Vancouver Medical English Institute

Medical Translation in Connecticut

Hospital breaks down language barriers
MARIAN GAIL BROWN
Article Last Updated: 05/07/2008 12:42:33 AM EDT

Assume a patient races into a hospital emergency room in the dead of night, moaning, sweating with his hands shielding his eyes.
The guy reaches the triage area and shouts: "Tengo una golpeando la migrana. Estoy viendo destellos de lux plateada. Puedo oir la electricidad en la pared. Y creo que voy a vomitar ahora!"

Or maybe he wails: "Ich habe einen stampfenen migrane. Ich sehe blinkt der silbermen lichts. Ich kann horen die elektrizitat in der wand. Ich gehe jezt zu erbrechen!"

Obviously, the nurses can tell he wants medical attention. But if they don't speak his language — in this case Spanish or German — well, it might as well be Greek. Otherwise, they'll never know this poor guy is trying to tell them: "I have a pounding migraine. I'm seeing flashes of silvery light. I can hear the electricity in the wall. And I think I'm going to barf now."

A growing number of Connecticut hospitals are relying on certified medical interpreters, staff proficient in a foreign language, to act as intermediaries, conveying critical patient information to doctors and vice versa. In fact, the state Department of Social Services is trying to assess the need for interpreters. Hospital administrators around Connecticut began receiving notices from the state agency Monday that it wants to know to what extent their facilities rely on interpreters in their emergency rooms and other departments.

In Bridgeport, where 71 languages and an untold number of dialects are spoken,

Bridgeport Hospital is taking a unique approach in situations where it would otherwise be hard pressed to find translators proficient in languages from Bengali to Mandingo to Zange.
"We contracted with a firm that provides us with two-way live video conferencing language translation services," said Lynn Charbonneau, director of patient relations for Bridgeport Hospital. "Our patients can see the interpreter and the interpreters can see them, too. And I think that visual element is important because they can assess them in a way you can't when you're just on the phone."

From February to early May, the hospital used Language Access Network to converse with emergency room patients who spoke Arabic, Turkish, Cantonese, Mandarin Chinese, Creole French, Farsi, French, Gujarati, Portuguese, Hindi, Somali, Bengali, Vietnamese and sign language.

About 56,000 Bridgeport area residents speak a language other than English at home, according to the U.S. Census Bureau, and 53,655 of them have only a limited proficiency in English.

Bridgeport Hospital has signed a five-year contract with Language Access Network for the Ohio-based firm to provide translators in any foreign language, as well as sign language, on demand at any time.

"Bridgeport Hospital is our first client in Connecticut, but we expect to have additional ones soon," says Michael Guirlinger, chief executive officer at Language Access Network. "It usually takes us less than 60 to 120 seconds to connect an interpreter" with a hospital.

Among the firm's other clients are Boston Medical Center, Memorial Sloan-Kettering in New York City and Texas Children's Hospital.

Beyond its contract with Language Access Network, Bridgeport Hospital offers a Spanish proficiency exam in-house for staff who want to be certified as medical interpreters. So far, 30 staffers from a variety of departments have passed the test. For further training, the hospital has many of them enrolled in a University of Massachusetts program.

The most common languages after English and Spanish heard in the emergency department in Bridgeport are Portuguese and Polish.

"We are starting to think about asking a question on our employment applications if an individual speaks another language and if they are interested in becoming certified as an interpreter," Charbonneau said. "There are times when a patient will want to rely on a family member, but unless that person is specifically trained in communicating medical information, we would discourage that because we need to make sure that we get complete information from a patient and that what our staff has to convey is being communicated in its entirety."

For that reason, even in cases where a non-English speaking patient wants to enlist a relative to talk to nurses and doctors, Charbonneau encourages hospital staff to call for an interpreter anyway. In an emergency room, quick and accurate communication can make the difference in how a patient recovers — or not — from a medical trauma or illness.

According to the Connecticut Health Foundation, language barriers are a major contributor to systemic disparities in health care, which contribute to higher health care costs and poorer treatment outcomes.

"The result is an inferior health system for patients who do not speak English well and who lack access to doctors or other health care providers who can communicate with them in their primary language," Ann Bagchi, a health researcher with Mathematica Policy Research, informed state lawmakers during a 2007 public hearing.

