Over the last ten years a large number of Somalis have been relocated from their war-ravaged country to the Minneapolis area and are spreading into some of the surrounding communities. Estimates of the population range from 15,000 to 75,000. Two reasons for the discrepancy in the estimates are the tendency for extended Somali families to live in one home and under report their numbers. They also tend to relocate from the 23 other states that took refugees from Kenya and Ethiopia to the Minneapolis area to be with family.   These refugees are cross generational.  Many of the adults do not speak English or have LEP.  The children may speak some limited English. The Somali language has several distinctive language variants.  The two main variants are Af Maay and Af Maxaa.  In 1972 Af Maxaa became the official language of Somalia. Literacy rates in Somalia are estimated at less than 24%.  Most Somali refugees came to the United States knowing little to no English. As with many refugees, the children often know more English as they are able to learn different languages much easier and quicker.  The local schools have been working with the University to help with the language barriers and have been monitoring children in the classrooms.   The bilingual program in the schools is one of the best in the country.

Case/Story
Headaches of a CEO

This case focuses on how a small community hospital dealt with the influx of a new culturally different population. Hospital staff from the CEO to the staff in the emergency department needed to find a way to provide services to members of this community.

Mass immigration

About a year ago, the community of White Lake had a large influx of Somali refugees. The institution and community were unprepared to deal effectively with this sudden change in the population. The first indication that change was in the air was when Somali patients started to show up in the emergency room. Staff had difficulty understanding these patients when they presented their medical problems. White Lake Hospital does have a couple of Hmong and Spanish interpreters on the payroll, who are called on an “as needed” basis. The hospital is a small community hospital and does not have resources for a full interpreter services department. While the hospital was able to serve the few Somali patients seen, they could have been better served with improved communication. Assuming the influx of Somali patients was a temporary fluke, CEO Diane Mathis did not move forward to establish a Somali interpreter service. In hindsight, she now realizes that these few patients were only the tip of the iceberg. Over the next 6 months White Lake became home to over 100 Somali refugees.

Communicating with our new community members

When Diane Mathis realized that there was a significant Somali population in White Lake she started working with local groups who were here to help the Somali’s settle into their community. She had been working with some of the Somalis who were LEP to help identify leaders within “their community”…It took a great deal of time; however, they had identified two people who were in the process of becoming qualified medical interpreters. Fortunately, they spoke both Somali dialects. The hospital was struggling with the idea that the Somali community was quite small, and there was concern that there may be a risk to individual’s privacy within such a small, close knit community. As an interim measure, staff was instructed to use a language line. Diane knew that the language line was not an ideal way to provide care, but thought that it was a temporary “fix” while she made contact with the community and figured out what this was going to do to the already strained hospital budget.

Meanwhile, the emergency room staff were frustrated with the inability to communicate with the Somali patients coming into the ER. They did not realize that the new CEO was working on this issue and tried to be independent in responding to the need for a Somali interpreter. They proactively formed an e-mail campaign about the problem to some of the state legislators and senators. Although this was quite enterprising on their part, they did not communicate their efforts to Diane Mathis.

This episode reminded Diane that there are not a lot of culturally diverse people seen at the hospital and she had to remind her staff that they do have access to a language line for all people who come through the doors. Adapting the system of care delivery is a process that takes time. Diane understood this concept, but did not communicate this to her staff providing direct patient care.

 

Things to consider about this case

There are several issues to consider about this case. You will explore these issues more fully in the learning activities.

• This is an example of increasing diversity in a small community setting. Is the diversity of your patient population increasing?
• How can health care providers, individually and as an institution, provide access to services to patients who do not speak English?
• What are your legal responsibilities to provide these services?

 

What to do next

Now that you have read the case, go to the lecture section to gain a better conceptual understanding of the issues related to qualified medical interpretation.