Receta Medica: Communicating Medication Information Across the Language/Literacy Divide

Abstract

Clear communication between physicians and their patients is essential for the success of any health program or intervention. In some cases, though, doctors and patients do not speak the same language. Also, patients sometimes cannot read, or they read very little in any language, including their native tongue. Occasionally, interpreters may be available during the medical consultation. But what happens when the patient goes home and does not remember when or how to take a prescribed medication? Such situations arise on a daily basis for immigrants who do not speak the language of their new country. Not only are the patients and their families confused and frustrated, the health care providers perplexed by low compliance of medication follow through, but there are also real dangers in medicines not being taken properly. Though written instructions are provided on labels of medicine containers, these are not always adequate in that they can be indecipherable to speakers of other languages, the pre-literate, or illiterate. These dilemmas are compounded when the doctors are missionaries and their patients live in the developing world, sometimes in rural villages. What happens when the patient does not remember anything about the medicine and the missionary doctors have moved on to another village or it is a two-day trip to return to the clinic? This was the scenario facing our faith-based medical missionary team that traveled to Santa Cruz, Bolivia in May of 2004. A group of family physicians, fourth-year medical students, and nurses from the University of Oklahoma-Tulsa and the University. of Virginia traveled to Santa Cruz to treat patients for one week at the Mission of Hope, a free out-patient clinic established in 2000 by a nurse from the University of Virginia. As I am bilingual in English and Spanish and a former physician in Mexico, I was asked to collaborate with the team as interpreter and coordinator for dispensing medications. In addition to administering to patients at the clinic, team members made two trips to outlying villages. In one of these villages, inhabited by Aymarian Indians, very little Spanish was spoken, so even oral interpretation was difficult. Before leaving for Bolivia, I created a one-page form to be completed by the physicians and handed to the patients or their families along with verbal instructions in Spanish. The form included a variety of pictograms providing medication information. It was inserted into the plastic bags containing the medicine that was distributed to patients. Thinking back on my experiences in Mexico, I remembered that in many regions of the world, medications come in small boxes (similar to over-the-counter packages here in the States), or in plastic bags. Many times pills or liquids are left over, saved, and used later. I wanted to create something that people could insert in the boxes or bags that would remind them of the indications or even what the medicine is intended to cure. It would be a traveling prescription form. My goal was to make a tangible and pictorial reminder of medication instructions that was also as user-friendly as possible for both doctors and patients. In busy clinics, doctors need something simple and clear to hand to patients. This is usually written down on a small piece of paper in the patient's language. In Bolivia, though, none of the team's other physicians or nurses spoke Spanish, so this was not possible. They could not write in Spanish, and, though I could, I was not available for every consultation. Also, many of the poor have little education, which adds another dimension of incomprehensibility For the low-literate patient, it has been proposed by Hours, et al. (1998) that the use of specially designed pictograms could facilitate comprehension and expedite compliance. Several studies report that using pictograms enhances patients' ability to recall medical instructions (Houts et al., 1998; Mansoor & Dowse, 2003; Hours, Witmer, Egeth, Loscalzo, & Zabora, 2001; Morrow, Leirer, & Andrassy, 1996). …