Congratulations to Brynn Quick, whose entry into the 3-minute-thesis competition won the Macquarie University Department of Linguistics People’s Choice Award yesterday!
Brynn’s research examines what happens when people go to a hospital but don’t speak the dominant language (well). How do these linguistic minority patients communicate their health concerns, and how do hospital staff help them if a language barrier exists? What kinds of multilingual communication strategies and tools exist in hospitals? How do hospital staff even know if a patient needs a multilingual communication strategy?
Watch the award-winning entry here and find the script below.
Curing Confusion: How do hospitals communicate multilingually? Brynn Quick’s 3MT script
Have you ever been a patient in a hospital? If you have, do you remember feeling confused or scared? Imagine having to navigate that process……. in another language. What if you were hospitalised and you couldn’t understand what your healthcare providers were saying to you? What would you want the hospital to do to make sure that you received the same quality of care as the patients who could understand the language?
My research looks at the ways in which hospitals facilitate communication when there is a language barrier between linguistic minority patients and the hospital’s healthcare providers. Since I can’t call every hospital and ask how they manage linguistic diversity, I’ve done the next best thing – a systematic literature review. This means that I developed a very specific search strategy to find academic papers from the last 5 years that would answer my questions about this topic. First, I wanted to know what communication tools and strategies are currently in use in hospitals. And second, I wanted to find out how a hospitalised patient is identified as needing a multilingual communication strategy. After a rigorous screening process, I landed on 50 studies that would help me find the answers to these questions. So, I got to reading, and found an answer that I wasn’t expecting.
Here’s what I found. Human interpreters are really important to bridging language barriers between hospitals and linguistic minority patients. Professional medical interpreters are considered the gold standard, and even though it’s 2023, translation apps and AI are not yet reliable methods of conveying the complexities of medical concepts and emotions that interpreters can. But here’s the catch – healthcare providers are hesitant to actually use an interpreter if they feel that the process of organising for one will take a long time, OR if they feel that the interpretation itself will be time-consuming.
But how do these healthcare providers even know that a patient needs an interpreter? The answer to that question is what surprised me most – in almost half of the studies I looked at, this wasn’t even addressed. But! Of the studies that did, the majority pointed to hospital admission staff as the people who were responsible for finding out if a patient needed an interpreter. In most of the studies, this is where the responsibility seemed to end, though. Admission staff noted the need for an interpreter in the linguistic minority patient’s record, but then whose responsibility was it to actually organise the language service? The answer to that question was much less clear.
So what does my study tell us? Hospital admission staff with language needs training may be an untapped resource when trying to ensure that all hospital patients have equal access to information and care. Healthcare providers may be more inclined to utilise interpreters if they know that there is a dedicated team of people who are trained to identify a patient’s language need, book a language service, and follow up to make sure the patient is receiving that service. My research is important because it is identifying areas for health communication improvement – and ensuring equal communication access means ensuring a healthier community for us all.
This work is licensed under a
Brynn has addressed such an important topic in an excellent manner. Besides the limitations in terms of the quality of the health attention patients receive, fears including discrimination and excessiveness in health care charges inhibit many migrants from having their health taken care of.
Besides improving the relationship between interpreters and healthcare providers, it is pivotal to develop potential patients’ awareness in terms of their rights and the tools they have to navigate the intricated pathways of Australian health and legal systems, along with motivation to work on their EFL skills as a means towards autonomy.
Good point, Jhonny! Receiving language assistance starts long before you actually set foot in a hospital through education about your options, rights and responsibilities; the availability of a free interpreting service needs to be part of public health literacy campaigns.
Dear Ingrid,
Thank you very much for sharing this article and video. Both human and machine translation have their advantages. Machine translation is convenient and practical, and can translate one language into multiple languages. It saves both time and labor for some simple sentences because it uses literal translation as long as people can understand. However, the machine has limitations in the translation of some important occasions and books, etc., such as accuracy cannot be guaranteed, especially for simultaneous interpretation. It is difficult for machines to distinguish some people’s accents and words. At this time, interpreters need to use certain translation skills to convert the language into words that others can understand. Human translators can interpret context, understand creative uses of language, such as metaphors and puns, and convey them into the same meaning, understand the differences in expression between different languages, and find the most appropriate translation for content that cannot be translated literally while ensuring accuracy.
