The Refugee's Dilemma, Fictionalized
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.
Refugee Stories, By Refugees
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 permissable jokes in the Middle East, to descriptions of nights of terror in Congo.
Asian Domestic Violence: The Follow Up
Remember the Tip of the Week regarding a new state-funded report on violence against Asian women and children? (Find a short summary of the report here, or read the complete report at this Minnesota Department of Health web page.) Here are a pair of community forum follow-ups sponsored by a consortium of groups including Hmong American Partnership, CAPI, Hmong Women Achieving Together and others.
The forums are set for noon - 3 PM, Saturday, May 13, at Harrison Education Center, 501 Irving Ave. N. in Minneapolis, and noon- 3 PM, Saturday, May 20, at Hmong American Partnership, 1075 Arcade St., St. Paul. The program in both instances starts at 1 PM. Organizers say the goal is to "empower community members to address violence against Asian women and children."
Get more information from Christy Nguyen, 651-201-5652.
Here's More on Reservation Homelessness
Lack of affordable housing, high unemployment, health issues, and lack of transportation are major factors contributing to homelessness and near-homelessness on American Indian reservations in northern Minnesota, according to a newly released study by Wilder Research.
Nicole Martin Rogers of Wilder Research and Jordan May of Red Lake Homeless Shelter appeared on TPT's Almanac to discuss the results of the study. Watch it now.
You can also learn more by reading the full report here.
Are the Anti-Vaxxers Winning?
Minnesota's latest measles outbreak is concentrated in the Somali community, in which just 42 percent of two-year old children have received their first MMR shot, reports the StarTribune newspaper. In Minnesota as a whole, the vaccination rate is 88.5 percent.
Anti-vax groups have promoted the notion in the Somali community of a link between autism and vaccinations, says Kris Ehresmann, infectious disease division director at the Minnesota Health Department.
That soundly disproven hypothesis was investigated in the New York Times recently, weeks before the latest Minnesota outbreak. In his opinion piece, How the Anti-vaxxers Are Winning, Peter J. Hotez, a Baylor College of Medicine pediatrician and director of the Texas Children’s Hospital Center for Vaccine Development, made this prediction: "It’s looking as if 2017 could become the year when the anti-vaccination movement gains ascendancy in the United States and we begin to see a reversal of several decades in steady public health gains. The first blow will be measles outbreaks in America."
Asian Domestic Violence: The State Report
A new state-funded report on violence against Asian women and children recommends an awareness campaign, more money for family-building, and ethnic-specific services to deal with issues related to housing, immigration, child custody and marital problems.
The study, commissioned by the Minnesota legislature, found that about a quarter of Asian-female respondents to a survey reported some form of stalking in their lives, while 15 percent had experience of partner violence. But women’s concerns about blame, stigma, shame, divorce and injury to their children prevented about nine out of ten women from making reports to police.
From Sweden, a Tragic Snow White Story
Here's another fascinating and perplexing New Yorker magazine story about the immigrant's plight, played out this time in Scandinavia. Rachel Aviv describes the cases of hundreds of refugee children who have fallen into a coma-like state after being informed that their families will be forced to leave Sweden. Read the story, The Trauma of Facing Deportation, here.
Dubbed uppgivenhetssyndrom, or resignation syndrome, by Swedish authorities, the condition is believed only to exist in Sweden, and only within the refugee community. “They are like Snow White,” one doctor said of his young patients. “They just fall away from the world.”
This story may sound familiar to those who remember the mysterious 1980s deaths of Minnesota Hmong refugees, who cried out in their sleep and never woke up. The Swedish cases serve as another reminder of the myriad consequences of dislocation.
Voices of the World, A Click Away
Just in case you seem to have too much time in your day, here's a way to make it disappear. Check out LocalLingual.com. The website offers a map of the world. Click on a country and you'll be given options to hear people speak in the language of the place. It's not always strictly accurate — for instance, Russia seems to be heavy on foul-mouthed pranksters — but on the whole the site is another window into the richness of language on our planet.
Bonus tips: Health equity in the news! Get two views on health equity issues from recent issues of the StarTribune. Minneapolis physician Stephen C. Nelson examines his own behavior in an op-ed piece titled, Rx for the inequity that plagues health care in Minnesota. And AP reporter Roxanna Hegeman describes the attractions of working in areas with high immigrant populations for young doctors. See her story, Refugee populations drawing doctors to rural Kansas.
HealthEast Offers Hmong, Karen Videos
Get Hmong and Karen versions of patient eduction videos on mammogram, colonoscopy and pap smear in this series posted on HealthEast's YouTube.com channel.
The six videos range from about three to five and a half minutes long, and offer an introductory explanation of these common procedures.
Bonus Ttp: The StarTribune offered up a view of the changing role of hospital chaplains in an increasingly diverse state. See "God, Allah, Buddha, Great Spirit: Minnesota hospital chaplains adapt to diversity."
O Canada! Refugees Flee Over MN Border
How jittery are recent refugees and immigrants regarding the new administration's talk of tougher immigration policies? One answer was provided in this Sunday's New York Times, where reporters tracked the dangerous, overland journey of Somalis who are hiking from the Minnesota border town of Noyes, through snow-drift covered farm fields, to the Canadian town ot Emerson. Once in Canada, a quirk of law allows refugees fleeing the US to apply for asylum. Read the complete story, Losing Hope in U.S., Migrants Make Icy Crossing to Canada.
Meanwhile, President Donald Trump's for now court-stymied immigration ban is creating concern in medically-underserved rural Minnesota communities that rely on foreign-born doctors for care. Minnesota attorney general Lori Swanson observed, "One out of five doctors were born in another country. That’s huge, and many of them are serving in rural parts of our state to deal with this crisis of not having enough primary care doctors.” Read the complete StarTribune story, Minn. nursing homes, rural health care could be devastated by a travel ban, Swanson warns, here.
Policy Shift Hits Thousands of MN Refugees
Against the background of new Trump-administration immigration policies, the StarTribune newspaper published a summary of Minnesota's refugee arrivals and foreign-born residents. It's a useful reminder of how many Minnesota families will potentially be affected by changes in immigration regulations.
