In this episode, Brynn and Dr. Cho discuss Dr. Cho’s new book, Multilingual Practices and Monolingual Mindsets: Critical Sociolinguistic Perspectives on Health Care Interpreting. With a novel approach, which sees interpreting as social activities infused with power, Dr. Cho’s research and this book have captured the dynamics of cultural, linguistic, and ethnic power relations in diverse sociolinguistic contexts.

For more Language on the Move resources related to this topic, see Reducing Barriers to Language Assistance in Hospital, Life in a New Language, Linguistic Inclusion in Public Health Communications, and Interpreting service provision is good value for money.

If you liked this episode, be sure to say hello to Brynn and Language on the Move on Bluesky! Support us by subscribing to the Language on the Move Podcast on your podcast app of choice, leaving a 5-star review, and recommending the Language on the Move Podcast and our partner the New Books Network to your students, colleagues, and friends.

In this episode, Brynn and Leah discuss a 2024 paper that Leah co-authored entitled “Language Access Systems Improvement initiative: impact on professional interpreter utilisation, a natural experiment”. The paper details a study that investigated two ways of improving the quality of clinical care for limited English proficiency (LEP) patients in English-dominant healthcare contexts, by:

1. Certifying bilingual clinicians to use their non-English language skills directly with patients; and
2. Simultaneously increasing easy access to professional interpreters by instituting on-demand remote video interpretation.

Brynn and Leah talk about the results of this study and what they mean for improved communication with LEP patients in healthcare.

If you liked this episode, be sure to say hello to Brynn and Language on the Move on Bluesky! Also support us by subscribing to the Language on the Move Podcast on your podcast app of choice, leaving a 5-star review, and recommending the Language on the Move Podcast and our partner the New Books Network to your students, colleagues, and friends.

The Multiethnic Health Equity Research Center is based at UCSF (Image credit: UCSF)

References

A discussion about the terms “limited English proficiency” (LEP) and “non-English language preference” (NELP) in healthcare, which is also laid out nicely in Ortega et al.’s (2021) Rethinking the Term “Limited English Proficiency” to Improve Language-Appropriate Healthcare for All

Leung et al.’s (2025) paper entitled Partial language concordance in primary care communication: What is lost, what is gained, and how to optimize

And for more Language on the Move resources about the intersection between language and healthcare:

• Reducing Barriers to Language Assistance in Hospital
• Language policy at an abortion clinic
• Mismatched public health communication costs lives in Pakistan
• Why it’s important to use Indigenous languages in health communication
• Linguistic diversity in a time of crisis: Language challenges of the COVID-19 pandemic

Transcript (coming soon)

(Image credit: RACGP)

The global impact of the coronavirus pandemic has reshaped societies worldwide, altering human interactions and perceptions of the world and brought unprecedented challenges, not only in terms of public health management but also in communication. Australia experienced low infection and mortality rates during the initial eight months of the pandemic compared to other regions. This success in containment has been attributed to rigorous testing, contact tracing, mandatory quarantine measures, and timely shutdowns, along with the advantageous geographical location of the country.

During this period, Australian news outlets played a crucial role in disseminating information and shaping public perceptions of the pandemic. This examination delves into the linguistic evolution of media coverage, shedding light on how risk communication strategies evolved over time. The linguistic choices in media coverage significantly influenced public response and adherence to health directives during the pandemic. The strategic changes in language helped stabilize public sentiment and enhance cooperation with health guidelines.

I conducted a study on Australian news outlets at Monash University during the peak of the pandemic. Utilizing the vital work of Mark Davies’ international corpus (Davies, 2019-), I created my own corpus, focusing on nationally recognized news outlets in Australia, such as The Age, ABC (Australian Broadcasting Corporation), and Channel 9. This resulted in a comprehensive collection from 18 outlets, comprising 5,969 articles and 961,390 words, covering the period from January to September 2020 (Munn, 2021). Articles from these sources were analyzed, focusing on key words used to frame aspects of the virus. The results of this analysis are detailed in this article.

Novel Coronavirus to COVID-19: the Linguistic Evolution

From ‘Deadly’ to ‘Wuhan’: Negative Connotations and Their Impact

When COVID-19 first became acknowledged by Australian news outlets in early January there was a noticeable use of the adjectives ‘deadly’ and ‘mysterious.’ While ‘deadly’ was quite apt in hindsight the use of negative adjectives is something the World Health Organization (WHO) heavily discourages as it can amplify undue fear in the wider public (2015). The changing and evolving information about the virus lead to a familiar pattern of different media sources reporting different and sometimes inflammatory perspectives that happened during the SARS and H1N1 outbreaks (Berry et al., 2007).

‘Wuhan’, the second-most occurring modifier, continues to exhibit a pattern of negative influence. Labelling the virus as the ‘Wuhan coronavirus’ not only implicates a specific geographical region but also inadvertently fosters discrimination against the Chinese community, contributing to a surge in racist incidents globally (Human Rights Watch, 2020).

Drawing from the research of Tang and Rundblad (2015) and WHO (2015), which emphasizes the significance of linguistic framing in risk communication, it becomes apparent that the language used in media reporting can influence public perceptions and behaviours. This observation underscores the importance of employing responsible language to mitigate fear and prevent stigmatization.

Standardization of Terms: The Introduction of ‘COVID-19’

In reaction to the growing negative connotations a new name was introduced by WHO in February 2020. COVID-19 (Corona VIrus Disease 2019) marked a pivotal moment in the risk communication of the virus. The new name was created using the guidelines presented in WHO’s “Best Practices for the Naming of New Human Infectious Disease” (2015).

This standardized nomenclature aimed to alleviate the negative connotations associated with ‘coronavirus’, thus promoting a more objective understanding of the disease and the data shows they were successful as ‘COVID-19’ showed no notable examples of the negative modifiers used with coronavirus.

The presence of the two names for the singular virus led to a spike of instances of ‘coronavirus COVID-19’ and ‘COVID-19 coronavirus’ the instances of both names used as modifiers for the other peaks in March after the introduction of ‘COVID-19’ in February. Over half of the instances of these occurrences were in the single month of March. There is a clear sense of interchangeability between the two terms that the Australian media grasped and communications to the wider public that ‘coronavirus’ and ‘COVID-19’ where the same thing, facilitating its widespread adoption.

By June, ‘COVID-19’ emerged as the preferred term, eclipsing ‘coronavirus’ in media discourse. This shift reflects a conscious effort to streamline communication and ensure consistency in messaging. This was not only the case in Australia, but Oxford English Dictionary also report the same result in their worldwide examination of words use relating to COVID-19 (Oxford English Dictionary, 2020).

Crisis Communication Narratives

Linguistic Framing: Proactive vs. Reactive

As the pandemic unfolded, media coverage shifted from solely focusing on the virus to addressing its broader societal impacts. The term ‘COVID-19’ was associated with proactive actions like understanding the cause, prevention efforts, and managing the ongoing challenges (cause, prevention, handling, etc.). In contrast, ‘coronavirus’ narratives often emphasized containment measures, warnings, and identifying hotspots (stop, warn, strain, epicentre, origin, etc.). These differing narratives reflected the multifaceted nature of the pandemic response, highlighting both proactive and reactive approaches to managing the crisis.

Handling Death

The differences in language usage between ‘coronavirus’ and ‘COVID-19’ regarding reporting on deaths attributed to the virus reveal contrasting narratives in media coverage. While ‘coronavirus’ often precedes mentions of ‘new cases’ and ‘more deaths’, emphasizing the novelty and severity of the virus. ‘COVID-19 ‘conveyed a sense of familiarity and normalization, omitting the need for such qualifiers. This distinction suggests that media outlets may unintentionally amplify fear and uncertainty when using ‘coronavirus’, while portraying ‘COVID-19’ as a manageable entity. Understanding these linguistic nuances is crucial for crafting effective risk communication strategies that promote informed decision-making and resilience among the public in navigating the ongoing challenges posed by the pandemic.

‘Fight’ against coronavirus vs ‘Battle’ against COVID-19

There were distinct linguistic nuances were observed in the portrayal of efforts to combat the virus. While both ‘fight’ and ‘battle’ were employed, ‘battle’ was exclusively associated with ‘COVID-19’, suggesting a more protracted struggle with no definitive endpoint in sight. The media viewed ‘coronavirus’ and ‘COVID-19’ as a fight, while only ‘COVID-19’ was a battle. Fighting coronavirus suggests a victory is possible, but the battle against COVID-19 has no clear victory in mind but just to struggle against the virus.

Linguistic Framing of Non-Pharmaceutical Interventions (NPIs)

Testing

The testing regime for COVID-19 emerged as a crucial strategy employed by the Australian government to curb the spread of the virus. Throughout the analyzed period, there was a discernible uptick in mentions of testing within the corpus, reflecting its increasing importance in public health discourse. Notably, spikes in discussions around testing coincided with the onset of the first and second waves of infections in Australia, underscoring its pivotal role in outbreak management.

While ‘positive tests’ remained consistently prominent, there was a notable anomaly in June, just preceding the second wave, where the frequency of ‘negative tests’ momentarily surpassed that of ‘positive tests.’ This anomaly highlights the dynamic nature of testing trends and suggests potential shifts in public health priorities or testing strategies during specific phases of the pandemic.

Lockdowns

The implementation of restrictions on the Australian public emerged as a crucial measure in controlling the spread of the virus, serving as the second major factor in virus containment. However, the timing and intensity of these restrictions displayed unexpected patterns, both preceding and following the two significant waves of COVID-19 cases in Australia, with ‘lockdown’ being most prevalent during infection peaks. During periods of easing restrictions, language referring to these measures became vaguer, reflecting a gradual relaxation of stringent policies, while during phases of enforcing restrictions, more specific terminology like ‘lockdown’ was employed, indicating a heightened urgency in response to escalating transmission rates.

Conclusion

The linguistic choices made by the Australian media in their coverage of COVID-19 significantly shaped public perceptions and actions in response to the pandemic. By moving from initial, fear-inducing language to more neutral and consistent terminology like ‘COVID-19,’ the media played a pivotal role in stabilizing public sentiment and enhancing adherence to health directives. This strategic linguistic transition underscores the profound impact of media language on public behavior during a health crisis. This observation sets the stage for further research and development of effective communication strategies. By optimizing the linguistic approach in media communication, the aim is to enhance public understanding and cooperation in emergency responses, ensuring that the gap between expert recommendations and public behavior is effectively bridged.

References

Anastasia Tsirtsakis. (2020, July 10). Australia’s COVID-19 response may have saved more than 16,000 lives. https://www1.racgp.org.au/newsgp/clinical/australia-s-covid-19-response-may-have-saved-more

Berry, T. R., Wharf-Higgins, J., & Naylor, P. J. (2007). SARS Wars: An Examination of the Quantity and Construction of Health Information in the News Media. Health Communication, 21(1), 35–44. https://doi.org/10.1080/10410230701283322

Davies, M. (2019-). The Coronavirus Corpus. https://www.english-corpora.org/corona/

Gabriella Rundblad, & Chris Tang. (2015). When Safe Means ‘Dangerous’: A Corpus Investigation of Risk Communication in the Media. Applied Linguistics, 38(5), 666–687. https://academic.oup.com/applij/article-abstract/38/5/666/2952207?redirectedFrom=fulltext

Human Rights Watch. (2020, May 12). Covid-19 Fueling Anti-Asian Racism and Xenophobia Worldwide | Human Rights Watch. https://www.hrw.org/news/2020/05/12/covid-19-fueling-anti-asian-racism-and-xenophobia-worldwide

Munn, C. (2021). What’s In a Name: A Corpus Analysis of Australian Media’s Naming Conventions and Risk Communication During the Coronavirus Pandemic [Masters]. Monash University.

Oxford English Dictionary. (2020, July 15). Using Corpora to Track the Language of Covid-19. Https://Public.Oed.Com/Blog/Using-Corpora-To-Track-The-Language-Of-Covid-19-Update-2/

Stanaway, F., Irwig, L. M., Teixeira‐Pinto, A., & Bell, K. J. (2021). COVID‐19: estimated number of deaths if Australia had experienced a similar outbreak to England and Wales. Medical Journal of Australia, 214(2), 95. https://doi.org/10.5694/mja2.50909

World Organisation for Animal Health (OIE), & Food and Agriculture Organization of the United Nations (FAO). (2015). World Health Organization best practices for the naming of new human infectious diseases (World Health Organization, Ed.). World Health Organization. https://www.who.int/publications/i/item/WHO-HSE-FOS-15.1

If you enjoy the show, support us by subscribing to the Language on the Move Podcast on your podcast app of choice, leaving a 5-star review, and recommending the Language on the Move Podcast and our partner the New Books Network to your students, colleagues, and friends.

Transcript (by Brynn Quick, added 07/07/2024)

Brynn: Welcome to the Language on the Move Podcast, a channel on the New Books Network. My name is Brynn Quick, and I’m a PhD candidate in Linguistics at Macquarie University in Sydney, Australia.

My guest today is Dr. Ella van Hest. Ella is a postdoctoral research associate at Ghent University in Belgium at the Department of Translation, Interpreting and Communication, where she is a member of the MULTIPLES research group. She is also affiliated with the interdisciplinary Centre for the Social Study of Migration and Refugees, also known as CESSMIR. Her research interests include language and migration, multilingual communication, (non-professional) interpreting, and language policy. Her previous research for her MA focused on the effects of Flemish language and integration policy on adult newcomers to Belgium.

Today we are going to talk about the research that she conducted for her PhD, which was a linguistic ethnography on language diversity at an abortion clinic in Belgium. The paper, which she co-wrote with July De Wilde and Sarah Van Hoof, is entitled Language policy at an abortion clinic: linguistic capital and agency in treatment decision-making and was published in 2023.

Ella, welcome to the show, and thank you so much for joining us today.

Dr van Hest: Thank you for inviting me.

Brynn: To start off, can you tell us a bit about yourself and how you became a linguist as well as what led you to wanting to conduct research into the language practices of an abortion clinic in Belgium for your PhD?

Dr van Hest: Yeah, sure. So actually, when I was 17 years old and I had to make a decision on what to study, I just knew for sure, okay, I want to do something for languages. Like at that point, I was not so reflexive or so aware of what linguistics actually was or what you could do with it.

But I really wanted to do something with languages. So I started Applied Linguistics, German and Spanish, and then into Dutch, which is my native language. And after that, I did a master’s in interpreting.

And well, as I said, at that point, I was not so aware of all the options within linguistics and all the sub fields, but it sort of started when I was doing my master thesis research that I really got interested in the link between language and migration, and especially what it is like for people who come to Belgium, for instance, or any other host society, so to speak. How is it for them if they are learning the language, which was what I focused on for my master thesis, or how is it for them when they don’t speak the language, they’re needing language support, which was then the focus for my PhD research. So that’s how I sort of got interested in that.

