Healthcare Interpreting in Austria: Research and Policy

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Healthcare Interpreting in AustriaResearch and
Policy

• Franz Pöchhacker
• Center for Translation Studies, University of
  Vienna

Access to Health Care for Language Minorities
Bar-Ilan University, 23-24 May 2006
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Outline
? Demographic background ? Early responses ?
Vienna community interpreting initiative
Research Implementation ? Progress?
Vienna / Austria / EU context
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Demographic background
Austria
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Population
8.2 million (incl. some 80,000 ethnic Croats,
Slovenes and Hungarians w/ special
language rights) 9.6 foreign nationals
(790,000) Vienna 1.6 million - 18 foreign
nationals Districts 15th 31
16th, 20th 25 9,100 deaf persons
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Foreign nationals
Yugoslavia (Serbia, Montenegro) 133,000
Turkey 128,000
Bosnia and Hercegovina 108,000
Germany 72,000
Croatia 61,000
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Main sources
Labor migration (guest workers) - 1970s
Bosnian conflict - early 1990s Family
reunification (esp. Turkish) Asylum-seekers
(Chechnya, Turkey, Nigeria, Afghanistan, India)
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Early responses
getting by making do Cleaners (YU) as
hospital interpreters 1989 two
native-language assistants for Turkish hospital
patients in Vienna
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Native-language liaison workers
bilingual (Turkish/German) some medical
background in ob/gyn (and/or pediatric) wards
2 persons, extended to 6
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1992
Study by Schmid et al. (1992) finds general
lack of translation services in hospitals
City Councillor for Health states that further
needs will have to be assessed, and where there
is sufficient demand, the service should be
offered
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1995 A new impetus?
Strasbourg Forum on Community Interpreting
(incl. ISM Paris, Tolkencentrum, etc.) First
Critical Link Conference in Canada ? Needs
assessment study (1996) commissioned by
Vienna Integration Fund
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Hospital survey
765 questionnaires distributed via dept. heads
to doctors, nurses and therapists in 71
departments (internal medicine, surgery, ob/gyn,
ENT, pedicatrics, psychiatry) of 12 hospitals
in Vienna
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Principal research questions
Frequency of contacts with non-German-speaking
patients (NGS patients) Language backgrounds
Who enables communication? Satisfaction
Preferences
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Response

• 508 questionnaires filled in and returned
• 184 doctors (m/f ratio 2 1)
• 204 nurses, 120 therapists
• Response rate 66.4

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Main findings
95 of respondents stated that they were seeing
patients with little or no command of German (NGS
patients)
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Frequency
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Language backgrounds
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Who enables communication?
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Accompanying persons
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Shortcomings
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Hospital staff
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Satisfaction
Female doctors significantly less satisfied
than male doctors (38 satisfied vs. 57)
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Respondents comments
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Respondents comments
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Respondents comments
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Respondents comments
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Preferences
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Recommendations (1997)
Raise awareness among service providers
Launch a training initiative Create/extend
hospital interpreting services Establish a
community interpreting agency
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Raising awareness
CASE STUDIES Chance interpreting in speech
therapy 2 cases (Pöchhacker 1999)
Linguistic barriers to care 4 cases (Wimmer
Ipsiroglu 2001) Patient mix-up in Graz (2004)
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Speech therapy case study
Th Therapist M Mother Int Niece F
Father S Sefanur (child patient)
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Sefanur he or she?
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Case history
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(contd.)
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Teddy bear
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They dont understand that!
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Action plan (1999)
certificate training course (at
University) community interpreting
agency budget allocation in hospitals
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Training course
30 credits (340 hours) basic training (16)
specialization (14) one-third of instruction in
language pairs evening weekend schedule (over
1 yr.)
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Curriculum
Subjects Credits
Introduction / Basic concepts of interpreting 3
Techniques 4
Migration and Institution 4
Professional ethics 1
Interpreting exercises (role-play) 4
Subject-matter knowledge 6
Terminology 4
Interpreting exercises (role-play) 4
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Cost
Full course (no prior training) ca. 125,000
per course (2 language pairs) ca. 5,000
per person (25 participants) Course for TI
graduates ca. 70,000 ( 2,800 per
participant) Agency ca. 135,000 per year
(staff of 2) self-financing at 315 int.
hours/month ( 75 per one-hour assignment
281928)
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Pilot course (2001)
Interpreter training for bilingual hospital
staff Basic training curriculum (at half
intensity) 90 hours 16 days of instruction (8
x 2 days) 2 language groups (B/C/S, Turkish)
15 participants (esp. nursing staff various
hosp.) 9 instructors
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Results
course evaluation highly favorable main
criticism by participants Too short! lack of
organizational arrangements for
nurse-interpreters in some hospitals lack of
follow-up
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Policy Hospitals
most rely on employee language banks (lists
of bilingual staff no interpreter training)
no legal obligation to bear cost of
interpreting The costs of any interpreting
services required shall be borne by the
patient. Krepler et al. (200242) Law
in Hospital Practice
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Policy Hospitals
consent form (to be signed by NGS patients) I
hereby instruct the XXX Hospital of the City of
Vienna to call in an interpreter for the ..
language to assist me during my treatment and I
hereby undertake to bear the costs of
interpretation myself. As a patient I hereby
acknowledge that there is no statutory obligation
for the body operating the XXX Hospital of the
City of Vienna to recruit and pay an interpreter
for me. Date Signature
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Policy Vienna city govt.
language courses for migrants focus on
diversity management Vienna Integration Fund
(19922004) replaced by government subdivision
native-language liaison staff/interpreters
maturing (prospects of CPD) some efforts
toward CLAS
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National perspective
GRAZ university course (30 credits) in
community interpreting (Oct. 2004 Feb. 2006)
principal hospital uses language bank external
interpreters supplied by migrant-services
NGO INNSBRUCK employee language bank (no
training some org.)
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Conclusions
Lack of interpreting services in healthcare
persists Lack of legal basis for
professionalization Lack of funds for
purchasing and training Need for medical research
(quality of care for migrants) Need for studies
on quality of communication/interpreting
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European perspective
Migrant-Friendly Hospitals Project 10/2002
03/2005 (coord. LBISHM, Vienna) 12 hospitals
12 countries (AT, DE, DK, EL, ES, FI, FR, IE, IT,
NL, SV, UK) 3 subprojects A improving
interpreting services B mf information
training for mother-and-child care C
staff training towards cultural competence
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Main problems (needs assessment)
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Interpreting Problems
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MFQQ surveys (pre post)
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Intervention results
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Limitations
different interventions in different
hospitals professional interpreting ?
uneven (small) samples in staff surveys
limited data from migrant patient surveys See for
yourselves at www.mfh-eu.net
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Overall conclusion (AT/EU)
Improving interpreting in clinical communication
is possible only if it is integrated into a
hospitals general policy on diversity, if it
becomes mainstream rather than relying on local
champions, if adequate political will and
funding are assured.