Préoccupations et attentes en réadaptation physique
dans des contextes pluralistes :
vers un cadre théorique interculturel [2012]

Abstract

Concerns and Expectations for Physical Rehabilitation in Pluralistic Contexts: Towards an Intercultural Theoretical framework

This thesis is based on the intercultural and institutional dynamics of health care in pluralistic contexts. The clinical context makes it possible to understand what is at stake in encounters between people of different ethnic and religious backgrounds. The field of physical rehabilitation is a particularly interesting context for understanding these dynamics because interventions require long-term assessment and sustained collaboration on the part of clients. The current research examines three types of actors in this context: immigrant clients, health care specialists (or practitioners), and third party payers (CSST). In order to elaborate an intercultural theoretical framework, the thesis critically examines modernist and postmodernist orientations in anthropology, and through an epistemological approach proposes an interactionist orientation. These differing epistemological orientations are studied from a clinical standpoint and, the resulting analysis prepares the way for a dialogue between practitioners and anthropologists. The ethnographic context sheds light on various themes concerning the politics of healthcare in pluralistic contexts, but also the policies that influence different relationships between macroeconomics and local-level encounters in organizational settings. The system of physical rehabilitation in Quebec serves as a canvas to understand concerns and expectations of the different types actors solicited by this research.

The ethnographic data presented here highlights the convergence and divergence between those who are involved in administering and receiving care. After describing the conditions and terms of intervention in the field of physical rehabilitation, there is a discussion of the specificity of immigrant clients and healthcare in pluriethnic contexts. Data collected from different actors highlights the difference between objective barriers to adequate services and factors which can be linked to culture. Analysis of the data focuses on communication in an intercultural or pluriethnic context and the flow of information, carefully examining the relationship between information, expertise and prejudice. The analysis also offers certain pathways to better understand the lack of reactivity in pluralistic contexts. The conclusion proposes a complementary approach which is intended to facilitate a dialogue between models based on discrimination and those on interculturalism. Anthropologists are presented as being particularly well positioned to answer new challenges generated by intercultural situations in an era of neoliberalism.

Keywords : physical rehabilitation, health, reactivity, pluralistic contexts, pluriethnic contexts, handicaps, immigrants, social insertion, discrimination, intercultural relations, care, intercultural anthropology, neoliberalism, Québec, Canada, United States of America.