What does global health translate into?

doctor 19

(Ani Kolleshi, Unsplash)

This article was exclusively written for The European Sting by Mr. Felipe Leonardo a third-year medical student at the Pontifícia Universidade Católica de São Paulo (PUCSP), in the city of Sorocaba, state of São Paulo, Brazil. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Since 2010, a large Haitian migratory wave has brought to Brazil approximately 49 thousand immigrants from that country who have spread throughout the territory from the northern border, concentrating, however, on the southern region. It began a process of organization marked by the acquisition of housing (often in the poorest areas and with less basic sanitation) and job, which led to the establishment of small colonies throughout Brazil. Included in this migratory event is the fact that they started to use the national health system (SUS), which has as one of its doctrinal principles the universality.

Near the completion of the first decade of this event, however, one still perceives a very intense ethnographic obstacle in some of these colonies: linguistic incompatibility. Being officially a bilingual country, Haiti has as official languages ​​French and Haitian Creole, which do not resemble phonetically or etymologically the Portuguese spoken in Brazil. This factor acts as a fundamental social determinants of health when addressing the migratory phenomenon, as it directly influences the health care that the individual will receive, which is strongly dependent on communicative ties.

Recently, a case of a Haitian woman who sought medical attention with severe hypertension was identified in a basic health unit in the interior of the state of São Paulo, which was only identified after the basic clinical propaedeutics, since no attendant of that unit spoke French – let alone the Creole – and neither Haitian nor any relative spoke Portuguese or English. However, after checking for this circulatory abnormality, the consultation couldn’t proceed adequately since there wasn’t way to advise secondary prevention behaviors, or even the correct way to take the prescribed medication. At the end of the consultation, both doctor and patient were distressed by the nullity of the established dialogue, stating that semiology alone is not a universal language capable of establishing an efficient and integral physician-patient relationship.

It is foreseen by the UN Global Compact for Safe, Ordained and Regular Migration at the end of 2018, from which Brazil withdrew earlier this year, which is the responsibility of the countries that receive migrants to “reduce communication barriers”, which translates to what comes next: “train health care providers in a way that makes them culturally sensitive.” In this way, although not aligned with the block of countries that are following this global norm, Brazil owes this to the aforementioned principle of universality. To this end, it is imperative to formulate public policies that respond to this demand, and for these to be effective, they must involve both properly translated and textual resources translated and freely provided to health services that help professionals to communicate with Haitians (and other mainly immigrant peoples, as is also the case with Venezuelans), as well as well-trained and strategically distributed human resources in places with the highest concentration of immigrants.

References

Global Compact for Safe, Orderly and Regular Migration. Intergovernmentally Negotiated Agreed Outcome,  ONU, v.1949-97, New York, 2018.

World Health Organization. Promoting the health of refugees and migrants: Draft framework of priorities and guiding principles to promote the health of refugees and migrants. Seventieth World Health Assembly, 2017.

Oliveira, Wagner. Haitianos no Brasil: Hipóteses sobre a distribuição espacial dos imigrantes pelo território brasileiro. DAPP – FGV, 2017, disponível em http://dapp.fgv.br/haitianos-no-brasil-hipoteses-sobre-distribuicao-espacial-dos-imigrantes-pelo-territorio-brasileiro/

Rosa, LA; Souza, ACS. A língua portuguesa e os imigrantes haitianos em Campo Grande-MS. Departamento de Letras, UEMS, 2015, disponível em https://semanaacademica.org.br/system/files/artigos/artigo_leomar_0.pdf

About the author

Felipe Leonardo is twenty-four years old and a third-year medical student at the Pontifícia Universidade Católica de São Paulo (PUCSP), in the city of Sorocaba, state of São Paulo, Brazil. Current Local Office Medical Education Director (LOME-D) of Local Committee of IFMSA Brazil. He is also tutor of the FELLOWS student improvement program and secretary of the Paulista Alliance of Trauma Leagues (ABLAT).

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