A few key facts:
Suddenly, Machine Translation Got Better
It's far from a five-minute read, but to learn more about the future of machine translation, check out this story from the New York Times Magazine: The Great A.I. Awakening — How Google used artificial intelligence to transform GoogleTranslate, one of its more popular services — and how machine learning is poised to reinvent computing itself.
The story explains the work behind a huge leap made recently by Google Translate in providing non-comical renderings of text in other languages. Don't plan on laying off the translators yet, but you can take Google Translate for a test run here.
Get Stats on New Refugee Health
Need the latest data on the health status of newly arriving refugees? Check out the Minnesota State Health Department Refugee Health Program's data and summary reports. The reports can be used to:
Local Cops Have Message for Immigrants
St. Paul police have a message for immigrants in multiple languages: they're here to protect citizens, not to enforce immigration law. Immigrants shouldn't be afraid to call police when they need help, says police chief Todd Axtell, with assistance from Hmong, Karen, Somali and Spanish-speaking officers in a series of Facebook videos.
Meet ACA Language Requirements
Wondering about the language access requirements under the Affordable Care Act? The federal Office for Civil Rights has posted Frequently Asked Questions about language access regulations. If you receive federal funding, the law requires your organization to take reasonable steps to provide meaningful access to individuals with limited English proficiency.
OCR has prepared translated model notices and nondiscrimination statements that you can use. Find that compendium here.
Toolkits Help Fight Bias
Check out this pair of toolkits that show you ways to combat the backlash against refugees and Muslim-Americans. Offered by Welcoming Refugees, with support from the US Office of Refugee Resettlement, these resources are:
The Welcoming Refugees website includes a number of other promising practices and resources that makes it well worth a look.
Get a Health Literacy Toolkit
Check out the Minnesota Health Literacy Partnership’s Health Literacy Toolkit to help improve your organization's written and spoken communication.
The toolkit includes resources such as trainings, guides and assessment tools. It's keyed to the priorities of the Partnership's Minnesota Action Plan to Improve Health Literacy,
These priorities are:
Get Anti-Smoking Videos in Karen
Here are four Karen language anti-smoking videos with English subtitles. Produced by Wellshare International, the videos are directed at four audiences — female non-smokers, young males, women whose husbands smoke, and young teens subject to peer pressure from friends who smoke.
Each of the videos are under three minutes and feature recent Karen immigrants.
AARP Explores Multicultural Care Giving
Get a multicultural perspective on caregiving for the elderly in a series of three videos produced by the senior advocacy organization, AARP. The films are "meant to serve as a catalyst to start caregiving conversations in our communities," says AARP's Daphne Kwok. The videos include:
Tips for Trans Treatment
Still confused about how your organization should interact with transgender patients? Here's a video simulation with accompanying debriefing questions, provided by the Montgomery College (Maryland) Nursing Skills and Simulation Lab.
The video addresses the nurse's role as a practitioner, educator, leader and advocate. It also exposes barriers to care — staff insensitivity, mis-gendering the client, using the wrong pronouns, and placing the burden of educating the provider on the client.
Cultural Care: When Yes Means No
Here's a potentially helpful realization from Karen Alaimo, former global media coordinator for the United Nations and spokeswoman for international affairs in the Treasury Department:
"My South African boss had to explain what would never have occurred to me: In many cultures, it is rude to say no. So some people would say yes to anything I asked, regardless of whether they had any intention of delivering."
Alaimo compiled a list of cultural communication pitfalls and confounders in the process of interviewing senior communication professionals in 31 countries about how they help clients modify messages and strategies for particular cultures. She notes that among the factors to consider when communicating across cultures are emotion, context, notions of time and social expectations.
Love & Tolerance: Pro Wrestler Wisdom
In case you missed this recent web meme, here's a celebration of American diversity and a description of true patriotism from that well-known authority, professional wrestler John Cena, with help from the Ad Council.
Free Guides to Refugee Child Welfare Work
Are you a child welfare worker with refugee clients? Here are two new, free, downloadable guides from St. Paul's Center for Advanced Studies in Child Welfare. The guides offer information and resources to help you provide culturally responsive, appropriate services:
Try Saying It Simply
Here's a short, funny video on why and how to write simply. You might question the source — the Minnesota Department of Revenue (!) — but there are lessons here for anyone who's had to translate bureaucratic or technical subject matter for everyday readers.
Health Literacy and Palliative Care
Here's a free, downloadable exploration of the important connection between health literacy and palliative care. Prepared by the National Academy of Sciences, Engineering, and Medicine’s Roundtable on Health Literacy, this summary of a one-day workshop examines the need for clear communication in treatment of people with:
The workshop examined the interaction among patients, their families and providers, plus providers' knowledge of palliative care principles. The workshop featured presentations on
By the Numbers: Immigrants in the US
Looking for a comprehensive rundown on immigrants in the US? Check out this article by the Migrant Policy Institute, Frequently Requested Statistics on Immigrants and Immigration in the United States.
If you need an overview for a grant application or justification for spending on language services, this article provides many of the most frequently requested facts and figures on U.S. immigration, such as:
The answer, often, is: More than you think.
The U.S. immigrant population stood at more than 42.4 million, or 13.3 percent, of the total U.S. population of 318.9 million in 2014. Between 2013 and 2014, the foreign-born population increased by 1 million, or 2.5 percent.
Immigrants in the United States and their U.S.-born children now number approximately 81 million people, or 26 percent of the overall U.S. population.
Why Are You So Hard to Understand?
What makes it so difficult to learn to speak English clearly? You can gain some insight by watching the video above, as native English speakers struggle to replicate the basic sounds of the Spanish language. The clip is good for a laugh, good for developing sympathy for those struggling with English, and good for recognizing, again, the accomplishments and hard, frustrating work of so many new immigrants.
In Minneapolis, Food Safety in Translation
In case you missed it, here's a revealing story in the Minneapolis StarTribune on the city's efforts to bring food safety information to restaurant workers in translation. See Food Safety in Many Tongues: Minneapolis employs multilingual inspectors to educate restaurateurs.
The story details how the public can be at risk when food workers don't understand the hundreds of regulations that govern the restaurant industry. And it outlines the steps Minneapolis has taken to hire inspectors who speak Spanish, Chinese, Hmong, Thai, Lao, Somali and Spanish; release training videos in multiple languages, and host meetings with Somali and Latino restaurant owners.
