Eliminating linguistic and cultural barriers to service

Health care is also the melting pot for cultures

One can only imagine the confusion and anxiety someone who does not speak English may experience when faced with a health care decision or crisis. Even with the best scenario in which the patient and family speaks the language and understands the customs we take for granted, there is sometimes miscommunication. "It can be terrifying to come to a hospital if you don’t speak the language," says Nouria Belmouloud, a medical interpreter for Duke Hospital in Durham, NC.

Medical interpretation is more than simply translating language for both entities. "We are conduits for information, and clarifiers of both the language and cultural expectations. We often interpret the language for the patient, and interpret the patient’s culture for the provider. This helps the patient and the provider feel more comfortable and it helps create more culturally appropriate care, as well," states Belmouloud.

Many hospitals have international patient services for foreign patients, as well as domestic interpretation services for domestic patients who require differing cultural needs. Duke recently consolidated those services.

"It made sense to extend this linguistic and cross-cultural sensitivity to all patients whether they are international or domestic patients," says Henry Meguid, coordinator for patient services at the International Patient Center. "Duke has made a strong commitment to eliminate linguistic and cultural barriers to providing health care to patients with limited English proficiency. These barriers limit patient access to heath care and social services, reduce quality of care, tax out resources, and increase cost."

Federal mandate sets the rules

Meguid points out that "Title VI, of the Office of Civil Rights (OCR), states that health care providers receiving federal financial assistance must have a procedure for identifying the language needs of patients, and have ready access to and provide services of proficient interpreters in a timely manner during hours of operation. It also requires us to develop written policies and procedures regarding interpreter services and ensure staff awareness of these policies and procedures and of their Title VI obligations to people who have limited English proficiency.

"However, federal and state regulations lack explicit standards for determining competency and standards for quality interpreting. Our goal is to ensure that we are offering not just the minimum required by law, but that we are being true to the mission of Duke. We want to provide the best possible service because we believe that medical interpretation is not only a right for patients; it truly is a part of the patient care we offer, and it affects how that care is received," he explains.

Although it is a specifically mandated service, language interpretation is just a first step for foreign patients and their families. Many other aspects interplay to make them feel comfortable and welcome and to relieve stress. The Cleveland Clinic’s Web site, www.clevelandclinic.org, has a page for its International Center that outlines, in the language of your choice, many other services and information it provides for its foreign patients. Among them are the following:

• embassy telephone numbers;

• assistance in the location appropriate houses of worship;

• the location and instructions about how to contact lodging in which a language barrier can be overcome;

• assistance in locating culturally appropriate restaurants;

• the location of banks in which foreign currency may be exchanged and financial arrangements may be made;

• international and local travel options, such as car rental, taxi cabs, and airports and airlines;

• how to use the telephone to reach local and international contacts;

• assistance in extending or replacing visas and passports and related issues;

• maps of the city;

• information about how to mail packages and letters;

• driving tips and local driving laws;

• information about sales tax;

• information about tipping;

• weather information, both local, travel, and international;

•information about U.S. business hours and holidays;

• metric-to-English conversion information;

• how to contact the telephone language interpretation service.

Adhering to cultural food distinctions

There are many cultural distinctions to be considered when caring for foreign patients and their families. Food and its preparation can be as important as religious customs. For instance, most Muslims follow the doctrines of the Koran, which forbids ingesting alcohol and the flesh of scavenger animals (pork), birds, and fish, including shellfish.

In general, Hindus shun all animal and fish products except milk and honey because of the Hindu doctrine of nonviolence, karma, and rebirth. Additionally, some Hindus do not eat root vegetables such as potatoes, carrots, or beets.

It is also important to keep in mind that some countries are renowned for their foods, and their citizens may consider the American versions of their food inferior. Japanese people, for instance, may prefer to be served green tea instead of the standard cafeteria fare.

As we increasingly become more globally connected, we must learn to do more than the bare minimum for our culturally different patients if we are to truly remove the barriers to providing them with the best possible health care. For more information about Duke’s interpreter services, visit their Web site at www.mc.duke.edu.