Addressing the Issue of Communication & Language Barriers for Non-English Speaking Pregnant Women in the UK

Communication forms the backbone of the relationship between healthcare professionals and their patients. With an increasingly mobile global patient cohort– 25% of all pregnancies here occur in mothers born outside of the UK – healthcare providers need to consider not just which words to choose to identify, diagnose, and treat a woman, but also what language would best convey the situation as a whole, and offer support. William Osler reminded us that the difference between a good and great physician was that the latter treated patients, the former – just disease.
 
Whilst most hospitals have access to translators in person or over the telephone, the process can be cumbersome and impinge on patient privacy. Ad-hoc translators on the other hand are not trained in medical terminology and may have a relationship with the patient that renders their involvement inappropriate. Knowing whether your patient’s concerns have been addressed and the information taken on board can be difficult to gauge without fluency in their native language. As George Bernard Shaw remarked, “the single biggest problem with communication is the illusion it has taken place”.
 
That this illusion perpetuates can be seen in the stark statistics representing the past 10 years of maternity care, identifying women who are not native speakers of their host country’s language to have a threefold higher morbidity and mortality rate.
 
In 2011 The Centre for Maternal And Child Enquiries report listed professional interpretation services as a top 10 recommendation stating: “Professional interpretation services should be provided for all pregnant women who do not speak English. These women require access to independent interpretation services because they continue to be ill-served by the use of close family members or members of their own local community as interpreters. The presence of relatives, or others with whom they interact socially, inhibits the free two-way passage of crucial but sensitive information, particularly about their past medical or reproductive health history, intimate concerns and domestic abuse.”
 
The National Institute for Clinical Excellence found that 2/3 of pregnancy related morbidity and mortality was because “recent migrants…not proficient in English, did not readily access medical help and are particularly vulnerable”.
 
The latest Mothers and Babies: Reducing Risk through Audit and Confidential Enquiry 2014report found maternal mortality higher amongst migrant women, making up greater than 1/3 of all maternal deaths.
 
A review of the health of migrants in the UK conducted by the University of Oxford migration observatory in 2014 found “Barriers [to access, resulting in poor statistics] include inadequate information, particularly for new migrants unfamiliar with health care systems in the UK, insufficient support in interpreting and translating for people with limited English fluency… and cultural insensitivity of some front line health care providers (Phillimore et al. 2010; Johnson 2006). [These] cut across length of residence, affecting longer established migrants as well.”
 
With 4 million migrant women in the UK  – a quarter of whom lack proficiency in English – healthcare providers are recognising the value of sensitively using technology to assist them with communication. Whilst new live stream translating devices are being developed that hope to bring some semblance of The Hitchhiker’s Guide’s Babel fish to life, online computerised translations remain patchy at best. A study looking at the effectiveness of Google translate in converting 10 significant medical phrases into 26 languages resulted in only a 57.7% accuracy rate.
 
The Kings Fund organisation – an independent charity that conducts research and analysis that can inform policy, for the betterment of healthcare in England – published an article this year looking at the technologies that will revolutionise healthcare delivery. At the top of their list – smartphones and mobile applications. Examples of this include the winner of their grant money – an app aptly entitled New Natives – that is being designed to help vulnerable members of the population navigate healthcare service registration, in their own language. Last year’s UN world summit award for mobile healthcare apps went to Universal doctor – and its offshoot Universal woman. It provides an offline language translation service with phrases previously professionally translated. Medibabble and Canopy developed across the pond offer a similar service for free.
 
Alongside the sad rise of the refugee crisis there has come a new wave of humanitarian technophiles, dedicated to developing translatable mobile resources. One such example is Techfugees – a volunteer collective that has run hackathons across the world to identify and build language and tech specific solutions to the problems of refugees. Empowerhack is an innovative collective that focuses on challenges specific to women accessing healthcare as refugees, and their mobile app Hababy (in production) aims to address those needs in a sensitive and language specific manner.
 
What these groups and others have identified is the paucity of quality information available on- and offline to non-English speaking women. However, while we continue to mold our clinical atmospheres to facilitate open communication between healthcare professionals and their patients, the Internet and Smartphone as a static, vetted, autonomously accessed resource, remains under-utilised. The majority of available patient information is in English, though because of the ease of posting opinion less than half of the websites reviewed in one study provided accurate information. This changed drastically when only NHS or government approved clinical websites were searched, with almost 80% providing clear and accurate answers to common questions posed. We hope to contribute to this with an offering going live later this year (www.earlypregnancyservice.org), providing information regarding access to healthcare pathways, signposts to cultural and faith based organisations that provide support, and frequently asked questions in early pregnancy.
 
Ibn Sina (Avicenna) when speaking of the art and science of medicine said: “In truth every science has both a theoretical and practical side”. Though the art of communication is infinitely nuanced, the medical and tech communities have come together to acknowledge the deficit of medical information to non-English speakers, and are addressing it through practical, pragmatic tools.
 
Dr. Natasha Abdul Aziz
MBBCh BAO(NUI) LRCP&SI DRCOG MRCPI(O&G)
Grad. Cert. Early Pregnancy Ultrasound (UCD)
Cert. Executive Leadership in Healthcare (Cornell)
 
Natasha is a clinical research fellow in the Nuffield Dept. of Obstetrics & Gynaecology at the University of Oxford, and honorary registrar in obstetrics and gynaecology with the Oxford University Hospitals NHS Foundation Trust.
 
Her fellowship project to address the needs of vulnerable communities within the UK stemmed from her role as National Women’s Health Lead with the Muslim Doctors Association in the UK – a community service group - and her volunteer work with NGO’s. She acts as clinical advisor for Hababy and New Natives apps.
 
To access the website or its content for your organisation, or sponsor this endeavor please contact the author.
 
Funding for technical development of the website has come from the Switz Group [http://www.switzgroup.com/]. Funding for translations has been crowd sourced.