The story is fascinating in itself, but also suggests a road map for educators in other Minnesota communities who are looking for obvious ways to improve public health.
Why English Is Rough
Retrieved from the Stone Age-era of television, this clip provides evidence why English will always be a tough language to master.
A Rich Collection of Translated Videos
Honoring Values in End of Life Care, featured above and available in basic English, plus Spanish, Somali and Hmong with English subtitles, is just one example of numerous videos translated into languages most commonly spoken in Minnesota.
ECHO videos are produced in close collaboration with the communities served, making them a particularly valuable tool in your efforts to reduce disparities.
Trouble and Hope in St. Cloud
Media reports recently have explored hostility directed toward St. Cloud-area Somalis, with the weekly newspaper City Pages declaring St. Cloud the worst place in the state to be Somali.
Owens, a CentraCare health literacy/cultural competency specialist, acknowledges that cross-cultural relations in the city are imperfect. But she also describes the hard work local leaders have undertaken to build a more cohesive community.
"It's very bad that the community that I live in, that I love and I support, that I work in, that the media is always portraying that there is something wrong," Owens told the MPR reporter. "Let me tell you, we've done a lot of things across racial class, income, in a lot of amazing ways. And people don't realize that."
Diversity Comes to the Suburbs
The City Lab story is a detailed examination of how local government has attempted to adapt to change, and a clear-eyed look at successes and failures. Overall it's worth a read for anyone whose institution works in a changing demographic environment — which is to say, just about everyone.
The Dangers of Skin Whiteners
The cream, manufactured in Mexico, is labeled in Spanish and sold primarily in Latino communities at flea markets and retail outlets. It's promoted to whiten skin, treat acne, and remove warts and blemishes.
Exposure to mercury can cause kidney and nervous system damage and interfere with brain development in children. Symptoms include irritability, shyness, tremors, changes in vision or hearing, memory problems, depression, and numbness and tingling in hands, feet or around the mouth.
This is just the latest wrinkle in recurrent efforts to peddle dangerous skin-lightening products. For instance, the New York Times reported in 2010 on steroid-laced skin products stocked in Asian markets and sold to what a dermatologist described as "an amazingly international cross section of women of color."
Why did women buy the ultimately disfiguring products? Said one West Indies woman: she wanted "to be more accepted in society."
Is that Spanish?
Steer Clear of Top 10 HIPPA Blunders
Get a Primer on Muslim Beliefs, Culture
“Our intention is simply that this resource will open doors, minds, and hearts and dispel stereotypes and myths about Muslim neighbors just enough to start more conversations,” writes Lutheran Social Service CEO Jodi Harpstead.
This resource includes chapters on:
The Flu in Translation
These simply-illustrated handouts include basic information about the disease, tips on cleaning to prevent flu, how to talk to kids about it, and how to care for them if they get sick.
The materials, translated into Arabic, Amharic, Burmese, Dzongkha, English, Farsi, Karen, Kurundi, Nepali, Oromo, Somali and Spanish, are available here.
Help with Adopting CLAS Standards
Get a regular dose of similar information on providing culturally appropriate care from the US Office of Minority Health by signing up for the Think Cultural Health newsletter.
The South Asian Heart Risk Dilemma
Here's another unexpected example of health disparities among racial groups, courtesy of the New York Times. South Asians, notes cardiologist Sandeep Jauhar, account for more than half of the world’s cardiac patients.
In India, Pakistan and Bangladesh, heart disease is the leading cause of death. South Asian immigrants to the United States develop earlier and more malignant heart disease and have higher death rates than any other major ethnic group in this country.
Why? For now the answer is, Who knows? Traditional cardiac risk models, developed by studying mostly white Americans, don't necessarily reveal the roots of disease in ethnic communities.
For a deeper explanation — and a preview of a study that may provide answers — see Jauhar's piece, The Heart Disease Conundrum.
Map App Displays LEP Data
Here's another way to get a handle on how many people are speaking various languages in Minnesota and other states.
The US Dept. of Justice Civil Rights Division’s Language Map App is an interactive mapping tool that helps users find out the languages spoken and how many people speak them in particular communities.
You can click on your state or county to identify the number or percentage of LEP persons, download language data, or visually display LEP maps for presentations.
The Hidden Part of Culture
The notion of the cultural iceberg is credited to anthropologist Edward T. Hall, and appears in various versions in numerous web locations. Get a deeper interpretation of the ideas presented in the graphic here, at the Language and Culture Worldwide website.
Stay on Top of CHW News
Here's an easy way to keep up with latest developments in the Minnesota Community Health Worker (CHW) field — subscribe to the Minnesota Community Health Worker Alliance newsletter. Your free subscription is a click away at http://mnchwalliance.org/contact-us/
The Alliance is a group of CHWs, educators, employers, policy makers, providers and media representatives who work together to build awareness of the CHW role, promote education, and share research. The Alliance also provides networking opportunities at regular meetings, plus consulting, and technical assistance services.
Individuals vs. Communities
Take a look at this cautionary tale from Rosemond Owens, CentraCare's long-time liaison to the Exchange. In an opinion piece that appeared recently in the St. Cloud Times, Show kindness to all individuals, don’t lump in groups, she warns against the tendency to define people as "communities."
"I’d like to suggest that, instead of lumping people together and calling them “those Africans,” “the immigrants,” “refugees,” or “those Somalis” or “those white women,” let’s remember we are all individuals," Owens writes. "Taking kindly actions toward someone in your path, like my neighbor, Heidi, does, or like my friend Saadia and co-worker Sam do, will go a long way to help inform our view of others."
That's Multilingual: One Man, 32 Languages
Meet Ioannis Ikonomou, a Greek who speaks 32 languages. Not so astonishlngly, he works as a translator for the European Commission. Of the 24 official languages at the Commission, Ikonomou works in 21 of them, missing only Estonian, Maltese and Irish. Read more about his mind-bending linguistic talent here.
