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Language and cultural barriers can be critical weak links in providing patient care, and the issue is getting needed attention locally and nationally, experts said Tuesday in Rockville at a conference on health disparities.

"We deserve to be able to communicate our needs to our providers — we all deserve to be heard," said Amy Wilson-Stronks of the Joint Commission on Accreditation of Healthcare Organizations, who delivered the morning keynote address at Adventist HealthCare's Center on Health Disparities Fall Conference.

"Providers also need the resources available to them to do their jobs," said Wilson-Stronks, principal investigator for a study of hospitals, language and culture being conducted by the joint commission.

Although having staff available to translate between English and other languages is important, it is often not enough, she said.

That became evident in responses the joint commission got from providers at 60 hospitals across the nation when they were asked how they would handle a theoretical patient, "Juan Lopez," described as a Mexican immigrant who speaks no English.

In the scenario, Lopez shows up at the hospital with his 12-year-old English-speaking daughter and is seeking temporary relief for severe abdominal pain until he can visit a traditional healer to help him remove a hex he believes an angry neighbor put on him to cause his suffering.

Wilson-Stronks said some respondents said they would order a psychiatric evaluation, others said they would write down or draw what they were trying to tell him. Some said they would try to convince Lopez that his beliefs about the hex were wrong.

The commission is working on developing standards for "culturally competent, patient-centered care," she said.

Among hospitals in the study, about 90 percent reported that they had some bilingual staff, but only about half were doing any assessment or training, Wilson-Stronks said.

Shady Grove and Washington Adventist Hospitals are even training staff who are not direct-care providers to be able to help interpret on the spot between providers and patients.

Adventist Health also assesses potential interpreters to determine if their language proficiency qualifies them to translate medical information or only conversationally, said Marcos Pesquera, executive director of Adventist's Center on Health Disparities.

Even with the help of good translators, cultural differences can stymie the delivery of care, as in the case of a patient who refused to pay attention to what a woman doctor was trying to ask or say.

Hospital staff had to show the patient how many male doctors the woman doctor supervised before the patient would listen because women did not have such authority or roles in her culture.

Translators also learn through training that they have to pay attention to subtle cues and body language.

"The important thing is about creating an atmosphere for the patient that is not only confidential but safe," said Rubina Mason, a native of Panama who is fluent in English and Spanish and heads the Women's Center at Washington Adventist Hospital.