Medical Interpreters Share Stories of Culturally Savvy Healthcare Providers

Healthcare interpreters hold a unique vantage point, witnessing patients’ experiences across various stages of their medical journeys, often through the lens of a single language. While their daily interactions reveal patterns of cultural conflicts, communication errors, and misunderstandings that are unique to specific language groups, they also observe exemplary communication strategies and innovative approaches that dedicated providers employ to ensure patient-centered care.

Drawing from the rich insights of medical interpreters, we’ll be taking a closer look at some of the skills and approaches of healthcare professionals who excel in delivering culturally sensitive, informed, and compassionate care.

Effective Communication Strategies

The Importance of Initial Patient Interactions

Formerly a staff Arabic interpreter in the Texas Medical Center, Ahmed Abdulmajeed knows well the experience of international patients seeking treatment in the United States. He notes that “providers who spent the first few minutes of their first meeting with an international patient welcoming them and getting to know them and their background” tended to build rapid rapport and trust, setting the stage for more effective communication than those who didn’t. “They would seat themselves in front of the patient, face them, and speak directly to them with curiosity about their culture and country of origin,” Ahmed adds.

Direct engagement marked by curiosity and respect for the patient’s culture sets a foundation for effective communication. But what does that look like? Ahmed describes providers who had a better chance of connecting with their patients as those “who were calm, had grace, were observant to mannerisms and cues, made fewer assumptions, and asked more questions.”

Asking the right questions early is especially important when working with indigenous patients.

Asking the Right Questions

One assumption that often catches many health professionals off guard involves a patient’s preferred language. There are 22 distinct Mayan languages spoken by more than 7 million people in Guatemala. Many Indigenous Mayan speakers have only some or no fluency in Spanish. Despite this, Dr. Winston Scott, a cultural anthropologist with over 15 years of experience as an interpreter for Q’eqchi’ and K’iche’ Mayan, notes that “Q’eqchi’ Mayan speakers often find themselves at an appointment with a Spanish interpreter or Spanish-speaking provider.” Due to the difficulty in finding Mayan language interpreters last-minute, these Spanish interactions may fall flat or lead to serious miscommunications, with provider assumptions about what was understood being overestimated.

Dr. Scott encourages asking a patient what their preferred language is directly. Visual aids can make this process easier:

 

Making liberal use of visual aids can go a long way in alleviating patient anxiety, fostering trust and comfort between provider and patient. In dialogues with Deaf patients, visual aids may be particularly helpful.

Visual Aids in Action: Enhancing Clarity for Deaf Patients

Cody Francisco, an experienced interpreter trainer and Certified Deaf Interpreter (CDI), shares a very effective strategy providers can take advantage of when working with Deaf patients.

Recalling an interaction he once interpreted between a savvy cardiologist and a Deaf patient who was not fluent in American Sign Language, Cody shares how a description of a surgical procedure was successfully communicated: “As I interpreted, the cardiologist allowed me to directly manipulate an anatomical model of the heart and lungs that he used for consultations. The patient was more easily able to visualize and understand the surgeon’s explanation and quickly felt more comfortable about the procedure he was to undergo.”

A Certified Deaf Interpreter (CDI) is an interpreter who is deaf or hard of hearing and has specialized training in providing interpretation services. CDIs possess proficiency in communicating in and understanding both English and American Sign Language (ASL) or other sign languages. CDIs often work in tandem with hearing ASL interpreters, especially in complex or sensitive situations where cultural and linguistic nuances are critical.

In this case, it’s important to note that both the use of a specialized interpreter and the use of visual aids led to a successful outcome. The recently released Final Rule Section 1557 (ACA) emphasizes that visual aids should be used in conjunction with other communication methods to meet the diverse needs of patients effectively.

Cultural Sensitivity in Practice

Cultural Symbols and Gestures

Originally from Mexico City, Graciela Zozaya is a Spanish interpreter and interpreter trainer with over 30 years of experience. She continues to be impressed by healthcare professionals who learn about common cultural beliefs that many of their patients hold and use that knowledge in their consultations.

