Should the arts be considered an essential ingredient in general well-being? And should therapeutic art or hobby-based treatment be prescribed as part of a treatment plan?
The answer is yes, according to United Kingdom Health Secretary Matt Hancock, who has promoted a “social prescribing” initiative to the country’s doctors for maladies such as dementia, psychosis and mental illness, as well as ailments such as lung conditions.
Regarding the arts, Hancock says,
“They’re not just a right in their own terms as the search for truth and expression of the human condition. We shouldn’t only value them for the role they play in bringing meaning and dignity to our lives. We should value the arts and social activities because they’re essential to our health and wellbeing. And that’s not me as a former Culture Secretary saying it. It’s scientifically proven. Access to the arts and social activities improves people’s mental and physical health.”
How many patients are capable of fully understanding the care instructions they’re given? The answer: barely one in ten.
A 2006 national survey found that 12 percent of patients fit the “proficient” health literacy category. Things get even more bleak for the elderly. For those 65 and older, only three percent qualify as proficient, while fewer than one in four can claim intermediate health literacy.
Poorer health at higher cost,
Higher hospitalization rates,
Less use of preventative tests and immunizations.
According to an analysis in the New York Times, This Type of Illiteracy Could Hurt You, health care providers can’t view themselves as blameless. Says Rima Rudd, a Harvard University health literacy researcher, “We give people findings and tell them about risk and expect people to make decisions based on those concepts, but we don’t explain them very well. Are our forms readable? Are the directions after surgery written coherently? If it’s written in jargon, with confusing words and numbers, you won’t get the gist of it and you won’t get important information.”
With the Trump administration poised to deport a large group of legal Cambodian immigrants to the United States, among the questions that arise is, How will those booted from the US adapt to Cambodia, a country that in many cases they’ve never known?
Those at risk of deportation include members of families that fled the murderous Khmer Rouge regime and were declared refugees in the US. But those who failed to become citizens and were convicted of felony crimes are now at risk of deportation.
Want to be viewed more often as a liar? Try telling the truth in another language.
That, roughly speaking, is the conclusion of research conducted by University of Würzburg psychologists Kristina Suchotzki (photo, right) and Matthias Gamer.
In their experiment, the researchers asked participants to answer questions, sometimes honestly, sometimes not, in their native tongue and in a second language. Some questions had an emotional core; others involved a simple statement of fact. The results, as summarized by Medical Xpress:
“It is not easy to tell when someone is lying. This is even more difficult when potential liars speak in a language other than their native tongue.
“Most people don’t find it more difficult to lie in a foreign language than in their native tongue. However, things are different when telling the truth: This is clearly more difficult for many people in a foreign language than in their native one.”
The effect for non-native speakers: they are perceived as less truthful and trustworthy. The result could be especially dire for asylum seekers answering government officialdom’s questions.
Here’s another note on the consequences of inadequate language services, this time from the St. Paul public school system.
Como Park high school student and Karen immigrant Lor Ler Kaw got placed in mainstream English and social studies classes with fluent English speakers, even though he read at a second grade level. He was caught up in a district policy to mainstream ELL and special-ed kids in regular classrooms.
Parents George Thawmoo and Mary Jane Sommerville suspected their child needed special education services. Eventually they took their complaint to the St. Paul Department of Human Rights and Equal Employment Opportunity, which found probable cause that the district discriminated against the students on the basis of national origin.
In a negotiation ordered by the US District Court, the school district awarded Lor Ler Kaw’s family $12,500, and agreed to substantial changes in its ELL policies.
Looking for a cheap and easy way to learn how to say hello and exchange a pleasantry or two with recent immigrants? Check out the language lessons — many of them free — at the Open Culture website.
You’ll find introductions to 48 languages, ranging from Spanish, German and French, to Amharic, Bambara, Lao, Swahili, Vietnamese and more. Many of these courses are Foreign Service Institute book and audio packages intended to prep the diplomatic corps for a new assignment.
There’s much more to this wide-ranging website, including in-depth interviews with literary luminaries such as Margaret Atwood, Jorge Luis Borges, Roland Barthes and Toni Morrison, plus some oddball diversions, such as how to make, wear and fight in medieval armor.
Here’s a twist on a communication problem that has bedeviled Minnesota’s emergency management departments. How do you let non-English speakers know about imminent hazards if your audience doesn’t speak English, or isn’t familiar with the nature of the hazard itself? Consider, for example, the prospect of a blizzard from the perspective of a just-arrived Somali.
While not exactly analogous, here’s an interesting twist on emergency communication from the Indonesian island of Simeulue. When a tsunami roared through Indonensia in 2014, more than 150,000 Indonesians perished. On Simeulue, just seven died.
Why the disparity? The answer is linked to a well-known song that allowed islanders to recognize the signs that predict a tsunami, and warned them of the steps necessary to save themselves.
One frequently cited observation in the world of cross-cultural care is that patients feel more comfortable dealing with providers who look like them.
How to get there? Here’s an example from the Minneapolis StarTribune. The article, Ladder program helps youngsters step up to health care careers, describes a north Minneapolis-based mentorship and training program aimed at turning more people of color into doctors, nurses and dentists.
