Research in an intercultural context: mediator-investigators of epidemiological health studies, bridges between two worlds.

Context: French Guiana is a French overseas department where very different linguistic, cultural and societal populations live together in a small area. Health issues and their specific epidemiological profiles call for research projects crossing several cultures. In this context, health mediators have a role to play in research. The aim of this study was to describe the perceptions, attitudes and opinions on research of mediators and researchers collaborating on research projects, and to describe the strengths and difficulties encountered during this cooperation. Methods: The Inter-med project was conducted in French Guiana between February 2022 and April 2023 on the base of semi-directive interviews with mediators, or researchers, all working in health research in the intercultural context of French Guiana. The socio-demographic characteristics of the participants were described. An inductive thematic analysis was carried out on all the interviews, and word occurrence analysis on certain themes. The information was triangulated with field coordination notebooks from two epidemiological surveys conducted in French Guiana between 2021 and 2022. Results: A total of 26 semi-structured interviews were conducted and 1,328 notebook pages analyzed. Mediation was described as an indispensable interface between the world of research and that of the population targeted by a survey. Mediators have a role to play at different stages of projects, in respect of good clinical practice, ethics and legislation. They act as interfaces between languages, concepts and representations. Their profession remains under-defined and under-dimensioned. The jobs offered are often precarious. Mediation work is emotionally costly, calls on soft skills and requires a combination of rigor and flexibility. All these aspects are implemented in the specific world of research, where there are common concepts and divergent perceptions. Researchers and mediators converge on a common goal: improving health. Conclusion: This study covers several aspects of the development and implementation of research projects. Respect for good clinical practice and people, transparency and data quality are redundant concerns, and this study touches on ethnocentrism, stigmatization and cultural representations. This study points out that the integration and recognition of mediators could be beneficial in research conducted in a cross-cultural context.

Anthropology and ethnobotany in health mediation: an illustration of a clinical, personalized approach for Haitian migrants in a French Guianese hospital.

Introduction: In French Guiana, a European territory in Guiana shield in the Amazon area, close to 40% of the current population was born abroad. In this context, it is important to listen to the experiences of migrants to better understand the difficulties encountered within the healthcare pathways. This is the aim of ANRS Parcours d'Haïti project, an epidemiological, biographical and socio-anthropological study conducted on a representative sample of the Haitian community in French Guiana and focusing on the social determinants of health. Methodology: Within the framework of this study, the Infectious and Tropical Diseases clinical team of Cayenne Hospital has established close collaboration with health mediators and the ethnobotanist anthropologist of the study. To illustrate the contribution of a personalized approach to health mediation, we report the case of a migrant woman of Haitian origin admitted to the Infectious and Tropical Diseases Unit. We highlight the different socio-cultural aspects addressed and their place in the care process through a thematic discussion and socio-anthropological analysis of the care relationship, based on participatory ethnography and inductive analysis of an in-depth interview with the patient. Result: This example illustrates the need for a multidisciplinary approach to ensure culturally adapted care for patients. Personal interviews are important because they allow to better take into account the cultural specificities of patients' experiences and the socio-cultural environment in which they live (and especially, in the case of Haitian patients, their religious affiliation). By allowing them to speak and express themselves freely, they integrate not only their own cultural baggage, but also their own expectations and representations of the disease they suffer from and how it should be treated. Ultimately, this tripartite collaboration between patient, caregiver, and anthropologist or health mediator leads to a better therapeutic alliance. Conclusion: The analysis of this health care relationship is emblematic of the issue of cultural competence and pre-conceptualizes what intercultural mediation in health care could be, as close as possible to the caregiver and the individual.

Access to health care for migrants in French Guiana in 2022: a qualitative study of health care system actors.

