Posted on December 29, 2008

Language Called Health Care Barrier

Lesley Ciarula Taylor, Toronto Star, December 23, 2008

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.