Concerns with a language barrier

People with a migrant background are not always fluent in the language or languages used by doctors. It is not uncommon for them to bring their child along to interpret. "That's always a bad idea," says Mosè Piazza, intercultural mediator at the East Limburg Hospital in Genk. "It's not up to a minor to explain to his mother that she has breast cancer."

Communication is extremely important in the interaction between doctor and patient. But what if you don't speak the language? Belgium has a large migrant population, and newcomers in particular need time to learn our language. Mosè Piazza brought this issue to the fore during Taboo Week on November 6 in Genk. Taboo Week, which ran from November 3 to 8, was organized by the non-profit organization Actieve Interculturele Federatie+ (AIF+) and cancer was on the agenda that day. People with a migrant background who have not been in our country for long often face language barriers, while language is essential for establishing a proper care relationship between caregiver and patient. What if something serious happens to them?

Professional interpreters

Doctors can call on the services of a professional interpreter. At the East Limburg Hospital (ZOL), it is possible to work with intercultural mediators who, in addition to language, also translate cultural aspects for the care provider. The use of an interpreter or mediator must always be planned in advance. Mosè Piazza regularly provides language assistance in his hospital and takes cultural differences into account. ‘You can call in a professional interpreter via a video call, the interpreting telephone service, or by having someone come to the location.’ Doctors inside and outside hospitals can also call in a social interpreter via the Agency for Integration and Civic Integration. Social interpreters are professional interpreters who can be called upon by healthcare providers as well as educational institutions and local authorities. This interpreting service is subsidized and free of charge for the patient. In 2024, 484 interpreters were requested by healthcare professionals, including hospitals, according to the Agency for Integration and Civic Integration. This accounts for approximately 10% of all requests. In four years, social interpreters were called upon just under 60,000 times for medical consultations, which is less than 20,000 times per year on average. It is a drop in the ocean.

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It is not up to a minor to explain to his mother that she has breast cancer.

Translation apps

Translation apps may have a role to play here. Can translation apps, such as Google Translate, replace professional interpreters? "Absolutely not," Mosè responds. "Translation apps translate literally, make mistakes, and do not take cultural sensitivities and differences into account. If the doctor cannot check the translation, serious errors cannot be ruled out and miscommunication is likely." A 2024 research report on the quality of translation apps by the Agency for Integration and Civic Integration concludes that the various apps available, including ChatGPT, perform more or less similarly, but that the quality depends on the language for which the app is used. For some less common languages, these apps often do not work well yet. "These translations also do not take into account sensitivities or cultural differences," adds Mosè Piazza. "These apps are fine for short, simple conversations, such as asking for directions abroad, but not suitable for consultations between a doctor and a patient." Incidentally, the healthcare provider speaking into the app must do so carefully, in clearly understandable sentences with the correct intonation, otherwise such an app will make a complete mess of things.

Informal interpreters

The most common way to bridge the language barrier is to bring along a partner, sister, or neighbor who speaks the language to the consultation. "Informal interpreting is never a good idea for difficult conversations," says Mosè Piazza. "A partner who has to tell his wife that she has cancer will rarely do so in the same way as a professional interpreter. He may leave out painful details, so she doesn't get the whole story. Perhaps the man himself has not understood the doctor properly, so he cannot convey the message correctly." Many people with a migrant background and a language barrier take their minor children with them to consultations. "Children are kept out of school for this, whether appropriate or not, putting them at risk of falling behind in school," Mosè notes. "What's more, they become responsible for conveying the right message to mom or dad. They often do their best, but it takes its toll. Having a minor interpret during a difficult conversation is not okay and is traumatic for the child. And by child, I mean anyone under the age of 18." Mosè Piazza refers to a campaign currently running in the Netherlands that warns against using children as interpreters in healthcare. The poster "This is a child, not an interpreter" speaks volumes. "A similar campaign would also be useful in Belgium."

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