Presented by Janet Liang Specialist Intensivist and Anaesthetist, North Shore Hospital

1. Listen Please
A clinical translation
system

2. My talk
 The demand for clinical translation
 The case for electronic clinical translation
 Listen Please
 Alternatives
 What more would I like
 Questions
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3. The demand for translation
 NZ is an increasingly multicultural society, e.g. Asians
represent ~22% of total regional Auckland popn
 Proportion of non English speakers within Asian
groups is (Statistics NZ)
 17.9% for Chinese
 29.6% for Korean
 5.3% for Indian
 Proportion of non English speakers within Pacifc
Islanders is 13% (Statistics NZ)
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4. The demand for translation (cont).
 Being able to explain what is happening and what will
happen to the patient makes care easier (Gadon et al 2007)
 It certainly can improve patient satisfaction (Jacobs et al
2007)
 Clinicians find language barriers impede the delivery of
quality care and are a source of workplace stress (Bernard
et al 2006); more stressful for nurses
Gadon M et a. Caring for patients with limited English proficiency: the perspectives of small group practitioners. J Gen Intern Med
(2007); 22(S2): 341-6
Jacobs EA, Sadowski LS, Rathouz PJ. The impact of an enhanced interpreter service intervention on hospital costs and patient
Satisfaction. J Gen Intern Med (2007);22(S2):306-11
Bernard et al. Impact of language barrier on acute care medical professionals is dependent upon role. J Prof Nurs (2006); 22: 355-8
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5. The case for electronic translation
 Trained interpreters still have their limits
 availability : at NSH, 10 min by phone, 30 min + to
arrive at scene
 cost: at NSH ~$70/hr
 accuracy: may still have errors but less likely to be
of clinical significance cf family (Flores et al 2003)
 Doctors still tend to use a patient’s family & friends to
interpret because of perceived cost, inaccessibility
and inconvenience of trained interpreters (Gadon et
al 2007) but may not be as effective (Flores et al 2003)
& can be inappropriate
Flores G et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics
(2003) 111;6-14
Gadon M et al. Caring for patients with limited English proficiency: the perspectives of small group practitioners. J Gen Intern
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Med (2007); 22(S2): 341-6

6. The case for electronic clinical
translation (cont.)
-Bilingual clinicians ? Absolutely but
-you can’t assume that well naturalised immigrants
will remember their language of birth
-they may know the language of everyday life, but not
that associated with clinical management
-Pacific people many may respond best to spoken words
and diagrams, rather than the written word (Buetow
et al 2002)
Buetow S, Adair V, Coster G, Hight M, Gribben B, Mitchell E. Reasons for poor understanding of when and how to access GP care
for childhood asthma in Auckland, New Zealand. Family Practice (2002); 19(4): 319-325

7. Listen Please
 A clinical translation app which works on
iPads. For those who can’t speak English, or
can’t speak at all
 Mainly for seriously ill patients but
adaptable to other contexts. Aims at
 Urgent questions that can’t wait for an
interpreter
 Mundane questions that you wouldn’t keep an
interpreter around for 24/7
 Has printed statements, audio, pictures/
photos
 Stand alone, does not need WiFi

8. How it started
 I won the Health Informatics NZ Clinicians’ Challenge
in 2011
 I used the $10000 prize to fund :
 Printed language/ audio translation of ~ 400 sentences/
questions into Mandarin & Cantonese Chinese, Korean,
Samoan, Tongan (WDHB Asian and Pacific Health
Services)
 High quality audio recording of above
 Illustrations/ photos to go with above
 By Guy Body www.gbstudioart.co.nz
 Photos by Scotty and Sonya English

9. Who and How to program
 Therefore, to use the translations & pictures
 I got $20000 from WDHB Asian Health Services grant
(via Sue Lim) to pay for MEA Mobile to produce my
design of Listen Please
 Early assistance with project management by Annie
Ualesi
 Rod Mac Farlane and Mike Aston (MEA Mobile) have
worked long and hard
 Dr Johan van Schwalkyk is producing web based app –
but not finished & requires wifi access

10. ‘Listen Please’ !

11. Choices

12. Examples of ‘Patient talks’
 Patient statements/ questions – some of list

13. Examples of ‘Patient Talks’

14. Examples of ‘Clinician Asks’

15. Examples of Clinician Asks

16. Examples of ‘Clinician Explains’

17. Examples of Clinician
Explains

18. Overall Listen Please is…
 Well yes it is a sort of fancy electronic phrasebook
 But my design intentions were:




Speed
Usability
Several modes of conveying ideas with patient
Design for contexts where most likely to be useful
 Few other electronic translators & of these, they use
translation software = more complex & expensive

19. Alternatives: Google Translate
 It can work well and it’s free…
 But:
 Accuracy not that good, especially for Asian languages
(Nguyen-Lu et al 2010)
 Doesn’t handle colloquialisms well
 Needs web connection
 Doesn’t do graphics
Nguyen-Lu N, Reide P., Yentis S.M. ‘Do you have a stick in your mouth?’ –use of Google Translate as an aid to anaesthetic
pre-assessment. Anaesthesia (2010); 65:94-113

20. Alternatives: other iOS
 SmallTalk Intensive Care
 only English, for those who can’t speak at all
 simple graphics and audio
 www.aphasia.com/products/apps/smalltalk
 ThumbsUp
 doesn’t translate Asian or Pacific languages other than
Mandarin Chinese
 simple graphics and audio
 much more about patient communicating with clinician
than vice versa
 www.thumbsup.ch
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21. What more would I like ?
 Does it work ???!!!! i.e. will patients and clinicians use it
in practice ?
 Having versions on other platforms, i.e. Android and
Windows tablets. iPhone ???
 Having my original idea of allowing family (if they
wish) to record their version of translation of
statements/questions
 I’m open to including other statement/ question lists
and other languages
 But for all this I need more $$$. App pricing ??

22. Acknowledgements
I would also like to acknowledge the help of
others at NSH and University of Auckland
who have helped me to get Listen Please
developed.
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