In every encounter people do not only exchange words, they also communicate messages by body language and objects. The specialty of non-verbal communication NVC is that many people communicate that way unconsciously and spontaneously and that in most situations it cannot be controlled by the communicator. In this seminar paper I will analyze the diverse functions and forms of NVC. In addition, I will focus on business context, although it could be worthwhile to interpret NVC in other areas, like sport - goal celebration of footballers, or the military- facial expression of North Korean militaries, or politics - e. Business context in this paper means the realm of big companies with at least branches in two different cultures.
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Findings gathered in recent years have mainly focussed on the perspective of care providers, whereas this study includes migrant perspectives. It explores the primary care network of Eritrean immigrants in Switzerland as well as their experiences of interacting with health professionals. Semi-structured face-to-face interviews with intercultural interpreters from Eritrea were conducted.
In this network, encounters with health professionals were predominately expressed positively. The main barriers reported were language difficulties and intercultural understanding. Nevertheless, they are also relevant for other groups of migrants in European countries. As a result of increased migration, cultural diversity in health care has also increased [ 3 ]. Migrant friendly health care provision and equal access to health care are topics that have moved into political, social and scientific focus in Switzerland and abroad [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ].
Socio-economic disadvantages and psychosocial stress factors linked to migration are known to have a negative impact on health [ 6 , 14 , 15 , 16 , 17 , 18 ]. Most barriers and difficulties are due to the interrelation of social determinants, individual characteristics and institutional conditions [ 20 , 21 ]. Health professionals perceive communication to be the major challenge in encounters with migrants: language difficulties and different intercultural understanding of roles, health and illness, and examination and treatment options [ 21 , 22 , 23 ].
To deal with diversity and to overcome difficulties, intercultural interpreters play an important role [ 21 , 22 , 27 , 28 ]. Moreover, fostering health literacy of patients with a migration background and the transcultural competencies of healthcare professionals are emphasised [ 5 , 21 , 22 ].
Despite the findings gathered in recent years, there are still knowledge gaps regarding the quality of care in relation to communication difficulties, and barriers for migrants in accessing healthcare [ 4 ]. Many studies have investigated provider perspectives but research lacks the inclusion of migrant perspectives [ 13 , 23 , 29 ].
Furthermore, focusing on specific migrant groups would help to clarify cultural differences and experiences of health care [ 29 ]. By the primary care network, we mean the persons and institutions that the migrants contact first in case of health problems. Answering the above mentioned questions should contribute to better understanding for providers and policy makers, and to fostering satisfactory interactions between migrants and healthcare professionals.
The focus was set on immigrants from Eritrea as they have accounted for the largest group of asylum seekers and recognised refugees in Switzerland for some years [ 30 ]. In addition, the cultural background of immigrants from Eritrea is very different from the Swiss context.
The focus was set on the role of primary care physicians because in Switzerland, general practitioners are usually the first contact point in case of illness [ 31 ], whereas a general practitioner system is not known in Eritrea [ 26 ].
The empirical basis of this paper is eight semi-structured face-to-face interviews with intercultural interpreters. Participants eligible for this study were adult immigrants from Eritrea living in Switzerland and being active as intercultural interpreters.
Intercultural interpreters were chosen since they are seen as bridge-builders between patients and healthcare professionals.
They know both the Eritrean and the Swiss culture, and are able to report on the experiences of different individuals. In Switzerland, the placement of qualified intercultural interpreters is organised by regional agencies [ 32 ]. For the recruitment, an e-mail accompanied by an information sheet was sent to all eleven institutions in German speaking Switzerland, which are organising the placement of translators there are four different language regions in Switzerland of which the German speaking part is the largest.
Seven of them forwarded the request to their Eritrean interpreters. Eight volunteers responded to this request and took part in the study. All participants signed an informed consent form. According to the Ethics Committee Northwest and Central Switzerland, ethical approval was not required for this study as it did not involve research on disease or the structure and functioning of the human body.
The interviews were based on an interview guide with a series of open questions to identify the institutions and the persons relevant for the refugees in case of health issues. This technique, originally developed by Jacob Levy Moreno, is based on a systemic approach and allows visualising relations and their quality. Furthermore, the interview included open questions on experiences with health professionals in Switzerland and on relevant cultural aspects.
Each interview took about an hour and was conducted in German. All interviews were audiotaped and transcribed verbatim. In addition, the author made field notes. Table 1 shows the demographic and work characteristics of the eight intercultural interpreters interviewed. With four female and four male participants, the gender balance was even. The age ranged from 26 years to 53 years with a mean age of On average, the participants had been living in Switzerland for An initial inclusion criterion was that the participants were born in Eritrea.
However, one participant was born in Ethiopia, another in Sudan. Nevertheless, they were included as they are familiar with the Eritrean culture and interpret for Eritrean people. All participants were qualified intercultural interpreters and on average had been active for 5.