The obvious question for anyone who has struggled to learn another lanugage is, How do people like Ikonomou do it? You can learn more about possible answers to this question by checking out the book, Babel No More: The Search for the World's Most Extraordinary Language Learners. Written by journalist Michael Erard, this work examines the accomplishments of language savants such as the Bolognese Cardinal Mazzofanti, who was reputed to speak 72 languages. Get a glimpse of the book's contents in this review that appeared in the Economist.
Health Literacy Help from the CDC
Wondering how to communicate effectively with patients and community members on health-related topics? Take a look at this deep set of health literacy resources from the Centers for Disease Control and Prevention.
In the video above, Harvard Professor and health literacy expert Rima Rudd explores tenets of the field. At the CDC health literacy website, you can find a wealth of training materials, including guides on how to prepare and evaluate materials that meet the education needs of different patient groups, plus special resources available by region and state.
When Interpreting Goes Wrong…
Here's another example of why using family members as interpreters in a medical setting just doesn't cut it. This video from Britain's Royal College of Obstetricians and Gynaecologists demonstrates how wrong communication can go when a stubborn husband interprets for his non-English speaking, pregnant wife.
Reading Tips in Translation
Here's a collection of useful tips in translation to help boost reading skills in babies, toddlers and young children. Offered by Reading Rockets, the national multimedia literacy initiative provides information and resources to help young kids learn to read, explain why so many struggle, and show how caring adults can help.
The message behind these materials is that it's never too early to read to your baby. Just by talking to, playing with, and caring for your baby every day, you help him or her develop language skills necessary to become a reader. By reading with your baby, you foster a love of books and reading right from the start.
These tips are available free in English, plus Spanish, Arabic, Traditional Chinese, Haitian Creole, Hmong, Korean, Navajo, Russian, Tagalog and Vietnamese. Find them here.
Check Out African Immigrant Overview
Get an overview of Minnesota's African immigrant communities in a two-part series from the St. Paul Pioneer Press published on July 5 and 6.
Sunday's paper featured a story that offered a snapshot of the local Oromo, Cameroon, Somali, Eritrean and Nigerian communities. Writer Fred Melo observes that Minnesota ranks ninth among the states in numbers of African immigrants, with the population pegged at 73,000 by the federal 2008-2012 American Community Survey. The article, Making St. Paul Feel a Little More Like Home: Several African immigrant communities have established or plan to create community centers in the city is available here.
A second piece, When It Comes to Africans in Minnesota, Numbers Might Lie, details the findings of Concordia University economics professor Bruce Corrie. Corrie says that the local African population is drastically underestimated and its economic power frequently overlooked.
By Corrie's reckoning, local Africans:
The Joint Commission on LEP Needs
Still need to convince colleagues regarding the importance of trained medical interpreters? Here's a fresh, condensed piece of analysis from the Joint Commission:
"When compared to English-speaking patients, LEP patients have:
A Source of Free Photographs
Finding affordable, quality images to complement health education materials can be a huge challenge. Here's a free resource that can help make the job easier.
Check out Photoshare, a service of the Knowledge for Health project, based at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs. The project's mission is to demonstrate the value and impact of photography in global health efforts.
The library of 20,000+ images is free for educational and nonprofit purposes. The photographs, by Photoshare's description, "capture the realities of urban and rural life in developing countries, as well as global efforts to improve health and save lives."
Register and investigate the site at photoshare.org.
Training to Improve Food Safety
Here's another reason to attend meetings of the Metro Refugee Health Task Force (which start again in September) — fascinating presentations such as that provided early in June by Farhiya M Farah, MPH, director of GlobeGlow Consultant and Research, Inc.
Farah has worked with the University of Minnesota and the National Center for Food Protection and Defense Fund to investigate cultural norms around food handling and safety among Somalis both in Africa and here in the US.
As a former City of Minneapolis health inspector, she's familiar with the inner workings of that common new-immigrant business, the restaurant. Restaurants are required to have a certified food manager on the staff to help reduce the risk of foodborne illness by demonstrating safe food handling practices and sharing food safety knowledge with employees.
In focus groups with Somali food service workers, Farah identified sometimes spotty understanding of proper cooking temperatures, cross contamination of foods, the need for separate sinks for cleaning of meats and vegetables, and sanitizing with bleach, among other concerns.
The differences between the food preparation environment in Somalia and the US make these outcomes easy to understand. In Somalia, said Farah, water is scarce, cooking is often done outdoors, refrigeration might be non-existent, time is plentiful and training comes from trusted elders. The rushed and regulated world of US food service is a glaring change.
Part of the problem in adapting to food service norms in the US, Farah observed, is the difficulty in getting new immigrants trained and certified as food managers. Language issues are often a barrier. She's working now on a push to change Minnesota laws to allow non-written certified food safety exams, along with audio visual training modules that leave new immigrants with the knowledge they need to work safely with food.
We'll keep you posted on developments in food service training as they evolve.
Disparities? No Shortage.
Wondering whether health disparities were eliminated since you last checked? The answer, in a word: No.
Several recent reports from the U.S. Department of Health and Human Services highlight the persistent disparities faced by communities of color.
The 2014 National Healthcare Quality and Disparities Report, published in April by the Agency for Healthcare Research and Quality, concluded that “disparities remained prevalent across a broad spectrum of quality measures.” For example,
The Women of Color Health Data Book, published in April by the National Institutes of Health, reports that:
In May, the Centers for Disease Control and Prevention issued Vital Signs: Leading Causes of Death, Prevalence of Diseases and Risk Factors, and Use of Health Services Among Hispanics in the United States — 2009–2013. It is the first national study on Hispanic health risks and leading causes of death in the United States. Among the findings:
Once again, HHS officials observe, these studies underscore the need for culturally and linguistically appropriate services in health care.
Hajj Pilgrimage to Mecca? Prep Now.
Are your Muslim patients ready for the rigors of travel to attend Hajj or Umrah?
The annual Hajj pilgrimage to Mecca, Saudi Arabia, is among the largest mass gatherings in the world, drawing about 3 million Muslims. More than 11,000 Americans make the pilgrimage each year.
This year, Hajj will take place from approximately September 20–25. Umrah is a similar pilgrimage that can be undertaken at any time of the year but is likely to be more crowded during the month of Ramadan (approximately June 17 to July 17).
