LINGUISTIC BARRIERS TO HEALTH CARE A 40 years old Brazilian woman rushes into the emergency room.

When she is attended, she says in her broken English that she is constipated and she needs some medicine. The woman presents other symptoms, but the doctor gives her a prescription based on the provided information. Problem solved, isnt it? The expression to be constipated is a literal translation of the Portuguese expression estar constipado, which means having a cold. Due to miscommunication, that patient received inappropriate care and she will have to come back to the hospital or health centre to receive adequate treatment. This is a light example of what might happen when patients have none or limited proficiency of the language spoken in their country of residence. When patients do not understand what their healthcare providers are telling them, the quality of health care can be compromised. In addition to a myriad of other barriers to health care faced by migrants, such as the eligibility of health benefits, level of poverty and education, inconvenient hours, lack of transportation, cultural differences, etc., the linguistic factor is one of the most evident barriers to health care for migrant and ethnic minorities. This is true especially in case of newcomers, who have none or elementary knowledge of the language spoken in the host country. Language barriers can have deleterious effects, as they compromise quality of care and increase costs and inefficiencies. People who face linguistic barriers are less likely to search medical attention, to follow the exact medical regimens, to adhere to medication, or to go to a follow-up appointment. They also receive preventive services at lower rates, mostly because the provided information on those screenings is written in a language they do not master. In case of patients with psychiatric conditions, those who encounter language barriers are more likely to be diagnosed with a severe psychopathology or leave the hospital against medical advice. In order to overcome this barrier, it would be good if hospitals or other healthcare centres could provide interpreting services at no cost for the migrant and ethnic population. Today, many healthcare centres do not have qualified medical interpreters on hand, and even

if they do provide interpreting services, patients are asked to pay for each fifteen minutes of interpreting. Ad hoc interpreters, such as family members or relatives, untrained medical staff or even strangers found in waiting rooms are commonly used as interlinguistic mediators. However, these interpreters are more likely to commit translation errors or to filter information and assume the role of the decision maker. Aside from this, the presence of family members or relatives who act as interpreters may inhibit discussions regarding sensitive issues such as domestic violence, substance abuse, undesired pregnancy, psychiatric illness or sexually transmitted diseases. The use of professional interpreters for patients with none or limited proficiency of the dominant language has been proved to improve access to health care and understanding, increase satisfaction, rise the levels of compliance and participation, and diminish the amount of medical errors. Free interpreting services may be cost effective, since the provision of these services could save health care money by preventing unnecessary hospitalisations and treatments. Another way to overcome language barriers is to recruit skilled bilingual staff members who reflect the cultural diversity of the community served and provide them additional training in interpretation, cultural competency and ethics. Bilingual staff, acting either as healthcare providers or interpreters, create a welcoming environment for the migrant patients, thus increasing the patients satisfaction and trust in the quality of received medical care. Bilingual staff is also more likely to be cultural aware. Culture influences the way a community sees the world and it creates a certain pattern of accepted values, beliefs and behaviours. When linked to health, culture influences peoples lifestyle choices, their perception of illness and its causes, their reaction to certain diseases, the choice of treatment, among others. For example, culture may constrain some patients from speaking about cultural taboo topics or may discourage a wife from speaking freely in front of her husband. This is where the bilingual and bicultural staff can step in and provide information about health or suggest different treatments in a way that does not shock patients from other migrant and ethnic minorities. Since patients are more likely to open themselves and disclose more information when the person attending them is from the same community, bilingual and bicultural staff will be able to establish a therapeutic relationship and, thereby, help the patients.

As for the medical information delivered in writing (informed-consent forms, discharge forms, preventive screening brochures, etc.), they should be provided in several languages, so that patients with limited knowledge of the dominant language could be informed of their treatment options, screenings, and other services provided by the healthcare centres.