Vancouver Medical English Institute

The UndercoverThe Rise of “Medical Tourism”

by Jon Herring 12/23/2009 Several years ago, I enjoyed an amazing vacation in Costa Rica. Shortly after I arrived, I found myself reclining in a comfortable leather chair. I leaned back and relaxed, staring at the flawless blue sky and the steep, misty mountains surrounding San Jose. Soft, soothing music played in the background. I was beginning to drift off when a young woman walked over. She placed her hand on my shoulder. “Good afternoon, Jon. I hope you’re comfortable,” she said, in perfect English. “Can I adjust the chair for you? Would you like something to drink?” “No, thank you. I’m just fine.” I told her. A few moments later, Dr. Telma Rubinstein walked in and sat down beside me. “We have a long day ahead, Jon. Are you ready to begin?” she asked. I nodded – and with that, she flipped a switch on the light above my head and began to examine the inside of my mouth. Seven hours later, after three specialists had completed 10 separate dental procedures, I was walked out the doors of Prisma Dental. My mouth was sore and numb, but I was ready to enjoy the rest of my “vacation.” For the next ten days, I traveled in Costa Rica and Nicaragua. At the end of my trip, I returned to San Jose, where Dr. Rubinstein completed my dental work. My trip to Central America is just one example of what has become known as “medical tourism.” For a variety of reasons, people from around the world are traveling abroad to obtain dental, medical, and surgical treatment. In many cases, the cost savings are so substantial that the “tourism” aspect of the trip is an added bonus. Say Goodbye to Bags and Sags! Triumph over the annoyances of aging and thrive every day… for life! Finally — the anti-aging solution with: • A first-rate memory… • Keen eyes and sharp ears… • A strong-pumping heart… • Tip-top immune defenses against "body breakdown"… • And endless vigor! Click here to read more… An article in India’s BusinessWorld Magazine states that “medical tourism” accounts for more than $40 billion a year in medical and travel expenses. A study performed by Deloitte Consulting suggests that more than three million Americans will travel for medical procedures in 2010. And these numbers are growing rapidly. The top regional destination for medical tourists is Asia. Singapore, Thailand, Malaysia and India attract well over a million medical travelers each year. But large numbers of people are also traveling to Central and South America. They are able to enjoy high-quality, affordable healthcare. And at the same time they enjoy numerous options for tourism and convalescing in the tropical air and healing sunlight. Why Would Someone Travel for Healthcare? Over the last 20 years, the standard of healthcare has rapidly improved in a growing number of lesser developed countries, especially in private hospitals. In many cases, the doctors and specialists in these facilities were trained in the top medical and dental schools in the U.S. These emerging countries boast a variety of modern hospitals and state-of-the-art outpatient facilities. Often, the technology is newer and even more advanced than the equipment used in facilities here. The bottom line is that many lesser developed countries now offer world-class medical services. In fact, they often exceed the standards you would expect in the U.S. or Europe – but at a small fraction of the cost. Medical tourism began primarily with elective and cosmetic procedures. Today, growing numbers are traveling for life-saving and medically necessary procedures, such as joint replacements, cataract surgery, bone marrow transplants, and even bypass surgery. Virtually any medical procedure can be safely obtained for pennies on the dollar in a foreign country. A recent CNN article told the story of 61-year old, Sandra Giustina. Without insurance, she had no way to afford the heart surgery she needed to correct an abnormal heart rhythm. The surgery would have cost $175,000 in the United States. Instead, she traveled to New Delhi, India. There she had the operation for less than $10,000. That included the cost of travel… and a brief vacation after her recovery. And her experience was not unusual. According to the Medical Tourism Association, here are the approximate costs of several procedures: Heart Bypass $150,000 in the U.S. $8,500 in India Liver Transplant $315,000 in the U.S. $75,000 in Latin America Dental Implant $2,500 in the U.S. $1,000 in Costa Rica Face Lift $15,000 in the U.S. $4,000 in Singapore Knee Replacement $40,000+ in the U.S. $10,650 in Mexico Hip Replacement $50,000+ in the U.S. $8,000 in Philippines Bone Marrow