And then the fact that I ended up doing research on abortion care and linguistic diversity in abortion care in Belgium was sort of a matter of, okay, what is an unknown context, an underexplored context or setting to study language diversity, because we already know something about it in other medical contexts, for instance, but I thought, okay, abortion care is so relevant and so understudied. And yeah, that’s actually a little bit how I ended up doing that. And I’m also, I have to say, I’ve been very grateful for the clinic, the abortion clinic where I could carry out my research that they allowed me in and let me do that ethnographic research there.

Brynn: That’s what I found so interesting about your paper was the setting. The research that I’m doing for my PhD also looks at medical settings and how language is assessed and how linguistic proficiency is assessed and then how interpreters are then called or used or not used. That’s what was so interesting in reading your paper was that it was at an abortion clinic, which I personally haven’t come across before. But as you said, it is such an important setting where we do need to know more about what happens with language at this clinic.

And in the paper, you start off by talking about the language policy of that clinic where you were conducting the research. This particular institution’s policy said that a patient seeking a medical abortion needed to have a strong proficiency in Dutch, English or French.

Can you just tell us as listeners, what exactly is a medical abortion? How does that differ from a surgical abortion? And why did the clinic state that this language policy was necessary?

Dr van Hest: That was indeed the most important point of this particular paper that we’re discussing now, which was also published in the Journal of Language Policy. So, like the focus was really on that particular aspect of the linguistic diversity in the clinic, because I also focused on, as you mentioned, right, like using interpreters or not, or also conversational, interactional dynamics of multilingual counselling sessions.

But for this particular paper, the focus was on this language policy about medical abortion. So, what is medical abortion? Well, in Belgium and also in a lot of other countries, but there are some differences, but in Belgium, usually women, when they want to terminate the pregnancy, they can choose between two different treatment types.

And one is a medical abortion and the other one is surgical. And the medical abortion, which this paper is mainly about, consists of taking several pills, medication. Usually this is done in two phases, but again, there are differences in approaches and in other countries, sometimes they only use one type of medication or they do it in a different way.

So, but the situation in Belgium is that usually women first take medication that blocks the pregnancy hormone. And then later on, like two days later, they have to take medication that actually will make the uterus contract and cause a miscarriage. So that’s one treatment option.

And that’s very different from a surgical abortion where it’s actually a doctor who performs the abortion, who empties the uterus via a suction, like a suction aspiration. And so those are two completely different types of treatments. And there’s some factors that influence eligibility.

For instance, pregnancy duration. And here there’s differences between countries, but in Belgium generally, they limit it until about eight, nine weeks of pregnancy. Because after that term, the foetus is larger and it could lead to more complications.

So, a surgical abortion is preferred. And then there’s also all other kinds of medical or psychosocial factors that could influence the decision for which treatment. But, and that’s the main point of this paper, in this particular clinic, also language plays a huge role.

And it’s actually a little bit complicated, so maybe bear with me. The whole point of this medical abortion, as I just explained, it’s about taking medication on two different days and it’s about your body causing you to have a miscarriage. And it’s really a whole process of managing, it’s a woman who has to sort of do the work.

There is a small risk of complications. It’s very small, it’s a very safe procedure in general, but something might happen, and usually that’s excessive blood loss. But in any case, these complications might occur.

And especially since COVID, there’s a lot of emphasis on making sure that the clinic can follow up while women are doing this treatment at home. So, before the pandemic, that’s also, I didn’t specify that earlier on, but a large part of my data collection was during the pandemic. Before the pandemic, the clinic made sure to sort of plan the two phases of the medication in the clinic.

So, women would have that miscarriage in the clinic usually, but also there, there was sometimes, the problem sometimes was that the miscarriage did not happen in the foreseen timeframe. And so, they reserved a certain time slot for women to be in the clinic to have that miscarriage, but then in some cases it didn’t happen. And then they sort of, they had to send her home and say, look, okay, you’re going to have this miscarriage at some point during the day.

In case there’s anything wrong or you have questions, you need to call us on this phone number. And so that’s where phone communication, verbal communication comes in and that’s where language starts playing a key role. And during the pandemic, the clinic decided sort of as a measure to limit the amount of people present in one physical space, right?

They said, okay, let’s do all these miscarriages from home. So, like, let’s have the women manage the miscarriage from home all by themselves, but with telephone backup, right? So, it’s sort of almost like a kind of help line to call the clinic, but not even just a help line.

Like they were actually also really supposed to call the clinic between a certain timeframe during a treatment to update them. Like how is it going? How is the blood loss? How is the treatment going?

And so, with that in mind, the clinic said, okay, this is too complicated when there’s a language barrier. When we cannot understand each other, it’s very hard for us to assess, are these cramps normal? Is this too much blood loss or is it a normal amount should we send this woman to emergency care or not? Yeah, what is she feeling? How is she doing?

And so, to ensure safety, the clinic said, okay, look, if there’s too much of a language barrier, we don’t offer this option. And as you mentioned, Dutch, English and French are the three languages which are allowed, so to speak, to have the medical abortion. So, if a woman has some or enough proficiency, whatever that is, because the definition of what exactly is enough proficiency is not that clear-cut.

But in any case, she needs to have proficiency in one of those languages. And that’s a logical consequence of the linguistic reality in Flanders, which is where I carried out my research. So in Flanders, Dutch is the official language, mother tongue of all the staff working in the clinic.

But since we’re in Belgium, and French is another official language, many of the staff also speak some French. And then there’s English as the global language that everyone in high school learns and is supposed to know or have proficiency in when they look for jobs and so on. So those three institutional languages, so to speak, are okay for being eligible for a medical abortion.

It’s quite complicated. It has to do with safety and the unpredictability as well of the medical abortion. Perhaps I did not emphasise that enough before, but I talked about the small risk of complications, but there’s just also a general unpredictability in the sense that with surgical abortion, you know upfront very clearly, treatment is going to happen like this and it’s going to take about 20 minutes.

Whereas with the medical abortion, for some women, this miscarriage happens within three, four hours. For others, it can last up to even 24 hours. So there’s a very high variation in how smooth it goes, also in terms of pain, like some women experience like bearable cramps, others have a lot of cramps, a lot of pain.

And so that’s why it’s so hard to manage. And that’s why communication plays a key role for this clinic.

Brynn: And it’s really interesting that what you mentioned about the communication on the telephone being so important, and especially in this sort of post-COVID world, and like you said, collecting this data during COVID, all across the world, we all know that medical centres kind of had to make a lot of choices. Whether you were in a hospital or a GP or an abortion clinic, anything like that, there was this real reduction in the number of people who could come into the medical centre. And so that’s what is fascinating in this paper, is the amount of telephone communication that needs to be happening in this circumstance.

And kind of on that note, a really interesting piece of data that you uncovered in your research was that this staff at this clinic seemed to be kind of unaware of the potential for using telephone interpreters with their linguistic minority clients. And that non-professional interpreters, or what we might call ad hoc interpreters, such as the client’s family member, were often used to facilitate communication, especially for the psychological counselling aspect. Can you tell us about why the clinic had not made the use of professional interpreters more of an institutional policy?

Dr van Hest: Yeah, of course. And I think I have to also nuance here a little bit or give some background information. First of all, you mentioned that sometimes they use non-professional interpreters, like the client’s partners or relatives or friends, like a person they brought along to the clinic with them for language support and other types of support.

And so perhaps I should explain here that in Belgium, women, when they want to terminate the pregnancy, they first need to receive counselling, like the first appointment. And then they have to sort of do this session with an employee of the clinic, which can be a psychologist or a nurse or social worker to sort of see, you know, are they sure that they want the abortion and then explore a bit the context. There’s usually also the whole explanation of the treatments, you know, like what to expect.

And, you know, also this decision-making usually when they’re eligible for both. And contraceptive counselling. So that’s sort of this first session.

And then, and then that’s stipulated by Belgian law, women have to wait for six days before they can have their actual treatment. Yeah, so then during that first appointment, it’s the second appointment for the actual treatment is then scheduled. And so, it’s during those counselling sessions that they do sometimes use professional interpreters. I have to say rarely, but I mean, there were staff who offered this option. I sometimes saw it happening. It was not the majority of cases while I was there for sure.

But very often this person that the client had brought along would act as the interpreter during that consultation, that counselling session, let’s say. But then this medical abortion and then this whole fact of, you know, it has to be followed up on by telephone. There, indeed, as you mentioned, I noticed while interviewing staff that they were not really considering to use telephone interpreters and that they were not really aware of the technical option to do so, so that you sort of have like this three-way telephone conversation.

But what they also mentioned, and that’s actually true, looking at the numbers of interpreting services in Flanders, is that there’s just a shortage of certified interpreters. And especially in terms of what I just explained about this unpredictability of the medical abortion, the clinic says, yeah, look, even if we would know how to technically do this with telephone interpreters, we’re still not sure that there’s actually an interpreter available at that point, because we never know when the client is going to, if she’s going to call us, if so, when she’s going to call us to ask about certain problems or complications that she’s experiencing. So that unpredictability aspect is still there, despite, I mean, even if you would have the technical knowledge to connect an interpreter on the phone.

And then what I perhaps should also explain is that in this particular clinic where I carried out my research, it was just one, like it didn’t visit various clinics in Flanders or in Belgium for that matter. But the majority of clients is, well, let’s say, I mean, I have difficulty using the word native, but you know what I mean? Like there’s usually like not really a huge communication barrier.

And there’s sort of like this minority parts of the clientele with whom the staff need to find ways to communicate. So perhaps it’s also, I can imagine, for instance, settings where clinics, where there’s a higher amount of migrant clients or that have a very specific target audience, for instance, where they would be more aware of and more explicit about language. But that was not really the case here.

And then in general, the use of interpreters. So even, let’s say for the counselling part, leaving aside now the medical abortion for a moment. Also there, I noticed, I mean, they have the infrastructure, they do sometimes offer, I mean, they have like this agreement with the certified interpreting service.

What I saw there was a lot of differences between staff members in terms of how familiar they were with the options of how to book an interpreter, how to make the phone call, what to ask, what to do when you’re doing a consultation with an interpreter. And yeah, also just like personal preference. Like there was a lot of discretionary power for staff to sort of decide what they wanted to do about it.

But I have to say that actually now I’m still in touch with people from the clinic where I conduct my research. So, I finished my PhD in October last year. So now I’m sort of seeing with them how we can make the findings of my PhD usable, like having really practical relevance for them and to sort of help them with decision-making aids on when to use an interpreter or when not and this kind of thing.

So, I do have to say that being there as a researcher, as an ethnographer, as an observer, this language awareness and awareness of using interpreting services did sort of grow. Yeah.

Brynn: And that part that you were just saying about it being so discretionary and how the decisions would sort of differ between staff members about, does this person have enough language proficiency to be eligible for a medical abortion or no, they don’t have enough language proficiency. They need to only be able to get a surgical abortion. That was really, really fascinating to see that there wasn’t sort of this, you know, assessment checklist or anything like that, because I’ve come across that in my research as well, that really having some sort of a concrete step-by-step process of this is how you assess a patient’s language proficiency, it doesn’t exist in that many places in the world.

So it was interesting to read in that context that that was happening for you too. And I’m really glad that you mentioned about how you as a researcher and ethnographer, sort of the research that you’ve conducted has now potentially led to some effects, which I want to get back to that. I want to hear about that in a minute.

I do want to come to one point in the paper because it stuck out to me. In the paper you say, and this is a quote, among the diverse group of clients in the clinic, a social order or stratification becomes apparent due to the linguistic capital that is unequally distributed.

Talk to us about what you mean by linguistic capital because not everyone who listens to us is a linguist. They might not know what this concept of linguistic capital is, but how did that capital affect the clients from different linguistic backgrounds?

Dr van Hest: Yeah, okay, so linguistic capital, we’re really entering into sort of the theory of social linguistics now, right? So basically, what’s the most important to understand that that’s sort of the viewpoint for which I look at language is that it’s a very social thing. Language can be a regulator or an enabler.

It’s like a resource for people to use. Language allows us to act as social human beings, you know? And this concept of language capital or linguistic capital, which was coined by the French sociologist Pierre Bourdieu, is sort of a concept that helps us to see how language functions as a form of social power or within the framework of Bourdieu.

It’s a kind of cultural capital that gives you access to certain spaces in society and that has a certain value, and that’s the most important. So that’s also the linguistic capital. So Bourdieu theorized it as this kind of economic metaphor, like some languages are more valuable on the market than others.

So yeah, that idea of his has then been sort of picked up by social linguists, and then nowadays we also see this more as a dynamic. We use the concept to sort of also unpack the dynamics of how do these processes of differentiation come about and so on, whereas with Bourdieu it was a little bit more like static, there’s a certain value or not, whereas nowadays we sort of also look more like how do linguistic resources travel, right? That’s an idea of Jan Blommaert, this idea that your linguistic capital or your resources may be valuable in one place, but then when you go somewhere else, they’re not, or they’re only valuable in certain contexts or domains of society.

So yeah, that’s a little bit what linguistic capital is about. I mean, in a nutshell, right? I am sure there’s others who would explain this so much better than I do now, but I sort of found the concept useful to discuss what was going on in the clinic here because it sort of seems like certain clients in this abortion clinic, when they do have the linguistic capital, they have the free choice to choose between medical and surgical abortion, which is often also important emotionally, because there’s a difference between the clients in the clinic in that they have different linguistic capital, and if they dispose of the right linguistic capital, it sort of allows them to freely choose between medical or surgical abortion, which are two completely different ways of experiencing an abortion.

So, there’s this emotional aspect to it. And it also goes beyond the choosing between the two treatment types. I’m also thinking about looking up information on the website, for instance, before they actually go to the abortion clinic.

Also, the website is available in Dutch, French and English of this abortion clinic. And so, you sort of have this difference in which linguistic capital you can, or how much your linguistic resources are worth in that setting. And Dutch, English and French are highly valued because they allow for you as a client to be cared for when you’re at home doing the medical abortion and the clinic is talking to you on the phone. So that’s what it’s about, actually.

Brynn: It’s really evident in the paper, and that’s something that I found really fascinating, was this idea of choice and how somebody who comes in with that linguistic capital of speaking or having, quote, high proficiency in French, Dutch or English, they are going to have a choice. They’re going to a certain extent, obviously. At a certain stage of the pregnancy, they’re going to have a choice if they want to do the medical abortion or the surgical abortion.

And you’re right. It can be an emotionally trying decision or time. And to give a person a choice in that type of situation does mean a lot.

