Tip of the Week
Emergency Communication: Accuracy, Life and Death
Somewhat to the side of medical translation and interpretation, but interesting nonetheless: here’s a summary of a study on how words commonly used in English to describe disasters might be heard differently by immigrants from other cultures.
In Losing cultural context in emergency communication can be a matter of life and death, published in The Conversation, the authors observe, “We noticed how minor deviations in translation can cause significant differences in understanding. Such misunderstandings can have catastrophic consequences.
“Clear language is essential in emergency communication. Being able to distribute disaster information can be a matter of life or death. We’ve seen how migrant communities are often hit harder than others by disasters, such as in Hurricane Katrina, when many failed to evacuate in part because storm warnings were broadcast mainly in English. Many migrants to the U.S. do not arrive with a clear understanding of basic hazard terms in English, such as ‘hurricane’ and ‘tornado,’ that are used by local weather channels and in emergency communications.”
Check out the piece for an interesting foray through the meaning of terms such as tornado or typhoon in various languages. It’s also worth taking a broader look at The Conversation, which describes itself as delivering academic rigor with journalistic flair, here.
The New Face of Minnesota Immigration
Here’s a look at how the face of immigration to Minnesota has changed since 1990, courtesy of the StarTribune newspaper. The long and short of it: 30 years ago the preponderance of immigrants arrived from Southeast Asia,with significant numbers of Canadians, Germans and Brits mixed in. Today, Mexicans rule, with combined new arrivals from Southeast Asia trailed by Somalis and Indians.
For more analysis, check out What are the top five immigrant groups in Minnesota: Immigration has changed in the past 30 years.
Maternal Care Done Right for Everyone
Learn how to better deliver culturally appropriate maternal care in this free, online class offered by Think Cultural Health, a division of the US Department of Health and Human Services.
The 2-hour e-learning program is for providers and students looking to improve their cultural competency, combat implicit bias, and develop better approaches to person-centered care.
Here’s the breakdown on the four-module course, which qualifies for two CEU credits:
- An introduction to CLAS in maternal health care. Examine the role of CLAS (Culturally and Linguistically Appropriate Services) in improving quality and eliminating disparities in maternal health care.
- Self-awareness. Become more aware of your beliefs and values, as well as your privilege, power, bias, and stereotypes.
- Awareness of a patient’s cultural identity. Learn how and why to get to know a patient’s cultural identity.
- Providing CLAS in maternal health care. Explore ways to deliver respectful, compassionate, high quality care that responds to patients’ experiences, values, beliefs, and preferences.
A Vault of COVID Materials from MDH
Looking to boost your ongoing COVID information campaigns? Take a look at this repository offered by the Minnesota Department of Health.
In addition to Stay Safe Minnesota logos, social media content and newspaper ads, you’ll find health education materials translated into Amharic, Dakota, Hmong, Karen, Ojibwe, Oromo, Russian, Somali, Spanish and Tibetan. Among the topics covered include vaccination timelines, information for seniors, guidance updates, testing sites, quarantine rules and much more.
Get This Free Ad Council COVID Toolkit
Want to get your COVID-related messaging out as effectively as possible? Here’s a toolkit from the Ad Council and COVID Collaborative that features downloadable graphics, plus messaging recommendations, do’s and don’ts, and tips about language and tone.
The non-profit Ad Council brings together creative minds in advertising, media, technology and marketing to address social causes, and was the driving force behind ad campaigns including Friends Don’t Let Friends Drive Drunk, Smokey Bear, and Love Has No Labels.
The toolkit includes:
- Messaging Recommendations. Strategic guidelines, messaging elements that resonate (and don’t), language considerations, and trusted messengers.
- Messaging That Resonates. Strategies to build confidence and trust, remind people why the COVID vaccine is important, and help them see it as a critical step in protecting themselves and their families. This also provides specific recommendations for communicating with Black and Latino audiences.
- Core Insights. Insights from research by the Ad Council and others about the key concerns behind low vaccine confidence — safety, side effects, lack of information, and the speed of the clinical trials. This includes specific research on Black Americans and Latinos, as well as trusted messengers.
- Downloadable Videos and Graphics. Videos, vaccine FAQs, suggested talking points, and customizable social media copy.
Black Physicians Make the Case for COVID Vax
For Black patients who need convincing that it’s a good, safe move to get a COVID-19 vaccination, here’s a video from the Black Physicians Network of Columbus, Ohio that makes the case. Dozens of Ohio Black physicians in this short video address the reasons why Black patients might be skeptical, and explain why they ultimately decided to get vaccinated themselves. Well made, and definitely worth a watch.
Translation Without Words
Not all translation depends on words, as is made clear by a New York Times obit for graphic designer and artist Rajie Cook.
In 1974, Cook’s design firm was hired by the US Department of Transportation as it prepared for what was assumed would be an influx of foreign visitors around the time of the 1976 bicentennial. Cook’s charge was to create symbols that could efficiently convey to people who didn’t speak English key information — for instance, where are the bathrooms, which gender do they serve, where’s the elevator, or the train or bus stop.