As a group, they had a high educational level, with half of them having received a tertiary education. All participants spoke Tigrinya, the most widespread language in Eritrea, plus English and German.
In addition, participants covered several other languages spoken in Eritrea. The religious affiliations in the sample were comparable to the distribution among Eritreans in Switzerland, where the vast majority are Orthodox and Catholic [ 26 ].
Participants bring in a broad variety of work experiences in diverse health care settings in urban and rural areas in German-speaking Switzerland. Their clients are Eritrean immigrants of all ages. The participants described their clients as people with insufficient local language skills, most of whom have been living in Switzerland for less than five years sometimes up to 10 years and with little contact with the local population.
Participants reported that the number of interpreting assignments varies, but usually ranges from three to five assignments per week. After reading and familiarisation with the data, a complete coding across the entire dataset was carried out, after which patterns and themes were identified. The coding and the analysis were based on the approach proposed by Braun and Clarke [ 34 ].
Quotations from the interviews were selected to illustrate the findings. All quotations were translated into English. The results were discussed with an Eritrean epidemiologist who lives in Switzerland and studied medicine in Eritrea and his feedback is incorporated into this article the corresponding parts are declared. Figure 1 provides an overview of the most important informal and formal points of contact and their main forms of support.
The characteristics of each actor are described below, with a particular weight on the primary care physician. Although in the interviews it was emphasised that resident status plays a relevant role in the assignment of a doctor, interpreter or financial support, the pictured network did not differ fundamentally between individuals with different resident statuses.
Where applicable, differences are described. Source: own illustration based upon the interviews. Family and relatives are important for giving advice and care in the case of illness or health related issues.
However, many Eritrean immigrants do not have family in Switzerland, and this fact is linked with psychological stress.
For those, in particular adolescents and young adults under 25 years, friends and acquaintances or professionals play an essential role. As a result of language barriers and cultural aspects, these friends and acquaintances are mostly fellow Eritreans contacts from the asylum centre, language school or Eritreans who have lived in Switzerland longer.
They provide care or information on where to seek help. Volunteers were named as important support, and not only in case of illness. They support integration and can be persons of trust, who are contacted in cases of questions or health problems.
Volunteers are mostly Swiss who have been recruited by an NGO such as Caritas, which is engaged in supporting the integration of migrants. In some cases, volunteers act on an individual basis and met the immigrant at a neighbourhood event, for example.
In some cases, the connection to relatives in Eritrea seems relevant, too, for example to import healing clay, plants and herbs to support recovery. The meaning of religion and religious persons was assessed inconsistently and is not displayed in the figure. The majority opinion was that religious persons are seldom consulted for health problems though they can sometimes be consulted in cases of mental health problems.
However, for some individuals, the use of sacred water, prayer and attendance at holy mass in their mother tongue play a role in staying healthy or in recovery. Concerning formal support, the role of social workers is particularly stressed. In Switzerland, every person seeking asylum is entitled to assistance from a social worker. Initial support is provided in the federal asylum centres. Social workers provide information about medical support and the health system in Switzerland, and they are responsible for the financial support to which migrants are entitled.
Contact with social workers is described as fundamentally important as they provide relevant information not only concerning health, but also about life in Switzerland and integration. For people in asylum centres and in particular minors, social workers are often the first contact in the case of health problems and they are typically the ones to make referrals to a physician. However, social workers from the social welfare office are also frequently contacted, for example, when it comes to financial issues or for support in organising an appointment or an interpreter.
Eritrean immigrants seek medical treatment in hospital or at their primary care physician, though not typically the pharmacy.
While people are waiting for the decision on residence status from the State Secretariat for Migration, the primary care physician is assigned by the State. Later migrants can choose a primary care physician freely. Upon arrival in Switzerland, many Eritreans tend to seek medical help at a hospital rather than with a primary care physician, which may be related to the fact that participants reported commonly visiting the hospital in Eritrea, since the general practitioner system is not known there.
However, when they have learned about and experienced the general practitioner system, the primary care physician may become an important person of trust. The migrants consider it positive that their physician knows them and their health history personally. In Swiss hospitals, the health history of patients who have been previously treated by a primary care physician or in another hospital is often not available, since an e-health database of this information is not very well developed in Switzerland [ 35 ].
Private or state-run counselling centres and organisations like Caritas or Swiss Red Cross are mentioned as important support sources for information on the health care system and addresses of services and professionals. In some cantons, such organisations coordinate interpreting services or volunteer interpreters.
Eritrean immigrants mostly get to know about these options through their social workers, or through relatives and friends. When people are lacking local language skills, intercultural interpreters are essential support in the interaction between patients and health professionals. Participants stated that Eritrean immigrants frequently face the problem that they do not know contacts for interpreting when health professionals tell them to bring an interpreter with them.
A further difficulty is that the financing of interpreters is not fully clear.
Edith Broszinsky Schwabe
Interkulturelle Kommunikation : Missverständnisse - Verständigung
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The Role of Non-Verbal Communication in Intercultural Business