“I certify that during the discharge procedure I received my baby, examined it, and determined that it was mine. I checked the Ident-a-Band® parts sealed on the baby and on me and found that they were identically numbered 5043 and contained correct identifying information.” (Anne Fadiman, The Spirit Catches You, 1997)
This is a normal and routine thing that every mother does after giving birth and before taking the baby home. What could be simpler? Well, if you’re the mother depicted here, a new immigrant from Laos, unable to understand Arabic numerals and speaking only the language of her culture, the normal and routine becomes abnormal and irregular. Something as simple as verifying numbers and a name are impossible for the Hmong mother depicted above. Is it really her baby? Does she have a clue about special (or for that matter – routine) discharge instructions?
Not only is this a problem for mother and baby, it is an ever-increasing challenge for health care providers. This is not a challenge of “other people,” it is a challenge for those of us who seek to “do no harm” right here in the Heartland.
According to a 2003 report by the U. S. Census, nearly one in five people (47 million) living in the United States speak a language other than English at home. While many speak English with varying levels of fluency, hearing a word and understanding the meaning of a word may be two entirely different things. No matter the level of fluency, in times of stress, the ability to understand a newly acquired language may be lost or severely impaired.
Local events point to the problems that occur when language and cultural differences surface. We need only look at the case of the Sudanese family who had their children removed from the home because the babysitter was derelict. How many of us have been disappointed because a teenage sitter fell short of our expectations? As a registered nurse working with children in burn and trauma units I cared for many children who were injured in the care of a sitter or the parent. What was different? What kept those children in the home even though the child had significant injuries?
The difference was place of birth and native language (with a little variation depending on socioeconomic status). These are privileges that we take for granted but can have lifelong consequences in the health care (and law enforcement) arena.
There are 37 different languages spoken by the children enrolled in the Omaha Public School system. The children and their family members also will come to our clinics and hospitals. So, whose responsibility is it to bridge the cultural and linguistic gaps that “do harm” to our newest neighbors?
Beginning this month a series of two-hour presentations called CARING with CLAS[S] will be presented. The presentations are open to everyone and will provide a means of understanding Culturally and Linguistically Appropriate Services (CLAS) standards. The CLAS standards were promulgated in December of 2000 and guide the practice of health care provision in a society with rapidly changing demographic profiles.
Join in an enlightening series on current challenges and issues experienced on our campus every day. The first session will be Thursday, April 15 from noon until 2 p.m. Contact Stephan McNeil at smcneil@unmc.edu if you are interested in attending. You will be contacted with the schedule of presentations.
References
Fadiman, Anne, The Spirit Catches You and You Fall Down: A Hmong Child, her American Doctors and the collision of two cultures. Farrar, Straus, and Giroux, New York, 1997
U.S. Office of Health and Human Services, Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services in Healthcare. March 2001 (available 4/03).