While working a clinic in semi-rural North Carolina, I was heard various complaints and arguments against the need for Spanish for healthcare professionals, including:
- Spanish, like medical terms, is Latin based. Therefore Spanish speaking patients should be able to understand medical terminology.
- The Spanish-speakers are immigrants who are in our country, therefore, they need to learn our language.
- Usually Latino patients have a family member who can interpret so I do not need to learn Spanish.
- My clinic is equipped with an interpreter line. I can easily call and have a phone interpreter available.
- Spanish is too difficult and I am too busy.
Though some of these claims are easily disputed. For example, the Spanish term hígado is nothing like the English word used in clinic, liver, or even the medical term for something relating to the liver, hepatic. Regardless, others appear more convincing. This is why it is advantageous to understand the reason we teach Spanish to healthcare professionals not because we hope to stay employed, but because the reasons are motivating for both the professor and the medical professional.
In this post, I will not cover the research and the supporting arguments in detail. Instead, what I hope present is a brief overview of the main points and then offer a list of resources for further reading on the topic.
According to SeonAe Yeo
Language is the means by which a patient accesses the health care system, learns about services, and makes decisions about her or his health behavior. Language is also the means by which the health care provider accesses a patient’s beliefs about health and illness, and thus creates an opportunity to address and reconcile different belief systems (2004: 59, 60).
Marcos (2008) then explains why we cannot expect that language interchange to always occur in English even when we are working patients who have some knowledge of the language:
cuando una persona se encuentra mal de salud es natural recurrir a su lengua natal para expresarse. La razón es que el individuo experimenta una regresión emocional a aquellos tiempos de la infancia en que se encontraba al amparo de la familia y protegido por ella. (981)
When reviewing the current research, it appears evident that this language barrier impacts both access to the healthcare system and quality of care. Here, I will briefly highlight a few of the studies demonstrating this fact. The first study I would like to highlight is by Timmins (2002) who conducted a review of studies published between 1990 and 2000 in biomedical journals. This study investigated the impact of language barrier on healthcare specifically in the Latino population. One result of the study is that 86% of the studies evaluating quality of care showed a significant negative impact. Another study, conducted by David and Rhee (1998), found that the doctor is less likely to explain medication side affects to non-English speaking patients and that this lack of information resulted in a decrease in medication compliance. They also found that patient satisfaction was negatively impacted by the language barrier even when an interpreter was present. These outcomes are supported by the data presented by Young (2005) which reveals at least half of the Spanish-dominant patients had difficulties in communicating with their care provider and almost 50% reported having difficulties in understanding the instructions of their prescribed medications. Finally, a more serious case is recorded by the study implemented by the Moore School of Business of the University of South Carolina which interviewed several social workers. In the study, the social workers reported cases in which Latinos underwent operations without an explanation of what the surgery was or why they needed it. For example, according to one social worker: a 33 year old Latin American woman underwent a surgery with no prior explanation of what the operation was for only to learn afterwards that it was a histerectomy.
However, this does not necessarily mean that medical professionals must learn Spanish. What about the use of a family member or a professional interpreter? Next week, I will address the use of ad hoc and professional interpreters as compared to bilingual medical professionals.
Bibliography and Resources:
Darla Moore School of Business. (2001, June). “Hispanic needs assessment field study.” Columbia, SC: University of South Carolina. Recuperado el 8 de enero 2013 de http://www.sph.sc.edu/cli/documents/Hispanic%20Needs%20Assessment%20Field%20S%20tudy-DMSB_june01.pdf.
David, Rand A y Michelle Rhee (1998): The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mount Sinai School of Medicine 65 (6) 393-397.
Ennis, Sharonn R (mayo 2011): The hispanic population: 2010. Recuperado el 29 de noviembre 2012, de www.census.gov/prod/cen2010/briefs/c2010br-04.pdf
Flores, Glenn (2006): Language barriers to health care in the United States. The New England Journal of Medicine 355: 229-23. Recuperado el 29 de noviembre 2012, de http://www.nejm.org/doi/full/10.1056/NEJMp058316
Fortuny, Karina; Chaudry, Ajay (2011): A comprehensive review of immigrant access to health and human services. Recuperado del Urban Institute el 29 de noviembre 2012, de http://www.urban.org/UploadedPDF/412425-Immigrant-Access-to-Health-and-Human-Services.pdf
Jacobs, Elizabeth A; Agger-Gupta, Niels; Hm Chen, Alice; Piotrowski, Adam; Hardt, Eric J (August 2003): Language barriers in health care settings: An annotated bibliography of the research literature. Recuperado el 29 de noviembre de www.hablamosjuntos.org/pdf_files/cal.endow.bibliography.pdf
Jacobs, Elizabeth A; Shepard, Donald S; Suaya, Jose A; Stone, Esta-Lee (mayo 2004) Overcoming language barriers in health care: Costs and benefits of interpreter services. American Journal of Public Health 94 (5) 866-869. Recuperado el 29 de noviembre del Research and Practice.
Marcos Marín, Francisco (2008): Los servicios públicos en español: Atención al ciudadano. Enciclopedia del español en los Estados Unidos Anuario del Instituto de Cervantes 2008. Recuperado del Centro Virtual Cervantes el 4 de diciembre 2012, http://cvc.cervantes.es/lengua/anuario/anuario_08/pdf/servicios03.pdf
Marcos Marín, Francisco A y Domingo Gómez (2008) Los servicios públicos en español: Servicios médicos y hospitalarios. Enciclopedia del español en los Estados Unidos Anuario del Instituto de Cervantes 2008. Recuperado del Centro Virtual Cervantes el 4 de diciembre 2012, de http://cvc.cervantes.es/lengua/anuario/anuario_08/pdf/servicios02.pdf
State Center for Health Statistics and Office for Minority Health and Health Disparities (July 2010): North Carolina minority health facts: Hispanics/Latinos. Recuperado el 29 de noviembre 2012, de www.schs.state.nc.us/schs/pdf/Hispanic_FS_Web_080210.pdf
Timmins, Caraway L (2002): The impact of language barriers on the health care of Latinos in the United States: A review of the literature and guidelines for practice. Journal of Midwifery and Women´s Health, 47 (2), 80-96. Recuperado el 29 de noviembre de Wiley Online Library.
Young, Richard D. (2005): The growing Hispanic population in South Carolina: Trends and issues. Recuperado el 29 de noviembre 2012, de http://www.ipspr.sc.edu/publication/Population%20In%20SC.pdf