Transplant $250,000 in the U.S. $25,000 in India When you consider the costs, it is easy to see why medical tourism is booming. But cost is not the only reason why people are traveling for healthcare. Surging demand in the developed world is exposing the flaws in our system. Under the socialized healthcare plans in the in the U.K and Canada, for example, some patients are required to wait years for treatment they need today. In the U.S., the wait times are not as long, but the medical system has become a massive paper-pushing bureaucracy. It is plagued by fraud, inefficiency and waste. And the costs of healthcare have risen to the point of being ridiculous. Those who are uninsured have very few choices, within the current system. In fact, before the financial and housing crisis, the number one cause of bankruptcy in the United States is due to medical expenses. This is not surprising when you consider that 45 million Americans have no health insurance coverage. What about the Service and Standard of Care? Doctors, dentists, and hospitals that cater to medical travelers actually have to meet a higher standard of service than those in your home country. These facilities and practitioners have to compete in the free market for cash-paying customers. They also get much of their business from word-of-mouth referrals. Unless their patients receive a high-quality experience, they are unlikely to spread the word. In some cases, options exist for full-service travel arrangements, private chefs and adjoining suites where family members can stay close to their loved ones. An appointment with a specialist, diagnostic testing and follow-up can often be completed within hours. In the U.S., that would usually require several appointments and hours upon hours in waiting rooms. Why I went to Costa Rica to have my teeth fixed… One of the fastest-growing areas of medical tourism is dentistry. That is because most people don’t have comprehensive dental coverage. In my case, most of the work was necessary. I had a broken tooth. I needed a root canal and an implant. And I needed to have a few fillings replaced. On top of that, I wanted to fix two gaps in my smile. When I priced all this work here in the states, the total came to more than $18,000. And none of it was covered by insurance. Based on my research, I knew there were a number of first-class dental practices in Costa Rica. It is a quick flight to get down there. And the cost of dental care is very low there, compared to the U.S. I chose a practice called, Prisma Dental. The facility is bright, clean and modern. It also happens to be the friendliest and most accommodating dental practice I have ever visited. More importantly, the dental work that they performed was better than any I have received in the past. (And, no, I did not - and will not - receive any discount or commission for this recommendation.) By getting the work done in Costa Rica, I received as good or better results than I could have expected here in the states. And it cost me less than one-third of what I was quoted here. My entire bill for the trip, including travel and lodging, was around $6,000. That amounts to a savings of more than $12,000 – and a free vacation in Central America. What are the downsides? You can get some of the best health care in the world here in the United States – and, in some cases, some of the worst. The same can be true in other countries as well. But there are some obvious downsides to consider: • Your insurance policy may not cover treatment (although more and more plans are offering coverage). If your plan does offer coverage, you may have to pay first and wait for reimbursement. • All surgeries and medical procedures carry a certain level of risk. This is true, no matter where they are performed. But if a procedure goes wrong overseas, you have the added complication of being far from home. • There is little opportunity for follow-up care. It might be a good idea to give yourself a few extra "cushion" days after your last appointment and before you plan to leave the country. • Part of the savings you achieve in a foreign country is because they are not strapped by the same malpractice litigation we see in the states. High-quality facilities still have full coverage, of course. But due diligence is imperative. I hope I’ve opened your eyes to the many possibilities that exist. As always, my best advice is to focus on “health care” so that you won’t need “medical care”. But if you find yourself or a loved one in a position where a medical or dental procedure is necessary, now you’re aware of other options you may consider. Jon Herring Editorial Director Total Health Breakthroughs