The firm came up with 34 pictographs, still in use today. Cook’s analysis of that work contains a lesson that remains relevant to anyone trying to communicate across cultural spans: “We held firm to the principle that design communicates to its maximum efficiency without frills, contrivances and other extraneous material.”
Read Rajie Cook, 90, Who Helped Make Sense of Public Spaces, here.
Biden Bump in Refugees: It’s Good for Business
Among President Joe Biden’s first actions in office was to bump up the number of refugees that will be allowed entry into the United States. In a series of executive orders, he laid the groundwork to increase the ceiling to 125,000 refugee resettlements annually — a potentially huge jump from the 11,814 refugees admitted in the last year.
The online Insider observes in this opinion piece — Biden’s plan to let more refugees into the country is a great way to drive the economic recovery after COVID — that refugees will be a resource for businesses springing back with the post-pandemic economy.
Why? Even now industry is struggling to find sufficient numbers of workers. An example: there are 27 open healthcare practitioner jobs for every unemployed healthcare worker; a gap only expected to grow as boomers retire.
Refugee workers are especially enticing to employers for a host of reasons. They’re in the US legally, can stay indefinitely, and are eligible to work immediately. As a group, refugees are more willing than others to relocate for work. Plus, they tend to stay longer in their jobs.
The article’s author, Gideon Maltz of the Tent Partnership for Refugees, concludes that a boost in refugee resettlement “will be good for the US economy — refugees earned more than $77 billion in household income and paid almost $21 billion in taxes in 2015. And it will be good for businesses that will add employees with resilience, dedication and loyalty.”
U of M Opens Resource Center for Refugees, Immigrants
Here’s another source of resources and training for public health professionals working with refugee, immigrant, and migrant (RIM) communities that have been disproportionately affected by COVID-19. The National Resource Center for Refugees, Immigrants, and Migrants — housed at the University of Minnesota and funded by the Centers for Disease Control and the International Organization for Migration — offers services that include:
- Collecting and sharing best practices for serving RIM clients
- Providing linguistically and culturally appropriate health communications and health education resources
- Creating online training and other help for public health professionals working with RIM communities
- Supporting pilot projects between health departments and community-based organizations
- Assisting state and local health departments through technical assistance requests
You can find translated health materials, plus a variety of toolkits and communication guides on the organization’s website.
The Center’s description of its goal: “We aim to strengthen connections and information sharing between community-based organizations and state and local health departments and to establish a venue in which those that are successful can share practical lessons-learned with those that are facing challenges.”
In Translation: A Trove of CDC COVID Materials
It’s not the easiest collection of COVID-19 education materials to navigate, but the Centers for Disease Control and Prevention has posted a mini-library of useful, downloadable posters and flyers in multiple languages, all available here. You’ll have to do some hunting and pecking, since English-only resources are interspersed with those in multiple languages.
Among the numerous items posted are information sheets on how to manage COVID symptoms at home, the difference between quarantine and isolation, how to protect yourself and others in public, key steps to take while waiting for test results, and much more.
Another CDC avenue that’s more direct if you’re looking for material in a specific language is its Communication Toolkit page, a repository for resources specifically directed at the needs of migrants, refugees and other limited English populations. Here you’ll find COVID-related resources, including detailed information about the Pfizer vaccine, plus general health education materials, sorted by language.
From Mexico: A Gay-Sensitive, Tear-Jerker Doritos Ad
For proof that subtle messaging can arrive in the most unlikely packages, consider this Doritos ad broadcast by the corn chip producer for the Mexican Christmas market.
In it, a young man returning home for the holidays from his university calls his father to announce that he is also bringing a friend. Upon their arrival, dad realizes that they are more than platonic friends. He’s uncertain how to proceed, so consults that source of all knowledge, the internet.
Armed with the crowd’s advice, the next morning he tells his son in the kitchen that he has something to tell him. Haltingly, he says, “I just want to say that… I love you.”
His son replies, “What you want to tell me is that you love me as I am?”
Dad nods. They embrace. Take our word on this: there aren’t many dry eyes left focused on the screen.
The ad has been viewed more than 14 million times. See a New York Daily News story about this web phenomenon here.
Why Wear a Mask? Video Has Answers
Here’s a way to communicate with young people of color on why it’s important to wear a mask to slow the spread of COVID-19. This short video, created by Briva Health with help from the Minnesota Department of Health, shows young people masking up and explaining that they’re doing it to protect specific friends and family members. It’s short, moving and worth a look.
Pandemic Vs. Emergency Care: Videos Explain Why, When to Get Treatment
Here’s another effect of the COVID pandemic — a reluctance among the ailing to get checked out when experiencing symptoms of serious health problems such as stroke and heart attack. This series of translated videos by the Minnesota Department of Health quickly explains when to call 911 and why emergency treatment is safe and potentially life saving.