The Ladder program took off six years ago, when Dr. Renee Chrichlow of the University of Minnesota’s Broadway Family Medicine Clinic, founded the non-profit organization. Kids can start in the program at age nine, but they can hang on to mentorship opportunities throughout high school, college, and medical or nursing school.
Immigrants’ lives will become that much harder as the Trump administration imposes new rules on those who legally use public benefits such as food stamps, Part D Medicare drug coverage, or Section 8 housing vouchers. They could be denied green cards that allow them to live and work in the United States as the government aims at barring people it views as an economic drain.
The rule change could affect about 382,000 people a year, and is part of what the New York Times calls “the latest in a series of aggressive crackdowns by President Trump and his hard-line aides on legal and illegal immigration.”
Here’s a interpreting/translation-related lawsuit that could have a major impact on your organization. The case started in 2015 when Houston resident Song Xie was sent home from the hospital with discharge instructions in English that his caretaker son couldn’t read. Song Xie later suffered a stroke. His family now wants to hold the hospital liable.
The resulting lawsuit alleges that the hospital violated a clause of the Affordable Care Act’s prohibition on national origin discrimination by failing to translate discharge instructions into a language the son could understand.
A detailed story from Bloomberg News — Hospitals: Patients Who Don’t Speak English Have Rights Too — explains that the ACA’s Section 1557 allows patients to sue providers when language barriers aren’t effectively addressed. Fines and damage awards, warns Bloomberg, could add up to hundreds of thousands of dollars under this new twist on the law.
Let’s take a break this week from wondering how to help English language learners, and stop to think why most people in Minnesota only speak English. For some fresh perspective on how weak this is in comparison to the other end of the scale — that of the world’s premier polyglots — take a look at this recent story in the New Yorker magazine: The Mystery of People Who Speak Dozens of Languages: What can hyperpolyglots teach the rest of us?
Among the hyperpolyglots who appear in the piece is Luis Miguel Rojas-Berscia. Author Judith Thurman observes that Rojas-Berscia has “command of twenty-two living languages (Spanish, Italian, Piedmontese, English, Mandarin, French, Esperanto, Portuguese, Romanian, Quechua, Shawi, Aymara, German, Dutch, Catalan, Russian, Hakka Chinese, Japanese, Korean, Guarani, Farsi, and Serbian), thirteen of which he speaks fluently. He also knows six classical or endangered languages: Latin, Ancient Greek, Biblical Hebrew, Shiwilu, Muniche, and Selk’nam, an indigenous tongue of Tierra del Fuego, which was the subject of his master’s thesis.”
How does he do it? What can you learn from him and others with amazing language abilities? You’ll have to read the story to find out. Check it out here.
In case you doubted that it’s a hard language to master, here’s a video that demonstrates the quagmire through which English learners must wade. In this short film, Aaron Alon shows what happens when you apply consistent vowel-sound rules to English. The result is something that sounds like a version of Old English — sort of familiar, but often difficult to decode. Run through the video once and you’ll gain a new appreciation of the tough work that English learners take on.
“On the Autism Spectrum: Families Find Help and Hope,” is a series of five short films produced by the Minnesota Department of Human Services that raise awareness and understanding of Autism Spectrum Disorder (ASD) and services available to Minnesota families. The videos are aimed at specific communities, including:
The films provide support for families experiencing ASD within communities that have historically underutilized available resources. Each 15-20 minute film features interviews with parents, advocates, medical professionals, educators, and community leaders speaking in the language of the target community, with subtitles in English.
Here’s a thought-provoking article from Psychology Today that explores how language can affect memory and behavior. Author Viorica Marian, Ph.D., psycholinguist at Northwestern University, describes how memories of multilingual people are linked to the language used while the event occurred. “Memories,” she observes, “will often be more emotional when there is a match between the language spoken when the experience took place and the language spoken when remembering it.”
Among the results:
multilingual speakers may experience more stress when taboo words are spoken in their native language;
but they may be less biased and more consistent in their non-native language;
and their assessment of risk may be altered depending on the power and variety of examples that come to mind — which, again, may depend on the language spoken when previous examples presented themselves.
Where’s the significance for health care providers? This is how Marian sees it: “How risky something feels affects the choices that we make for everything from medical decisions to national security. For example, in the United States, over 25% of doctors are foreign-born and many of their patients speak another language as well. It is important to be aware of how the language being spoken may be influencing the decisions we and others around us make.”
What if it was widely understood that Soviet premier Nikita Khrushchev had said, “We will outlast you,” instead of “We will bury you,” in 1956 at the height of the Cold War?
What if, days before the atom bomb was dropped on Hiroshima, Japanese prime minister Kantaro Suzuki had been correctly understood to tell a US emissary, “No comment. We need more time,” instead of being thought to convey an attitude of “silent contempt”?
The perils of sketchy translation and interpretation are explored in a New York Times opinion piece, “Why Mistranslation Matters” by Mark Polizzotti. Pilizzotti, author of the recent book, Sympathy for the Traitor: A Translation Manifesto, lays out a series of translation- and interpretation-inspired misconceptions, starting with the so-called apple tree in the Garden of Eden.
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.