And like you said, if someone is deemed to not have that proficiency, then that choice is kind of automatically taken away. And their treatment option is chosen for them. And in the paper, towards the end of the paper, you discuss a concept called exclusive inclusion, which was written about by Roberman in 2015.

What does exclusive inclusion mean? And how did you see it play out in the language policy at this clinic?

Dr van Hest: Yeah, so this concept, exclusive inclusion, refers to a kind of exclusion, but not the exclusion that we typically think of in terms of completely discriminating people or not allowing them access to crucial spaces in society or crucial services or means. So, what Roberman explains is that when we look at inclusion, exclusion dynamics, we should look beyond material sufficiency and sort of like her paper is also titled, not to be hungry is not enough. So, it’s like it’s not just about making sure that people can buy food and that they’re not living in poverty.

It’s also about making sure they can actually participate in spaces, practices that are socially relevant. Yeah, that are, as she describes it, it’s about access to social resources of real value and to participation in the arenas of social recognition and belonging. So, in terms of the abortion clinic and why I found the concept applicable in this case is because I thought, well, these women for sure also receive good abortion care.

They’re helped by this very engaged team of practitioners, which I also really want to emphasise. They were so engaged. They were so helpful. This whole policy was also thought of for their safety, right? So, it’s like out of genuine concern. And they receive good care.

They’re helped in a timely manner. You could actually even say that the surgical abortion is sort of, I mean, and there’s definitely discussions about that, but I mean, it’s sort of like, I talked about this unpredictability, right, of the medical abortion, whereas, you know, with surgical abortion, you know, like, okay, it’s that day. It’s going to be just 20 minutes, then it’s over. It’s immediately checked with an ultrasound and so on. It’s like sort of, I mean, it is a good abortion care. It is a good abortion treatment.

So, they’re not excluded, but they are exclusively included in the sense that they don’t have the same level of participation. They don’t have the same level of choice. When you compare them to other clients who did possess or do possess the right linguistic resources.

So that’s for me what the concept is about.

Brynn: Yeah, it’s all about that choice, right? It’s saying that, okay, well, this group of people can have a choice. This group of people is still going to get good treatment, but they can’t have the same level of choice as the other group of people.

And you do in the paper, you really do a great job, I think, of taking great care to mention that this abortion clinic really did create this language policy from a place of genuine precaution and medical care for its clients. And you mentioned that it’s been reconfiguring other policies to reflect its linguistically diverse clients. You do reflect that it could do more to make medical abortions accessible to clients of all linguistic backgrounds.

And maybe that circles us back to what you had sort of hinted at before, that you’re working with that particular clinic now and talking about what the clinic could do to facilitate that. Are you able to tell us anything that you’re working on in that space now with the clinic?

Dr van Hest: Yeah, sure. So, first of all, again, I cannot stress it enough that this clinic where I studied the language practices, I mean, I do adopt sort of a critical stance in the paper, of course. I mean, it’s a critical social linguistic endeavour, but they were so engaged as a team.

And so, I remember their literal wording about their clients, also talking to them on the phone, such as, I’m worried because, you know, like they’re really, they really want to just make sure that they’re safe. And it’s also a matter of responsibility, obviously, like legal responsibility, you know, like as a clinic, they’re responsible for making sure these abortions happen in safe circumstances. And, you know, as soon as that cannot be fully guaranteed, they have to be very careful with that.

But then, yeah, again, you could say, OK, this is safety and these safety concerns are justified, but the safety structure or the sort of securitizing structure that’s now in place, fully relies on verbal communication. And I think that’s something that they, where they might rethink the possibility, like the role of communication, perhaps with the use of technology, perhaps making sure there are some visual aids with which clients could, I don’t know, indicate the levels of pain they’re experiencing or the amount of blood loss or something like that. I don’t know.

I mean, of course, it’s not a quick solution that’s available for us, but rethinking the need for verbal communication and thinking about alternatives, I think. And then perhaps I should also mention here that it’s not only telephone follow-up, like on the day where women are self-managing the miscarriage. There’s also an important aspect, communication aspect, to the counselling or to the, let’s say, when women come to the clinic to receive their first medications.

Remember, I explained, first they take medication that blocks the pregnancy hormone. So, when they come for that first medication, that’s done in the clinic because at that appointment, they also receive all the instructions for them managing the miscarriage two days later in their homes. And so those instructions are also really detailed.

You know, it’s like it’s two pages with written instructions, which are again available in Dutch, French and English. And that then usually nurse goes over and explains point by point, like you should be careful for this or when this happens, this is normal, when this happens, this is not normal. Then you should call us, then you should go to emergency care.

You know, like all this kind of, also the schedule, like when to take the medication, how many pills, which pain medication can you take and when and so on. So, they’re like quite complicated instructions. And also on that part, the staff is worried in terms of language, like that clients might not understand fully how they should then perform the abortion themselves.

But there, for instance, I think you could work with translated or multilingual video instructions or translated materials in any kind of way. And then to answer your question about sort of what I’m working on now or talking about now with the clinic is that they actually do have these videos explaining the different treatment types and again, available in Dutch, English and French, but they are considering to on the long term having those translated as well to, I would say minority languages, but I mean, languages that a considerable part of their clients speak. So that I think would be one step where you sort of have like the all the control over the process of explaining the instructions.

But then again, the telephone follow-up from a distance will remain an issue. Now, one of the ideas that I’m currently discussing with the person responsible for the clinic, like coordinator, is to understand how abortion practitioners abroad deal with language diversity when offering medical abortions. Because, I mean, generally, as we were mentioning, as we were discussing in the beginning, there hasn’t been that much attention for linguistic diversity in abortion care.

And I mean, abortion care generally, it’s like, as I said, the linguistic aspects of that are quite understudied. And so, I would love to set up a study to investigate how the medical abortion is dealt with abroad. Because I think, and as I mentioned in the beginning, there are some differences between different countries.

And whereas in Belgium, you still sort of have like very high, I mean, majority of the performed abortions are still surgical abortions. But there is an evolution towards more medical abortion that’s ongoing. Like, I think in like 10 years or so, the amount of medical abortions doubled.

And so, it’s really some more and more often chosen treatment type. And so, I think it would be very interesting to see, okay, in countries where this medical abortion is already more common. I mean, it’s impossible that they don’t face a linguistic diversity among their clients.

So how do they do it? And what could be learned from them? Which best practices are there that could be applied also here?

Brynn: That would be really interesting to be able to do that type of research with other people abroad. Because you’re right, it really does differ country to country. And I would be so fascinated to hear what you learn.

And I love that idea of the potential for video instructions. It reminds me of a paper that I read for research that I did that talked about translated discharge papers like from a hospital. They found that the patients that needed it translated into other languages sometimes also had low levels of literacy in general.

And they found that it was easier to actually audio record the discharge paper instructions. And they were able to put it into… Have you ever seen those greeting cards where you can open them and they’ll play a song?

Dr van Hest: Right, yes, yes. Yeah, yeah. Like birthday cards?

Brynn: Yeah, like birthday cards. So they were able to record the discharge instructions onto these cards where you would open it and it would play the instructions for you. And so obviously something like that wouldn’t necessarily work in this type of a medical situation, but kind of what you said, just sort of thinking outside the box, reconfiguring things, making things different than they have been potentially could be a solution.

Other than this really, really interesting postdoctoral work that you’re doing, is there anything else that’s coming up for you? Any other projects that you’re working on or anything that your research group is doing that you find interesting that you’d like to talk to us about?

Dr van Hest: Yeah, so as you mentioned in the beginning, when introducing me, I’m now a postdoctoral research associate here at the department. So, I’m not really working currently, I’m not really working on the abortion topic, but I do hope to sort of find ways in the near future to develop the ideas I have now and sort of collect more data. But what I am working on now is on something completely different.

Nothing to do, it has nothing to do with abortion, but it is still about language and migration and linguistic diversity in institutional settings. But I’m currently working on a project which is very applied, very practice oriented and which is called MATIAS, which stands for Machine Translation to Inform Asylum Seekers. And the idea is that we develop a prototype of a notification tool, a multilingual notification tool that can be used in asylum centres, in asylum reception centres.

So, we also work together very closely with the federal agency, the Belgian federal agency for the reception of asylum seekers. And so, I’ve been visiting various reception centres for data collection in the past year, because what we want to do with this tool is it’s going to be a tool that will allow staff working at reception centres to sort of to update and inform residents about activities and practical stuff, things that are going on in the centre. Like, oh, apologies, the water will be shut off between four and five tomorrow because they’re going to come and do some works.

Or don’t forget, tomorrow we have this activity at 8 p.m. Please join us, something like that, because that’s often very rapid communication or it’s not always feasible to translate that in so many different languages. And obviously in asylum perceptions facilities, there’s a lot of linguistic diversity. And the idea is that the tool would then allow staff to just write that message in Dutch, English or French.

Again, we have those three dominant languages there. And that then the system will translate and send out the messages in the right language to the residents who would then receive the message on their smartphone. And then, you know, one resident would receive that same message in Arabic and the other one in Turkish, for instance, and another one in Pashto.

And so that’s the idea. So, something completely different, very, very practice oriented, very practical, very applied. But it’s really, it’s a lot of fun and it’s my first steps in the field of machine translation as well and language technology.

So that’s fascinating. And then on the sides, I am obviously still developing my ideas on the data I collected for my doctoral research. And also, this whole phenomenon of nonprofessional interpreting really caught my attention when I was doing my PhD.

So, they have like these clients bringing in relatives or their partner or a friend, someone close to them for language interpreting. And what we see in interpreting studies is, I mean, there’s already a lot of research going on that takes this very interactional and institutional point of view. Sort of like, OK, in this particular setting, you have these people coming and going.

And I’m very fascinated to see how those interpreters, those nonprofessional interpreters, so to speak, how they sort of make sense of that and also of their own role and how does that differ when they go from one setting to the other and so on. So, I’m working on something to hopefully in the near future research that. And yeah, I’m also working together with my colleagues on collecting work that deals with nonprofessional interpreting and sort of trying to really get this contextualised perspective.

Like, who are these people? What are the institutional, interactional expectations to sort of shed light on all these different kinds of nonprofessional interpreting practices and different kinds of nonprofessional interpreters? So yeah, that’s sort of something that really became a topic of interest for me research wise.

So yeah, and then we’ll see what the future brings and what I can get funding for and so on. It will also depend a little bit on that. The connecting thread for sure is always language and migration, linguistic diversity in institutional settings.

So, I will continue to be working on that, yes.

Brynn: Ella, your work sounds so cool. Massive congratulations to you for finishing your PhD last year. As someone who has just started on her PhD, I’m looking at you and thinking, okay, I can do this. She did it. We can do it.

Dr van Hest: It’s so exciting for you. You still have the whole trajectory ahead of you. So yeah, enjoy it, I would say as well. It’s so fascinating.

Brynn: Exciting and scary, but also very awesome. So, all of the things. Ella, thank you so much for taking the time to talk to me today, to talk about your work. And I can’t wait to hear where your work goes from here.

Dr van Hest: Thank you so much again for having invited me here today. It was amazing to talk to you.

Brynn: And thank you for listening, everyone. If you liked listening to our chat today, please subscribe to the Language on the Move podcast. Leave a five-star review on your podcast app of choice and recommend the Language on the Move podcast and our partner, The New Books Network, to your students, colleagues and friends.

Until next time.

Flag for autism rights (Image credit: Deviantart)

In this post written for autism acceptance month, autistic anthropologist Gerald Roche discusses connections between the communication styles and life expectancy of autistic people, and encourages sociolinguists, linguistic anthropologists, and applied linguists to help work towards a better life for autistic people. 

Content warning: This post discusses suicide, sexual and physical violence, discrimination, and negative attitudes about autistic people. If you are in Australia and find this post distressing, you can call Lifeline on 13 11 14 or chat online. Lifeline offers language support services. For non-urgent information about autism, call the Australian national autism helpline on 1300 308 699.

***

Hi I’m simply dying to speak to you! I have so much I want to tell you about being autistic because I’ve learned so much since I found out that I’m autistic. I’d love to tell you everything I know but that would probably take too long, so let me just tell you one thing about being autistic. Let me tell you why I went online and searched up “autism life expectancy” soon after I was diagnosed.    

Around that time, I’d just published an article examining how linguistic minoritization reduces life expectancy. To write that article, I’d been reading across literatures in the anthropology of violence, genocide studies, and critical public health for several years, learning about how different minoritized populations are subject to structural violence that produces a ‘slow death’ and reduces their chances of living a long, healthy life. This creates ‘death gaps’ in the social fabric, where the ultimate benefits of privilege are additional years of existence. So when I found out that I was autistic, I had a sense that I might be living in a death gap. And I was right. 

Autistic people in Australia, where I live, have a life expectancy 20 years below the national average. Similar findings have been produced elsewhere. Studies from the UK, USA, and Sweden all show that autistic people die alarmingly early. A recent study in The Lancet has suggested that the ‘death gap’ might be closer to 7 years, showing that the figures are still being debated. But, the pattern of severely reduced life expectancy seems clear. Why is this, and what does it have to do with language?      

First, it’s important to understand that differences in communication styles and preferences are central to how autistic people experience the world. Whilst autistic people don’t speak a different language from allistic (non-autistic) people, our communicative practices are vastly different from those of allistic people. The differences are found across multiple areas of language, including acquisition, gesture, pragmatics, lexicon, and preferred modalities. Failure to acknowledge, accept, and accommodate these communicative differences plays a crucial role in reducing autistic life expectancy. 

The most direct connection between autistic communication and premature death relates to health communication. Autistic people experience increased rates of multiple chronic health conditions, including physical health problems across all organ systems, as well as increased rates of multiple mental health issues, such as anxiety and depression. The impacts of all these health conditions is multiplied by failures to accommodate autistic communicative styles and preferences in healthcare settings. For example, one study from 2022 found that many autistic people struggle to make doctors’ appointments by phone (we generally have a strong preference against using phones), and then experience difficulties communicating with doctors, often feeling misunderstood. A 2023 study from Australia found that autistic people frequently felt that healthcare providers did not take their concerns seriously. These communication issues potentially result in delayed treatment, undiagnosed conditions, misdiagnosis, healthcare avoidance, and other problems that lead to poor health.  

Beyond issues of health communication, there are also more diffuse links between communication and the premature death of autistic people. To understand these, we need to think about autistic people as a minority group who experience “exclusion due to discrimination, stigma, and their perceived inferiority.” Since communication is part of what makes us different, it is also part of what makes autistic people vulnerable as a minority. 