Bachi testified before the General Assembly's Human Services Committee in support of a bill last year that made interpreter services available under Medicaid.

What the 2007 law left unanswered is what hospitals can or should do about the costs they incur providing translation services. Bridgeport Hospital eats the cost of such service, which Charbonneau estimates "are in excess of $100,000."

That's the quandary many hospitals are in, said Patricia Baker, executive director of the Connecticut Health Foundation, adding that federal Medicaid law allows participating hospitals to bill their state Medicaid programs for medical interpreter services. Connecticut has not adopted that policy — yet.

Interpreter services cost about $50 an hour on average, but data about how much time translators spend with patients is scarce, Baker said, because most providers don't directly track it. Based on government reports and academic studies, the Connecticut Health Foundation estimates that Connecticut hospitals spend $4.7 million annually for interpreters. If the state billed Medicaid, it could cut those costs in half. MariAn Gail Brown, who covers regional issues, can be reached at 330-6288.

English is an Asian Language

Commentary
Myths about languages in the Philippines

By Isabel Pefianco Martin
Philippine Daily Inquirer
First Posted 02:27:00 03/01/2008

While the nation awaits the outcome of the hearings on the ZTE-NBN deal, a small, almost invisible battle continues to be waged among stakeholders of language and literacy in the country. Very few are aware of the persistent efforts of lawmakers to institutionalize English as the sole language of learning in basic education. Even fewer wonder if the Speak English Only Policy of some schools or the present Bilingual Education Policy of the Department of Education actually works.

I have been reflecting on these movements in language and literacy for some years now. I have come to realize that many arguments about the issue are hinged on buried premises, on myths about languages in the Philippines.

The first set of myths has to do with English in the Philippines. There is a prevailing belief that if you don’t know English, you simply don’t know! This myth is evident in Filipinos who laugh at those who do not speak English with native-like fluency and accuracy, in school heads who will not hire a teacher because he or she has a strong Ilocano accent, and in teachers who give low marks to students with subject-verb agreement or preposition errors in their compositions. These teachers overlook depth of insight or evidence of critical thinking in the students’ writings. The link between intelligence and English language proficiency is very flimsy. In this world, you will find intelligent people who cannot speak a word of English, as well as not-so-smart ones who are native speakers of the language.

Another misconception about English is that the language cures all economic ailments. This is evident in House bills that seek to make English as the sole medium of instruction in the elementary and high school levels. The goal is to produce English-proficient graduates for contact centers, hospitals and medical transcription offices, never mind if these graduates are unthinking products of the schools. This belief that English brings in the money is also evident in most contact center training programs which overemphasize proficiency in the language, while sacrificing the agents’ ability to manage culture-diverse environments. Working in a contact center is very demanding. The ability to speak like an American will certainly not ensure excellent performance in the contact center jobs.

That some Filipinos aspire for native-like proficiency in English is symptomatic of another misconception about the language. This aspiration points to the myth that there is only one kind of English language in this world, and that is, Standard American English. What many do not know is that World Englishes exist, and Philippine English is just one among these many Englishes.

In 1969, Teodoro Llamzon, the first president of the Linguistic Society of the Philippines, already wrote about this in his trailblazing “Standard Filipino English.” In 1996, at De La Salle University-Manila, a conference on the theme “English is an Asian Language” reintroduced this idea of English as a Philippine language. It was at this conference that poet Gemino Abad proudly declared that the Filipinos have “colonized the English language!”

And then there is the myth that English and Filipino are languages in opposition to each other. This is evident in those who insist that English should be totally removed from basic education, as well as in some of the reasons cited for opposing House Bill 305 and Executive Order 210. Nationalism always seems to be associated with the Filipino language, as if one cannot express one’s love of country in English or in the local languages.

Finally, the most dangerous of all myths is the belief that there is no place for the local languages in basic education. This is evident in the existence of the Bilingual Education Policy, as well as in the persistent efforts of lawmakers to pass House Bill 305 (formerly known as HB 4701). In public schools across the nation, teachers have already been using the local languages (a.k.a. first language or mother tongue, which includes English and Tagalog in the cities) in teaching basic concepts to schoolchildren. No amount of legislation can remove the first languages from their natural settings, which to my mind include the schools.