Program for Medical Translators in Japan

The Japanese and the English Language / Creating healthy dialogue Hiroko Ihara / Daily Yomiuri Staff Writer OSAKA--As anyone who has found themselves acting as interpreter between a non-Japanese friend and a Japanese doctor well knows, good intentions and daily conversation ability alone are not enough to deal with such complex communication. To accurately translate a patient's symptoms or a doctor's instructions, specialized training is required. With more than 2 million foreigners registered as residents in Japan and the number of foreign visitors to the country now in excess of 8 million a year, the demand for trained medical interpreters is rising rapidly. In this nation, English-Japanese medical interpreting in particular has a crucial role, not only because English is the most familiar foreign language among Japanese, but also because large numbers of foreigners living here learned English as a second language in their own nation. These crucial workers negotiate the language barrier for people throughout the medical process, from dealing with reception to paying fees and everything in between--consultations, prescriptions, treatment plans and even surgery. Responding to a growing need, interpreting services firm Inter Group is to run a yearlong training course for English-Japanese medical interpreters from May. Such an expert role requires a high level of bilingual proficiency, and among Japanese people, there are many more who have this level of skill in English than there are who have this level of skill in other languages. It is much more feasible, then, to provide medical institutions with trained English-Japanese interpreters than it is for Japanese to any other language. "As English is taught as part of the Japanese school system, many people can use the language well. We believe we can train good Japanese-English medical interpreters, because students will enter our course already having high English proficiency and the ability to deal with difficult language concepts," said an Inter Group spokesman. "Our firm was founded in 1966 and has a great deal of accumulated knowhow with regard to training English-Japanese interpreters," the spokesman said. Based in Kita Ward, Osaka, the firm will offer the course at its Osaka, Tokyo, Nagoya, Hiroshima and Fukuoka schools. The course plans to bolster the medical interpreting service currently provided by affiliates of local governments and nongovernmental organizations, which sees volunteer interpreters dispatched on request. These interpreters--who offer their services purely because they feel it is important for foreigners to have access to such assistance--usually take part in intensive training before their first assignment and take follow-up seminars about once a month, but Inter Group plans to offer more thorough preparation. The yearlong, 40-lesson course is a joint project with the Rinku General Medical Center in Izumisano, Osaka Prefecture. In April 2006, rather than rely on temporary volunteers, the center set up its own medical interpreter system, which is very rare for a medical facility in Japan. According to Mamoru Ito, vice director general of the center, it now has a pool of about 50 trained volunteer interpreters skilled in English, Chinese, Spanish and Portuguese to help outpatients at the three hospitals managed by the center. About 30 percent of the patients require Japanese-English interpreting. Ito, who supervises the system, will also oversee the curriculum of the new course. "Medical interpreting requires expertise that can't be obtained without training," he said. "There's nowhere in Japan where people can learn these skills efficiently, so we decided to share the knowledge and expertise we've built up." "The curriculum is based on actual situations and problems known to occur at the center, so students will be able to use what they learn at work immediately," Ito said. Students will be required to have English-language ability at least equivalent to a score of 730 in the Test of English for International Communication (TOEIC). According to Ito, the course is intended to cover the four main facets of being a medical interpreter--language skills, basic medical knowledge, intercultural communication, and appropriate professional behavior. Each 105-minute lesson will feature a 30-minute TV lecture given by Ito on the functions of different organs. Inter Group instructors who have worked as interpreters at medical conferences will instruct students in essential vocabulary, such as disease names, descriptive terms for explaining symptoms, and procedural language for medication instructions. "Learning drug terms is important, as it is said 20 percent of medical errors involve incorrect drug administration," Ito said. Role-playing sessions using texts jointly prepared by Inter Group and the center will focus on acquiring practical skills. The curriculum will also cover the workings of the medical insurance system, ethical issues, and possible culture-gap problems