Like other minoritized groups, autistic people experience personal and systemic discrimination from the dominant population. The press typically reports negatively on autistic people. Derogatory views of autistic people circulate openly online. Allistic people find us to be deceptive and lacking credibility, in part because of our ‘low quality and inaccurate’ facial expressions. They judge us as less likable, trustworthy, and attractive than allistic peers, and have reduced interest in pursuing social interactions with us. Even when allistic people express explicit positive views of autistic people, psychological testing shows that their behavior is guided more by their implicit negative views. Exposure to such bias and stigma is ‘constant’ for autistic people.

Rather than simply experiencing bias and stigma in the abstract, they manifest in our lives as violence. This begins in childhood, with autistic children experiencing much higher rates of multiple forms of violence than their allistic peers. This continues into adulthood, with autistic people experiencing higher rates of several forms of violence, including sexual harassment, stalking and harassment, sexual violence and physical violence, producing a condition known as poly-victimization. One recent study found that 99.6% of autistic adults had experienced at least one form of violence. Autistic women suffer disproportionately: in one study, nine out of ten autistic women reported being victims of sexual violence. Surrounded and overwhelmed by this violence, many autistic people normalize it as an inevitable part of our life, and even blame ourselves for it. 

Allistic people are able to target us for discrimination and violence in part because our communicative difference makes us visible to them. Perhaps not surprisingly then, many autistic people engage in ‘masking’ or ‘camouflaging’ – suppressing visible signs of autism, such as stimming, and changing our communicative practices to be more acceptable to allistics. However, this only defers the direct and immediate harm of allistic discrimination and violence. In the long term, masking is bad for our mental health, leading to higher levels of depression and anxiety, as well as lower self-esteem. It also contributes to autistic burnout, a debilitating condition characterized by “exhaustion, withdrawal, executive function problems and generally reduced functioning.” 

Masking, discrimination, and violence accumulate in a form of ‘minority stress’ in autistic people that results in “diminished well-being and heightened psychological distress.” In research carried out with other minoritized populations, the impact of such chronic stress on the body has been described as a ‘weathering’ that reduces overall immune function and leads to higher incidence and severity of disease. Chronic discrimination and violence thus harm autistic people both physiologically and psychologically. 

But perhaps the most distressing and tragic impact of this violence and discrimination is autistic people’s increased risk of suicide. Numerous studies show that autistic people are more likely to think about, attempt, and commit suicide; a 2023 meta-review of this literature concluded that “suicidality is highly prevalent” in the autistic population.

When I look at all this information as an autistic person, even though I’ve only learnt the statistics recently, none of it is particularly surprising. It more or less accords with my own lived experience. However, when I look at this information as a researcher, I am surprised: not so much by the information itself, but by who produced it and how. 

We are looking here at a population that is minoritized, in part, because of communicative differences. They are then subjected to discrimination and violence, with tragic outcomes. Despite the centrality of language to this situation, research in this area is led primarily by psychologists, with some speech therapists, a few sociologists, and the occasional anthropologist. The cluster of allied disciplines that look at language and communication in relation to social justice, including applied linguistics, linguistic anthropology, and sociolinguistics, have so far had very little to say about this issue. 

It’s clear to me that our disciplines have a significant contribution to make here. We collectively know so much about the harms of language: slurs, labels, insults, jokes, and insidious discourses. We pay attention to the maldistribution of respect and resources to different language communities. We study how minoritization is produced and reproduced in everyday institutions, like schools, and how it enters into the most banal and intimate spaces and relations. We think carefully about how policy and practice stratify, exclude, and harm through and on the basis of language. And we also have plenty of ideas about what justice looks like, and the languages it uses. It therefore seems to me that we have an important part to play in conversations about what it really means to accept autistic people, and how to go about doing it. As a researcher, I know that we can, and as an autistic person, I hope that we will. Because right now, I’m dying to speak to you, and I wish that I wasn’t.    

Hospital corridor, by Sadami Konchi ©

In this episode of the Language on the Move Podcast, Brynn Quick speaks with Erin Mulpur about how hospitals can provide linguistic minority patients with access to interpreting services.

Erin holds a Master of Public Health and is the System Director at Houston Methodist Global Health Care Services in Houston, Texas, United States.

The conversation addresses the potential barriers to both communication and healthcare that linguistic minority patients may face in hospitals, as well as Erin’s 2021 paper Reducing Barriers to Language Assistance During a Pandemic which details Houston Methodist Hospital’s innovative use of a particular language assistance technology during the first waves of Covid-19.

This episode is a natural extension of Distinguished Professor Ingrid Piller’s chat with Dr Jim Hlavac, so be sure to listen to both episodes!

Enjoy the show!

This is early days for the Language on the Move Podcast, so please support us by subscribing to our channel, leaving a 5-star review on your podcast app of choice, and recommending the Language on the Move Podcast and our partner the New Books Network to your students, colleagues, and friends.

Artwork

The artwork in this post is from Sadami Konchi’s hospital collection. To learn more about Sadami Konchi’s art visit her website or follow her on Instagram.

Surgery, by Sadami Konchi ©

Reference

Mulpur, E., & Turner, T. (2021). Reducing Barriers to Language Assistance During a Pandemic. Journal of Immigrant and Minority Health, 23(5), 1126-1128. https://doi.org/10.1007/s10903-021-01251-2

Episode Transcript

Brynn: Welcome to the Language on the Move Podcast, a channel on the New Books Network. My name is Brynn Quick, and I’m a PhD candidate in Linguistics at Macquarie University in Sydney, Australia.

My guest today is Erin Mulpur. Erin holds a Master of Public Health and is the System Director at Houston Methodist Global Health Care Services in Houston Texas, United States. Today we are going to talk in general about her work with hospital patients from non English-speaking backgrounds, and in particular about the 2021 paper that she co-authored with Travis Turner entitled “Reducing Barriers to Language Assistance During a Pandemic”.

Welcome to the show, Erin. It’s lovely to have you.

Erin: Thank you so much, Brynn. I am delighted to be here today.

Brynn: So, can you start us off by telling us a bit about yourself? How did you become interested in working with hospital patients from non-English speaking backgrounds, and what kind of work do you do now?

Erin: Absolutely. So, I originally grew up in Montana, a state in the US, and I actually grew up on an Indian reservation. It was the Flathead Indian reservation, so the Salish and Kootenai tribes both lived on that reservation. At a young age, I had a deep, deep desire, instilled by my family, to be respectful of all cultures, and also a deep understanding that language is such a vital part to people’s culture. It’s their voice, it’s how they articulate themselves in the world, and when there isn’t a shared language, then it’s really difficult to connect.

Nurse, by Sadami Konchi ©

And so, at a young age that is definitely something that was a part of my life. Moving on, I went to graduate school and, you know, went to undergrad and then to graduate school, and ended up getting my Masters in Public Health after spending some time in Uganda working for a government-run hospital in Iganga District. And again, this focus on wanting to deeply understand other cultures, be respectful of other cultures, and understanding that language is such a vital part of that – it really led me into this role at Houston Methodist, where I am now.

So, what I do at Houston Methodist, I’ve been here for about 10 years, and I oversee our Special Constituent Management Program and also our Global Patient Services Program. So, what that means is that we have patients who travel from over 70 countries from around the world, speak multiple different languages, and they are facilitated by an amazing team here at Houston Methodist that I have the privilege to work with every day. And my staff come from over 30 countries from around the world. They speak so many different languages, and it’s this beautiful, diverse scenery where we have the ability to take care of patients from different backgrounds, different cultures here at out hospital because they travel to Houston for care.

And we also oversee our Domestic Language Program. So, when you think about it from a healthcare perspective, when a physician walks into a room and he notices that a patient does not speak English, he or she is not thinking, “Is this patient traveling internationally, or is this patient a local patient from our community?”. So, our team, my team, has the privilege to take care of both of those patient populations here at this hospital.

And for those who may not know as much about Houston, TX, we are the fastest-growing diverse city in the United States. So, over 40% of people over the age of 5 speak another language than English in our city, and so when you think about that, over 140 languages are spoken in our city. And when we just looked at our data last year, over 70 languages are spoken just by patients at our hospital. So, it’s so, so important to think about language assistance and think about making sure that patients understand the care that they’re receiving, and that is what I’m doing today.

Treatment room, by Sadami Konchi ©

Brynn: That is fascinating, and what an amazing opportunity to do that kind of work. That’s incredible. So, can you tell us what are some common barriers that patients face if they don’t have a high level of English proficiency and seek treatment at an English-dominant hospital? And this could apply at Houston, but it could also apply to where I’m coming from in Sydney, Australia.

Erin: Absolutely. Absolutely, Brynn. I would say that everything can be a barrier, honestly. When you think about patients navigating a website to a hospital – is the website available in multiple languages? If the patient is calling the call centre to schedule an appointment, is that call centre offering language assistance? Are there options to push for Spanish or Arabic or Vietnamese? What is that infrastructure around language assistance? So, I can say that everything is a barrier if it’s not thought about and intentional to make sure that you’re opening access to everyone, not just English-speaking patients.

And that’s what we see here at Houston Methodist, and that’s why we have created content that’s in multiple languages. That’s why we have our phone system that can be in multiple languages. We have so much infrastructure and technology because we know that if you don’t create that, then patients don’t have a voice.

Brynn: Absolutely, and I absolutely agree. And that brings us to your paper, “Reducing Barriers to Language Assistance During a Pandemic”. This is a fascinating paper, and if anyone has the chance to read it, I would highly recommend. So, can you tell us a bit about something called the Vocera Smartbadge? What is that, and how was your hospital already using it before the Covid-19 pandemic struck?

Erin: Absolutely, so our nurses, prior to Covid, had what is referred to as a Vocera Smartbadge. The way that I would articulate that is that it’s like a smart walkie-talkie where you can dial in, you have the ability to ask the device to call other departments and other services, and so it was really leveraged and utilised amongst the clinical team for patient care. So, if the nurse was in a room, needed another nurse, she could push the button and she could say, “Dial this nurse in this other room”, and so it had that technology and was utilised in that way prior to Covid. It was really helpful because it allowed a hands-free way to care for patients, but also have the ability to connect with other people on the care team.

Brynn: And I think for those of us who’ve been in hospitals before, we’ve seen this happen with handheld phones. We’ve seen nurses be in hospital rooms and call each other on handheld phones, so from my understanding, the Vocera Smartbadge is really kind of that same idea, but, like you said, hands-free, and it’s more voice command, voice-activated.

Treatment, by Sadami Konchi ©

Erin: Absolutely, so it can attach to the lapel or a jacket, and you don’t have to dial anything, you can push a button and you can ask the Vocera device to call into a directory that has already been created.

Brynn: Exactly, and so your hospital, during Covid-19, was able to use the Vocera Smartbadge in a really novel way to provide language services to patients during the pandemic. Can you tell us how that happened and what you observed?

Erin: Absolutely, so unfortunately, with the Covid pandemic, here in the US and in many other countries, we had a limited supply of personal protective equipment. So, I currently have staff who provide in-person interpretation. So, you think about any time an in-person, someone needs to go into the room and provide in-person interpretation, they would have to don and doff gowns. So, with the limited supply of PPE, really the goal was to just use PPE for people who were physically clinically caring for the patient to keep them safe. So, it was really a difficult time to think about, “How are we going to provide language assistance and still keep with that value of ours and making sure that our patients understand the care they are receiving, but not have enough PPE for our in-person interpreters?”

So, what we ended up doing is we ended up integrating our technology around language assistance. Over the phone interpretation was then embedded within that Vocera device to where a nurse who was in PPE, speaking with a patient who was limited English proficient, would have the ability to dial in an over-the-phone interpreter and that patient would still be able to hear, from the nurse’s chest, to that patient to be able to understand the care that they’re receiving, and receive care in the language that is needed to them. That was something that we were able to do. We were able to stand that up fairly quickly because we already had the Vocera device in action and already utilised across our system. It made it really, really easy for us to be able to do it once we were able to accomplish that.

What we found during some of the waves during the Covid pandemic, a few of the surges of patients, there was a large Latino population that ended up receiving care at our hospital that were Spanish speaking. So, it came right in the nick of time, I would say, for us to be able to have that in-person, that interpretation provided by the nurse between the patient and the nurse.

Brynn: And that’s so important because, part of the research that I’ve been doing has been looking into the disparities, the health disparities between majority language speakers and linguistic minorities. We know that there was a larger Covid-19 mortality amongst linguistic minority patients. So, the fact that you were able to integrate this technology could have made the difference, literally, between life and death for patients. So, that is fantastic that that was able to happen.

Patient, by Sadami Konchi ©

You mentioned this, this is something that I found really interesting in your paper, was that concept of the voice coming from the person’s chest because the Vocera Smartbadge was located on the chest, so it was almost like that interpreting voice was coming from the healthcare provider which, as we know, can sometimes be something that is tricky to deal with. When there is this, especially over the phone interpreting, or video interpreting, is this idea of distance between the person who is trying to receive the healthcare and then the healthcare provider. So, the fact that it was literally coming from the healthcare provider’s chest, I think, made it that much more valuable.

Erin: Absolutely, no you’re absolutely right, Brynn. When talking with patients and, you know, hearing their experience with that, they understood the limited amount of PPE, and they also understood and felt that that connection with the nurse and having that voice be so close to the person’s heart, it allowed it to be more intimate than it otherwise has been in the past with some of the technology that has been created around language assistance.

Brynn: Absolutely, thank you. Sort of shifting gears a little bit, what do you feel is something that people, generally monolingual English-speaking or Americans or, even in my case, monolingual English-speaking Australians, I know I don’t sound Australian, I’m originally American, obviously. What do you think is something that those people get wrong when they think of people from non-English speaking backgrounds who seek treatment in predominantly English-speaking hospitals?

Erin: That’s a great question, Brynn, and I would have to say that there’s a tremendous amount of unconscious bias that can occur in a healthcare setting, and even outside of a healthcare setting. It persists in the world that we live in, and so that unconscious bias can impact the provider, it can impact the patient, and so what I would say is – have no assumptions. Be curious. Always be willing to learn something new.

So, as an example, in the role I’m in, I work with patients who are coming from the Middle East, and there are Muslim men who come to our hospital for care, and I know that I’m not to extend my hand. It’s a sign of respect in US culture to extend your hand and to shake someone else’s hand, but in other cultures it’s not necessarily seen as respectful. So, that is something that I have had to learn and implement into my life and my routine. That’s the piece around monolingual cultures, I think it’s important to draw no assumptions. To be curious, and to be open to learning. And, when you’re open to learning, you’re also open to making mistakes. Once you’ve made a mistake because, maybe you find out that you have unconscious bias that you’re not aware of, change. Adapt. Evolve. Learn. Continue to grow. Be curious about other cultures.

Brynn: Absolutely, I couldn’t agree more. In your opinion, what can hospitals do to ensure that linguistic minority patients can access care in a language they can understand?

