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Patients don’t have language barriers; the healthcare system does
  1. Rachel Showstack
  1. Department of Modern and Classical Languages and Literatures, Wichita State University, Wichita, KS, USA
  1. Correspondence to Dr Rachel Showstack, Department of Modern and Classical Languages and Literatures, Wichita State University, Wichita, KS 67260, USA; Rachel.Showstack{at}wichita.edu

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Benda et al found that in an emergency department in the eastern United States, Spanish-speaking patients who needed language assistance received inconsistent and often non-recommended language access services across different phases of patient care.1 These ranged from emergency department staff speaking English to the patient, the provider speaking Spanish (with varying levels of proficiency) or the use of either professional or ad hoc interpreters. What happens in the hospital investigated in their study undoubtedly occurs in hospitals across the USA: linguistic minority patients are left without adequate language services, potentially reducing their access to quality healthcare. Similar scenarios exist in other countries, including the UK and Australia.2 3

In the USA, the the Affordable Care Act (ACA) requires that health care facilities that receive federal funds offer a qualified interpreter to individuals with “limited English proficiency” when the provision of an interpreter constitutes a “reasonable step” in providing “meaningful access” to a health program or activity. Under this legislation, agencies are restricted from allowing an adult or minor accompanying an individual to interpret except under very specific circumstances; and may only rely on qualified bilingual/multilingual staff to communicate directly with individuals with limited English proficiency. .4 The use of non-professional ‘ad hoc’ interpreters can cause dangerous errors in communication; in addition, using children as ad hoc interpreters, or ‘language brokers’, can cause them to suffer from emotional trauma.5 6 Similar to the the anti-discrimination measures of the ACA, the UK implemented the Public Sector Equality Duty in 2011, and public service agencies are required to have due regard to the need to eliminate unlawful discrimination and advance equality of opportunity.7 However, according to Szczepura, healthcare for minority populations is not being adequately monitored. 8

The authors of the study in the Emergency Medicine Journal suggest that machine translation …

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