This year, as we celebrate the International Year of Languages, we must also celebrate the reality that the Philippines is a multilingual paradise.

As the nation focuses on the present crisis of credibility, it has become trapped in the past sins of its leaders. But what about the future of this nation which lies in the tiny hands of the schoolchildren who continue to drop out of school because they cannot understand their teachers?

Isabel Pefianco Martin is president of the Linguistic Society of the Philippines. She is associate professor at the Department of English of the Ateneo de Manila University and part-time commissioner of the Komisyon sa Wikang Filipino (Commission on Filipino Language), representing Kinaray-a/Hiligaynon. She is also a member of International Year of Languages Committee-Philippines (IYLC Philippines). For information about the contributions of LSP to IYLC Philippines, please visit www.lsphil.org. You may email your comments to linguisticsoc@gmail.com.

Language Barriers at the Drugstore

Gotham Gazette - http://www.gothamgazette.com/article/health/20080204/9/2420

Language Barriers at the Drugstore
by Courtney Gross
04 Feb 2008

When Catalina Martinez of Ridgewood walks into a pharmacy to get a prescription, the task may not be as easy as it seems.

Beyond the long lines and their physician's unintelligible handwriting, Martinez, like thousands of other New Yorkers, faces a seemingly insurmountable wall at their local drugstore: a language barrier.

"When I go to the pharmacy, I see that the bottles are in English and I want to know what it says on the bottles," said Martinez, who was interviewed through a translator. "So many times I leave the pharmacy without knowing what it is saying. That's scary for me."

According to immigrant and health care advocates, the majority of pharmacies, particularly in the outer boroughs, do not provide translation services to their customers. This leaves thousands of New Yorkers with limited proficiency in English to fend for themselves. Labels remain untranslated, so crucial instructions from the pharmacist may be incomprehensible.

Unlike hospitals, which, under state regulations, must provide translators, pharmacies are under no such requirement. That, some city leaders say, may soon change.

Where Regulations Stand
For the hundreds of thousands of New Yorkers who do not know English, the local pharmacy and its rows of bottles with labels reading Zoloft or Ambien can be baffling. With Americans increasingly reliant upon prescriptions, advocates say an inaccurate translation -- or none at all -- can pose a significant danger.

The 2000 Census showed that nearly half of New York City households speak a language other than English, and one out of four New Yorkers do not speak English at all. That leaves 25 percent of the city's population scrounging for health care in their own language or care at a facility offering translation services.

While the state approved regulations in 2006 that set out language requirements for hospitals, pharmacies were overlooked, said some advocates. According to a recent report by the New York Academy of Medicine, two thirds of city pharmacies do not translate prescription labels, despite the fact that 88 percent said they served limited English proficiency patients daily.

A report released late last year by the advocacy groups New York Lawyers for the Public Interest and Make the Road by Walking details nearly a dozen anecdotes from Brooklyn and Queens residents who do not speak English.

Catalina Martinez is one of them. She suffers from gastritis and has a 14-year-old son prone to allergies, forcing her to visit the pharmacy often. A native of Mexico who has lived in Ridgewood for a decade, Martinez sometimes stops strangers on the street, hoping to get her prescriptions translated since the pharmacies she frequents do not provide language assistance. Sometimes, she said, she will not give her son medication for fear of administering it incorrectly.

"Maybe I have to give him this much medicine, sometimes I have to give less," said the 49-year-old. "Sometimes I won't even give it to my son because I won't know how to do it."

Martinez's apprehension is shared by many immigrants, said Nisha Agarwal, a staff attorney with New York Lawyers for the Public Interest. To address this, the lawyers group, along with City Councilmember Eric Gioia and Public Advocate Betsy Gotbaum, is drafting legislation that would require translation services be provided at all city pharmacies.

"Giving New Yorkers access to the information they need starts with simple, common sense steps, like providing translation services and extra medical instruction for those with limited English proficiency who are filling prescriptions," said Gotbaum in a prepared statement. "Our proposed legislation will help break down the barriers many currently face when seeking health care and ensure that no New Yorker is left guessing when it comes to questions about their medication."

