Diverse pathways to care for children with stomach pain in a Canadian cosmopolitan city

Authors

  • Sylvie Fortin PhD,

    Corresponding author
    1. Anthropology Department, Université de Montréal, Montréal, Quebec, Canada
    2. Pediatric Department, Université de Montréal, Montréal, Quebec, Canada
    3. Research Center, Sainte-Justine's Pediatric University Hospital, Montréal, Quebec, Canada
    • Correspondence

      Sylvie Fortin

      Anthropology Department

      Université de Montréal

      C.P. 6128, succursale Centre-ville

      Montréal, Quebec, Canada H3C 3J7

      E-mail: sylvie.fortin@umontreal.ca

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  • Annie Gauthier PhD,

    1. Research Center, Sainte-Justine's Pediatric University Hospital, Montréal, Quebec, Canada
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  • Liliana Gomez MSc,

    1. Anthropology Department, Université de Montréal, Montréal, Quebec, Canada
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  • Gilles Bibeau PhD,

    1. Anthropology Department, Université de Montréal, Montréal, Quebec, Canada
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  • Andrée Rasquin MD,

    1. Pediatric Department, Université de Montréal, Montréal, Quebec, Canada
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  • Christophe Faure MD

    1. Pediatric Department, Université de Montréal, Montréal, Quebec, Canada
    2. Gastroenterology Division, Sainte-Justine's Pediatric University Hospital, Montréal, Quebec, Canada
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Abstract

In Montreal, Quebec, 31% of the population is born outside Canada. Yet, only 9% of patient consultations for symptoms associated with functional gastrointestinal disorders (FGIDs) are from immigrants at the Paediatric Gastroenterology Clinic at Sainte-Justine's University Hospital Centre. This discrepancy inspired a multidisciplinary exploratory study (anthropological and paediatric) to examine the sociological, interpretative and pragmatic aspects of immigrant and non-immigrant patients and family life with FGIDs. This paper examines the discrepancy between immigrant and non-immigrant paediatric patients with FGIDs and presents the different pathways to care utilised by families. Semi-structured interviews were carried out between November 2008 and June 2009, with children and their parents. In total, 38 families were recruited: with 27 families (including a child experiencing abdominal pain, his/her siblings, mother and/or father as well as any other significant individual living in the family home) from the community and 11 from the paediatric gastroenterology clinic. A comparative analysis between the immigrant and non-immigrant groups focused on perceptions, meanings and actions taken to relieve/alleviate symptoms. Immigrant and non-immigrant families alternate and combine different therapeutic environments: home, alternative healing therapies and medical paths to care. Our analysis suggests that culture (as a set of values, beliefs and ways of being), as well as social interactions within family life and the clinic, shape pathways to care. The analysis highlights the centrality of receptiveness – and more widely the social dimensions – of all medical encounters. Treatment disparities between immigrant and non-immigrant families in pathways to care help us to understand these patients' social world and the intricate relationships between values and social milieux, between culture, practices of symptom management and rationales guiding diverse therapeutic actions.

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