Background: Access to health care is a major public health issue. The social determinants of health have a role in accessing health care and in meeting the health needs of populations. With 281 million international migrants around the world, population movements are another major issue. Migrants are particularly exposed to precariousness during their migratory journey and after their settlement. These vulnerabilities may have deleterious effects on their health status and on their social conditions. In French Guiana, 36% of the population is of foreign origin. The objective of this study is to explore the barriers and the facilitators to accessing health care for migrants in French Guiana in 2022, from the perspective of health care professionals, social workers and local NGO actors. Methods: This research is an exploratory qualitative study based on the experiential knowledge of health care professionals, social workers and local NGO actors in French Guiana. 25 semi-structured interviews were conducted with these professionals and actors between April and June 2022, using an interview guide to explore their practices, representations and beliefs of access to health care and accompaniment of migrants in their patient journey. The interviews were transcribed and analyzed using the thematic analysis method. Results: A total of 25 health care professionals, social workers and local NGO actors were included in the study. Participants highlighted that migrants are exposed to many factors hindering their access to health care in French Guiana (administrative complexity, language barriers, financial barriers, mobility issues, etc.). With the situations of great precariousness and the inadequacies of the public authorities, associative support (social, health and legal accompaniment process provided by NGOs and associations) has an important role in providing close support to migrants. Moreover, health mediation supports migrants in their social and health care journey to lead them toward empowerment. Health mediators contribute to promote a better understanding between professionals and migrants. Conclusion: In French Guiana, associative support and health mediation promote access to health care and social accompaniment for migrants. This article highlights the issues surrounding access to health care, associative support and health mediation in the Guianese context, which is marked by significant socio-cultural diversity and precariousness. Considering the benefits of associative support and health mediation, as well as social inequalities in health, is essential for health care professionals, social workers, local NGO actors, associations, public health authorities and political decision-makers to initiate concrete and suitable actions in favor of access to health care and social support for migrants in French Guiana.

Adaptive ecological knowledge among the Ndjuka Maroons of French Guiana; a case study of two 'invasive species': Melaleuca quinquenervia and Acacia mangium.

BACKGROUND: To understand how local ecological knowledge changes and adapts, here in the case of the recent introduction of plant species, we report the knowledge and perceptions of the Ndjuka (Maroon) of French Guiana concerning two tree species, Acacia mangium and niaouli (Melaleuca quinquenervia), which are categorized as "invasive alien plants" in the savannas of their territory. METHODS: To this end, semi-structured interviews were conducted between April and July 2022, using a pre-designed questionnaire, plant samples and photographs. The uses, local ecological knowledge, and representations of these species were surveyed among populations of Maroon origin in western French Guiana. All responses to closed questions collected during the field survey were compiled into an Excel spreadsheet in order to perform quantitative analyses, including the calculation of use reports (URs). RESULTS: It appears that the local populations have integrated these two plant species, which are named, used and even traded, into their knowledge systems. On the other hand, neither foreignness nor invasiveness seem to be relevant concepts in the perspective of the informants. The usefulness of these plants is the determining factor of their integration into the Ndjuka medicinal flora, thus resulting in the adaptation of their local ecological knowledge. CONCLUSION: In addition to highlighting the need for the integration of the discourse of local stakeholders into the management of "invasive alien species," this study also allows us to observe the forms of adaptation that are set in motion by the arrival of a new species, particularly within populations that are themselves the result of recent migrations. Our results furthermore indicate that such adaptations of local ecological knowledge can occur very quickly.

[Overview of infectious and non-infectious diseases in French Guiana in 2022]. / Panorama des pathologies infectieuses et non infectieuses de Guyane en 2022.

Source of many myths, French Guiana represents an exceptional territory due to the richness of its biodiversity and the variety of its communities. The only European territory in Amazonia, surrounded by the Brazilian giant and the little-known Suriname, Ariane 6 rockets are launched from Kourou while 50% of the population lives below the poverty line. This paradoxical situation is a source of health problems specific to this territory, whether they be infectious diseases with unknown germs, intoxications or chronic pathologies.Some infectious diseases such as Q fever, toxoplasmosis, cryptococcosis or HIV infection are in common with temperate countries, but present specificities leading to sometimes different management and medical reasoning. In addition to these pathologies, many tropical diseases are present in an endemic and / or epidemic mode such as malaria, leishmaniasis, Chagas disease, histoplasmosis or dengue. Besides, Amazonian dermatology is extremely varied, ranging from rare but serious pathologies (Buruli ulcer, leprosy) to others which are frequent and benign such as agouti lice (mites of the family Trombiculidae) or papillonitis. Envenomations by wild fauna are not rare, and deserve an appropriate management of the incriminated taxon. Obstetrical, cardiovascular and metabolic cosmopolitan pathologies sometimes take on a particular dimension in French Guiana that must be taken into account in the management of patients. Finally, different types of intoxication are to be known by practitioners, especially due to heavy metals.European-level resources offer diagnostic and therapeutic possibilities that do not exist in the surrounding countries and regions, thus allowing the management of diseases that are not well known elsewhere.Thanks to these same European-level resources, research in Guyana occupies a key place within the Amazon region, despite a smaller population than in the surrounding countries. Thus, certain pathologies such as histoplasmosis of the immunocompromised patient, Amazonian toxoplasmosis or Q fever are hardly described in neighboring countries, probably due to under-diagnosis linked to more limited resources. French Guiana plays a leading role in the study of these diseases.The objective of this overview is to guide health care providers coming to or practicing in French Guiana in their daily practice, but also practitioners taking care of people returning from French Guiana.

