Norman Swan: Aboriginal people and Torres Strait Islanders have much higher rates of chronic and acute and life-threatening illness than non-Indigenous Australians, and the result is a greater need to be in hospital. There have been complaints for many years from Aboriginal communities that hospitals are alien and frightening places which aren't tailored to their needs, especially when it comes to communication.
In some parts of Australia there are high rates of Aboriginal people discharging themselves against medical advice or leaving hospital before they have recovered sufficiently, presumably in part because of the environment being so alien. This is a particular problem where communities speak their own languages and English is a second language. The Northern Territory is at the frontline here and the Menzies Institute of Health Research in Darwin has had a lot of interest in communication with Aboriginal patients and their families, and in fact we've covered this from time to time on the Health Report. Their latest study has been into improving access to interpreters. Professor Anna Ralph is head of Global and Tropical Health at the Menzies, and is also an infectious diseases physician at the Royal Darwin Hospital. Welcome to the Health Report, Anna.
Anna Ralph: Thank you, it's nice to join.
Norman Swan: What are the tangible effects of poor communication…I mean, I've outlined some of them there, but you are at the frontline here, you tell us.
Anna Ralph: Yes, it has problems for patients, both their experience of care can be quite negative, as you said it can be very alienating in the hospital environment and especially if you don't really have a clear picture of what on earth is going on. But that can also translate into actually impaired health outcomes, and taking leave from hospital, so voting with your feet and just not necessarily recognising why you need to stay but getting up and leaving is one of the obvious and measurable ways that people have poor outcomes. If you take leave from hospital, then clearly you are prematurely terminating your care and then you have a much higher readmission rate which has bad consequences for the individual and high costs for the health system.
Norman Swan: So if you look at the Royal Darwin or, say, Alice Springs Base Hospital, what would be the rate of people leaving of their own volition when they shouldn't be?
Anna Ralph: If you look at just the Indigenous population, it's around about 12%, which is very much higher than Australia-wide figures, and also higher than non-Indigenous rates in the Northern Territory. And we do believe that that is likely to be related to the quality of communication, as well as how culturally safe the care is and how well nurtured people feel in the hospital environment.
Norman Swan: How many languages do you have to be equipped to deal with in the Northern Territory?
Anna Ralph: Well, that's the complexity, and you'd look at this and think this isn't rocket science; if you use an interpreter you're going to get better outcomes. But…
Norman Swan: Well, just before you get onto that, Alan Cass and your group have shown in the past that just having an Aboriginal health worker doesn't cut it because they could not be from the same language group or the same community and therefore culturally almost as alien as somebody who is white.
Anna Ralph: Yes, that's right, and so the Aboriginal interpreter service here in the NT says that they cover up to 100 languages…
Norman Swan: 100!
Anna Ralph: Yes. Often when we look at translating resources into Aboriginal languages, that the top eight cover probably about…this is just the top end I'm talking about, about 60%, 70%. But then you go out to the top 13 languages and you capture a broader component of the population. But there are many, many languages that are mutually incomprehensible. So obviously you need to get language right, and yes, it's not one size fits all, one Aboriginal health practitioner is not necessarily going to be the right person for a given patient.
Norman Swan: So you tried in this study to increase the availability of interpreters and make it easier for clinicians and healthcare workers to use interpreters. What did you actually do?
Anna Ralph: There were three components of this study, and one of them…this was a partnership between Menzies and Top End Health Services that manages the hospital, and so after a bit of advocacy and demonstrating what some of the barriers were, we advocated for the employment of an Aboriginal interpreter coordinator. And so Top End Health Services have done exactly that and this study reports on the first 12 months of that. That person is still employed, which is great.
The other two components of the study were working with interpreter training for healthcare providers. It's not always intuitive, how best to get the most out of that interaction with the interpreter. They need a good briefing beforehand, they don't have training necessarily in health terminology, so you can't as a doctor bowl in and expected that the interpreter is going to be fluent in knowing what cardiac catheterisation means and that sort of thing, so making sure doctors know how to deal with the interpreter properly. And then the final bit was championing. So that means…
Norman Swan: Marketing it.
Anna Ralph: Yes, that's right, getting doctors to use interpreters in their day-to-day practice.
Norman Swan: And it improved but not a lot.
Anna Ralph: Yes, so it provides us with some optimism, and there was improvement, but it sort of went from a small proportion of people needing an interpreter getting one, to a slightly less small proportion. It's still basically less than 20% we calculate of people who would benefit from an interpreter actually get access to one during a given hospitalisation.
Norman Swan: We are short of time now. So what happens next to make this even better?
Anna Ralph: A couple of things. Firstly, we need to link data so we can tell exactly what happens to those individuals who do or don't get access. We need to scale it up significantly and do a whole lot more interventions to make it easier for healthcare providers who want to do the right thing to be able to practice medicine more easily in this context.
Norman Swan: And whether or not it actually reduces people leaving hospital of their own volition.
Anna Ralph: Yes, so we did definitely see a decrease in that. We want to explore whether that just happened to be a spurious correlation or whether there is a genuine relationship there. We think there is a true cause-and-effect relationship there and that needs more exploration.
Norman Swan: Anna, thanks for joining us.
Anna Ralph: No worries, thanks a lot for having me on.
Norman Swan: Professor Anna Ralph is head of Global and Tropical Health at the Menzies Institute for Health Research and the Royal Darwin Hospital.