The asymmetrical relationship between the health care professional and the patient in public hospitals

The relationship between the health care professional and the patient is universally seen, in medicine, as the core of medical practice. Through it, the doctor acquires professional abilities and pursues the objectives of medicine, among them, that of curing. This relation is contextualized here by using articles 47 and 48, from the chapter on Human Rights, found in the Code of Ethical Medicine of the Federal Council of Medicine of the Federative Republic of Brazil--both in the sense of the transformational link between two people, and as a relationship of interpersonal tolerance. The objectives of this article are: 1) to evaluate the asymmetry present in the clinical doctor-patient encounter, with respect to the doctor's social and political commitment regarding the patient. Recorded testimonies were used, of individuals who utilize medical assistance in Public Hospitals, carried out in the hallways of the 'das Clínicas Hospital' in Recife, Pernambuco; and 2) to weave an analogy with the book "Masters and Slaves" ('Casa Grande & Senzala'): 'Formation of the Brazilian Family under the Regime of a Patriarchal Economy', written by the Pernambucan sociologist Gilberto Freyre. Among the recorded talks, the resentment regarding discrimination and the authority of the doctor's position can be clearly observed. As a result, this power relation was considered the focus of our discussion--the same power relation as that which reigned over the Brazilian colonization period, in the times of "Masters and Slaves" (Casa Grande & Senzala).

Continuing the dialogue: postcolonial feminist scholarship and Bourdieu ? discourses of culture and points of connection

Postcolonial feminist theories provide the analytic tools to address issues of structural inequities in groups that historically have been socially and economically disadvantaged. In this paper we question what value might be added to postcolonial feminist theories on culture by drawing on Bourdieu. Are there points of connection? Like postcolonial feminists, he puts forward a position that aims to unmask oppressive structures. We argue that, while there are points of connection, there are also epistemologic and methodologic differences between postcolonial feminist perspectives and Bourdieu's work. Nonetheless, engagement with different theoretical perspectives carries the promise of new insights - new ways of 'seeing' and 'understanding' that might enhance a praxis-oriented theoretical perspective in healthcare delivery.

Decolonising research: a shift toward reconciliation

Although awareness of cultural differences that distinguish Indigenous peoples has increased worldwide following attention from international human rights bodies, Indigenous cultural values have had little influence in shaping research agendas or methods of inquiry. Self-determination and reconciliation policies have been part of the decolonisation agenda of governments for several decades; however, these have not, until recently, been considered of relevance to research. Indigenous peoples feel that they are the most studied population in Australia, to the point where even the word research arouses feelings of suspicion and defensive attitudes. Indigenous people are generally cynical about the benefits of research and cautious toward what many perceive to be the colonial mentality or 'positional superiority' ingrained in the psyche of western researchers. This article examines the characteristics and colonising effects of traditional research methods and describes an alternative, decolonising approach. Decolonising research methodology is congruent with Indigenous epistemology and is guided by the values and research agenda of Indigenous people. The Guidelines for ethical conduct in Aboriginal and Torres Strait islander health research, developed by the National Aboriginal and Islander Health Organisation (NAIHO) with the National Health & Medical Research Council (NHMRC) in 2003 are examined, as they exemplify a decolonising paradigm for researchers.

Research brief: the need for historically grounded HIV/AIDS prevention research among Native Americans

This is a brief report that summarizes the need for historically grounded HIV prevention research among Native Americans living in the United States. It illustrates the intersection of culture and history, showing that ethnic groups can respond to historical traumatic events for generations, often to the detriment of individual and collective health.

HIV risk, systemic inequities, and Aboriginal youth: widening the circle for HIV prevention programming

BACKGROUND

In Canada, Aboriginal people are overrepresented in the HIV epidemic and infected at a younger age than non-Aboriginal people. This paper discusses some of the ways Aboriginal youth in Toronto understand HIV/AIDS risk and the relevance of their comments for HIV prevention education. This research is part of a larger study conducted with Ontario youth through the Gendering Adolescent AIDS Prevention (GAAP) project.

METHODS

We conducted 11 GAAP focus groups with Ontario youth. This paper focuses primarily on the four groups of Aboriginal youth. A modified grounded theory approach guided analyses. Data were coded using Nud*ist qualitative data management software.

