clinical focus
ACI: Monita, residents can often be left behind due to
language difficulties, but do these difficulties create barriers
to care as well?
MM: They generally do. Within the hospital, what we’re finding is
that if there’s a patient who’s not seen by an interpreter, there’s
a direct correlation between longer length of stay in hospital
and higher readmission rates as well, and certainly much more
miscommunication. It is a bit more challenging to be looked after
in a language that’s not your own.
The language of care
Interpreters are rare in aged care, I would imagine, due to
cost and other reasons.
Yes. Certainly in aged care, residents might see an interpreter at
the beginning and when they have a clinical encounter. So when
health professionals have to come in, it’s quite limited. Whereas
in hospital, there might be a bit more frequent attendance by an
interpreter. What you then get is a bit of guesswork by the health
professionals, trying to figure out what a resident might need. That
becomes challenging from a language perspective, certainly.
Does culture also affect the way pain is communicated?
Caring for the linguistically diverse in aged care.
Monita Mascitti-Meuter and Karen Thode interviewed by Conor Burke
G
eorge Aki sat in the Sydney hearing of the royal
commission to give testimony, and unlike most given that
day, his was fairly positive. Aki was happy with the care his
father had received towards the end of his life.
However, Aki wanted to bring up a slight issue – one which, in
his opinion, suffers from a lack of policy direction.
Aki’s father was Egyptian with fluent English and with degrees
and a master’s in construction. His father was a charismatic and
intelligent man, Aki said, but his health declined in 2015 and he
was eventually diagnosed with Lewy body dementia. He slowly
lost his English, and with it, his ability to communicate with the
world.
Aki tried to find language-friendly facilities, but this was a
struggle, and with the exception of the occasional nurse or
volunteer who spoke Arabic, his father was alone.
“He couldn’t communicate and he loved talking,” Aki said. “His
frustration would then sometimes trigger his psychosis.”
His father passed away in 2018 after a short period of
deterioration, and Aki believes his father had more to give. If he
had been able to communicate, things may have been different.
“Short of the volunteers and strategies like drawings that Dad
could point to when his English became incomprehensible,
there appeared to be no effective policy or resources relating to
the complex communication issues for [people with English as
a second language]. I was disheartened that the inequality and
disadvantage was minimised virtually to the point of invisibility.”
Sadly, this is a common story in a country where seven million
of us were born overseas and 23 per cent of homes speak a
language other than English.
To discuss how we can improve the lives of culturally and
linguistically diverse residents, Aged Care Insite spoke with Monita
Mascitti-Meuter, a cultural diversity program coordinator, and
Karen Thode, a cultural diversity officer and residential support
program clinician, from St Vincent’s Hospital Melbourne.
30 agedcareinsite.com.au
It does. We’re talking about learned behaviour: how we perceive
pain in others. There is enough research evidence to show that
culture influences the way we perceive and have empathy for
others. Certainly it influences pain tolerance, pain threshold,
anxiety, pain severity, and the emotive expression of pain.
I found some interesting articles recently on how we cope with
pain from a spiritual perspective too. From a culture perspective,
it becomes a grey area that makes it even more challenging to
make sure we’re getting it right, because it can be very different
from the person giving care to the other, as well as the person
communicating their pain as well.
Can you explain the idea of low and high-context cultures?
That’s something we tend to refer to when talking about
intercultural communication. It was a concept that was probably
first introduced by Edward Hall in his 1959 book, The Silent
Language, where he looked at how in cultures you have two kinds
of communication.
High-context is communication that’s quite implicit. In those
cultures, you’re looking at how things are said and what is meant,
not just what it says. Those cultures tend to be fairly indirect in
their communication. In the Hall framework, cultures like the
Japanese culture would be a good example of a high-context
culture, but equally Italian and Greek cultures are considered high-
context as well and they’re highly non-verbal.
Low-context cultures are seen as a bit more explicit in their
communication. They look at what is said, not what is meant. So
“yes” means yes. If a patient says, “I’ll come to that appointment
tomorrow,” it is understood as yes, they will come to that
appointment tomorrow. In high-context cultures the “yes” might
be construed as a “maybe”, a “no” or “I’ve heard you”.
Low-context cultures are more direct in their communication
too. Nordic cultures tend to be typified like that. I guess that the US
culture is typified like that as well.
But when Hall gives you the list of countries, it’s not meant to
stereotype certain cultural groups, but to give you an indication
of what to expect. It’s not necessarily the case that everyone from
a certain area of the globe will be on that level or respond in that
way. It’s more about understanding that, when miscommunication
happens, it could be a mismatch between high and low-context.