Clinical tips: Language, culture and medicines

pharmacist with patient explaining medicines

Language and culture doesn’t have to be a barrier to communication about health and medicines, writes Karalyn Huxhagen

When interacting with patients/consumers it is important that they understand the pharmacist and the messages we deliver. For many languages there are dialect and tribal differences in language.

Questions to consider include:

Who to use as an interpreter? If you use a family member will the patient be willing to allow this interaction? Will they give open and frank answers with a loved one as an interpreter? Do you know what the interpreter is saying/translating to the consumer and is it accurate?

If you use an interpreter from a government service such as the police will the patient discuss their business in front of a stranger?

In my area the local council maintains a network of people that they call on to support new migrants and visitors to the town. These people do more than act as an interpreter service. They support the assimilation of the new families into the town.

They produce a local newsletter each month highlighting the cultural diversity of the population. They also organise activities to assist the new arrivals to meet others of their culture.

They assist with translating the myriad of forms and government requirements that are required for the various departments e.g. housing, health care, migration.

When sitting and talking about medicines with a person whose first language is not English you have to be mindful not to use technical words or jargon. You can use tools such as pictures and videos e.g. Lung Foundation videos on how to use a spacer/inhaler.

Last week I worked in an Aboriginal settlement undertaking home medicine reviews and aged care medication reviews. The patients presenting to the hospital each day were very used to health worker interventions and would discuss how they felt with gentle prodding and words.

The residents of the aged care facility were not as easy to work with. It was impossible to define whether the behaviour that was exhibited when put in a lifter for showering was due to pain, fear or was just a behaviour response. Defining the causes of issues such as behaviour is not an easy assessment when you are not part of their culture.

Home visits were always with a liaison officer and out of respect we never entered the yard or house unless invited. It is natural for this community that when you visit you beep the horn as you pull up to the fence and you call out till answered. You do not go onto their land without invitation.

Adherence to medications was fairly good as they have weekly contact with the service to deliver their dosage administration aid and check on whether they take their tablets. When they came into clinic the next day I often found out a little bit more as they would sit and yarn with those that they trusted.

For one such encounter we discovered an old Seretide inhaler (out of date by two years) that one lady was using twice a day. The Doctor and the hospital had no record of her being on Seretide for the two years she had been on the lands. There was no label or box.

It was a complete fluke of an intervention as we were having a chat about her recent admissions for the flu, and her sister while not taking her eyes off her phone on which she was playing a game, said “her asthma breathing been real bad”.

On further questioning out came the old purple puffer which started a sequence of events of needing a health worker to explain the need for a new inhaler and a spacer.

On further interaction about spacers I discovered she had a few of these at home but never used them. Someone along the way had given her medicine she needed and a tool to use but the carry through of using them appropriately and renewing her puffer was lost.

Dispensing labels are another level of issue. Does the patient read English? Is there someone in the house who can read English and administer the medication appropriately?

I have worked in pharmacies where the dispensing software can dispense in Italian as that is the language that the older members of the town can read and write. The problem for me is that I cannot read Italian, so I need to trust that the computer has converted the directions correctly.

In the community pharmacy each day I am presented with both patients and doctors who do not have English as a first language.

We encourage the new doctors to visit the pharmacy and become familiar with the Australian version of the medications. They are well trained medical personnel but the Australian names and the system of prescribing on the PBS, RPBS, authorities etc is all completely foreign to them.

Their strong accents on the telephone make communication very difficult for me and I often struggle to understand what they are asking. The patients come in with a prescription and often they ask us to explain what the doctor just said as they could not understand with the doctor’s accent.

Whether you are working in community pharmacy, performing interactions at a hospital bed or in aged care or home visits it is important to bring the language and syntax to a level that the patient is able to understand, comprehend and retain.

If you need to use an interpreter consider carefully whether there are cultural barriers to using a family member. For example in Aboriginal culture if dealing with a female patient you may need to use a female person as an interpreter while male patients prefer to interact with male staff.

There are tribal differences to be understood as well. While on my recent visit to the Aboriginal community the health care worker I was assigned refused to take me to three patients. She would not say why, she just refused. I had to use another health worker to see these patients.

Interpreter services are available—look to your local council and local police station for support. If you cannot find assistance through their contacts then you may need to use a government service.

I sourced this explanation of the TIS National service from the NPS website. Translation and Interpreting Service (TIS) National is an interpreting service provided by the Department of Immigration and Citizenship for people who do not speak English and for the English speakers who need to communicate with them.

TIS National is available 24 hours a day, seven days a week for any person or organisation in Australia requiring interpreting services. It provides immediate telephone interpreting services, as well as pre-booked telephone and on-site interpreting. To use an interpreter over the phone, call 131 450.

Access to free telephone interpreting services is available for:

  • registered pharmacies around Australia;
  • general practitioners providing Medicare services and their reception staff to arrange appointments and provide results of medical tests;
  • non-profit, non-government, community-based organisations for case work and emergency services, where the organisation does not receive funding to provide these services; and
  • local government authorities to communicate with non-English speaking residents on issues such as rates, garbage collection and urban services.

Visit the TIS National website for more information on specific services. If you have questions about your eligibility for free interpreting, please contact the Client Liaison and Promotions team at TIS National on 1300 655 820.

The Australian Government Settlement Services is a free government service to help migrants resettling to Australia.

In Queensland we have a service available through the Queensland Health website titled “ Multicultural Health- A Guide for Health Professionals.’ The website states “Community Profiles for Health Care Providers is a practical tool that assists health care providers to better understand the health beliefs, pre-migration experiences, communication preferences and other aspects of their clients’ culture.

“The profiles provide information for health care providers on the communication styles, health in Australia, health beliefs and practices, social determinants of health and utilisation of health services of 18 multicultural communities in Queensland.

While this website is not actively maintained currently the material gives a good background to guide the health care professional.

Many of the services that we utilise for providing support to health consumers do produce material in other languages. On discharge from hospital or a health service it is important that the pharmacists have ensured that there is someone in the close family/support person who can read the material provided and who can ensure that the understanding of what is to happen is accurate.

Australia is a land built on cultural diversity. We need to ensure that we have taken the best steps to provide good quality health care in an appropriate format that the patient understands and is comfortable implementing.

Karalyn Huxhagen is a community, consultant and locum  pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management. Karalyn currently has many roles within the Health and Hospital Services and Primary Health Network sector in Queensland.



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