Toronto: Language called health care barrier

Harold Schiffman hfsclpp at
Wed Dec 24 14:22:55 UTC 2008

Language called health care barrier - News & Features - Language called health care barrier


Dr. Jose Silveira, of the University Health Network, is part of a
program that treats people in five languages. Not just words Canada
now has its first national standards for translators in medical care,
but the debate over whether they should be professional conduits or
cultural interpreters rages on.
Five of five Tamil translators interpreted one diagnosis – "You have
only two months to live" – as "You will live a long life" because
there's a cultural taboo against telling someone he or she is dying,
says Sunder Singh, executive director of RivInt Interpretation and
Translation Services, a non-profit organization used by Toronto
hospitals. Her organization was screening interpreters with a test.

All of RivInt's 460 interpreters in 60-plus languages have been
certified as trained professionals. "We train them to say what the
doctor says," Singh says. Ponmalar Thriugnanam is a trained
interpreter who worked for many years as a volunteer at Scarborough
General Hospital and knows how difficult being an unemotional conduit
can be. "I only speak to what is said and we keep everything
confidential. But particularly with the psychiatric patients, you have
to be very, very careful," she says. "Sometimes they talk nonsense and
I want to laugh or cry. When I am at home, sometimes my experiences
come as a wave. I sit and think, `How do I manage?'" There are nuances
in the way people speak, says Andrew Clifford, professor at the School
of Translation at Glendon College.

He recounts a case in which the children of an elderly
Cantonese-speaking man tried to stop the interpreter from telling him
he likely had terminal cancer. It was their duty to protect him, they
said. The doctor insisted he know and be able to decide on treatment
or palliative care. "It exploded into a horrible mess," says Clifford.
"Perhaps the interpreter should have spoken to the family first before
the doctors arrived and asked who was going to make the decisions."-
Lesley Ciarula Taylor

Newcomers ill because they can't communicate with doctors and lack
services of interpreters

December 23, 2008
Lesley Ciarula Taylor
Immigration Reporter

A significant number of immigrants, including many newcomers to
Toronto, say they are ill because they can't speak English well enough
to tell anyone, a doctor who advocates for immigrant health reveals in
the current Canadian Journal of Public Health. "We found clear
linkages" between health and language, says Dr. Kevin Pottie, a
researcher at the Institute of Population Health and professor at the
University of Ottawa. "It's another level of evidence." "People don't
really want to talk about this. People are hiding it or not
documenting the poor outcomes. There is a certain shame in the medical
profession that we don't do a better job."

Pottie and four other researchers talked to 11,802 immigrants in
search of data for what he calls "one of the most important issues for
health care for immigrants and refugees right now." Unlike in the
United States, there are only a few case studies of dangerous medical
lapses because of lost translations, some stretching back 20 years. In
the U.S., multi-million dollar lawsuits have forced 13 states to
require trained professional translators in hospitals and clinics. In
Canada translators are mandated only in courts. "These are
marginalized people who can just barely survive, let alone create the
kind of atmosphere where someone would write about them," says Pottie,
a specialist in immigrant and refugee health.

Just over a year ago, a Vietnamese mother of three was dying of cancer
but her medical team at North York General Hospital couldn't tell her.
"She had no idea what was happening to her," said Frank Wagner,
bioethicist for the Toronto Central Community Care Access Centre. "It
was a basic violation of a human right. She has the right to get her
affairs in order, to die with dignity, to agree to palliative care if
she wants it." His organization swallowed the costs of a translator
for three visits. "We're waiting for a volcano to explode," says
Stella Rahman, co-ordinator of Cultural Interpretation Services at the
Centre for Addiction and Mental Health. "And it will."

The 2006 census found 44 per cent of people in the GTA had a first
language other than English. While big teaching hospitals, such as St.
Michael's and the CAMH, use translators, smaller hospitals and
community health centres tend to get by on bilingual staff or
relatives. "Doctors spend hundreds of thousands of dollars on their
education and then ask a child to deliver a diagnosis," says Axelle
Janczur, executive director of Access Alliance Multicultural Health
and Community Services, which supplies interpreters for health
services. "We think it's okay for the janitor or the kitchen staff to
do the translating." Dr. Jose Silveira is director of the Portuguese
Mental Health and Addiction Services of the University Health Network,
part of a unique program that uses bilingual teams in five languages
to treat people who otherwise would, in Janczur's words, "have to suck
it up."

"It is easier for me to order a $1,400 CT scan than a translator ...
even though that information will be more valuable than a CT scan,"
Silveira says. "It's up to me to decide on enormously expensive
medical tests. It's up to the hospital administration to decide on
interpreters." The damage caused by the language wall is enormous, he
says. "Our patients are some of the sickest in psychiatry. Many of
them don't have family doctors. By the time we see them, they are much
further along and their treatment is prolonged." University of Toronto
professor Kathi Wilson also found fear and confusion keep immigrants
away from doctors. Findings from her focus groups with 53 immigrants
in the Dixie-Bloor Neighbourhood Centre area in Mississauga, published
last March, discovered language was a main reason why they avoided
getting medical care.

"It's a daily concern on their minds – asking for directions,
describing what was wrong, whether doctors would be able to understand
them or that they wouldn't be able to understand what the doctor was
telling them to do," she says. Despite Wilson and Pottie's studies,
Canada still doesn't have the kind of research already done in
Australia and New Zealand to back up the theory that translators mean
faster, better care and fewer dangerous or deadly mistakes. "There is
lots of literature (showing) that the cost is infinitesimal compared
to doctors' or nurses' time. Overall, costs go down when professional
interpretation services are used," says Elizabeth Abraham, president
of the board of the Health Interpretation Network at UHN.

She argues the lack of translators violates the fundamental right of
universal access to health care. There has been progress. The Health
Interpretation Network brought together community health and
translator groups for the first time to come up with the National
Standard Guide for Community Interpreting Services, which spells out
requirements for interpreters, clients and institutions. Next year,
all city hospitals will have to tell the Toronto Central local health
information network how they plan to ensure patients get "culturally
competent, high-quality interpretation."  The impetus was a report in
July by Dr. Bob Gardner, director of policy at the Wellesley
Institute, that pointed to language as one of three big blocks to
equal health care.

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