Because of the crowds, mass gatherings such as Hajj and Umrah are associated with unique health risks. Check out the CDC’s advice on prudent pre-trip preparations, including necessary and recommended vaccinations, travel health kits, insurance, food and water safety measures, safe head-shaving measures for men and much more.
Is There a Black Doctor in the House?
Check out the opinion piece, The Case for Black Doctors, in the Sunday New York Times. Duke University Medical Center psychiatrist Damon Tweedy makes the case that one way to address the numerous health disparities between black and white populations — two times the number of prostate cancer deaths, 40 percent higher death rate from breast cancer, to cite just two indicators — is to take steps to increase the number of black physicians.
Tweedy writes: "The usual explanation for these health disparities — poverty, poor access to medical care and unhealthy lifestyle choice, to name a few — are certainly valid, but the longer I've practiced medicine, the more I've come to appreciate a factor that is less obvious: the dearth of black doctors. Only around 5 percent of practicing physicians are black, compared with more than 13 percent of Americans overall."
Torture Victims & Interpreters: A Guide
Working with interpreters is challenging in its own. But you're in a different realm of complexity when interpreters are working with victims of torture.
Get help managing these delicate encounters with this information guide recently released by the National Partnership of Community Training. Working with Interpreters: Service Provision with Torture Survivors steers you and interpreters toward best practices to help anticipate, manage, and address challenges faced by refugees, interpreters and service providers.
Download the information guide here.
Chaplains: Sermon Notes for Organ Donors
Wondering how to place the benefits of organ donation in a Christian, Jewish or Zen Buddhist context? Here is a collection of citations and a guide to hymns that provides a structure on which to hang a sermon or conversation.
Get a Free ELL Health Curriculum
You can get free, downloadable health lessons for adult English learners from the Minnesota Department of Health Refugee and International Health office.
Lessons include sections on:
Training Tips on Religious Sensitivity
The Tanenbaum Center for Interreligious Understanding offers free resources to help providers deliver care that respects the religious beliefs of patients. Its downloadable curriculum, Religious and Cultural Competence for Medical Students: Advancing Patient-Centered Care, is designed for medical educators to use in teaching students.
Curriculum modules include a PowerPoint presentation and facilitator’s guide. The facilitator’s guide provides a detailed outline on how to present the materials and instructions for leading discussions and skills-building activities.
These materials are posted on MedEdPORTAL, a peer-reviewed publication run by the Association of American Medical Colleges, and are available for free download at the Tanenbaum Center website.
New Edition of Classic Cultural Care Text
Here's the latest edition of a classic text, featuring 300 case studies that illustrate cross-cultural conflicts or misunderstandings, plus examples of culturally competent health care.
Caring for Patients from Different Cultures gives providers a rundown on the expectations, anxieties and needs that patients from other cultures bring to the exam room.
Author Geri-Ann Galanti is a medical anthropologist and Assistant Clinical Professor of Psychiatry at the David Geffen School of Medicine at the University of California, Los Angeles, where she teaches in the Doctoring program.
Interpreters: Your Jobs Are Safe
Check out this BBC News story on new machine interpreting services offered by Google and other concerns. The good news for medical interpreters: your jobs are safe for now.
This comical piece by reporter Kevin Rawlinson traces his efforts in Bilbao, Spain, to use interpreting apps to accomplish simple tasks, such as getting a shop owner to pose with him for a selfie, or getting the story behind a stranger's first kiss. The results vary from more or less acceptable, to baffling, to absurd.
Improve Colorectal Cancer Screening
Routine screening can prevent colon cancer or find it at an early, treatable stage. But three key groups are much less likely to get screened — the newly insured, people with money trouble, and the insured who fall into the procrastinator/rationalizer category.
Here is a collection of tools and resources to reach these groups with effective messages.
80% by 2018 Communications Guidebook: Effective messaging to reach the unscreened is based on new market research from the American Cancer Society with guidance from the National Colorectal Cancer Roundtable Public Awareness Task Group. The Communications Guidebook is designed to help educate, empower and mobilize key audiences who are not getting screened for colorectal cancer.
The guidebook reviews what we know from market research about the unscreened and introduces and explains new tested messages. It also provides new tools with messages that will help get you started:
How Stereotypes Are Born
We know it's misleading, offensive, dumb — and usually all of the above simultaneously — but we do it anyway. That is to say, label members of cultural or ethnic groups as cunning, industrious, lazy, or, well, fill in your own blank.
So why do we keep doing it? Here's new research from University of Aberdeen psychologist Douglas Martin, showing that racial/cultural stereotypes are the downside of how we process and communicate information.
Our minds, Martin writes, are hard-wired to create mental shortcuts that help us categorize information. It's a way to use minimal mental effort to retain knowledge, and provides a sense of structure to a world that otherwise appears chaotic.
Martin came by his results in an experiment that relied on participants passing on information regarding races of imaginary alien stick figures. Find a more thorough description of his absurd but revealing experiment here.
Tomatoes in Your Eyes?
If you've ever wondered how complicated an interpreter's job can be, here's more to think about. We spew idioms in English that make sense to us but are baffling to English learners. It's raining cats and dogs. It costs an arm and a leg. You're not even in the ballpark. And that's just the tip of the iceberg.
Needless to say — but not that we often think of it — other languages are full of idiomatic expressions as well. In German, for instance, "You have tomatoes in your eyes," means, "You're not seeing what is obvious to everyone else." Interpreters are working overtime to make sense in both directions of language that, strictly speaking, often doesn't.
For an interesting and comical view of idioms in other languages, check out this TED Blog post, 40 Idioms that simply can't be translated literally.
Get Fire Safety Videos from ECHO
Have you learned that new arrivals in Minnesota need education on home fire safety? Here are videos in English, Hmong, Spanish and Somali that will help refugees and immigrants keep their families safe.
These half-hour videos from ECHO Minnesota help viewers learn how to prevent fires in the home. They also explain how fire behaves, so viewers understand how to keep their families safe if a fire occurs.
Find Fire Prevention in the Kitchen here. Fire: Anything But Child's Play is available here. They're part of an extensive library of safety and health videos in translation that are available on the ECHO website. View a complete index of these materials.
