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Q&A (part 3): What is the role of language when providing care to Indigenous patients?

  
https://www.infirmiere-canadienne.com/blogs/ic-contenu/2022/12/05/role-de-la-langue-patients-autochtones

Tłı̨chǫ-speaking nurse Lianne Mantla-Look answers our questions

By Lianne Mantla-Look
December 5, 2022
istockphoto.com/portfolio/FatCamera
The smallest detail can give a health-care provider the clue they need to figure out a patient’s health concern. When language is a barrier, those clues might be missed.
Editor’s note: Lianne Mantla-Look was profiled in Canadian Nurse on November 14. In this four-part series of followup Q&A articles, she provides candid and first-hand insight into her experience as an Indigenous nurse working in the North.

Language is key to building relationships between practitioners and patients. Having a common language sets patients at ease so they can express themselves better. This creates a trusting relationship.

Many English-speaking patients and providers have trouble even imagining what it would be like not to understand their health system because of language. Unfortunately, language is taken for granted. I’ve been present in situations with non-Indigenous health-care providers when they realize that their patient does not speak English as a first language.

Courtesy of Lianne Mantla-Look
“I feel blessed that I am fluent in my Native tongue and in English. I firmly believe my fluency helps in building relationship and trust as a health-care provider,” Tłı̨chǫ-speaking nurse Lianne Mantla-Look says.

It’s disheartening to see the disappointment and sometimes shame on the patient’s face when this occurs because they have to wait for an interpreter to be called, which lengthens their wait to see their health-care provider. They feel shame because they can’t communicate with the nurse or doctor, and they can see or sense the frustration from the health-care provider when this barrier presents itself. Does an interpreter interfere with a patient’s ability to advocate for themselves or the quality of care they receive? The smallest detail can give a health-care provider the clue they need to figure out a patient’s health concern. When language is a barrier, those clues might be missed.


Next week — Q&A (part 4): How can non-Indigenous practitioners support the care you provide?


My experience

As an Indigenous nurse who works in the North, I recognize first-hand that language is both an opportunity and a barrier.

During my time as a hospital nurse, I was delighted to help co-workers learn simple Tłı̨chǫ (pronounced tli-cho or tlee-cho) phrases and words for when they were assigned to Tłı̨chǫ elders as clients. Tłı̨chǫ elders were always delighted to hear the efforts their nurses made to make them feel comfortable. If I was present, the elders would inquire if I taught the nurses and, in turn, tell me how proud they are of me.

Later, I became a community health nurse in Behchokǫ̀, which is where I grew up. One encounter always makes me smile: I saw an elder in the walk-in clinic, and she appeared nervous after I called her name. After she followed me into the exam room, she asked in broken English about an interpreter, and I responded in Tłı̨chǫ, “What do you need an interpreter for? I can understand you just fine.” She was shocked at first, and then she laughed! She said, “You’re Tłı̨chǫ? I thought you were White!” She laughed again and inquired about my parents and grandparents. After establishing my place in the community, we got on with her reason for coming to the health centre. She was so relieved to be examined by a Tłı̨chǫ-speaking nurse and not have to rely on an interpreter to explain the reason for her visit. At the end, she shook my hand and thanked me profusely while telling me how happy she was to see a Tłı̨chǫ nurse working in the community.

I’ve found that health-care interpreters are vitally important, but that service is not available to patients who have to attend medical appointments out of their territory. In those situations, the patient has to rely on a family member/escort to interpret for them. This can create barriers to health care.

Although it has not happened regularly, family members and friends sometimes deliberately withhold key medical information from their loved ones whom they were interpreting for. When this occurred, I would call them out on this and tell the family member that this was not ethical and they were not acting in the patient’s best interest. Afterward, the family member would relay the correct information to the patient. The reasons they gave for not providing the correct medical information were many. Some said they were trying to spare the patient’s feelings; others said they didn’t want the patient to be depressed or to lose hope. Some family members deemed the patient too weak and frail to deal with the information.

Relying on friends or family to interpret can also be a real challenge in terms of privacy because the patient may not be as forthcoming with key information if they are embarrassed or too shy to speak through their family member or friend. Also, medical terminology is not easily translated into an Indigenous language. One simple word in English could be a long phrase in an Indigenous language and still not be medically accurate, and this could lead to providing the wrong information.

We shouldn't rely on friends and family for medical translation, and we need to train and support more medical interpreters. This is necessary when there is a language barrier between patients and providers.

I feel blessed that I am fluent in my Native tongue and in English. I firmly believe my fluency helps in building relationship and trust as a health-care provider. I feel that I’ve provided the best care possible when I can advocate for my patients in their first language. I’ve written about this experience in Northern Public Affairs magazine (Mantla-Look, 2020), an excerpt from which appears in my November 28 Q&A article.

Reference

Mantla-Look, L. (2020). Bridging the gap between two world views: Perspectives of an Indigenous nurse. Northern Public Affairs, (August), 25–27.


Lianne Mantla-Look is a registered nurse who lives and works in Yellowknife, Northwest Territories. She uses the language she grew up with to bridge gaps in accessing health care for people who speak Tłı̨chǫ (pronounced tli-cho or tlee-cho) and to advocate for Indigenous patients whose first language is not English. Read her profile to learn more.
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