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Language, cultural barriers challenge healthcare providers

In the spring of 2002, the Mississippi State Department of Health (MSDH) released a report titled “Mississippi’s Plan to Eliminate Racial and Ethnic Health Care Disparities.” In that report, the MSDH referred to the critical need for healthcare providers to have “cultural competence” when treating patients of diverse backgrounds and nationality.

The report said, “Despite similarities, fundamental differences among people arise from nationality, ethnicity and culture, as well as from family background and individual experience. The delivery of high-quality primary healthcare that is accessible, effective and cost efficient requires healthcare practitioners to have a deeper understanding of the socio-cultural background of patients, their families and the environments in which they live.”

With Mississippi’s ever-growing Hispanic population, healthcare providers in the state meet these cultural challenges head-on on a daily basis. In-state healthcare providers are devoting increasing assets to meet these challenges that add an extra level of complexity in the delivery of quality, effective services. Unfortunately, there is no one-answer-fits-all, and the state’s healthcare community continues to meet this issue creatively and on a case-by-case basis.

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“The learning curve hasn’t gotten any easier,” said David Putt, interim CEO of University of Mississippi Medical Center (UMC). “It’s a daily challenge. The Hispanic population is growing, especially in nearby Scott County. And, we’re seeing more and more non-Hispanics who present the same challenges.”

Putt added that while UMC has policies and procedures in place to deal with this issue and has devoted more and more resources to better serve those of other cultures, each case is different and requires a degree of flexibility. Having procedures and policies spelled out is crucial, but no set plan is going to account for all the challenges healthcare providers face in this fluid environment.

Forrest General Hospital in Hattiesburg is a good example of a Mississippi healthcare organization that several years ago developed and implemented a plan for dealing with non-English-speaking patients. Protocol was established. Staff members, including physicians, with foreign language skills were identified, and Forrest General subscribed to a language assistance program through AT&T that provides over-the-phone service in 140 languages as an extra safeguard.

According to Forrest General spokesperson Millie Swan, these measures have resulted in the hospital’s staff being able to generally handle any problems with communication immediately, and she said language barriers do not affect the effective delivery of patient care. However, even after all of these efforts, some incidents prove problematic for Forrest General’s staff.

“We do occasionally encounter individuals who speak specific dialects of a language that are rarely known,” said Millie Swan, spokesperson for Forrest General. “For instance, we once had a patient who spoke Mistecca, a fairly recent deviation of Spanish that is known by relatively few in the Spanish-speaking population. Fortunately, the patient’s spouse spoke both Mistecca and Spanish fluently, allowing our staff to translate through the assistance of an interpreter and the spouse.”

Putt said, “Obviously, you can’t have an interpreter for every dialect.”

Putt added that UMC also has hired Spanish interpreters, one for the adult side of the hospital and one for the children’s side, has identified staff who have language skills and utilizes language phones. However, even with the language barrier breached, healthcare providers still have to deal with other cultural differences that may affect the proper delivery of care.

One of the major hurdles when dealing with those of other cultures is nutrition. Knowledge of a patient’s diet is crucial to effective treatment, but that knowledge is often lacking.

“Most of these patients don’t eat what we eat,” Putt said. “Understanding lifestyle and diet is extremely important, and it remains a challenge on a case-by-case basis.”

Treating the problem

The aforementioned MSDH report identified numerous strategies for overcoming cultural and linguistic barriers.

On the micro-level, the report recommended the following:

• Require providers to develop and implement clear CLAS (culturally and linguistically appropriate services) policies and provide ongoing training for all staff, especially frontline staff that has patient contact.

• Identify and disseminate best practices in care delivery for LEP (limited English proficiency) patients to facilitate replication of these efforts.

• Require that publicly-funded hospitals and managed care organizations hire and contract with bilingual providers/interpreters who can meet the needs of their patients.

• Foster partnerships between providers and ethnic organizations to assist in adapting their service delivery to meet the needs of various cultural groups.

• Encourage healthcare institutions to partner with community organizations to develop language banks (or pooled interpreter services), staff lists and language-assistance policies to ensure adequate access for the LEP population.

Contact MBJ staff writer Wally Northway at northway@msbusiness.com.

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