- Don’t Delay Care for Medical Emergencies – Vietnamese
- Don’t Delay Care for Medical Emergencies – Nepali
- Don’t Delay Care for Medical Emergencies – Russian
- Don’t Delay Care for Medical Emergencies – Swahili
- Don’t Delay Care for Medical Emergencies – Karen
- Don’t Delay Care for Medical Emergencies – Chinese
- Don’t Delay Care for Medical Emergencies – Hmong
- Don’t Delay Care for Medical Emergencies – Spanish
- Don’t Delay Care for Medical Emergencies – English
Get Help with COVID-19 Vax Messaging
Wondering how to get information about the COVID-19 vaccine to patients and clients? Check out this free webinar, COVID-19 Vaccine Distribution: Supply and Logistics Messaging, on Tuesday, January 12, noon to 1 pm. Public health and media experts will answer your questions on most effective strategies for vaccine distribution-related communication.
After you register, you can submit questions in advance. Here’s an obvious one: how to get the best information to limited English speakers?
Newsletter Offers Tips on Building Health Literacy
Looking for ways to improve communication with patients and clients? Take a look at the latest edition of In the Know, the online publication of the Minnesota Health Literacy Partnership.
The newsletter is packed with information on:
- How to simplify health-related messaging,
- How to make sure that patients understand the directions they’re given,
- How to find resources that improve plain-language communication,
- How to involve people in shared decision making that improves health outcomes.
You’ll also find a glossary of plain-language examples of terms related to vaccinations — an obvious necessity in the months ahead.
For Deaf, Hard of Hearing, Zoom and Competitors Ramp Up
Seemingly overnight, the COVID era also became the age of the Zoom meeting. But how does that work out for the deaf and hard of hearing? The answer has been, Not very well. For example, you might start out with the image of a signed-language interpreter beside the speaker, but in the blink of an eye that interpreter might languish on the last row of faces.
Recently Zoom made improvements that allow ALS-reliant users to keep interpreters visible on the screen. Get a detailed description of how to make Zoom work better for the deaf and hard of hearing in this article from Mashable, Zoom catches up with new accessibility features for sign language interpretation.
Of course Zoom isn’t the only option.
Mashable reporter Sasha Lekach observes that Cisco offers a solid menu of accessibility features baked into its WebEx product. Skype and Google Meet provide transcription and real-time closed captioning to give a boost to deaf and hard of hearing users.
Get Translated Audio Files on Basic COVID Topics
Looking for simple, brief explanations of COVID-19 related concerns in multiple languages? Here are translations provided by the Centers for Disease Control and Prevention that could be useful for both patients and interpreters alike.
- COVID-19 Everyday Prevention Actions
English: Audio | Transcript
Spanish: Audio and Transcript - COVID-19 Readiness
English: Audio | Transcript
Spanish: Audio and Transcript - Cleaning and Disinfection
English: Audio | Transcript
Spanish: Audio | Transcript - What To Do If You Are Sick
English: Audio | Transcript
Spanish: Audio | Transcript - How To Wear a Mask
Arabic: Audio | Transcript
Burmese: Audio | Transcript
Chinese: Audio | Transcript
Dari: Audio | Transcript
English: Audio | Transcript
Kinyarwanda: Audio | Transcript
Korean: Audio | Transcript
Pashto: Audio | Transcript
Russian: Audio | Transcript
Spanish: Audio | Transcript
Swahili: Audio | Transcript
Tagalog: Audio | Transcript
Ukrainian: Audio | Transcript
Vietnamese: Audio | Transcript
Mixtec: Audio - I Think/Know I Had COVID-19
Arabic: Audio | Transcript
Burmese: Audio | Transcript
Chinese: Audio | Transcript
Dari: Audio | Transcript
English: Audio | Transcript
Kinyarwanda: Audio | Transcript
Korean: Audio | Transcript
Pashto: Audio | Transcript
Russian: Audio | Transcript
Spanish: Audio | Transcript
Swahili: Audio | Transcript
Tagalog: Audio | Transcript
Ukrainian: Audio | Transcript
Vietnamese: Audio | Transcript
Mixtec: Audio - Key Times to Practice Social Distancing
Arabic: Audio | Transcript
Burmese: Audio | Transcript
Chinese: Audio | Transcript
Dari: Audio | Transcript
English: Audio | Transcript
Kinyarwanda: Audio | Transcript
Korean: Audio | Transcript
Pashto: Audio | Transcript
Russian: Audio | Transcript
Spanish: Audio | Transcript
Swahili: Audio | Transcript
Tagalog: Audio | Transcript
Ukrainian: Audio | Transcript
Vietnamese: Audio | Transcript
Mixtec: Audio - Key Times to Wear a Mask
Arabic: Audio | Transcript
Burmese: Audio | Transcript
Chinese: Audio | Transcript
Dari: Audio | Transcript
English: Audio | Transcript
Kinyarwanda: Audio | Transcript
Korean: Audio | Transcript
Pashto: Audio | Transcript
Russian: Audio | Transcript
Spanish: Audio | Transcript
Swahili: Audio | Transcript
Tagalog: Audio | Transcript
Ukrainian: Audio | Transcript
Vietnamese: Audio | Transcript
Mixtec: Audio
Biden and Immigration on Day One
What does the Biden presidency mean for US immigration policy? Here’s a quick overview from the online media service, Axios.
In Biden’s Day One Challenges: The Immigration Reset, the authors observe that among the new president’s first acts will be to rescind the Trump administration’s Muslim ban; use executive action to shore up DACA; stop border wall construction, hit pause on deportations, and work to reunite immigrant families.