Patient, by Sadami Konchi ©

Erin: I would say, Brynn, that depending on where these hospitals are located – I know that not all hospitals are looking at this data. Maybe some hospitals don’t even have data to look at. So, you know, in our system, we have an electronic medical health records system, and we utilise EPIC. We’re able to see, based on how that patient is flagged within EPIC, we’re able to see if they need language assistance or not. So, we’re able to see that data, and we’re able to implement solutions and structure and infrastructure and policies around that.

For other hospitals, maybe there are some hospitals that don’t have that kind of access to data, and so what I loved about your paper, Brynn, is that you’re looking at what is the community? What is the language of the community that you’re serving? If you don’t have the data within your hospital, expand to your population. What languages are spoken in your population? Those people are coming to your hospital for care. So, what language programs and language assistance do you need to set up to make sure that these patients feel seen and valued and heard? That is something that I think is so important.

And if you don’t have that expertise, it’s ok! There are consultants. There are different organisations, I mean we have a consulting arm to our operations as well. We have the ability to come in and advise, but be ok asking for support and expertise outside if you don’t have that infrastructure created, because, ultimately, what will happen in any hospital setting, is if a patient receives care that does not share the language of the provider, and they consent, or they end up having a surgery, and they have some sort of complication that they were not aware of, the legal risks and the lawsuits that come from patients not understanding their care are so grave for organisations. So, first and foremost, providing language assistance is just the right thing to do. It’s just the right thing to do. If that’s not convincing you enough, there are major financial risks if you do not provide language assistance to patients.

Brynn: 100%, absolutely. So, before we wrap up, can you tell us what’s next for you and your work? It sounds like you all are doing some truly amazing work at Houston Methodist, and I would just love to know where you go from here.

Erin: Yes, so as you can hear from my history, I am a bridge-builder. I like to bridge people to have access and resources and understanding. So, I love the idea of building bigger bridges in the future so more people have access to care, more people understand the care that they’re receiving. I also believe that when you look at healthcare right now, it’s being so rapidly disrupted. There’s so much technology that is being pushed into healthcare. You see so much artificial intelligence as well being utilised in healthcare. That is where I see language assistance going next, but it could be leveraged. I do think artificial intelligence will be leveraged in a healthcare setting in the future and even with language assistance in the future.

But artificial intelligence will never take away from human connection. It will never take away from in-person interpretation and from a person being seen, heard and valued by a person who physically is there with them and is able to speak their language. But when you think about the amount of care that patients receive at a hospital – there’s nurses rounding on them, physicians rounding on them, specialists, respiratory therapists, occupational therapists – there’s all sorts of people that are part of the clinical care team that help that patient while they’re here. Being able to allow them access to multimodalities for language assistance just means that that patient is getting as much language assistance as they can while they’re at our hospital. So, I do see the bridge getting bigger and wider in the future, and I see technology being a big part of that. And that is really where we are looking in the future here at Houston Methodist.

Brynn: And I love that idea of, yes, there’s absolutely a place for these technologies that we’re seeing expanding and developing, but that, at the core, we as humans still need other humans. We need that human connection and interaction that human interpreting can provide.

With that said, Erin, thank you so much for speaking with us today. We really appreciate it, and I feel like our listeners have learned a lot. Thank you.

Erin: Wonderful, thank you so much, Brynn, it has been such a pleasure connecting today.

Dr Hlavac is a senior lecturer in the Monash Intercultural Lab in the School of Languages, Literatures, Cultures and Linguistics. He is a NAATI-certified and practicing professional interpreter and translator. NAATI is Australia’s National Accreditation Authority for Translators and Interpreters.

Dr Hlavac’ research interests relate to interpreting in healthcare settings, interprofessional practice with trainee professionals with whom interpreters commonly work, and the incidence of interpreting and translation amongst multilinguals and in multilingual societies.

In the conversation we explore how professional interpreters, language mediators, and language brokers help to support fair and equitable access to healthcare and other forms of social participation.

How does interpreting work in practice in a hospital setting? Who gets to interpret? How is the need for an interpreter identified? Who pays? What is the role of policy vis-à-vis bottom-up practice? Is the process the same for all languages? Will AI make human interpreters superfluous?

Enjoy the show!

This is early days for the Language on the Move Podcast, so please support us by subscribing to our channel, leaving a 5-star review on your podcast app of choice, and recommending the Language on the Move Podcast and our partner the New Books Network to your students, colleagues, and friends.

Further reading

Healthcare interpreting (Image credit: Sydney Local Health District)

Beagley, J., Hlavac, J., & Zucchi, E. (2020). Patient length of stay, patient readmission rates and the provision of professional interpreting services in healthcare in Australia. Health & Social Care in the Community, 28(5), 1643-1650.
Hlavac, J. (2014). Participation roles of a language broker and the discourse of brokering: An analysis of English–Macedonian interactions. Journal of Pragmatics, 70, 52-67.
Hlavac, J. (2017). Brokers, dual-role mediators and professional interpreters: a discourse-based examination of mediated speech and the roles that linguistic mediators enact. The Translator, 23(2), 197-216.
Hlavac, J., Beagley, J., & Zucchi, E. (2018). Applications of policy and the advancement of patients’ health outcomes through interpreting services: data and viewpoints from a major public healthcare provider. The International Journal for Translation and Interpreting, 10(1), 111-136.
Hlavac, J., Gentile, A., Orlando, M., Zucchi, E., & Pappas, A. (2018). Translation as a sub-set of public and social policy and a consequence of multiculturalism: the provision of translation and interpreting services in Australia. International Journal of the Sociology of Language, 251, 55-88.
Long, K. M., Haines, T. P., Clifford, S., Sundram, S., Srikanth, V., Macindoe, R., Leung, W.-Y., Hlavac, J., & Enticott, J. (2022). English language proficiency and hospital admissions via the emergency department by aged care residents in Australia: A mixed-methods investigation. Health & Social Care in the Community, 30(6), e4006-e4019.

Transcript (created by Brynn Quick)

Dist Prof Piller: Welcome to the Language on the Move Podcast, a channel on the New Books Network. My name is Ingrid Piller, and I’m Distinguished Professor of Applied Linguistics at Macquarie University in Sydney.

My guest today is Dr Jim Hlavac. Dr Hlavac is a Senior Lecturer in Translation and Interpreting at Monash University in Melbourne. Today we’re going to talk about language barriers in a diverse society and how they can be bridged through interpreting between different languages. Welcome to the show, Jim.

Dr Hlavac: Thank you very much for the invitation, Ingrid, and to be on the Language on the Move Podcast.

Dist Prof Piller: Maybe I should say servus and tell our listeners – Jim and I are old friends, and usually we would have this conversation in German because that is our main shared language. So, doing this in English is actually a bit unusual for us. Maybe, Jim, you can tell us a little bit about yourself. How did you get into interpreting?

Dr Hlavac: Well, Ingrid, it’s probably not uncommon for people in my situation to have been brought up bilingually, or with even three languages, but also mobility – living in different countries – being born in Australia but then going to the birthplace from my parents when I was 7.5. And then, going back to other places where I have relatives and friends, spending time in Europe growing up, then coming back to Australia. So, often mobility has been affected which has accounted for my acquisition of languages and also my use of them.

When I travelled again from Europe to Australia in 1995, I had done kind of ad hoc unpaid translation and interpreting work for others, and I decided I really should formalise my credentials. So, I attempted a test and passed it, and since then I’ve been a what’s called a NAATI – NAATI for those who don’t know – it’s the National Accreditation Authority for Translators and Interpreters – I’m a NAATI translator and interpreter, and I work across 3 languages – English, Croatian and German.

Dist Prof Piller: Thanks a lot, Jim. Jim, maybe can you tell us what a professional interpreter actually does? I don’t think everyone knows. I mean, it sounds very glamorous. What do you do?

Dr Hlavac: I’m glad it sounds glamorous. Some parts are glamorous, some parts are less glamorous. So, what you do if you’re a professional interpreter is that you should have training, which I do have. You should have credentials such as I have from NAATI. Basically, when you work with other people you are working with 2 or more people who don’t have another language. When you work with them, you interpret everything that they say or sign – everything – so you don’t leave things out. You don’t add things. You don’t distort things. You’re impartial. You’re neutral. You’re not on anyone’s side, regardless of who’s paying for you. If you do have a particular relationship with a particular party, that should be declared to the other one.

You also observe confidentiality. Often, interpreters work in situations where people are talking about quite personal or intimate details, and it’s important for an interpreter to observe that confidentiality and to not pass on to anyone else information of events happening in interpreting assignments.

Interpreters work sometimes on site face-to-face with others. Sometimes it’s remote by video interpreting facilities or telephone. We all know about COVID. Everything went remote. So, there are different modes that you can use to communicate with people. But that, in a nutshell, is what a professional interpreter does.

Dist Prof Piller: So, you’ve been stressing “professional” interpreter now, and I’m wondering about – I mean any bilingual can interpret, right? People who don’t have the qualifications you have can also go and interpret, so can you maybe tell us what’s the difference between a professional interpreter and a language mediator or language broker?

Dr Hlavac: So, Ingrid, lots of bilinguals do interpret. If you speak to some bilinguals, they’ll say, “I can’t interpret, and I hate having to do it,” so it’s not a natural progression. It is something else, but you’re right in that many bilinguals do, as a matter of course, do it within their families or circles of friends or whatever.

So, what distinguishes a professional interpreter from a mediator or a broker is the following. I’ve talked about a professional interpreter. A mediator typically is someone who has a different role. They might be a youth worker, a settlement worker, a social worker, housing worker or perhaps a guide at a hospital, etc. where their primary role is to do something else, i.e. to help a person find employment or housing or what have you. And they might do so using another language other than, let’s say, English in Australia, which is the dominant language. Sometimes they’re just having conversations in that language. Sometimes they might be working with an English speaker as well, in which case they do interpret. But they often don’t know or care to know that when they work as an interpreter relaying other people’s speech or signing, that they have to do so fully without distortion. They can’t add their 2 cents’ worth, so to speak.

So, there’s always an issue with a mediator that their own primary role gets in the way, or they’re advancing the situation of a person for settlement or housing, and often the linguistic skills that they have are questionable. Sometimes they can be good, but they haven’t been tested. They don’t see themselves as an interpreter. They don’t know about ethics, etc.

A broker is something else. A broker is typically a family member who is often pressed into service. Sometimes they put their hand up, but often they’re pressed into service. Often, it’s a child who, if the parents don’t speak English, let’s take Australia, is there to interpret what the parents say to an English speaker and vice versa. Classic situations are hospitals, maybe police stations, other places, etc. Now, a broker is a family member, and so although they might look like a person doing interpreting, what they’re doing, their primary role, is being a family member. They’re looking after their parent, or whoever it is. They’re advocating for their interests. They’re making sure that what they hear and what they say is conveyed to their advantage. They’re also available all the time. They understand the parents’ language very well, etc. They’re also available all the time, and they’re free. So, they sound like they’re really great people to use in these situations, and often they are.

But there are some pitfalls, and the pitfalls are that not every child wants to or should be in that kind of a situation. A child can never typically tell a parent how to behave, what to do, because the power relations are such that they’re there to simply hear what they’re told to do.

There’s also many cases of brokers intentionally or unintentionally changing things. Imagine in a healthcare interaction the parent says something and the child doesn’t quite understand or really fully grasp what it’s about and says what they think the parents says. They convey that into English, and so what the healthcare worker hears is a description of symptoms that are actually different from what the parent says. Or, conversely, they might not understand the healthcare professional properly, be too shameful or kind of shy to ask for repetition or clarification, and they tell the parent something else that they think they’ve heard from the healthcare professional.

So that can lead to misdiagnosis, forms of treatment being misunderstood or not followed, to quite embarrassing situations. Let’s say an adult has a particular health issue which is an intimate issue. Is it appropriate that the child is privy to that information, and are they really likely to convey that? And also, when you think about yourself, would you like to go to the doctor and have your brother-in-law sitting next to you and you’re divulging information about your medical history and expecting your brother-in-law or whoever it is to recount this accurately and correctly, and they’re not going to change things that the doctor might say to them? How does that affect your relationship with your brother-in-law afterwards if he’s privy to all these things?

Dist Prof Piller: Yeah, look, I’m sure there are many, many difficult situations, and you’ve probably got a huge amount of stories to tell us. You’re not only an interpreter yourself, you’re also an interpreting researcher. A lot of the research you do is in healthcare, and you’ve already started us on healthcare. I guess, by the sound of it, it sounded like you’re not a huge fan of language brokering, and you pointed out all the problems that there are with family members actually interpreting for other family members.

But at the same time, we kind of know that it happens, and so I guess I’d be curious to hear from you specifically about interpreting and language mediation and language brokering in the healthcare system. What are the main barriers that patients in Australia who do not speak English, or who don’t speak English well, what kind of barriers do they face in accessing adequate healthcare in Australia?

Dr Hlavac: Typically, they have a number of barriers. There are often low levels of health literacy. They don’t know the health system in this country. They don’t know what services are available or that they’re entitled to. If they don’t speak English fluently, then they might not know that they’re entitled to an interpreter in most healthcare interactions that they’re likely to have. If they don’t know that, then they’re not going to ask, or ask a family member to ask on their behalf.

So, the challenge is for healthcare workers to recognise that a person is unable to communicate effectively in English and to offer or to organise an interpreter on their behalf. I’ve done some research, and even amongst those people who claim that they do know that health interpreting services are for free, it’s often the healthcare provider who still ends up providing them. And it sounds silly, or sounds obvious, but often people with so little English don’t know how to ask for an interpreter. They don’t even have those skills sometimes. And if you haven’t got effective communication, then, as you know, as the healthcare professional, they can’t work out what the symptoms are, what the level of health literacy is. They can’t work out a diagnosis and things like that.

Dist Prof Piller: So, who actually has to ask? I mean, you’re saying patients may not know they have the right to an interpreter, or they may not know how to ask. What’s the role of the healthcare professional, or how does – if I go to the doctor and I don’t speak any English, how does it actually work that an interpreter comes in? How is that decided, and what’s the process?

Dr Hlavac: So, the process is that, if you go into a large hospital, particularly in a metropolitan area like Sydney or Melbourne, you’re likely to have front of house staff who knows that this is one of the questions that they would ask as a regular feature when they’re addressing you for the first time through triage or whatever. Now, if you can functionally express yourself clearly, fluently, then they’re unlikely to ask you, but they still might. So, they’re obliged to ask this question, “Do you need an interpreter?” or “What language would you like your healthcare services provided to you in?”, which is a kind of optimal question, you know.

