Hearing Multi-voiced Dialogues in Healthcare: Towards Transformative Engagement

Celiane Camargo-Borges

University of Sao Paulo, Riberão Preto

Arlene Katz

Harvard Medical School

Sheila McNamee

University of New Hampshire

http://pubpages.unh.edu/~smcnamee/

The field of healthcare traditionally privileges  SEQ CHAPTER \h \r 1the categorical where, for example, diagnosis of physical and mental problems are pathologized as located within the person.  We seek to address the gap between policy and lived experience and between pre-determined systems of healthcare delivery (one size fits all) and situated, local participatory healthcare creation.  Is there another way to focus on the health and well-being of people in their social context – one that appreciates and respects the value of medical science while simultaneously placing at least equal focus on communication and relational engagement that facilitate or impede the health of a community?

This workshop will explore the ways in which an emphasis on relationship, interaction, language and embodied practices draws attention to our own participation in diagnosis, assessment, and treatment, as well as drawing attention to the ways in which we navigate healthcare.  We will present exemplars of collaborative, participatory practices in which the voice of the community informs professionals’ work with them.  By centering on how dialogue – a fundamentally relational process – offers us various resources for creating ways of going on together, participants will be introduced to generative ideas for transforming our understandings of health and healthcare delivery.  We will explore a variety of options for relational engagement that offer resources for action that move us beyond pathology to forms of interaction that are centered on potential.  These resources include specific ways of inviting others to:  (1) participate in dialogue, (2) enter into different lived experiences, (3) notice what is striking,  (4) appreciate alternatives, (5) navigate multiple experiences and views, (6) embrace stories that create opportunities for different conversations, and (7) engage in relational responsibility. We will consider how such resources transform not only social life but how they refigure the responsibilities of healthcare professionals thereby helping to transform traditional practices into more collaborative and engaged practices.

We invite participants to bring in events from their own healthcare experiences (as healthcare professionals and as users of healthcare services) that they have found exemplars of dialogic, collaborative practice.

CRITICALLY CONFRONTING HIV/AIDS AND ALCOHOL RISKS IN CAMBODIA (2000-2007): MAPPING COMMUNITY HEALTH CHALLENGES, TECHNIQUES AND RESOURCES

Ian Lubek, Jillian Schuster, Trisha Pagnutti, Maggie Hall, Alison Rothwell, Psychology  Department, University of Guelph, Canada

Mee Lian Wong, Lakshmi Ganapathi, Dept. of Occupational and Family Medicine, National University of Singapore

Helen Lee, Health Psychology, University of Staffordshire, UK

Tiny van Merode, School of General Practice, University of Maastricht, Netherlands

Sochua Mu, Cambodian Minister of Women’s Affairs, 1997-2004; Khemara, NGO, Cambodia)

Jessica Cadesky, Humanitarian Policy and Advocacy Unit,Office of Emergency Programs,UNICEF, New York, USA

Sarath Kros, Savun Touch, Maryan Chitt, Tim Tra, Sary Pen, Siem Reap Provincial AIDS Office and SiRCHESI NGO, Cambodia

Bory Ou, Phallamony Em, Sochivy Khieng, Sophea Paal, Srei Neang, Brett Dickson, Pring Noeun, Song Heng, SiRCHESI, NGO, Cambodia

