Transcript Working with Spanish-speaking LEP Patients

Working with
Spanish-speaking
LEP Patients
Jason Roberson, MA
Medical University of South Carolina
Interpreter Services
Acknowledgements
 Deborah Williamson, DHA, CNM
Associate Dean for Practice
MUSC College of Nursing
 Charlene Pope, PhD, MPH, CNM
Assistant Professor
MUSC 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
35
30
25
20
%
15
10
5
0
Language
MoneyIns
AcuteAvoid
Where to
Go?
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 = Linguistically
A = Appropriate
S = 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 biological
processes that can be studied
and manipulated
Holistic health:
The forces in a natural balance
or harmony (to protect health)
Social system:
Differing resources & practices
within home country
**Magic/Religious:
The world (health) is an arena in
which supernatural forces
dominate fate (well-being)
Leinenger, 1978
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 godparents.
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 Discharge planning
for medical treatment
Change in regimen
Legal issues (explain
environmental conditions 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, MA
Coordinator, MUSC Interpreter
Services & Cultural Competency
Medical University of South Carolina
169 Ashley Avenue
PO Box 250347
Charleston, SC 29425
(843) 792-5078
[email protected]