Working with Spanish-speaking LEP Patients

1. Working with Spanish-speaking LEP Patients Jason Roberson, MA Medical University of South Carolina Interpreter Services

2. Acknowledgements • Deborah Williamson, DHA, CNM Associate Dean for Practice MUSC College of Nursing • Charlene Pope, PhD, MPH, CNM Assistant Professor MUSC College of Nursing

3. 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

4. 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

5. 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.)

6. “Our Changing Community”

7. 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/

8. The Hispanic Health Needs Assessment – National Alliance for Hispanic Health adaptation http://www.hispanichealth.org

9. Primary Barriers to Care

10. 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”

11. 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”

12. Challenges for South Carolina • New population growth area- recent arrivals to the U.S. • Lack of knowledge & confidence within the new Hispanic community

13. 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

14. 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)

15. 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.”

16. 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

17. 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

18. Patient-Provider Communication How do we link communication to outcomes? COMMUNICATION PATIENT SATISFACTION ADHERENCE HEALTH OUTCOMES (Betancourt, 1997)

19. 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

20. “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!!

21. 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.

22. Global Health Belief Systems Social system: Differing resources & practices within home country Scientific/Biomedical: Life/health is controlled by physical and biological processes that can be studied and manipulated **Magic/Religious: The world (health) is an arena in which supernatural forces dominate fate (well-being) Holistic health: The forces in a natural balance or harmony (to protect health) Leinenger, 1978

23. 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 god-parents.

24. 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.

25. Folk Healers (“Curanderos”)

26. 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.

27. 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)

28. 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

29. Interpreter vs. Translator • Interpretation is spoken. • Translation is written.

30. When is an interpreter needed?Mandated by federal law:

31. 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.

32. 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.

33. 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 robers@musc.edu