For anyone with children (or really, anyone at all) the news about Central American immigrant kids being separated from their parents is heart-rending. But that’s not to say that American history is free of numerous other similar examples.
Get some historical perspective in this piece by CNN: Actually, the US Has a Long History of Separating Families. The story is a brief reminder that African-American slaves, native people, Mexican immigrants in the 1930s and Japanese-Americans during World War II all experienced family separation.
CNN’s final analysis: “Critics say the policy… is not emblematic of who we are as a nation. Others say it runs counter to the America they know and love. But history shows policies like this have been implemented time and time again since the nation began.”
The topic in this short video isn’t health care — it’s about a new version of The Odyssey rendered by Classicist Dr. Emily Wilson. As the first woman to translate The Odyssey into English, she discovered that many men before her added sexist or misogynist terms that never existed in the original Greek.
Though interesting in itself, it also raises perplexing questions for health care providers. What cultural notes are being added or subtracted by interpreters during a patient/provider encounter?
Here’s another dimension of the move toward outcome-based pay for providers. In a recent New York Times op-ed piece, Dhruv Khullar, a NewYork-Presbyterian Hospital doctor and researcher at the Weill Cornell Department of Healthcare Policy and Research, reflects on the difficulty in reaching similar outcomes for patients with radically different incomes and lifestyles.
“Value-based payment models try to measure quality, outcomes and costs — and reward or penalize providers based on their performance,” Khullar observes. “They generally adjust for patients’ medical problems, but not social ones.”
His experience as a resident with a load of impoverished patients showed him the flaw in buried within an unadjusted value-based payment system. “What strained our abilities,” Khullar writes, “was not our patients’ medical complexity, but their social problems: They were poorer, less educated, more isolated, from rougher neighborhoods. We quickly learned that while it’s hard to dose insulin, it’s harder still for a patient who speaks no English, has no refrigerator and regularly has his medications stolen.”
Of course you’ve been wondering, What are the top ten movies of all time that feature interpreters? Well, wonder no more. That list has now been assembled by the United Kingdom blog, Kwintessential. Take a look here.
The top ten includes familiar titles such as Lost in Translation, Zero Dark Thirty and Amistad. Then there’s the film, Desert Flower, that lays out the problems with non-professional medical interpretation.
But there’s also a touch of the screwball, such as the entry, The Mummy. This 1999 film features an Egyptologist, who, thanks to her knowledge of ancient Egyptian, stops a 3,000-year old mummy from destroying the world. Luckily.
It’s time to check out the latest edition of the Minnesota Health Literacy Partnership’s e-newsletter, In the Know: Health literacy news and best practices.
The new issue covers topics such as health literacy training for dental professionals, and how to make informed consent more patient-centered. Plus you’ll find the usual helpful listings of health literacy resources and events.
View the newsletter here. And look forward to additional issues in the future, as In the Know moves to quarterly publication.
Bonus Tip: Last week’s tip, originally titled New to Using Interpreters, drew a worth-noting objection from a reader, who observed: “Utilizing the term ‘use an interpreter’ has become offensive and inappropriate in the field of language access nationwide. The proper term is to say “to work with an interpreter.” Interpreters are not objects to be used. Interpreters are professional human beings who are working very hard to raise the bar, have a code of ethics, and have a couple of national bodies that certify them professionally.”
Have colleagues who are working with interpreters for the first time? Here’s a short video that covers the basics.
For old hands, the video’s directives might seem obvious, but for first time users these instructions on seating, sentence length, frequent pauses, maintaining eye contact and avoiding jargon might make the difference between a satisfying encounter and a mini-disaster.
Despite the many travails immigrants experience while adapting to a new life, there are also befuddling and ridiculous moments, some of which are captured in this charming, short video produced by The Guardian newspaper.
For instance, a Syrian refugee now trying to make sense out of his new home in Germany explains that among the many perplexing aspects of German social behavior is the loud sneezing — even among elf-sized German women. His son, meanwhile, says he was surprised that in prosperous Europe, he wouldn’t immediately get the things he wanted, such as a bike, merely by wishing to have them.
