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B. Bilingual/Bicultural
Community Health Workers
By hiring staff who reflect the linguistic and cultural diversity of
the community, community health worker programs connect mainstream health
care institutions with communities that have often lacked access to adequate
care. Community health workers improve the quality of health care services
in several ways: facilitating access through outreach and health promotion
activities; facilitating community participation in the health care system
and educating providers about cultural relevance; and contributing to the
continuity, coordination, and overall quality of care as members of a comprehensive
health care team. It should be stressed that to be most effective, community
health worker programs must provide training and on-going support to their
staff, who often work alone or in isolation from their colleagues and the
mainstream agency. |
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C. Employee Language
Banks
The in-house language bank is one of the oldest strategies for dealing
with language barriers in health institutions, especially hospitals. This
strategy utilizes employees who speak other languages as volunteer interpreters
when needed. One advantage is its apparent low cost since no extra staff
need to be hired; another is that the language bank interpreter may be readily
available and on-site for emergency requests.
However, problems with this approach are rampant unless the language
bank program is carefully designed and organized. Usually no formal evaluation
of language skills has occurred, with employees self-assessing their level
of fluency. Also, few employees have received any training in medical interpreting
skills, ethics, or vocabulary. This may lead to inappropriate, and even
dangerous, situations. For example, a hospital housekeeper, in the US for
two years, fluent in her native language but barely speaking English, may
be called upon to interpret for a patient being prepared for surgery. Or,
an American-born nurse with two years of college French under her belt may
be asked to interpret for a Creole-speaking Haitian refugee with a grade
school education. In either situation, can we be sure that communication,
let alone informed consent, has truly occurred?
Job conflicts can also arise when "volunteer" interpreters
are called away from their regular duties. Supervisors and coworkers may
blame the bilingual employee for time spent away from regular duties, leading
to a negative work environment and resentment by the employee as well as
colleagues and supervisors.
Some institutions are doing a good job of improving the quality of language
banks by formalizing their structure: assigning a coordinator to assess
language and interpretation skills of employees, maintaining updated lists
of bilingual employees, providing interpreter training, and assessing the
quality of service provided. These institutions have also found it useful
to include interpretation as a listed job duty, to enlist the support and
cooperation of supervisors, and to provide compensation for bilingual skills
as a bonus or differential. Institutions with large numbers of limited-English
speaking patients may find the language bank an effective back-up to other
strategies when managed properly. |
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D. Professional Interpreters
When bilingual providers are not available to care for monolingual patients,
well-trained interpreters can do much to bridge the language and culture
gaps. A variety of hiring approaches are currently used to obtain professional
interpreter services:
- Interpreters are hired as full-time or part-time regular employees
- most common where need for a particular language is high.
- Interpreters are hired as hourly, on-call employees or as independent
contractors - most useful where demand for a particular language is intermittent.
This also works best where most of demand is for pre-scheduled appointments,
although emergency needs can be met when interpreters carry pagers and
are accessible 24 hours a day.
- In-person interpreter services are obtained through an outside agency.
This agency may specialize in medical interpreting or provide a spectrum
of interpretation specialties. Alternatively, an organization with another
set of services (such as an immigant social service agency) may decide
to develop and market an interpretation service. Use of an outside agency
works well where need is intermittent and diverse, and can also supplement
an organization's regular interpretation staff.
- Telephone interpretation - also known as remote consecutive interpretation
- can be obtained through outside agencies that specialize in this service.
Often hospitals use such services for emergencies when it will take too
long to get an interpreter in-person or for rare languages where a local
interpreter is not available. Telephone interpretation may also be used
for simple communications, such as setting up appointments, giving lab
results, etc. - the many normal functions that are conducted by phone with
English-speaking patients. More complex communications are best left to
in-person interpretation services, where non-verbal cues are an important
part of the communication process and accuracy of the interpretation is
critical.
The cost of using professional interpreters is often cited as a barrier
to using this strategy: what often is not examined is the cost of using
untrained or ad hoc interpreters (family, friends, other patients). Potential
liability costs, the cost of poorer health care due to inadequate communications,
and undesired health outcomes may be more expensive than providing well-trained
interpreters. Family, friends and other individuals called upon as ad hoc
interpreters may lack appropriate language skills and knowledge of medical
terminology, leading to gross errors in communication. Also confidentiality
is compromised, vital information may be censored, and internal family dynamics
jeopardized, especially when children are used to interpret. |
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E. Written Translation
Materials
Materials which place English alongside the target language are sometimes
used to communicate with non-English speaking patients. Providers and patients
then communicate by pointing to the appropriate phrase in their language.
This method is obviously limited in usefulness and also requires patients
to be literate in their native language. It is most often used in emergencies
in the absence of a readily available interpreter, or for simple needs a
hospital inpatient might have, such as indicating the need for a bedpan
or a drink of water. It can also be useful for receptionists trying to identify
the language of a patient before requesting an interpreter.
Translated forms, documents, and health education materials play a role
in increasing access to service. Many agencies have developed a variety
of translated materials. These can be useful with some populations if tailored
to the reading level of the audience and adapted and tested for cultural
appropriateness. Protocols for translating materials need to be standardized
and clearinghouses developed to aid in the dissemination of appropriate
and effective materials. |
