Past, Present, and Future PerspectivesNovel coronavirus (COVID-19) introduced itself on the global stage at the tail end of 2019. A mere number of weeks later, it began to spread throughout the world, devastating healthcare institutions and sending most of the world’s economic systems into panic. But COVID-19 isn’t the first pandemic we’ve survived, and it certainly won’t be the last. Nonetheless, for countless businesses that have had to endure severe setbacks, the focus must now transition to one of economic survival and recovery. We must all take a sober look at how well prepared we were before this crisis hit, how well-built our internal infrastructures are to withstand economic blows, and how versatile we are moving forward. The following report is divided into three sections — past, present, and future, each highlighting the critical need for language services pre-, during-, and post-COVID-19. For many of the hardest-hit sectors (especially healthcare), these sections pinpoint the main challenges in communicating effectively with a diverse multilingual population and provide viable solutions to help in your recovery plan now and in the weeks and months ahead. As we gradually return to some semblance of normalcy, it is our sincere hope that this report and the multi-faceted Akorbi solutions we offer, provide support to you during this most unsettling time in our collective history. — The Akorbi Team
Learning From The Past
Challenge: How can small towns with minimal resources meet the needs of
their diverse limited-English proficient (LEP) population?Despite the many negative misperceptions regarding refugees, the United States continues to benefit from their arrival. Refugees not only help offset population decline and fill labor shortages, but they also greatly support the American economy. “In 2015 alone, refugee households earned more than $77 billion in income, paid nearly $21 billion in taxes and held more than $56 billion in spending power, supporting countless local businesses from clothing shops to electronics stores to restaurants.”1 Nonetheless, a great many refugees arrive with limited English proficiency (LEP). Although in recent years, the current US administration has greatly curtailed the country’s refugee resettlement program, according to the United Nations High Commissioner for Refugees (UNHCR), “the United States remains the top country for refugee resettlement… [having] resettled more refugees in 2019 than any other country.”2 In fact, historically, the United States has resettled more refugees than any other nation. Between 2002 and 2018, over half of the more than 1 million refugees who arrived in the United States, settled in 10 U.S. states. One wouldn’t naturally think of Guymon, Oklahoma as a mini-United Nations. However, this small town in middle America actually represents the demographics of many small American towns throughout the country that revived themselves after the devastating blows of the 2007 Great Recession. By accepting the resettlement of refugees willing to do the work that many Americans weren’t (and many still aren’t) willing to do, these townships found innovative solutions to improve their economic status. However, with an increase in the arrival of new immigrants, these townships now represent some of the country’s most diverse multilingual communities. In Guymon alone, a town of roughly 12,000 residents, 37 languages are spoken — and in a town that is prone to its own share of natural disasters from scorching heat, to severe thunderstorms, tornadoes, and blizzards, these added languages pose a significant communication challenge for the local government, educational institutions, and healthcare. To put this into perspective, in 2018 several students came close to frostbite exposure waiting for a bus, unaware that schools had been cancelled due to the extreme temperature. And during the warmer months, the dangers of living in “tornado alley” are just as threatening. In advance of any imminent crisis, the town’s emergency preparedness announcements are communicated over the radio and within their school settings and churches. But these efforts cannot possibly begin to address the complex linguistic and cultural needs of the town’s limited-English proficient (LEP) population, the vast majority of which represent the town’s 33.4 percent of foreign-born persons. As Dennis Andrulis (a Texas Health Institute researcher and professor at the University of Texas Schools of Public Health) points out, “[y]ou can’t just cookie cutter a message and say, ‘…I’ll take this message in English and translate to Somali’” since words tend to carry a variety of meanings in different contexts and cultures — and that’s putting it mildly. So, how do these small resettlement towns with limited resources meet the needs of their newly-arrived LEP population?
