1. Meeting Language Needs in Indigenous Languages and Languages of Lesser Diffusion  Kaweah Delta Health Care District  Visalia, California Presenter Gloria Grijalva, MS, Ed. Admin.

2. Kaweah Delta Health Care District 581 Bed Hospital Level III Trauma Designation  KD Medical Center  KD Rehabilitation Hospital  KD Mental Health Hospital  KD Imaging Center  KD Exeter Health Clinic  KD Urgent Care  KD Visalia Dialysis  KD Porterville Dialysis  KD Hospice  KD Sleep Disorders Center  The Lifestyle Center  And maintains partnerships w/  Cypress Surgery Center  Quail Park Retirement Village  Sequoia Regional Cancer Center

3. Introduction  If there is no harmony internally; it will be reflected externally. Culture Service Data Kaweah Delta Beliefs Health Laws Respect Language

4. “To be culturally competent doesn’t mean you are an authority in the value and beliefs of every culture. What it means is that you hold a deep respect for cultural differences and are eager to learn, and willing to accept, that there are many ways of viewing the world.” -Okokon O. Udo, PhD Integrative Health and Wellness Northwestern Health Sciences University Cultural Competency

5. CULTURAL & LINGUISTIC TOOLS

6. KDHCD TOOL KIT Interpreters (5) Part-time (1) Per Diem (3) Health Care Interpreter Network 1/18/10 Interpreter Services Policy AP.122 Waiver of Interpreter Services Form Language Resource Assistants/Pins COS HCICP Internship Signage Spanish Vidatak EZ Boards Cultural & Linguistic Advisory Board *Spanish TestLanguage Line Placards SDL TRADOS Technologies software Hands on Communication (ASL) Panational (other languages) Deaf & Hard of Hearing Services Transperfect (Translation vendor)

7. Spanish Test  Administered to all Interpreters and Per Diem Interpreters  Administered to all applicants applying for bilingual positions  Administered to staff members who are asked to interpret –Language Resource Assistants (LRA) Test consists of 6 parts:  Reading – English and Spanish  Sight Translation – English to Spanish  Oral Interpretation – 3 scenarios between physician & patient  Confidentiality – 5 questions, multiple choice  Cultural knowledge – Mexican traditional medicine & healers  Anatomy – parts identified in English, write Spanish term  Point system determines general or advanced level

8. DEMOGRAPHICS

9. Kaweah Delta Health Care District Languages Identified by Patients –Achinese (Acehnese), Afrikaans, Arabic, Armenian, Bengali, Bosnian, Cambodian, Cantonese, Chinese, Dutch, Farsi, French, German, Hmong, Hindi, Illocano, Iloko, Iroquoian, Italian, Japanese, Kannada, Korean, Lahu, Lao, Mandarin, Mien, Mixteco, Persian, Philippine, Polish, Portuguese, Punjabi, Romanian, Spanish, Tagalog, Tamil, Thai, Tongan, Turkish, Urdu, Vietnamese (41) –ASL

10. KDHCD Top 3 Languages  Spanish  Lahu  Lao  Spanish  Lao  Lahu

11. Communities with Communication Barriers  Lahu  Interpreters needed  Language Line does not have  Vendor has one  Solution –  Test our staff  8 have been tested  Mixteco  Interpreters needed  Often mistaken for Spanish speakers  Language Line has  Vendor has limited use  No internal staff identified

12. Laotian Populations  Lahu is majority of the minority –Approximately 1,500 in Visalia –Tulare County 1,700  Mien, approximately 1,100 in Visalia  Hmong, approximately 500 in Visalia –Approximately 1,500 in Tulare County  Lao, approximately 400 in Visalia –Approximately 1,000 in Tulare County –(*Asian American Coalition)

13. Lahu “ Children of Blessing ” ‘All Lahu – regardless of their sub-group or religion are deeply concerned with and constantly striving for blessing.’ - Peoples of the Golden Triangle

14. Migration The Lahu are a mountain tribal people that have their roots in southeastern China. Their ancestors migrated from China to the hill country of northern Laos and lived there for approximately 300 years. Following the Communist take over of Laos in the late 1970’s, ten’s of thousands of Lahu and other tribal people fled into northern Thailand. Because of the Lahu people’s support for the United States, approximately 4,000 Lahu were encouraged to immigrate to the United States. The Lahu people immigrated to Utah, Minnesota and North Carolina. Following 2 years of assimilation and English school, they eventually came to Tulare County, California. They had strong connections with the prominent Mien who were already in Tulare County. The Mien had connections with the Hmong, who were in Fresno County. Agriculture was the draw.

15. Lahu Groups  Yellow – Largest in Tulare County  Black  Red  White

16. Lahu Health Problems  Diabetes  High Blood Pressure  Asthma- 70% of adults smoke  Cancer –Colon –Stomach

17. Lahu Staff at Kaweah Delta  Need to test and qualify staff members  Staff invited to discuss concerns  Requested input and interest indicated  How would we test/none available  Asian American Coalition contacted Recommended evaluators Staff approval solicited  Evaluator trained to administer test

18. Oral Test Evaluation  Total Beginner  Beginner  Intermediate (2)  The candidate has no knowledge of the language whatsoever  The candidate can communicate in a simple way in specific situations such as ordering food, asking directions and expressing basic needs  The candidate can handle successfully a limited number of interactive task-oriented social and business activities

19. Oral Test Evaluation  Advanced (5)  Nearly Fluent  Fluent  The candidate can handle successfully a limited number of interactive, task-oriented social and business activities.  The candidate can initiate and sustain a wide variety of communication tasks with finesse.  The candidate speaks at the level of a native speaker.

20. Lahu Staff Meetings  What was missing from the test? –Medical Knowledge  Solution? –Teach Anatomy  Front View Female/Back View & Internal Organs Male  Cultural Understanding –Peoples of the Golden Triangle

23. “Aw bon wi ja” Thank You