Primary Health Care und die Folgen einer Verleugnungsstrategie

 

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Zusammenfassung

Trotz hoher Prävalenzen werden nichtsomatische Gesundheitsprobleme in der Dritten Welt bei der medizinischen Grundversorgung oft vernachlässigt. Defizite in der Qualifikation und Motivation des Personals, die mangelnde Bereitschaft der Klienten, ihre Probleme als psychogen wahrzunehmen und „abergläubische” Ursachenzuschreibungen, materielle Beschränkungen und die Nichtanwendbarkeit westlicher psychotherapeutischer Verfahren in außereuropäischen Kulturen werden als mögliche Erklärungen bemüht. Wir überprüfen deren Stichhaltigkeit und eventuelle Auswirkungen auf die Qualität des Dienstleistungsangebots; eine veränderte Form der Personalausbildung mit dem Ziel, die Berücksichtigung psychischer Probleme in den üblichen Leistungskatalog einzugliedern, wird diskutiert.

In spite of high prevalence rates, non-somatic health problems remain largely neglected in Third World First line health services. Deficits in staff qualification and motivation, clients' lack of readiness to perceive their problems as psychogenic, and „superstitious” beliefs as to their causation, material constraints, and the inapplicability of Western psychotherapeutic techniques in non-Western cultures are quoted as possible explanations. We assess their validity and potential consequences for the quality of service delivery; a different approach towards the training of staff, aiming at the integration of attention to psychological problems into everyday service provision, is discussed.

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Dr. med. Pitt Reitmaier

Abteilung Tropenhygiene und öffentliches GesundheitswesenRuprecht-Karls-Universität Heidelberg

Im Neuenheimer Feld 324

69120 Heidelberg

Email: Pitt.Reitmaier@URZ.Uni-Heidelberg.de