Healthcare for patients with limited English proficiency
OPEN LETTER TO GOVERNORS AND HOSPITALS
The Certification Commission for Healthcare Interpreters (CCHI) has issued an open letter to governors and hospital associations to raise awareness about the safety of healthcare interpreters and language access services for patients with limited English proficiency (LEP) and their families, as well as the safety of all healthcare workers during the current unprecedented COVID-19 pandemic. Healthcare interpreters work in close quarters and in close proximity to patients and the safety of all workers with direct patient contact must be the number one priority. This includes physicians, nurses, allied professionals, and face-to-face/on-site healthcare interpreters.
PERSONAL PROTECTIVE EQUIPMENT
The open letter reminds hospitals and healthcare systems that face-to-face/on-site healthcare interpreters should be provided the same level of protection and use of personal protective equipment (PPE) as any healthcare provider for whom they are interpreting while also recognizing that PPE shortages may necessitate certain limiting measures. It is extremely important for managers to have transparent and honest conversations with interpreters and collectively come to an understanding on when and to whom PPE is provided.
ALTERNATIVES TO ON-SITE INTERPRETATION
When PPE is not available there are alternatives to face-to-face/on-site interpretation. Ultimately, if appropriate PPE is not available for an interpreter, then alternatives must be provided to both reduce the spread of the coronavirus by interpreters and ensure their personal safety. Unlike most healthcare providers, interpreters work in different departments, different facilities, and even different campuses throughout the day. Their inadequate protection will result in spreading the virus not only in the community and to their families but also to other healthcare workers and patients within and outside a specific facility.
The CCHI recommends that all hospitals, health systems, clinics, and healthcare providers deploy remote interpreting for most of their interactions with LEP patients and their families, as the primary modality for delivery of language access services in the time of this pandemic. The implementation of remote interpreting may take time and require certain information technology solutions as well as evaluation for compliance with laws and regulations. However, the implementation of remote interpreting will allow facilities to reserve much needed PPE for healthcare professionals who must be in direct contact with patients. Furthermore, face-to-face interpreters have a higher risk of becoming a vector of infection even with the appropriate use of PPE due to the mobility of their job. When institutions utilize telemedicine and telehealth options for providing care, they must incorporate remote interpreting into these solutions to ensure equal access to healthcare for limited English proficiency patients.
HOW TO IMPLEMENT REMOTE INTERPRETING
Remote interpreting may be implemented in the following ways:
A BRIEF NOTE ON CONFERENCE INTERPRETING
The International Association of Conference Interpreters (AIIC) has issued best practices for interpreters during the COVID-19 crisis. AIIC's Technical and Health Committee and Taskforce on Distance Interpreting specify rules on social distancing in interpreting booths, social distancing for sign language teams, disinfection, and the use of disposable gloves and personal headset covers.
CCHI Open Letter on Ensuring Healthcare Interpreters’ Safety during the COVID-19 Pandemic. April 3, 2020. https://cchicertification.org/covid-19/covid-19-update/.
AIIC Taskforce on Distance Interpreting, Technical Committee. "AIIC best practices for interpreters during the Covid-19 crisis.” aiic.net March 17, 2020. http://aiic.net/p/8956.
The role of Chinese herbs in the treatment of novel coronavirus
TRADITIONAL CHINESE HERBAL REMEDIES
As evidenced by a February 18th tweet from China Xinhua News, healthcare practitioners across China are relying on centuries-old remedies to treat the novel coronavirus. In the absence of targeted drugs and vaccines, with continual updates to the national diagnosis and treatment program for novel coronavirus, the role of traditional Chinese medicine (TCM) is on the rise. More COVID-19 patients are being treated with Chinese medicine or integrated Western-Chinese medicine, and the role of TCM herbal prescription formulas is expanding. What formulas are they using? What do the properties of these herbs tell us about TCM approaches to the virus?
USE OF CHINESE HERBS TO TREAT THE CORONAVIRUS
With an array of treatment methods and a wealth of experience in its arsenal, Chinese medicine has been used to fight plagues and epidemics for thousands of years. The focus of TCM is not just the virus itself but also symptoms and changes to the body caused by the invasion of the virus. Treatment starts with the patient as a whole, to identify patterns and then dispel sickness and support health.
HERBAL FORMULA USAGE RATES 80% TO 95%
Reports from throughout China indicate TCM formula usage rates of 80% to 95% in confirmed cases of novel coronavirus. One specialist described isolation wards containing a mix of mild, typical, and severe cases of novel coronavirus. Typical cases are characterized as imaging findings in the lungs but the absence of disease progression to respiratory failure. In hospitals, traditional Chinese medicine plays a significant role in regulating diarrhea, constipation, and other gastrointestinal symptoms; in addition, intervention with Chinese medicine may stop the condition from progressing to the severe and critical stages.
