Language barriers

When the differences in culture include language barriers, the potential for problems arising is greater.

REFLECTION

Think of a time when you have not been able to make yourself understood. What was the situation? What was it like for you? For the other person?

It is possible that you have thought of some or all of the following words to describe the feelings you might have had:

• • Frustrated
• • Unskilled
• • Powerless
• • Helpless
• • Angry
• • Embarrassed
• • Loss of identity.

If we add that to the feelings already experienced by someone in a health and social care setting who needs support or advice or information, we can see that the language barrier brings with it huge pressure and stress, particularly for the person seeking help. Our cultural identity is inextricably linked to our language; we learn about our culture through language and our culture is transmitted through our language. In a situation where we are not able to express ourselves or make ourselves understood, we risk losing our sense of self and this can have a damaging impact on our self-esteem and self-worth. According to the 2011 Census carried out by the Office for National Statistics (2013):

• • English is a second language to one in thirteen; more than 100 dialects are spoken by large numbers of people in the UK
• • In England and Wales, 138 000 people cannot speak English at all

• • More than 4 million people speak English as a second language - 7.7 per cent of the population
• • Polish is the second most spoken language in the UK with 546 000 reporting it as their main language.

These statistics highlight the importance of providing high-quality interpreting services to all health and social care services to enable effective communication between the patient / service user and health and social care staff. The Equality Act (HMSO, 2010) states that all people should have equitable access to services, regardless of ethnicity or language spoken.

^REFLECTION

You are a nurse working in outpatients and you are just about to meet a new patient, an asylum seeker from Syria catted Dr F. You are told that an interpreter has been booked.

What are your thoughts and feelings?

What might Dr F be thinking about your appointment?

Some of the concerns might include:

• • Is the interpreter going to be skilled enough to interpret accurately and will he or she speak the same dialect?
• • Can I trust the interpreter to keep what he or she hears confidential?
• • What religion or political ideology will the interpreter hold?
• • Will the interpreter be sufficiently respectful?
• • Will I feel ashamed or embarrassed, will I feel judged?
• • If I need to come back again, will the same interpreter be used?

Tribe (2007) gives the following guidelines for professionals who need to use an

interpreter:

• • Create an atmosphere where each member of the triad feels able to ask for clarification and explanation when necessary
• • Speak directly to the service user
• • Minimise the use of specialist or technical language
• • Use an interpreter who has experience of (and ideally training in) working within your area of expertise
• • Consider the seating arrangements - an equilateral triangle usually works best
• • Remember that you hold clinical responsibility for the meeting and explain this clearly
• • Try to speak slowly and clearly and in short segments, because the interpreter has to remember what you have said and then interpret it

• • Try to find someone from the same country. Matching for gender, age and religion may be useful, although this needs careful consideration
• • Do not use a relative.

The last point is very important as very often family members or friends will be used as an interpreter, either at the request of the service user, or because it is the only option, especially in emergency situations. However, there are very important safeguarding implications when a family member or friend is used, particularly when the service user is vulnerable. The following is taken from the Serious Case Review of Daniel Pelka which pointed out the consequences of Daniel’s older sister being used as an interpreter:

“Sometimes family members or the male partner was asked to act as interpreter, and whilst their use, particularly at times of an emergency or when a crisis situation arose was a pragmatic and understandable way to deal with a situation, overall it should have been balanced with opportunities to discuss the presenting situation in a more controlled and calm setting with an interpreter. Working Together states that ‘Family members or friends should not be used as interpreters, since the majority of domestic and child abuse is perpetrated by family members or adults known to the child’.” (Coventry Local Safeguarding Children Board, 2013).