From "stuck" to satisfied: Aboriginal people's experience of culturally safe care with interpreters in a Northern Territory hospital

Vicki Kerrigan, Stuart Yiwarr McGrath, Sandawana William Majoni, Michelle Walker, Mandy Ahmat, Bilawara Lee, Alan Cass, Marita Hefler, Anna P Ralph, Vicki Kerrigan, Stuart Yiwarr McGrath, Sandawana William Majoni, Michelle Walker, Mandy Ahmat, Bilawara Lee, Alan Cass, Marita Hefler, Anna P Ralph

Abstract

Background: Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia's Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019.

Methods: This research was embedded in a larger Participatory Action Research study examining cultural safety and communication at Royal Darwin Hospital. Six Aboriginal language speaking patients (five Yolŋu and one Tiwi), three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully sampled. Data sources included participant interviews conducted in either the patient's language or English, researcher field notes from shadowing doctors, doctors' reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted.

Results: The hospital experience of Yolŋu and Tiwi participants was transformed through consistent access to interpreters who enabled patients to express their clinical and non-clinical needs. Aboriginal language-speaking patients experienced a transformation to culturally safe care. After initially reporting feeling "stuck" and disempowered when forced to communicate in English, participants reported feeling satisfied with their care and empowered by consistent access to the trusted interpreters, who shared their culture and worldviews. Interpreters also enabled providers to listen to concerns and priorities expressed by patients, which resulted in holistic care to address social determinants of health. This improved patient trajectories and reduced self-discharge rates.

Conclusions: A culturally unsafe system which restricted people's ability to receive equitable healthcare in their first language was overturned by embedding interpreters in a renal medical team. This research is the first to demonstrate the importance of consistent interpreter use for providing culturally safe care for Aboriginal patients in Australia.

Keywords: Aboriginal; Communication; Cultural safety; Health; Interpreters; Patient.

Conflict of interest statement

At time of writing, Sandawana William Majoni and Anna P Ralph were employed by Top End Health Service. Michelle Walker and Mandy Ahmat were employed by the NT Aboriginal Interpreter Service. Alan Cass was a Board Director for Top End Health Service from 2015 until June 2017. Bilawara Lee was a member of the TEHS Health Advisory Group and a member of the NT Health Ministers Advisory Committee. No competing interests were declared by other authors.

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