Other council members have also expressed support for the measure. "Although I appreciate the efforts already taken by a number of pharmacies to help their customers read their prescription label in a more familiar language, these businesses still have more work to do," said Councilmember Joel Rivera, chair of the Health Committee, in an e-mailed statement. "People should not have to guess how to administer their medicine just because they can't read the directions. Clearly the consequences can be devastating. The translate of drug labels by pharmacies is not only a good idea, it is the right thing to do."

What Advocates Want
Advocates, like Agarwal, believe the city's existing human rights law, which prohibits discrimination based on race or ethnicity in public places, requires pharmacies to translate. So far, though, pharmacists do not interpret the law that way.

Both New York Lawyers for Public Interest and Make the Road by Walking filed a formal complaint with the state attorney general's office, claiming 16 pharmacies in Queens and Brooklyn routinely failed to translate drug labels or provide instruction to non-English speakers, thus violating their statutory duty. That complaint is pending, said Agarwal.

They hope the legislation currently being drafted will replicate what the state required from hospitals in 2006, making language access a requirement of quality health care. Agarwal said the legislation should be introduced in the coming weeks.

The specific standards for pharmacies would strengthen the current requirements under the human rights law, said Theo Oshiro, the director of health advocacy at Make the Road by Walking.

Oshiro said his group has already seen some success. Pharmacies in Bushwick, for example, stepped up their language education campaigns with signs announcing translation services behind some counters.

"I guess there has been spotty results; there has not been a whole chain setting out clear guidelines," said Oshiro. "We're still looking for that kind of sweeping solution, not only in Bushwick and in Woodside."

City officials spearheading the legislation say the proposal would simply turn an assumed right into an explicit one. Business leaders, however, disagree.

Business Barriers
James Detura owns his own pharmacy in the South Bronx where the population is predominantly Spanish speaking. Detura, who is president of the New York City Pharmacists Society, said a translation mandate would be catastrophic. It is already difficult to find any pharmacist -- due to a nationwide shortage of pharmacists -- let alone a bilingual ones, he said.

For communities that do not have one or two dominant languages, but three, four or even five, it could be next to impossible to meet strict language access guidelines. "What about a pharmacy that is in certain area of New York City when you've got Spanish and Russian?" asked Detura. "What do you do in a case like that? Are you going to have a separate pharmacist for each one?" There are enough pharmacies in the city, especially locally owned businesses that cater to certain communities, that customers who cannot find the services they need at one pharmacy can always find another one a block or two away, he said.

Detura also fears inaccurate translations. He said it may be easy to translate "one pill a day," but more complicated instructions may not be as readily interpreted -- especially if there are no services available for a local pharmacist to double-check a phoned-in translation.

But advocates said there are plenty of accurate resources for a local pharmacist, such as subscriber hotlines that can translate at the click of a dial. Oshiro also said they were not looking to require bilingual pharmacists.

Like Detura, others question whether the legislation would put an unreasonable burden on small, independent pharmacists. In response, Oshiro said the smaller pharmacies already do a better job accommodating immigrant populations' needs.

Instead, advocates argue that it is larger chains, such as Duane Reade and Rite Aid that fail to translate. Even if the big chains have the ability to provide the service (some have telephone translation networks or bilingual staff), they often do not advertise it to their customers.

A Bilingual Call
While many of the details must still be worked out, immigrant and health care advocates said they are keeping both business and health interests in mind. The idea is to save people's lives, or at the very least prevent confusion and sickness.

Convinced she became ill after incorrectly taking medication with a label she couldn't understand, Martinez said she cannot, nor can she give her son, medication with an easy mind.

If pharmacies cannot provide bilingual or trilingual employees, they should at least provide labels in other languages, Martinez said. That way, she added, she and thousands of other New Yorkers can take their medication with confidence.

Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

Prescription for doctors: read books

Publish Date: Saturday,8 December, 2007, at 01:40 AM Doha Time
THERE is a clear link between reading books and becoming a good doctor, a senior faculty member of Weill Cornell Medical College in Qatar (WCMC-Q) has said.
Dr Mohamud Verjee, assistant professor of family medicine and director of both Primary Care and the Clinical Skills Centre, was speaking to an audience of aspiring doctors at WCMC-Q recently.
Literature had inspired him to travel both in terms of learning and experience. “Running away with a world of thoughts gave me my own ideas,” he recalled.
Verjee introduced students to the ‘friends’ that connected him to knowledge and understanding - books ranging from Rudyard Kipling’s ‘Just So’ stories to ‘Madam Secretary’, a memoir of the US former Secretary of State, Madeline Albright.
“Literature has enriched my life, career, ambition, sense of enquiry and provided guidance on ethics, it has fed my ambition, seeded my imagination, provided me with discipline, and propelled me forward like a car accelerating,” he said.
Verjee said life is not merely a matter of reaching a point of satisfaction. “It is the quest, the thirst for more,” he said.
The faculty member was referring to the link between literature and medicine explored in an Undergraduate Research Experience Programme (UREP) by second-year undergraduate WCMC-Q students Ustav Nandi and Sabrina Alam.
The conclusions of the study, ‘An Investigation Into the Possible Beneficial Effects of Literature in Weill Cornell Medical College in Qatar’, revealed that most students and faculty agree that first year writing seminars assist doctors in developing better relationships with patients.
Senior lecturer in English and co-ordinator of the first year writing seminars at Weill Cornell, Peter Fortunato also endorsed the link between literature and medicine.
“Even when the subject matter of a literary work is painful or its method a challenging ‘rough magic’ one’s own life can be transformed by the experience,” he said.
Fortunato said that a person acquires his or her own aesthetic sensibility through the exercise of imagination, life experience and personal reflection.
“This fosters a discerning intelligence that is both analytical and feeling and who would not want to be treated by a doctor with this capacity?” he asked.
The Gulf Times

Strange English Words

Top 10 English language oddities

07.12.2007 Source: URL: http://english.pravda.ru/society/stories/102438-english_language_oddities -0

1. “Bookkeeper” is the only word that has three consecutive doubled letters.

2. The two longest words with only one of the six vowels including y are the 15-letter defenselessness and respectlessness.

3. “Forty” is the only number which has its letters in alphabetical order. “One” is the only number with its letters in reverse alphabetical order.

4. The superlatively long word honorificabilitudinitatibus (27 letters) alternates consonants and vowels.

5. Antidisestablishmentarianism listed in the Oxford English Dictionary, was considered the longest English word for quite a long time, but today the medical term pneumonoultramicroscopicsilicovolcanoconiosis is usually considered to have the title, despite the fact that it was coined to provide an answer to the question ‘What is the longest English word?’.

6. “The sixth sick sheik’s sixth sheep’s sick” is said to be the toughest tongue twister in English.

7. There is only one common word in English that has five vowels in a row: queueing.

8. The two longest words with only one of the six vowels including y are the 15-letter defenselessness and respectlessness.

9. “Asthma” and “isthmi” are the only six-letter words that begin and end with a vowel and have no other vowels between.

10 “Rhythms” is the longest English word without the normal vowels, a, e, i, o, or u.

Source: listverse.com

© 1999-2006. «PRAVDA.Ru». When reproducing our materials in whole or in part, hyperlink to PRAVDA.Ru should be made. The opinions and views of the authors do not always coincide with the point of view of PRAVDA.Ru's editors.

Trained interpreters: a necessary expense

PROFESSIONAL ISSUES
Trained interpreters: a necessary expense
Ethics Forum. Dec. 3, 2007.
American Medical Association News

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Why should doctors provide interpreter services, and how can they afford to?

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Scenario: Why should doctors provide interpreter services, and how can they afford to?
Title VI of the 1964 Civil Rights Act, which prohibits discrimination on the basis of ethnicity by any entity receiving federal funds, directs that physicians who receive Medicare and Medicaid funds must arrange interpretation for patients with little or no proficiency in English. How far must I go in implementing this unfunded mandate?

Response

If you've ever been ill while vacationing in a land whose language you did not speak, you probably don't need to be convinced of the compassion and fundamental humanity of having foreign language interpreters for medical encounters. In the U.S., having interpretation available has been federally mandated since 2000 for anyone who receives Medicare or Medicaid funds for patient care.

With this article

A matter of interpretation

Discuss on Sermo

See related content
The dictates of our professional ethics long preceded the law in emphasizing that physicians must provide care with compassion and respect for human dignity; must, while caring for a patient, regard responsibility to that patient as paramount; and, more recently, must participate in efforts to reduce medical error.