that may arise. Cultural misunderstandings can lead to frustration and, for the patient, a loss of confidence in the medical staff, Ito said. He offered the example of a Chinese woman who, after giving birth at the center, asked to take the placenta home to eat it, as is common in her culture. The doctor refused her request as he was worried about the risk of infection. "The patient was extremely unhappy about it until an interpreter explained why the doctor had refused. We were also very surprised to hear from the interpreter that the woman had misunderstood the doctor completely--she thought that the hospital staff wanted to eat the placenta," Ito said. Sample lessons already given by Inter Group have been well attended. Among the prospective students was Mamie Yamada of Neyagawa, Osaka Prefecture, who teaches English to company workers and university students. She first considered undergoing this kind of training after volunteering as an interpreter for a foreign government official at an international conference in Kyoto last year. The official was diabetic but forgot to bring insulin, so Yamada accompanied him to a local hospital to help him acquire the medicine. "Although it was volunteer work, I felt really rewarded. I also realized I needed some training, though," Yamada said. "This kind of work shouldn't rely on volunteers alone, because it requires a lot of expertise," said Prof. Yasuhide Nakamura of the Department of International Collaboration at Osaka University's Graduate School of Human Sciences. "Medical interpreters also deserve to receive proper payment." There is currently no system of formal qualifications or certificate recognition for medical interpreting in Japan. To help improve the role's professional status, the Japan Association of Medical Interpreters was founded in February by nongovernmental organization workers, medical interpreters, doctors, and researchers. Nakamura, a pediatrician, chairs the the association and said he realized the importance of medical interpreting when he treated foreign patients at Tokyo University Hospital's international outpatient clinic in the 1990s. According to Nakamura, the association will learn from precedents set by similar organizations overseas, such as the U.S.-based International Medical Interpreters Association. Founded in 1986, that association intends to launch a national certificate test this year, a big step forward for the profession. Australia also has an advanced system, under which community interpreters take a national accreditation test. Nakamura said: "The Inter Group course indicates the business sector is interested in this field. So many people would be able to work as medical interpreters--foreign residents who speak Japanese, for example. They also sometimes have medical qualifications from their countries. Japanese doctors and nurses who speak foreign languages could also do this work." === Bilingual access benefits all parties Medical interpreting is provided free of charge to patients at the Rinku General Medical Center, located near Kansai Airport. The advantages of the free service occurred to Ito, a neurologist, after he treated a Filipino woman who gave birth to a premature baby at the center after suffering a brain hemorrhage on her flight to Japan. Both mother and child survived, but they returned home leaving their medical bills unpaid. The center had been unable to discuss payment with her due to the language barrier. "At the time, it seemed to me that a medical center so close to an international airport should be well-equipped to overcome language-related obstacles," Ito said. The center now has English interpreters available four days a week, meaning patients needing their help can usually get it even without a reservation. Spanish and Portuguese interpreters are available two days a week, and Chinese interpreters one. According to Ito, the number of patients using the service has increased as awareness of it has grown. While 88 people took advantage of the system in fiscal 2006, the number soared to 427 in fiscal 2008. Interpreters at the center are paid 5,000 yen plus transportation costs for a 9 a.m.-3 p.m. shift. "That is much less than an ordinary interpreter would be paid, however," said Dr. Kaori Minamitani, who interprets for Portuguese-speaking patients at the center in addition to her work as a practitioner. Nevertheless, the number of people applying for positions as interpreters at the center is steadily rising, Ito said. Stressful moments do arise, and the center has a number of support measures in place for interpreters. Computer records of patients' symptoms can be accessed before consultations, enabling interpreters to prepare for likely scenarios. Some long-term interpreters have been hired as part-time staff, and it is common for them to mentor junior members of the team by working together in pairs. Minamitani herself is also available to address concerns and questions as they come up. "That support system is necessary," Minamitani said. (Apr. 28, 2009)

