Language barriers can have a negative impact not only on initial access to health services, but also on the quality of health care and treatment outcomes.
In Canada, three main groups of patients can face language barriers: newcomers who still haven’t gained enough fluency in one of the official languages; French speakers with limited English living outside Quebec or English speakers in Quebec with limited French; and some members of First Nations and Inuit communities.
For immigrants and refugees, language barriers are generally considered a “newcomer” issue, which is overcome once the immigrant learns enough English or French to become independent of interpreters.
However, even after several years in Canada, some immigrants are still not sufficiently able to understand the official language of the province they reside in. According to a Health Canada report, “Language Barriers in Access to Health Care,” such immigrants are “more likely to be women with young children, the elderly, poorly educated or those suffering traumatic events or psychological disorders.”
The report also says that some immigrants are able to communicate adequately in everyday situations, but face difficulties in coping with “highly stressful health-related events in a second language.”
Lack of privacy and confidentiality, embarrassment, and other kinds of psychological discomfort are some of the disadvantages of using family members and friends to translate.
Pitfalls of using non-professional interpreters
For patients who face language barriers, it is a common practice to visit hospitals and physicians’ offices accompanied by family members or friends acting as interpreters.
This practice has its advantages – these non-professional interpreters are easy to find, often compassionate, and in most cases accompany the patient at no cost. The stress of falling sick and visiting a hospital in a new country can be reduced if the patient feels supported, physically and psychologically, by loved ones.
But this experience is not always the case.
Soon after Aiko (not her real name), a 15-year-old girl from Japan, came to Canada to join her father, she started to experience menorrhagia – excessive bleeding that lasted more than seven days each month.
However, with no knowledge of English, she was reluctant to see a doctor. She felt uncomfortable talking to her father or her stepmother (with whom she had a conflict) about her problem, and couldn’t imagine going to a physician’s office with one of them as the interpreter and talking about her period in their presence.
A few months later, she started feeling weak and tired, and she fainted one morning in the kitchen. At the hospital, a blood check showed that Aiko had developed iron-deficiency anemia as a result of the untreated heavy bleeding.
Her father translated during the examination. She was embarrassed when the physician asked her about her menstrual cycle.
“The doctor was a woman and I might feel okay talking only with her in the room,” Aiko remembers, “but because my father was there, I didn’t want to answer. It was terrible.”
Even if good intentions are present, the use of untrained interpreters still carries serious risks of errors in translation that can lead to misdiagnosis and improper treatment.
Aiko had to answer all the questions and eventually made a full recovery, but until her English improved, she dreaded seeing a physician again.
Lack of privacy and confidentiality, embarrassment, and other kinds of psychological discomfort like those Aiko experienced are some of the disadvantages of using family members and friends to translate.
But there are other, even more serious disadvantages: sometimes the interpreter may not act in good faith and can twist the information in a way that can harm the patient. Also, important sensitive information – about domestic violence, psychiatric illness, substance abuse, sexually transmitted diseases, and so on – may be hidden from the physician or distorted.
But even if good intentions are present, the use of untrained interpreters still carries serious risks of errors in translation that can lead to misdiagnosis and improper treatment.
A 2003 research paper, “Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters,” concluded that mistakes in medical interpretation are common, and errors made by untrained interpreters are significantly more likely to have potential clinical consequences than those made by professional interpreters.
Professional interpreters: specially trained
For all these reasons, hospitals in Canada often use independent and specially trained interpreters.
In Toronto, for example, many hospitals find professionals though RivInt Interpretation and Translation Services, managed by the Elspeth Heyworth Centre for Women (EHCW). The centre has a roster of about 600 professionally trained people who cover more than 80 languages.
The good news for the patients is that they don’t pay for interpreters – the expenses are covered by the hospitals.
“Since our clients are most often hospitals, our interpreters are mainly specialized in health care,” says Sunder Singh, executive director of EHCW.
“We don’t take anyone who is not language tested and trained. One of the main elements of the training is mastering the medical terminology. The participants have to become familiar with all kinds of medical words and learn their equivalents in their own languages.”
Singh adds, “Another important element is the understanding of the responsibilities of the job. For example, interpreters have to be aware that the information communicated between the patient and the medical staff is strictly confidential. Interpreters who don’t obey that rule would not be called to work again and will lose their income.”
Training is provided by different colleges and organizations like Seneca College, Barbra Schlifer Commemorative, Multilingual Community Interpreter Services and others.
“Training is expensive,” Singh says, “usually between $800 and $2000, but if the participants become good interpreters and the hospitals are satisfied by them, they are called again and again. And if the language is on demand, then there is a quick return on the investment.”
The good news for the patients is that they don’t pay for interpreters – the expenses are covered by the hospitals.
“The hospitals pay [the fees for] the language services to us,” Singh explains, “and we pay the interpreters at market rate. The federal budget, unfortunately, doesn’t pay a lot for interpreters’ services, so the hospitals keep aside some budget for that – because they understand how important professional translation is.”
While across Canada there are organizations that provide new immigrants with information about the Canadian health-care system, there is a growing number of newcomers who still don’t know about these resources. As such, this is part of an occasional series by NewCanadianMedia.ca that will look into access to health care for immigrants.