There’s plenty more in the piece itself, which offers perspective on the depth of work necessary for Biden to undo four year’s worth of Trump’s restrictive immigration policies.
Contact Tracing, Explained in Translation
Struggling to explain COVID contact tracing to patients and clients with limited English? Here’s are translated videos from the Minnesota Department of Health that explain in simple language what contact tracing is and why it’s important to cooperate with interviewers to help slow the spread of disease. A significant added note for clients fearing fraudulent calls: these videos also list the type of questions that a legit contact tracer will ask.
The English version is here. The translated versions are:
For Translated COVID Video, Look Here First
We’ve said it previously here, but it bears repeating. If you’re on the hunt for helpful, concise COVID-related videos in translation, a good first stop is this Minnesota Department of Health compilation.
You’ll find numerous videos in these categories:
School
Masks and face coverings
Testing
If you are sick
Protect yourself and others
Hand hygiene
They’re available in languages that include:
English, Amharic, Arabic, Chinese, Hindi, Hmong, Karen, Lao, Oromo, Russian, Somali, Spanish, Swahili and Vietnamese, plus American Sign Language. (A word of warning — some videos are not available in every language above.)
Another Wrinkle: Cognitive Testing in Translation
If you thought interpreting was already a fraught exercise, here’s another wrinkle to consider. How to do effective interpreting during sessions intended to test cognitive functioning in children?
The American Translators Association takes on this issue in an article, Cognitive testing using an interpreter — A psychologist and an interpreter find solutions to reduce linguistic confusion.
The piece offers an overview of potential issues, and a laundry list of possible solutions. It’s well worth a read for anyone interested in the deep complexity of the interpreting process in medicine.
COVID Resiliency, In Translation
Here’s a series of short videos from Twin Cities Public Television in which people of color explain their experiences with COVID-19 within their family. It’s a close, personal look at the effects of the disease. Find the videos here:
Spanish Stories of COVID-19 Resiliency – Erendira Garcia
English Stories of COVID-19 Resiliency – Roosevelt Mansfield
Hmong Stories of COVID-19 Resiliency – Kongmeng Lee
Somali Stories of COVID-19 Resiliency – Abdirahman Issa Kahin
The Squalid Refugee Camp on the Texas Border
In case you figured that squalid refugee camps were solely a feature of the undeveloped world, consider this account, Inside the Refugee Camp on America’s Doorstep, from the New York Times. The filth-ridden camp near Brownsville, TX holds would-be refugees who have waited in some cases more than a year to have their cases considered by our government.
According to the Times, “The members of this displaced community requested refuge in the United States but were sent back into Mexico, and told to wait. They came there after unique tragedies: violent assaults, oppressive extortions, murdered loved ones. They are bound together by the one thing they share in common — having nowhere else to go.”
The Times’ piece chronicles a life for kids that includes no school, scarce food and water, and housing comprised of fraying canvas tents, this a consequence of the current administration’s unprecedented limits on asylum.
Coke vs. Pepsi: Is There a Lesson for Providers Here?
Can Quebec’s cola wars offer a lesson for health care providers aspiring to connect with local audiences? Here’s an intriguing example of how speaking the right language — both culturally and orally — can reap huge results.
The case study is from the Canadian province of Quebec, where Pepsi sales had traditionally lagged way behind Coke. Quebec, of course, is an outlier in Canada, with its roots in French language and traditions. But instead of using ads tailored to local sensibilities, Pepsi had simply repurposed its other Canada advertising by dubbing the message into French.
Then it fired its interpreters and took on a new approach — building ads in French from the ground up with strong connections to Quebec cultural tropes. The result: Pepsi surged past Coke in sales.
Read the complete story here: How Pepsi Stomped Coke By Firing Their Translators: Tapping into a local culture is the key to unleashing a huge sales increase.
How Black Patients Get Cut Out of Care
Here’s an analysis from the New York Times that explains yet another reason why Black patients sometimes fail to get the treatment they need.
In Why a Hospital May Shun A Black Patient, University of Pennsylvania health policy professors Amol S. Navathe and
“The approach used most frequently by health insurers to remedy this,” Navathe and Schmidt write, “is to financially motivate hospitals to control costs and improve quality by tying payments to achieving these goals. The aim is laudable and some programs do benefit disadvantaged populations. The Pennsylvania Rural Health Model, for example, is a collaborative effort by Medicare, Medicaid and private health insurers to provide a fixed payment to rural hospitals each year for all the health care services they provide. Because they’re receiving a fixed payment, hospitals can worry less about which services are more profitable and instead focus on preserving access and improving care for rural populations, whose health outcomes have lagged behind those of urban counterparts.
“But because a vast majority of programs that tie payment to cost, and quality goals aren’t focused on disadvantaged populations, they create incentives for hospitals to avoid patients from these groups.
For example, in the 1990s, the New York State Department of Health began grading surgeons who performed coronary bypass surgery and making their report cards available to the general public. The aim was to make outcomes more transparent and to help surgeons improve. But to this day, the initiative makes it harder for Black patients to get surgery. Why? Because statistically, outcomes are generally worse for Black patients because of larger issues of systemic racism. So surgeons avoid them to protect their scores.”
