Miscommunication among Latinos and health care providers

mis1.jpg

Nearly 6 in 10 Hispanic adults have had a difficult time communicating with a health care provider because of a language or cultural barrier, and when they do they often turn to outside sources for help, according to a new study conducted by The Associated Press-NORC Center for Public Affairs Research.

The survey finds that half of those who have faced those barriers turned to a family member or to another health care provider for assistance. In addition, more than 1 in 4 looked to a translator, public resources in their community or online sources for help when they faced those issues.

Antonio Torres, 53, of Orlando, Florida, who is bilingual and legally blind, told The AP he regularly struggles to understand the medical terms used by doctors and nurses.

"When I tell them I don't understand them, they'll bring someone over to speak to me in Spanish and I don't understand them, either," said Torres, who is Puerto Rican and was raised in New York. "We didn't grow up speaking that formal Spanish, so I have no idea what they are saying."

At times, Torres said he even gets medicine with his name misspelled on the bottle. "And I don't know if I'm taking my medicine or someone else's," he said.

The language and cultural barriers in health care for Latinos are something advocates have been pointing out for years.

In 2014, for example, the Obama administration faced criticism following the rollout of the Spanish version of the federal health care website, CuidadoDeSalud.gov. The translations were so clunky and full of grammatical mistakes that critics say they must have been computer-generated. The website also translated "premium" into "prima," the Spanish word more commonly used to mean a female cousin among Mexican-Americans and Mexican immigrants.

Along with communication challenges, many Hispanics are concerned about language or cultural accommodations for people in their community who seek long-term care services.

Fewer than half say it would be easy for older Latinos in their area to find a nursing home or assisted living facility with staff that speaks their language, or to find a home health aide who does. Even fewer — less than 3 in 10 — say the same about finding long-term care providers who can prepare the kind of food they are used to. Some have concerns about finding nursing homes and assisted-living facilities that will respect their religious or spiritual beliefs, though fewer have the same concern about home health aides.

Torres said he's not confident he'll find a culturally sensitive nursing home when he's gets older. "I'd rather just live alone and poison myself by accident rather than stay in one of those homes right now," he said.

Like other older Americans, many Hispanics age 40 and older expect to rely on government programs like Social Security, Medicare and Medicaid to pay for long-term care services, even though Medicare does not cover most nursing care or home health aides. But only about 2 in 10 think any of these programs will still be providing at least the same level of benefits five years from now. Just 15 percent of older Hispanics are very confident they will be able to pay for their own future long-term care needs.

The survey also finds that a large majority of older Hispanics are open to using at least one type of telemedicine to receive care, including phone consultations, text messages or video services like Skype, although older Hispanics are somewhat less likely than others in their age group to say they'd be comfortable using some types of telemedicine.

Gabriel Vargas, 41, of Lancaster, South Carolina, who is from Veracruz, Mexico, said he felt these resources in his area already were helping Latino residents. The growth of online options, he said, is breaking down the stigma held by Hispanics around regular checkups and preventative care.

"There's a nonprofit group here that goes out of its way to help," said Vargas, whose first language is Spanish. "Maybe 10 years ago, it was tough. But today I think it's become easier."

Source:  ABC News

The Growth of Medical Tourism in the World

com12.jpg

A report issued by VISA and Oxford Economics, the Medical Tourism industry was valued at a staggering USD 100 billion, with a projected growth rate of up to 25% year-over-year for the next 10 years as an estimated three to four percent of the world’s population will travel internationally for healthcare and health-related treatment.

For years the medical travel industry seemed undervalued, yet VISA’s report accounts for growth factors – like some 340 new international airports over the next decade – and the medical travel market could soar to an astronomical USD 3 trillion by 2025.

In its just-released 2016 report, industry-leading journal, Medical Tourism Index™ (MTI), listed the top 41 destinations for those seeking value-added services and high quality of healthcare across the globe. In it, the similar pattern of global growth emerges: that the United States leads in terms of market share of healthcare travel spending, but Asia’s Thailand, Singapore, and South Korea continue to thrive. Both VISA’s and MTI’s™ findings expect China to overtake the US spot within the next 10 years due to the population’s demand for higher quality of care.

The findings don’t just span the global spectrum but also the age spectrum as well; VISA expects 13 percent of all international travel by 2025 to be older travelers. Meanwhile, a recent survey of 31,000 18-34 year olds from 134 countries by popular booking site TopDeck Travel found that some 88% of them travel internationally between 1 to 3 times annually and that the number only continues to grow.