It doesn't take any stretching of the imagination or even any deep thinking to realize that errors are more likely to occur when patients and physicians don't understand each other than when they do. The documented reduction in adverse drug events and improvements in patient safety in hospitals where computerized physician order entry replaced handwritten orders demonstrates that misunderstanding of the written word contributes to medical error. How much more likely, then, that misunderstanding of the spoken word would do so. The lion's share of the medical encounter is conducted in oral speech.

Messages that encourage interpreter services emphasize being certain that patients understand you -- your explanation of their diagnosis and treatment plan, your instructions on how and when to take their medications. Little mention is made of your understanding them -- as though the physical exam and diagnostic testing speak for themselves.

Imagine the reduction in time, frustration and even unnecessary testing that could be achieved if you understood properly the history of your patient's current complaint, and the tests and results that he or she already had received for these signs and symptoms. Imagine the enhanced patient-physician communication and trust. On this level, proper communication with patients who have limited proficiency in English, and with those who have limited health literacy, is a matter of personal and professional pride and self-interest -- not a matter of obeying the law.

Once you are convinced of the need for language access services in your practice and have gathered some facts on the number of languages spoken by your patients and the average frequency with which you see each limited English proficiency population annually, you are in a position to determine the optimal type(s) of services for your practice. Options include: trained bilingual physicians and/or support staff, trained telephonic interpreters, and trained on-site interpreters.

The option you choose depends on the geographic location of your practice as well as your need for language access services. Professional or trained on-site interpreters often are not available in rural locations, which leaves little choice other than remote telephonic interpretation.

What do we mean by "trained" interpreters?

Competency in medical interpretation requires more than fluency in a language or even knowledge of medical terms in a language. Trained medical interpreters have received professional instruction in medical concepts and terminology, interpretation skills and process, communication skills, ethics, confidentiality and cultural issues. There is a national code of ethical and agreed-upon standards for practice in interpretation, but standards for training are only in the development stage.

This places physicians in a somewhat awkward situation; you may be able to gain a sense of the quality of the program by reviewing the curriculum utilized in the training of your interpreter. It is hoped that consensus will be achieved for training standards within the next few years.

Why is it so important to use trained interpreters rather than family or friends, or bilingual staff who have not received any formal training in interpretation?

The justification for using trained interpreters in all but "low risk" clinical situations -- patient scheduling, annual vaccinations or a wound recheck -- comes from evidence that the use of family and friends or "ad hoc" interpreters has been associated with medical errors. On the other hand, research has shown that use of professional interpreters improves quality of care and contributes to both continuity of care and greater patient satisfaction.

Physicians are therefore faced with the importance of using trained interpreters without a mechanism for financing them. Fortunately, there are some strategies you can implement to minimize your financial outlay.

If there are large numbers of patients with limited English proficiency who speak one language, the optimal choice is to use trained bilingual staff.

Medicaid or State Children's Health Insurance Programs provide reimbursement for interpreter services in 10 states currently; it is worth checking to see whether your state is one of them.

You may be able to negotiate discounted rates with local hospitals that provide interpreter services.

Try to develop collaborative contracts for use of remote, telephonic services with other local and regional physician practices, such as through an independent practice association or network.

Some bilingual students who are in health professions have volunteered to serve as medical interpreters. These students should be provided with training in medical interpretation before their service in this capacity. This option may be more realistic in an urban area with a large number of health professions schools, but, with the increasing numbers of Hispanics in rural areas, it is also possible that you can recruit students from local community colleges and provide them with a small stipend to serve as interpreters if you pay for their training.

Finally, if you do need to use an on-site interpreter, it may be more cost effective to schedule patients with limited English proficiency on a specific day for nonemergent appointments.

--Margaret Gadon, MD, MPH, director of the Health Disparities Program, American Medical Association, Chicago

Go Back and Learn Grammar

Saturday, November 17, 2007
A Medal: Good English can be rewarded

By Richard Creed
JOURNAL COLUMNIST

Richard Creed
From a Winston-Salem reader: “I moved to Winston-Salem two years ago and quickly became a fan of your column. This is a little odd, since much of the time I can’t understand the esoterica of grammar you are discussing. As a specialist in various rather obscure areas of medical knowledge, I guess I simply appreciate the performance of an articulate expert.

