Written by Tabitha Carvan
What should a ten-year-old child be responsible for? Their guinea pig, perhaps. Their lunchbox. Making sure they’ve brushed their teeth.
They should not be responsible for life-or-death decisions about their parents’ health.
According to a study conducted by the ANU Medical School, this is the burden being placed on children in refugee families whose parents don’t speak English.
The University’s Dr Katrina Anderson works as a GP at Companion House, a not-for-profit service for refugees and asylum seekers in Canberra, where they recently conducted research into their patients’ interactions with the broader healthcare system.
“Many of our patients have fled countries where there has been war, violence and horrendous hardships on lots of levels,” Dr Anderson says. “And many of them, when they come to Australia, have very little English, if any at all.”
“What we found in our research—to our real surprise—is that children in these families, because they learn English more quickly, are being used to interpret for their parents in interactions with medical professionals.
“We found incidences where doctors have asked children to translate their parents’ history of psychological trauma after their parent has suffered a distressing mental health episode.
“We saw examples where children are being asked to organise chest x-rays and other procedures. There was a ten-year-old child who was given instructions at hospital for their parents’ discharge medications for an acute illness and told, ‘Your dad must take all these tablets or he’ll die’.
“I can hardly understand the discharge medications when someone is coming out of hospital, and this is a child!
“That’s child abuse to ask a ten-year-old child to take responsibility for severe illness in a parent.
“And in English-speaking Australian families, we would not allow our children to even be present for a parent’s psychological treatment, let alone carry the burden of their parents’ stress by translating it. It’s shocking that this is happening.”
Dr Anderson says she understands that doctors and others in the health system are under pressure to deliver treatment quickly, “so they look around for someone to help them, and grab the child”.
But, she says, there’s no excuse not to use a professional interpreter.
“There’s a simple solution. Anyone in the public or private health system can get a trained interpreter on the phone through the Federal Government’s Translating and Interpreting Service (TIS). The interpreter is just at the end of a quick phone number, and you can get access anywhere, anytime, even for a five-minute consultation. You just put the interpreter on speaker-phone on your mobile.”
Companion House doctors use phone interpreters for almost every patient interaction, Dr Anderson says.
“When refugees arrive in Australia, although they’ve now got some of their basic needs met, they’re still very stressed from trying to manage everything without any English. The most stressful time is when you have to see a doctor because you have something wrong with you. If that doctor can’t understand what you’re saying, it’s a very scary situation.
“You see in the patient’s face that as soon as we get the interpreter on the phone, straight away they feel an assurance. Here is someone who understands me!
“And a lot of these interpreters, they really do understand because they come from similar backgrounds to the patient. They might have even been in the same refugee camp. So as well as being highly trained medical interpreters, they can convey for us that empathy and understanding. A child can’t offer that, because they’re too caught up in the situation.”
Dr Katrina Anderson
Hongsar Channaibanya is an interpreter with TIS who himself arrived in Australia as a refugee from Burma 21 years ago, so he understands the importance of providing a voice.
“When I arrived in Australia, I didn’t have a medical record and I didn’t understand anything about the medical setting here. I had never done paperwork in my life. I only had very basic English and I couldn’t get my message across because doctors speak what is a different language.”
It’s a language that children don’t understand, Hongsar says, especially since many refugee children have extremely limited health literacy, even without the language barrier.
In addition to causing distress to children, the failure to use appropriate interpreters can have serious health consequences for patients.
“In our research, we really had our eyes opened to how many medical incidents have occurred because a doctor or allied health worker has failed to use a proper interpreter, and how much distress this has caused refugee patients.
“They can get admitted to hospital without ever being told what was actually wrong with them, or they can take medication without understanding the side-effects, or they might keep taking the medication without realising they can stop.”
Dr Anderson, who has won an Australian Award for University Teaching for teaching patient centredness and integrating her work with refugees into the classroom, says the ANU Medical School curriculum includes a compulsory task for students to do a real consultation using an interpreter.
“We’re trying a grassroots approach, where those students then change the culture above them. And when they become doctors, they will know not to use a child as an interpreter.”
But it’s more than just training doctors in the correct processes, she says. It’s about “being kind, and being caring.”
“One of the crucial things we’re trying to teach our students is, as future doctors, to be aware of what it’s like to come to a place where you don’t understand the language. Try to put yourself in their shoes.”