Like any good entrepreneur, we’ve decided to specialize… in OBGYN clinics.

Like any one else just starting their own venture, we’ve been following and reading every blog we can find, every book that’s out there, and every professional who has made it. The advice we keep hearing over and over is, “find your niche”, “specialize”, “you can’t narrow your market too much”. For translators, there are entire blogs written about the benefits of specializing.

So, we decided to specialize. But how?

Everything we have read recommends specializing in something you are passionate about, something you can identify with, and something that you feel a bit of camaraderie with.

Therefore, we chose to focus on OBGYN clinics serving limited English proficiency (LEP) individuals. Here is why:

As you may have heard, I served as a Peace Corps Volunteer in Eastern Ukraine where I learned and spoke Russian. Like anywhere in the world, I had to do my annual female check-up. I had an unfortunate and embarrassing experience where this check-up involved more than a dozen (male) doctors staring in at my private places.

Why did it take over a dozen doctors you may ask? I have no clue because no one took the time to ensure I understood what they were saying in Russian.

One good thing about this mortifying experience was a development of empathy for limited English proficiency (LEP) women seeking OBGYN services in the U.S.

OBGYN clinics are one of the places in the world where a woman’s entire shield must go down, and she must expose herself to a complete (and hopefully only one!) stranger. You know nothing about that stranger, yet every few years you have to give them permission to stick a random object inside of you in the name of health (Yah, I know, men have to do this too, and I am guessing it is equally invasive).

I was lucky. I had the Peace Corps to advocate for me, and my experience was not made worse by past experience. However, this experience can be traumatizing for the 1 in 4 women who have been sexually assaulted, and the rate for refugees is even higher.

What should have been done instead was to ensure I fully and completely understood what they were going to do before, during, and after the procedure. I should have had an interpreter, and I shouldn’t have been asked to signed a document that I could barely understand.

Just a quick side point, by time this happened, I could easily converse one-on-one in Russian. However, I was almost completely unable to comprehend the document I was required to sign. The terminology was well beyond my level, and the written form did not allow for the use of context or experience with the speaker to increase understanding. My point: just because your patient seems to be able to speak with you in English does not mean they can do without translated documents or a professional interpreter.

“Just because your patient seems to be able to speak with you in English does not mean they can do without translated documents or a professional interpreter.”

I like to think that if you’re reading my revealing and personal experience, you have empathy and understand that language access is truly vital. Assuming that’s the case, it is important that language access is defined.

1.  Language access is not allowing a husband to interpret for his wife.

If you’re truly trying to provide the best healthcare, then getting the truth is important. Interpreting through a husband drastically decreases the chances of truth being told. You might think this won’t matter for seemingly harmful questions like,”Have you had any itching down there?” However, in my experience while dating a man from the Saudi Arabia, appearance is extremely important, and any bodily functions that are not “attractive” should not be spoken about with the man present. Sexist? I don’t think that matters if the goal is to treat the patient.

Our recommendation: Make it a POLICY that no male relative is allowed to interpret for your female patients (really though, no relative should be interpreting either…).

2.  Language access is using a trained interpreter or translator only.

Having a bilingual staff member or family member also does not count as language access. While taking the Bridging the Gap interpreter course, I was surprised to find that my (and everyone else’s) tendency is to summarize. It is only after experience and training that a translator and interpreter learn that what you say must completely and accurately match the source language. In fact, while coordinating interpreters for a past position, doctors always reported they could tell the difference once an interpreter was officially trained. They said the appointments went smoother and there were less miscommunications. If you work with one language in particular, it might be worth your time to get your bilingual staff trained.

It is especially not okay to summarize a legal or medical document, and you could end up liable if you try to bypass this. Again, see above. People naturally summarize, and that’s not okay when a missed word can result in bad health, legal, or financial (medical bills) outcomes. Sometimes, it is okay for a trained interpreter to sight-translate documents, but anything that needs to be signed should be professionally translated.

Our recommendation: Make it a POLICY to only use interpreters and translators who are trained.

3.  Language access is budgeting in more appointment time for limited English proficiency (LEP) patients.

What you have to say may only take five minutes, but now that it has to go through an interpreter, that time doubles. The same goes for any questions or replies from the patient.

Also, many women around the world don’t have access to the same OBGYN services that we have, and they may not understand the importance of recommended procedures. You can’t just tell them its necessary and expect them to do it. You need to need to take time to explain the why, the how, and the how long.

Finally, LEP women may not be open to talking about their bodies, and it is going to take a lot of patience and building of trust to get their full medical history.

4.  Language access is ensuring all of the documents that the patient signs or reads are in their native language.

Hopefully by this point, you read my personal experience above. The ability to converse in English does not equal the ability to read medical documents in English.

Translation is especially important for prescription instructions. Personally, those instructions that come with the Walgreen’s prescriptions are a life-saver. I have the memory of a goldfish, and everything must be written down, or I may accidentally forget and misuse it.

For example, in Ukraine, it wasn’t common to use or even know about Ibuprofen. It was expensive, and they had their own folk medicine remedies to use instead. Once, I gave some to a co-worker when she had a headache, and she was so impressed with the results that she bought some. Except, what she bought had a much lower dosage, and it didn’t have the same impact as what I gave her. It could have been the other way around though where the local dosage was much higher, and she was sent to the hospital. Luckily that didn’t happen, but either way, she should have received some instructions from the pharmacy on how to use the pills.

On another, and much more hilarious, occasion, a friend from Germany was visiting me in the U.S. I asked him if he would want to join me in my daily dosage of fish oil to strengthen his joints. However, I failed to instruct him that he should not chew the pill, which of course turned into a screwed up face and the comment, “Wow, this pill is super fishy!” Note: fish oil should also include instructions in one’s native language.

5.  Language access is patient-focused.

I love that this has become a trend, and I think this is a great way to end, considering this list could literally be endless.

Good quality healthcare for limited English proficiency (LEP) patients requires you to take more time to see what their needs are. LEP patients are not going to be obvious or intuitive like with someone from your own culture. Facial expressions and body language do not mean the same things across the world. And women from around the world may not be as aware about their bodies as they are in the U.S. However, if your services are patient-centered, I do believe you will find a way to provide them quality OBGYN services.

Working with limited English proficiency (LEP) patients is incredibly rewarding.

Not that you should do this for the reward, but working with LEP patients is incredible and memorable. My friends and students in Ukraine and around the world shaped me into what I am today and have had a huge impact on my life. From recently being invited to a Sri Lankan food night, to being asked to join a two-week hiking trip throughout the Crimean mountains, and having Ethiopian lunch with Ethiopian co-worker: these are all experiences I wouldn’t have had otherwise, and they are some of my most cherished memories.

Please gives us your feedback and suggestions on working with female LEP patients in the comments section!

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