“The borders to quality healthcare access have begun to disintegrate.” MTI™ Co-Authors, Renée-Marie Stephano, JD President of the Medical Tourism Association and Marc Fetscherin, Associate Professor of International Business and Marketing at Rollins College, said a joint statement. “Speculation about the medical tourism industry as a ‘phenomenon’ is over. This report and the rankings of the Medical Tourism Index™ provide a unique opportunity for investors seeking new ventures to make smart choices in destinations driving patient travel.”

The entire medical tourism and health tourism industry will descend upon Washington, D.C., September 25-28, 2016 for the 9thWorld Medical Tourism & Global Healthcare Congress. Over 3,000 attendees from 50+ countries brought USD 1 billion in new deals last year paving the way for leaders this year to catch the next wave in partnerships and medical tourism investment.

In a conclusion, VISA said, “We believe that medical tourism is primed for accelerated growth as more of these travelers seek new treatments, as well as lower cost or higher-quality care not available in their home country.”

Source: Medical Tourism Mag

Article: Teaching English to the Medical Profession

teaching.jpg

Five years ago when visiting an English family member in the reference hospital for the Balearic Islands, Son Dureta Hospital, I recognized the enormous necessity for English for medical purposes, as stated above by Dr. Javier Lucaya. Dr. Lucaya later says, “I may be exaggerating...” He is not; he is understating. English is essential at all levels of the health system in Spain for communication with the enormous influx of foreign visitors taking their vacations in the country in the summer. Doctors must also write articles in English for international journals and take part in conferences held in English to advance their careers. The needs were there but were not being addressed. Seeing an opportunity to merge my interests in teaching and medicine, I began to fill this gap.

Jim Scrivener2 notes that there are three kinds of teachers: the explainer, the involver, and the enabler; I have always seen myself as the last of these three. Scrivener states, “This kind of teacher is confident enough to share control with the learners, or to hand it over to them completely.” Carl Rogers (1902-1987) considered authenticity to be the most important characteristic for a teacher (Scrievener, 1994). It is vital to be yourself and not the “teacher,” and to build up a rapport with the students. I agree with both. I try to share control and be myself. When I start a course, the first thing I say is, “I am the teacher and the student, and you are the students and the teachers. My aim is to teach you English and I hope to learn about your different specialties.”

I started teaching at Hospital Son Llàtzer in Majorca in 2003. It is a provincial hospital, within the region of 400 beds, not all the specialties. I had the great luck to begin working there about six months after its inauguration and therefore was there from the beginning. I taught groups of 25, and very often, especially with the low levels, I needed to give them grammar lessons. But, even at the low levels, I made them give “presentations.” The groups were very mixed. There were doctors, nurses, auxiliary nurses, pharmacists, porters, lab technicians, computer staff, receptionists, and administrative staff. This enormous variety of people all working in the same hospital was a great advantage both for me and for them. The classes were a way of allowing hospital staff to interact, who in the normal course of events would not do so. Hospitals are very cliquey places, and porters do not often have the possibility to speak to the head of the Psychiatric Department.

You can never “learn” a language, but you can develop your knowledge to a sufficient level to be able to achieve different things such as speak to patients, give an explanation of an illness to the mother of a sick boy, give directions to a lost relative, or give a presentation to the American Society of Nephrology.

I have since focused on teaching in particular departments, such as ENT, Gynaecologists, Paediatrics, or Dermatology. I have continued to use presentations, as they are integral to the life of a doctor. My students give “talks” in the classes, later to be criticised by me for the linguistic content and by their peers for the scientific. They learn from me about the use of the definite article, and I learn from them about “dermoscopy of pigmented facial lesions.”

In 2005, the ENT department of Son Llàtzer Hospital gave a symposium about the importance of image-guided surgery. Originally the meeting was going to be conducted in Spanish with me interpreting, but I suggested that they should give their talks in English. It seemed the ideal situation and it worked well. I sat at the front of the lecture hall and took notes on my students. The following day I went into class and explained where they had slipped up with their use of language and pronunciation.

As readers of this article, you might begin to think that I have misled you with the title. I have talked about my experiences as a teacher of English to members of the medical profession, but where does the subtitle come in?

Isn’t bringing the humanities to medicine seemingly an oxymoron?

I have no medical training, but the medical world fascinates me. I am drawn to it, but my training is in the arts; therefore, medicine is a field I find difficult. Many people are interested in both arts and sciences, but there is a crucial difference. If you study the sciences, you can delve into the arts, while the opposite is not really true. This is why I have been drawn to a specialty called the “Medical Humanities.”