SOLUTION: Localization and In-Language CreationTo strengthen outreach during times of crisis, townships with significant percentages of multilingual residents require more than translation and interpreting services. By investing in localization, governments, healthcare institutions, and businesses ensure their message is not only accurately translated but further adapted for local audiences. Localization captures the subtleties and nuances in a language but it goes one step further — it takes into consideration each culture’s belief systems, values, and traditions. Localization, when done right, renders a message that feels as though it was written specifically for the given culture. In-language creation would also greatly benefit multilingual communities such as Guymon. As a cutting-edge service, in-language content involves professionally crafted messages written by native-speaking content writers directly in the target language, thereby avoiding the need to translate altogether. In-language creation ensures timely, culturally-relevant content, and in times of crisis, finding language services providers (LSPs) with the quickest, most accurate, and most culturally-relevant solutions that provide effective multilingual communication are well worth their weight in gold.
Learning From The Present
Challenge: How can an overwhelmed and under-resourced healthcare
system meet the needs of their critically-ill LEP patients?Amid the COVID-19 pandemic, a growing number of doctors’ offices have recently had to close their doors, laying off staff, and opting instead to offer relatively healthy patients “virtual” medical appointments. Many hospitals across the nation have also been facing a similar reality. The unprecedented shortage of personal protective equipment (PPE), the sharp decline in essential healthcare workers, and the sudden influx in patients infected with the virus have all culminated to create the perfect storm. This shortage of medical and support staff has also hindered the administrative function of healthcare facilities from patient check-ins and data entry, to payment posting, claims processing, billing, coding, and more. To make matters worse, in a nation home to more than 25 million LEP residents, many hospitals have also lost their healthcare interpreting support. Hospitals throughout the United States have traditionally invested in on-site interpreting services either through partnerships with LSPs or through bilingual staffing programs. Some have even relied heavily on interpreting services provided by community volunteers or bilingual family members (although this is technically not permissible under the current federal law). However, in what felt like a mere heartbeat in time, on-site medical interpreting came to an abrupt halt. The sudden onset of COVID-19 has created chaos across all healthcare sectors and, “as the pandemic has disproportionately affected minority communities that require interpretation”3, a shortage in healthcare interpreting services can literally mean the difference between life and death. Several US-based studies have shown that LEP patients are at a higher risk for adverse events than are their English-speaking counterparts. In fact, in one particular seven-month study, 1,083 adverse-incident reports from six US-based hospitals were analyzed comparing physical harm experienced by both English-speaking and LEP patients, and the results were alarming. Nearly half of the study’s LEP patients experienced physical harm versus 29.5 percent of the study’s English-speaking patients. And, “[o]f those adverse events resulting in physical harm, 46.8% of the limited English proficient patient adverse events had a level of harm ranging from moderate temporary harm to death, compared with 24.4% of English speaking patient adverse events.”4 However, under the current conditions, how can an overwhelmed and under-resourced healthcare system meet the needs of their critically-ill LEP patients?
SOLUTION: Multilingual staffing, remote healthcare interpreting, and BPO supportEven before the virus began wreaking havoc throughout the medical community, many hospitals throughout the country were already experiencing a shortage in healthcare personnel. Due in large part to an aging population and an increased demand for healthcare services, hospitals have been turning to specialized staffing agencies to help fill the gap. These agencies offer an abundant pool of highly sought-after medical professionals, including medical technologists, occupational therapists, respiratory therapists, per-diem nurses and more. Now, faced with the distressing reality of even greater staffing shortages, hospitals that haven’t invested in staffing agencies may wish to reconsider. It may be surprising to some to learn that specialized LSPs also offer medical staffing solutions with an extensive pool of multilingual medical professionals ready to serve a hospital’s LEP population. And, as their actual title suggests, “language services providers” also offer professional linguistic services. Choosing an LSP that can offer temporary relief with over-the-phone and remote interpreting services while also supplying professional staffing solutions seems like a no brainer. Some LSPs even offer another layer of healthcare support in the way of business process outsourcing (BPO). Depending on the LSP, this often includes support with appointment setting, rescheduling, call-back reminders, as well as a number of other essential back-office support BPO services. As a growing number of hospitals continue to face a shortage of specialists within their administrative, IT, and billing departments, outsourcing business processes might just be the cost-effective solution they’ve been looking for.