Bun Chemm Dy, Siem Reap Provincial Health Department, Cambodia

 “Critical” insights are drawn from a longitudinal, 7-year multi-sectorial, multi-disciplinary community health program in Siem Reap, Cambodia, guided by theoretical/methodological frameworks from critical health psychology, feminist theory, and Participatory Action Research. We illustrate: first contact/problem assessment, cultural sensitization, in-depth interviews, focus groups, forming an implementing local NGO--SiRCHESI (Siem Reap Citizens for Health, Educational and Social Issues)-- and funding. Workshops for women at risk for HIV/AIDS sent selected peer-educators regularly into the community, while behavioural monitoring surveyed 560 persons annually, child souvenir vendors and men at risk were added, and annual community conferences provided feedback. We prod the globalized beer industry’s recalcitrance to improve workplace health/safety for young women selling international brands (20% HIV+), some forced, inebriated,  into risky sex-work by inadequate wages (www.ethicalbeer.com, www.frairtradebeer.com, www.beergirls.org) . Demonstrations show “data transformations”-- videotaped field interviews, transcriptions, quantification– and development of culturally-sensitive materials for non-literate women. Expansion to “alcohol overuse” involves interviews, questionnaires, breathalyzer testing, and prevention workshops for men drinkers and women sellers, compared to safer Canadian counterparts. SiRCHESI targets 6000 community outreach “secondary-prevention” contacts in 2007. Simultaneously,  a “primary-prevention” project was implemented (2006-2008) to remove women increasingly from high-risk, beer-selling jobs, and train them for safer careers in the Hotel industry, which previously rejected their job applications. Videoclips showing development of this training program and job/academic performance indicators are presented. Additional political and policy-formation activities include the involvement of trade union organizational activities, government legislators, and debating international beer executives in the press and scientific journals (e.g., the Lancet, Sept. 23, 2006).  As partial response to evidence-based claims of unsafe/deadly workplaces, a “professional association” and  “code of conduct” for beersellers was created, but without provision of  fair wages and free access to lifesaving medications (HAART). A 17-minute clip from the documentary, VIRGIN HARVEST (2006), shows one co-author’s actions to reduce enslavement of Cambodian women and children. A give-and-take audience session considers further work and transfers to other settings.  Finally, illustrating self-sustaining processes for health interventions in the developing world, a small  boutique is available with Angkor Wat souvenirs: these help  finance SiRCHESI’s health-delivery services.

MEDIA LITERACY, EDUCATION AND AT-RISK YOUTH

Helena Angell, College of Journalism and Communications, University of Florida Gainesville, Florida, USA

This workshop will examine the effectiveness of media literacy programs available for at-risk adolescent youth.  Media literacy is the ability to access, analyze, evaluate, produce and communicate a variety of media texts and forms. There are many different perspectives on how to educate youth about media, but few programs exist that directly address the needs of at-risk adolescent youth. Studies suggest that the social environment is a key component in the healthy psychosocial development of children. In American society, the broad socialization practices, where there is little conformity, allow for more exposure to risk-taking behaviors and attitudes. The educational, criminal justice, and medical communities now recognize that media play an active role in promoting risk-taking behavior in youth and adolescents. Because of the risk factors identified in the home, individual, and external environment, such as lack of parental involvement, the at-risk adolescent is more susceptible to the information presented in media. Substantial anecdotal evidence and some empirical data suggest that media-literate at-risk youth are more likely to avoid violence, substance abuse, and other negative behaviors. Examples of media literacy programs designed for at-risk youth, such as Flashpoint, exemplify how effective this approach may be in discouraging risk behaviors.

USING SOCIAL EPIDEMIOLOGY AS A TOOL FOR RESEARCH, PROGRAM PLANNING AND COMMUNITY INTERVENTIONS.

EXAMPLE: SAFE MOTHERHOOD IN THE DEVELOPING WORLD – INCORPORATING LESSONS FROM THE FIELD

Julie Cwikel, The Center for Women's Health Studies and Promotion, Ben Gurion University of the Negev, Israel

In this workshop, the SOCEPID model will be presented based on Cwikel, 2006*, the first comprehensive textbook of social epidemiology. This approach draws on theories of community psychology while using the research methods of both epidemiology and the social sciences. Participants will learn how to incorporate qualitative and quantitative methods, to develop culturally-sensitive research and intervention approaches, using the model as a heuristic. World statistics shows that close to 600,000 deaths annually occur from complications of pregnancy and delivery, 99% in the developing world. The method will be demonstrated using qualitative and quantitative research on Safe Motherhood approaches in developing countries.  Using a critical, feminist analysis, this examination leads to policy proposals that both promote women's health and empower women's social status. The application of the SOCEPID model reveals: some traditional practices in developing countries are effective in protecting and promoting health, while others increase the risk of maternal mortality and morbidity. Traditional birth attendants provide services in rural and remote areas where the toll of maternal mortality is particularly high and can be targeted training to enhance their effectiveness as women's health care providers and activists.  This analysis calls for the use of community-based action research models to develop women-centered improvements in the health care services for pregnant and birthing mothers in developing countries.