Episode 13: Talking about medicines in culturally and linguistically diverse communities

Voiceover:

Welcome to the NPS MedicineWise podcast, helping health professionals stay up to date with the latest news and evidence about medicines and medical tests.

Anna Samecki:

Hello, and thanks for joining us. I'm Anna, a GP and medical adviser at NPS MedicineWise, and I'll be your host for today's episode. It's Multicultural Health Week here in New South Wales from the 7th to the 11th of September [2020], so I thought it would be an opportune moment to discuss some of the health issues experienced by culturally and linguistically diverse communities. So we're joined today by Veronica Nou, a pharmacist working in Western Sydney, who is passionate about improving medicines literacy and communication, especially among vulnerable populations. Hi Veronica.

Veronica Nou:

Hi, thank you for having me.

Anna Samecki:

Thanks so much for joining us today. Could you give our listeners a little bit more information about yourself and what you do?

Veronica Nou:

Okay. So I own and operate two pharmacies in Western Sydney, Morris Care Pharmacy in Oxley Park and Colyton Centre Pharmacy and beautiful Colyton. I also devote a lot of my time to humanitarian causes. So I do a great deal of work with refugees and asylum seekers and CALD [culturally and linguistically diverse] communities generally, especially in Western Sydney, because they are a very, very high risk group with very, very complicated issues on top of the normal issues that are facing us all at the moment at this pandemic. It's very, very challenging but it's also very rewarding. And I think one of the things that pharmacists, community pharmacists especially, we love to see it when we have made a tangible, a real difference in the quality of someone's life, and it's an area that definitely needs more attention. And what better time to talk about it than multicultural week?

Anna Samecki:

Thanks for sharing. As you've already touched on as a pharmacist you would certainly see numerous patients each day taking medicines and with a variety of different health problems. And it's no secret that COVID has, I guess, introduced new obstacles in the way that we interact with patients and deliver healthcare. And that's particularly challenging for those vulnerable patients as well. So what are some of the key challenges faced by culturally and linguistically diverse communities when it comes to taking medicines, particularly during this pandemic?

Veronica Nou:

Most of the issues are either cultural or to do with language. There are so many examples that we could give. Language is the obvious one, and there is this amazing resource which is available free of charge to any community pharmacy that registers, and that's the TIS, the Translating and Interpreting Service. And may I encourage anyone out there who is not registered for it to sign up and use it. It's very simple, all that it is, is you have the patient in front of you, you figure out what language it is that they're fluent in, you dial a number, you give them your code over the phone, and then within a matter of minutes there's someone on the phone who you can put on speaker phone and you can have a three way conversation.

So I think the challenge facing community pharmacists is that we are often very, very time-poor, and you might be dealing with someone who's a little bit embarrassed, doesn't necessarily want to be there, just wants to get out of there. So the challenge is to engage with them in such a way that they can take the time to hear you out and hear what is important, the important take-home messages that they need to understand about their medicine. And it's too easy for us as healthcare professionals to think, "Oh, there'll be someone at home who can read the directions off the box or read the leaflet and they can explain it," but that's not always how it works out.

There is this one particular example that always stays with me. There was a woman with a young child who had recently arrived in Australia. She's of refugee background and unfortunately had seen some terrible, traumatic things. And so she was diagnosed with a very impressive array of mental illnesses. She was prescribed antidepressants by the GP and was unfortunately not explained well how to use it, and then when she came into the pharmacy that dispensed it they also unfortunately put it into the too hard basket.

She had with her her young son who tried to figure out what was going on for her, but he was very young at the time, I think he was six or seven, and he completely misunderstood. So he then told his mother the appropriate dosage of her antidepressants were two in the morning and two at night, and she did that for a week and it was of course way too much and she ended up carted off in the back of an ambulance to the local hospital with no idea what was happening to her, what was going on, and completely traumatising her already traumatised young son who now blames himself, unfortunately for what has happened to his mother.

He's taken on that responsibility himself and he carries that burden of guilt all before he's old enough to ride in a car without a car seat. So when I saw that case present to me I was truly appalled at the failures along the way that this poor woman had confronted. She was let down at multiple levels purely because she was in the too hard basket, the language barrier was too difficult to overcome. To really think that we all need to sometimes take that step back and have a look at this situation and say, "I know I'm busy, but if I let this person go out the door without knowing what they're doing, then it's really on me."

It's not enough to say that there's someone else that can do the translating when they get home, and it's not enough to say, "Oh, the doctor would've explained it." We all need to be in this situation together, we all need to make sure that everything's going to be okay for them. Then aside from the language barrier there's also just the plain old cultural issue where people can be uncomfortable. One of the strengths that I find as a community pharmacist is that, as you know Anna, it's a much less formal environment and so therefore it can be way less confronting than going into even a GP's practice or even into a specialist's office where you're sitting down behind the desk, there's someone there's looking at you and this one on one situation, it's a little more intense.