Migrant Pharmacopoeias: An Ethnobotanical Survey of Four Caribbean Communities in Amazonia (French Guiana).

French Guiana is an overseas French department in South America at the margin of the Amazon basin. Its population is characterized by an important number of cultural groups. Many inhabitants originate from the Caribbean (mostly Saint Lucia, Martinique, Guadeloupe, Haiti, and the Dominican Republic). The objectives of this study were to present an overview of the main uses of plants among the Caribbean populations in French Guiana, and how they contribute to the dynamics of plant-based practices, in order to provide insights into ethnobotanical convergences, divergences, and hybridizations (such as the importation of new species and associated practices, and the adoption of Amazonian species by Caribbean people). Interviews and botanical voucher collections were conducted throughout the coastal area of French Guiana. Sixteen Saint Lucian, nineteen Haitian, eighteen French Caribbean, and twelve Dominican informants were interviewed during the fieldwork. Altogether they use 212 botanical species. Some plants have recently been imported directly from the Caribbean, while adaptations have also taken place: some species that do not exist locally are abandoned while Amazonian species are integrated to form hybrid pharmacopoeias. The phytotherapies of these communities in French Guiana are still conserved as consistent sets of knowledge, although they tend to blend through an ongoing process of hybridization. Supplementary Information: The online version contains supplementary material available at 10.1007/s12231-021-09529-0.

La Guyane française est un département français d'Amérique du Sud situé à la marge nord du bassin amazonien. La composition de sa population est caractérisée par une très grande diversité d'appartenances culturelles. De nombreux habitants sont notamment originaires des Caraïbes (principalement de Sainte­Lucie, Martinique, Guadeloupe, Haïti et de la République dominicaine). Les objectifs de cette étude étaient de présenter une vue d'ensemble des principaux usages de soin par les plantes chez les populations caribéennes de Guyane française, et la manière dont ils contribuent à la dynamique des pratiques de phytothérapie locales, afin d'apporter un éclairage sur les modalités de convergences, de divergences et d'hybridations ethnobotaniques (telles que l'importation de nouvelles espèces et d'usages associés et l'adoption d'espèces amazoniennes par les migrants caribéens) auxquelles elles donnent naissance. Des entretiens et des collectes d'herbiers ont été menés sur l'ensemble de la zone côtière de la Guyane française. Seize informateurs saint­luciens, dix­neuf haïtiens, dix­huit caribéens français et douze dominicains ont été interrogés au cours du travail de terrain. Au total, ceux­ci ont mentionné utiliser 212 espèces botaniques. Certaines plantes ont récemment été directement importées des îles de la Caraïbe, et des adaptations ont également eu lieu: certaines espèces qui n'existent pas localement sont progressivement délaissées par les migrants caribéens tandis que, a contrario, des espèces amazoniennes sont intégrées à leurs pharmacopées respectives. On observe enfin que les phytothérapies de ces communautés caribéennes de Guyane française conservent un ensemble cohérent de connaissances ethnomédicinales, qui tend cependant à se mélanger dans un processus continu d'hybridation bioculturelle.

Geopolitics of bitterness: Deciphering the history and cultural biogeography of Quassia amara L.

