Many migrants find themselves socially isolated as they may not speak English very well and there may not be any neighbors or friends nearby who are of the same ethnicity. Their children may be living far away, their relatives may be overseas and they may lack the traditional supports available in their homeland.

Like most people, they may at some stage in their lives be faced with difficulties which may effectively be dealt with by talking to a professional and experienced Counsellor, who can assist in developing strategies and ways of dealing with personal and relationship/family issues. This is particularly important for non-English people who may not have the traditional supports. But, how does one find out about these supports? And are there linguistically and culturally sensitive bicultural professionals who can assist them in a time of need? I’m talking about people who won’t access this forum as they are not computer literate or English proficient. Any ideas on how to engage them? What would you recommend to someone who needs help and is in this category?

Hi Donte’,

This is an interesting and important conversation in my opinion :)

I’m not a migrant so I can’t speak from direct personal experience. But my parents and some of my extended family are migrants.

I agree with you that the language barrier, amongst other things, is a key issue when it comes to seeking professional help as it’s not always easy to find a professional who speaks another language.

Purely as an example, I have a relative who speaks very limited English. One of her key considerations when it comes to finding a health professional is she wants one who can speak her native language. She would struggle immensely to communicate only in English.

So this really limits her “pool” of professionals. She has seen the same GP for years, and even though she has repeatedly complained about this GP’s incompetence and laziness (as do some of my other family members), she continues to see her.

Why?

This GP speaks the same language as her so she puts up with it because it can be hard finding a health professional who not only speaks another language but is also a good match, competent, sensitive, etc.

I’m not sure if this already exists but perhaps a public online database of bilingual and multilingual health professionals, and made available in multiple languages might be a good starting point?

Kind thoughts,

Pepper

Hello Pepper,

Great recommendation! Perhaps we should consider something along these lines for our ‘Multicultural people’ section of the website! At least top 10 languages as there are more than 200 ethnicities in our State alone! However, perhaps links to Multicultural organizations and Migrant Resource Centres could be a good start as they service newly-arrived communities who are small in numbers and not as well established as some of the older communities who have large populations - eg Italians or Greeks.

The case with your relative visiting the same GP for years purely due to the language barrier despite the poor outcomes is so common among culturally and linguistically diverse people. I have heard this over and over. They just feel they have nowhere else to go!

It is not uncommon for non-English speaking people to travel two hours and across ten suburbs to visit a GP that speaks their language, when they actually have an English-speaking GP across the street where they live!

Perhaps if GPS made interpreters easily accessible and used interpreters from the point of the first call when client rings or pops into the clinic to make an appointment, it could assist in easier access to these services. Maybe having bilingual publications on the reception area in various languages together with big posters placed in visible spots at the waiting areas could also help. A good start would also be if every GP recruits reception staff that reflect the ethnic origins of their predominant client group demographics. Having bilingual and bicultural staff at front line always helps. It’s not easy but it’s not impossible and considering that 39% of our 65+ population is non-English speaking, I don’t think we can afford to not address this ongoing issue. :)

Hello again Donte' and Pepper 😊

I think you have a great point about front line staff skill sets Donte'.

I worked in a culturally diverse workplace for 7 years as a front line public servant. Translation was ALWAYS via colleagues with multiple languages.

Translation services were explained as an option but noone ever used them for one key reason... Time restraints. We had many people to help and had to do it as quickly as possible. So calling the translation service was just not a realistic option. Likewise with GPs. A standard bulk billed appointment is 10 minutes. A long appointment is 20. That really is not a long time to help someone... Even patients without a language barrier feel rushed.

Translators or multilingual GPs are an excellent option. In my capital city there is a major clinic that has staff with other languages (they list the languages spoken even by reception staff and all nurses and doctors on their website and in the waiting rooms). I think this is fabulous.

Another factor I feel needs to be addressed is the access to after hours services. A lot of people hubby and I know like to have a family member come to translate however if clinics are open the standard 9-5 mon to fri and a few hours on Sat you often have to wait ages for an appointment because the Sat appointments are booked out. Or you have to take leave from work. There is alot to be said for non standard office hours for medical clinics.

I worked as a health professional working with many CALD clients with & without interpreters. Another issue is people with reasonable English skills can still have problems as it is assumed they understand everything so don't need an interpreter but when discussing medical issues there are often things which can be misinterpreted. This is a significant issue if they think they understood but haven.t. Years ago I saw a pediatrician with my dtr. He spoke with a very strong accent which made it hard to understand. He recommended my giving my dtr some over the counter medication. I bought what I thought he said but it turned out to be incorrect (weaker than she required) so she made no improvement. After the following consult I returned to my GP stating that I couldn't work with the pediatrician. Several other times I have seen GPs who have come from overseas & had strong accents. This has made it impossible to feel confident that I'm getting the correct advice because I don't understand them enough & asking them to repeat themselves becomes too hard. I imagine CALD clients would have similarr or worse difficulty understanding English speaking doctors .

