Communication with patients who cannot speak German or speak at best very little is considered one of the biggest challenges facing health care professionals in Germany. Providing adequate medical service under conditions of miscommunication is rarely possible. As a result of misunderstanding, patients cannot establish the necessary relationship and trust with their health care providers. As for professional interpreters, they are not easily available; especially in rural areas. Besides, their funding is mostly unsolved. In such a situation, health care professionals depend mostly on amateur interpreters (usually accompanying the patients). However, this poses many hazards regarding the accuracy of translation and the protection of patient’s private data.
In the DICTUM-Friedland project, we want to improve the communication between medical personnel and their non-German speaking patients through a digital communication assistance tool. The digital communication assistance tool will be tested in the primary healthcare center at transit border camp Friedland. Through its piloting in Friedland, the digital communication assistance tool will be adjusted accordingly and customized for broad and long-term use. During the last phase of our project, we would like to provide the program for five selected family medicine practices in the southern region of Lower Saxony, which have often contact with migrants and refugee patients.
About the digital communication assistance tool
The digital communication assistance tool facilitates collecting a structured medical history from patients who speaks one of the following languages or dialects:
- Arabic (Modern Standard Arabic, Syrian Arabic, Egyptian Arabic, Tunesian Arabic, Morocian Arabic)
- Kurdish (Kurmanci, Sorani)
- Pashtu (Pashtu Kandahari, Pashtu Mashreki)
This happens by giving intuitive input on a Tablet PC, before meeting the doctor (e.g. while in the waiting room). The software responds adaptively to the patient's given data. In addition, it asks for the subjective patient assessment of symptoms in order to express distress, fears and expectations as the patient feels it. Questions and answers are also available constantly through the program in a video and audio based format, so that functional illiterates could benefit from the software on one hand, and on the other hand, the different dialects, which have no literary equivalent, can be integrated into the software and used by patients.
The collection of medical history using the digital communication assistance tool is therefore culturally sensitive. It documents culturally-specific disease impressions and thus brings culturally-translated information with explanations that can be viewed by doctors immediately before or during the consultation. In addition, the patient receives a paper report printed in both languages, which he /she can use at that time. For the purpose of direct interaction, a tablet PC will be available to support both parties in simple communication mode.
About the Border Transit Camp (GDL) Friedland
The border transit camp at Friedland has a long and eventful history. After the Second World War, it was used as a transit camp for refugees, homecoming soldiers and displaced people. Today, it harbors mostly of asylum seekers. Up until now, Friedland GDL has offered temporary shelter to over 4 million people.
The GDL is involved with different responsibilities: It is one of many centers in Germany for people who are applying for asylum. The GDL registers refugees, takes up their asylum cases and at the same time provides them with short term necessary protection and care. In addition, as the GDL initiates further living accommodations in Germany. Usually, people are looked after in the GDL for a few weeks to months then they are moved to different cities and towns (according to the so-called "Königsteiner Schlüssel" of redistribution process).For the temporary care up to 2,000 people, the GDL has a wide range of facilities: from sleeping sites to cafeteria, social work services, child day care center and schools, and a primary healthcare center.
This primary healthcare center provides primary medical care services to the GDL residents and is considered the first point of contact for all kinds of medical problems. There is also a small inpatient area to take care of patients who need inpatient medical care. The working hours are supervised by four general medical practices from Friedland and the surrounding communities. If there is a need for a further medical investigations or treatment, the primary medical care service team arranges transfers to specialist practices or hospital admission.