In terms of medical care, interpreters who have been professionally trained by hospitals can accurately and clearly translate what doctors say, especially some medical terms. Even if the patient does not understand, the interpreter can explain it in layman’s terms, which helps the patient understand their condition and the doctor’s recommendations better, but some simple processes, such as how to pay and where to pick up medicine, are easier and more convenient through machine translation.
Leaders of some countries bring interpreters with them when they meet to discuss politics, which highlights the importance of human translation. People have brains that can think, and they use some professional translation skills to make the leaders fully understand each other’s words. Similarly, the translation of poems and songs will not read or sound catchy if used by machine translation. Although people can understand the meaning, some of them may not even make a coherent sentence. In this case, the interpreter’s translation skills are needed to translate into sentences that are smooth and beautiful.
Thanks, Siyao, for laying out the different affordances and limitations of human and machine translation so clearly. One danger I see in relying ever more on machine translation is that we actually forget about these nuances; human interpreters will then only be available to the elite (like the politicians you mention) and everyone else has to make do with inferior machine translations … for instance, one of the studies Brynn was looking at found that doctors just write “US” when ordering an ultrasound; machines consistently translated that into Spanish NOT as “ultrasonido” (the Spanish word for “ultrasound”) but as “Estados Unidos” (the Spanish word for “United States”) …
What a crucial and yet underestimated subject… I absolutely agree with the statement that translation apps and AI are not able to convey the complexities of medical concepts and emotions that human interpreters can. If a hospital system works well, the admission team will arrange translation for the patient’s appointment. However, in many cases, we see that the process might be disregarded since it can be time-consuming and as a result, the doctors and patient both take the linguistic barrier to get through and reach a successful and accurate communication (if they do). On the other hand, AI brings to the table what it does best: potentially helpful data which is convenient.
I read this article about a tragic case of a nine-year-old Vietnamese girl who died due to a drug reaction because her parents primarily spoke Vietnamese, and no competent interpreter was provided during her medical encounters in the US. Consequently, the article introduces Stratus Video Interpreting which is a provider of Video Remote Interpreting (VRI) services, dedicated to breaking down language barriers in healthcare and other industries. Their advanced technology allows healthcare facilities to connect with a network of certified interpreters proficient in over 175 spoken and sign languages. The company’s commitment is mentioned to improve patient safety and the quality of service in the face of linguistic diversity as a vital resource in bridging communication gaps and ultimately saving lives. So maybe we could use technology to find a faster way to an interpreter but not rely on AI fully to break the linguistic barrier in medical situations which can be extremely sensitive.
https://www.healthitoutcomes.com/doc/nine-year-girl-dies-language-hospital-video-healthcare-hazard-0001
Thanks, Arghavan, for the reference! I hadn’t come across this case before and I’ve added it to my collection of media reports about language barriers. This particular write-up, of course, is an infomercial and pushes the services of a particular company. Australia, btw, has offered these kinds of services through a national translating and interpreting service since the 1980s 🙂
Thanks, Brynn for sharing this interesting research. Language barriers in medical context are never something ignorable. We are living in the era of technology and numerous people assume that machines can totally replace people in interpretation. I partly agree that it’s convenient and accessible, but I don’t think that machines can convey the full messages that people want to give. This is obvious in the medical context, I think.