So, it’s up to them, and there’s a lot of cultural competence training happening in hospitals. There’s a lot of information that healthcare workers learn through professional development through their respective professional associations – how to work with interpreters. There’s a lot of skilling up that has happened across, particularly, hospitals. GP clinics are not so skilled up very much. I’m tracking data that’s looking at use of interpreters by GP clinics. It’s lower. Aged care facilities are also lower, so we do have variation. They key thing is, often it’s the front of house person to make the diagnosis. If they don’t, though, the healthcare professional can make the call that this person, this patient, needs an interpreter. So that’s how it usually happens.

The other challenge is, I mentioned health literacy and what have you. There’s a lot of information that’s been translated as well. I know we’re talking about interpreting mainly, Ingrid, but here in Victoria, I’m based in Melbourne, there’s the Victorian Health Translations website, which is 28,000 translations of material related to healthcare across 150 languages. There’s a lot of information out there to advise people about healthcare conditions, and one of the challenges is the discoverability of these resources. How do you get to them? They’re there, but how does the person for whom they are intended actually access them?

Dist Prof Piller: I’ve been wondering about that a lot, actually, because they’re usually organised by language, right? So, if you’re not good at spelling the Latin alphabet, or if you don’t know the name of your language in English, it’s really hard to find that information.

Dr Hlavac: It is. Typically, it’s a family member often, a younger family member, I did talk about brokers, who can lead them there. But they also need to know about this existing. So we do have a challenge in the accessibility of this information to people we want it to reach. When you do get to that site, you’ll find that there’s not just written text there. They’re moving now to audio files as a way of conveying information to people because we have a lot of data to tell us that this is the way people like to consume health information. Not through written text, but through an audio file. And there’s audio plus video. So, the repository of translations in Victoria does reflect people’s preferred ways of reading or gaining information in other languages. And it’s also quality checked.

There’s a lot of work happening recently of, firstly, the translations being checked and sampled amongst communities. And secondly, when healthcare departments or healthcare facilities are looking to compose a document in English, let’s say about Covid or whatever, that they actually involve translators at the stage where the plain English version is developed in the first place. It’s very helpful if you can have translators as part of the group, working on them, so that when the translations are then developed you don’t have the issues of “What does this mean? Let’s rephrase this”, etc. So, there is a lot of work happening in this area to optimise health translations. But we’ll go back to interpreting because I know that’s your focus.

Dist Prof Piller: Yeah, well look, I mean translation is fascinating too, and that leads me to another question. How do we actually know which languages are needed? We can go back to the clinics, so the receptionist establishes that this person needs an interpreter, but how do they find the right interpreter? Or, going back to your translations, how do we actually know in which languages do we need to make available information about a particular condition, for instance?

Dr Hlavac: The big hospitals collect data on not only interpreter requests, but the languages that are being requested, and they direct their resources to employing interpreters either in-house or freelance for those languages which are in demand. But they could have, you know, within the catchment area of northern health here in Melbourne, they service residents across 150 languages. They also have data from the ABS. Every 5 years we have the census.

So, we do have a fairly fine-grained idea in each municipality or local government are, what the profile is of the languages of the residents there, and also the level of English proficiency. The census data, the census has a question – “If English is not your language spoken at home, what is your level of proficiency in English?”, right? There are 2 gradings – “not at all” and “not well”. When residents tick those responses, that’s pretty indicative that those are people that will need an interpreter. So, we’ve got some demographic data. We’ve got data from hospitals themselves to know which languages are needed.

In terms of sourcing the interpreters, yes, Ingrid, this is a challenge because for bigger languages we do have an ok kind of cohort of interpreters to fall back on, but for new and emerging languages like Rohingya, when Rohingyas started to arrive say, 5, 6, 7 years ago, Chaldeans 15 or 20 years ago, we had to quickly develop testing for potential interpreters for those languages. Then getting them out to be able to work in communities. Often, it’s a kind of chicken and egg situation where you kind of approach people who are community leaders and ask them if they know of people who have good language skills who might have been doing this before migrating to Australia. And to locate people who have the attributes that you’re looking for in a potential interpreter and supporting them through training.

Dist Prof Piller: Yeah, I guess one problem that also kind of relates to named languages, you know. I mean, in my own research I’ve encountered people who’ve said they needed an Arabic interpreter, but they actually needed someone with Sudanese Arabic but then got someone with Lebanese Arabic and it was really, really difficult. The interpreter couldn’t really understand them. Or there have been all these media reports about the Yazidis in northern NSW who speak a variety of Kurdish but couldn’t really work with the Kurdish interpreters because their brand of Kurdish was quite different. So, I guess that’s an additional challenge.

Dr Hlavac: It is, and we do know about them. South Sudanese Arabic – there are 3 varieties of Kurdish that NAATI credentials. There are regular meetings, and I’ve been a part of them, between the language service providers who are at the coal face (Australian or British idiom for “front end” or “grassroots level”). They supply the interpreters, and they get together with NAATI, with the professional associations, and they say, “Hey, we’ve got this problem. We can’t find interpreters for this language. We’ve got a high incidence of people reporting this language, but they can’t understand the interpreters.” There are different varieties of Kurdish, etc. So, these things are fairly quickly made aware to the people who need to know about them, and we do respond accordingly.

Australia, through NAATI, is probably the only crediting organisation to have 3 varieties of Kurdish. And that’s simply because, as you said, there are Kurdish varieties that are mutually incomprehensible. And the whole thing of interpreting is that you need to be able to communicate effectively. If Lebanese Arabic interpreters aren’t able to communicate effectively with a South Sudanese Arabic speaker, the interpreter needs to inform the service provider, the English speaker, about this issue, that they are unable to communicate properly and that they need to rebook the assignment with a South Sudanese Arabic interpreter.

You do have speakers who might be speaking varieties that are not your primary one. You kind of, well you know about this very well, Ingrid, you practice accommodation. You try and work out how do they speak, you try and avoid things that are specific to your variety. I’m often working with Slovenians, who I don’t understand that well, and they, through misallocation that happens. If you really can’t understand that, the onus is on the interpreter to declare this issue, and for that assignment to be booked with the correct interpreter.

Dist Prof Piller: So, does that happen a lot? Like, you talk about misallocation. Is that a problem in the system, and then if I’m, I don’t know, I need to attend the emergency department, for instance. Maybe there is not a whole lot of time, actually, for people to find out what language I speak, and then to book and rebook, so how does that work?

Dr Hlavac: Yeah, it’s not easy, but there is infrastructure to address this. If you turn up to emergency and you’re incoherent or what have you, there are people at front of staff who will try to work out how much English you have, and if you don’t have English, what’s your language. They’ll often ask you anything – your country or language – in English, etc. It’s often possible for front of house staff to at least work out the language or the country of birth. Often, the country of birth does not coincide with the language, but that’s at least a piece of information that’s helpful for the front of house staff to start the process of locating an interpreter.

The free interpreting service is available 24/7. This is financed by the federal government. It’s free, so the healthcare facilities with emergency departments use this service, particularly after hours, and the ability to be able to locate and get an interpreter on the other end of the phone is not bad. The waiting time is usually between 3 and 5 minutes on average, which is not bad. There is a fair bit of infrastructure in place to address this issue.

People say, “This costs a lot of money”, etc. But if you look at the sums and if you look at the rates of misdiagnosis, healthcare workers not being able to communicate properly, the health effects, etc. and how much it costs the health system when these things happen – it’s much cheaper to pay for interpreting services that address the linguistic discordance in the first place.

Dist Prof Piller: Jim, you’ve got fantastic data, actually, on how the provision of interpreting services kind of reduces length of stay in hospital and how it reduces readmission rates for linguistically diverse people. So, really, this kind of value for money that our interpreting system gives Australian society – can you maybe talk us through that research and how interpreting really, you know, improves outcomes for people from non-English speaking backgrounds and overall lowers the burden on the Australian taxpayer if you will?

Dr Hlavac: So Ingrid, yeah, that was data that was collected by a colleague of mine, and friend, Emiliano Zucchi, based at Northern Health here in Melbourne. He tracked the use of interpreting services over 10 years. In those 10 years, interpreting services greatly expanded, as did the population in the area, but what we had happening was, and we can’t quite say it was only the interpreting services that resulted in lower length of stay in hospital and lower readmission rates. We’d need to do what’s called multivariate analysis to say that conclusively. But what we did see was that the increase in interpreting services co-occurred with these really good health outcomes – reducing the length of stay in hospital, lowering readmission rates – those are compelling reasons. They’re also reasons that hospital managers like to see. It’s not just the fact that patients and healthcare workers can communicate with each other optimally. There are great healthcare outcomes that have occurred or co-occurred with this happening.

Dist Prof Piller: Yeah, that’s really brilliant. I mean, we’ve already been talking about NAATI a lot and provisions in Australia. Our listeners come from all around the world, so I was wondering whether you could talk us through how Australia compares in terms of provisions for people who don’t speak English or don’t speak it well to other countries and the interpreting provisions and translation provisions available there?

Dr Hlavac: So, Australia compares favourably. I go back to really 1975 when they changed the macro policy, social policy of Australia, to introduce multiculturalism. If it wasn’t for multiculturalism, the flow on effect of that such as interpreting services would not be in this country to the extent that they are. So, Australia compares favourably in that throughout your provision of services acorss health, education, defence, employment, welfare – no matter what it is, each department has to have a multiculturalism policy, including linguistic diversity.

Part of linguistic diversity is the linguistic diversity of the government employees in that department, but also the people who use those services. So, when you’re unemployed and you need welfare assistance, the government department that you go to has to have a policy on providing interpreting services if you require them. Health is a big area, what I’ve mentioned. The courts, police, defence, tourism, etc. So, it’s actually built into the provision of all government services.

When you have money from government at federal and state level to support this, you can build up an infrastructure. When you don’t have the government support, it’s much harder. It’s much less prevalent and widespread, so that’s really the reason why Australia does compare favourably and why, compared to other countries, you do find, you know, a good service in terms of interpreting service and translation.

Dist Prof Piller: So, you’ve already spoken a lot about top-down and that the policies in Australia are really favourable, and the funding situation is quite favourable. Can you maybe talk us through bottom-up efforts? What needs to happen in institutions? Government can only do so much, you know. We need the policy framework in place, but at the same time at the institutional level, as you said earlier, people have to make things happen. There has to be a commitment to multilingualism and service provision for everyone and so on and so forth. I know that, from your research, you’ve also done a lot at the institutional level. Can you tell us a bit about what works and what doesn’t work?

Dr Hlavac: That example I gave before, when language service providers gather around a table to talk shop, to talk about what’s happening, what are our problems, issues, things we’re not doing well. That’s an example where people who are at the coal face do tell those people further up about what their gaps are and how they can be addressed. People aren’t short of suggestions. Now, sometimes those suggestions can’t always be addressed, but there’s this interchange of people at various levels that does characterise the system here which is pretty comprehensive.

If I go back to the 1970s though, when I was talking about multiculturalism being a key thing, there were people such as police officers complaining to their local members of parliament to say, “I can’t actually interview this potential witness because they don’t speak English and I don’t speak their language. They’re getting someone off the street to interpret. What are you going to do about it?”. You had doctors writing letters to say, “I can’t treat my patients. What are you going to do about it?”. When the country had actually gotten to a stage where they thought, “Ok, migration is an ongoing thing. This problem is not going to go away. How are we going to solve the problem?”. There were a lot of activists in that period coming up with lots of suggestions, and that’s how a lot of almost revolutionary things happened in that period. We’re fortunate we’ve had bipartisan support from both Liberal and Labor parties. Both sides of politics continue to support multiculturalism. So, interpreting services have not become a political football which can affect their future existence. So, that’s how things kind of panned out.

I’m sorry I’m not giving you a very good bottom-up example, but there’s a lot of interchange happening at many levels, and the system is kind of being fine-tuned, reviewed, and it’s open to lots of suggestions which are forthcoming from lots of people.

Dist Prof Piller: Yeah, look, I mean, that’s the democratic process, I guess, and it is encouraging to see it working. Now, I hear a lot of people currently coming forth with suggestions about AI and saying, you know, “We won’t need interpreting anymore in the very near future because AI is going to do it all for us,” and all those translation apps and so on and so forth. So, I have to ask that question, Jim. Are language technologies going to make human interpreting and translation superfluous?

Dr Hlavac: Ingrid, what a question! It might, one day, not tomorrow or the day after. With voice recognition technology which is the basis for technology understanding human talk and then being able to convert it into another language is really advancing, as we all know. We can turn on the captions function and that will probably give a pretty good rendition of what I’m saying and what you’re saying.

So, we’re speaking English, and hopefully we’re speaking standard English and speaking reasonably slowly and clearly, so voice recognition technology is good if you’re speaking a big language slowly, clearly, and a standard version of it. If you’re speaking a slow, standard version of another big language, you’re probably going to be able to use technology that is going to, I don’t know, probably interpret most of what is said correctly without too many mistakes and distortions. So, the technology is there, and it’s improving.

However, there’s two things. Most of the interpreting assignments that interpreters work in in this country is they’re working with people who typically don’t speak standard varieties who are often, particularly in health, they might be sick, distraught, unwell, unhappy, they don’t speak coherently. They don’t speak slowly. They don’t speak clearly enough. And so, the technology is not there to be able to pick up what they’re saying to then reliably be able to transfer it into English.

For the time being, the technology is not good enough to deal with the vast array of different varieties that people use in their vernaculars when they’re interacting with a healthcare worker. You need a lot of feeding of data from all sorts of languages, including colloquialisms, dialect, variation, etc. to have a voice recognition technology system that reliably can replace an interpreter. I don’t think it’s going to happen tomorrow or soon, but it might happen in 10 or 15 years, but it’s up to interpreters to work with this because there still needs for many things to be some sort of human overview, or at least supervision of this.

I’ve got a PhD student who’s testing voice recognition and using a tablet and asking interpreters, “Do you want to take notes like you normally do, or do you want to look at the tablet and see what the transcription looks like? When you interpret, is it easier from that or from your notes?”. So, there’s research happening.

The other thing is though, Ingrid, if the technology makes a mistake and there’s some sort of horrible outcome, who has liability for it? If you try and contact Google Translate and say, “Hey you made a mistake and this cost me $100 million. Can I sue you?”, you won’t get an answer, probably, because it is unclear who is responsible for that transfer of recorded speech from one language into another if you use automatic or neural translation technology. So, it’s a grey area, but we’re not going to be replaced tomorrow I don’t think.