This specialty was given two formulations by the then editors of the journal of the same name:3

The first is concerned with complementing medical science and technology through the contrasting perspective of the arts and humanities, but without either side impinging on the other. The second aims to refocus the whole of medicine in relation to an understanding of what it is to be fully human; the reuniting of technical and humanistic knowledge and practice is central to this enterprise. We have described these two approaches to medical humanities as “additive” and “integrate,” respectively.

This field is little known in Spain, even amongst doctors. It has been around for a lot longer in the USA and the UK, and is part of the medical training in many universities, such

as New York University, University of Texas, and University College, London. It is not an easy discipline to integrate into the courses in the hospitals, but since the beginning, it has infiltrated into my teaching, both in content and in style.

I have tried to instill it into my courses in more concrete ways, especially since 2005 when I began to teach at Son Du- reta Hospital, where the groups have been smaller and more focused on the clinical side of medicine. In relation to the above quotation, I have made literature prominent in tackling the first “additive” point, by using texts with a direct interest to medical professionals, such as Jean-Dominique Bauby’s poignant description of the “locked-in syndrome,” or Raymond Carver’s honest poem “What the Doctor said,” which is an account of the writer’s doctors telling him he has lung cancer,4 or Chekhov, himself a physician, who treats medical topics with cool precision.

I have used the second “integrated” point — “an understanding of what it is to be fully human” — as a kind of foil to the ever-growing trend in medicine to specialization or maybe over-specialization. In the medical profession, it is essential never to lose sight of the overall picture because if you do, sometimes grave errors will arise. I have worked on the “patient-centered approach,” with texts, video work, and role-playing. We spent a few weeks working on the “art of dying,” and looked at this from many angles — the medical, the ethical, the religious, and the philosophical. Here, I was indebted to an interesting website put together by King’s College, London5 based on a year-long symposium addressing a range of questions associated with death and dying.

This term, we have begun to work on the question of the role of the doctor, what they can do apart from curing and caring, and how conversation can help them to be better doctors. As a source text I used an article entitled “How work can be made less frustrating and conversation less boring”6 by Dr. Theodore Zeldin, in which he writes, “The healthcare profession contains a vast reservoir of potential going to waste, of talents which are not properly appreciated, and of conversations which never take place.”

The article is directed toward doctors and written for a medical journal. It led to essays by my students, with those essays being sent to the author and commented on by him, which in turn led to further debate amongst the students. This was a very vital experience of opening out the enclosed “classroom,” and only became possible with modern technology, e-mails, and web-links. Technology plays its part, but human interaction is the core. This online conversation between students and Dr. Zeldin is a thread for this year’s course, and perhaps epitomizes my ideas about how to try and use the humanities in a classroom full of scientists.

Good communication skills are integral to medical and other healthcare practice. Communication is important not only to professional-patient interaction but also within the healthcare team.7

This is integral to what I have been trying to install in both hospitals in Majorca —good communication skills in the English language, both oral and written. I have paid a lot of attention to the writing of abstracts, articles, presentations, and posters. I have also set writing assignments, the latest being a term project concentrating on an idea picked up from the BMJ. At the beginning of this year, the BMJ chose the 15 most important medical milestones since the first publication of the journal in the 1840s. The topics ranged from immunology to the Pill, sanitation to chlorpromazine, and smoking to vaccines. First, my students had to choose the topic they thought had made the biggest impact, write an essay on it, and then give an oral presentation with PowerPoint slides on the same theme. In this way, they practiced both oral and written communication skills.

As I explained earlier, I have always seen presentations or “talks” by the students as a way of furthering their ability to use the language and, at the same time, impart information of interest to the rest of us. In June of 2006, to conclude the first year of the English course at Son Dureta Hospital, accredited by the Local Health Ministry for the Baleares Islands, I set my students the task of giving presentations in the lecture hall of the hospital. There was a mixture of medical and non-medical topics: “The Eating Disorders Unit” alongside “Photography: A technique to relive a magic instance,” and “News from the lab” next to “Dreams,” with “Popular architecture” combining with “Team building.” It was a fitting culmination of a year’s work, but only the beginning of what will hopefully become an annual event in this teaching hospital.