“I should understand you - I was given the English Medal in my graduating high school class - but I do not. I didn’t deserve it, in truth.

“I would particularly like to understand the who/whom rules you discussed recently, but it seems like the rule is buried under a mountain of prior knowledge not in my head. I actually have a grammar book (sort of) that I occasionally consult, called The Deluxe Transitive Vampire. It doesn’t help me very often.

“I recall Garrison Keillor once singing, ‘I need more help than I get when I press Help.’ Do you have any recommendations for a book I could learn from? (From which I could learn?) Thanks.”

You don’t say how long ago you graduated from high school, but if you were given the English Medal, you must have been ahead of your peers in your knowledge of grammar back then. That suggests that you may have become rusty and merely need to relax, do some fundamental reviewing, and have fun doing it.

I have not read The Deluxe Transitive Vampire, but from what I have read about it I would guess that it is fun to read. After all, its subtitle is “A Handbook of Grammar for the Innocent, the Eager and the Doomed.” One reviewer wrote that it “addresses classic questions of English usage with wit and the blackest of humor.”

If that book doesn’t afford the help you think you need, it may be because the humor and wit get in the way of someone who does not already have a good grasp of the nuts and bolts of grammar. That might be especially true for someone who lacks confidence in his or her ability to learn a particular subject, grammar in this case. I sense that you might be such a person.

I hesitate to recommend particular books to you. One of my longstanding favorites, however, is Theodore M. Bernstein’s The Careful Writer. I frequently cite it in my columns. It was first published in 1965, and some commentators consider parts of it out of date. I find it very instructive nevertheless.

A caution: Many books on grammar and usage, Bernstein’s included, presuppose that the reader already has a grasp of the basics, the “prior knowledge” that you refer to. I am thinking of such concepts as objective and nominative case, indicative and subjunctive mood, and dependent and independent clauses.

Those are the kind of things you call esoterica, the things that you say seem buried under a mountain of prior knowledge not in your head. If you do not understand them, much of what you read in such books as Bernstein’s will be of limited help. For instance, your difficulty in grasping the proper use of who and whom may be rooted in your not clearly understanding the nominative and the objective case of nouns and pronouns.

So how do you get as much help as you need when you press Help? I recommend that you do some salutary regressing. Find a basic grammar textbook, perhaps like the ones that helped you win the English Medal. You might want to start with, say, an eighth-grade textbook, study it until you understand the things that are giving you trouble, and progressively promote yourself to higher grades.

If you think you need outside help, you might consider taking a remedial course in basic grammar at a college or a community college. You can also find a number of basic grammar courses online, some of them free.

If you do that, I think you will find that much of what you once knew will return. You will have unburied that prior knowledge and put it back in your head. You might even want to get out that English Medal, if you still have it, and polish it up.

■ Richard Creed is a retired Journal editor. He can be reached at richcreed@triad.rr.com.

Doctor Patient Communication Needs Common Language

Doctor-patient communication a problem
NZPA | Friday, 26 October 2007

Doctors are having a hard time communicating with an increasing number of patients with limited English skills, a new survey shows.

The New Zealand Medical Journal (NZMJ) conducted a survey of 80 Auckland GPs, asking them about how often they conducted non-English consultations and any language problems they encountered.

Almost all of the doctors – 91 per cent – said they struggled with communication due to language issues in consultations.

Forty-three per cent experienced problems on a weekly basis.

Asian patients, whose first language was not English, caused the most problems according to the survey.

The NZMJ recommended development training for dealing with patients with limited English, that more attention be paid to interpreters services and that the needs of non-English speaking patients be addressed.

"Communication between doctor and patient is very important in the general practice setting," the report said.

"Co-ordinated local and national activity is needed to ensure that GPs are supported in their non-English consultations through training, ready availability of resources and sharing of good practice initiatives."

Roadblocks keep foreign-trained doctors from working here

Monica Wolfson, The Windsor Star
Published: Tuesday, September 18, 2007
Egyptian-born Siham Mansour says she'd love to practice medicine again, but the obstacles she'd face to become a doctor here are almost unsurmountable.

