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Notes on Bridging the Technological Divide

[Once again, my notes on the session. My thoughts, digressions, and insecurities will be safely compartmentalized by square brackets.]

Amy Shellabarger and Sahra Noor work at the Community-University Health Care Center here at the University of Minnesota. Their project involves using technology to improve communication with patients from immigrant communities.

Sahra Noor talks about a new use of video technology to aid in interpretation for patients. This is not to ignore the barriers to using these technologies--barriers such as access to hardware and educational efforts, etc. Nevertheless, the benefits of using oral interpretation (whether by Skype or another technology) are clear. Something as simple as preventing an overdose by helping to interpret a pill bottle is a clear example.

Although there is a misconception hat immigrants don't have access to emergent technologies such as smart phones, statistics show that Latino immigrants for example have smart phones at a higher rate than the rest of the population.


Question and Answer Session
Q: I was interested in hearing the emphasis on language. Can you talk about the disconnect between the cultures represented by immigrant populations and the culture of western medicine?
Sahra: Our interpreters are trained in medical interpreting. We also have a strong focus to help the interpreters become part of the care team . This helps act as bridge between these two communities.
Amy: We also work with the health care professions to help them understand better how to interact with immigrant populations. I often say to health care providers: "Use your interpreter."

Q: Do you also train about folk illnesses and remedies?
A: Yes, we are familiar with some of the remedies in the community, and we are working on a brochure about drug interactions and making sure that patients tell their providers if they are taking any kinds of vitamins or herbs.

Q: Do you use technology in a public health sense? I'm thinking of outbreaks and vaccinations.
Sahra: We use videos that we publish through Facebook and YouTube. But the challenge is still that the clinicians themselves are not from the community. So you can have an interpreter or a translator, but if the message is coming from someone outside the community, it's harder to get the community to accept and embrace the issue. We work to socialize the issue as opposed to medicalizing it, but we have a long way to go in terms of using technology to help us with this.
Amy: And when we make these videos, we have learned that we have to really look at out audience and make sure the presenters and the interpreters are all communicating in culturally appropriate ways.

Q: Are you exploring the use of visual communication in these efforts?
A: We have looked at this. For example, we have worked on maps. If you've ever been in a hospital and not known how to get from point A to point B, you know it can be very frustrating.

Bridging the Technological Divide

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Sahra Noor: While technology can be useful for connecting immigrants with health care and health care campaigns, there are barriers to access. Need to consider cultural competence issues, of course, and literacy rates in local immigrant populations. For some, videos can help communicate important information. Their studies found that Latino immigrants use smart phones to access the internet, so health care providers now can devise more effective ways of communicating with them. The small group discussion begins:

Amy: each immigrant group that comes to the US has different experiences with technology, so their work involves finding out about the specificities.

Sahra: interpreters become part of the health care team, a bridge between technical experts (doctors and nurses), the patient, and others. An interesting and useful perspective...especially since our medical system privileges the technical expertise of doctors.

Amy: we take into consideration remedies people use on their own, by learning more about culturally specific remedies, and by informing people about interactions between the medications patients are prescribed and remedies they might use on their own.

Sahra: It's important to emphasize the social, and not just the medical. For example, during a recent measles outbreak we went to the West Bank and organized forums where people could learn more and talk with each other.

Question: use of visual information for communicating? In a project I was involved in, we developed communication that used only symbols. Sahra: some of the materials we developed were not necessarily multicultural, but did emphasize visual images, symbols. For people with language barriers we created videos that were posted on a portal.

Amy: we have a color coding system to make our directions even more clear. For example, we can direct people to a blue door or a yellow door.

Question: What about translation issues, for example, what if the translator mistranslates to avoid conflict? Sahra: we follow the four steps of translation, a review process. We had to outsource this for legal protection. There are still translation issues. But, what I find most difficult is that as health care providers we make things much more complicated, which renders the translation useless. Amy: we really need qualified interpreters. The family member as a translator can have disastrous results, especially when the patient needs to discuss private matters. Sahra: Being bilingual and being an interpreter are two different things. One is knowing two languages, but to translate you need a different set of skills.

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