Access to Medical Interpreter Services and Quality of Healthcare

Medical care avoidance is a common problem in the US, with over ⅓ of participants in a study by the NIH stating that they have skipped an appointment due to high cost, aversion towards health care organizations, as well as discomfort interacting with physicians (1). One of the causes of discomfort is having to navigate confusing medical terminology. Many Americans with native language skills face health illiteracy, and this is only amplified for those with limited English proficiency. Furthermore, this issue is compounded by a shortage of available medical interpreter services, especially for those who already face barriers to quality care due to socioeconomic circumstances.

Immigration to the US has quadrupled since 1965 and immigration policy is one of the highly debated political topics as well as access to free healthcare (2). Documentation and health insurance is only the first obstacle to accessing quality healthcare; moreover, there is another aspect that many fail to consider: Language. In a study done by the UCSF Department of Medicine, it was shown that the “use of professional interpreters [was] associated with improved clinical care more than [the] use of ad hoc interpreters, and professional interpreters appear to raise the quality of clinical care for limited English proficiency patients (3)."

Further studies have shown that communication is the best when “patients have access to trained professional interpreters or bilingual providers (4).” This is especially true for those who require treatment and attention for mental health conditions where a diagnosis is based purely off of communication rather than traditional examination tests. The best plan of care for those with limited English proficiency is either having a bilingual care provider or access to a trained professional interpreter.

Americans with limited English proficiency are constantly reminded of the language barrier, however, this problem is rarely noticed by native speakers and healthcare providers. Healthcare and medical terminology is hard enough to understand already, and access to interpreters is crucial in preventing fatal errors. Providing better access to interpretation services is one of the many improvements that need to be made to our inequitable healthcare system.

Edited by: Huda Haque

Graphic Designed by: Devin Mulcrone

References

1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351276/

2) https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/

3) https://pubmed.ncbi.nlm.nih.gov/17362215/

4) https://pubmed.ncbi.nlm.nih.gov/15894705/

Crowdfunding Medical Campaigns

Crowdfunding is the idea of gradually collecting small sums of money from large groups of people. Popular websites like GoFundMe are notorious for gradually gathering large sums of money from large populations through relatable, heart wrenching causes like healthcare, food scarcity, etc. However, crowdfunding is commonly taken advantage of through deception and dishonesty in campaign narratives. Several examples may include lying about an illness, unpaid medical bills, natural disaster, etc. Not only do websites like GoFundMe blindly support false narratives and competition in telling the most “compelling” stories, but also heighten the gap that exists in wealth inequality rather than increasing access to available resources (notably in healthcare). Crowdfunding is also considered to be a threat to traditional fundraisers that have a more “direct” and “reliable” approach to who and where donations are given, (as many people feel that individuals need to donate towards a broader issue rather than a specific one). These issues beg several questions and debates that critique the ethicalities of running medical crowdfunding campaigns through websites like GoFundMe.

Oftentimes, utilizing crowdfunding websites like GoFundMe may seem like an efficient, accessible, and reasonable way to receive financial help in a state of urgency. However, the realities of popular fundraising websites like GoFundMe uncover the detrimental and inequitable costs of supporting these platforms. During the COVID-19 pandemic, out of 165,000 pandemic related campaigns, more than 4 in 10 received no donations. Although over $418 million dollars were raised throughout the pandemic, this money was majorly donated to populations that did not necessarily need financial assistance. This inequity highlights the detrimental effect websites like GoFundMe have on high wealth inequality, mainly helping wealthier populations raise even more money. Explanations for this strengthened wealth gap may include the fact that the majority of donations may go to those who already have an adequate financial status, and campaigns run by those with wealthier connections and networks may receive more attention.

Many people may find themselves in a position where they are hesitant to donate towards a traditional or non-traditional platform. Well-known charities like St. Jude Children’s Research Hospital, Feeding America, Habitat for Humanity, and Relay for Life are known for funding major issues like world hunger and cancer. However, charities like Relay for Life are criticized for not properly allocating their funding towards cancer research causes and initiatives that directly help cancer patients. Instead, fundraisers may spend large sums of money promoting their own brands and not directly helping the cause at hand. Although charity websites like GoFundMe may seem like a realistic, genuine way for individuals to receive financial assistance, others may argue that mass online charities push away attention from traditional charities. However, websites like GoFundMe ensure most of the funds gained go directly to the individual in need. This sparks the question for many regarding whether mass online charities are a more efficient and reliable way for individuals to ensure that their donations are directly benefiting those in need.