And though it shouldn't be that way, people can be intimidated by these surroundings, they're embarrassed, whereas when they come into the pharmacy it can be a much more casual. You're still talking to them on that healthcare professional level, but they feel less confronted by their surroundings. And then if there's that need for a private discussion, you can take them into the private consulting area and have a chat.

So I like to use this example of a very, very lovely Greek gentlemen who has a great relationship with his GP, he's on many different medications, he uses a blister pack, all of those things, but he was truly embarrassed to talk to his GP about his erectile dysfunction. He was culturally ashamed for it, he was embarrassed as a man as well. So the only way that we could overcome that was because he came into the pharmacy and said, "Look, I really need to talk to you about this. I'm so ashamed. I can't talk to my family about it, they would laugh at me. I am less of a man. I can't talk to my wife about it or my friends about it, but I can talk to you. What can you do to help me?

And we say to him, "Well, really this sort of a thing you can't fix just by walking into the pharmacy and taking a magic tablet, you need to be talking to these other health services. And he would say things like, "But I'm scared to talk to them. They're good people, my GP's a good person, but I'm embarrassed." And I've said, "Well, why aren't you embarrassed to talk to us? It's just the same thing." He said, "No, because you're my friend." So there is something to establishing that personal relationship with people so you can overcome these cultural and personal levels of embarrassment, and then you can convince them to seek the help they need and you can guide them down the path for the attention that they require.

Anna Samecki:

Well I think you've certainly raised a number of very important points, Veronica. I thought for the listeners, I would just quickly give a summary. I mean, what I'm hearing is that a lot of the challenges are around communication. So not necessarily that the patient themselves doesn't understand content or information, it's really a communication barrier. But there are certainly ways to facilitate that, and as you've pointed out, there are services available. I just thought I'd point out that TIS is a free and rapid access service, so you can have an immediate interpreter available if you call the hotline up. So you don't have to necessarily pre-book, although pre-bookings are also available. And to top that off, everybody has a role to play. Every health professional as well as the patient have a role to play. So certainly pharmacists have a massive role to play with helping patients stay medicinewise.

So in terms of concluding our discussion, are there any other tips that you have for health professionals in engaging them and helping them, or helping open up the channels of communication with patients, particularly with COVID? Are there any particular resources or other things you've had to change or do to facilitate that during this challenging time?

Veronica Nou:

I think during COVID especially, because a lot of the communities that I work with are very, very vulnerable already, they don't consider COVID to be the main issue ahead of them. A lot of them just consider it to be background noise. When they're already struggling to put food on the table to feed their kids, they might be in insecure work, they might be struggling to make ends meet financially. So COVID, unfortunately, isn't taken as seriously in some communities as it should be. The ones that we're trying to reach specifically are the ones that they already don't have good English, if they get any information it might be from a distant cousin overseas who is spreading perhaps some rumour that she heard that someone told her, and we all know that that's not factually correct.

And saying, "Oh, the NSW Health website has resources in other languages," it's not really enough. You really have to reach out and engage these people. So I would say you have to lean on your personal relationships both in [inaudible] and, if you have the time, in local groups as well. We do plenty of work with the local school, meeting with CALD groups. You have to reach out directly and talk to people to overcome the myths. I find it best just to have printed resources in other languages that I can put in people's hands. I like to use, there's some digital resources from NSW Health, and there's a wonderful website called Ethnolink that we can use.

And the other thing is to try to emphasise what people need to do with a message which resonates with people culturally. So many CALD communities are very, very family-centric. They're focused on looking after the family as a whole. So if you couch messages in those values, you say, "Look, you want to make sure that you're not taking anything home to your elderly parents or to your kids. You want to protect them, you want to do the best you can for them." Then that's far more resonant than saying to them, "There's this percentage of people who were affected. There's this number of people who unfortunately were diagnosed or who passed away." Those sorts of numbers don't have the same impact as telling people that you're going to protect your loved ones, by using their own values.

It's helpful as well to not necessarily come across in a very authoritarian way. Pharmacists and healthcare professionals have a great deal of respect in the community, and sometimes it's helpful to come down from that pedestal and talk to people face to face and engage them like that, and use messages that work. You’re not just the person in the white coat, you're a person who's concerned for them, for their wellbeing. It's not necessarily about the rules, you're not necessarily going, "Oh 1.5 meters or else." It's that we want to do your 1.5 meters and the hand washing because we want to help you protect the ones that you love.

Anna Samecki:

Yeah, exactly. And some fantastic messages, Veronica, and certainly some great tips there. I believe, unfortunately, we're out of time, so I wanted to say thank you again for your time today. And thank you for our listeners for joining us. We hope you've enjoyed this podcast, and remember that if you have any comments or tips for our podcast, please reach out to us via email, Twitter, or LinkedIn.

Voiceover:

For more information about the safe and wise use of medicines, visit the NPS MedicineWise website at nps.org.au.