Ratsaphoumy Jurine Adyine, Merlet Rachel
Médecin, ancienne interne de la subdivision Antilles-Guyane, formatrice CESISMA, intervenante à l’Université de Guyane (IFSI, DUMG) – CHK – Montsinerry – France.
Docteure en anthropologie et sociologie, Experte GITPA, chargée de cours à l’Université de Guyane (IFSI, DFR Santé) – UG – Cayenne – France
Sante Publique. 2022;34(5):683-693. doi: 10.3917/spub.225.0683.
In French Guiana, Amerindian populations find themselves in a health system whose therapeutic itinerary revolves around their traditional medicine and modern medicine provided by health professionals mostly from hexagonal France. The latter intervene in a “complexity of intercultural contact” which influences the caregiver-patient relationship and affects therapeutic adherence.
To better understand the practices and representations of the health system in an intercultural context, qualitative research was carried out in the field between 2018 and 2019 with seventeen health professionals working in health centers located in the municipalities of the Interior of French Guiana. Semi-structured individual interviews were conducted in order to explore the representations, the difficulties encountered, and the tools used by these caregivers in their daily practice. These interviews were crossed with participant observations and bibliographical research in the medical and anthropological fields.
The caregiver-patient encounter was asymmetrical, unequal and was part of a power relationship. The caregivers remained marked by ethnocentric representations -inherent to each culture- far removed from those of the populations and this divergence impacted the practice.
It would be advisable to shift the focus in order to « penetrate » the frame of reference of the Other and rebalance relationships. The exploration of popular knowledge and skills and the application of proven teaching methods would encourage therapeutic adherence. « Homethnic workers » and intercultural training could help promote community health.
在法属圭亚那，美洲印第安人群体置身于一个医疗体系中，该体系的治疗流程围绕着他们的传统医学以及主要由来自法国本土的医疗专业人员提供的现代医学展开。后者置身于一种“跨文化接触的复杂性”之中，这种复杂性影响着医护人员与患者的关系，并影响治疗依从性。
为了更好地理解跨文化背景下医疗体系的实践与观念，2018年至2019年间在法属圭亚那内陆各市镇的健康中心对17名医护人员进行了实地定性研究。进行了半结构化的个人访谈，以探究这些医护人员在日常实践中的观念、遇到的困难以及使用的工具。这些访谈与参与观察以及医学和人类学领域的文献研究相互印证。
医护人员与患者的接触是不对称、不平等的，且是权力关系的一部分。医护人员仍然受到每种文化所固有的民族中心主义观念的影响，这些观念与当地人群的观念大相径庭，这种差异影响了实践。
建议转移焦点，以便“深入”他人的参照系并重新平衡关系。对大众知识和技能的探索以及采用经过验证的教学方法将有助于提高治疗依从性。“同族裔工作者”和跨文化培训有助于促进社区健康。
