Language concordance in healthcare: Beyond just talk.

Abstract

If you talk to someone in a language they understand, you speak to their head. If you talk to them in their own language, that goes to the heart. Image credit: African Paediatric Fellowship Program www.apfp.uct.ac.za One, a 7-year boy, COVID-19 positive, with severe lobar pneumonia and poor treatment response. Repeated questioning was negative for history of choking and, complicating the situation, bronchoscopy was not easily accessible as the hospital was tackling a COVID-19 surge. When the bilingual doctor discussed it again with the family in their home language, they better understood what the concern was and were able to say that he had in fact swallowed a pen-top around the time the symptoms started. Safe bronchoscopic removal of this was expedited with excellent outcome. Another encounter was of a parent from a neighbouring country refusing gastrostomy feeding for their infant with severe laryngeal incompetence, despite extensive counselling. The mother spoke very good English and she and attending doctors insisted she understood the situation, but she still refused the advice. When we arranged a colleague who spoke her home language to talk with her about it, she was able to voice her fear about what the procedure would mean for her and her child returning home. We were then able to address this and safely connect her with the appropriate care back in her home country. The third case, an angry mother wanting to discharge her child against medical advice. Her child had a healing broncho-oesophageal fistula secondary to severe pulmonary TB, which required a complicated feeding regimen. When given the opportunity to speak to a doctor in her home language she was able to say how she had felt the doctors were not listening to her and that she actually had a very good idea of how to care for her child safely—she proved us right. Language-concordant care, increased access to appropriate care, empowered parents, enhanced trust in the doctors and lead to improved health outcomes. Language-discordant care goes beyond threats to informed consent (which regrettably persist particularly in areas with limited clinician-patient language concordance), it threatens health outcomes and perpetuates health inequity for diverse populations. The world is wonderfully linguistically diverse, with over 7000 languages spoken worldwide: Chinese, English, Hindi, Spanish and Arabic being the five most spoken. Our communities are increasingly ethnically and culturally diverse, making the power to interact and communicate with each of increasing value. Historical and current inequities have impaired trust between communities and language plays a powerful role in healing this. Language-discordant healthcare is often borne by the most disadvantaged, highlighting the crucial importance of addressing this in advancing health equity. None declared.