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Health care report 2008: Trust and translation: Communication, strong relationships critical in health care

For Sharon Kelly, the key to healing sick or hurting
patients is a strong medical relationship.

For Sharon Kelly, the key to healing sick or hurting
patients is a strong medical relationship.

If patients don’t trust caregivers, they are less likely to
follow proper treatment plans, she said.

“And if you can’t understand your caregiver, then you’re not
going to trust him,” said Kelly, who works at PinnacleHealth System in Harrisburg.

Since Harrisburg’s
number of foreign-born residents is growing faster than the national rate,
Kelly said, hospitals and the rest of the health care industry must be
prepared.

A multitude of languages

Kelly, who manages patient and community education for
Pinnacle’s Central Education Department, has studied the languages of Dauphin County for 15 years. She has learned
that translation needs change every couple of years as older foreign-born
populations become acclimated and learn English well enough to no longer need
translators.

Between 20 and 30 languages, including American Sign
Language, are translated each month in Dauphin, York and Lancaster counties’
hospitals. Spanish is the primary foreign language spoken, followed by
Vietnamese and Russian.

But many others are used, including Pennsylvania German –
spoken by the Amish population in Lancaster – and a growing number of French
and lesser-known languages spoken by immigrants from Africa.

“Some of the languages are so obscure that I have to look
them up to find out where they come from,” Kelly said.

Those lesser-known languages are used infrequently enough
that having staff translators for those languages is costly and less necessary,
she said.

So health care professionals such as doctors have been using
a phone-translating system. The more common system to use is CyraCom, which
offers translators trained specifically for medical situations, including
terminology and emergencies, Kelly said.

There is a lot more to translation in a health care setting,
Kelly said.

“They have to know the correct medical terminology, ethics
of interpreting, body language, such as where do you sit and how do you help
the physician perhaps to share back and forth culturally,” she said, adding
that a phone system takes away a lot of these variables.

Translation needs changing

For years, medical personnel relied on family members and
bilingual staff to translate between nurses and doctors and
non-English-speaking patients.

But in recent years, local hospitals have rethought their
translation services.

Since 2000, the federal government has required hospitals to
provide translators for non-English-speaking patients.

The government also puts the financial burden on the hospitals,
said Ann Kunkel, director of case management for WellSpan Health in York County.

Insurance agencies do not pay for these services, Kunkel
said.

York
Hospital has part-time
translators who live and work in the community and who are on call for medical
emergencies when a translator is needed, Kunkel said.

And yet the service is needed, she said. Studies have shown
that when children translate for family member, the children tend to filter
information in terms they understand or feel comfortable with.

That means, she said, that the information may not be
accurate.

Jim Page, vice president of diversity and inclusion at
Lancaster General health system, said using children or any family member is
not a practical solution. Children, he said, might be afraid to use words that
make them uncomfortable, such as bowels and private body parts. They may leave
out important words during translation.

Major medical mistakes have happened from improper
translation, Page said.

More than language at stake

Now that the health care industry realizes amateur
translation can lead to mistakes – and lawsuits – changes are under way, Page
said.

Lancaster General is revamping its translation and
interpretation services to form a language ladder, Page said.

Bilingual employees are no longer used to translate unless
they are interested and are thoroughly trained, he said.

The idea is to create a system that lets bilingual employees
translate if they wish, he said. And the new system will allow those who do not
wish to translate to have a symbol on their badge stating as much since those
employees may be uncomfortable with medical emergencies.

Instead, employees who are bilingual and trained will be
used for what they do best. Some staff, for instance, will be great at greeting
patients, so that may be where they begin on the language ladder.

As they climb, each step will celebrate their successes,
which Page hopes will build morale among Lancaster General’s bilingual staff,
he said.

Additionally, staff is trained in cultural awareness, he
said, adding that knowing subtle differences among cultures can be urgent in
some situations.

A caregiver, for instance, should know that some northern
Mexican people use herbal healing or that the Vietnamese rub a coin on the
chest of a sick person.

“It’s not our job to say it’s right or wrong,” Page said,
“but to recognize this as fact and understand that this is not a symptom of the
illness, but a part of their culture.”

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