Find out more about how good intentions reap unintended consequences by reading the complete piece here.
Trump Sets All-Time Low Refugee Limit
More tough times for would-be refugees ahead, as the Trump administration sets an all-time low limit on allowing those fleeing persecution in their home countries to enter the United States. Here’s an analysis from the Washington Post:
The Lighter Side of COVID: Fashion and the Mask
COVID-19 got you down? Here’s a short video from #WeWeartheMask and the Minnesota Department of Health on accessorizing with a fashion-foward mask.
Treasure Trove of Translated COVID-19 Materials
Here’s the best first stop when you’re looking for translated COVID-19 health education materials in languages most commonly spoken in Minnesota. Check out this Minnesota Department of Health web page that features a wide range of relevant video and print pieces in English, plus Amharic, Arabic, Chinese, Hindi, Hmong, Karen, Lao, Oromo, Russian, Somali, Spanish, Swahili and Vietnamese.
Among the topics covered are safe use of masks, testing, what to do if you’re sick, how to protect yourself and others, managing illness at home, when you can return to work, hand hygiene and more.
Updates and additions make this site worth a look on a regular basis.
Immigrants: We Get the Job Done. See the Video!
Take a look at this music video from the Hamilton Mixtape, inspired by the Lin-Manuel Miranda musical, Hamilton. It’s a post-Labor Day salute to the risks and back-breaking work performed by immigrants to the US.
For more information about the thinking behind this video project, see this explanation by director Tomás Whitmore that appeared in BuzzFeed.
Learning from COVID-19
Wondering if there’s any conceivable upside to the pandemic? Check out this free webinar, What Can We Learn from Crisis? Leadership, Post-Traumatic Growth ad COVID-19. It’s set for 2 pm, Thur., Sept. 24. Register here.
Speakers Joe Parks, Medical Director of the National Council for Behavioral Health, and Elizabeth Guroff, Director of Trauma-Informed Services, National Council for Behavioral Health, will take a close look at the possibilities for post-trauma growth and explore ways to come out of this crisis ahead both personally and professionally.
In Translation: What to Do If You’ve Got COVID-19
Get a quick rundown on COVID-19 symptoms and advice on what to do next from the Minnesota Department of Health in the following languages here:
- What to do if you have COVID-19 in Amharic (PDF)
- What to do if you have COVID-19 in Arabic (PDF)
- What to do if you have COVID-19 in Chinese (PDF)
- What to do if you have COVID-19 in Hmong (PDF)
- What to do if you have COVID-19 in Karen (PDF)
- What to do if you have COVID-19 in Lao (PDF)
- What to do if you have COVID-19 in Oromo (PDF)
- What to do if you have COVID-19 in Russian (PDF)
- What to do if you have COVID-19 in Somali (PDF)
- What to do if you have COVID-19 in Spanish (PDF)
- What to do if you have COVID-19 in Vietnamese (PDF)
In addition, MDH YouTube animated videos on COVID-19 symptoms and next steps are also available in Chinese, Hmong, Spanish, Swahili and Vietnamese, with more to be added shortly.
Safe Hmong Funerals During the Pandemic
The MInnesota Department of Health recently released a fascinating set of safety recommendations for the multi-day Hmong funerals that often draw a throng of participants from around the country.
Along with the typical injunctions — wear a mask, wash your hands, maintain social distance, etc. — the guidance sheet hits some very specific notes on the minimum ingredients that remain necessary for a proper funeral. An example:
- Spiritual Guide’s song to guide the Decedent’s spirit back to the Ancestors.
- Reed pipes (qeej) song to acknowledge and confirm the death of the Decedent and prepare the Decedent for the Journey to the Ancestors.
- Reed pipes (qeej) song to hoist the Decedent onto his/her Winged Steed and to give him/her their offerings to take with them on their Journey to the Ancestors.
- Reed pipes (qeej) song to accompany the serving of breakfast, lunch and dinner.
- Reed pipes (qeej) song offering additional spiritual live stocks, if any.
- Reed pipes (qeej) song offering money to the Decedent from Family members.
- Reed pipes (qeej) song signifying the departure from the funeral home to the final resting place of the Decedent.
What about the Kids If You’re Smacked by COVID-19?
Here’s a step both you and your clients can take to prepare for coronavirus infection that leaves you unable to care for your children. Draw up a written plan now that identifies possible caregivers and gathers vital family and child information. Then share it with people who need to know.
How to get all that done, with good advice along the way? Get assistance in English, Hmong, Spanish and Somali with Make a Plan, Minnesota — a roadmap through the process that includes a form that helps families gather information that a temporary caregiver will need.
This State of Minnesota site offers guidelines and a plan template, available here:
English Guidelines, Spanish Guidelines, Hmong Guidelines, and Somali Guidelines.
English plan template, Spanish plan template, Hmong plan template and Somali plan template.