I work in a dental clinic and the first few months were so stressful to me. The patients of different backgrounds came or called to describe their situations before booking appointments. Reluctantly, I had to be the one who described their cases with the dentists before setting up the appointments though I was not totally sure. I could see the double barriers there: the patients, with the little ability to communicate in English, and me, with my insufficient knowledge of dentistry. They tried to use translation apps to express what they mean, but it’s never enough to provide necessary information before the treatments. Some people gave up when they were required to fill in a medical history form because they didn’t understand anything. Therefore, to avoid misunderstanding, various patients come to ask if there are any doctors speaking the same language with them. Otherwise, we need a staff member to speak the same language with them as an interpreter. That is the reason why the dentists and staff in my clinic come from different countries, whose L1 is not English. Living and working in a multicultural country like Australia, I think everyone knows the linguistic difficulties that people have to confront. While people try to use machines as temporary solutions, I consider hiring staff from different backgrounds to give language minority patients more options to communicate is a praiseworthy solution of my clinic in the effort of bridging language communication barriers.
Thanks, Chloe, for sharing! I really like your idea of making sure health professionals have bilingual skills. It won’t remove language barriers for everyone (e.g., there are lots of Vietnamese dentists around, in my experience, but few Arabic dentists, another community language of similar size) but it’s definitely an important step in the right direction.
Congratulations Brynn! Such an important work!
Although most symptoms and phenomena in healthcare necessitate accuracy in diagnosis, which machine may be able to figure out better, the role of human interpreters in healthcare is considerably significant in terms of communication, or considering certain context of patients, as human organisms are also as intricate and variable as language.
As you know, We still have no idea how much potential these AIs have to empathise with humanity. If these AIs or other machines can totally understand personal contexts or flexibility, similar to human beings, I would say those digital friends could outperform human interpreters especially in healthcare in which the accuracy needs to be. However, there will certainly be a linguistic barrier between human and non-human which cannot be settled without human’s touch.
I have a little hope that both human and machine can collaborate and coexist in language so they both can collapse the language barrier, like the music industry in which digital and analogue resources are coexisting at the same time, giving off their own charms.
Thanks, Jaehoon! Interesting comparison with music. My view is darker: the business model of platforms like Spotify has essentially killed independent music and lead to an incredible concentration (e.g., here or here). Artists and music lovers have lost; and I fear that the same will happen with machine translation – language workers such as interpreters and those who need their services lose 🙁
One of my relatives – a senior, who has lived in Australia more than 10 years. She uses her digital tablet to watch online videos for entertainment and cannot use AI or translation apps.
She just knows about 3 English words which are “Vietnamese” and “No English” that her daughter taught her. This is how she signal to other people that she cannot speak English. She lives in the suburb which has a large population of Vietnamese so she can get her necessities and essential services such as doctors, foods and drinks, banks, etc. When she picks up her phone or when other people want to talk to her and hear those “signals”, they will call other people to help to interpret or end the conversation.
Her daughter has registered a Vietnamese aged care agent which can help her to interpret to communicate with doctors and other people. They also help her in anything she needs such as giving her a lift, cleaning up, etc. It is good to know that Australian government has support income senior, so that she does not worry about the fee for the agent. I think this kind of agent can be a good solution to bridge the communication barriers.
Thanks, Brownie! So glad that your relative can get by in Vietnamese – I take my hat off to her because living without English in Australia, even in a Vietnamese-dominated suburb, takes a lot of courage.
Congratulations, Brynn! Well done. Interesting topic you have worked on. It is a big responsibility for hospital admission to decide whether the patient needs an interrupter or not. I can relate to a similar experience with me in the emergency department. I had an injury in the gym, I didn’t feel it until later that night. I rushed to the hospital and the health care providers assumed that I understand English even though I was in a lot of pain, and I couldn’t communicate well. I would imagine the situation would have been worse if I hadn’t any knowledge speaking English. I believe health care providers well defiantly benefit from a well-trained staff on language services to insure all have equal access to health care services.
Thanks, Abed! Good point that even highly proficient English speakers may need an interpreter or other form of language support when they are feeling unwell and are in distress. Hope your injury healed well!
I have an enjoyable memory of a taxi ride in Lisbon while traveling to the beach. Despite my lack of Portuguese knowledge, the taxi driver ingeniously conveyed the idea of swimming through animated gestures and vocalizations. Instead of getting frustrated, I eagerly followed what he did for language acquisition. Embracing a foreign language in a foreign land became an enjoyable endeavour. This is the only positive aspect of my experience with a language barrier which was well-supported.
