The basic cornerstone of the health care profession is “to do no harm.” However, because of the phenomenal growth in the number of people who have settled in Nebraska who have limited English proficiency (LEP), health care providers are challenged to provide safe, effective, and linguistically and culturally appropriate services. Within the borders of Nebraska, the number of people who are new to the community has increased dramatically.
Why, you say. Why not? The Omaha area is one with low unemployment, reasonably safe streets, many educational opportunities, and plenty of land for housing developments. And, of course, the Omaha area always has been the stopping place for people migrating across the country or moving to the country. Perhaps your parents or grandparents (or great grandparents) have roots in Europe, Asia, Africa, or South America. Ask them if they spoke English fluently when they came here.
Developing strategies to effectively overcome barriers to health care stemming from language deficits between the patient and the provider is essential to improving the health of the community. Formal programs dedicated to increasing the number of properly trained medical language interpreters are few and far between. There is much more that can and should be done to ensure safe, effective, and respectful care.
Unfortunately many providers use a variety of approaches when confronted with patients who are English language learners (ELL): provide no interpreter services, ask the patient to provide interpreter services, use pantomime and gestures, use providers with varying levels of language proficiency, use ancillary personnel who speak other languages but who have no experience with medical terminology or medical procedures, or use language line services or a qualified medical language interpreter. Far too often the patient’s care is compromised because of the lack of well-designed and organized infrastructure within health care organizations.
Hispanics/Latinos comprise the largest racial/ethnic minority group in the state of Nebraska. While they make up 5.3 percent of the population of the state, the prevalence of individuals within this group who identify themselves as fair or poor English-language speakers is as high as 60 percent. This decreased ability to communicate may be an inconvenience in daily activities, but in the health care context may cause serious, if not irreparable harm.
According to the Nebraska Behavioral Risk Factor Survey (BRFSS) 40 percent of people who speak English as a second language stated that they felt their care would be better if they spoke English. That’s especially true if the health care provider is unwilling or unable to bridge the language gap.
Why don’t they just learn to speak English, you say. Well, how many of you have tried to learn another language as an adult. It’s not as easy as, say . . . setting the time on the VCR. Having the opportunity to take French for the last four years of high school, I would be hard pressed to provide anything resembling safe interpretation – especially in the health care setting. Trust me, you would not want me to be the person explaining a stem cell transplant or even a hair transplant in my rusty and broken French.
In Arabic I can ask if you have pain, where is the pain, and how long have you had the pain. I cannot, however, follow you if you give me more than a five-word answer. And even worse, I truly cannot make the leap in determining if you have an allergy or sensitivity to the medicine I want to give you. So, though I may be better than nothing (though I doubt it), I am far from a good alternative and I am absolutely not a safe or effective alternative.
So, whose responsibility is it to bridge the gap? Well – it’s ours and for a number of reasons. One, let’s just go to the Golden Rule “Do unto others as you would have them do unto you.” Two, it’s more effective than pantomime. Three, it will keep the company’s dollars out of the litigation pot. Four, it will make you – as the provider or facilitator of care feel a lot better about the interaction (and yourself). Five, it will help you get in and remain in compliance with the CLAS standards — Culturally and Linguistically Appropriate Services standards — promulgated in December of 2000.
According to CLAS, we have a lot of work to do to protect the most vulnerable among us – our patients. So, check with your unit or department. Find out what your responsibility is and do whatever is necessary to “do no harm.”
For more information on the standards for caring for people with limited English proficiency visit: http://www.hhs.gov/ocr/lep/fact.html.
For more information and background on CLAS visit: http://www.omhrc.gov/CLAS/finalcultural1a.htm.