Language barriers and communication challenges may be small inconveniences in some aspects of expat life, but in high-stakes contexts like health communication, they can pose serious, even life-threatening risks. If you're not fluent in the local language of your expat country, how can you ensure your health concerns are accurately conveyed to the doctor and that you fully understand your prescriptions and discharge instructions?
Many healthcare systems have a language barrier problem
Public healthcare systems around the world tend to suffer from underfunding and understaffing. This means that, unfortunately, language training for doctors and nurses, along with the hiring of professional translators and interpreters, tend to be among the first items to be affected during budget cuts.
DW News reports that Germany has yet to fully implement translation services across its public healthcare system. Despite being a leading global economy and home to a population where 15% (approximately 13 million people) do not speak German as their first language, the country lacks a centralized public system for booking medical interpreters. This gap has unfortunately led to discriminatory practices in some private healthcare settings, where patients with limited German proficiency are turned away unless they bring their own interpreter. Doctors defending this practice argue that agreeing to treat patients without clear communication poses risks, such as the potential for giving incorrect advice or misinterpretation. They do not want to bear the legal liability of such risks.
In other countries, centralized systems are in place to arrange medical interpreters. In the UK, for example, the National Health Service (NHS) is responsible for providing interpreters to patients in need. Patients can request this service through their local GP practice or surgery, which will schedule the nearest available appointment with an interpreter. To reduce costs, interpretation is typically conducted remotely, via phone or video call, rather than having the interpreter physically present at the hospital. Most interpreters used by the NHS either hold a degree or certification in interpretation or possess equivalent relevant experience, as medical interpretation requires specialized skills that untrained bilingual people typically do not have.
Despite the system in place, funding and staffing challenges within the NHS have occasionally hindered the provision of adequate linguistic services, particularly for rare languages, in remote areas, and within emergency services. Slator, a source of market intelligence about translation and interpretation, found that a third of frontline workers in the UK, including in the NHS, resort to Google Translate and ChatGPT when communicating with people whose native language is not English. This can be dangerous, and research has cautioned medical professionals against it.
One stark case of how dangerous it can be is the case of a Syrian expat in the UK who, in 2018, ended up having a hysterectomy (womb removal) without her consent after hospital staff used only Google Translate to tell her about the procedure. In Arabic, she had explicitly refused the procedure, but the staff did not understand her because of the limitations of app translation. While translation apps can be handy for tasks like asking for directions on the street or ordering food, they are unsuitable for conveying highly sensitive information, such as obtaining patient consent or providing discharge instructions. Even when medical documents are machine-translated, they are constantly reviewed by a human post-editor.
As an expat, you probably have private medical insurance since you are unlikely to qualify for free public healthcare as a non-citizen. Ensure that any bilingual doctors with private practices are included in your insurance network. You may even find expat doctors from your home country who can communicate as fluently in your native language as in the local language. You can seek recommendations for expat doctors on forums like Expat.com or other support groups. This will save you the hassle of requiring interpretation services if you visit a public hospital.
Tips to navigate healthcare abroad without risking your safety
Get your medical records translated early on
A few months before your departure or as soon as you arrive at your new expat destination, gather all your medical records and have them translated into the country's official language. This will simplify things when you need medical assistance. You don't want to be scrambling for a more expensive last-minute translation only when you get an asthma attack or need to get a painful tooth removed!
Similar to interpretation, it's important to rely on professional translation services. Avoid asking an unqualified family member or friend to translate specialized documents. In some countries, medical translators are legally required to be sworn in or certified by a regulating authority. For instance, in Australia, translators of official legal and medical documents must be certified by NAATI (National Accreditation Authority for Translators and Interpreters).
You can find qualified translators on ProZ, where you can create a job listing detailing your translation needs and budget. Be sure to specify the country for which you need the translation. For instance, if you're translating into Spanish, indicate whether it's for Spain, Mexico, Argentina, or another country. As for alternatives like Upwork and Fiverr, these platforms feature a mix of both amateurs and professionals, making them less reliable compared to ProZ.
Alternatively, you can explore the "find a professional" directories of translator and interpreter associations. These directories allow you to narrow your search by location, language pair, and specialization (in this case, medical translation). While these associations are often based in one country, they also include international members practicing in other regions. Below is a list of these directories, along with links to access them:
- National Accreditation Authority for Translators and Interpreters (NAATI), Australia
- Institute of Translation and Interpreting (ITI), UK
- American Translators Association, US
- German Federal Association of Translators and Interpreters, Germany
- Asociación Española de Traductores, Correctores e Intérpretes (ASETRAD), Spain
- Société française des traducteurs (STF), France
- Canadian Translators, Terminologists and Interpreters Council (CTTIC), Canada
- Translators Association of China, China
- Japan Association of Translators (JAT), Japan
Avoid relying on apps, family members, or friends for interpretation
As previously said, while translation applications, including the latest ones powered by AI, are incredibly useful, relying on them for medical interpreting without human verification remains risky. As far as possible, seek the assistance of a professional interpreter who can help clarify any doubts on both your end and the doctor's end while also serving as a cultural broker. An app may struggle to recognize cultural nuances, such as the use of euphemisms when discussing sexual health, or finer technical details, like variations in medication names across different countries.
Bringing a family member or friend to the hospital for emotional support is natural, but having them act as an untrained interpreter can be dangerous, especially for more serious health issues (e.g., a cardiology consultation versus a routine GP visit for a common cold). EthnoMed, a network of healthcare providers in Seattle that cater to immigrant patients, gives two reasons why this is not advised: one, a relative/friend may not understand specialized medical terms and communicate the wrong information, and two, they might omit or modify information depending on their emotional ties with you. It remains much safer to request an interpreter through the hospital, seek one from a professional interpretation organization or an NGO that supports expats and immigrants, or consult a doctor who speaks your native language.
Learn the basics of healthcare communication in the local language
Before or during your preparation to move to your new expat destination, you've likely started learning the local language. Make sure to learn key healthcare phrases such as “My stomach hurts,” “I have a fever,” or “I took painkillers.” Remember that medications with the same chemical composition can have different brand names across countries, so research the local names for common medicines like cough syrup and painkillers.
If you have pre-existing conditions and are already taking medication at the time of moving to a new country, it's crucial to learn their names in the local language. For example, if you are a diabetic expat living in China, even if your Chinese is limited, knowing the term “táng niào bìng” for “diabetes” could be life-saving in an emergency, as a single word might convey critical information to a doctor.
If you have a language tutor, ask them to help you practice doctor-patient role-playing scenarios. Additionally, platforms like Coursera and EdX offer online courses focused on healthcare communication in foreign languages, such as “Spanish for Successful Communication in Healthcare Settings” by Rice University and “Clinical Terminology for International and U.S. Students” by the University of Pittsburgh.
Subscribe to medical insurance that provides language assistance
When choosing your private medical insurance plan as an expat, give preference to plans that can provide you with language assistance and interpreter services. For example, Cigna Global, specializing in expat insurance, provides these services to its customers.
