Germany’s health system has a language problem – DW – 11/03/2024

Hedvig Skirgard, a Swedish linguist who came to Leipzig for her postgraduate studies, had only been in Germany for a few months when she had to go to the doctor. The resulting experience still haunts him now, after several years of living and working in Germany.

“My doctor referred me to several specialists,” she said. “I contacted them using Google Translate and the little German I could find. I asked if they could speak English with me, but none of them could. I asked if there was a translation service – there wasn’t. One therapist suggested that “d bring a friend or family member to come and talk to me. This was impossible: I have no family here and I don’t have a friend that I feel comfortable bringing with me for a close conversation.” of medicine.

The strangest thing he remembers was the impression he had that the doctors didn’t seem to know what to do when they weren’t talking to their patients. “Would I be the first person to move to my town to practice medicine without having advanced knowledge of German? Right?”

Skirgard was almost certainly not. Germany’s Federal Statistical Office found in 2023 that about 15% of people living in Germany do not speak German at home. However, as Skirgard was a little dismayed to discover, there are few procedures in place when health care providers encounter non-German patients, and many doctors do not know what what systems are there. Finally, Skirgard found useful medical information who speak different languages ​​- although his doctor did not know about it.

“It was stressful and scary, and I hope this doesn’t happen to anyone. I know other cases that went well,” he said. “Physicians feel overwhelmed and pressured to provide care outside of their comfort zone and competence.”

Health care translation is required in some countries

It seems that many German doctors would agree: in May, the German Medical Association’s doctors’ conference voted in favor of two options calling for free professional interpretation services – on the grounds that a lack of such services make it difficult for them to do their job. activities.

“Every day, we doctors treat patients whose language is not German,” one of the references read. “Often, communication is only possible with the help of family or colleagues and medical professionals, nursing staff or service staff. This ineffective language communication is not only a burden for the translator, but also for the team of medicine and patients, and it complicates proper diagnosis or treatment.”

Such services are not a new concept. In some European countries, it is up to the health care system, rather than the patient, to find a common language. In the Swedish state of Skirgard, 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 does not speak Swedish. In Norway, patients have the legal right to receive information about their health and medical treatment in a language they understand, while the Irish Department of Health has issued guidance on how doctors should find translators.

Meanwhile, in Germany, doctors and patients are often left to fumble as best they can – sometimes relying on charities and volunteers such as the Leipzig-based Communication in Medical Settings, a university group in Leipzig that organizes explanations. for the appointment of doctors, in particular. more refugees and asylum seekers.

“We see ourselves as people who fill the gaps for the translation that needs to be done and paid for professionally,” Paulina, from Communication in Medical Settings, told DW. “But we see that there is a gap, because the government or the health insurers or the doctors’ offices or the hospitals will not take responsibility to take the costs.”

‘Nice to have’ or ‘need’?

As it happens, the federal government of Chancellor Olaf Scholz is aware of the problem and has promised in its 2021 federal contract to make the country’s national health insurers cover the cost of translation services. A spokesman for the German Ministry of Health confirmed to DW that this is indeed still part of the project, and would recommend that the joint organizations introduce it to the Health Promotion Act.

But that issue has not yet happened, and it seems to have been blocked by disagreements in the Government coalition. Bernd Meyer, professor of intercultural communication at the University of Mainz, has studied language, integration and culture for many years, and has co-authored a book of recommendations on language in public institutions. He was invited to the Bundestag last year to explain why the measure is needed.

“Everyone says this is a problem and it needs to be solved,” he told DW. “But there is a problem in the political process.” Although he argued that providing such services would be cheaper, relative to the cost of health services in general, his understanding was that the corporation, as Meyer say, it decided that translation services are considered a “nice to have,” rather than a “necessity.”

“It was basically closed to all discussions about the budget and debt obligations,” he said, referring to the way the government is forced to balance the books and impose strict limits on borrowing. new.

Germany is a multilingual society

As Skirgard and others have noted, Germany is trying to attract skilled workers. According to the German Institute of Economics (IW), about 570,000 jobs were not filled by 2023, and companies were struggling as a result. In September, Scholz signed a labor skills agreement with Kenya to help close the gap.

Of course, some would say that German is the official language and that anyone who lives here must learn it. “Oh, I agree, that’s 100% true,” Skirgard said. “But when someone arrives, one month from Kenya, and breaks their bone, shouldn’t they be taken care of until they take a strong course in Germany? I think that if Germany wants to be a country which attracts skilled immigrants, then the translation might be ‘must have’ and not ‘nice to have’.

Indeed, as researchers like Meyer often point out, the truth is that Germany is a multilingual society. Many people live their lives rarely speaking German: during his research at the hospital, Meyer met a 60-year-old Portuguese heart patient who did not know any German who has spent more than 30 years working on the German plateau.

“He basically carried half a pig around all day, and in the evening he went to a Portuguese club and watched football,” he said. “He never had much contact with Germans. Why should he have? His life was fine. He never had a reason to learn German.”

Although – as a linguist – Skirgard has learned German during his four years here, he also rarely uses it in his working life at the university where he works. “You can say that’s bad and it shouldn’t be, and I completely understand that point of view,” he said. “But here’s the situation, so how do you deal with what’s happening instead of what you want to happen?”

Edited by: Rina Goldenberg

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