Q&A with Shiva Bidar-Sielaff
by Nathan J. Comp
Shiva Bidar-Sielaff has dedicated much of her career to helping non-English speakers navigate America’s formidable health care system. Born in Spain, Bidar-Sielaff is fluent in three languages beyond her native Spanish: Farsi, English, and French.
As manager of Interpreter Services and Minority Community Relations at UW Hospital and Clinics, Bidar-Sielaff connects patients to interpreters, covering more than 100 languages. She is also the vice chair of the Latino Health Council of Dane County and a committee co-chair with the National Council on Interpreting in Health Care.
She’s also been named by Madison Magazine as one of the city’s most influential people. In 2005, she received a YWCA Women of Distinction Award.
Population surveys show that 28 million Americans were born in other countries and that 22 million have limited or no ability to speak or understand English. Language and cultural barriers present myriad challenges for doctors treating non-English-speaking patients.
Bidar-Sielaff recently spoke to The Madison Times about why interpreter availability is important to some patients and the role cultural competency plays in health care.
TMT: Why is interpreter availability important for non-English speakers in the health care system?
SBS: Without communication, we can’t get good health care. Ensuring that we have good communication with health-care providers is essential to good health care. Language has been shown to be one of the biggest barriers for immigrant communities to access health care. By removing the language barrier, you can ensure that people have access to health care.
TMT: In what ways is the health-care experience different for immigrants than for natives?
SBS: There are a number of issues. One is the language barrier. Two is their ability to understand the American health-care system, because it is very complicated. For someone who is new to the system, it is even more complicated.
Also, their exposure to health care may not have been as extensive, depending on the country of origin. Understanding issues like preventive health care, going to the doctor for no other reason than to get checked, may be a difficult concept for an immigrant to understand.
Then there are cultural issues: differences in practices. So if the health-care system isn’t culturally competent, it creates another barrier for the immigrant community.
TMT: You’ve written that “The meaning and expression of pain are influenced by people’s cultural background.” Does that mean that, depending on where and how we were raised, we experience pain differently?
SBS: Not only do we maybe experience it differently, but certainly we express pain differently. Again, depending on where you grew up, maybe it’s OK to express pain very openly, or maybe it is the opposite. Maybe it’s that you’re supposed to hold it together and not mention that you have pain. When talking about pain assessments, it’s important to take that into account.
TMT: How can doctors better identify these cultural barriers when treating patients?
SBS: My big thing about cultural competence is that if you ask open-ended questions, as opposed to close-ended questions, people will get more information and understanding. Instead of asking, “Do you have pain?” a more open-ended discussion might be, “How are you feeling?” because then there is a conversation, and you can hear how people are expressing themselves.
TMT: What would you consider your biggest achievement?
SBS: My biggest achievement is the smile on people’s faces when they come in for medical care and feel welcome because there is someone there to break the language barrier for them.
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