A language problem has arisen in the German healthcare system – DW – 11/03/2024

Hedvig Skirgård, a Swedish linguistics student who came to Leipzig to study for her doctorate, had only been in Germany for a few months when she needed to see a doctor. The experience still bothers her now, after several years of living and working in Germany.

“My doctor recommended several specialists,” she said. “I contacted them using Google Translate and what little German I had learned. I asked if they could speak English to me, but none of them could. I asked if there were any translation services – there were none. One specialist suggested to me “I would invite a friend or family member to translate for me. This was impossible: I have no family or friend here whom I could take with me for an intimate medical conversation.”

The strangest thing, she recalls, was the impression that doctors did not know what to do if they did not speak the same language as their patients. “Can I be the first immigrant in my city to undergo a medical procedure without having advanced German speaking skills? Of course not?”

Skirgard almost certainly wasn’t. In 2023, the German Federal Statistical Office found that about 15% of people living in Germany do not primarily speak German at home. Still, Skirgaard was a little perplexed to discover that there are few systems in place when health care providers see non-German patients, and many doctors don’t know what systems actually exist. In the end, Skirgard found useful database of doctors who speak different languages ​​- although her own doctor did not know about it.

“It was stressful and scary and I hope it doesn’t happen to anyone else. I know of other cases that didn’t go so well,” she said. “Doctors feel exhausted and forced to provide care outside of their comfort zone and capabilities.”

Other countries require medical translation

Most German doctors seem to agree: in May, a conference of doctors of the German Medical Association voted in favor of two proposals requiring free professional translation services – on the grounds that the lack of such services made it difficult for them to do their jobs. jobs.

“Every day, we doctors treat patients whose first language is not German,” read one sentence. “Often communication is only possible with the help of family or colleagues in the medical profession, nursing staff or support staff. Such unprofessional language mediation is a burden not only for the interpreter, but also for the medical team and patients, and also complicates diagnosis or appropriate treatment.”

Such services are not a new idea. In other European countries, it is the health care system, not the patient, who must find common ground. In Skirgård’s native Sweden, there is a centralized system that allows doctors to book a conference call with an interpreter if they have an appointment with a patient who doesn’t speak Swedish. In Norway, patients have the legal right to receive information about their health and treatment in a language they understand, and the Irish Health Service has issued guidance on how doctors should find interpreters.

In Germany, meanwhile, doctors and patients often have to cope as best they can, sometimes relying on charities and volunteers such as the Leipzig-based Communication in Health Care Facilities, a university group based in Leipzig that organizes translations for medical appointments , mostly more refugees and asylum seekers.

“We see ourselves as a gap-filler in translation, which should be done and paid for professionally,” Paulina from the healthcare communications department, who preferred not to give her last name, told DW. “But we see that the gap exists because neither the government, nor health insurance companies, nor doctors’ offices, nor hospitals will take responsibility for covering the costs.”

“Nice to have” or “must have”?

As it happens, Chancellor Olaf Scholz’s coalition government is aware of the problem and promised in its 2021 coalition contract to oblige the nation’s public health insurers to cover the cost of translation services. A spokesman for Germany’s health ministry confirmed to DW that this is indeed still part of the plan and would recommend that coalition parties include it in the Health Care Strengthening Act.

But this has not yet happened and appears to have been blocked by divisions within the government coalition. Bernd Meyer, professor of intercultural communication at the University of Mainz, has studied issues of language, integration and culture for many years and co-authored a book of recommendations on language in public institutions. Last year he was invited to the Bundestag to explain why this measure was so necessary.

“Everyone says this is a problem and needs to be solved,” he told DW. “But there is a problem in political implementation.” While he argues that providing such services would be relatively inexpensive given the cost of the health care system as a whole, he understands that the coalition, as Meyer put it, decided that interpreter services were considered a “nice to have” rather than a “need to have.”

“Essentially, it’s been blocked in the whole debate about the budget and the debt brake,” he said, referring to the mechanism that forces the government to balance its books and sets strict limits on new borrowing.

Germany is a multilingual society

As Skirgaard and others have noted, Germany is struggling to attract skilled labor. According to the German Economic Institute (IW), around 570,000 jobs will not be filled in 2023, and companies are struggling as a result. In September, Scholz signed a skilled labor agreement with Kenya to help bridge the gap.

Of course, some will say that German is the official language and that everyone who lives here simply must learn it. “Oh, I agree, that’s 100% true,” Skirgard said. “But when someone comes in the first month from Kenya and breaks a bone, shouldn’t they get medical attention until they have an intensive course in German? I think if Germany wants to be a country that attracts skilled immigrants, then transfer may be a “need to have” rather than a “nice to have”.

Indeed, as researchers such as Meyer often point out, the reality is that Germany is a multilingual society. Many people rarely speak German in their lives: during his research at the hospital, Meyer met a 60-year-old Portuguese heart attack patient with almost no German, who had spent over 30 years working in a German slaughterhouse.

“Basically he would carry halves of a pig with him all day and in the evenings he would go to a Portuguese social club and watch football,” he said. “He just never really interacted with the Germans. For what? His life was fine. He never had any reason to learn German.”

Although Skirgaard, a linguist, learned German during her four years here, she also rarely uses it in her work life at the university where she works. “You can say this is bad and it shouldn’t be this way, and I completely understand that point of view,” she said. “But that’s the situation, so how do you deal with what happens versus what you want to happen?”

Editor: Rina Goldenberg

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