She would have to take a battery of exams, needs Canadian work experience and somehow has to secure one of the limited residency spots to redo her training even though she practiced as an internist in Egypt for more than 20 years.

She's hesitant to take medical exams, so instead she cares for her three sons and helps some others in her predicament. There are about 100 internationally trained medical graduates living in Windsor who are preparing to join the Canadian medical profession. Mansour has provided them with updated medical study materials, secured training sessions on palliative care so potential doctors can update skills and helped establish a physician shadowing program.

Her hard work has paid off. Twenty foreign-trained doctors in Windsor have passed the medical exams, but only five have snagged residency spots over the past three years, she said.

Her experience here in Windsor mirrors what is happening around the country. A Statistics Canada report released Tuesday shows that since 1990, foreign-trained physicians and engineers are having an increasingly harder time working in their chosen profession. According to the report, your country of origin has a lot to say about your success getting a job in your chosen profession.

In 2001, there were 5,400 foreign-trained medical graduates in Canada. While 90 per cent of Canadian-educated medical graduates were working as physicians, only 55 per cent of of international medical graduates were working as doctors.

"We have a lot of clientele who are engineers and doctors," said Padmini Raju, executive director of Windsor Women Working with Immigrant Women. "They are seeking to become doctors, but the cost of the exam is very high. It depends on their income. They are trying their best to get into the system."

According to the report, immigrants who came to Canada recently were less likely to be working as doctors. Of the foreign-trained medical graduates who came to Canada before 1980, 95 per cent are employed as doctors, compared to 70 per cent of those who came between 1990 and 1996.

The provincial governments created roadblocks for foreign-trained doctors by cutting back on medical school spaces and residency spots in the early 1990s, said University of Toronto professor Jeffrey Reitz, head of ethnic and immigration studies.

"During some periods, if they had a medical background, they couldn't even get into the country," he said. "That is changing now that there is a perception of a shortage."

The report also found that internationally-trained medical and engineering graduates are treated differently depending on which country they come from. Immigrants who come from Vietnam, China, Korea, Cambodia and the Middle East have lower levels of employment in their chosen field than immigrants from Western Europe, Africa, India and Pakistan.

"Confirming occupation credentials is the biggest difficulty in settling in Canada," Reitz said. "It causes a lot of stress. It's a pervasive problem across all professional fields."

In engineering, job prospects for newcomers are even dimmer than for doctors. While 40 per cent of Canadian-educated engineers were employed in the field, only 26 per cent of international graduates had managed to secure a job in engineering. Graduates from North American and Western European countries had the same employment rate as Canadians. One in five foreign-trained engineers was a women, which is twice the rate of Canadian-educated engineers.

© The Windsor Star 2007

Immigrant Doctors need English in New York

Tapping immigrant resources
EDITORIAL - 08/30/2007
El Diario /La Prensa
New York

While some Latino immigrants are filling demands in the service sector or bringing their entrepreneurship to long-neglected parts of the city, others are here with professional skills and degrees.
They are doctors, lawyers, engineers and other professionals unable to continue their careers here because of limited English proficiency or status limitations. Failing to tap this pool of professionals, or to further the career tracks of U.S.-born Hispanics, has serious implications for Latinos.
Take the case of doctors. In the United States, Hispanics are 14 percent of the population yet represent only 3.2 percent of doctors, according to the American Medical Association. Doctors who understand the cultural sensibilities of Latinos and who can communicate in Spanish are integral to building the confidence of patients. With Latinos over-represented in the late diagnosis of diseases, those assets are even more needed.
Some initiatives focus on bringing immigrant professionals into the fold. At Lincoln Hospital, a Hispanic Academy helps immigrant doctors train for passing medical licensing exams here. And the organization Upwardly Global works with immigrant professionals to help them navigate the job market. It also educates corporations about the expertise of immigrants, talent that can help them reach wider markets.
But one of the biggest barriers to closing the gap between a growing demands and a potential supply is English proficiency. While one out of four New Yorkers is limited English proficient, there is a severe shortage and long waiting lists for English-language classes.
The city recently added funding for these classes. But the state and federal government must also increase resources as part of workforce investment. With the demand for Latino health professionals and an aging native workforce, those resources are needed now.