Find more COVID-19 information at staysafe.mn.gov/
The Disparities File: Local Blacks, Hispanics Hit Harder by COVID
A recent story in the StarTribune, People of color hit harder by COVID-19 in Twin Cities, ZIP code data confirm, describes another aspect of the bulging healthcare disparities file: Black and Hispanic Minnesotans make up five and six percent of the state population, but account for 20 percent of confirmed COVID-19 cases.
These distinctions extend to the death rate, with people of color comprising 16 percent of the state population under age 64 but accounting for 63 percent of the deaths. For older people of color, the COVID-19 death rate is triple their share of the population.
What causes these disproportionate outcomes? “Lack of access to bare necessities and space to social distance has made stay-at-home orders challenging for households where one emergency could upend their finances or housing for months,” local experts told reporters. “The pandemic is forcing communities of color to confront longtime fears of doctors, hospitals and medical research; also, the lack of diversity among health professionals often makes them delay care.”
Minnesota Immigrant Experience: The Insider’s View
Looking for an insider’s view on immigrant and refugee life in Minnesota? Check out Sahan Journal, an independent non-profit that aims to “chronicle the struggles, successes and transformations of Minnesota’s new Americans, whose stories are often overlooked by traditional news organizations. As Minnesota becomes more diverse, Sahan will bring the stories of these immigrant groups to the mainstream, with the skill and deftness that they deserve.”
The free website is funded by the Knight Foundation, the St. Paul and Minnesota Foundations, the Facebook Journalism Project and the McKnight Foundation, among others. Recent coverage has included stories about the impact of COVID-19 on immigrant communities, the murder of an singer/political figure in Ethiopia that sparked outrage within the local Oromo community, and new Somali school principals.
Have a story you think Sahan Journal should know about? Contact Executive Director/Editor Mukhtar M. Ibrahim at editor@sahanjournal.com
Pandemic: It’s Also an Infodemic
In case you needed one more COVID-19 related worry, here’s a consideration from Wired magazine. What about the information needs of the millions of people worldwide who speak languages such as Kodava, Marathi, Oshie, Aghem or thousands of others — languages so obscure that they rarely qualify for translation, even when the information is a matter or life or death?
In the Wired article, COVID-19 Is History’s Biggest Translation Challenge, writer Gretchen McCulloch points out that to translate information merely into the primary language of the world’s regions, it would be necessary to produce material in up to 2,000 languages — still a far cry from the world’s estimated 7,000-plus languages.
McCulloch observes that despite the daunting nature of the task, efforts to address the translation shortfall are springing up around the globe. She writes, “Adivasi Lives Matter has been making info sheets in languages of India including Kodava, Marathi, and Odia. The government of Australia’s Northern Territory has been producing videos in First Nations languages including Yol?u Matha, Pintupi-Luritja, and Warlpiri. Seattle’s King County has been producing fact sheets in languages spoken by local immigrant and refugee communities, such as Amharic, Khmer, and Marshallese. VirALLanguages has been producing videos in languages of Cameroon, including Oshie, Aghem, and Bafut, starring well-known community members as local “influencers.”
McCulloch’s optimistic conclusion: COVID-19 “is the first pandemic in human history where we’ve had an understanding of diseases and hygiene, where we’ve actually known what we needed to do to hold it off for long enough to develop a vaccine… This is also, therefore, the first pandemic in human history where we have the power and the responsibility to share this understanding, a network of linguistic care that ultimately spans every corner of the globe.”
The Shocking Disparities in COVID Infection Rates
After filing a Freedom of Information Act request for COVID-19-related data from the Centers for Disease Control, the New York Times received files on 1.5 million cases, which gave it the basis for a shocking analysis on the disparate rates of infection among US racial groups.
The Times‘ conclusion: “Latino and African-American residents of the United States have been three times as likely to become infected as their white neighbors, according to the new data, which provides detailed characteristics of 640,000 infections detected in nearly 1,000 U.S. counties. And Black and Latino people have been nearly twice as likely to die from the virus as white people, the data shows.”
The piece, “The Fullest Look Yet at the Racial Inequity of Coronavirus,” includes a clickable map that shows infection rates for individual counties. For example, in Hennepin County, the infection rate is 27 per thousand for whites, and 23 per thousand for Asians. But for Blacks the rate is 146 per thousand; for Hispanics it’s 135 per thousand, and for Natives it’s 73 per thousand.
The Times continues: “The higher rate in deaths from the virus among Black and Latino people has been explained, in part, by a higher prevalence of underlying health problems, including diabetes and obesity. But the new C.D.C. data reveals a significant imbalance in the number of virus cases, not just deaths — a fact that scientists say underscores inequities unrelated to other health issues.
“‘The focus on comorbidities makes me angry, because this really is about who still has to leave their home to work, who has to leave a crowded apartment, get on crowded transport, and go to a crowded workplace, and we just haven’t acknowledged that those of us who have the privilege of continuing to work from our homes aren’t facing those risks,’ said Dr. Mary Bassett, the Director of the FXB Center for Health and Human Rights at Harvard University.
“Dr. Bassett, a former New York City health commissioner, said there is no question that underlying health problems — often caused by factors that people cannot control, such as lack of access to healthy food options and health care — play a major role in Covid-19 deaths.
