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Language: English
Context: It is difficult to choose the more significant one for me among the many moments of my professional life. I am not saying that they have been all equally important, indeed…
Title of document: INTERDISCIPLINARITY: UTOPIA OR POSSIBLE PATH?
Name of compiler: Sabrina Grigolo
Actors involved: HEalthcare professional - speech therapist
Description of the experience:
It is difficult to choose the more significant one for me among the many moments of my professional life. I am not saying that they have been all equally important, indeed…
Every time I approaches a new patient, it is true, I am deeply grateful for the opportunity I am offered: that of not only knowing the clinical case, but also the human story of that specific person. This saves me, on a daily basis, from the risk of losing interest in a job that is never sterile nor repetitive when it implies being in contact with patients, because you can continuously see gratification in their actions and in their words. However, this positive feedback, it is disheartening to say, does not characterize other moments and situations at work that have an institutional nature.
Therefore, the need for dialog as well as, perhaps, the need to train oneself in contexts even outside the health care sector become compelling to be able, as an operator and as a person to overcome and go ahead, despite the frustrating conditions of daily operations.
To better convey this idea, I will tell you about two experiences particularly relevant for me, as they point out the inspiring motives, or better the values which underlie my professional life.
The first stresses the importance of working on the net even for adult patients from an inter-institutional point of view.
The second relates to the opportunities offered by narrative medicine, that can be successfully applied even in rehabilitation.
After I had worked exclusively with children for 15 years, I started to deal also with adult and elderly people, and 15 years ago I decided to take care only of them. Circumscribing my field of action was positive in the sense that, although the workload has not decreased, now I feel I am more useful, given the complete lack of educational facilities aimed at people who have become disabled suddenly. The disparity between the educational, rehabilitative and/or recreational opportunities offered to people with disabilities during childhood and adolescence and those offered to disabled adults seems to me to be profoundly unjust. We are an aging population, bound to an increase in the number of the chronically ill, in need of continuing care, but we do not invest in services dedicated to these people at all. Instead, we experience the opposite tendency, i.e. the cutting of facilities and services (see LEA, “Essential Levels of Assistance”). Intolerance against this inequality has pushed me to search for alternative solutions for the patients I care for. There is no doubt that having worked with children for many years has taught me how useful the comparison is with other professions and/or with operators of other institutions in the territory. Of course, it would be appropriate to use the same operating model also with adults. However, psychologists or psychiatrists often deal almost exclusively with emergencies and social workers are inactive. I have attempted many times at raising awareness within the context of health care and to the benefit of different patients who share the same problem: that of having become disabled suddenly, due to a disease of a vascular, neurological, tumour and/or traumatic nature. In other words, an event that can disrupt your life overnight, at any age, even at an early stage.
I have looked for support and interdisciplinary debate: I have received no reaction, only silence and isolation and, in some respects, I have lived and experienced within the health care environment the same conditions of isolation and helplessness that the patients I care for live on a daily basis.
Finally, I did not find understanding and collaboration in the health care context, but in cultural services. I have received significant support from XY, the former director of the Library of the Town of Settimo Torinese. He was the only one not to show indifference or suspicion, and he immediately understood what I needed for my patients, providing me with premises, structures and operators. I will be forever grateful for this. Thanks to his support, I succeeded in achieving my first experience of integration between different entities (Health Care and Municipality). Since 1999, in fact, I have collaborated with the Operators of the Multimedia Library of the town of Settimo Torinese for the use of new communication and information technologies, with aphasic and dysarthric patients. The need to make it possible for people with communicative disabilities to access information sources, enabling compromised cognitive functions in an "ecological" way, gave me the opportunity to devise and implement the Edicol@bile Project, which started in January 2002. This project was among the best ones presented in Italy to the 6th edition of the Prize Andrea Alesini for good practices in Health Care 2002 (prize for Health that works, established by the Court for the rights of the sick in 1997-Rome, 14 February 2003).
The General Direction of the Health Care Company, where I work, was contacted to invite the owners of the Project at the awards ceremony, which would be held in Rome in the following days (it took some days to the senior leaders to reconstruct the facts and to trace the author of Edicol@bile). Because there was very little time and Edicol@bile was among the first twenty classified projects, but it was not the first, they decided not to send any representative to Rome. In a very short time, I drew up a poster about the experience to be sent to the organiser of the event, and, from a technical point of view, I was not assisted by the Asl press office, but by the operators of the Multimedia Library. Once again, total support was given me by the operators belonging to different authorities and by patients.
To follow up the path I had undertaken, in 2006 I decided to join training courses in a multicultural context on the topic of autobiography. Thanks to this, I became interested in engaging such methodology in the traditional rehabilitative practice.
At the end of 2006, at the Department of Physical Medicine and Rehabilitation of the Local Health Department TO 4, where I work as a speech therapist, I started to include some moments of autobiographical narrative with selected patients. This experimentation started with the aim to prove that autobiographical practices may also be used with patients who have suffered brain damage and whose ability to speak has been compromised completely or in part because of vascular, tumour, or traumatic causes. This communicative disease, known by the term of aphasia, gives no hope to the person who is affected by it. The aphasic patient, thus, becomes a narrator who is hurt both in the body by an organic pathology and in his ability to speak since he is deprived of his voice and his own identity. Who has the task of re-educating people with communicative disabilities cannot ignore the universal and ancient need to narrate one’s story, that belongs to every human being. This awareness must push the speech therapist to legitimize and encourage patients to narrate not only to improve their linguistic performance, but to help them make sense of what has happened and to find cohesion and continuity between life before and after the disease. The autobiographical method seems to be particularly suitable for the purpose. In fact, it allows to re-establish contacts with the aphasic patient as a person, despite his speaking with great difficulty (words are trapped, strangled, and worn), giving him back the joy of communicating that he has lost.
Thus telling a story without voice, by starting from a disadvantaged condition as that of aphasia, has become possible. The path followed reveals the results achieved not only by the individual patients involved, but also the potential benefits for operators wishing to experiment with methods of a biographical nature.
Objectives:
The first stresses the importance of working on the net even for adult patients from an inter-institutional point of view.
The second relates to the opportunities offered by narrative medicine, that can be successfully applied even in rehabilitation.
Means and Strategy:
Therefore, the need for dialog as well as, perhaps, the need to train oneself in contexts even outside the health care sector become compelling to be able, as an operator and as a person to overcome and go ahead, despite the frustrating conditions of daily operations.
Conclusions:
Thus telling a story without voice, by starting from a disadvantaged condition as that of aphasia, has become possible. The path followed reveals the results achieved not only by the individual patients involved, but also the potential benefits for operators wishing to experiment with methods of a biographical nature.
Name of Institution: Gradenigo Hospital
Role: Project Manager

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