Obstacles And Implementation In Healthcare Discussion Help

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Implementation__ :

you can use different sources to provide the cost and the required information.

__Includes the cost of the project from start to finish with specific numbers and an explanation of how those numbers were arrived at (ideally, based on research of similar projects). [4-5 sentences]

__Includes a list of actual people or titles of individuals who will be responsible for implementing the project and an explanation of what duties they will perform. [4-5 sentences]

__Includes an explanation of how the project will be implemented with attention to possible concerns the employer may have about the process. What steps are needed to make your project become a reality? [4-5 sentences]

__ Includes a timeline of when the steps of the project will take place (this can be combined with the above point, if you wish.)

__Includes a list explaining the materials and labor needed to make this project a reality. [3-4 sentences]

__ Uses 3 database sources ( I will include 3 pdf files to take quotes)

__ At least 300 words

this section needs to be filled with thoughtful and precise details that reveal the amount of research and time you invested in this project. Locating a similar or related project could be very helpful in this section of the report. Other research may be required, as well. Do not be vague - be specific. Topics that must be addressed are:

  • The cost of the project from start to finish with specific numbers and an explanation of how those numbers were arrived at (ideally, based on research of similar projects). [4-5 sentences]
    • Do not claim that the project will cost nothing; everything will cost something (for example, consider that employee hours are a cost, as are refreshments, office supplies, guest speakers, etc.).
    • Do not throw out a random number, such as “this project should cost $34,000” - you must explain how that number was calculated.
  • A list of actual people or titles of individuals who will be responsible for implementing the project and an explanation of what duties they will have to perform. [4-5 sentences]
    • If you don’t know enough about the organization to complete this section effectively, simply put in a phone call to the organization. Their website could be an excellent resource, as well.
  • An explanation of how the project will be implemented with attention to possible concerns the employer may have about the process. What steps are needed to make your project become a reality? Remember to be logical and realistic. [4-5 sentences]
  • A timeline of when the steps of the project will take place (this can be combined with the above point, if you wish.)
  • A list explaining the materials and labor needed to make this project a reality. [3-4 sentences]


__Obstacles__

__ 3 separate paragraphs and minimum of 12 sentences

__ Obstacle #1 & how obstacle will be overcome

__ Obstacle #2 & how obstacle will be overcome

__ Obstacle #3 & how obstacle will be overcome

I will include a background information to be able to focus on specific implementation such as hiring interpreters and it will be for health departments.

Background:

Development and growth will open a new path towards people taking actions and moving to different countries around the world looking forward to better improvement in their life including education and work environment. “English has long been the lingua franca of scientists,” (Adams, P. Fleck, F. 2015). The first thing that comes to people’s mind is to look for connections around the area to make it easier for them to communicate. Indeed, if people don’t have connection; language barrier will be the first thing that comes to their mind. “Language can be a barrier to accessing relevant and high-quality health information and delivering appropriate health care – an unmet need that is amplified on a global scale.” (Adams, P. Fleck, F. 2015). It will also affect their ability to have education and job. Booking appointments and going to healthcare departments is going to be the most challenging concept, according to Schyve, “First, the language differences themselves are a barrier to effective communication.” It will cause people to avoid going to the healthcare departments because of the lack in their language, it could lead to cause more health concerns and more error towards the patient’s health results, as Schyve mentioned, “In the absence of comprehension, effective communication does not occur; when effective communication is absent, the provision of health care ends—or proceeds only with errors, poor quality, and risks to patient safety.” Healthcare providers can manage this issue by providing interpreters, “For example, it is more effective to incorporate a language interpretation service (an evidenced-based practice) into redesigned work processes int he emergency department (a subsystem in a hospital), rather than to simply graft it onto the department’s current system of operations and expect it to integrate itself smoothly and efficiently without interfering with other work processes.” (Schyve, 2007). Another factor that could minimize language barrier as it was mentioned in the world health organization bulletin, “In addition, some United States based websites provide multilingual health information, such as the Health Information Translations collaboration and the National Network of Libraries of Medicine.”

References

Adams, P., & Fleck, F. (2015). Bridging the language divide in health. World Health Organization.Bulletin of the World Health Organization, 93(6), 365-366. doi:http://dx.doi.org/10.2471/BLT.15.020615

Schyve, P. M. (2007). Language differences as a barrier to quality and safety in health care: the Joint Commission perspective. Journal of general internal medicine, 22(2), 360-361.


