Opinion: refugees and migrants often encounter problems if they do not share the same language and cultural background as the healthcare provider
Can you recall a time that you were sitting waiting for a healthcare appointment with a sense of anticipation that you were finally going to get to talk to a healthcare provider about your symptoms or concerns? Can you recall that wonderful sense of relief after a good consultation, when issues have been thoroughly discussed and you have a clear and trusted plan of action?
But have you ever had the experience of not being able to communicate your symptoms and concerns because you did not share the same language and cultural background as the healthcare provider? This is a cross-cultural consultation - and it's not a comfortable position to be in.
Refugees and migrants often find themselves in this position if the health system in their new country has not been adapted to support communication in cross-cultural consultations. The gold standard adaptation is to use a trained, accredited professional interpreter in consultations whose role is to provide impartial support to patient and provider.
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From RTÉ Radio 1's Today With Claire Byrne Show, Shane Phelan, Legal Affairs Editor with the Irish Independent, on District Court judge Miriam Walsh who has been criticised for comments on use of interpreters in courtrooms
However, there is very low use of trained interpreters in many host countries, including Ireland, and the status quo is reliance on ad hoc solutions. For example, the use of a family member or friend of the patient as an interpreter is extremely common. Even children are used as interpreters, which means that they may miss school and hear information that is not age appropriate. Healthcare providers may ask a receptionist or hospital cleaner who has the same language as the patient to act as interpreter.
These examples of informal interpreting are fundamentally flawed for three reasons. First, it is well documented that many informal interpreters do not necessarily have good enough fluency in the language of their host country to be considered bilingual. Second, being bilingual is necessary but not sufficient to be a good interpreter. Third, an informal interpreter is not trained as interpreter and, therefore, cannot have the required knowledge and skills about interpreting ethics, professional practice or technical terminology.
Automated translation tools are also popular because they seem so pragmatic and handy in a busy clinical setting. However, research to date indicates that they are inadequate to capture the complex and holistic nuances of communication in healthcare consultations.
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From RTÉ Radio 1's Morning Ireland, Alex Chernenko from translation and interpreter provider Translit, on the company's initiative to train more interpreters to help Ukrainians arriving in Ireland
Recently, an NGO colleague described a situation where they were talking to a Ukrainian refugee and trying to explain that there was childcare that her child could attend. The use of an automated translation tool let to a misunderstanding: the mother thought that her child was going to be taken into care. This was obviously extremely distressing and not the desired outcome at all.
The status quo has negative consequences for patient safety. There's evidence of higher rates of hospital acquired infections, complications and adverse drugs events and dosing errors when people from ethnic minorities (including refugees and migrants) were compared with the wider population. This was due, in part, to inadequate use of trained interpreters. In general practice, there is evidence of incomplete information exchange, inaccurate diagnosis and lack of trust in the care provided. Overall, the status quo undermines refugee and migrants’ human right to access healthcare.
How can we change this in Ireland? We need to move from thinking that the use of ad hoc solutions is somehow acceptable. The 2014 Public Sector Equality and Human Rights' Duty Act is an important legal instrument in this regard. It is necessary for stakeholders in government, the HSE, education and commercial interpreting agencies to promote the use of trained interpreters across health care settings, as per the HSE Intercultural Health Strategy 2018-2023.
These actions are an investment in refugee and migrant health that will lead to more equitable and efficient use of healthcare resources
Strong inter-sectoral buy-in is also needed for initiatives that promote accredited training opportunities for interpreters. This academic year, with funding from the Department of Health, the Irish College of General Practitioners and the Roscommon Leadership Partnership Company, the University of Limerick and Dublin City University are launching new micro-credentials for interpreter training. The course is developed in partnership with the Irish Translators' and Interpreters' Association.
Healthcare providers also need training to work effectively in interpreted consultations so that the roles and responsibilities of each party is clear and comfortable. It is necessary to have a system for monitoring and evaluating interpreting in practice so that challenging or inappropriate experiences can be addressed.
These actions are an investment in refugee and migrant health that will lead to more equitable and efficient use of healthcare resources. These actions were necessary in the early 2000s when inward migration flows increased significantly for the first time. If they had been taken then, Ireland’s healthcare system would have been prepared for the unexpected emergency arrival of Ukrainian refugees in February of this year. Twenty years and counting…change is needed now.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