Although fundraising websites like GoFundMe provide a platform for any individual to advocate for their own cause, many individuals are critical of the fact that receiving adequate assistance is reliant on one’s ability to create a compelling story. This sense of competition between fundraising initiatives is controversial and may cause several fundraisers to remain ignored and have low success rates. However, telling a compelling story may be beneficial in instances where one’s story is rare or overlooked. For instance, telling a compelling story may raise awareness towards a rare disease that is underfunded and lacks assistance or attention. ON the other hand, telling a “compelling story” may be taken too far when an individual ends up lying about their cause out of desperation. This sparks the debate on whether crowdfunding campaigns should be fact-checked or not. Although fact-hecking may seem like a reasonable alternative to ensure money is allocated to desired populations, the right to privacy may been threatened. Should the government intervene when people are simply trying to help those who are struggling?

In a society filled with bad news, human beings want to feel a sense of hope towards the issues their confronted with. Fundraising websites like GoFundMe grants virtually anyone the opportunity to donate towards a cause out of their own generosity, concern, and compassion. On the other hand, there are innumerable systematic problems in our healthcare system that are systematic and need to be addressed. If people are donating towards a cause they feel compelled and empathize with, should their contributions be villainized? In a world swarmed with inequality, is it right to critique those who wish to donate towards a specific issue rather than on a broader scope?

Edited by: Min Ju Lee

Graphic Designed by: Harris Upchurch

Inequities in Cancer Screenings for Transgender Patients

In the United States, there are 1.4 million individuals that identify as transgender, which is a term used to describe someone whose gender identity does not correspond to the one assigned at birth [1].

While medical research within the transgender community is limited—even moreso within cancer-specific healthcare— there is strong evidence suggesting that this population is likely to experience greater incidence of cancer based on increased risk, socioeconomic obstacles, and lack of cancer screenings [2]. For any individual, whether they be cisgender or transgender, it is important to receive proper and regular screenings for cancer, but transgender people face more obstacles in getting these screenings, especially when it comes to birth-sex cancer screenings that may require the examination of sex organs they feel do not correspond to their gender. Even reaching a birth-sex based cancer screening is an obstacle for most transgender patients since it can be associated with feelings of unease and gender disphoria [3]. Reluctance to see primary care providers reduces vital opportunities to get screened for diseases, especially for cancers pertaining to birth-sex organs or cancers that have higher rates in certain sexes over another. Examples include screening for breast cancer, prostate cancer or cancers within the reproductive organs.

Not only does hesitancy of seeking clinical care for transgender patients stem from a high likelihood of experiencing gender dysphoria, but most clinicians are inadequately trained on protocol for recommending cancer screenings for transgender patients [3]. Only 30% of obstetricians and gynecologist providers in one study reported feeling comfortable treating transgender patients [2]. Among that 30%, 80% were willing to treat these patients, however, over half said they did not know the recommendations for breast cancer screening these individuals. A knowledge disparity is clearly present among healthcare providers for treating transgender people, especially when it comes to procedures that are generally more utilized by one gender over another.

Because there are no comprehensive transgender cancer screening guidelines, so those for cisgender individuals are applied. For example, 9.2.% fewer transgender women were up to date on cervical cancer screenings compared to cisgender women [3]. And rates of HIV are two times higher among the transgender population than cisgender men and ten times higher than in cisgender women [3]. While there is great lack of direction for those who are a transgender man or woman, there is even less guidance and research for those who identify as non-binary [3].

Even though the transgender population is at higher risk of a number of diseases such as HIV or conditions such as depression, many neglect seeking clinical treatment due to prior negative experiences of themselves or others. 41% of transgender patients report widespread discrimination in a healthcare environment [4]. Forms of discrimination could include being addressed as the wrong name or gender, not having access to an appropriate bathroom, or staff mistreating patients. Not only does fear of discrimination contribute to hesitancy to receive medical care, especially primary care in a non-emergency or gender affirming context, but lack of provider knowledge may reduce quality of care that transgender individuals may receive.

Comprehensive guidelines for physicians specific to caring for transgender popuations respectfully and equitably could increase the number of cancer screenings for transgender people and consequently decrease a health gap. Educating physicians on how to treat transgender patients and allow them to feel comfortable in a clinical setting is also important, and that is something that no one should be denied regardless of their gender identity.

Edited by: Deven Gupta

Graphic Designed by: Natalie Chou

References

1. Unger CA. Care of the transgender patient: a survey of gynecologists’ current knowledge and practice. J Women's Health (Larchmt). 2015;24(2):114–8. https://doi.org/10.1089/jwh.2014.4918.

2. Roznovjak, D., Petroll, A., & Cortina, C. S. (2021, January 4). Breast cancer risk and screening in transgender individuals - current breast cancer reports. SpringerLink. Retrieved November 28, 2022, from https://link.springer.com/article/10.1007/s12609-020-00403-x

3. Sterling, J., & Garcia, M. M. (2020, December). Cancer screening in the transgender population: A review of current guidelines, best practices, and a proposed care model. Translational andrology and urology. Retrieved November 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807311/

4. How Many Adults Identify as Transgender in the United States? UCLA School of Law, Williams Institute. Accessed October 15, 2020. <https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/>