As I am expecting my parents’ forthcoming settlement in Australia, a pressing concern lingers: will they have access to timely translation services when needed? While they can manage basic communication in survival English, I believe it would be ideal for them to converse in their home language from a pragmatic perspective. This is not solely for the sake of basic communication but also for their psychological well-being. Just as I enjoyed embracing a new culture during my travels, they, too, have a deeply ingrained cultural connection that only their home language can fulfill. My hope is that they can strike a harmonious balance between the two worlds and enjoy life to the fullest. I also wish them to avoid suffering the language barrier during critical situations when they settle in Australia.
Good holiday memories! The thing is that nothing much is at stake on holidays; if the taxi driver had not made an effort, it would have been less enjoyable but wouldn’t otherwise have had any negative consequences …
Good luck to your parents! Hope they can find both a new community both in the home language and in English!
I believe that the Australia’s current medical interpreter service is sufficiently good. After watching this video, I realized that the advancement in this domain could be based on strong research in the academic field.
I now have questions about whether there are related research studies in Korea. I found one article, “The Current State and Future Tasks of Medical Interpreter Policy for International Patients in Korea(2019),” by Mi Young Chung, addressing that issue in Korea. The writer says that there is a lack of prior research on Korea’s medical interpreter policy. In Korea, Medical interpreters are employed by hospitals, and under poor working condition. Other than interpreting, they also need to handle a lot of paper works and even attract foreign patients. But their salaries are not high.
According to statistics from the Korean government, as of 2023, foreigners account for 3.2% of Korea’s total population. Apart from Korean Chinese, Vietnamese and Thais are the two foreign nationalities most prevalent in Korea. I was so surprised to learn that Vietnamese and Thai are not even included in the language options for medical interpreter certification. Korea has a long way to go; I think it’s time to consider their language barrier in medical service in Korea.
Thanks, Logan, for providing this informative background on medical interpreting in Korea!
Thank you for the interesting article. Also the challenge might be the patient’s responsibility: would everyone admit that they need an interpreter? Probably not.
This made me remember when I was working in a childcare centre in Finland with children whose (Finnish) literacy was still forming, and the teachers constantly used these key word signings, and visuals. I think that was a wonderful way to break the barrier of understanding, and also to support the literacy development. Since then, I have had two kids and now my oldest one is developing her English literacy in formal settings, and I have found that at least visuals have been an awesome way to support her journey. I did put my child into preschool without any English skills. So actually, I think she can relate to the patients who went to the hospital without appropriate level of language skills. Her literacy has started to form quite quickly, but there are no support methods, such as key word signing, in public preschools at least in our area, so I’m not sure how they have communicated with her.
Have you ever heard about the key word signing?
Thanks, Em! I know where little about key word signing other than that it is used with children with Down Syndrome or similar conditions. Never knew that it is being used with 2nd language learners, too. Would love to hear more about your experience and/or Finnish practice. Is there a reference you can recommend?
I work in a Japanese retail shop and have had a lot of opportunities to translate from Japanese to English. This is because instruction manuals of the products are written in Japanese and most customers are functionally illiterate. As soon as they notice that I am Japanese, some of them ask me additional questions about the products. Sometimes, we even have small talk and I can build a relationship with them quite easily. On the other hand, some customers who do not speak English or Japanese use a translation app. I can only convey a minimum amount of information and it is very difficult to establish a relationship.
In the past, some of my students in Japan asked me why they needed to study English despite the development of translation apps. They probably cared about linguistic competence and paid scant attention to the differences between human translation and machine translation in terms of communication. As a teacher, I would like to tell my future students about the importance of learning languages so that they can successfully bridge communication barriers.
Thanks, Japanda! That’s such a frequent questions nowadays: why do we still need to learn languages instead of letting machines do it? It’s good that you have an answer to give to your students! For language learners, I would add that human interaction beats going via a mediator anytime – this is true whether that mediator is a human or a machine.