The article, written by a doctor serving aboard a rescue vessel run by the NGO Proactiva Open Arms, describes a mission in which the organization’s 120-foot tug boat patrols for refugees wallowing in unseaworthy inflatables as they attempt the Mediterranean crossing from North Africa to Europe. The rescue boat ends up crammed with more than 400 refugees while the captain searches desperately for a port that will accept them.
It’s a gripping story, and another reminder of the harrowing conditions that refugees suffer both in their home countries and when they attempt to flee.
Check out a four-part series on integrating immigrant and refugee physicians into the US health care system. Immigrant docs bring their training and cultural/language skills to their new environment, but overcoming the barriers to resume their medical careers in the US can be an arduous undertaking.
The video below profiles Cuban-trained doctor and immigrant Dr. Berto Torres, who returned to medicine with support from Minnesota’s unique immigrant physician integration effort.
Here’s a quick brush up from Scientific American magazine on the topic, “How to Think about Implicit Bias.”
The authors — UNC Chapel Hill Psychology and Neuroscience Professor Keith Payne and Duke University Center for Cognitive Neuroscience postdoc Laura Niemi — observe again that everybody works off stereotypes in their daily life. You notice patterns, you make generalizations. And that leads often enough to over-generalizations and implicit bias.
Their short piece takes a look at the controversy surrounding the Implicit Association Test, which teases out evidence of implicit bias in subjects. And for anyone looking for new research-related traps to avoid, there’s a description of the Divining Rod Fallacy and its co-conspirator, the Palm Reading Fallacy.
The authors’ conclusion? “Many of us are more biased than we realize. And that is an important cause of injustice — whether you know it or not.”
So, that Spanish-speaking patient shows up in the clinic. The doctor believes he or she speaks Spanish well enough to get through the encounter. But is this a case of delusion? Would an interpreter be the better solution?
Here’s research that shows how accurate physicians are in self-assessment of their language ability compared to the results of actual testing of their language skills:
The nutshell answer: One study found that docs who rated themselves as possessing high or low language proficiency had the clearest picture. Those who thought they fell in the middle of the scale were more likely to be flattering themselves. The other study revealed that once docs got test results, they felt less comfortable rolling out their Spanish in patient encounters.
Though not quite from right down the street, this video series from the University of Glasgow on the complexities of the medical interpreter’s role is unusually well filmed and acted, with nuanced scripts that go beyond the usual easy answers.
Among the topics explored here are the sometimes difficult-to-draw professional boundaries, the perils of family-member interpretation, and how to deal with pesky interlopers. It’s well-worth checking out all five of these approximately five-minute films.
Looking for a window into the living conditions and thoughts of refugees? Check out Refugee Voices, a feature offered on the website of Refugee Center Online.
This space gives refugees an opportunity to write about their experiences and attempt to make sense of the trauma in their lives. The content varies from explanations of acceptable jokes in the Middle East, to descriptions of nights of terror in Congo.
In the world of literature, these are boom times for dystopian fiction and refugee sagas. A recent stand-out in the latter category is “Exit West,” by Mohsin Hamid.
The short novel starts with a set-up familiar to anyone who reads the newspaper. Violence in an unnamed Middle Eastern country drives the protagonists, Nadia and Saeed, from their home, leaving behind family and the familiar world.
The tale veers into the realm of magical realism as they escape to Greece, London and California through a series of doors that open and close unpredictably. But at heart the story is about the complex relationship between Nadia and Saeed, and the difference in their ability to cope with the relentless change that defines a refugee’s passage.
Here’s the New York Times’ view of Hamid’s concern in this novel: The author, says reviewer Michiko Kakutani, “is less interested in the physical hardships faced by refugees in their crossings than in the psychology of exile and the haunting costs of loss and dislocation…. In “Exit West,” Hamid does a harrowing job of conveying what it is like to leave behind family members, and what it means to leave home, which, however dangerous or oppressive it’s become, still represents everything that is familiar and known.”
For anyone working with refugees, “Exit West” offers a view of the hope and dismay that accompanies escape from the world’s many war-torn countries.