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BackgroundIn todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved.MethodsWe accompanied 32 migrant patients (16 of Albanian and Turkish origin each) during their medical encounters at two outpatient clinics using an ethnographic approach (participant observation and semi-structured interviews with patients and healthcare professionals). Overall, data of 34 interviews with patients and physicians on how they perceived their encounter and which difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues.ResultsPatients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients’ behaviour in relation to doctors’ advice< and > relationship issues<.ConclusionsA deeper understanding of the difficulties and challenges that can arise in cross-cultural settings could be provided by bringing together healthcare professionals’ and patients’ perspectives on how a cross- cultural clinical encounter is perceived. Ethical aspects surrounding some of the difficulties could be highlighted and should get more attention in clinical practice and research.

The decision for or against interpreter use in the "real world" of clinical care is complex and shaped by small, frequently inconspicuous decisions with potential for suboptimal health care. Physicians occupy a key position in the decision-making to initiate the process of medical interpreting. The development and testing of a conceptual framework close to practice is crucial for guiding physicians' assessment of patients' language proficiency and their decision-making on the use of interpreting services.

While prosecutions of women who have had an illegal abortion are rare in Cameroon, women who have a legitimate claim to a legal abortion, e.g. following rape, can rarely take advantage of it. This is because the law in Cameroon is not applied, either when it is violated or when it is indicated. This paper examines the histories of four young women who became pregnant and had an abortion in the Anglophone region of the Cameroon Grassfields. Three of them became pregnant following rape or sexual coercion, in one case by the girl's priest, in the second case by her employer's son, and in the third case by a stranger. The fourth young woman, who sold sex for survival money and food, had two abortions while in prison for committing infanticide following a failed attempt to abort an earlier pregnancy. The four young women were interviewed as part of a qualitative, hospital-based study among 65 women who had had abortions in 1996-97. The women's affecting personal histories illuminate the reality of living under a restrictive abortion law, the troubling conditions in which they have to manage their lives, and the harsh circumstances in which they become pregnant and seek (but may not find) a safe abortion.

Introduction As a result of transnational migration, health institutions are faced with growing demand for “restoration” of virginity. The practice of hymen reconstruction constitutes a challenge for health care providers in medical, ethical, judicial, social, and cultural dimensions, for which they are not well prepared. Aim The aim of the presented nationwide survey was to investigate the experience of Swiss gynecologists with women requesting hymen reconstruction. Methods A questionnaire specifically designed for this purpose was sent to 100 public hospitals. Main Outcome Measures Main outcome measures included demands for (number of requests, origin of women) and attitudes toward hymen reconstruction (requests granted, decision-making for or against intervention, surgical technique applied, problems associated with the requests for hymen repair, cost coverage, need for further information) in Switzerland. Results The response rate was 68%. Of the 43 clinics (63.2%) confronted with requests for hymen reconstruction, 38 (90.5%) claimed to see up to five patients per year. The predominantly mentioned countries of origin were Turkey in the German-speaking part and Arab countries in the French-speaking part. More than half of the clinics (27/64.3%) reported that they always (12/28.6%) or mostly (15/35.7%) granted the request. Decision for surgery was made after intensive counseling in 44.2% and on demand of the patient after brief counseling in 32.7%. The so-called approximation method was the most frequently applied surgical technique. A third of the participants (19/35.2%) reported problems with confidentiality. More than half of the clinics expressed their need for further information on this topic. Conclusions Hymen reconstruction is rarely performed in Switzerland, even though two-thirds of the responding hospitals are confronted with this issue several times per year. No guidelines exist on how health professionals should deal with these requests. Interdisciplinary research on how to meet the needs of women and health care providers in such cross-cultural encounters is needed.