3. Communicating with interpreters and your patient

Sometimes you'll have people who will speak English perfectly. And that's not to say that, you know, you go ahead and have a full conversation with them. You still need to understand that we are not all doctors. Ask the specialist, a podcast where doctors from Royal Darwin Hospital ask a team of specialists to answer the questions they have about working with Aboriginal patients. My name is Bill O'Rourley. Bill O'Rourley means the red tumbler cocteau. I'm an elder of the laryquia nation. My name is Brawai Engie, Polentatomeria, a Teewee elder. And my name is Rathjoy Melanie Hirdman. And I am from Irelandland. The specialists are laryquia, Teewee and Yulngun leaders who have all had personal experiences in hospital in the Northern Territory of Australia. Do you know how many Aboriginal languages are spoken in the Northern Territory? In the European Union, there are 24 official languages. On the subcontinent of India, there are 22 recognised languages. Whereas where we live in the Northern Territory, where there are about 75,000 Aboriginal people, 100 Aboriginal languages and dialects are spoken. That's huge! 100 Aboriginal languages and dialects in the Northern Territory. So, unless you speak an Aboriginal language, or many languages, communicating with patients through Aboriginal interpreters seems like a good option to consider. Unfortunately, a royal down hospital at the moment, only about 7% of patients who need an interpreter get one. So there's definitely room for improvement. My name's Vicky Kerrigan, and in this episode, we're talking about working with interpreters to improve how you communicate with your patients. I've been working with the interpreter service for a long time. I speak in the same language as I was in the UK. I've got a family there too. I've been doing this job for a long time now. My name is Benedett, and I work with the Aboriginal interpreters. I interpret two languages, Creole, which is from East Catherine. It covers all around Bourbon, Baswick, Nucca, Nimboua, Minieri. And one, which is my language, which is Berrata, comes from a place called Manningrida. And that's only just one other language that's spoken in Manningrida. About 12 languages. And that's not dialects, is it? It's language. In this podcast, we're focusing on working with an Aboriginal interpreter. So we ask Bernadette to join our team of specialists. Bernadette speaks three languages fluently. Berrata, Creole, and English. She comes from Manningrida, which is about 500K's East of Darwin in Arnhemland. And as Bernadette said, there are at least 12 different languages spoken in her community. Manningrida is one of the most linguistically diverse communities in the world. I heard a story about the Manningrida 40-gram final a few years ago. Apparently, the commentary was delivered in nine languages. Ask the specialist is about getting answers to the most frequently asked questions. Like this one, which is asked by co-host Stuart McGraw. One of the questions is when do you think a doctor should get an interpreter? Absolutely. The moment you realise that English is not their first language, absolutely critically important. And you've got to be very aware of body language. If you can see frowning and not comprehension in their eyes, well then you slow it back down and ask them. If they're going to be telling the patients, the treatments, everything else that the doctor's going to be doing to them, use an interpreter. It's best way. And that's not to say that you go ahead and have a full conversation with them. They can speak English, but of course they're not going to understand aortic rupture or renal failure. And sometimes, and I'm not saying all the time, my experiences with doctors have been wonderful. But sometimes I feel like it feels like a burden to have to sit down and go through it slowly at their pace, at the patient's pace and not the doctors, and they just rush through the conversation. And that's feedback that I've got from other relatives that has gone away for treatment. And I'm the person that always gets told, "Oh, your cousin's gone. She's going to get dialysis." She'll be back next week. Are you sure? So they've skipped to the part where all they've taken on is dialysis, home. Everything else doesn't matter. It's sort of like selective hearing, but only because they're the words that they understand. So they just pick and choose what they want to take and hear. And they say, "Yep, she's all good." They said she was going to go on dialysis, but actually she's coming home. Two months later, she started dialysis. Remember in our first podcast, we talked about the importance of building rapport with your patient. You can yarn about fishing or footy or family, but be careful not to fall into the trap of thinking that just because you've had this great yarn about everyday life, that your patient's going to understand a complicated medical consult in English. When they say yes, it doesn't mean they understand clearly. They can hear the words coming out of their doctor's mouth, which is simple words that they would know. And they are only saying to that, "Yes, to that." It's like when I do training, we do five and one. We challenge them. So it goes like this. Shopping. So what did you understand? Was your brain scrambling to try to piece together the story? It's a great exercise and it gives us English speakers a small sense of what it might be like for people who don't speak English as their first language. Here's the story in English. The Aboriginal interpreter service offers training on how to best work with interpreters. And they suggest in that training session that you should tell the patient that you are the one who needs the interpreter, which is maybe the opposite to what you've been taught. You've probably been taught to think that the patient needs the interpreter. But think about it the other way. When you explain to the patient that it's you who needs