Graciela recalls one experience when a non-Mexican American surgeon’s understanding of the “evil eye” or “mal de ojo” instantly improved a post-surgery interaction with a Mexican patient’s family:

“The surgery was over, and the family had a little baby with them wearing a tiny red ribbon with a seed around her wrist. The baby kept smiling and batting her eyes at the surgeon. I could see the mom was looking back and forth at the baby and then at the surgeon and was becoming apprehensive.

And the surgeon caught it! He had spotted the red ribbon, noticed the mother’s concern, and responded in a culturally appropriate way – with a simple gesture.

Without saying a word, he bent down and gently touched the baby’s head, smiled at the parents, and continued his conversation with them. You could see the stress in the mother’s face just melted away the moment he did it.”

The evil eye is the belief that a person can inadvertently cause harm to another, particularly to infants and young children, simply by looking at them with envy or admiration. Mexican mothers who hold this belief feel a heightened sense of anxiety and responsibility to protect their infants from the evil eye, commonly tying a red string or ribbon around the baby’s wrist with the belief that it can ward off the evil eye and protect the infant from harm.

Touching a baby’s head after admiring them is believed to help protect the baby by breaking the connection and neutralizing the negative energy that might have been unintentionally transferred through the admiring gaze. This gesture, often done with a light affectionate touch, can reassure the parents that the admiration is not envious or harmful, reducing their anxiety about potential negative effects.

Graciela continues:

“When the meeting with the family concluded, the surgeon and I walked out together and I said, ‘Hats off to you!’

‘I got that one right, didn’t I?’ he said. And we both had a laugh.”

The surgeon had learned about this belief, including the significance of the gesture of touching an infant’s head, and other helpful insights by asking interpreters questions before and after consultations, from his conversations with the many patients he had treated over the years, and from cultural competency training he had attended.

Interestingly, Dr. Winston, a Q’eqchi’ and K’iche’ interpreter, has noticed that an increasing number of nurses and physicians are being proactive about building cultural competence “by asking interpreters for insights on how to better interact with patients from cultural backgrounds not well-understood by them.”

Cultural Competence Over Time: Learning and Adapting Through Experience

Ian McKamey, who now directs interpreting operations for MasterWord, is a certified Vietnamese interpreter with over two decades of experience. He explains how, over time, he’s noticed healthcare providers increasingly understanding the Eastern medicine concepts of ‘hot’ and ‘cold’ as well as traditional therapies like wind scraping, which is also called spooning or coining.

“I first started out interpreting in Seattle where there was a very large Vietnamese population, and patients would often refer to themselves as being “hot inside”. At that time many providers misunderstood this as the patient having a fever.

The broader cultural interpretation of this however is that the individual’s “Chi” or in Vietnamese “Khí” was out of balance. Essentially it refers to the imbalance of Yin and Yang properties stored in the body. In traditional eastern medicine this is believed to be the cause of a collection of symptoms that, to name just a few, include dehydration, fatigue, acne and of course the sensation of feeling “hot inside,” and can lead to even more serious health issues down the road. The closest cultural equivalent would be one’s “core body temperature” vs. their peripheral body temperature.

To prevent patients’ comments being misinterpreted, I would routinely provide this extra cultural context in addition to stating exactly what a patient had said so that the physician clearly understood the meaning. Interestingly, about halfway through my career as an interpreter, I wasn’t needing to provide the cultural context as often as providers were more frequently expressing greater familiarity with these non-western concepts.”

This change seems to reflect a broader shift towards greater cultural competence in healthcare and indicates that the collaboration between healthcare professionals and interpreters has led to long-lasting improvements in the patient experience for LEP individuals.

In sharing these interpreter insights, we hope to highlight the significant role that culturally aware healthcare providers play in improving patient outcomes. The experiences and observations of medical interpreters offer valuable lessons in communication, empathy, and understanding. These stories not only celebrate the successful strategies of culturally savvy healthcare professionals but also serve as a guide for others striving to enhance their own patient care practices.

We look forward to sharing more articles in the coming months, where we will continue to explore the rich insights from interpreters and the impactful ways they contribute to culturally competent healthcare.

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