Felisha Rohan-Minjares, MD Assistant Professor, FCM Director of Cultural Competency Curriculum Development Office of Diversity

At the end of today’s session, residents will be able to:  Explain the importance of language access and why interpreters should be utilized when needed  Explain best techniques of how to utilize medical interpreters

A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross- cultural situations. Cross, T L et al. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children, National Center for Cultural Competence, Georgetown University, 1989.

No one provider can or should be expected to know about every type of culture they might encounter. What is important is that they learn to listen respectfully and learn and respect that patients bring their own health beliefs and value systems into each encounter.

 Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.  Required of all health organizations receiving federal funds.

 Translator a person who takes a written document in one language and converts it to another language  Interpreter a person who takes a spoken language and converts it to another language.  Cultural Broker

 Resident physicians recognized that they underused professional interpreters, and described this phenomenon as "getting by”  Resident physicians made decisions about interpreter use by weighing the perceived value of communication in clinical decision making against their own time constraints

 The decision to call an interpreter could be preempted by the convenience of using family members or the resident physician's use of his/her own second language skills  Resident physicians normalized the underuse of professional interpreters, despite recognition that patients with LEP are not receiving equal care.

Chance Interpreters – Family, Friends Bilingual Support Staff – Untrained Bilingual Support Staff – Trained Professional Medical Interpreters – in person, via video, via telephone

 Omit questions or instructions  Leave out or instruct patients not to answer personal questions  Try to influence the patient’s decisions  Summarize the message instead of relaying it exactly  Answer questions on their own

 Spanish, Vietnamese, Navajo & American Sign Language in house  Services available in person, video, and via telephone  Contracted Language Services Provider Pacific Interpreters for over 200 languages

 Find the best interpreter available.  Never use a child.  If it all possible, avoid family members interpreting.

 Avoid the Triangle.

 Introduce yourself to the interpreter.  You may briefly tell the interpreter about the patient and the case if you are familiar with the patient.  Speak in the 1 st person and make eye contact with the patient while speaking, not the interpreter

 Speak clearly and in your normal tone of voice. Speak at a normal to slow-normal pace.  Use short sentences.  Be aware that many concepts you express have no linguistic or conceptual equivalent in other languages. Don’t use idioms. (i.e., “It’s a long shot”, “kill two birds with one stone”)

 Language  Cultural Background  Religion  Spirituality  Family Structure  Historical Trauma  Familiarity with and acceptance of western medicine  Education  Socioeconomic status  Role in family  Role in community  Bias  Immigration history  Etc.

21 yo Vietnamese female patient accompanied by her husband. Husband tell you that he wants to interpret for her WHAT WOULD YOU DO?

65 yo Swahili speaking man comes in to the clinic at 4:45pm on Friday with chest pain. He is accompanied by his 16 yo grandson WHAT WOULD YOU DO?

You saw a 72 yo Iraqi man yesterday. Today you are reviewing his labs from the hospital and find that his sodium is 118. WHAT WOULD YOU DO?

You are doing your rural rotation in Santa Rosa. A 16 year old Spanish-speaking patient is accompanied by her aunt who knows English and is serving as interpreter. You are ready to ask the questions about risk behaviors including sexual history and drug and alcohol use. You don’t speak Spanish and there are no trained interpreters at the clinic. Several clinic staff members speak Spanish. WHAT WOULD YOU DO?