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“I Speak Your Language”: Cultural Sensitivity Ensures Better Health Care

By Carolyn Q

August marks National Language Month in the Philippines, which celebrates the incredible diversity of languages spoken in the country. According to the Philippine Department of the Interior and Local Government, there are 130 languages that have been recorded, and up to 20 additional languages that are being validated 1. With more than 150 languages, the Philippines has one of the highest concentrations of languages per capita in the world 2. The origins of National Language Month date back to 1934, when the Institute of National Language was established to develop a national language for the Philippines 3. Tagalog was chosen as the national language in 1937, however, English is widely spoken. As my friend, Ivy, recalls, “National Language Month is also referred to as National Heritage Month, and it is a big deal. I speak a language called Hiligaynon. My second language is English. Our school would celebrate by having all the kids dress in their traditional outfits; we would then play games and eat traditional food.”

As Filipinos have migrated all over the world, language diversity has followed. The intersection of language diversity and workforce mobility highlights the particular importance of language in the U.S. health care system. There are over 150,000 Filipino nurses in the U.S. health care workforce 4. Over the years, these Filipino nurses have filled critical nursing shortages, especially in rural and underserved populations. Their linguistic and cultural skills allow them to provide culturally competent care to diverse populations. As my mentor and former Vice President of Nursing and Patient Care at The Johns Hopkins Hospital said, “I don’t know what the U.S. health care system would do without the significant contributions of Filipino nurses.” Sadly, this was particularly highlighted during COVID-19, where one study found that registered nurses of Filipino descent had the highest mortality rate of COVID-19 among all ethnic groups 5.

In Colorado, over 5,800 Filipino nurses make up about 5% of the state’s nursing workforce.” 6 The nurses’ skills, strong work ethic and compassion provide high-quality care to thousands of patients daily. However, language barriers and access to translators inhibit their ability to provide optimal care. Tagalog and Llocano have been identified as the most commonly spoken Philippine languages in Colorado 7. In addition to language, some common health conditions faced by Filipinos are hypertension, diabetes and heart disease. Furthermore, as my colleague Edith shared, “The Filipino-American population is aging. The top barriers experienced by the Filipino Medicaid population are transportation, understanding eligibility, and lack of certified interpreters.” My colleague, Vicky went on to explain that culturally, it is not customary for Filipinos to question their medical providers. All these factors underscore why it is so important to provide high-quality language interpretation services, along with addressing social determinants of health barriers.

Here are some clear steps that health care organizations can take to improve language access:

  1. Conduct annual language assessment to identify the top languages spoken by patients and determine gaps in services. This can be done through surveying patients, reviewing medical records, and analyzing population demographics and trends.
  2. Provide on-site assistance and contract with a telephonic professional medical interpretation services.
  3. Translate patient intake forms, signage, wayfinding tools, prescriptions, instructions and informed consents.
  4. Ensure direct access to professional interpreters during emergencies and high-risk/high-stress procedures.
  5. Partner with community organizations to recruit multilingual staff that represent the diversity of patients.
  6. Provide ongoing training for staff on cultural competency and working with interpreters.
  7. Develop a language access plan for your organization. Click here for a guide from the Centers for Medicare and Medicaid Sciences (CMS).

The goal is to continually assess the language needs of the patient population and the organizations’ capacity to meet those needs. This allows health care systems to strategically improve language access services over time. Additionally, here are some specific Filipino Community Organizations in Colorado that could serve as great partners:

  1. The Filipino-American Community of Colorado
  2. The Philippine-American Society of Colorado
  3. The Philippine Nurses Association of Colorado

Partnering with grassroots organizations embedded within the Filipino community can help improve language access and other barriers. Ultimately, supporting language access upholds Filipino voices while advancing high-quality care. As we celebrate the linguistic diversity of the Philippines, we must also celebrate the Filipino nurses and health care workers who so greatly

contribute to the U.S. medical system. When we break down barriers through cultural sensitivity and diligent effort, we build a health care system where all can thrive. This translates into patients feeling heard, health care workers feeling empowered, and lives that are saved.

**With special thanks to Victoria Navarro, MAS, MSN, RN, Executive Director, The Philippine Humanitarian Coalition and 17th President of the Philippine Nurses Association, RN, MBA,MPA, MMAS, MSS Philippine, Bob Gahol, Philippine Nurses Association of America Western Region Vice President, and Edith Passion, MS, RN, founder of the Philippine Nurses Association of Colorado and President of the Philippine American Society of Colorado for your willingness to share your knowledge and experiences for this blog post. **

 

  1. dilg.gov.ph/PDFFILE/factsfigures/dig-facts-figures-2023717_4195fde921.pdf
  2. Lewis et al. (2015). Ethnologue: Languages of the World.
  3. Gonzalez, A. (1998). The Language Planning Situation in the Philippines.
  4. Xu et al. (2015), Characteristics of Internationally Educated Nurses in the United States.
  5. Pastores et al. (2021), Disproportionate COVID-19 Mortality Among Registered Nurses From Racial And Ethnic Minority Backgrounds.
  6. Migration Policy Institute (2015), Philippine Immigrants in the United States
  7. Modern Language Association (2015), The 30 Most Spoken Languages in Colorado
  8. Dela Cruz et al (2011), Health Conditions and Risk Factors of Filipino Americans.