Patients referred to Gandhi Hospital need help with basics such as what their prescription says or directions to the CT scan room.

Hyd health files How language barrier affects patients at Gandhi Hospital
news Health Care Tuesday, August 21, 2018 - 19:37

For the last three years, Naresh, a health worker at Gandhi Hospital, has been helping patients make sense of their doctor’s prescription and get to the right doctor. He arrives at the hospital at 9 am, even before the doctors do, and sits at a small desk in the hospital corridor. People approach him with a variety of queries, ranging from “What is written on this prescription?” to “Where is the CT scan room?”

On an average, 1,800 people visit the OP ward of Gandhi Hospital, one of the key tertiary care hospitals in Telangana, daily. Naresh helps over 800 of these patients make sense of what their doctors tell them.

“People mostly ask me for directions, but then many ask me to translate what is written on the prescription or to explain what they have been diagnosed with,” explains Naresh, who is a volunteer with Helping Hand Foundation, a healthcare NGO launched by a team of IT professionals from Hyderabad in 2007.

“Most people who visit Gandhi are from villages or are illiterate. They speak Telugu, Hindi or Urdu but do not understand what the doctor tells them. I explain things to them as much as I can. I now understand some of the medical terms, but I am not a doctor,” he adds.

When TNM met 62-year-old Nafeesa Begum at Gandhi Hospital, her daughter and granddaughter were wandering about cluelessly in the hospital general ward basement in search of the CT scan room. There are no signboards with directions; the existing signboards were in English, only a few were in Telugu. Even changes in hospital consultation hours are printed out and posted on the hospital walls in English but those who visit the hospital have little or no grasp of the language. The practice is followed at almost all government hospitals in the city.

“We have been trying to find the place, it is somewhere in this building,” says Nafeesa who refers to her ailment as “a heart problem in the heart”. Neither Nafeesa nor her daughter or her teenage granddaughter could explain what the heart condition was, they were unaware of the actual ailment. “My doctor at Mahbubnagar told me to go to Gandhi and so I came,” she adds.

“The absence of an adequate vocabulary for technical terms in most Indian languages and the fact that health workers are often not completely fluent in languages that are not their mother tongue often results in non-English-speaking patients receiving very simplistic messages or crude translations, free from the nuance that is essential for a patient to make a genuinely informed decision,” points out Lalit Narayan in his 2013 study titled ‘Addressing language barriers to health care in India’ published in The National Medical Journal of India, the only such study on language barrier with respect to India.

The study points out that the inability to make an informed decision “is compounded by the fact that patients who are more likely to experience language discordance in the clinic such as members of linguistic minorities and illiterate migrant labourers are also more likely to access care in overcrowded, understaffed public hospitals and clinics where health workers cannot spend much time with each individual and the power differential between doctors and patients is greater”.

Hospital overcapacity

The superintendent of Gandhi Hospital, Shravan Kumar, however, believes that language barrier is not much of an issue at the hospital. Like his fellow superintendents at other tertiary care hospitals in the city, he too blames it on hospital overcapacity.

“The doctors know Telugu, Hindi and Urdu, but it has got to do with how the doctor deals with the patients. The OP consultation timing is just for three hours and at any given time 150 patients are waiting to see a single specialist doctor. How much time can a doctor spend in explaining the health condition to the patient?” he asks.

The superintendent calls for a better patient referral system from the districts as a solution to hospital overcrowding.

Citing an example, he says that between January and July this year, 4,700 cases of dengue were referred to the hospital. “It has become a habit to refer even the simplest of dengue, malaria or typhoid cases to a tertiary care hospital. If there are complications, sure yes send them to us, but not routine cases,” Shravan says.

The doctor is of the view that the referral system followed by PHC, regional and community level hospitals needs to be more systematic.

“When they refer, they should mention in detail the type of case and what investigation has been done so far, and more importantly the reason they are sending the patient to the tertiary care hospital. But this is not done properly, they refer even simple cases and so the patient thinks it’s something serious and the cases pile up,” he adds.

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