The Latest on State Health Inequities
In case you missed it, here's the latest update on Minnesota's health inequities — the Minnesota Community Meansurement report on health outcomes among whites, blacks, Hispanics and immigrant groups. Find the complete report here, and a StarTribune summary here. The report compares rates of optimal care for diabetes, vascular disease, adult and child asthma, plus colorectal screening among race and language groups and by state region.
Among the key findings:
Limited English is a deep challenge to providers who seek to provide optimal care. For instance, only 56 percent of those who prefer to speak Spanish reported speaking English “very well” and 9 percent reported not speaking English at all. Similarly, 56 percent of Hmong and 50 percent of Laotian speakers reported speaking English “very well."
Meet the Interpreter
Machine translation isn't ready yet for sophisticated transactions such as medical interpretation. But here's a New York Times piece that details new developments in free, consumer-level interpretation and translation.
Skype is currently offering simultaneous interpretation and translation of conversations in Spanish and English. The video below is a somewhat hopeful Skype promotional view of what you might expect.
At the same time, Google Translate offers written translation of 90 languages, and spoken interpretation of several languages, plus a free interpreter for Android phones. In addition, Google will also soon announce a service that enables you to hold your phone up to a foreign street sign and create an automatic translation on the screen.
Don't expect miracles. The Times reporter describes the interpretation as "a little as if two telemarketers using walkie-talkies."
Make the Case for Intepreters
You know that medical interpreters can save lives and help providers offer quality care. But do you find you sometimes need to convince colleagues about the importance of interpreters?
Free Help for Translators, Interpreters
Searching for the right way to describe an arcane medical term or procedure? The International Medical Interpreters Association has compiled a Terminology Resource Database that includes glossaries, dictionaries, terminology databases, anatomy atlases, nomenclatures, thesauri, lexicons, vocabularies, manuals, encyclopedias and other word-based documents in the fields of medicine and healthcare in numerous languages. The material includes books, CDs, web pages and video.
The database provides the title and other bibliographic information, the medium, language, direction (for bilingual and multilingual resources), what important features are included (such as definitions, synonyms, etc.), plus commentary on the contents of the terminology resource.
Rights of LEP Patients Explained, Again
Just in case your colleagues are unclear about the rights of limited-English speakers to language services and your obligations under the law, here's a thorough video from the federal Department of Justice, Breaking Down the Language Barrier.
Available in English, Spanish, Chinese, Korean and Vietnamese, the video runs through scenarios in medical, social service and law enforcement environments to demonstrate the right way and the wrong way to meet the needs of people with limited English. You'll find a concise summary of the law, with help in determining whether and how you're obliged to provide language services under Title VI of the Civil Rights Act of 1964.
Two Ways to Settle Refugees
Here's a fascinating description of two radically different ways of helping refugees to settle in a new country. Faith Nibbs’ book, Belonging: The Social Dynamics of Fitting in as Experienced by Hmong Refugees in Germany and Texas, is an in-depth examination of how different systems achieve very different results.
One small example: in the German village of Gammertingen, new Hmong refugees were given a year to learn the language and accommodate themselves to cultural differences before getting a job. In Texas, sponsors lined up jobs for new Hmong residents before they arrived.
Nibbs observes that in the German village where Hmong refugees resettled, the Hmong and old-time residents have strong, ongoing relationships 30 years later. In Texas, any remaining connections are exceedingly few and far between.
Advanced Training for Interpreters, Staff
Looking for training for your medical staff and intepreters on how to build team skills to improve patient safety? Here's a sophisticated training module from the Agency for Healthcare Research and Quality that will help you recognize and meet the challenges presented by patients with limited English.
AHRQ's TeamSTEPPS LEP training module, with full PowerPoints, trainer instructions, videos and handouts is available here. The modules feature two main videos — one demonstrating what can go wrong when interpreters are not integrated into the team, and another demonstrating successes. Several brief clips from the Success video show key practices, such as briefing the interpreter.
A Wealth of Sign Language Material
Here's a treasure trove of American Sign Language videos on a variety of health care topics. The video above is a quick explanation of the Ebola virus, but there's much more at the DeafHealth.org site.
You'll find an A-Z list of diseases with corresponding signed videos that offer explanations of the disease and treatment. The site also offers an Understanding Tests category, plus a Find A Doctor locator to help direct patients to deaf-friendly physicians.
The Maryland-based organization is funded in part by the National Institutes of Health and the Centers for Disease Control and Prevention.
Get Translated Ebola Fact Sheets
The Minnesota Department of Health added to its collection of translated Ebola fact sheets. You can now find a basic two-page description of the disease in English, French, Hmong, Somali and Spanish, both in the Exchange library (for members) and at the Ebola page on the MDH website.
MDH officials recognize that more languages need to be added to serve Minnesota's English as a Second Language population, and are now in discussions with the Centers for Disease Control and Prevention to provide further translations. Check the Exchange library and the MDH website for additions as they become available.
Additional Ebola fact sheets and infographics from the CDC are also available in the Exchange library in Amharic, Arabic, Burmese, English, Nepali, Oromo, Russian, and Spanish. Log in and use the search term Ebola to find these materials.
High Quality Interpreting, Explained
Check out this excellent video from UCLA Interpreter Services. With vignettes and convincing explanation, it shows how using family members for interpreting can go wrong, and how professional interpreters can make a crucial difference in difficult provider/patient conversations.
In addition it describes the federal law governing patients' rights to interpretation, and calls to attention the $71 million judgment awarded to a Latino man whose use of the word "intoxicado," when misunderstood by providers, left him paralyzed.
Get Help Explaining Ebola
The Minnesota Department of Health can help you explain ebola to both native speakers and recent immigrants from West Africa. Go to the Ebola Virus Disease page of the MDH website for fact sheets in English and French (often spoken in West Africa), FAQs, and best treatment practices for health professionals.
Free Health Curriculum for ESOL Classes
Staying Healthy is an award-winning curriculum by the Florida Literacy Coalition that is used throughout the United States. Written at a 4th-5th grade reading level, it is suitable for low intermediate level ESOL learners and above.
The newly-released Staying Healthy for Beginners is written at a lower reading level, making it more accessible to high beginner English learners.
Staying Healthy for Beginners includes chapters on health care, doctors, medicine, healthy food and staying healthy, plus a useful glossary of terms and a teacher's guide.
