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Summary
In Colombia, the humanitarian response to extracontinental flows in the Darién jungle represents significant challenges to assist non-Spanish speaking migrants. Language is one of the main barriers to effective service delivery. This inspired the development of the Multilingual Medical Application with the support of the United States Department of State, Bureau of Population, Refugees, and Migration (PRM). Thanks to this tool, migrants can now receive health services with an improved differential approach through a mobile application that facilitates communication between hospital staff and beneficiaries, mitigating language-related barriers when providing medical assistance. The application functions as a translator that uses specific medical language to facilitate communication between doctor and patient. It allows health professionals to collect detailed information about a patient's condition to understand their clinical status and define their treatment. It also includes specific forms for women, men, and children so that doctors can easily collect relevant information about signs and symptoms for each population group. The application allows the health professional to ask questions about the patient's health status – which are predetermined in the application – and for the patient to listen to them in their native language. In this way, they can then respond by making gestures or pointing to the places where they feel pain, for example. In summary, the application allows health personnel to ask questions, providing the patient with tools to respond to these questions. The application works offline, which represents a strategic advantage in a region with limited connectivity. Additionally, it has different questionnaire modules: one for user identification upon entry, a triage module for health risk assessment, and a third for medical consultation to determine the severity of a patient's health condition. Beneficiaries can choose their preferred languages to read and play back the questions from each module, thus facilitating medical care and access to timely health services for people on the move. The languages currently available are English, French, Creole, Chinese (Mandarin), and Portuguese. Two indigenous languages (Kuna and Wayuunaiki) have been incorporated in response to the need to address the cultural and linguistic differences of the indigenous peoples of Colombia. The application is a sustainable and affordable tool that can be generalized if properly socialized and promoted among health personnel. Moreover, it can be replicated in other territories and in different emergency contexts, not only those linked to human mobility.
Organizations
Partner/Donor Organizations
Benefit and Impact
At the same time, there has been an improvement and streamlining of the medical care process. In this regard, even though these are only early indications in the implementation, this application/platform has shown very useful potential for enhancing medical care, allowing for more accurate and faster diagnoses.
Likewise, the possibility of downloading it on any mobile phone allows for easy access and dissemination.
Key Lessons
The initiative began as an online platform designed to fill medical records in hospitals, but a server in the hospital was required to preserve patients' personal data. Consequently, the development was re-oriented towards an app to be used as a specialized translator avoiding medical staff from having to do double work by entering data into the app and then into medical records. The app does not store personal data of the beneficiaries; it only functions as a translator, with the hospital remaining responsible for preserving the data and ensuring that medical records are always complete, as well as for the reservation and custody of users' personal information.
To encourage the use of the app by medical staff, it was necessary to carry out a sensitization process both for the adoption of a differential approach in care and to allow health personnel to overcome the fear/potential resistance to the use of technological tools.
The constant changes in personnel at hospitals, both at the management level and in the care staff, become a risk for the maintenance of the tool's use. This has required maintaining support and management processes to strengthen and preserve the use of the tool.
Feedback from users in different parts of the country has been essential for improving the APP. For this, piloting each new language of the App was very important.
Recommendations(if the practice is to be replicated)
It is advisable to maintain support and management processes to consolidate in order to maintain the use of the tool.
At the same time, it is important to disseminate the existence and information about the application so that more healthcare personnel use it.
It is also important to keep updating the available languages, this linked with migratory flows.
It is advisable to adopt an open position to adjustments and improvements proposed by users that better reflect the cultural richness of our global community.
Innovation
While there are other applications to provide information to non-Spanish-speaking migrant populations, such as T-Zen on the App Store (apple.com), this practice is innovative precisely because it addresses specific content to meet a specific need, such as access to healthcare for non-Spanish speakers. Additionally, it not only provides information but also facilitates communication between healthcare personnel and patients.
Furthermore, the application strives to be sensitive to the cultural differences of its users. In this regard, literal translations are not performed; instead, the content is adapted to make sense and fit into the local culture. Particularly in the case of indigenous communities, community members participated in validating the content by collaborating in the adaptation of questions and the way certain diseases are named based on beliefs. Once the content was validated, community members performed the translations.
Moreover, in order to address cultural differences, aspects such as the design of the application were considered to make it easy to understand for people from different cultures. Thus, efforts were made to ensure that all users feel identified with and welcomed by the application.
Additional Resources
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*References to Kosovo shall be understood to be in the context of United Nations Security Council resolution 1244 (1999).