When the Patient Gets Lost in Translation

April 23, 2009 Doctor and Patient When the Patient Gets Lost in Translation By PAULINE W. CHEN, M.D. Every morning after his liver transplant, and often in the afternoons as well, I visited Armando (not his real name) as part of my daily rounds. In his 50s, with still dark hair and even darker eyes, Armando had developed liver failure from hepatitis C, contracted from a blood transfusion when he was a young man in Mexico. I was the surgeon on call the night a liver became available for him. Despite his wiry build, there was plenty of room in Armando for a good-sized new liver. And a pair of gloved surgeon’s hands. While some bodies seem tightly packed from within, as if organs might spring loose at any moment, Armando’s abdominal cavity, broad and flat, possessed a luxurious sense of space. His intestines fell away from the walls, allowing me to see, without craning my neck, the gossamer lining of the abdominal cavity and the outlines of the last ribs curving down below his chest. After five hours in the operating room, I knew one part of Armando probably better than any other person ever would. Yet despite this encounter with his innermost parts and the lifesaving exchange of organs, I would never learn as much about him as I had about his abdomen. Armando did not speak English, and I could only feebly stumble through three, maybe four, words of Spanish. Pressed for time and acutely aware that a couple dozen more patients were always waiting, I never called an interpreter to Armando’s room during my daily rounds after his operation. Although interpreters were available at all times, it would take time, I thought, for one to arrive, and then the translation itself could slow things down. While I always asked for interpreters to help with discussions about potential complications, worrisome lab results, or the complex immunosuppressive medication regimen, I tried to get by on my own during what I thought were more routine checks. So morning conversations between Armando and me were always the same. After my exam, I would smile, point to his belly and give him a thumbs-up sign. “Dolor?” I would ask. “Un poquito,” he would reply. For over a decade now, researchers have documented the effects of language barriers on health care. Patients who speak English poorly or not at all face longer hospital stays, an increased risk of misdiagnoses and medical errors, and decreased access to acute and preventive care services, often regardless of socioeconomic or insurance status. These disparities exist, in part, because of a lack of access to trained medical interpreters and translation services. But according to a new study published in The Journal of General Internal Medicine, doctors’ assumptions about communication — what they deem important in a conversation — may also have a role. Dr. Alicia Fernandez and colleagues at the University of California, San Francisco, and at Yale University examined language barriers between patients and doctors at two teaching hospitals with excellent interpreter services. The investigators interviewed 20 residents, young doctors recently graduated from medical school who make up the clinical frontline at these two urban medical centers. A complex picture emerged from the interviews. While the doctors acknowledged that they were underutilizing professional interpreters, many made the decision not to call an interpreter consciously, weighing the perceived value of patient information against their own time constraints. Moreover, despite their personal misgivings, the doctors often felt that this kind of shortcut was acceptable and well within the norms of their professional environment. I called Dr. Alicia Fernandez, the senior author on the paper, to discuss her findings. I also found myself confessing that like the study doctors, I had more than once just “gotten by.” “People have discussed the findings,” Dr. Fernandez said, “and they’ve recognized themselves. I recognized myself. If I’m rounding late at night, I might just decide not to use an interpreter. It has become an acceptable shortcut in care. But the truth is that the patient deserves to speak to the doctor as well.” Doctors will triage their conversations with patients, categorizing discussions about advanced directives or risky medications as “high stakes,” and those that occur during routine rounding on a stable patient as “low stakes.” Doctors will then tend to use interpreters in “high stakes” conversations but will muddle through “low stakes” topics themselves, resorting to gestures, mimicry or bilingual family members in order to communicate. “To a certain extent,” Dr. Fernandez said, “physician-patient communication is driven by the physician’s need for patient input rather than by the patient’s need to communicate. Communication is viewed as something that is supposed to change decisions that the doctor can foresee. So the use of interpreters may have more to do with how we think about communication with our patients and less to do with our views on interpreters, limited English proficiency patients or even time pressures.” She then added, “Of course, from the perspective of a hospitalized patient, the stakes are never so low that they would not wish to speak with the doctor caring for them.” Technology can help facilitate translation services. In one hospital where Dr. Fernandez sees patients, interpreters are centrally located in one room but provide their services throughout the hospital by video. While the video faces the patient and doctor during the initial part of the visit, the video is turned away during the physical examination. “You can actually do a pelvic exam in Cambodian,” she said, “but at the same time not violate the patient’s privacy.” But Dr. Fernandez was quick to acknowledge that at present, many doctors simply do not have access to basic interpreter services. “Time and cost are very real issues,” she said. “If we could tackle language barriers in health care on a statewide or regional level so not every physician had to reinvent the wheel — if there were, let’s say, ’central banks’ of interpreters on video — it would be much easier for each physician.” She pointed out that California recently passed an unprecedented law mandating that health and dental plans supply interpreters and translated material to H.M.O. and P.P.O. patients . Given that 43 percent of people in California do not speak English at home , this law appears to be an important first step toward increasing the availability of translation services for all doctors and patients. But that still leaves a growing segment of the population — more than 20 million people in the United States — with inadequate care . “Although immigrants want to learn and are learning English,” Dr. Fernandez said, “our health care system has to come halfway through offering interpreter services and training doctors to use them. There has to be a minimum standard. I personally believe that a hospitalized patient should be able to talk to his or her doctor once a day.” “This is where humility and compassion and professionalism all come together,” she continued. “Right now, they are the only things that keep us from cutting corners. We need to shore those qualities up, but at the same time we need the right structures and the reimbursement that will allow all of us to do the right thing more easily.” Copyright 2009 The New York Times Company