FINDINGS

Aboriginal youth were more aware of HIV/AIDS and the structural inequities that contribute to risk than their non-Aboriginal counterparts. In addition, they were the only group to talk about colonialism in the context of HIV in their community. Aboriginal youth were, however, more likely to hold a fatalistic view of their future and to blame their own community for high infection rates.

INTERPRETATION

We argue for incorporating structural factors of risk, including the legacy of colonialism, in HIV prevention programs for all youth. This may help to eradicate the stigma and self-blame that negatively impact on Aboriginal youth while allowing other youth populations to distance themselves from the disease.

The changing conceptions and focus of health research in East Africa

Perceptions in health research are a product of the circumstances within the society, where the research activities are situated. In East Africa there has been a change in conceptualization over a period of time from an elitist de-linked status to the present, which has evolved to embrace the local community. Here we trace the changes and highlight some occurrences that exerted the greatest influence in shaping the notions that currently dominate in research. We conclude that the paradigm shift is a positive development and that the present conception is suitable for heath research at this point in time.

Knowledge development and evidence-based practice: insights and opportunities from a postcolonial feminist perspective for transformative nursing practice

Although not without its critics, evidence-based practice is widely espoused as supporting professional nursing practice. Engaging with the evidence-based practice discourse from a vantage point offered by the critical perspectives of postcolonial feminism, the incomplete epistemologies and limitations of the standardization characteristic of the evidences-based movement are analyzed. Critical analysis of evidence is suggested, such that it recognizes the evidence generated from multiple paradigms of inquiry, along with contextual interpretation and application of this evidence. We examine how broader interpretations of evidence might contribute to nursing knowledge development and translation for transformative professional nursing practice, and ultimately to address persistent health disparities within the complex context of healthcare delivery.

Empire matters: implications for pastoral care

In this essay, I argue that the American Empire matters for pastoral care. I begin with a discussion of the meaning of empire and the particular historical roots and characteristics of the American Empire. From this, I contend that the American Empire matters because the United States has had a long history of expansionist aims, which has been couched in idealized secular discourse as well as ensconced in theo-political discourse. These discourses, which have, implicitly or explicitly, supported foreign policies and actions aimed at political, economic, and military dominion, are joined to an empire psyche. This empire psyche and the actions of U.S. governments are matters for pastoral care because of a) the various physical, psychological, and spiritual harms that attend hubris, greed, entitlement, and the quest for hegemony, and b) the theological contradictions inherent in Christian discourse that supports the American Empire. These consequences and contradictions serve as reasons why pastoral theologians and caregivers ought to bring these matters to public reflection and conversation. I conclude with a brief depiction of possible pastoral actions given the reality of the American Empire.

Health at the time of Native-European contact in Southern Patagonia: First steps, results, and prospects

The objective of this paper is to present the first steps into the study of health in southern Patagonia during pre and post Native-European contact. Thus, our work has a double purpose. First, to discuss characteristics and relevance of human bone records of southern Patagonia, in order to study health in a population context. Second, to show some new lines of information, which include paleoparasitology, nutritional paleopathologies, and the study of lifestyles from human remains. In this context, we have started working on the first Spanish settlement "Nombre de Jesus", founded in 1584, and with historical documentation of "La Candelaria" Mission in Rio Grande (1896-1931).

Engaging diversity's underbelly: a story from an immigrant parish community

: This story explores an intervention conducted in a Catholic parish community in New York City. The intervention, conducted by the author and a Jesuit priest, focused on issues of unity and diversity among the various Chinese immigrant subgroups in the parish (primarily Cantonese- and Mandarin-speakers). Issues of class, power, and a history of colonialism in the Catholic Church are explored as central to the relations among culturally diverse Chinese American community members and between the members and the practitioners and the church authority. The author especially focuses on how the dynamics that played out in the intervention reflected wider issues of economics, labor practices, and political elitism in the wider Chinatown community. A central part of the author's argument is about power relationships between this parish community and Chinatown and how these power relationships are embedded within broader racial and economic oppression within the United States.

Colonialism and countertransference: two cases of the sexual abuse of women by doctors

The presentation of encounters with two migrant doctors with a past history of extreme sexual exploitation of their female patients presents an uncomfortable coming together of cultural observation, medical ethics and therapeutic transference. Colonial and postcolonial stereotypes evoked by their actions are briefly considered.

