When doing my internship at the obstetric department as a medical student I helped to take care of a heavily pregnant woman coming to the emergency room in the middle of the night. She had severe stomach ache and couldn’t speak Swedish or English. We had trouble registering any heartbeat from her baby and could not get hold of an interpreter.
It took 30 minutes until we finally registered the heartbeat. It was a very traumatic experience for all involved, especially for the woman who wasn’t able to make herself understood, or understand us.
This is what reality looks like for patients every day.
I believe we all feel it is important to easily communicate with ambulance personnel, nursing staff in the emergency room, or the midwife when giving birth. Yet today, patients who don’t master the same language as the healthcare professionals generally face big communication problems, even though everyone should be able to receive the same healthcare treatment according to the law. Why is this?
A lot of countries, including Sweden, have laws that give patients the right to be assisted by an interpreter when in need. In practice, this means that an interpreter is booked to a meeting with for example the doctor, nurse or counsellor when the meeting has been scheduled in advance. The interpreter will either be physically present, or interpret by speaker phone.
In emergency situations or non-scheduled meetings there is still a possibility to get hold of an interpreter but usually with a delay that could be up to an hour. Normally, an interpreter will be booked for a fixed one hour session. This is what conditions are like. But how does this work in reality?
In reality, the majority of all communication will be handled without interpretation. While it is common to book an interpreter for a meeting with the doctor, nurses usually do not have the same access, and therefore generally do not use interpretation or translation services in the reception or triage at the ER.
Likewise for ambulances or on the ward. Why do we draw a line for when to use an interpreter, even though the law states the opposite? Is it because we think the communication is less important in these situations? I don’t think so.
There are probably many reasons for this, however, I believe that the following three are the major ones:
The majority of current interpreting services in Sweden lack the possibility to provide interpreters on demand, and bookings are usually set for a fixed one hour meeting. This means that the waiting time can be too long in emergency situations, and that the services are not adjusted according to how nursing staff usually work with shorter non-scheduled patient meetings.
I just want to emphasize that I do not think that an interpreter charges too much for his or her work, it is the pricing model that is not adapted according to how we work in healthcare. Most communication with a patient does not go on for an hour straight, we rather have short conversations divided amongst all healthcare staff members.
Yet, most interpreter services charge per hour instead of, for instance, by minute. Studies have shown that interpreters are avoided due to high costs and lack of time, especially by nursing staff who feel pressured to cut down on costs and instead prioritize interpreter time with the doctors.
From my own experience working and doing internships in many different departments, combined with my experience from running Care to Translate, I believe that nursing staff generally lack the knowledge that they actually can book interpreters whenever they need to. This is not something that is usually communicated or embraced by the management. Why this is the case is still unclear to me.
During our seminar in Almedalen in the beginning of July this issue was brought up, clearly showing the discrepancy of knowledge about the subject. The head of the ER nursing staff who was being interviewed explained the problem of not being able to communicate with patients, as interpreters were only used by doctors. The attending people from major interpreting service providers were shocked, and explained that they didn’t know that the issue was handled like this within healthcare departments.
The first two issues can be solved with flexible translation and interpretation tools that can help all staff. They have to be easy to access, have a low threshold to use, and be available 24/7. They may be introduced as a combination of different tools, such as our translation tool Care to Translate combined with an on demand interpretation service, where usage is charged by the minute.
But what is also very important, is that the management prioritizes the implementation of these solutions through promoting the tools and educating the staff in how to use them. This is also a solution to the third issue. We need management to take greater responsibility in increasing the usage of translation and interpretation tools.