Translating differences into quality health care

A Bosnian refugee is referred for counseling due to clinical depression that is attributed to post war stress. A Somali woman misses her prenatal appointment that was scheduled on a Friday afternoon because she needs to go to the mosque for prayer. A Spanish interpreter arrives to the emergency department and finds that the patient he was called for speaks only Conjobal, a Guatemalan dialect. A Vietnamese immigrant delays seeking care for chest pain because he is uncomfortable utilizing the 9-1-1 emergency system.

Similar situations are occurring more frequently as communities across our nation are becoming more diverse. Furthermore, the extent of patient diversity is no longer limited to major metropolitan areas. Smaller urban communities are experiencing a rapid influx of individuals from numerous regions around the world. The current environment in other countries necessitates emigration for political, religious and economic reasons. The United States may be the first stop for an immigrant or a "stepping stone" between a refugee camp and another foreign resettlement community. Thus, health care providers are finding themselves faced with the challenge of meeting the needs of patients from a myriad of ethnic, linguistic and religious groups.

Legal and ethical considerations also specifically impact health care delivery to patients who need communication assistance. Most providers understand the requirements of the Americans with Disabilities Act (ADA) as it pertains to the use of professional sign language interpreters for deaf or hard-of-hearing clients. Health care agencies are becoming increasingly aware of the requirement to comply with Title VI of the Civil Rights Act of 1964.

Guidelines for this statute have recently been issued by the Office of Civil Rights, which oversees the mandatory provision of free oral and written language services to Limited English Proficient (LEP) patients. The Health Care Financing Administration (HCFA), the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), professional codes of ethics and professional licensure guidelines address clinical requirements for confidentiality and safety, both of which can be threatened without adequate communication. Therefore, regardless of the ADA or Title VI, it is prudent for health care providers to ensure appropriate assistance to LEP patients or clients from diverse cultural backgrounds.

Fortunately, there are resources to support nurses and other health care professionals. Translation and interpretation agencies are available in many cities, and most will provide services at health care settings. Often, they can be found in the Yellow Pages under "Translation Services" or on the Internet under the specific service needed. There are also professional association Web sites, such as the American Translators Association, the Massachusetts Medical Interpreters Association, the Michigan Translators and Interpreters Network and the California Healthcare Interpreters Association.

There are also organizations that specialize in providing in language and culture services for health care providers. Their interpreters must have a working knowledge of clinical practice settings, the roles of health care providers and understanding of the procedures themselves. One nurse, Michelle A. Scott, wanted to improve the quality of medical interpretation, specifically to address patient confidentiality and clinical safety. To fill this need, she founded Voices For Health in 1997 in Grand Rapids, Mich. with the goal of offering high-quality linguistic and cultural services that are affordable for health care budgets.

"We need to be advocates for patients' communication needs-professional interpreters, bilingual staff and translated documents-in order to provide the best care possible," says Scott.

"We need to understand how difficult it is to learn another language and how long it takes to become proficient enough in another language to be able to communicate one's own needs appropriately in a health care setting."

To meet these needs, she says, interpretation services at Voices For Health can be requested 24 hours a day and are available in over thirty-five languages, either on-site at the health care agency or by phone. Nurses, physicians and medical assistants from around the world provide many of these services in addition to cultural seminars, research assistance, language courses and interpreter education.

At the request of health care organizations, the Voices For Health added other services. Written document translations are requested for numerous reasons, such as to assure informed patient consent or promote health care services. More than 40 specially designed Spanish language and culture courses have been taught at hospitals, clinics and universities. These classes give health care providers a basic working knowledge of grammar and vocabulary to assist them in working with Hispanic clients. Providers can also attend seminars to learn about other cultures, such as Bosnian or Vietnamese. Assistance is provided to researchers who need linguistic or cultural consultation, back-translation of instruments, or transcription of non-English interviews.

"We need to be aware of global issues, since these affect our current patients, and people affected by global issues often become our patients-refugees, asylees and illegal immigrants," says Scott. "At the same time, we need to remember that times of war, conflict or economic crisis are special circumstances that are not representative of a patient's culture."

This article also provided to Monster.com's Health site.