WHAT FORMULAS ARE BEING USED? WHAT FORMULAS HAVE BEEN VALIDATED?
The National Health Commission and the State Administration of Traditional Chinese Medicine recommend Qingfei Paidu decoction (清肺排毒汤); clinical observation and data analysis have been performed on the therapeutic efficacy of this classical TCM formula. One formula for Qingfei Paidu decoction appearing on multiple sites, including Baidu, listed 21 ingredients. The top ingredients in terms of quantity are calcium sulfate, Radix bupleuri (common name bupleurum, effective in the treatment of alternating chills and fever; may induce headache or nausea), Poria cocos (efficacy in draining dampness and transforming phlegm; concurrent administration of diuretics contraindicated), Radix dioscoreae (Chinese yam, known to tonify qi and yin of the lungs, spleen, and stomach; may have hypoglycemic effects, use with caution in comorbid hepatobiliary disease).
Pneumonia Formula No. 1 (肺炎一号), developed by the Chinese Medicine Department at Guangzhou Eighth People's Hospital, and its variations Pneumonia Formula No. 2, Pneumonia Formula No. 3, Pneumonia Formula No. 4, and Pneumonia Formula No. 5 are also in use. Formula No. 1 has achieved favorable clinical results in Guangzhou. Formula No. 1 includes two herbs that clear heat and relieve toxicity, Flos lonicerae (honeysuckle flower) and Fructus forsythiae (forsythia fruit), along with 16 other ingredients.
In Chinese medicine, the treatment regimen adopted varies by person. If a patient is in poor physical condition, dispelling disease is not enough, treatment must focus on supporting health. For example, in those with poor appetite it is necessary to focus on spleen health; in patients with damp-heavy qi and thick tongue coating it is necessary to improve the flow of urine. Ear needling (acupuncture) may be used to treat the patient’s psychological state and resolve issues of insomnia, in order to restore the patient’s biological clock.
Just as treatment varies by individual patient, the virus varies by region. This too is a factor in treatment selection. It would not be appropriate to select one uniform formula for the entire nation.
NOT ADVOCATED FOR THE HEALTHY
NOT ADVOCATED FOR THE PREVENTION OF CORONAVIRUS
According to the head of a university of traditional Chinese medicine, the entire populace does not need to take this medicine. Healthy people need to improve resistance in order to avoid getting sick. High-risk populations, including healthcare providers, may take herbal remedies as appropriate.
Practitioners emphasized that these are treatment prescriptions and are not recommended as preventive prescriptions. The general public should not self-administer these prescriptions.
This blog briefly examines TCM principles and herbal remedies in light of recent Chinese media reports on novel coronavirus treatment in China. This examination is not intended to replace medical advice from a trained and qualified professional, and the use of herbal preparations is not recommended without the advice of a healthcare provider. Substances in herbal preparations may interact with prescription drugs to eliminate therapeutic efficacy or induce toxicity.
JANUARY 24TH UPDATE FROM THE CHINESE GOVERNMENT WEBSITE
The January 24, 2020, news update from the Health Emergency Response Office on the Chinese government website reported hundreds of confirmed cases of novel coronavirus nationwide and 25 deaths in Hubei Province and Hebei Province – an additional eight deaths compared to the January 23rd update, which detailed the anonymized medical histories of these initial 17 deaths. The majority were of advanced age (15 of the 17 over age 60), male (13 of 17), and suffered from such underlying conditions as liver cirrhosis, hypertension, cerebral infarction, diabetes, heart disease, chronic obstructive pulmonary disease, chronic renal insufficiency, Parkinson’s disease, and bronchitis. Most but not all presented with fever. Other symptoms at admission:
Novel coronavirus was confirmed through positive nucleic acid testing and monitored by electrocardiogram, lung CT, and blood-gas analysis. Therapies included oxygen, extracorporeal membrane oxygenation, endotracheal intubation (refused in some cases), anti-infectives, antibiotics, antipyretics, analgesics, and sedatives, supplemental fluids, and symptomatic therapies.
Outcomes were intensifying respiratory failure, continuous declines in terminal oxygen saturation, reduced blood pressure, and ultimately death.
Seven hospitals in Wuhan are offering intake for patients with high fever in order to identify new cases.
Kerilyn Sappington is the founder of Integrative Translations, which specializes in Chinese-to-English and Spanish-to-English translation of conventional and complementary medicine.