“But she also said a big determinant of who dies is who gets sick in the first place, and that infections have been far more prevalent among people who can’t work from home. ‘Many of us also have problems with obesity and diabetes, but we’re not getting exposed, so we’re not getting sick,’ she said.”
The Disparity Machine
The COVID pandemic has revealed, again, the tremendous racially-based disparities in US health outcomes, with death rates among black and latinx populations much higher than those for whites. Here’s a thought-provoking piece from the New York Times, “Many Medical Decision Tools Disadvantage Black Patients,” that explains how disparities get baked into the system of medicine via tools, software and formulas that dictate care.
This is the nub of the Times‘ story: “Unbeknown to most patients, their race is incorporated into numerous medical decision-making tools and formulas that doctors consult to decide treatment for a range of conditions and services, including heart disease, cancer and maternity care, according to a new paper published Wednesday in the New England Journal of Medicine.
“The unintended result, the paper concludes, has been to direct medical resources away from black patients and to deny some black patients treatment options available to white patients.
“The tools are often digital calculators on websites of medical organizations or — in the case of assessing kidney function — actually built into the tools commercial labs use to calculate normal values of blood tests. They assess risk and potential outcomes based on formulas derived from population studies and modeling that looked for variables associated with different outcomes.
“’These tests are woven into the fabric of medicine,’ said Dr. David Jones, the paper’s senior author, a Harvard historian who also teaches ethics to medical students.”
How to Use a Mask, in Multiple Languages
Get the low down on best practices for mask use from this short video provided by the Minnesota Department of Health. It’s available in ASL, Amharic, Arabic, Chinese, Hmong, Karen, Lao, Oromo, Russian, Somali, Spanish and Vietnamese with YouTube links from this MDH web page.
At the same MDH site you can also find similarly brief and to-the-point translated videos on other coronavirus topics, including Basic Safety, Testing, How to Wash Your Hands, and Cleaning Your Hands with Hand Sanitizer.
Telehealth: Another Barrier for Limited English Speakers?
Among the changes driven by the COVID-19 pandemic is the sudden increased reliance on telemedicine. In the article Telehealth Wasn’t Designed for Non-English Speakers, the online news organization The Verge considers the effect on patients who struggle with English.
Here’s the nub of the Verge’s analysis: Participating in a successful telemedicine visit is tough enough if you speak English, own the equipment, can afford data service and possess technical and language skills that allow you to navigate through sometimes complex instructions. But if you don’t have English language capacity, lack the necessary device and can’t afford a web hook-up, you’re out of luck.
The concerns go beyond the immediate COVID crisis, says Alejandra Casillas, a primary care physician and assistant professor of medicine at UCLA Health quoted in the article. “Casillas worries about her patients’ exposure to COVID-19, but she’s also worried about their other health conditions,” The Verge reported. “Non-English speakers in the US already are more likely to have chronic conditions like diabetes and hypertension, and they’re more often poorly controlled. Any disruption in care could widen the gaps.
“‘That’s the concern with digital health,’ Casillas told The Verge. ‘That it’ll improve health care for some people, but for others, it’ll throw up more barriers. Digital health is a great thing. But we haven’t been as good or intentional in thinking about how it works in different populations, she says. ‘The limited English speaking population isn’t a small group. And we’ve left them out.’”
COVID Control without Words
Here’s an interesting COVID infection control animation from Sanford Medicine that tells patients and caretakers what they need to know without the use of words. Well worth a look for both the information conveyed, and for alternate methods of presenting information to people who speak many of the languages of the world.
From Japan, A Pandemic History Lesson
History doesn’t necessarily repeat itself, but it often rhymes, observes the crew at Open Culture in recounting Japanese efforts during the Spanish flu epidemic to quell the disease. The article on the Open Culture website — Japanese Health Manual Created During the 1918 Spanish Flu Pandemic Offers Timeless Wisdom: Stay Away from Others, Cover Your Mouth and Nose, and More — offers a fascinating look at how little has changed in more than 100 years.
Reproductions of health information posters on the Open Culture site are worth a click through by themselves. The posters were part of Japan’s Central Sanitary Bureau’s plan to educate the public. Its 455-page manual detailed symptoms and prescriptions, and suggested four rules to avoid contracting the virus that will sound familiar to readers today.
More Translated COVID-19 Info Posters from MDH
Find a variety of COVID-19 related posters appropriate for health care settings at this Minnesota Department of Health website.
Available in English, Amharic, Hmong, Oromo, Russian, Somali and Spanish, these pieces describe the idea of flattening the curve of infection, illustrate the schedule for reopening the state, list steps to practice social distancing, give directions on where to get tested, and more.
COVID-19 Health Resources in 73 Languages
Here’s an extensive directory of COVID-19 translated fact sheets, flyers, posters, audio recordings, videos and more, all available for download here. Compiled by the Washington Department of Social and Health Services, these resources appear in 73 languages including English.
The translated materials are from United States government entities, International non-government agencies, community based organizations, and countries outside the United States.
Didn’t find what you need the first time around? Check back, since the directory’s organizers say the directory is updated on a regular basis.
