17 Aug 2024 Health care for all – leave no language behind

CLEAR Global

Language rights are a vital dimension of sustainable development and humanitarian aid. The following article outlines why they are important, what lessons have been learnt, and how innovative technologies can help in crisis and conflict situations.

At CLEAR Global, we help people to get lifesaving health care information and be heard, whatever language they speak. Good health care and well-being is a right for all, but it’s not accessible for all language speakers.

Language is critical for achieving SDG 3, universal health coverage, and access to safe and affordable medicines and vaccines for all. In 2021, four and a half billion were not fully covered by essential health services, and 25 million children missed out on important immunizations. Inequalities persist, and exclusion disproportionately impacts the health and well-being of marginalized populations worldwide. We can only make universal health care a reality if we include all language speakers in conversations that affect their health.

Health care providers and aid workers struggle with what is known as “the last mile” – getting services and information to the most marginalized. For many, language exclusion compounds exclusion from basic services. People can’t access health services or information if they aren’t available in their language. People can’t know what their medication is or how to take it if the package is unreadable. And care providers managing extreme workloads in multilingual contexts can’t diagnose their patients if they don’t know what word someone might use for “pain”.

Not only does a lack of information worsen health outcomes, it also spreads distrust and disinformation among people in vulnerable situations. When clear, evidenced-based health information isn’t available in someone’s first language, rumours, anecdotes and misinformation might be the only health information they have.

For women, poor communication may contribute to pregnancy complications and maternal death. In Malawi, a number of studies report poor communication between some health care providers and pregnant women. Language barriers are part of the reason Indigenous women are more likely to die in childbirth and pregnancy and to lack access to maternal health services. Globally, a woman dies every two minutes from preventable causes related to pregnancy and childbirth.

Without training, research and resources in the right languages, health systems around the world fail to support already marginalized groups including women, people with disabilities, migrants, refugees and asylum seekers. People risk falling through the cracks. And when the crack in universal health care coverage is 4.5 billion people wide, getting information and care into as many languages as possible is imperative.

Our team in Bangladesh, helps to put Rohingya people at the centre of the humanitarian response. We interviewed community members and service providers to understand how we can help uphold their right to access vital information and be heard. In our 2023 study, all participants stressed the importance of good understanding between patients and health care providers. But Rohingya people’s needs often remain unmet due to inadequate resources and staff to support communication. When treating Rohingya-speaking patients, Chittagonian-speaking health care staff say understanding, translating and explaining medical terms is difficult and they lack time and support to address these challenges.

Cultural differences and lower levels of health literacy among the Rohingya community can cause confusion, stress, and frustration for patients. This translates to Rohingya patients not properly understanding medicine dosage instructions, with potentially serious consequences. A lack of appropriate language and communication support like sign language interpreters means people with disabilities face even greater challenges.

By supporting inclusive solutions you can help shift power structures so people who have already faced so much trauma can feel confident and respected seeking health care. You can give people the valuable opportunity to ask questions.

Language inclusion, misinformation and COVID-19

When the pandemic began, dangerous misinformation spread quickly through the refugee camps across the world, from false cures to a dangerous and frightening rumours about what happens to infected people. Misinformation and disinformation spread in 25 different languages across at least 87 countries, including the United States. The impacts are widespread, including violence, deaths and injuries blamed on misinformation, disinformation and conspiracy theories related to miracle cures. People need accurate information via communications channels they trust.

• In Bangladesh, Rohingya people reported negative and neutral experiences and made fewer visits to health centers. A mobile ban and information shortage made it difficult for aid workers to spread safe advice.
• In Nigeria, people refused the COVID-19 vaccine because they were led to believe it was a plot to reduce the population or alter their DNA.

What we’ve done about it

Our language data and communication tools are used in local and global health emergencies to improve two-way communications. Better communication enables more efficient crisis response, especially in linguistically diverse communities that are often most severely affected by events such as weather pattern changes and public health emergencies. Globally, our language dataset is an invaluable resource for ensuring that communicators know what languages are appropriate.

Inclusive health information solutions: research and innovative technology

CLEAR Global has done research on health and language exclusion in many contexts. For example, in Bangladesh, we conducted research with health care service providers and their patients to learn how good language and communication practices help to provide quality, inclusive health care services to Rohingya refugees.

We used in-depth interviews and observations to develop practical actions for health care service providers and the health sector in Cox’s Bazar. We’ve also investigated Rohingya experiences and perspectives relating to culture, language, and health. And we’ve developed recommendations for humanitarians on engaging and communicating more effectively with the Rohingya community on health issues and services:

• Train health care providers to understand and engage with the way Rohingya think and talk about symptoms and conditions.
• Recognize the cultural importance of informal health providers and potential ways to work alongside them to improve patient outcomes.
• Interpreters and cultural mediators can help establish trust and empathy, while training on Rohingya medical terminology can help bridge communication gaps.

Innovative technology

Designed to improve communication between aid workers and the affected communities, CLEAR Global’s glossary apps provide clear and accurate translations of useful terms. Accessible on any device, online and offline, these tools help field workers listen to and better support people’s access to information in some of the world’s most linguistically diverse and challenging contexts.

• The Bangladesh glossary is in English, Bangla, Burmese, Chittagonian, and Rohingya, with 300 terms on humanitarian aid, protection, return and relocation, health, MHPSS, gender, and more.
• The WFP Community Engagement glossary covers health care and diseases for affected communities in various contexts, with a total of 216 terms in nine languages including sign translations in Sinhala, Tamil and Chewa sign languages. The glossary was developed in collaboration with technical and sign language specialists and in consultation with WFP’s accountability and protection team.
• The COVID-19 glossary identifies commonly used terminology and technical terms to develop a multilingual, plain-language glossary to assist field workers and interpreters engaging with communities to raise awareness. Available in over 60 languages, and in audio format.

Our conversational AI chatbots have supported access to information during health outbreaks. Unlike traditional bots, our bots use natural language understanding to create the look and feel of a real conversation. Shehu in Nigeria, and Uji in the Democratic Republic of Congo are designed to enable people to get accurate answers to their questions on COVID-19 and Ebola. The bots “speak” English, Hausa, and Kanuri (Shehu), and French, Congolese Swahili, Nande and Lingala (Uji), to deliver timely, reliable messages through Facebook Messenger, Telegram, WhatsApp, and SMS.

Instead of menus, users ask questions in whichever language they are most comfortable. They receive up-to-date information, based on Ministry of Health guidance. The bots “listen” to the users – letting them ask questions.

They can also detect new information gaps or concerns from users. For example, Nande speakers were asking Uji if Ebola could be passed from a pregnant mother to her child. Once we reported this trend, the authorities realized that there was no information on mother-to-child transmission and quickly put information out, including through Uji.

The results

• 31 research products that inform the humanitarian community of communication and information challenges, leading to changed humanitarian strategies.
• Our bots engaged in over 100,000 conversations with more than 10,000 individuals, earning a remarkable trust rating of 93%.
• 1000s of people trained with a 98% satisfaction rating.
• Over 4,000 people have downloaded our language datasets.

To achieve the SDGs, it is critical that health information is in the right language and format. In real terms, this means ensuring health care providers can effectively communicate with patients, and that people can get answers to their own questions easily. By promoting language inclusion in health care, we will make significant strides towards leaving no one behind.

Excerpted with permission from Speak Up for Language Inclusion: Meeting the Sustainable Development Goals: how to leave no one behind, whatever language they speak. CLEAR Global. For further information contact: info@clearglobal.org