Hello Quercus and thank you for your valuable input!

Your post highlights the reality that the 'patient/client' has to fit the 'system/clinic/service'. Would be great if we could improve on this, especially in the light of the 39% of our 65+yo state's population (Victoria) who are culturally and linguistically diverse and aging with multiple and complex health issues.

The after hours/weekend situation is also a great example of how people can be disadvantaged, as well as the duration allocated for a medical consultation. The amount of pressure medical staff are under and the often overstretched health/mental health system is unbelievable.

Your post made me think of the After Hours/Weekend Home-Visiting Doctor service which is totally bulked billed and the Nurse-On-Call telephone service. I have often used these services when too unwell to attend a clinic after hours or weekend and admittedly they do a fantastic job for emergencies/non-routine issues. Wondering if there would be a way for these services to list the various languages their GPs speak and if there was an option either on the phone-booking system or the APP to select a language when one makes a booking! Maybe I'll mention this in the post-visit Evaluation survey I complete next time I book a home visiting doctor!

Hello Elizabeth,

Thank you for joining this very important topic and raising such an important issue.

I remember being hospitalised some time ago and being in isolation with very high temperature. Even though I am an English speaker (with a strong accent), being with 39+ fever for over three days and first time in hospital I was confused, scared, lonely, didn't know some of the terminology used by medical staff, had different nurses and doctors coming in my room at various times conducting tests etc and it was a very daunting experience overall.

It was only the day after they had conducted a lumbar puncture (which I hadn't had a clue what it meant at the time, and during which the doctor had answered her mobile and was chatting which had brought up severe anxiety and fear/panic in me), that I saw the consent form left on the chair next to my bed (unfilled and unsigned).

I remember also not having eaten for two days as the staff would leave the menu form outside my door fearing that I'm infectious, but I was unable to get out of bed and didn't know that they would leave it there. On the third day as I started recovering with all the drips and antibiotics I told a nurse that I was starving and feeling very weak. She couldn't believe that I hadn't eaten for so long! So they brought the menu order form in my room and left it on my bed by my feet, with no pen or pencil for me to tick what I wanted to eat! This, together with a few other 'traumatic' experiences took place while I was hospitalised in an inner city major hospital.

This whole experience made me think of elderly people or newly-arrived migrants or others more frail than me who perhaps can't even speak or understand English and have had bad experiences from hospitals overseas or here and how terrible this must be for them, especially when so sick.

Someone told me months later that this was a good case for a lawsuit, however I wasn't aware of my rights as a patient at the time the ambulance took me to hospital, and that is a whole other issue, particularly pertinent to culturally and linguistically diverse patients.

Oh Donte' your story gave me chills. How disgusting that they treated you this way. And yes you're right unfortunately it does happen all the time.

My Grandfather was 90 and very ill (he died not long after) and my family made a point of having someone with him at every meal. Otherwise he wouldn't drink or eat because he needed help and couldn't ask (his stutter got very bad and often the staff left the room before he could get the words out).

Even now the feeling of helplessness haunts me. I knew we were there for him... But what about others who didn't have anyone to speak for them or help them??

And yet again it comes down to time and money. Too few staff. Too rushed. In such a hurry that basic human rights and respect lose out. It upsets me deeply.

Yes Quercus,

Neglect is abuse and it can happen intentionally or unintentionally. It is easy to take place considering the ratio of staff to patients and the amounts of pressure and ridiculous hours/shifts medical staff are operating under.

Hi Donte’ and all,

Great suggestions for multilingual health staff and the use of translators and interpreters. I like your idea of having bicultural or multilingual reception staff that reflects the demographics of an area.

Yes, money, time and understaffing are definitely issues in optimising health services for CALD groups. I suppose there’s also the issue of training because even most bilingual staff (unless they are health professionals themselves) may not know medical terms and things can get a bit confusing when translated from one language into another...

Great input from all :)

Pepper

Hi Pepper,

Yes. Training of staff is of outmost importance. Often the case is that because someone happens to speak another language, they get dragged in to translate and assist with various client issues that are beyond their job description. It’s not unusual to have reception staff counseling someone in another language etc.

I believe organizations need to put their energy in property supporting their staff through accredited training and upskilling and make extra efforts to employ bilingual and bicultural staff for specific positions to appropriately respond to needs of CALD populations.

Hi Donte’ and all,

Yes, great suggestions. I agree with you about how problems can arise when untrained bilingual staff are asked to translate really technical terms or inappropriately e.g. bilingual reception staff “counselling.”

Great points too, Hope.for.the.best :)

Caring thoughts,

Pepper