Brynn pointed out a problem that is also what the Vietnamese family I stayed with last year encountered, as I heard them talking about a member’s unpleasant experience in hospital. The language barrier was mentioned in their conversations, yet using an interpreter never came up. I wonder if the family or the hospital considered this at all.
Language difficulties are also present in another healthcare context – the pharmacy, despite less extensive exchanges. I’m glad that the one where I’m working features a diverse staff profile, with pharmacists and assistants having many language and cultural backgrounds to best assist customers. Talking about medicine is never simple across languages. Normally, customers show images or use Google Translate to state their desired products or services – technology surely helps with these terms. However, reading the information on packages can remain a daunting task to some, and my job is to explain in simpler terms. Sometimes I am surprised at how handy my linguistic tools are for information gathering and giving, as I read the labels or inquire the pharmacists and then inform customers. When it comes to health, I think real human communication offers a sense of reassurance and flexibility of which machines are not quite capable.
Thanks, Justin! Curious to hear more about your host family’s hospital experience …
Re your work in the pharmacy, I actually think using the language skills of bilingual staff strategically and systematically is probably be the most effective and realistic solution to many institutional communication problems!
Thanks, Justin! It’s very interesting that you point that out about pharmacies. One of the studies in my review very briefly mentions a program called Meds to Beds where pharmacists help patients understand medication dosing instructions before leaving hospital, and this study says that they (the pharmacists) utilise “professional interpreters when needed” (https://pubmed.ncbi.nlm.nih.gov/34627715/). I would be very curious to know more about that program!
Personally, I would say that the most challenging and demanding area of my interpreting studies has been the field of healthcare. The reason is simple: not only does it require a lot more knowledge than interpreting in any other fields, but it also requires a lot of care at the same time, as patients’ lives can be at stake.
This happened to me one day during my interpreting exam. It was a medical interpreting test, and I was in the position which I should do interpreting between a Korean patient and an Australian doctor. In response to the Australian doctor’s questions, the Korean patient kept answering using onomatopoeia and onomatopoeic expressions that only a native speaker would understand. Being Korean, I understood everything that was being said, but no matter how hard I tried, I couldn’t find the equivalents in English.
In the end, I managed to translate what the patient was trying to say into English by using totally different expressions, but for a while after the exam, I often talked to my study buddies about how the onomatopoeia and onomatopoeic expressions can be difficult to be interpreted clearly, even with translation software.
No matter how fast technology develops, the language we use as social animals is constantly changing, and the same expression can mean different things in different contexts. The more I study linguistics, the more I come to the conclusion that there are definite limits to what computers can do, even if they use translation software.
Thanks for sharing your experience! Good point about care – no matter what an algorithm can do with language, it can never do care and establish human relationships; and we should not let machines degrade those relationships …
I don’t know why my former comments are only partially visible on this post. It is because probably because I wrote it in a Word file first and then I copied and pasted it here.
By the way, it was a great opportunity to reflect on the importance of the medical interpreting again. In addition to medical interpreting, there is another field where the skills of an interpreter are just as important: legal interpreting. At MQ’s Translation and Interpreting course, we learn to interpret and translate in a variety of contexts, including medical, legal and business.
Legal interpreting is also very tricky because words can have a huge impact, even in our mother tongue. Legal interpreters currently working in Australia said that legal interpreters have to be good at both English and their mother tongue, as well as legal knowledge because the interpretation can make or break a case.
This is why I believe that no matter how much technology advances, machines will never be able to replace human interaction.
Thanks, Jung Ung! I agree that machines will never be able to replace human interaction. At the same time we can overlook the fact that this is precisely what is already happening. The result is a loss of quality and ultimately a degradation of human interaction …
If you are interested in legal interpreting, you will enjoy this post: https://www.languageonthemove.com/refugee-credibility-assessment-and-the-vanishing-interpreter/
This very interesting topic has been discussed on a few occasions at my current workplace. I work with a team of translators and interpreters (mostly from English to French) who are passionate about languages and linguistics. While they have expressed their concern that AI could take over their jobs in the future, these dedicated professionals firmly believe that a machine will never replace humans when it comes to conveying a message or information from one language to another accurately. Every day, I witness the hard work that goes into providing high quality translations and language interpreting, so I can only share their opinion on this subject. I believe context is everything, and while machines are very helpful for basic translations, only humans have the ability to select words in such a way that they carry the same meaning to the original version of a document or the speaker’s speech.
