Dealing with non-native speakers and people from a different culture - Migrants
Dealing with non-native speakers and people from a different culture
If you know or notice that your patient has trouble giving clear information in Dutch or has difficulty in understanding information in Dutch, adapt your communication.
A migrant who does not have a good command of the Dutch language often takes a family member, sometimes a child, to practice. This then assumes the role of informal interpreter. It is important to have a conversation with the patient, even if the family member interprets or tells the family member the story largely. Look at the patient and speak in his direction.
Often the conversation is good through the informal interpreter, although you do not know to what extent the family member contributes his own views. Sometimes it is necessary to call in a professional interpreter. However, deploying an interpreter does not solve everything. You do not know whether the interpreter translates everything you say and what the patient says. You also do not know whether he also conveys the emotions of the patient.
Extend extra time for a conversation where an interpreter is present.
In the case of medical care for asylum seekers who do not speak Dutch or English, (telephone) interpreters can be called in, reimbursed by the COA. A sign language interpreter can be used for the deaf and hearing impaired. Incidentally, some of the people in the asylum procedure learn to speak Dutch easily. If an asylum seeker no longer resides in a reception or asylum seekers' center, the interpreter's allowance will lapse.
Points of attention
The points of attention in dealing with low-literate people also largely apply to dealing with migrants, even though they are by no means all low-educated. The most important points for attention when communicating with migrants are in.
Points of interest in the conversations with people with a migrant background
- Make contact
- Tune your communication to the person and what happens in the conversation
General and reception
- Realize that migrants sometimes use different politeness rules than the Dutch
- Think about rules about: looking directly at, who (first) speaks, after proposing whether or not immediately respond to the complaint, say no, say that you do not understand something
|Explanation of the practical organization||
- Explain which people work in practice; practice assistant and practice assistant are probably unknown functions; tell what training you and your colleagues have had and what professional knowledge and skills you possess
- Explain that you ask all patients on behalf of the doctor / pharmacist what the complaints are to give professional advice
- Explain that an advice is sometimes sufficient, but that it may also be necessary for the patient to come to practice
2. Consultation duration
- Tell how much time is reserved for a GP visit / dentist visit
- Explain that a consultation is usually intended to discuss one complaint from one patient; if there are several complaints, this can be reported to the assistant and a double time can be scheduled
- Advise to prepare the visit well: why go to the doctor / dentist / pharmacy? what do you want to tell, what do you want to ask? what do you want to be discussed? for which complaint do you want to be treated?
- It may be useful to organize a discussion afternoon or evening about what migrants expect from GPs and pharmacies and how things actually work out in practice; in practices in which it was organized, mutual understanding arose; success factor in such a meeting is the deployment of a contact from the migrant community
4. Care in the Netherlands
- Explain the treatment of complaints in the Netherlands and that fewer medicines are prescribed here and certainly fewer injections than in many other countries
- Getting medication is often difficult to understand; a patient who does not receive medication often does not feel taken seriously or discriminated against: referring to films in which asylum seekers give an explanation about this (asylum seeker and self-care. Less often is better http://www.stichtingufa.nl/)
In the consulting room / treatment room / at the desk
- If the language is a stumbling block, then advise to take someone who speaks Dutch well
- Realize that certain topics and words evoke shame, for example certain psychiatric disorders, such as schizophrenia, depression or delirium, but also symptoms such as constipation, stool, vomiting, urinary problems
- If sensitive topics need to be discussed, explain that it is necessary to be able to help well; ask to indicate the location of the complaint on an image
- Use simple words (vomit, pee, poo); use these words first, then the patient can join and refer to it
|History||- Pay attention to migration history and its impact on health|
|Views, support and obstacles||
- Ask for habits and opinions, especially if you give advice ('what do you think?' or 'is that difficult for you?' or directly: 'how do you view this from your culture?')
- Involve the cultural background with advice on lifestyle (smoking, feeding, exercise)
- Ask if the patient receives support from his cultural community when he asks for care, for example in case of psychological complaints or in the case of dementia of a (clean) parent
- Ask whether the patient experiences obstacles or support from his environment to adjust his lifestyle
- Advise your advice on the views and possibilities of your patient and his environment and discuss possible solutions together; ask Muslims for example how they handle medication and dietary advice for diabetes during Ramadan
- Sometimes it is possible to call in a care consultant with the same migration background; it supports the patient in preparing the visit (clarifying the request for help and expectations) and during the visit (supporting the communication)
- Use national or local projects and materials that have been developed for this purpose, for example material from the Slotervaart hospital about diabetes and Ramadan, and medication use during Ramadan
- Check whether there are educational projects; group education is sometimes a motor for support from the community
How you can deal with situations in which (a lot of) family comes along, you can read in the next box.