Tourism dep't earns P200-M from English-learning, medical programs

By lala_rimando Created 02/10/2009 - 20:07 Tourism dep't earns P200-M from English-learning, medical programs [1] -------------------------------------------------------------------------------- abs-cbnNEWS.com | 02/10/2009 8:07 PM The educational and medical sectors of the tourism industry experienced robust growth last year, generating nearly P200 million in revenues for 2008. The English as Secondary Language (ESL) program of the Department of Tourism (DOT) earned almost P100 million, with most foreigners enrolling in schools in Bacolod and Baguio City. The two destinations contributed earnings of P62.6 million (or 34 percent) and P29 million, respectively. The DOT said Bacolod City, the most preferred location for the program, had 1,087 foreign student-visitors. Koreans represented the highest turnout of foreign students, with 2,873 of them enrolled in the program. The DOT credited the continued participation and visibility of partner schools in major educational tourism fairs in Korea and other source markets for the success of the ESL program. Under the ESL program, participants attend the course from 20 to 100 days. The DOT said peak registration months were May, August, and December. Medical tourism Meanwhile, the DOT said the medical tourism industry generated P108.8 million in revenues last year, attracting more foreign patients to visit world-class hospitals in the country. Tourism Secretary Ace Durano said 1,071 foreign patients sought medical services in the Philippines last year, with the average gross receipt per foreign patient estimated at P101,582. "Majority of the 885 tourist-patients came from Guam, Palau and Saipan. Other markets were Japan, Korea, and the USA," DOT said in a statement. To encourage the growth of the medical tourism industry, Durano said the DOT together with health care facilities in the country participated in major medical tourism fairs in the Middle East, Europe, and the United States. "Participation in these fairs showcased the Philippines’ leading edge in the field of medical and aesthetic services while promoting various tourist destinations where patients may relax and recuperate," Durano said. as of 02/10/2009 8:07 PM

Seeing doctors the Chinese way

ShanghaiDaily
Tan Xian | 2008-7-4 |
STRICKEN by the high cost of foreign doctors, many expats would like to see excellent Chinese physicians. Some public hospitals have international departments with Chinese doctors who speak English, writes Tan Xian.

For most expats, living in Shanghai is easy and convenient, but when they have a health problem, the situation can be intimidating. Getting sick in foreign country where they don't speak the language or don't speak it well can be a problem.

Many expats have been initially at a loss when they need medical assistance. Their friends often suggest "expat doctors" at foreign medical services because they provide Western treatment and speak English, or other Western languages.

You can see a doctor right away, you can communicate in privacy and the treatment is good. These visits are not cheap, nor are treatments, procedures and hospitalization.

Many expats, therefore, are interested in seeing capable Chinese doctors who don't charge a lot and can speak English.

There are a few Chinese doctors in private practice, but the cost is comparatively higher. Some are from Taiwan and Hong Kong and speak English.

Public hospitals are also a good choice and many of them have international departments where English is spoken.

Treatment can be described as the "Westernized Chinese way."

Reservations are required. Patients can also make appointments with specialists who usually work one or two days a week.

"Usually it costs much less than those wholly foreign-invested clinics," says American Christine Bush who has lived in Shanghai for two years.

Expats who speak simple Mandarin can also try basic medical services, just like most local residents. In fact, many doctors can speak some simple English. In this case, you can just show up and wait your turn.

"My experience of medical treatment in Shanghai is positive: The facilities are good, the staff are mostly friendly, and the service is decent," says Markus Tibbetts, from the UK. He has lived in Shanghai for three years.

"This has been my impression of standard hospitals like Ruijin Hospital and the No. 6 People's Hospital," he says.

Tibbetts first went to a hospital with a Chinese friend. Later, when he didn't have a translator, he would go to the international departments of big hospitals where most doctors speak good English. After he learned some Mandarin, he did it the Shanghai way.

"The only drawbacks are that the hospitals are crowded and noisy, and as a result, somewhat stressful," says Tibbetts. "However, living in a city of 17 million people, the crowds and the waiting are to be expected."