Thanks, Laura! Given how much hype there is around so-called “AI,” I sometimes worry that people who have deep experience with translation, interpreting, and intercultural communication like your colleagues are increasingly sidelined and we’ll all have to settle for the inferior, degraded vision of communication that big tech is pushing …
Congratulations, Brynn! So proud of you. Thank you so much for bringing up an engaging topic.
It makes me remember my mom’s story last week. She travelled from Vietnam to Sydney last month to take care of my baby.
Last week, she went from Bankstown to Lidcombe by train. Unfortunately, the trains were repaired, and she had to go by bus. When she came to the bus station, she saw some men with high-vis yellow vest day/night vests. My mom can’t speak English (except hello and bye). But she came to the man, took the phone, opened Google Translate, used the record button, spoke to it and showed the man what was on her phone (”Tôi muốn đi Lidcombe” – “I want to go to Bankstown”). Luckily, the man took her to the right bus, and she could go to Lidcombe.
She told me that story, and I told her that she was very confident and thanks to Google Translate.
I think the relative merits of humans and machines in bridging communication barriers can be clear through the story. It is true that machines and AI can facilitate our communication and remove language barriers. But they are sometimes problematic and not correct 100%. They can lead to misunderstandings in communication (Google Translate sometimes can not explain our ideas and even translates the wrong sentences). I would suggest, if possible, we can learn the language, even at the basic levels, to communicate and express ourselves. This is much better than depending on machines and AI.
Thanks, Lynn! That’s such a great story! Google Translate and Google Maps has certainly transformed all our lives! While it works well for relatively simple things like asking directions, machine communication is nowhere near capable to serve in high-stakes interactions. Sometimes, it even fails at small tasks, as in this story of a mistranslation of “good morning” as “attack them” – leading to a wrong arrest…
https://amp.theguardian.com/technology/2017/oct/24/facebook-palestine-israel-translates-good-morning-attack-them-arrest
Thanks Ingrid! I want to expand my answer in another aspect, that is communication tools can help us to explore ourselves in the mode of writing. I had a workmate who could not speak English well. This discouraged him from joining the conversation with everyone. When we discussed anything, he stayed silent. However, we had an online platform where all the team members could join and chat. This made him more confident to send messages and join the ”community”. It is true that writing is much easier than speaking because speaking depends on numerous elements, such as pronunciation, accent and vocabulary. While there are plenty of ”supportive digital tools” (Grammarly, Google Translate…) to support our writing. As a second-language speaker, I am sure that we might feel scared and afraid that someone would judge their pronunciation.
Thanks, Lynn! I second this a hundred percent – since running these writing tasks here on Language on the Move, I’ve learned so many interesting things about and from my students that I would never have heard in class, no matter how interactive I try to make the sessions …
Catchy summary, Brynn! I am especially interested in the gap you found in regards to how/by whom patients are identified as needing a multilingual communication strategy. You know my own work with Allie Severin, published in the Griffith Law Review, calling for improved communications policy to guide government departments and institutions (eg Dept of Health and public hospitals) about when to use languages for mass/public communications and to strategically plan their use and resourcing. The issue you’ve found with individual hospital communications echos what we found. You may also find interesting Ben Grimes’ analysis of a ‘duty interpreters’ model for courts (ie a bunch of interpreters on duty at the courthouse) to improve access to justice; this is similar to what you’re suggesting for hospitals.
Ben Grimes (2021) Judicial reliance on the executive: tensions, discrepancies and recommendations for court interpreter service delivery models across Australian jurisdictions, Griffith Law Review, 30:1, 71-96, DOI: 10.1080/10383441.2021.2014773
Congrats Brynn! What important work this is!
Congratulations Brynn, I’m really glad you are doing this urgent research and look forward to reading the systematic review!