1080/13648470.2013.853026.
This paper examines how children and families of diverse ethnic backgrounds perceive, understand and treat symptoms related to functional gastrointestinal disorders (FGIDs). It is questioned how different ways of dealing with medical uncertainty (symptoms, diagnosis) may influence treatment pathways. Semi-structured interviews were conducted with 43 children of 38 family groups of immigrant and non-immigrant backgrounds. The analysis takes into account (a) the perceived symptoms; (b) the meaning attributed to them; and (c) the actions taken to relieve them. The social and cultural contexts that permeate these symptoms, meanings and actions were also examined. It is found that, in light of diagnostic and therapeutic uncertainty, non-immigrant families are more likely to consult health professionals. Immigrant families more readily rely upon home remedies, family support and, for some, religious beliefs to temper the uncertainty linked to abdominal pain. Furthermore, non-immigrant children lead a greater quest for legitimacy of their pain at home while most immigrant families place stomach aches in the range of normality. Intracultural variations nuance these findings, as well as family dynamics. It is concluded that different courses of action and family dynamics reveal that uncertainty is dealt with in multiple ways. Family support, the network, and trust in a child's expression of distress are key elements in order to tolerate uncertainty. Lastly, the medical encounter is described as a space permeated with relational uncertainty given the different registers of expression inherent within a cosmopolitan milieu. Narrative practices being an essential dynamic of this encounter, it is questioned whether families' voices are equally heard in these clinical spaces.
本文探讨了不同种族背景的儿童及其家庭如何感知、理解和处理与功能性胃肠疾病（FGIDs）相关的症状。研究质疑了应对医疗不确定性（症状、诊断）的不同方式如何影响治疗途径。对38个移民和非移民背景家庭组中的43名儿童进行了半结构化访谈。分析考虑了以下因素：（a）感知到的症状；（b）赋予这些症状的意义；（c）为缓解症状所采取的行动。还研究了渗透于这些症状、意义和行动中的社会和文化背景。研究发现，鉴于诊断和治疗的不确定性，非移民家庭更有可能咨询健康专家。移民家庭更倾向于依靠家庭疗法、家庭支持，以及对一些人来说，依靠宗教信仰来缓解与腹痛相关的不确定性。此外，非移民儿童在家中更渴望为自己的疼痛寻求正当性，而大多数移民家庭则认为胃痛属于正常范围。文化内部的差异以及家庭动态使这些研究结果更加细微。研究得出结论，不同的行动过程和家庭动态表明，人们以多种方式应对不确定性。家庭支持、社交网络以及对孩子痛苦表达的信任是容忍不确定性的关键因素。最后，鉴于多元文化环境中固有的不同表达方式，医疗接触被描述为一个充满关系不确定性的空间。叙事实践是这种接触的一个重要动态过程，研究质疑在这些临床环境中家庭的声音是否能得到同等倾听。