Link to Interpreting Resources
Warning: these items aren't free. But the California company Voices for Health has compiled a list of more than 75 medical interpreting and translation resources, plus a few more light-hearted (but related) movies and novels. You can find the compilation here.
Links on this page are all to Amazon, so get our your credit card. Among the resources you'll find are medical glossaries in Burmese, Karen and Nepali, glossaries and workbooks for medical interpreters, guides to telephone interpreting, training guides and more.
Get Weekly Tips on Clear Communication
Need help putting together clear patient communication? Take a look at these two recent blog posts from the firm Communicate Health: How Not to Use Illustrations and Infographics, and How to Use (Or Not Use) Stock Photos. Both posts will help you rethink how and why you're illustrating written health education pieces.
Communicate Health's blog is full of quick, free, useful tips on health literacy topics. You can sign up for weekly tips here.
Videos Explain Patients' Right to Intepreter
Available in Arabic, Hmong, Karen, Oromo, Somali, Spanish and Vietnamese, these short pieces were translated and vetted by native speakers to reflect cultural values and common speech usages of viewers. Versions in Hmong, Somali and Spanish are close captioned in English.
The idea for the videos was developed by Exchange members as a patient-driven model for increasing usage of both interpreters and translated health education material. The project was funded by Stratis Health, and supervised by consultant Amy Shellabarger and Fariview's Sahra Noor.
Get Help Working with Refugees
The guide lists hospitals, clinics, and organizations that serve Minnesota's ever-increasing diverse cultural communities. Information is organized to direct you to general health services, dental services, home care, mental health, and help for sexual assault and battering. The guide covers Anoka, Carver, Dakota, Hennepin, Kandiyohi, Olmsted, Otter Tail, Ramsey, Rice, Scott, Stearns, and Washington counties. Download the PDF version here.
Should There Be An App for That?
In Speaking the Language of Health Care, writer Sophie Quinton takes a look at new phone apps that offer providers and patients simple ways to communicate across language barriers.
But she also offers the views of critics who contend that there is no effective substitute for the nuance that trained interpreters can tease out of the often fraught communication between doctors, nurses and patients who speak limited English.
Get the Culture Care Connection
The latest issue of the quarterly Connection includes articles on:
Try a Free Pediatric Cross Cultural Course
Offered by the Maternal and Child Health Grantee Training Network and supported by the US Department of Health and Human Services, these training modules include case studies accompanied by lecture and learning activities. Each case study involves a family from a different culture and focuses on specific issues of working with culturally diverse families, such as the Roma family in the photo above.
The course focus is not on teaching about specific cultures. The goal is to illustrate the types of beliefs or practices that can differ from culture to culture.
Dentists: Get Cross Cultural Guidance
The Cultural Competency Program for Oral Health Professionals:
The public health implications of untreated dental problems are striking. Untreated tooth decay can cause pain and infections that lead to additional problems in daily activities such as eating and speaking. African American and Mexican American adults are more likely than Caucasian adults to have untreated cavities. Racial and ethnic minority youth are more likely to be uninsured and have more unmet dental needs than Caucasian youth.
The program is designed for a range of oral health professionals, including dentists, dental hygienists, and dental assistants. The three-course program offers oral health professionals the opportunity to gain up to six free continuing education credits.
Find more information about the program here. (The registration link is in the right hand sidebar.)
Video Health Info for Refugees
Originally produced by the Ohio Department of Job and Family Services, the video version is presented by Healthy Roads Media. The 28 short segments cover specific topics in 17 languages. Among the topics in translation are:
The Healthcare Maze, Simplified
For an interesting take on this, see this piece that recently appeared in the Minneapolis StarTribune: UnitedHealthcare takes initiative to enhance health literacy.
The article describes efforts begun by marketing chief Terry Clark to develop easy-to-understand materials for seniors, and to scrub other documents of ponderous, bureaucratic language. Simplified communication gives UnitedHealthcare a competitive advantage, says Clark, as consumers are required to manage steadily increasing amounts of their own care.
A Simple Boost for Immigrant Kids
Here's a New York Times article and video— Trying to Close a Knowledge Gap, Word by Word — that explains how parents can give their kids an early boost long before they start school —simply by talking to them.
In programs around the country, some directed particularly at immigrant families, home visitors are explaining to parents that kids get an important language advantage when they're both spoken and listened to.
For providers with an expanded sense of how to build health in low income families, this article is worth a look.
Get Guidance on Language Service Hires
The Dramatic Case for Interpreters
Here's a video from the International Medical Interpreters Association that powerfully demonstrates the despair of people seeking medical treatment in a system and language they don't understand. That's a constituency of 25 million people in the US with limited English skills.
New Tricks for Old Dogs?
Their conclusion? Let's just say it's not a slam dunk case for doctor training. One study recently published in the Journal of the American Medical Association showed that doctors and nurse practitioners participating in a communication course were no better at communicating or providing end-of-life care than those who didn't get the training. However, the patients of trained providers were more apt to be depressed.
Gillian and Sekeres also explore the likelihood that doctors who receive quick training will end up sounding more robotic than human.
It's not exactly uplifting, but the piece, Can Doctors Be Taught How to Talk to Patients?, definitely provides food for thought.
As Digital Divide Crumbles, Opportunity
With an explosion of smartphone and tablet use in these populations, the digital divide is shrinking. Among the results of increased access to information are these:
Barriers to effective use of online information include low health literacy, trust and the need for culturally and linguistically appropriate material.
Read the complete report here: Promoting Consumer Engagement and Empowerment through the Adoption of HIT in Communities of Color.
Life and Death by Zip Code
Why do people in Prospect Park life 13 years longer on average than Frogtown residents? Get a glimmering of an idea — and some recommendations on how health care professionals can intervene — in a recent Robert Wood Johnson Foundation report from the Commission to Build a Healthier America.
Commission members declared that social factors can have more impact on health than the medical care system. It recommended that the country's priorities be shifted to emphasize three areas essential to improving the nation’s health: Increasing access to early childhood development programs; revitalizing low-income neighborhoods; and broadening the mission of health care providers beyond medical treatment..
Providing True Community Benefit?
