Lost in Translation: Auckland’s Primary Health Interpreting Services
Northern DHB Support Agency (NDSA)
Interpreting services to better serve the primary health care needs of diverse communities
Myo, an immigrant from Burma, depends on her daughter to translate her questions and make sure she understands the doctor’s instructions when she visits the clinic for her diabetes. But Myo’s daughter is not a professional, so even with some of this clarity, Myo’s health is at risk.
For a growing number of Auckland’s residents, Myo’s story is a familiar one. Yet, in a city with 37% diversity, the 4.1% non-English speaking population can be easily overlooked. Language proficiency is a well known barrier to accessing and receiving primary health care. Communicating across cultural differences can also challenge non-English speaking newcomers when it comes to seeking services and conveying symptoms to practitioners.
Interpreting Primary Care
Here lies the value of the Primary Health Interpreting Service (PHIS) initiative, a free service for non-English speaking clients and their health care providers. Launched in November 2008, as a signature project of the Auckland Regional Settlement Strategy (ARSS) Migrant Health Action Plan, PHIS is a cross-cutting government initiative for improving settlement outcomes while improving migrant health. Managed regionally by the Northern DHB Support Agency (NDSA), PHIS is delivered locally through the three Auckland region District Health Boards (DHBs): Waitemata, Auckland and Counties Manukau.
PHIS adapted an existing service model by adding telephone interpreting services and extending the service to primary care. The original model, Interpreting Service Providers, was developed by DHB to provide face-to-face interpreting services in secondary care settings and proved so successful it quickly generated interest among primary care service providers. Patients like Myo – and her family doctor – now have access to interpreters and a better prognosis for good health.
PHIS is available 5 days a week to a wide range of primary health services, from general practice to pharmacy services, laboratory services, palliative care services, family planning and well child services. The PHI service offers:
- telephone interpreting;
- on site interpreting;
- appointment confirmation; and
- telephone assignment (this service checks that clients are taking medications and following instructions for prescribed treatments).
Addressing commonly found issues
Although interpreting services in primary care is not new, research shows that these services are not well used by general practitioners (GPs). Common reasons cited are:
- GPs preferred to use family members as interpreters rather than professional interpreters as doctors’ perceptions were that interpreted visits take longer;p
- practices were unaware that PHIS were available; and
- where practices were aware of PHIS, reception staff attitudes to the use of interpreters was a critical factor in their use or non-use.
Determined to get it right, PHIS implementation is supported with rigorous and on-going education and training of health care professionals, including the all important gatekeepers – frontline reception staff.
To promote institutional and attitudinal shift essential for systematic change, primary health service providers who register to use PHIS are encouraged to complete two online accredited training courses: Culture and Cultural Competency and Working with Interpreters. The courses increase the cultural proficiency of primary health staff working with culturally and linguistically diverse clients and improve skills in utilizing interpreters to get maximum benefit from the interpreted consultation.
An evaluation of the Auckland DHB Refugee Health Collaborative conducted in 2012 showed a more than 50% increase in the use of interpreters over a 2 year period (2010-2012). Since PHIS was introduced in 2008, significant change has occurred in the health sector, with a continuing and growing emphasis in favour of primary care.
“Through an interpreter I found the information regarding my diabetes which had already been explained before. But my daughter might not get that information. Maybe she doesn’t quite understand the health terminology,” Myo commented.
For patients like Myo, access to PHIS interpreters means a better prognosis for good health.
Making it Work for You:
- The cultural and linguistic diversity in your service population requires a culturally proficient workforce.
- Use the lessons learned from existing projects and adapt field-tested service models to develop services customized to your target group’s needs.
- Make sure that you have the right systems in place to make the interpreting service easy to use for staff, practitioners and patients, e.g. on-line booking systems and speaker phones in all clinical rooms.
- Staff training and ongoing development is essential and rewarding. Keep primary health service staff up-to-date with training, newsletters, and information packs.
For this Good Idea contact:
Annette Mortensen , Northern DHB Support Agency (NDSA)
PO Box 11214
Auckland , New Zealand,