Gestures can go only so far when trying to find out whether a Farsi-speaking newcomer from Iran gets a burning sensation when she urinates.
But a special translation guide developed by Joel Ray offers relief: All a doctor or nurse must do is read out a question phonetically – in this case, Khoon dar edror – to the patient.
Now in use across the country, the guide is a simple tool – a computer-based list of phonetic pronunciations of medical symptoms and questions in the 15 most-spoken languages in Ontario – but it addresses a major obstacle that immigrants face when accessing health care.
"In the emergency department, if somebody comes in with a serious problem and there's nobody there that speaks that language," says Dr. Ray, 44, a clinician and researcher at St. Michael's Hospital in Toronto, "you immediately have a barrier to the information exchange that's critical to finding out what's wrong."
As Canada's immigrant population grows, he adds, delivery of health care must evolve. And that goes beyond language.
In one recent study, he identified a Caucasian bias in birth-weight standards used in most hospitals that could cause ethnic-minority newborns to be labelled as underweight. His revisions may reduce the need for unnecessary follow-ups, tests and worry among immigrant mothers.
In another study, he outlined the elevated risk for gestational diabetes for immigrant women, and called for improved ethnic classification (for example, "South Asian" instead of just "Asian") so practitioners can evaluate patients more accurately.
Doctors and nurses are on the front lines with immigrant patients, Dr. Ray says, so hospitals should be ground zero for cultural innovation.
"Universities look at 'sociology of health' rather than at health-care delivery," he says. "Hospitals should have academic research departments – that's where the research should be done."
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