Less than two weeks into his first visit to the United States in August this year, Kamissoko Cheickno began having unusual chest pains. The 55-year-old initially dismissed it as jet lag from his 13-hour flight from Mali to visit his daughter and nephew in the Morris Heights section of the Bronx. But persistent night coughs left his body weak.
A private doctor in the Bronx decided Cheickno was medically fit after a brief examination, but the Mali native was not so sure. The doctor spoke only English, which Cheickno’s nephew translated for him into his native Mandingo. It was his first time he had spoken to a doctor through a translator.
“It was like a wall, I could not talk with him directly,” Cheikno said later said through a translator.
Two weeks later, Cheickno’s health had deteriorated. He was rushed to an emergency room and hospitalized for one week. “My blood pressure had gone high and the doctors found out that I had a kidney problem,” Cheickno said.
The doctors who finally got the diagnosis right were part of the recently opened Diaspora Clinic, a new idea in health care designed to break down the cultural and language barriers between doctors and immigrant patients. The health facility associated with the Martin Luther King Jr. Health Center opened in June specifically for the growing West African immigrant population in the Bronx. It is staffed with West African volunteers who speak the various dialects of the region. Known as cultural brokers, the volunteers assist patients with registration and help translate for the doctors.
“There is a limit to what the cultural brokers can do. They help patients feel at home, but patients must agree to having a third party in the doctor’s office before we use them,” said Sohaib Majeed, a medical doctor who works at the clinic. So far, the Diaspora clinic has registered 1,100 visits since it opened four months ago.
In 2008, the U.S. Department of Health and Human Services estimated that over 23 million people in America needed the services of specially trained in-person translators or telephone translation to communicate with doctors. Without translation, the consequences could be dire.
President Bill Clinton passed a regulation in 2000 mandating that federally funded agencies must provide translators for speakers of minority languages. As a result, many hospitals created telephone translation services. These services allow doctors to call toll free numbers, where a specially trained translator brokers the conversation between doctor and patient.
In spite of new telephone technology, the lack of direct human connection still often stands in the way.
“From my experience, many West African immigrants I have worked with speak their local languages,” said Dr. Aboyemi Salako, head of primary care at the Lebanon Hospital. “Doctors who do not speak those languages cannot communicate.”
Dr. Salako, a Nigerian immigrant, has realized the need for hospitals to communicate with this population for more than 30 years. Since 1985, more than 36,000 Africans have moved to the Bronx, most of whom are from the West African countries of Ghana, Guinea, Mali, Nigeria and Sierra Leone. Few speak international languages. More commonly they speak West African languages such as Hausa, Mandingo, Twi and Ewe.
Before the Diaspora Clinic opened, health workers at the Martin Luther King Hospital found that many patients who speak minority languages ended up in emergency rooms. They tend to avoid early treatment due to language, cultural or economic difficulties. “We reach out to West Africans because we want to emphasize the need for primary health care,” said Lionel Stewart, executive director of the hospital.
Many patients now visit the clinic regularly for appointments with four specialist doctors who operate on Tuesdays, Thursdays and Saturdays. The clinic has a social worker, who helps those without medical insurance to sign on to what they require. For the unemployed, undocumented or temporary residents like Cheickno, the hospital provides charity care – at little or no cost. This goes beyond the language and cultural differences.
A study published in a 2008 issue of Journal of the National Medical Association found most parents of pediatric patients were satisfied communicating with doctors by telephone translation services. It differs from other studies, which reported low satisfaction. Dr. Dodi Meyer, an Associate Clinical Professor in Pediatrics with the Columbia University Medical Center, said using human interpreters in a medical environment is ideal, but that is costly. Telephone translators are better than nothing.
“Those cultural brokers are very important to bridge the trust between the patients that we serve and the medical system,” she said. “You only have to be careful it does not violate the privacy of the patient.”
Once, she remembers, a newborn baby with hip dislocation at birth had to be rushed to an emergency room because the non-English speaking parents could not read the instructions telling them to see a pediatrician regularly. “It almost got out of hand when the parents finally showed up,” she said. “That was a 100 percent case of language barrier.”
One Thursday evening in October at the Diaspora Clinic, Cheickno was waiting with more than 12 patients for a follow up visit. Many of them had heard about the clinic in their churches or mosques. They knew either of two cultural brokers who were present.
Cheickno was speaking in his native Mandingo with one cultural broker, Bourema Niambele, a Malian immigrant who has lived in the Bronx for 16 years. A former AmeriCorps worker, Niambele now owns a car-rental service in the Highbridge section of the Bronx. He was present on the day Cheickno got rushed to the emergency room.
His health has improved since he came here, Niambele said. He gestured to Cheickno, who had a blood pressure meter fastened to his arm. “My blood pressure usually goes high and I’m glad I found this place,” Niambele translated from Mandingo to English.