Dist Prof Piller: Yeah, look, personally I don’t even think in 10-15 years. I mean, there is so much technology hype, and I guess I’m also interested in the dangers of that belief that at some point in the future interpreters will be replaced because, as you’ve pointed out, it’s the most vulnerable and the most high-stakes situations where technology actually fails. Technology is great if I need to get directions, if I’m a tourist somewhere and sort of in the leisurely, fun situation. Then it’s really, really good to have Google Translate or Google Lens or whatever. But if I’m in a vulnerable situation, a high-stake needs situation in healthcare, before the courts or whatnot, I think there is a real danger, actually, of thinking that this leisure and fun situation is somehow going to transfer to that situation where it really matters. Where we need human accountability. Where we need to make sure that it’s the right variety, it’s all those connotations that are there and so on and so forth as you’ve explained so beautifully.

Dr Hlavac: Yeah, things are developing. People might think, “Hey, I used it on holiday, why can’t I use it with my legal client here?”. There are some disclaimers and warnings out there. So, for example, Optus has a particular function where they can do speech recognition software, so you can speak, let’s say, German to someone. And at the other end of the telephone call, someone can speak Italian or Swahili or whatever. They said this is good for general communication only. They’ve kind of used the term “general communication”.

They do warn that this is not suitable for health or legal or high-risk situations. So, it’s often up to people to assess what the level of risk, particularly if there’s a miscommunication or mistranslation, what the consequences of that are. So, you know, the messages, as you said, it might be good in low-risk situation, but as soon as you have something at stake, you need to ask yourself questions. And human beings are a better evaluator of risks are. Human beings do make mistakes, but they are better in dealing with high-risk situations than what the technology has to offer us at the moment.

Like we say to our students, though, those interpreters who don’t work with interpreters will end up without a job, but those interpreters who do work with technology can look forward to continuing to have a job.

Dist Prof Piller: Well thanks a lot. I think that’s sort of a good note to end on actually. Thank you so much, Jim. And thanks for listening, everyone. If you enjoyed the show, please subscribe to our channel, leave a 5-star review on our podcast or on your podcast app of choice and recommend the Language on the Move podcast and our partner, the New Books Network, to your students, colleagues and friends.

Til next time!

When: Thursday, December 14, 2023, full day
Where: Macquarie University
Keynote speakers:
Dr Alexandra Grey, University of Technology Sydney
Dr Trang Nguyen, University of Melbourne

What: Despite the ever-increasing linguistic diversity of Australian society, our institutions continue to be organized as monolingual spaces. This creates barriers to full and equitable social participation for those who do not speak English, do not speak it well, or have low levels of (English) literacy. At this point in time, research into language barriers to education, work, healthcare, law, and all aspects of social life faces at least three intertwined conceptual and methodological challenges, which this workshop is designed to explore:

1. Emerging languages: some of the fastest-growing communities in Australia include speakers of under-served, under-resourced, and non-standardized languages. This raises significant challenges for the provision of language services, from translation and interpreting to heritage language maintenance and community schooling.
2. Language technologies: the past few years have seen an explosion in assistive language technologies from automated translation via multilingual chatbots to digital diasporas. These technologies offer fresh opportunities for linguistic inclusion while also creating new barriers for linguistically minoritized populations.
3. Epistemic justice: the open science movement challenges us to rethink the research life cycle from design to dissemination. Co-design, data-sharing, multilingual team research, big data, and citizen science are some of the issues reshaping how we approach linguistic diversity and social participation.

The workshop is designed to be highly interactive and we are particularly interested in hearing from HDR candidates and early career researchers working in these areas. We have a small number of short presenter slots (10-15 minutes) on our panels. To have your abstract considered for presentation, submit here by Monday, November 06.

Attendance is free.

The talk brings together three of my studies, as follows:

Study 1 (Grey and Severin, 2021)

Focus: legislation and policy about the decision-making framework and standards which might underlie multilingual government communications in Australia’s largest state, NSW.

Summary: The NSW government’s public communications are not made within a clear or informed decision-making framework as to choice of language, and do not consistently acknowledge, plan for, or manage the public’s actual linguistic diversity.

We developed a typology of laws about language choices. The most common type (40 of the 91 relevant laws) protects people by requiring that rights, obligations or information are explained to vulnerable types of people in language that they understand. Not being an English-speaker and/or literate in English is not generally recognised as a vulnerability in these laws.

Most of these require that certain government representatives communicate in an understandable way, but the standard is unclear and variously phrased: ‘plain language’, ‘ordinary language’, ‘simple language’, or ‘language likely to be understood’. There is no mention that this language may need to be a language other than English.

Another type of law that we found (merely) acknowledges linguistic diversity. The key example is the Multicultural NSW Act, which contains NSW’s Multicultural Principle that ‘all individuals and institutions should respect and make provision for the culture, language and religion of others within an Australian legal and institutional framework where English is the common language’.

Based on this Multicultural Principle and a few policies that we could locate, we conclude that there is enough of a framework in NSW that the question, how do government language choices differentially affect different language groups? should nowadays be asked when decisions about the NSW Government’s public communications are being made.

Study 2 (Grey and Severin, 2022)

Focus: web communications of 24 departments and agencies of the NSW government.

Summary: The study identifies that the NSW Government makes some effort to publicly communicate in LOTEs but also identifies problems: we found no consistency or predictability across websites in relation to the range of LOTEs used, the amount of LOTE content produced, or the steps by which it could be accessed. The image shows a table of 64 languages other than English which appeared at least once: how many of them, and for what, varied widely across the NSW government’s websites.

Overall, the actual NSW Government website communications practices we analysed did not appear to meet the standard set in the Multicultural NSW Act from which I quoted above, because provisions are not reliably or thoroughly made for non-English dominant speakers and readers.

We argue that the NSW government should not necessarily spend more money on multilingual public communications, although that may help, but rather that it should spend money on multilingual communications in an informed, strategic way, and in a way that is accountable both to policy and to the multilingual public.

Study 3 (Grey, 2023)

Focus: Covid-19 communications from the NSW government and the Australian national government.

Summary: This study finds weaknesses in multilingual Covid communications much like we found in the first two studies about general government communications, and about which I gave a preliminary report on Language on the Move.

In its final form, this study also reviews of the commentary of international organizations as to how to take a human rights-based approach to pandemic communications to fulfill certain international law obligations upon Australia (and other nations). It found expectations are emerging that governments’ multilingual health communications will be not merely partially available, but rather produced without (unreasonable) linguistic discrimination; produced with minority communities’ involvement at preparatory stages; and produced after strategic planning, which bolsters our calls in the prior studies.

The international commentary also stresses that multilingual government communications should be effective, not merely exist. In explaining what more effective multilingual communications could entail, I advocate assessing government communications’ Availability, Accessibility, Acceptability and Adaptability — that is, the ‘Four As’ recognized by the UN Committee on Economic, Social and Cultural Rights, crisis communications scholars and applied linguists (for example, Piller, Zhang and Li, 2020).

Recommendations

I conclude the webinar by suggesting ‘3 Rs’ in response to recurrent problems with how government communications reach, and represent, linguistically diverse publics:

1. (further) Research (preferably with government collaboration because important data is not publicly available / governments are best placed to collect it);
2. Redesigning communications and their access routes (for example, redesign the ‘monolingual logic’ of government websites, to use a phrase from Piller, Bruzon and Torsh, 2023); and
3. Rights-based Regulation (to uphold standards and to strategically plan communities’ input).

References

Grey, A. (2023). Communicative Justice and Covid-19: Australia‘s pandemic response and international guidance. Sydney Law Review. 45(1) 1-43
Grey, A., & Severin, A. A. (2021). An audit of NSW legislation and policy on the government’s public communications in languages other than English. Griffith Law Review, 30(1), 122-147. doi:10.1080/10383441.2021.1970873
Grey, A., & Severin, A. A. (2022). Building towards best practice for governments’ public communications in languages other than English: a case study of New South Wales, Australia. Griffith Law Review, 31(1), 25-56. doi:10.1080/10383441.2022.2031526
Piller, I., Bruzon, A. S., & Torsh, H. (2023). Monolingual school websites as barriers to parent engagement. Language and Education, 37(3), 328-345. doi:10.1080/09500782.2021.2010744
Piller, I., Zhang, J., & Li, J. (2020). Linguistic diversity in a time of crisis. Multilingua, 39(5), 503-515. doi:https://doi.org/10.1515/multi-2020-0136

Brynn’s research examines what happens when people go to a hospital but don’t speak the dominant language (well). How do these linguistic minority patients communicate their health concerns, and how do hospital staff help them if a language barrier exists?  What kinds of multilingual communication strategies and tools exist in hospitals?  How do hospital staff even know if a patient needs a multilingual communication strategy?

Watch the award-winning entry here and find the script below.

Curing Confusion: How do hospitals communicate multilingually? Brynn Quick’s 3MT script

Have you ever been a patient in a hospital?  If you have, do you remember feeling confused or scared?  Imagine having to navigate that process……. in another language.  What if you were hospitalised and you couldn’t understand what your healthcare providers were saying to you?  What would you want the hospital to do to make sure that you received the same quality of care as the patients who could understand the language?

My research looks at the ways in which hospitals facilitate communication when there is a language barrier between linguistic minority patients and the hospital’s healthcare providers.  Since I can’t call every hospital and ask how they manage linguistic diversity, I’ve done the next best thing – a systematic literature review.  This means that I developed a very specific search strategy to find academic papers from the last 5 years that would answer my questions about this topic.  First, I wanted to know what communication tools and strategies are currently in use in hospitals.  And second, I wanted to find out how a hospitalised patient is identified as needing a multilingual communication strategy.  After a rigorous screening process, I landed on 50 studies that would help me find the answers to these questions.  So, I got to reading, and found an answer that I wasn’t expecting.

Here’s what I found.  Human interpreters are really important to bridging language barriers between hospitals and linguistic minority patients.  Professional medical interpreters are considered the gold standard, and even though it’s 2023, translation apps and AI are not yet reliable methods of conveying the complexities of medical concepts and emotions that interpreters can.  But here’s the catch – healthcare providers are hesitant to actually use an interpreter if they feel that the process of organising for one will take a long time, OR if they feel that the interpretation itself will be time-consuming.

But how do these healthcare providers even know that a patient needs an interpreter?  The answer to that question is what surprised me most – in almost half of the studies I looked at, this wasn’t even addressed.   But!  Of the studies that did, the majority pointed to hospital admission staff as the people who were responsible for finding out if a patient needed an interpreter.  In most of the studies, this is where the responsibility seemed to end, though.  Admission staff noted the need for an interpreter in the linguistic minority patient’s record, but then whose responsibility was it to actually organise the language service?  The answer to that question was much less clear.

So what does my study tell us?  Hospital admission staff with language needs training may be an untapped resource when trying to ensure that all hospital patients have equal access to information and care.  Healthcare providers may be more inclined to utilise interpreters if they know that there is a dedicated team of people who are trained to identify a patient’s language need, book a language service, and follow up to make sure the patient is receiving that service.  My research is important because it is identifying areas for health communication improvement – and ensuring equal communication access means ensuring a healthier community for us all.

You can order free hard copies of the booklet

Have you received your COVID-19 jab yet? Are you thinking about getting vaccinated? Are you confused by all the conflicting information out there?

A new set of resources published by the Australian Academy of Science in collaboration with the Australian Government Department of Health provides clear and credible answers based on the best science.

The Science of Immunisation

The Science of Immunisation is a set of resources that explain what immunisation is and how vaccines work. The aim is to help people make good health decisions.

The resources cover the following topics:

1. What is immunisation?
2. What is in a vaccine?
3. Who benefits from vaccines?
4. Are vaccines safe?
5. What does the future hold for vaccination?

Additionally, you can look up explanations of pesky terms such as “adjuvants,” “herd immunity,” “pathogen,” and many more. Furthermore, the website also features several short videos clips – informative to watch and easy to share.

There is also linguistics in the science of immunisation

The expert working group behind the The Science of Immunisation includes some of Australia’s most prominent medical experts, as you would expect. Additionally, there were also three language and communications experts, and I am honored to have been one of them.

The working group paid careful attention to targeting all audiences in our linguistically and culturally diverse society. Therefore, questions of linguistic inclusion and communicative accessibility played an important role in the development of the resources.

In terms of language and communication, The Science of Immunisation is a practical outcome of the research about language challenges of the COVID-19 pandemic that we’ve been publishing here on Language-on-the-Move.

To learn more about linguistic inclusion and communicative accessibility in healthcare communication:

• Does every Australian have an equal chance to know about COVID-19 restrictions?
• Crisis communication in multilingual Australia
• More about crisis communication in multilingual Australia

Check out all Language on the Move resources about “Linguistic diversity in a time of crisis.”

Additionally, multilingual crisis communication has been the focus of the research projects conducted by Master of Applied Linguistics students at Macquarie University as part of their “Literacies” unit. We close the year by sharing some of their findings.

Here, Monica Neve explores the language requirements of registering a business as “COVID Safe” in New South Wales (NSW).

***

(Image credit: NSW Government)

As restrictions rapidly increased during the beginning of Sydney’s lockdown in March 2020, the small yoga studio, which I had been attending for a number of years, closed its doors. Not just for the period of lockdown, but for good. Without students attending class and with no rent reduction in sight, the studio owner could no longer keep the business afloat. However, in June, with restrictions easing, a new yoga teacher took a leap of faith and reopened the studio.

When it reopened, the studio was identified as “COVID Safe” and sported the NSW “COVID Safe” logo that has by now become a ubiquitous sight in the business precincts of NSW.

For my research project, I wanted to discover how a business becomes “COVID Safe” and whether all businesses have an equal chance of being registered as COVID safe.

What is “COVID Safe”?

Under NSW Public Health Orders, COVID Safe registration is mandatory for hospitality venues (including cafes, bars and restaurants), gyms, and places of public worship. Penalties of up to $55,000 apply for businesses failing to comply.

Non-mandatory registration is encouraged for all other businesses.

The COVID-safe logo

COVID Safe registration requires the creation of a COVID safety plan in which businesses explain how hygiene and safety measures are being implemented on their premises. Once registered, businesses receive a digital COVID Safe logo for use on online platforms, as well as COVID Safe hygiene posters for display.

Language and literacy skills of NSW business owners

About a third of Australian small businesses are owned by migrants who speak a language other than English, according to the Migrant Small Business Report published by the insurer CGU.

While the English language proficiency of this cohort is unknown, it is reasonable to assume that some members of this group are among those 4% of the Australian population – or 800,000 to one million people – who do not speak English well or at all (Piller, 2020a).

It is also safe to assume that a number of business owners have low levels of literacy, as about 13.7% of the Australian adult population – or approximately 2.3 million people – possess literacy levels that equate to only elementary level schooling (OECD, 2012).

Seen against this background, COVID Safe registration for businesses in NSW is also a language and literacy hurdle, for some larger than others.

