Working with Spanish-speaking

LEP Patients

Jason Roberson, MA Medical University of South Carolina

Interpreter Services

Acknowledgements

Deborah Williamson, DHA, CNMAssociate Dean for PracticeMUSC College of Nursing

Charlene Pope, PhD, MPH, CNMAssistant ProfessorMUSC College of Nursing

Objectives

Identify limited English proficiency (LEP) as a source of health disparities

Review appropriate techniques for working with a medical interpreter

Discuss the most efficient & effective communication practices with LEP patients

Objectives

Define ethnicity, race, and language status according to national guidelines

Identify social and cultural variations within the local Hispanic community

Identify and eliminate stereotypes in delivering health care

Avoid use of non-qualified interpreters and computer-generated translations

Limited English Proficiency

Individuals who have a limited ability to speak, read, write, or understand English are considered to be

Limited English Proficient (L.E.P.)

“Our Changing Community”

Hispanic Population in South Carolina

400,000+ Hispanics living in South Carolina (~10% of the population)

330% growth since 1995

www.sph.sc.edu/cli/

The Hispanic Health Needs Assessment – National Alliance for

Hispanic Health adaptation

http://www.hispanichealth.org

Primary Barriers to Care

0

5

10

15

20

25

30

35

Language Money-Ins

Acute-Avoid

Where toGo?

%

Complexity of Language Problems

“ I don’t speak English well”

“They (the hospital) had no interpreters”

“ The Doctors/Clinics don’t speak Spanish”

“I don’t know what to say about the health problem”

“ I couldn’t explain what was bothering me”

Unequal Treatment

“Racism”

“Being Hispanic, you don’t always get good service”

“Discrimination”

“Attention given to Latinos is very superficial”

“One time they infected me and left me nothing…and because of the language I didn’t know who could help me”

Challenges for South Carolina

New population growth area- recent arrivals to the U.S.

Lack of knowledge & confidence within the new Hispanic community

Challenges for South Carolina

Lack of qualified medical interpreters

Lack of knowledge & motivation on part of providers to hire trained interpreters

Lack of training opportunities for medical interpretation

Lack of professional development/ organization for medical interpretation

Other challenges

“Scams” targeting the Hispanic patient population

“False fluency” on the part of the provider

Prejudice within the health care system

Resentment of new policies on the part of the provider

Disregard for hospital policy leads to unsafe care (without interpreters)

Title VI, Civil Rights Act of 1964

“No person in the U.S. shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.”

National CLAS Standards* (March 2001)

The CLAS Challenge: Being Culturally and Linguistically Competent in Health Care

C = Culturally &L = LinguisticallyA = AppropriateS = Services in Health Care

*JCAHO recommendation

CULTURAL EFFECTIVENESS

Cultural competency is the genuine sensitivity and respect given to all people regardless of their ethnicity, race, language, culture, sexual orientation, or religion.

Ability to anticipate and recognize misunderstandings that arise from differing cultural assumptions and to respond to such issues appropriately

Continued self-assessment of culture; paying attention to the ever-changing dynamics of culture and sources of bias and disparities

Patient-Provider Communication

How do we link communication to outcomes?

COMMUNICATION

PATIENT SATISFACTION

ADHERENCE

HEALTH OUTCOMES(Betancourt, 1997)

Ethnicity, Race, and Language Status:

Standard for U.S. Classifications for Data Collection

Only 2 ethnic categories: Hispanic and Non-Hispanic

Race: (1) American Indian/ Alaskan Native; (2) Asian; (3) Black/ African American; (4) Native Hawaiian/ Other Pacific Islander; (5) White; (6) Multiracial

“Hispanic” or “Latino”?

The terms “Latino” and “Hispanic” refer to people whose ancestry originates in Mexico, Central or South America, and other Spanish-speaking countries (Caribbean, Spain, etc.).

Hispanics can be of any race: White, Black, Indian, Asian

*** The term “Spanish” ONLY refers to the language or to people from Spain!!

Language Status

The US Census uses a standard dialogue for identifying language status:

(1) Do you speak a language other than English at home? (If yes,….#2)

(2) How well do you speak English?... very well?...well?...not well?...not at all?

All who answer below “very well” need a trained, certified interpreter.

Global Health Belief Systems

Scientific/Biomedical:Life/health is controlled by physical and biologicalprocesses that can be studiedand manipulated

**Magic/Religious:The world (health) is an arena in which supernatural forces dominate fate (well-being)

Holistic health:The forces in a natural balanceor harmony (to protect health)

Leinenger, 1978

Social system:Differing resources & practices

within home country

Beliefs of Some Hispanics

Good health may be considered a matter of “luck”; sick persons as victims of “fate”

Illness may be considered the result of negative forces or punishment.

Involve the family in decision-making and care; “la familia” in most Hispanic cultures also includes grandparents, cousins, aunts & uncles, close family friends, and god-parents.

Healers or “Curanderos”

Some Hispanics consult folk healers or “curanderos” to treat some traditional and unnatural diseases.

This is a system of care derived from a mixture of Aztec, Spanish, spiritualistic, homeopathic, and modern medicine.

“Curanderismo” plays a major role in health beliefs and practices of some Hispanics; providers should beware of dismissing it as irrelevant.

Folk Healers (“Curanderos”)

Keys to a Good Professional Relationship with Hispanic Patients

Make eye contact with the patient, NOT with the interpreter; however, some patients (especially rural) may consider it disrespectful to look the healthcare provider, an authority figure, in the eye.

Also, nodding may signify respect rather than comprehension.

Keys to a Good Professional Relationship (cont’.)

Accept a different sense of time: some Hispanics have a “global” or “indefinite” sense of time (rather than an exact sense of day and hour)

Order of Names

Hispanics have a double last name: father’s last name plus mother’s maiden name

BOTH last names must be included in the patient’s record and on the stamp plate.

Jesus Martinez Vega (father) Maria Lopez Gomez (mother) Baby’s name = Flor Martinez Lopez

Interpreter vs. Translator

Interpretation is spoken.

Translation is written.

When is an interpreter needed?Mandated by federal law:

Obtaining medical history

Explain change in medical instructions

Explain Procedures/surgery

Consent forms

Explain diagnosis or plan for medical treatment

Discharge planning

Change in regimen environmental conditions

Legal issues (explain advance directives, birth certificate forms, death certificates)

Working with an interpreter:

Speak directly to the patient, not to the interpreter.

DO NOT shout; the patient is NOT hard of hearing!!

Make a complete thought, then pause to allow time for the interpreter to speak.

Avoid side conversations. Everything said by all persons will be interpreted.

Respect the interpreter’s judgment about what is culturally appropriate or inappropriate.

Internet Translation Websites

“Babel Fish” at altavista.com is a website for translations.

DO NOT use any websites to translate ANY medical documents, e.g., discharge instructions, medications, etc.

Please call an interpreter to translate the written discharge instructions and any other written documents.

Contact Information:

Jason Roberson, MACoordinator, MUSC Interpreter Services & Cultural Competency

Medical University of South Carolina169 Ashley AvenuePO Box 250347Charleston, SC 29425(843) 792-5078robers@musc.edu