In China, medical treatment is not as private as in the West. Some doctors perform checkups in an open room, with other patients present. Although some will close the door, patients still rush in from time to time.

"Some patients are just behind you and listen," says William Edgar Merry, 65, who has lived in the city for seven years. "Privacy is not strictly protected here."

But Tibbetts calls the lack of privacy "acceptable" and says he will stop talking and "wait until they leave."

Language barrier adds confusion to pre-natal testing

Monday, 09 Jun 2008 09:09

Many people struggle to understand the complexities of genetic problems in pregnancy and find medical language difficult to understand, particularly when faced with major decisions such as whether to terminate a pregnancy. A recent study, funded by the Economic and Social Research Council (ESRC), investigated how Britain’s Bangladeshi community understand the disorders, and make decisions about testing and screening in the light of health care and religious opinion.

The researchers found language difficulties added a great deal of misunderstanding about the nature and cause of disorders. There were difficulties, for example, over the distinction between being ‘affected’ and being a ‘carrier’. The nature of risk, and the kind of inferences that can be made from genetic testing, can also be a source of confusion. While earlier studies have found that similar confusions are common among the general public as well, the difficulties of translation can make minority groups, such as the Bangladeshis, especially vulnerable to such misunderstandings.

Those who have English as a second language are not alone in struggling to understand the complexities of medical terminology. Researchers find that these misunderstandings are not solely connected to language as a barrier but commonly to misinterpreting medical information. Such as a 75% chance of a having a child that is not being affected by a particular condition can be interpreted as having a child that is 75% normal.

Problems linked to use of interpreters are compounded by the fact that there may be medical terms for which there is no appropriate translation. Women with limited English may be entirely reliant on their husband, or another family member, for an explanation of what consultants or genetics counsellors have said. As a result, information they receive may be inaccurate, misunderstood, or incomplete.

Senior Research Fellow, Dr Santi Rozario, said: “Genetic disorder is likely to be understood by Bangladeshi Muslims in Britain, at least initially, as a biomedical problem for which conventional medical treatment is appropriate, and indeed fard (obligatory) as an Islamic duty. Bangladeshi families will therefore almost always look to the British medical system for assistance.”

The research shows us that the issue is not simply one of numbers or availability of interpreters and it is a complex and difficult time for patients. Greater understanding of the language barrier and possible misunderstanding need to be considered when dealing with patients whose first language is not English.

© 2004-2008 www.politics.co.uk.

Alternatives for Foreign-trained Doctors

Health fair targets experts who can't find work in Canada

Joanne Laucius
The Ottawa Citizen

Wednesday, May 28, 2008

More than 60 doctors and other health care workers, many armed with résumés outlining extensive education and experience, were drawn yesterday to a job fair for foreign-trained doctors.

But the available jobs weren't at clinics, hospitals or practices that are short of family physicians. Instead, the booths set up at the Catholic Immigration Centre were for companies looking to hire personal care attendants and other non-regulated health workers: charities recruiting volunteers and institutions such as Algonquin College, which was promoting training for jobs in health-related fields ranging from dental hygiene to veterinary technology.

International medical graduates have been touted as one of the solutions to Canada's doctor shortage. But the graduates have to meet Canadian standards, which means passing qualifying exams and completing a residency. And they face hurdles ranging from language skills to lack of Canadian experience.

The doctors at the job fair, some lured to Canada with the promise that their skills are in demand, know the jobs on offer are not what they came to Canada to do. And many say the clock is ticking on their dreams of practising medicine in Canada.

Janet Chen has a medical degree from Human Medical University in her native China and an MBA from City University in Washington, D.C. She worked in China as a product manager and a clinical research manager on a cancer-drug portfolio before coming to Canada hoping to work in clinical research.

"I thought I could get set up in the field in less than half a year," she said. "I believed when they asked me to come that I would find a job."

Instead, she works in a call centre and as a volunteer with the Canadian Cancer Society. She has had eight interviews so far and no job offer. Her English-language skills and lack of Canadian experience are the biggest hurdles, according to potential employers.

Psychiatrist Alvaro Garcia and his wife, Maria-Helena Garcia, a psychologist, came to Canada seven months ago from Colombia.