There are many plans for the future, but two are already realities. First, a small translation unit is working in Son Dueta Hospital, which is essential for a hospital looking to be an important contributor to the field of research and investigation. Second, the ENT and the Paediatric Departments

of Son Dureta Hospital are carrying out clinical sessions in English, with doctors giving presentations and commenting on the day-to-day running of the unit. This is a big step forward, with other units already showing an interest in the idea. Another plan is to set up a blog for professionals from different hospitals to communicate with each other in English. I am beginning to do this with my students from both hospitals, but I think it can be carried further as a means of inter-hospital communication. My hope is that English will become an integral part of hospital training and life — a big hope, but attainable.

I wish to dedicate this article to Dr. Antoni Obrador (the late Head of the Digestive Unit, Son Dureta University Hospital – 1951-2006), who was a great support when setting up the English course.

Source: Medtrad

Latinos Underrate Adult Vaccines

vaccines.jpg

Adult illnesses that can be prevented by vaccinations cost society billions of dollars each year in treatment, hospitalizations and lost productivity. And sadly, there is also the incalculable cost of losing lives. Vaccinations are not just for kids. They are important for adults too; they prevent adults from getting certain diseases and they help stop the spread of illness. Every adult should check with a health care provider to find out which vaccines, in addition to the flu, that they should get.

Centers for Disease Control data show that 28.7 percent of adults aged 65+ have never had a pneumonia vaccination. When you look at rates of Hispanic adults, that number jumps to nearly 38 percent.

Thousands of adults in the U.S. die every year from vaccine-preventable diseases like pneumonia. I felt guilty that I did not get a chance to share this important information about adult vaccination with my brother. Today, I’ve turned this tragedy into advocacy. In Jerry’s name, I developed a bilingual training program for our “promotores” and community health workers in order to raise awareness — especially in our Latino population. Sadly, Latino adults are among the most under-vaccinated segments of the U.S. population.

According to the CDC, rates of adult vaccination remain “well below” the target levels of 90 percent. Here are some facts to consider:

  • Only about 33 percent of Latino/Hispanic adults in the United States got flu shots in 2015 — down 0.2 percentage points from 2014 and more than 15 percentage points lower than vaccination rates in the white community. It was the only race/ethnicity to see a decline and the lowest vaccination rate of any race/ethnicity.
  • This was even more pronounced in young adults aged 19-49; only 25.1 percent of young Latino/Hispanic adults got the flu shot in 2015 — down nearly two percentage points from 2014 and the lowest of any race/ethnicity. Whites in the same age group had rates of 34.6 percent, and African Americans had rates of 29.1 percent.
  • Only 64.1 percent of older Latino/Hispanic adults (65 and older) got flu shots in 2015, the lowest of any race/ethnicity and more than 10 percentage points lower than whites.
  • For adults living with chronic diseases like asthma, HIV/AIDS, COPD, liver, kidney or heart disease, the risks of being under-vaccinated are even greater. As many as one-third of adults living with chronic illnesses are at greater risk of contracting the potentially deadly pneumococcal disease.
  • People like Jerry, whose immune systems are compromised because of cancer or other non-communicable diseases, should absolutely be vaccinated against those diseases for which they are at risk.

Source: TribTalk

 

Article:  "An Investigation into Medical Students' English Language Needs."

medical-impor.jpg

 

Due to the acceptance of English in twentieth century as international language of science and medicine, a considerable body of medical research and literature has been produced in English. This dominance of English in medical accounts paves the way for emergence of a new ESP branch (English for Specific Purposes) as EMP (English for Medical Purposes).

The basic insight into this trend is to offer course design, content and materials by being responsive to target language learners' own agenda. Therefore, it is necessary to find out first what is specifically appropriate, available and applicable for the target situation and target language learners in terms of their needs. In discovering their needs, needs analysis is regarded as an integral part of decision making processes in EMP.

Without conducting a needs analysis process, using a medical English course book might not be enough for a medical student studying in an EFL (English as a Foreign Language) context like Turkey since most of the medical English course books in use are mostly addressing the needs of students in an ESL (English as a Second Language) context. Accordingly, as a part of a needs analysis process, this study aims to investigate academic English language needs of first year medical students who are attending advanced English course at the Faculty of Medicine at Karadeniz Technical University.

The data was collected via a structured questionnaire with 47 items. It covers five different parts focusing on medical students' purposes of learning English, significance of learning English, their preference of learning environment, language learning needs of major language skills (reading, writing, speaking, listening), their preference of assessment type. The questionnaire was administered to 169 students at the Faculty of Medicine at Karadeniz Technical University. Descriptive statistics was employed in order to analyze the data.

Source:  An Investigation into Medical Students' English Language Needs.