ETHNOPHARMACOLOGICAL RELEVANCE: Quassia amara L. recently came into the spotlight in French Guiana, when it became the object of a biopiracy claim. Due to the numerous use records throughout the Guiana shield, at least since the 18th century, a thorough investigation of its origin seemed relevant and timely. In the light of the Convention on Biological Diversity (CBD) and the Nagoya protocol, questions about the origin of local knowledge are important to debate. AIM OF THE STUDY: Defining cultural biogeography as the dynamics through space and time of biocultural complexes, we used this theoretical framework to shed light on the complex biogeographical and cultural history of Q. amara. We explored in particular the possible transfer of medicinal knowledge on an Old World species to a botanically related New World one by enslaved Africans in Suriname. MATERIALS AND METHODS: Historical and contemporary literature research was performed by means of digitized manuscripts, archives and databases from the 17th to the 21st century. We retrieved data from digitized herbarium vouchers in herbaria of the Botanic Garden Meise (Belgium); Naturalis Biodiversity Center (the Netherlands); Missouri Botanical Garden, the Smithsonian National Museum of Natural History, the Field Museum (USA); Royal Botanic Gardens Kew (UK); the IRD Herbarium, French Guiana and the Museum National d'Histoire Naturelle (France). Vernacular names were retrieved from literature and herbarium specimens and compared to verify the origin of Quassia amara and its uses. RESULTS: Our exploration of digitized herbarium vouchers resulted in 1287 records, of which 661 were Q. amara and 636 were Q. africana. We observed that the destiny of this species, over at least 300 years, interweaves politics, economy, culture and medicine in a very complex way. Quassia amara's uses are difficult to attribute to specific cultural groups: the species is widely distributed in Central and South America, where it is popular among many ethnic groups. The species spread from Central to South America during the early 18th century due to political and economic reasons. This migration possibly resulted from simultaneous migration by religious orders (Jesuits) from Central America to northern South America and by Carib-speaking Amerindians (from northern South America to Suriname). Subsequently, through colonial trade networks, Q. amara spread to the rest of the world. The absence of African-derived local names in the Guiana shield suggests that Q. africana was not sufficiently familiar to enslaved Africans in the region that they preserved its names and transferred the associated medicinal knowledge to Q. amara. CONCLUSIONS: Cultural biogeography has proven an interesting concept to reconstruct the dynamics of biocultural interactions through space and time, while herbarium databases have shown to be useful to decipher evolution of local plant knowledge. Tracing the origin of a knowledge is nevertheless a complex adventure that deserves time and interdisciplinary studies.

As vivid as a weed Medicinal and cosmetic plant uses amongst the urban youth in French Guiana.

ETHNOPHARMACOLOGICAL RELEVANCE: French Guiana is a French overseas territory with a rich history of migration that has led to a highly intercultural society. Today, its population is one of the youngest in the French territory and is rapidly increasing. Despite a context of cultural revival seeking "tradition", a distanced baseline of local practices is still lacking. This work addresses some aspects of the cultural hybridizations in progress in urban areas. METHODS: Semi directed interviews were conducted with willing participants aged between 18 and 40. Interviews took place in French Guiana's two main urban centres: Cayenne and Saint Laurent du Maroni. People were interviewed about the last medicinal plant they used in the preceding year. Due to the high use of plant baths in French Guiana, a focus was made on baths. RESULTS AND DISCUSSION: Eighty-three people answered: 43 women and 40 men (mean age of 28.7 years old). In total, 226 remedies were counted in our study, 155 single plant remedies and 71 compound remedies leading to 316 use reports of plants from 16 cultural groups. A surprising number of 108 botanical species were recorded. Eighty-one recipes for baths were also collected. Despite this high citation rate, a rather low proportion of people declare a systematic and regular recourse upon local pharmacopoeia (46%; 38/83). Although many interviewees used plants, far from the majority used them on a regular basis. In practice, 50% of the species (54/108 spp.; 99/316 URs) are non-native but domesticated exotic species, imported from Asia, Europe, Africa or remote parts of America, either during colonization, the slave trade era, or more recently with the latest migrations. CONCLUSION: Although phytotherapy use is often thought to be related to countryside dwellers and older people, medicinal plants seem to play an important role in the lives of urban French Guianese youth. Research shows a large diversity of medicinal species used linked with the great cultural diversity of the Guianese cities. One characteristic of this population is the hybridization process leading to a perpetual renewal of practices, both in terms of species and practice.