Check out this article, Engaging the Community to Eliminate Disparities in Health and Health Care, by Frederick Hobby in Hospitals and Health Networks Daily. It's an informed view on why and how to meet standards imposed by the Affordable Care Act and the US Department of Health and Human Services Office of Minnority Health.
Hobby warns that increased levels of scrutiny are likely regarding health care organizations' claims to community benefit. He cites research showing strikingly meager levels of true community benefit spending by many hospitals.
Among his recommendations: that representatives of cultural communities must be represented in your organization's governance. Meanwhile, you should, he says, develop and maintain open discussions with those communities to improve public health and access to care.
Affordable Care Act, in Translation
An extensive list of resources from the US Department of Health and Human Services, many available in Spanish, is available here.
A number of pieces in Green and White Hmong have been translated by HmongHealth.org, and are available free on the organization's website.
A PowerPoint presentation from HHS in Hmong, Khmer, Lao and Vietnamese plus other Asian and South Pacific languages is neatly packaged on the Asian and Pacific Island American Health Forum website.
Winter Survival Tips for New Arrivals
Winter Storms and Extreme Cold is a simple, helpful video from Healthy Roads Media that explains the basics of winter survival. The 2:02-minute video (English) covers what to wear, what to do in a storm and how to survive if you're stranded in a storm-bound car.
Help Parents Get Check-ups for Kids
A key part of good parenting is doing what you can to raise healthy children to adulthood. ECHO Minnesota recently released new videos in English, Spanish, Hmong and Somali that explain why parents should schedule their kids for regular check-ups, and how to make check-ups affordable. The brief videos are clustered in groups that are directed at the health and emotional issues of infants, children and teens
This multimedia project was sponsored by Anoka County, Ramsey County, and Dakota County Child and Teen Checkups. The Child and Teen Checkups program provides free preventative care to eligible children and teens.
These short videos can also be ordered on DVD by emailing Polcher@echominnesota.org to request a copy.
Videos Explore Somali Women's Health
The videos help to educate Somali women refugees about a variety of health issues that can affect – and possibly save – their lives, including reproductive health, diet and exercise, cancer screening, prenatal care and pregnancy. The series was developed in collaboration with Somali women’s health experts, women’s health advocates, and Somali refugee community organizations.
Find the series on YouTube:
English transcripts are included. Clcik on YouTube's Transcript icon below the videos.
Improve Service for LGBT Refugees
Dowload the toolkit here: Rainbow Response: A Practical Guide to Resettling LGBT Refugees and Asylees. For more resources, including videos, training curricula and materials, articles, and links for technical assistance, see the Chicago-based Rainbow Welcome website.
Videos Explain Patients Right to Intepreter
The idea for the videos was developed by Exchange members as a patient-driven model for increasing usage of both interpreters and translated health education material. The project was funded by Stratis Health, and supervised by consultant Amy Shellabarger and Fariview's Sahra Noor.
The Native View of Disparities
The result of a workshop convened by the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities of the Institute of Medicine, this report addresses the broad role of culture in contributing to and reducing health inequities.
The workshop brought together more than 100 health care providers, policy makers, program administrators, researchers, and Native advocates to discuss the sizable health inequities affecting Native American, Alaska Native, First Nation, and Pacific Islander populations. The report includes case studies that examine programs aimed at diabetes prevention and management and cancer prevention and treatment programs.
Download the PDF version or view an OpenBook copy for reading on your computer here. (The free version link is immediately below the offer to buy a hard copy for $36.)
Affordable Care Act Info in Translation
The website promotes the Affordable Care Act and provides general information on the new health coverage options under the law. The website has been fully translated into Spanish at www.cuidadodesalud.gov.
Both websites provide information in languages, including Vietnamese and Chinese, that direct consumers to translated downloads. (Scroll to the bottom of the website pages for these language options.)
When the Patient Is a Racist
This week we're introducing a twist. What do you do when the patient is a racist? How do providers meet the challenge of treating patients who are dismissive of care from providers of color, or who insist on being treated by a white physician?
This question was examined recently in the New York Times blog, Well, by Dr. Pauline W. Chen. Her piece is titled, When the Patient Is Racist.
Get Profiles of Bhutanese, Burmese
Bridging Refugee Youth and Children's Services and the Office of Head Start’s National Center on Cultural and Linguistic Responsiveness partnered to create two cultural backgrounders focused on early childhood: Bhutanese Refugee Families and Refugee Families from Burma.
Among the subjects discussed in the free, four-page pieces are family and community, child rearing and child development, health and mental health.
These resources provide general cultural information. The usual caveats apply: every family in every culture is unique, and cultural practices vary by household and by generation.
Free Air Quality Info for ESL Asthmatics
Help inform non-English speakers about how to protect themselves with information cards and posters from the Minnesota Department of Health's Asthma Program, available in Somali, Vietnamese, Lao, Spanish and English. Posters are available in Somali, Hmong, and Spanish.
Take the Quiz on Advanced Care Planning
Here's a quick way to get a view of issues in cross cultural advanced care planning (ACP). Take a seven-question quiz offered by the Twin Cities Medical Society.
Want a teaser question? Try this:
Multicultural ACP may involve a range of concerns including:
The quiz is part of TCMS's on-going Honoring Choices initiative, which seeks to spur conversations about future health care preferences and to assist health care organizations and community partners in creating a comprehensive advance care planning program. Among other resources, Honoring Choices offers health care directives that meet both Minnesota and Wisconsin legal requirements, available in English, Hmong, Russian, Spanish and Somali.
The pieces are on biopsy, chemotherapy, breast cancer surgeries and prostate cancer, each in Amharic, English, Khmer, Somali, Spanish, Tigrinya and Vietnamese. (Tigrinya is the language of the Tigrinya people of southern Eritrea and northern Ethiopia.)
This series was produced by Healthy Roads Media and EthnoMed, with funding from the National Network of Libraries of Medicine. During the associated study project, lay refugee health educators will useiPad tablets to show clients the materials. You can help this research effort by completing a short evaluation survey that is available on the Healthy Roads download page.
Help Teens Prevent Diabetes
Here's another short, informative video from ECHO Minnesota in which teens explain to other teens how to prevent Type 2 diabetes. The video addresses these questions:
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