Registration as COVID safe business

To gain insight into the registration process, I followed all the steps on the website (stopping just short of the final step of application submission) and developed a COVID safety plan for an imaginary business, “Monica’s Café.” I also interviewed a small business owner who had undertaken registration.

Initially, registration seems relatively straight forward. It involves providing details of the business and developing a COVID safety plan related to wellbeing of staff and customers, physical distancing, hygiene and cleaning, and record keeping.

Sample COVID safety plans are available in English as well as Arabic, Simplified Mandarin, Korean, Thai, and Vietnamese.

However, things get more complicated once you actually have to fill out the safety plan form.

Before you do, you need to work your way through the regulatory language surrounding registration, as in the following excerpt from the introductory COVID Safe registration statement:

“COVID-19 Safety Plans are comprehensive checklists designed by NSW Health and approved by the Chief Health Officer. The plans provide clear directions on how businesses and organisations should fulfil their obligations under Public Health Orders to minimise risk of transmission of COVID-19 on their premises.”

(Image credit: NSW Government)

Multisyllabic vocabulary such as comprehensive, obligations, transmission and premises, and long sentences demand a high level of English language proficiency. This is confirmed by the Flesch reading ease measure of 15, meaning this excerpt requires the reading skills of a university graduate.

The excerpt above is an example of regulatory language used in official health communication. This register – or type of language – is particularly difficult to understand for those with low levels of English language proficiency (Grey, 2020a; Grey, 2020b).

The difficulty of the overall guidelines and instructions renders the relative ease of the actual registration form void.

How can COVID safe registration be improved without compromising safety?

I suggest that the process of COVID-safe registration could be simplified and made more accessible to a readership with varying levels of English language proficiency and literacy through the implementation of the following improvements:

• Provision of simple, plain English and high-quality, comprehensive multilingual information
• Provision of English and multilingual safety plan blueprints that are easy to locate

More importantly, I suggest that communicating COVID safety online is not enough.

Providing alternative communication channels

In its current form, COVID Safe registration does not necessarily guarantee compliance. To achieve that, inspections of premises are needed.

Inspections would offer a good way of tailoring COVID safety to local needs, not only practically but also linguistically.

Inspections could be undertaken by multilingual officers. Inspections in language other than English (LOTE) would provide an opportunity to convey personalised LOTE advice relevant to a particular business. They would be a practical implementation of an approach that values NSW’s linguistic diversity as a resource.

References

Grey, A. (2020a, June 1). How to improve Australia’s public health messaging about Covid-19. Language on the Move.
Grey, A. (2020b). How do you find public health information in a language other than English. Submission to the Australian Senate’s Select Committee on COVID-19’s inquiry into the Australian Government’s response to the COVID-19 pandemic.
Piller, I. (2020a, October 13). More on crisis communication in multilingual Australia. Language on the Move.

Additionally, multilingual crisis communication has been the focus of the research projects conducted by Master of Applied Linguistics students at Macquarie University as part of their “Literacies” unit. We close the year by sharing some of their findings.

Here, Kinza Afraz Abbasi shows how mismatched language choices and mismatched communication channels render public health communication in Pakistan’s Khyber Pakhtunkhwa province ineffective.

***

English-Only COVID-19 signage in a school in KPK (Image credit: Express Tribune)

In Khyber Pakhtunkhwa (KPK), one of the four provinces of Pakistan, it is widely believed that polio vaccination is a Western plot to make children infertile in their childhood with the aim to control Muslim population growth. As a result of this belief, health clinics have been torched and health care workers killed. Polio, almost eradicated elsewhere, remains a health threat in the province.

What happens in a situation such as this – where mistrust between the population and public health services is rampant – when a new public health disaster such as the COVID-19 pandemic strikes?

There is wide agreement that Pakistan’s response to the pandemic has not been effective and that the country is now in a lethal second wave.

In my research project, I set out to discover what the government has done to inform the public about the dangers of the virus and about measures to stop the spread of the virus.

The linguistic situation in KPK

KPK is located in the northwest of Pakistan and shares a border with Afghanistan. The largest ethnic group in the province are the Pashtuns, who are comprised of many tribes and clans. Tribes are independent to govern themselves and most of the population live in rural areas. In addition to Pashto, Hazara, Hindko, Kohistani, Torwali, Baluchi, Persian, and other languages are spoken in the province.

This linguistically and culturally diverse rural population of around 35 million people has a literacy rate of 50%. In some tribal areas the literacy rate is as low as 9%.

Those who are fortunate to have learned how to read and write will have done so in a language that is not native to the province, Urdu, the national language of Pakistan.

In addition to Urdu, English also enters the picture because it is a co-official language of Pakistan.

English dominates official COVID-19 communication

English has, in fact, been the preferred language of communicating official information about COVID-19. Pakistan’s official COVID-19 website is entirely in English.

The government of KPK has followed the lead of the national government and also communicated most official information in English.

I explored a number of official websites and social media feeds and determined the language of communication was almost always English, with some Urdu communications, mostly on social media. I could not discover any use at all of Pashto, or any of the other languages of KPK.

Few people follow official government information

Equally noteworthy as the mismatched language choice is the lack of attention that official government communications receive.

The official Twitter account of Pakistan’s Ministry of National Health Services, for instance, has 29,400 followers. In other words, out of a population of 212.2 million, a minuscule 0.013 percent follow official health information on Twitter.

With 1,771,291 followers, their Facebook page is slightly more popular but still under 1% of the population.

The follower numbers of the official Facebook page of the KPK government are equally dismal: 11,544 followers out of a population of 35 million, or 0.03% of the population.

Given the dismal state of telecommunications in the province and the low literacy rates, these figures are not surprising.

Private TV channels broadcasting in local languages

The COVID-19 messages of the Pashto-language TV channel AVT Khyber are in English

TV is popular in KPK and many private channels broadcast in Pashto, Saraiki, Hindko, and other languages.

Unfortunately, the information related to COVID-19 broadcast on these channels seems to be in English, too, as I discovered when researching COVID-19 messages on the Pashto-language channel AVT Khyber.

Their COVID-19 messages are directly copied from the English language messages of the World Health Organization without any adaptation or localization.

Mismatched communication costs lives

In my research I identified three key communication mismatches:

• Information is made available through the medium of English and, to a lesser degree, Urdu to a population who largely lacks proficiency in either of these languages.
• Information is made available through the written medium to a population who has one of the lowest literacy rates in the world.
• Information is made available online in a context where telecommunications infrastructure is widely lacking.

Given these mismatches, is it surprising that people in KPK do not believe that COVID-19 is real? And that it is yet another plot – by the government, by the West – to oppress and exploit them?

Additionally, multilingual crisis communication has been the focus of the research projects conducted by Master of Applied Linguistics students at Macquarie University as part of their “Literacies” unit. We close the year by sharing some of their findings.

Here, Peter O’Keefe uses media sources to explore the public health communication strategies employed during Melbourne’s COVID-19 outbreak in Brimbank, a highly linguistically diverse suburb and, at the time, a COVID-19 hot spot.

***

A drive-in Covid-19 testing site in Melbourne (Image credit: Bloomberg; Photographer: Carla Gottgens)

Melbourne is a city that takes pride in being one of the most cosmopolitan in the world. Like the rest of Australia, it is home to many migrant communities and in some local government areas like Brimbank, the number of migrants exceeds that of those born in Australia. It seems then rather unfair that in this time of emergency, communicating vital information to residents who rely on a language other than English for day-to-day life has come in an ad hoc fashion. This piecemeal approach to public health communication has resulted in a delay that could arguably be claimed responsible for it becoming a “hotspot” for COVID-19 infections this past winter. I will argue that failure to communicate effectively about vital pandemic information leads to distrust; and distrust in the government not only fuels conspiracy theories but undermines social cohesion at a time when we need everyone to stand together.

Crisis communication in linguistically diverse societies

There is no doubt, COVID-19 has laid bare failure in policy for emergency communication delivered in minority languages by governments all over the world. Delivering pandemic information in linguistically diverse countries is a serious challenge and Australia is not alone in this regard. What is clear, though, is that some countries, most notably China, have taken the challenge a little more seriously and acted with greater speed in addressing it. From the outset of the New Corona Virus crisis in Hubei province, expert linguists were called upon to aid with not only dissemination of information but also with patient-doctor interaction in what is now known as ground zero for the COVID-19 pandemic (Li et al 2020).

Poor translation quality undermines trust

Compare this with the response in Australia, in particular in Brimbank. Although there were top-down efforts to deliver translations of pandemic information in various community languages, these were seemingly symbolic rather than serving a practical purpose.

All of these translations appear to have been simply machine done. The Japanese translation I examined contained pragmatic and discursive errors along with curious word choices.

Would the government seriously consider communicating with other governments in the world using Google Translate? Using poor translations is a sign of disrespect.

Deploying monolingual door knockers undermines trust

Perhaps in an effort to address the issue of communicating with non-internet users, the Victorian government dispatched door knockers to deliver in-person information about testing in hot spot suburbs. The private company to which this task was outsourced, employed poorly trained staff without proficiency in the main non-English languages of the area, whose communications reportedly caused further confusion.

Main languages spoken in Brimbank, according to Australian Bureau of Statistics data

Migrants cop the blame for public communication failures

This communication breakdown may also have contributed to stigmatizing migrants as unwilling to participate in the public health effort and get tested.

The chief health officer of Victoria at one point declared that conspiracy theories circulated by migrants on social media were perhaps “partially responsible” for people believing that COVID-19 wasn’t real. However, there actually was no evidence that anyone refused a COVID-19 test on the grounds of not believing that COVID-19 was real.

What is sadly ironic about this claim is that conspiracy theories rely on people’s distrust of government to be believed. Lack of effective communication with the community especially in times of emergency creates distrust, so surely the government must accept some responsibility for any conspiracy theories that may have been circulating.

COVID-19 crisis communication is a test of social cohesion

In this post I have attempted to argue that emergency pandemic communication is more than merely conveying information. It serves a purpose to also persuade and comfort. If it can be effective in comforting, then this will build trust. This is necessary to ultimately persuade people to change their behaviors in a spirit of cooperation. The Victorian government’s actions in this area have had the opposite effect.

Just as COVID-19 has exposed the injustices and inequities across societies, it has also shown the different levels of social cohesion in various countries around the world. It takes a team effort to beat a pandemic, where all members of the community stand together regardless of their language, their political and cultural beliefs, or their level of literacy.

Reference

Li,Y., Rao, G., Zhang, J., and Li, J. (2020). Conceptualizing national emergency language competence. Multilingua, 39(5): 617–623.

Additionally, multilingual crisis communication has been the focus of the research projects conducted by Master of Applied Linguistics students at Macquarie University as part of their “Literacies” unit. We close the year by sharing some of their findings.

Here, Yudha Hidayat shows that the over-reliance on written communication channels in rural Indonesia has resulted in a stark lack of information about how to prevent the spread of the virus.

***

Official COVID-19 information

The information gap between urban Australia and rural Indonesia

When the COVID-19 pandemic really took off in March 2020, I called my parents, who live in a village in West Nusa Tenggara (WNT) province. I asked them how the people in my village were preparing themselves to stem the spread of the virus.

Their shocking response was that they had no idea what to do.

I explained the health protocol in detail and sent money so that villagers could buy face masks. That was all I could do while I was far away from home.

For this research, I explore how it is possible that a community is not aware of COVID-19 prevention measures. How could my parents not know what to do? It is true that they do not own smartphones and do not have internet access but they do watch a lot of TV.

Unlike most people in my village, I am a literate and educated man. Having a strong internet connection in Australia, I can access a wide range of information from different sources in English and Indonesian.

Here, I argue that the pandemic has exposed global inequalities in information delivery and that local governments need to take local communication seriously in the fight against the disease.

How COVID-19 prevention information was delivered in WNT province

The local government has relied heavily on its official website and social media as the primary tools for delivering Covid-19-related information.

Official COVID-19 information

The official website is updated weekly and provides infection lists. The website also includes a long health protocol, and provides flyers, graphics, tables, and figures. All this information is only available in Indonesian with some English words and phrases mixed in, such as “social distancing”, “lockdown”, and “contact tracing”.

Monolingual information in a multilingual context

The reliance on the Indonesian language, as the only language used for this essential information, ignores the diversity of multilingual citizens.

WNT province comprises two main islands, namely Lombok and Sumbawa, and tens of small islands. The majority of the people in this province are from three ethnic groups, namely Sasak, Bima, and Sumbawa. Each of these groups has its own language including various dialects and at least nine other languages are spoken in the province, including Bajo, Balinese, Bugis, Javanese, Madura, Makasar, Mandarin Ampenan, and Melayu.

Given low levels of education in the province, the Indonesian language proficiency of many of these speakers of other languages will not be sufficient to fully understand the public health information provided to them.

Digital written communication in a low-literacy and low-technology context

The reliance on written text and on online delivery is also problematic.

According to data from the Ministry of Education and Culture of Indonesia (2019) WNT has a low overall literacy index (i.e., 33.64). Furthermore, only a small number of citizens use digital technology to access written materials (20.48), and reading is a habit for only a minority (38.17). Another indicator shows that 12.41% of the population of WNT are illiterate.

All these facts make it clear that COVID-19-related information provided only through the written medium on a website is out of the reach of many citizens.

English loan words exacerbate the problem

The use of foreign terms, tables, and figures on the website exacerbates these problems further.

Even among those who are proficient in Indonesian and have access to the internet, not everyone will understand English. The high level of English loanwords thus acts as a further barrier.

Infection numbers remain high throughout Indonesia

The same is true for the ability to interpret tables and figures.

What can be done?

As I have shown, vital information related to COVID-19 is provided in a way that makes it inaccessible to many in WNT. Although it is true that Covid-19-related reporting can also be found on TV and in newspapers, neither of these channels address the problems of illiterate people and/or those who live in remote areas.

It is obviously impossible to lift the literacy levels of a populations during a crisis or to catch up on telecommunications infrastructure. But that does not mean that public health information cannot be communicated effectively.

The alternative method that I propose is to utilise the oral method as an additional communication channel, as has been done successfully in Taiwan (Chen, 2020). The infrastructure exists as every neighborhood has a leader (‘Ketua RT’) who could be trained and tasked with providing COVID-19 information in this manner.

Oral communication could utilize the loudspeakers of mosques and temples that are readily available in every neighborhood. Oral announcements over loudspeakers are plausible since they can easily be delivered in local languages and are accessible regardless of literacy level and internet access.

This would not only help curb the spread of the virus but also accord local people the dignity and respect they deserve.

Reference

Chen, C-M. (2020). Public health messages about Covid-19 prevention in multilingual Taiwan. Multilingua, 39 (5), 597-606.