Language barriers in care
Language is one of the most common barriers to access care for a large group of older migrants, particularly late-in-life migrants and refugees. Not being able to explain your symptoms to the doctor or understand the treatment they suggest can have very negative consequences for your health. For care professionals, language barriers mean they cannot fulfill legal requirements to fully inform patients; gain consent and create a treatment plan together.
The interpreter telephone
There are new technological tools to overcome language barriers, like apps that can be used for translation. Still, in many cases, the best option is to work with a professional interpreter. Research repeatedly shows that the employment of interpreters leads to better health outcomes for patients and that care professionals very rarely evaluate their decision to contact an interpreter as unnecessary. In the Netherlands, there used to be something called “the interpreter telephone”. This was a phone number that care professionals could call, free of charge, to be connected to a qualified interpreter.
Policy changes undermining migrant’s rights to good care
Over the years, ‘the interpreter telephone’ became a known concept in the Netherlands. However, in 2011, the new government decided to roll back the financing of interpreter services. The government argued that communicating with the care system was the responsibility of the individual migrant, who either had to learn the language or organize their own interpreter. At the time of this decision, there were a lot of protests, but neither lobby organizations for migrants’ rights nor professional associations were able to convince the government to roll back their decision.
Waking up with the dream of change
While many people gave up the fight for the right to interpreters in care, epidemiologist and policy advisor Simone Goosen did not. In 2018 she woke up one morning and realized that what she wanted to campaign for the reinstatement of the interpreter telephone. As Simone says,
The morning wake-up call was the start of a long, but eventually successful campaign. Simone joined the Johannes Wier foundation for health care and human rights (JWS). The government formally changed their policy in 2020: the National Health Care Institute concluded that based on the Dutch health laws, health and social care professionals should be enabled to work with a medical interpreter and costs should be covered. How interpreter costs should be funded, however, is yet to be developed.
Triggered by the campaign, radio program Argos (VPRO/HUMAN) produced two podcasts and Simone and her team developed a poster campaign about how children are forced to interpret highly sensitive conversations between their parents and their doctor. The campaign was highly successful in the media and gained the attention of two politicians from the current government. With their support, a motion was voted through parliament in 2021 that requests the government to conduct a research study on how to finance the reinstatement of interpreters in care. And for one form of care – mental health services for those aged 18 years and up – interpreter costs are covered by health insurances as from 2022.New guidelines for when and how to work with interpreters in care
This year, Simone and colleagues at Amsterdam University hospital began a project together with patient advocacy organizations to draw up new guidelines for how to work language barriers in care. For example, they will investigate in which situations an in-person interpreter is needed. They will also investigate the use of apps, pictograms and body language to communicate with patients.
How to campaign for change
When Simone started the campaign, many Dutch care organizations and professionals had long given up. I ask Simone why she thinks that they were successful. There were a few key ingredients. Firstly, there was a new government which took migrants’ health and health inequalities more seriously. The refugee crisis in Syria and later In Ukraine also highlighted the urgency of the situation. Secondly, it was crucial to connect the issue of interpreters to children’s rights. Many people, including politicians, were deeply touched by the stories of children who had to tell their parents about a cancer diagnosis or about a miscarriage. Lastly, the effective use of social networks, on- and offline, repeatedly provided the campaign with the push it needed to move forward.
The power of a network
At the end of our interview, I ask Simone how she stays energized. Campaigning for human rights to equal health care is clearly a marathon, not a sprint. She tells me that sometimes, she just wants to stop, and do something else, perhaps become a care professional herself. But then for example a Dutch-Eritrean friend and medical interpreter calls her about another case of maltreatment due to language barriers. That reminds Simone why she is fighting. Another important source of energy is her close colleagues and people she has met on LinkedIn over the years who support the campaign . As many ENIEC members have experienced for themselves, the power of a network can be an important force for good.
Do you want to learn more about interpreter services in the Netherlands, or do you want some advice on how to do a campaign for older migrants’ rights to good care? Simone Goosen is active on LinkedIn and can also be reached via her email address S.Goosen@patientenfederatie.nl