Challenge: How can healthcare institutions, life sciences organizations, and private sector companies improve online multilingual communication?
Cultural Differences in Crisis ManagementAs the World Health Organization (WHO) and other life sciences organizations strive to develop an effective vaccine to stop COVID-19 in its tracks, they must regularly communicate with governments and healthcare institutions around the globe. However, one of the greatest challenges they face involves a delicate balancing act — How do they ensure that their messaging on how to implement basic protective measures reaches citizens of all nations but also remains culturally sensitive? If this critical information is not delivered with cultural sensitivity, the message risks getting lost altogether. Many countries respond differently to crisis management and risk mitigation. To that end, it is dangerously naive to assume every corner of the world will respond in lock step to emergencies. Perhaps Geert Hofsted’s widely-respected study of risk management is the best example to put these cultural differences into perspective. Hofsted’s “Uncertainty Avoidance Index” (UAI) “indicates to what extent a culture programs its members to feel either uncomfortable or comfortable in unstructured situations.”5 The lower the UAI score, the more apt a culture is to taking risks, and the higher the score, the more averse. As you can see from the following table (capturing a mere snapshot of the highest, mid-range, and lowest scores), when it comes to risk management, the world’s cultures differ greatly: However, even within a country’s borders, these cultural differences vis à vis risk management exist, and the more multiculturally-diverse a country, the greater these differences. In the United States, for example, there are currently “more than 40 million people [who] were born in another country, accounting for about one-fifth of the world’s migrants in 2017.”6 In fact, the United States welcomes more than one million immigrants each year from dozens of countries. With such a culturally-diverse population, the country’s economic, political, and social wellbeing greatly depends on a collective investment in multicultural communication at home and abroad. This investment almost certainly extends to a great many US-based companies that have up until now operated successfully at home and across international borders. Due to cultural differences in risk management, these companies may suddenly face sharp increases in the cost of doing business abroad, especially if countries begin to retreat behind their perceived protective interior borders.
Digital CommunicationOne quick internet search with keywords “crisis management” and you’re sure to turn up hundreds (if not thousands) of articles, blog posts, and webpages all devoted to sharing what steps to take to keep you and your loved ones safe in times of crisis. And while government, healthcare, and life sciences websites take great pains to ensure their online content publishes responsible, accurate, and reliable guidelines for people to follow during emergencies, how well are they able to moderate user-generated content (UGC), especially if that content is in languages other than English (LOTE)?
SOLUTION: Multilingual Content ModerationSince arguably all industries now use their respective websites and social media platforms as their primary mode of communication, by moderating both in-house and user-generated content (UGC) you will help to eliminate any uncertainty and strengthen confidence in your target audience. Without this investment, governments, healthcare institutions, and life sciences organizations risk miscommunication. But mere content moderation isn’t enough. By investing in multilingual content moderation, companies will improve international connections, remove the potential cultural and linguistic barriers from their own website, and further mitigate the risk of spreading misinformation via user-generated content regardless of the language — and spreading misinformation is just not a risk you want to take any time let alone in times of crisis.
Applying Intelligence for Future SuccessIn the months to come, companies will shift from focusing on the immediate crisis of the pandemic itself to navigating the immense upheaval of an economic contraction that threatens to be possibly as severe and as long-lasting as the Great Recession of 2008-10. The new realities that emerged after that crisis were collectively known as “The New Normal.” Perhaps the post-COVID-19 world can be anticipated as “The New Normal 2.0.” Some characteristics of this “New Normal 2.0” could likely include:
- An upturn in early retirement as competition for work in the struggling gig economy becomes too intense for the casual or part-time older worker
- A worsening of the crisis in rural healthcare within the United States, as doctors are forced to retire early or close their practices
- A second “lost generation” emerging just 12 years after the first, with both educational deficits and thwarted economic opportunities to deal with
- Dramatic political shifts resulting from the popular realization that big government is not necessarily bad government
- Labor costs in an atmosphere of high unemployment will likely hold wages down, although pressure for more complete universal health coverage is likely to go up as a reaction to the cracks revealed by the epidemic.