SUMMARY

The phenomenon of the massive migrations is not new, neither in Catalonia nor in Spain. Diverse secular migratory processes toward foreign countries or inside Spain constituted the proletariat in this country while migrations were never put into relation to health policies. Also, the particularity of the European political culture made migrations never be considered in ethnic-cultural terms although appellatives like xarnego, murciano or maqueto reflected something more than the strong linguistic, ethnic or cultural diversity of the Peninsula.

Spain, without colonies and being an emigration country, is incapable of understanding its internal cultural diversity, and doesn’t know either how to manage the new one coming from outside its borders. Since the question is, ideologically speaking, so conflicting, no debate has taken place on what model will be implemented -multiculturalism or integration-, not only on scale of the State, but also of the seventeen Autonomous Communities. These and the city councils that provide and finance health, education and social services face the difficulties generated by the unequal distribution of the immigrant population across the territory and therefore of a demand of services, whose financing is not being corrected by a State in which its responsible politicians continue occupied in making electoral demagoguery on the waiting lists.

The demographic explosion represented by the immigration population demands, with urgency, to solve many of the problems that some pointed out decades ago but before which, the health system and its professionals had remained blind to. The migratory wave not foreseen has represented for health professionals working in the administrations and in the clinical settings that society and culture exists, although the study plans at the Medical Schools -unless those of Nursery-, insist on the opposite. The immense majority of countries confronted with the immigration issue knew that it was necessary to review the training of health professionals, incorporating in the curricula the sociosanitary sciences -essentially Medical Sociology and Medical Anthropology-, since the sixties of the past century. The rigidity of the university model and of the corporate and academic resistances in our country remain outside that process because of the persistence of an obsolete model of Medical Humanities without real possibilities of implementation, and of the slow development of the sociosanitary sciences in institutions besides Medical Schools.

Before the biomedical pathology, biomedicine has aspired to reach the maximum diagnostic, prognostic and therapeutic efficiency, purifying the clinic and the laboratory of all those variables considered as accessory to those three acts, as the social and cultural variables, uncomfortable for the absence of analytic and interpretive instruments of the same in the theoretical building of biomedicine. However, the complete annulment of the interactive capability and of the inter-subjectivity between the professional and the environment -the patient, his/her social net, the institution, the other professionals- are almost never met.

Some idiosyncratic characteristics of the Spanish "insurance" culture, and especially the hegemony of the drugs as the panacea for all the wrongs, have been able to reduce the understanding of the socio-cultural variables to the minimum, but the migrations have meant a relative rupture in that cultural pattern. In front of this situation, the professionals must assume the cultural and social diversity, that is to say, to handle the troubles emerged in the communication and support process to the patients, difficulties in the monitoring, and adapt to cultural rules that break up with stereotypes and the most frequent cultural idioms found among native patients. For that, the "cultural" and the "social" in the pattern and current medical practice cannot continue being contemplated from cultural taxonomies but as permanent processes of construction and reconstruction of meanings in a world subjected to a dialectic between local or global cultural influences.