Bi-Lingual Health
Barbara Heifferon
Department of English
Both Clemson graduate and undergraduate students have helped design and develop a bilingual health project for Spanish-speaking patients.
For the first phase of the project, students in my global professional communication graduate seminar used many computer applications, such as Adobe PageMaker, Adobe Photoshop, and Adobe Illustrator, to develop a system of wall charts and a flip book to enable non-Spanish speaking health workers to triage Spanish-speaking patients without relying solely on often non-existent translators. The students began by visiting the mountain apple farms above Long Creek, SC and the valley truck farms to observe where large numbers of Spanish-speaking farm workers were served by the Joseph F. Sullivan Center's mobile primary health care unit. Each graduate student was able to follow a patient through the process and observe the challenges as English-speaking students attempted to take histories and physicals to present patients for treatment.
My students then visited an on-site, evening clinic in which 60 Spanish-speaking farm workers poured out of buses and trucks to be evaluated (triaged) from most critical case to least critical case. My students and I observed that Clemson's health science and nursing students (English-speaking) struggled to communicate because of the language barrier.
Throughout the process, we used laptops to record our impressions and complete needs analyses given the situations we experienced. In interviewing Linda Crew, the Sullivan Center's executive director, and Will Mayo, the project coordinator for the Sullivan Center, we discovered that triage was critical and time was of the essence, because one person could have chest pain or a serious, closed wound, head injury, while another could have a minor virus.
Our next step was to record and write up interviews with farm workers and their families, some of whom have stayed in the area, with a Spanish-translator and those of us in class who could speak and understand Spanish. We learned from our clients (as well as background materials) that the culture for which we were designing had much more modesty regarding body parts than our American culture. In the interviews, one woman suggested that we design charts and graphics to help identify symptoms.
Based on her advice, students, using the various Adobe software applications in our MAPC (Master of Arts in Professional Communication) computer lab, designed 11x17 laminated charts that can be used in the field, a requirement because many of the farm worker sites offer no shelter outside the mobile unit for the screenings. Separate charts for men and women were designed because women, we learned, would be more comfortable with a separate chart, one that was tastefully designed, not as explicit as a typical chart seen in doctors' offices in this country.
The students also created a prototype of a diagnostic booklet or flip book, 50 pages, laminated, and spiral-bound. Using Adobe PhotoShop, PageMaker, and Illustrator, they were able to design graphics that were more audience sensitive and culturally appropriate than any of the materials we reviewed prior to designing our own. In using the materials, for example, a patient points to the head on the chart, and then the health worker turns to the head section in the flip book. There are graphics there depicting a fall, another one showing blurred vision, another with ringing in the ears, etc. In addition to the graphics, we put in a short phrase in Spanish and English, privileging the Spanish rather than the other way around. The conversations in class were frank, often humorous, and also helped bind us into a community of shared experience. We all experienced a growth in our design potential, our usage of numerous software programs and our own culture awareness and language skills.
In the second phase of the project, Jacob Barker, one of my MAPC graduate students, whose master's committee I chaired, wanted to help further develop this project. I had already set up five test sites throughout South Carolina at clinics and nurses' offices at elementary schools serving Latino children. He elected to transcribe all the tapes we used to interview health professionals after using our charts and flip books with their patients. We developed an electronic database for our research and, based on these health professionals' input, the graduate student developed revision strategies to make the projects even more successful. Again using design software, including more recent releases, he re-designed confusing graphics and added more examples in various categories.
Although the hard copy charts and flip books are very helpful in identifying symptoms and doing some preliminary diagnostics, we also needed to think about moving these tools to digital interfaces. In phase three of the project, my honors technical writing class chose to help design these interfaces. This particular class was made up of almost all computer science, engineering and pre-med students. When I told them about this possible project to challenge their skills, they elected overwhelmingly to move this project from print to digital. They decided to compete in two teams to develop different designs. They explored various software options that would enable us to use touch screen technology and a monitoring device that would allow health professionals to see the track of the choices patients made (such as the example of a head injury in the print version given above).
The honors undergraduates developed two prototypes of the digital version: one features a touch screen in the form of a tablet; the other features a kiosk-in-a-box that can be set up wherever triage is needed. Both are field-capable and both can record patient choices into a print-out for the diagnostician or triage nurse. The computers used in our lab were not always equipped with the necessary software programs, so students brought in their own laptops and we downloaded trial versions of new software to accomplish the development of these two models.
In all cases of teacher-student work, I tried to make the learning strategies applicable to the students, to what they would face later in their careers. All of the students were enthusiastic about having real-world opportunities to use technology to help others, especially in our increasingly diverse country as well as in the so-called global village.
