You can file this one under “Now there’s a translation challenge.” A recent Associated Press story explored the unique translation demands facing U.S. translators working in Afghanistan.
The first complication is the language itself, Pashto. According to 2000 U.S. census numbers, fewer than 8,000 Pashto speakers live in the U.S., making for a small pool from which to draw, even smaller when you consider how many have experience as professional translators.
But that’s just the beginning. Many of the translators, who are hired by recruiting firms in the U.S., are finding themselves thrown into combat situations for which they have no training. Some are in their 60s and 70s and in poor physical condition. To make matters worse, they learn once there that if they don’t comply they risk losing their job, no small thing given their salaries start at $210,000 a year. One translator profiled was in his 50s and recently had to carry a 40-pound pack and keep pace with the Marines on a two-day ground assault in southern Afghanistan’s 115-degree heat.
So next time you’re struggling with a particularly demanding healthcare translation project, just take a moment to reflect on how nice it is to not really be under the gun.
Given the work we do for our clients, I tend to ask the same question when reading about a recent innovation in how healthcare organizations communicate with patients: “Yes, that sounds great, but how well does this serve non-English speakers?”
Kaiser Permanente has started a novel smoking-cessation program using automated phone calls, courtesy of a company called Eliza. Eliza’s interactive technology is more sophisticated than most robocall systems, and its intention is not to sell. In one call, patients heard a jingle about eating beans and 100 percent of those who received the call remembered it and were open to more contact.
Eliza might then follow up by sending information by mail, e-mail, or text, or passing a person over to a clinician. To focus the messages, Eliza created different phone calls for different at-risk groups. All used inclusive language to help make the messages seem nonjudgmental, warm, and empathetic.
But as it’s not mentioned in the Business Week article in which I learned of the program or on the Eliza website, I have to ask, what about limited English proficient (LEP) patients? Are calls conducted in Spanish as well? How about Chinese? Now that would be truly inclusive.
A couple of weeks ago, Senator Herb Kohl, Wisconsin (D), resurrected the State Court Interpreter Grant Program Act, a piece of legislation that seeks $15 million to strengthen state court interpreter programs.
Currently, state courts are required to provide interpreters to limited English proficient (LEP) speakers. Recent studies, however, have shown that nearly half of states do not deem it necessary to provide interpreters in all civil cases. As the Global Watchtower blog reminds us, the problem stems from a dearth of qualified interpreters and the money to pay for them.
As it happens, it is a situation with which healthcare professionals are all too familiar. The need for healthcare translation is only growing more acute as resources dwindle. This means that there is an increasing amount of pressure to find new and innovative ways to serve their LEP patients.
There are hopes that some of the $19 million the President’s American Recovery and Reinvestment Act devoted to healthcare will help. But a good first step, short of a grant program like Senator Kohl’s, is to consult your language service provider. They’re experts and should be able to help you cut costs and find new efficiencies in your healthcare translation process.
Anyone involved in healthcare, from a hospital to a patient, understands that costs remain a pressing issue. And as budgets are cut at the same demand increases, the situation is only getting worse.
One of the big pushes has been the move to electronic health records, or EHRs. Since former President George W. Bush set a goal that by 2013 every American would have electronic health records, hospitals and health systems have spent millions of dollars trying to make it happen. And things were going well — until the economic downturn. Since then, many projects have stalled, including, it is assumed, developing healthcare translation efforts intended to serve nascent EHR programs.
It is hoped that President Obama’s American Recovery and Reinvestment Act (ARRA) will help get these programs back on track. More than $19 billion has been set aside for EHR technologies and facilitating nationwide health information exchanges. About $17 billion of that is for hospitals and physicians as Medicare and Medicaid incentives for health IT.
As hospitals begin prioritizing their IT investments, it is critical that provisions be built into developing programs that account for the language needs of today’s — and tomorrow’s — patients. The money will not have been well spent if only a portion of patients benefit from the ARRA-financed advancements.
In recent years and most pointedly in the last year it’s rare to read a story about healthcare that does not reference the role the Internet does or should play. The two have become intertwined as lawmakers, healthcare professionals and patients try to determine what healthcare should look like.
According to a recent post in Triage, the healthcare blog of the Chicago Tribune, anesthesiologists are the latest members of the healthcare industry to find their way to the Web. Understanding that the Internet is increasingly where people turn for information about care, the American Society of Anesthesiology has launched www.LifelinetoModernMedicine.com.
The stated objective of the site is to share consumer-friendly information with patients. It’s a laudable effort and a welcome resource for the public. Dr. Roger Moore, president of the society, admits the site current pretty simple but says they plan on incorporating regular updates and improvements.
Having made a quick tour of the site, I have one recommendation: Don’t forget your limited English proficient (LEP) audiences. The site does not currently offer additional languages beyond English. To be a truly valuable tool for an increasingly multilingual public, offering visitors the choice of language is an absolute must.
Did you know that Vietnamese is the seventh most spoken language in the U.S.? About 1 million people speak it at home. Census numbers from 2000 put the total number of Vietnamese living in the U.S. at 1.2 million. That’s sizable.
Bringing with them a strong Buddhism influence, Vietnamese have their own unique way of looking at healthcare. Things like a respect for elders and those in authority, a belief that life is a cycle of suffering and rebirth, and a focus on the community over the individual all impact the way Vietnamese patients interact with healthcare in the U.S.
For example, medical treatment can be delayed because pain and illness are simply considered part of life. Decisions about care can be slow in coming as such decisions are frequently made as a family. Folk or herbal remedies might be favored or used in parallel with western approaches. But because western medication is sometimes viewed as too strong for the smaller Vietnamese body, patients may cut their dosage or discontinue it altogether after symptoms disappear.
Healthcare translation is about language, yes. But it is just as important with communities like the Vietnamese that those translations are informed by an understanding of the culture.
It’s a challenging time to be in healthcare. Shrinking budgets, accelerated timelines and uncertainty about the future are daily realities. The upside is that a great many people are now discussing the issues and pursuing a solution.
In a recent white paper published in the online journal Telemedicine and e-Health, a group of U.S. medical experts makes the case that telemedicine (or e-health as it is also called) must be a cornerstone to any new healthcare system.
The argument put forth by the paper’s lead authors hinges on the assertion that telemedicine “offers significant opportunities to address the issues of inequities in access to care, cost containment and quality enhancement.”
As language service providers (LSPs), we are most concerned with the first of those issues: access. Today, too many patients are denied equal access because healthcare translation is overlooked or undervalued.
But according to the authors, telemedicine can improve access to all levels of healthcare and address the “prevailing inequities in access to care that reflect geographic, socioeconomic, and cultural disparities.”
No specific mention is made of healthcare translation needs. But I’m choosing to assume that the authors of this paper understand that real access, and therefore a real solution, starts with language.