the interpreter, you reduce the possibility of the patient telling you they don't need or want an interpreter. If you haven't done a working with interpreters training session, try to get to one. It's full of really good tips. Stuff like how important it is to brief the interpreter about the patient's condition before you start the consult. That way I can know what to explain to the patient in language because some of the words we don't have in our language. And that's why the patient's not understanding medical words as well. So when you're interpreting with a doctor or a nurse, how can they best work with you? Do they need to keep sentence to the short? Yes. Sentence by sentence, it's for me to work out in language as well. If he's taught me in English and I can just pick that up while he's talking, pitching it up, okay, this is what he said. No, I can just interpret that. Don't use family members to be interpreters. They don't have the medical background usually. and they may not want to say something to the patient that will upset them. They shouldn't use the health workers because health workers have their own job, their obligation. The health workers could be a family. She might not be interpreting straight. She could be keeping or giving her opinion, giving her advice. But we interpret as interpreter, we don't do that. Because we will qualified interpreters. We have a code of ethic that we follow, accuracy, impartial and confidential. There was a story that a doctor told me that idea of discharging against medical advice. Lots of people are really worried about that when patients discharge themselves. The doctor said, "How can you say that people are discharging against medical advice if they don't understand the medical advice?" That's a good point, I think. In my experience, working in the clinic, a lot of the patients deemed non-compliant. I'm like, "This person doesn't really understand what's wrong with him." There was one cancer patient who was just really pissed off. That he said, "He's just angry all the time. He doesn't want to engage with the health care." That's the only body language they got. But really, he didn't know what was happening to his body. It was a language barrier. I had to work with him for like two months to build that bridge, to build that relationship between the doctors and him. What you're talking about the time, the time also means that that person is now actually receiving the care that they are entitled to. Yeah, engagement, that's all it is. But now, yeah, he's all good. He's attending chemotherapy, he's in Adelaide back and forth on time. I got called in once because the doctor didn't get in to a proper at first. They called me and, "Oh, there's something we didn't explain to the patient." And I said, "Did you explain it through the interpreter?" "Oh no, we're busy." And it was urgent job. There is time, if they're in hurry, call on the phone, when 24/7 on the phone as well. Even if it's an urgent matter of life and death, I can be on the phone. If there's things they have to be explaining, book in next day, or book on that day. Even when you book an interpreter, there is a chance your patient's going to be nervous about asking questions. For many Aboriginal people, asking questions is not culturally appropriate. Some don't like talking too much. They don't like asked questions. I tell them all the time, my family, ask questions, anything. If you feel not knowing what's happening, ask questions. And so the way that a medical practitioner has been taught to communicate is at the end of each consultation, the doctor will say, "Do you have any questions?" "Yes, I come across that." So when they say, "Oh, do you have any questions?" And a night would say, "Oh, in my language, question them for a doctor." "Have you got questions for the doctor?" And that'd be nuts. Alright, let's go over what we've learnt with the podcast paper route. Get an interpreter the moment you realise the patient's first language is not English. Don't use family members or health workers as interpreters. Tell the patient you need an interpreter. It may reduce the risk of the patient feeling shame when it's suggested their grasp of English is not as good as yours. The point is, you don't speak your patient's language. Brief the interpreter on the patient's condition before you speak to the patient. Avoid long explanations and medical jargon. Keep your sentences short to give the interpreter time to interpret your message. And I'm going to leave you with something to think about. Can you think of a different way to end your consult? That's standard, "Do you have any questions?" question. More often than not, the patient replies, "No, even if they do have a question." Is there a different way of phrasing that so that you can create an opportunity for the patient to engage with you? Next time I'll ask the specialist, "Why do people leave without telling the nurse or doctor?" I know there's different priorities, but why don't patients tell us more about why they're leaving? Some of these people who come to receive treatment and care in our hospital systems are sometimes the pillar of families. We'll talk about empowering your patient and explore why patients discharge themselves even when they are still really sick. Thank you to Artibola Warralee, Piroawang, Iporentata Mary, Rachi Roy, Melanie Hordman and Stuart Uart of McGraw for sharing their knowledge and personal experiences. I'm Vicki Carrigan. We hope you've learnt some stuff you can try at work. But we also hope you've been inspired to think about who you are and how you work. Because while it's helpful and completely fascinating to learn about Aboriginal cultures, if we're sincere about wanting to improve health outcomes for everyone, we need to critically think about our culture and how we can change. Not just as individuals, but also take a look at the places where we work and the policies we've created to suit how we think the world should operate.