BONUS TIP: The Minneapolis community newspaper North News offers a insightful story on how Hmong funeral practices have been disrupted by COVID-19. Multi-day ceremonies that often draw hundreds of mourners from across the country are impossible under the recent lockdowns. For a look at how families are adjusting, see Hmong families delay funerals to wait out social distancing rules.
Exposed by the Pandemic: Language Access Issues
Do patients know what you’re talking about? Especially now, in the scramble to deal with the coronavirus crisis, language access issues can expose patients, interpreters and the broader public to increased risk, according to an analysis in US News and World Report.
In Language Access Issues a Barrier During COVID-19, reporter Gaby Galvin observes, “Roughly 25 million people in the U.S. speak no or limited English, and language access has been a long-simmering problem in medical offices, hospitals and the public health field at large. But in the age of COVID-19, with hospitals in some areas scrambling even to treat patients, sick people don’t always have access to interpreters, and interpreters don’t always have access to crucial protective gear like masks.
“In good times, effective language access is often not the top priority,” says Mara Youdelman, an attorney in Washington, D.C., who works on these issues. “So when you’ve compounded it with all of the stresses on the health care system right now, it just falls lower and lower down the list.”
Sketchy procedures for interpretation can lead to delays and errors in delivering care, plus increased risk not only for interpreters but also the patients with whom they come in contact. Read the complete story here.
From St. Paul: Interpreters to Answer COVID-19 Questions
Do you have limited-English patients who want answers about the City of Saint Paul’s response to the coronavirus pandemic? A new phone line at 651-266-6000 is staffed with interpreters available to answer questions in Hmong, Karen, Oromo, Somali and Spanish. You can also get more information via email at LanguageResources@ci.
If you’re looking for written COVID-19 related health education material in English and 21 additional languages, check out the Minnesota Department of Health’s offerings here.
BONUS TIP: What’s the most commonly spoken language in Minnesota and other states after English and Spanish? Take a look at this map from Business Insider for the sometimes surprising answers.
Interpreters Confront the COVID Dilemma
Among the dislocations of the COVID-19 pandemic is the effect on health system interpreters, who are discovering new complexities in the already fraught world of medical interpretation. As revealed in the New York Times story, When Coronavirus Care Gets Lost in Translation, interpreters are increasingly called on to work over the phone in consideration of the lack of protective equipment and the risk of infection. This already difficult situation is rendered more complex by the distance providers attempt to put between themselves and their patients, the muffling effect of masks, and the hiss of oxygen tanks.
“Someone’s oxygen can be dropping and I have to get an interpreter on the phone, wait on hold, put in an access code, tell them where I am,” one Boston doctor said. “It’s hard for the patient. Imagine you’re in a loud room with a mask blowing oxygen in your face at 15 liters a minute and you feel crummy. You can’t comprehend things as much.”
The piece explores this as another health care disparity issue that results in poorer outcomes for non-white patients. Patient advocate Vonessa Costa told the Times, “A pandemic is not the time to build working systems.” She worried about the millions of limited English patients across the country who are now or will be struggling for access to care.
A Script for Difficult COVID Conversations, Translated
The Seattle-based nonprofit, Vital Talk, specializes in building communication skills for healthcare professionals. With the COVID outbreak, it recognized a vast new sector of work. “We’re facing conversations that we never expected — or wanted — to have,” the group announced as it made available a guide that covers topics such as triaging, counseling, grieving and much more.
This resource is available in English and 21 additional languages. In it you’ll find what Vital Talk calls “practical advice on how to talk about some difficult topics related to COVID-19” that it’s built on two decades of communication research and teaching, plus consultation with clinicians in the grip of Seattle’s struggle with COVID.
Find the English and translated versions of this guide here.
From United Arab Emirates: Talking with Your Hands (Plus more COVID material)
Get the low down on non-verbal communication in the United Arab Emirates with this demonstration of six hand moves that pack in a lot of information. Confused, threatened, threatening and more — you can get it all across with these maneuvers.
MORE COVID-19 MATERIALS: Looking for more translated patient information sheets regarding coronavirus? Check out the Public Health — King County and Seattle website, which features among other resources translated descriptions of the latest health recommendations. These pieces are offered in 23 languages, including English. Find them here. (Scroll down slightly and check the right margin.)
From Harvard: A Host of Translated COVID Info
Harvard Medical School
Here’s another batch of translated COVID-19 material, this time with information vetted by Harvard Medical School faculty and physicians. Available in English and 39 additional languages, the pieces include:
- COVID-19 Prevention
- About COVID-19
- Managing COVID-19
- COVID-19 and Pregnancy
- COVID-19 for 3-6 year olds
- COVID-19 for 6-12 year olds
- COVID19 for 13-18 year olds
These pieces are downloadable and free for use without copyright restrictions. Find them here.
Bonus Tip: Read about efforts by the Minnesota Department of Health and other organizations to reach out to Minnesota’s limited English speakers with COVID-19 information in this StarTribune story, Minnesota seeks to help immigrant residents cope with COVID-19. Among those featured in the piece is Danushka Wanduragala, who was for many years the Department’s liaison to the Exchange.