Language is a barrier to medical care for immigrants – 06/20/2023 – Health

“My daughter, aged one year and two months, felt sick with diarrhea and vomiting. I went to the hospital and no one could understand what I was saying. I went back to the shelter to look for a neighbor who spoke the language. [português]. So, my daughter was hospitalized with her mother, and I went to see what the girl had. I think my daughter died because the doctor couldn’t understand me.”

The account of the Venezuelan native of the Warao ethnic group interviewed by researchers in a shelter in Manaus highlights one of the main problems in the care of immigrants and refugees in Brazil. According to a series of studies funded by the WHO (World Health Organization), language is one of the biggest barriers to health care for this population.

“It is a barrier for the patient, who cannot express himself, and for the professional, who cannot understand or explain the treatment”, says Sonia Vivian de Jezus, professor at UFMT (Federal University of Mato Grosso) and one of the coordinators of research.

Since 2018, the country has recognized 57,662 people as refugees. Most of the requests were granted for serious and widespread human rights violations, and 81.6% of the decisions were related to Venezuelans, according to a panel by the UNHCR, the UN refugee agency.

The first results of the project were published in the scientific journal BMC Infectious Diseases based on tests collected from 903 immigrants, 77% of them from Venezuela.

The survey indicates the high prevalence of latent tuberculosis – when the bacteria Mycobacterium tuberculosis is present in the body and the person can develop the disease – among foreigners sheltering in Manaus (46.1% of participants), São Paulo (33.3%), Curitiba (28.1%) and Boa Vista (23.5%) %).

The numbers surpass the findings of a previous study, which indicated a 37% prevalence of latent tuberculosis among refugees and asylum seekers, with an average of 28% for those in the Americas.

For the researchers, the variation is in the socioeconomic conditions and in the country of origin of these immigrants, since tuberculosis is a disease directly associated with social vulnerability. The lack of medical assistance in the past, the precarious situation of some Brazilian shelters and unemployment when arriving here converge.

When the scientists expanded the sample and carried out an online questionnaire, thus including foreigners with better financial conditions, the rates became less discrepant, but the incidences were still higher.

At this stage, 553 immigrants and refugees from Venezuela, Cuba, Colombia, Peru, Argentina, Cape Verde, Morocco and the United States participated in the study. Among them, 3.07% reported having tuberculosis, 28.5% reported hypertension and 21.2% diabetes. In the Brazilian population in general, according to the study, these numbers are respectively 1%, 24.5% and 7.4%.

Among the vulnerabilities, 32% of the participants mentioned unemployment, 37.6% moved to Brazil due to the social situation in their country and 33.6% lived in a shelter.

“We need to create interventions to cover this population. We have the SUS and the door is open to everyone, but there are difficulties”, says Jezus.

In order to understand these bottlenecks, in the third phase, the group applied a questionnaire to 106 health professionals and interviewed 30 Venezuelan immigrants of the Warao ethnic group living in shelters in Manaus. This is how they found the impact of the language barrier on the consultations. “Most of them speak Warao and don’t speak Spanish as a second language”, says the researcher.

“The language barrier is one of the main obstacles to the enjoyment of access to the rights provided for the refugee population”, reinforces Paulo Sergio Almeida, livelihood officer at UNHCR Brazil.

The interviews also revealed difficulties in purchasing medication, adapting to foods that do not belong to the traditional diet and traveling to appointments and tests.

“The idea of ​​these studies is to provide subsidies for new health policies. We need to take care of these people”, adds the researcher. In addition to her, another author of the studies is Ethel Maciel, current Secretary of Health and Environment Surveillance at the Ministry of Health.

“Public health policies must contemplate the specific needs of refugees exactly to the same extent that they serve Brazilians according to their needs, ensuring that the wide diversity of people that make up our country is contemplated”, ponders Almeida.

In the city of São Paulo alone, there were more than 300,000 visits to foreign patients last year, according to Silvana Kamehama, director of the Primary Care Division of the Municipal Health Department.

To access the services, it is essential to have the SUS card, but proof of address is not mandatory to obtain the document, precisely considering the situation of sheltered and homeless people.

Regarding the language, Kamehama says that, in the regions of Brás and Pari, Bolivian community agents assist in serving the foreign community whose mother tongue is Spanish.

In other cases, it is common for friends and community leaders familiar with Portuguese to mediate the contact. “We can’t just put a translator in the consultation. It needs to be a person the patient trusts.”