Access to Health Care for Language Minorities: Kol La'briut telephone medical interpreting service as a case study

Abstract

Research shows that misunderstandings between patients and medical care-givers are common in cases where there are cultural and linguistic gaps between the two sides. Professional medical interpreting services have been in existence in a number of countries since the 1970s, but in Israel patient-provider language gaps and the need to establish professional solutions have only been recognized in the mid 1990s.

Among the linguistic-cultural minorities living in Israel today the Ethiopian community numbers some 116,000 persons. Many Ethiopian immigrants have personal and cultural baggage that make it difficult for them to adapt to life in Israel in general, and to the medical system in particular. The Tene Briut non-profit organization, which has been working since 1998 to promote health in the Ethiopian community, established the Kol La'briut ("Call for Health"): a telephone medical interpreting service. This service is aimed at “bridging the communication gaps in medical treatment and improving access to medical services for the Ethiopian community, thereby promoting better health for each individual” (Tene Briut articles of association, March 2007).

This thesis seeks to gain an in-depth understanding of the process of setting up and running a medical interpreting service, and to identify elements likely to help or hinder the functioning of language services. A qualitative research method was chosen, focusing on gaining an understanding of the process. The data analysis was based on literature in the fields of community interpreting, sociology of health, and organizational sociology.

The thesis is divided into two parts. The first (Chapters 2-4) introduces the study‟s theoretical framework. The second part (Chapters 5-8) presents and discusses the research findings. The fifth chapter deals with the steps in establishing the interpreting service from 2004 to 2008. The data analysis identified seven steps in the establishment of the Kol La‟briut interpreting service: putting the idea forward, ideas for service formats and recruiting partners, fundraising for the service, delays in service implementation, partnering with the academia and running interpreter trainings, service implementation, and organizational institutionalization.

The sixth chapter introduces both the catalysts for the establishment of the first telephone interpreting service in Israel and the factors that hampered it. Discussion of both is based on organizational theories of organizational-environmental relations.

In the seventh chapter, a comprehensive model for language access to public services in Israel is proposed, based on an analysis of the processes that brought about the establishment and operation of Kol La‟briut, and also drawing on contemporary perceptions regarding language access to public institutions in Israel and elsewhere. The model describes five phases: 1) chaos – lack of language access or partial language access only in

the public sector, 2) acknowledgement of the need to provide language access to services in the public domain, 3) establishment of a pilot interpreting service, 4) the decisive phase in which the public domain decides whether the interpreting services is to disappear, to operate in a limited format, or to be extended and institutionalized, and 5) 'spill-over' where interpreting services are perceived as part of the public sector‟s cultural competence when it comes to serving linguistic and cultural minorities.