Whiteness and difference in nursing

This paper uses a semiotic, performative theory of language and post-colonial theory to argue that nursing's representations of 'multiculturalism' need to be grounded in a theory of whiteness, an historicized understanding of how ethnic/cultural differences come to be represented in the ways they are and informed by Foucault's notions of power/knowledge. Using nursing education and 'cultural compentency' as examples, the paper draws on a range of literatures to suggest more critical and politically productive ways of approaching difference from within nursing's largely white interpretive framework.

Bringing safety and responsiveness into the forefront of care for pregnant and parenting aboriginal people

Poor access to prenatal care for Aboriginal people is well documented, and is explicated as an unethical barrier to care resulting from colonial and neocolonial values, attitudes, and practices. A postcolonial standpoint, participatory research principles, and a case study design were used to investigate 2 Aboriginal organizations' experiences improving care for pregnant and parenting Aboriginal people. Data were collected through exploratory interviews and small-group discussions with purposefully selected community leaders, providers, and community members. The study found that safety in healthcare relationships and settings, and responsiveness to individuals' and families' unique experiences and capacities must be brought into the forefront of care. Results suggest that the intention of care must be situated within a broader view of colonizing relations to improve early access to, and relevance of, care during pregnancy and parenting for Aboriginal people.

Moving beyond the "exotic": applying postcolonial theory in health research

Postcolonialism offers nursing scholarship a framework for understanding culture and identity as fluid and complex, historically situated, and discursively constructed. This article describes one version of implementing postcolonial theory, using examples from a research project conducted with urban American Indians on the topic of diabetes. I demonstrate the influence and value of postcolonialism throughout the research process. A postcolonial approach can help nursing researchers and practitioners avoid reproducing injustices and stereotypes, illuminate the complexities of life at the intersections, and contribute to the construction of a more socially just world.

Colonial mentality: A review and recommendation for filipino american psychology

Colonial mentality is a term used widely by ethnic studies scholars and by the Filipino American community to refer to a form of internalized oppression among Filipinos and Filipino Americans. The authors propose that colonial mentality is a construct that is central to the understanding of the psychology of contemporary Filipino Americans. Drawing on larger scholarship from postcolonial studies and psychological research on oppression, the authors review the historical and sociological contexts in which to understand the significance of the colonial mentality concept for the Filipino American population. The authors also review the existing literature on colonial mentality and provide specific recommendations for incorporating this construct into research and practice with Filipino Americans. It is argued, through this illustrative example of colonial mentality among Filipino Americans, that examining the psychological impact of colonialism is a way to incorporate larger historical and sociological contextual variables into ethnic minority research and practice.

Josephine Baker: psychoanalysis and the colonial fetish

This paper traces an intricate path connecting racial fantasy, aesthetic judgment, and the larger cultural problem of inter-subjective recognition. In particular, the author examines the theme of fetishism, both sexual and racial, in a Western historical, colonial context, in order to unravel a set of disturbances that cohere around the racial fetish then and now. Taking the figure of an entertainment icon of the 1920s, Josephine Baker, as a case study, the author shows how the imagination of the colonizing white male was both articulated and disrupted by Baker as a ready-made representation of the cultural, racial, and sexual other.

Globalization and global health: toward nursing praxis in the global community

Considerable evidence suggests that neocolonialism, in the form of economic globalization as it has evolved since the 1980s, contributes significantly to the poverty and immense global burden of disease experienced by peoples of the developing world, as well as to escalating environmental degradation of alarming proportions. Nursing's fundamental responsibilities to promote health, prevent disease, and alleviate suffering call for the expression of caring for humanity and environment through political activism at local, national, and international levels to bring about reforms of the current global economic order.

Race, culture and ethnicity in minority research: a critical discussion

Race and ethnicity are terms commonly used in ethnic minority research. Both these terms present a number of problems in terms of definition and classification. It is argued here that there is a need to move beyond essentialised concepts of race and ethnicity to examine the socio-political processes which relate to their social construction and the ways in which these terms articulate with other categories such as social class and gender and structure social relationships. The implications of the social constructionist position are discussed specifically in relation to the use of interpreters and ethnic matching of researcher and respondent in qualitative research on ethnic minorities.