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| Archive : Winter 2007 |
LOST IN TRANSLATION:
It’s your first time in a U.S. hospital // You don’t speak the language // You can’t read the signs // How can you tell doctors the red welts on your back are the result of a healing ritual,
not a sign of abuse?
Care Across Cultures [page 3]
 By Linda Keslar
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With increasing numbers of immigrants showing up at the hospital with advanced diseases that are difficult and expensive to treat, a priority at Glendale Adventist has been to encourage better health habits by staging educational outreach programs. After a poor response to early efforts, the hospital began recruiting volunteer health educators from the Armenian community. Many are housewives, who typically hold events in their own homes or with friends and relatives. In these relaxed settings, the volunteers provide information about diabetes, cardiovascular disease and other health conditions. “Women in the Armenian community are responsible for the family’s nutrition and lifestyle activities. So it’s important for them to play the major role,” says Nelson. These trained volunteers have reached thousands of people, he says, and the numbers who show up for health screenings have grown steadily.
This kind of immersion in the community can sometimes head off cross-cultural misunderstandings. For example, at many hospitals, a patient who arrives covered with welts would prompt an immediate call to authorities to report suspected abuse. But at Kaiser Permanente Medical Center in San Francisco, where an entire wing is devoted to caring for a large Asian immigrant population, the staff recognizes the red marks as a likely consequence of “coining,” a traditional healing ritual that involves vigorously rubbing the body with the edge of a hot coin or spoon to draw out illness.
“Our internists are trained in Western medicine, but many of us speak Chinese, have been brought up in the Chinese culture and understand that patients have tried all kinds of traditional remedies before coming in, so they can talk to us without reservation,” says Anne Tang, chief of the center’s Bilingual Chinese Module. Tang herself grew up in San Francisco’s Chinatown after immigrating to the United States from Hong Kong. “When patients receive advice from a physician of similar ethnic background who speaks their language, they tend to comply more readily with our recommendations,” she says.
Cultural competence, in the vision of its many advocates, would be embodied in a health care system that delivers high-quality treatment to every patient regardless of culture, race or language. Still, many harsh realities stand in the way of achieving those goals. For one, while many cultural competence strategies are funded by private donations, state and federal support, and nonprofit grants, Nelson says money is always an issue. “Cultural competence is so complex no one wants to look at it,” he says. “Often, institutions are afraid to address it, because they think they won’t be able to afford it.”
The cost of a medical interpreter, for example, according to a survey by the American Medical Association, ranges from $30 to $400 an hour, depending on the interpreter’s language and skill level. In many cases, that expense keeps health organizations from complying with federal rules requiring them to provide adequate access to language services, says Glenn Flores, a professor at the Medical College of Wisconsin in Milwaukee and an expert on language barriers in health care. He cites one study showing that in almost half of emergency department cases involving patients with limited English proficiency, no interpreter was provided. Instead, Flores says, many hospitals call on family members or untrained staff members.
Even when there is someone to interpret, inadequate training can cause problems. Flores tells of one interpreter who mistranslated the directions given by a nurse practitioner to the mother of a seven-year-old girl—causing the mother to think she was supposed to put the oral antibiotics in the girl’s ear. Only one in four hospitals provides training for staff who work with interpreters, Flores says, and very few states have interpreter certification programs.
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Photographs by Erica Berger |
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