Mr. Alvaro practised psychiatry for 25 years, taught university courses and wrote a text on psychopharmacology.

Maria-Helena has had three job interviews so far, but has had only one job offer in a small town. The couple is thinking of starting their own practice.

"They say, 'Your résumés are very impressive.' But getting ahead is very difficult," Mr. Alvaro said.

Sanjee Rahavan studied medicine in Russia and practised in her native Sri Lanka for five years. She came to Canada with her fiancé, an aeronautical engineer who is now in Australia because he too couldn't find work in Canada. In order to practise as a doctor, she needs to pass more exams, then do a residency, which will take at least four years.

Meanwhile, she is working at home for a U.S. information technology company. According to her calculations, she's not even making minimum wage.

"I'm depressed and disappointed," she said.

Internationally trained doctors often face a catch-22 situation, said Kent McDonnell, an academic referral officer at Algonquin College who was at the job fair yesterday to promote health-related programs at Algonquin.

Some doctors refuse to consider an alternative career in an area like respiratory therapy or practical nursing, he said. Others need to work to support their families and can't take the two or three years it takes to get a diploma.

Some eventually give up on their plans to practise in Canada and train in a related field, said Mr. McDonnell, who has seen a number of international dentistry graduates decide to become dental hygienists or dental assistants.

"Our goal is to keep them in their field," he said. "It's a waste of resources to have a medical doctor working as a cashier."

Ms. Chen knows of some international doctors who have gone five or six years without finding a job. She is contemplating returning to China after her daughter graduates from high school if she can't find a job in clinical research.

"You can't work in a call centre forever," she said.

© The Ottawa Citizen 2008

ENGLISH SPEAKING DOCTORS WORLDWIDE

May 13, 2008, 8:52PM
Membership in IAMAT is essential for any avid traveler

By ARTHUR FROMMER
King Features

Because I sent a donation to the International Association for Medical Assistance to Travellers (which can be of any amount, however small), I recently received a renewal of my membership card and a copy of its pocket-size 2008 directory, accompanied by several other valuable documents that I'll describe below. IAMAT was founded more than 40 years ago by the late Dr. Vincenzo Marcolongo, one of the first to realize how urgent was the need to create a reliable list of far-flung physicians for the first generation in human history to engage in widespread international travel.
"The traveler abroad," he wrote, "is already under the psychological stress induced by change ... and is coping with the physical conditions of different water, food, and perhaps climate and altitude. There is a good chance, too, that the traveler's own immunities do not match the foreign local environment. If a medical problem arises, where does one turn for quick and effective health care?"

The answer: a directory of competent, English-speaking (and thus able to communicate with most travelers) physicians in every destination of interest.

The 2008 directory, which I received this week, lists hundreds of physicians around the world who are qualified in travel medicine, fluent in English and willing to accept fees of $80 for an office visit and $100 for a visit to your hotel. Its information is awesome in its wide geographical reach. Going to Chengdu in the Sichuan province of China? Dr. Ni Rong and Dr. Sun Min both have permitted their cell phone numbers to be printed in the IAMAT directory, and they are at your disposal.

I can't imagine anyone scheduling a trip to any non-English-speaking area of the world who can safely depart without obtaining the IAMAT directory. It was obviously created for the most idealistic of purposes to facilitate widespread travel among the peoples of the world. And its physician-members, according to Dr. Marcolongo, "have a sense of solidarity which makes them like one family."

The nations covered? They range from Algeria to Zimbabwe, from Austria, Belgium and Bolivia to Vanuatu and Yemen. And when you join (through a contribution that should amount to at least $20, but it doesn't have to be that large), you receive three other publications of equal importance: a World Immunization Chart (both required and recommended immunizations for every country in the world); a World Malaria Risk Chart; and a pamphlet titled "How to Protect Yourself Against Malaria." If you have ever posed a question about immunizations or malaria to your own internist (few of whom are able to respond confidently), you will appreciate the extraordinary value of this carefully prepared information.

To join IAMAT, send your contribution to International Association for Medical Assistance to Travellers, 1623 Military Road, No. 279, Niagara Falls, NY 14304-1745. Or, for further information, visit its Web site at www.iamat.org.

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.