A tale of modern day Babel: The challenges of multiple languages in inner city hospitals

It is not surprising that multiple cultures and languages mix in the ‘melting pot’ of larger cities such as New York and London: in the inner city borough of Haringey, where the authors are based, there are at least 56 different languages spoken by 23 ethnic groups. Increasing numbers of asylum seekers and immigrants arriving in the UK means that healthcare workers are now more likely to encounter patients with limited proficiency in the English language. While there is no clear legal right to translation services in the UK, non-discrimination and equality in access to healthcare are fundamental human rights principles which are often violated when caring for non-English speaking patients (House of Commons 1998, 2000). Language barrier complicates many aspects of patient care such as inaccuracies in history taking, invalid consent, poor patient satisfaction, as well as prolonged length of stay (Flores 2005; Schenker et al. 2007). It has recently been negatively reported in the media that interpreting services cost the National Health Service over £55 million per year (Easton 2006), which in the current financial climate, has caused expression of concern and calls for review of language services. Rationing interpretation services however, is a false economy, as miscommunication between patient and provider results in reduced compliance to treatment, underuse of preventative services and unnecessary attendance at clinics and A&E departments (Baker et al. 1996).

The highly publicised incident of Willie Ramirez was a good learning experience: due to the absence of interpreters, the Spanish speaking teenager from Florida was misdiagnosed as a drug overdose (on the basis of the incorrect translation of the word ‘intoxicado’), which ensued in a delay in diagnosis and treatment of his intracerebral haemorrhage. The 18-year-old man, who became quadriplegic, won a US$71 million malpractice settlement and this catastrophic medical error involving language differences led to the compulsory availability of the qualified medical interpreters in the USA.

In the UK, contrary to the General Medical Council ‘Good Medical Practice’ guide (2009), the pregnant woman's partner or children are often used as interpreters to translate intimate details. Under these circumstances, important information usually relating to past reproductive history, psychological problems and domestic violence may not be elicited.

Data from two consecutive Confidential Enquiry into Maternal Deaths (1997–1999 and 2000–2002) highlighted ethnic minorities as a high risk factor in pregnancy and indicated that recently arrived non-English-speaking immigrants had up to a seven-fold increased maternal mortality risk (Lewis and Drife 2001, 2004). In the most recent Centre for Maternal and Child Enquiries report (Lewis et al. 2011), one of the top 10 recommendations was that ‘professional interpretation services should be provided for all pregnant women who do not speak English, as they are ill-served by the use of close family members or members of their own local community as interpreters’.

What can clinicians do in these times of lean efficiency? Telephone translation or ‘Language Line’ claim to be able to provide a translator for almost any language 24 hours a day. This is available through most hospitals using an access code and the costs incurred can be reimbursed from healthcare commissioners. Recently, innovative web-based medical translation softwares such as Medibabble have been available: this was developed by two medical school students from America and allows medical care providers to play back thousands of pre-recorded questions in patients’ native language (http://medibabble.com/). Clinicians do have to exercise some caution when using generic web-based interpretation devices such as Google Translator, which allows basic translation to a conversational level, but may miss the more subtle nuances necessary for an accurate medical history.

The sensory-impaired pregnant women also often find communicating with the obstetrics and gynaecology services frustrating, as there are only 200 trained interpreters for the 50,000 or so people who use British Sign Language as their preferred method of dialogue (Lee 2007).

Treating people from different cultures and backgrounds, although challenging at times, can be interesting and rewarding, as it encourages cultural sensitivity and the development of a range of verbal and non-verbal communication skills. Nonetheless, the authors often wish that they had access to the Babel fish, that ‘small, yellow, leech-like’ creature described by Douglas Adams in the ‘Hitchhiker's Guide to the Galaxy’ (1979), which when inserted into one's ear, becomes a unique ‘interspecies’ translator, decoding brain waves and allowing one to instantly understand anything said in any form of language (if only the Secretary of State for Health, Andrew Lansley, could bring this to reality).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.