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Language Differences as a Barrier to Quality and Safety in Health Care: The Joint Commission Perspective Paul M. Schyve, MD The Joint Commission, Oakbrook Terrace, IL, USA. Effective communication with patients is critical to the safety and quality of care. Barriers to this communication include differences in language, cultural differences, and low health literacy. Evidence-based practices that reduce these barriers must be integrated into, rather than just added to, health care work processes. KEY WORDS: language differences; cultural differences; low health literacy; health care; information management; accreditation. J Gen Intern Med 22(Suppl 2):360–1 DOI: 10.1007/s11606-007-0365-3 © Society of General Internal Medicine 2007 W hen a patient sees a clinician member of a treatment team, the clinician uses the available knowledge base (derived from her education and training, the literature, experience, decision-support systems, and protocols) to decide what data to collect about the patient and how to collect them. The clinician and other members of the team collect these data through conversations with the patient and the patient’s family, observation of the patient, a physical and mental examination, laboratory testing, and imaging. The treatment team then synthesizes these patient-specific data with the evidence-based information in the available knowledge base to create new information: the patient’s diagnosis and prognosis and, in the dialog with the patient, a treatment plan. Finally, the team disseminates this newly created information to the patient, the patient’s family, other members of the treatment team, other professional caregivers, pharmacists, insurance companies, and others. Dissemination occurs through oral communication (e.g., in conversations with the patient, patient’s family, and health care professionals), through writing (e.g., in consent forms, instructions, educational materials for patients, and in notes and instructions for other professional caregivers and pharmacists), and through electronic transmission (e.g., in pharmacy orders, insurance claims, and computerized, patient-accessible personal health records). This collection of data, transformation of data into information, storage of data and information, and dissemination of information are the key processes that comprise information management. Today, in health care, much of this information management is in the form of oral and written communications between team members, patients, and patients’ families. The more the care is patient- and family-centered, the more frequent the communication with the patient and the patient’s family to understand the patient’s perspective and to involve the patient in the treatment team itself. 360 Because much of medical care is really information management, this communication between treatment team members and the patient and patient’s family is a core component of health care—it is more than an adjunct or facilitator of health care. Collection of accurate and comprehensive patientspecific data that are the basis for proper diagnosis and prognosis; involving the patient in treatment planning; eliciting informed consent; providing explanations, instructions, and education to the patient and the patient’s family; and counseling and consoling the patient and family requires effective communication between the clinician, the patient, and the patient’s family. Effective communication is communication that is comprehended by both participants; it is usually bidirectional between participants, and enables both participants to clarify the intended message. In the absence of comprehension, effective communication does not occur; when effective communication is absent, the provision of health care ends—or proceeds only with errors, poor quality, and risks to patient safety. When patients with limited English proficiency are treated by physicians and other health professionals who are proficient only in English, 3 factors converge to create a “triple threat” to effective communication. First, the language differences themselves are a barrier to effective communication. Unfortunately, this language barrier is often not immediately evident. Instances in which patients identified themselves as (reasonably) proficient in English, but were not, have been reported, and a Joint Commission study found physicians and hospital staff who believed themselves to be sufficiently proficient in another language, but were not.1 Both the patient and the clinician can underestimate the language barrier between them. Second, cultural differences—which are often associated with language differences—are a barrier to effective communication. One’s culture affects one’s understanding of a word or sentence and even one’s perception of the world. To learn a language is not the same as understanding a culture—even those who share a common native language may not share a common culture. And not everyone born in the same place and speaking the same language necessarily shares all the features of a common culture. Therefore, there is a risk of either underestimating the effect of cultural differences or of stereotyping individuals by their culture. Both will interfere with the effectiveness of communication. Third, low health literacy is a barrier to effective communication.2 Low health literacy in patients may be associated with language and cultural barriers, but is also found in patients who are proficient in English and who share the common U.S. culture. This latter group may be especially at risk of having their low health literacy go unrecognized. When language or JGIM Schyve: Language Differences, a Barrier to Health Care Quality and Safety cultural barriers are identified, it often leads the clinician to explore whether the patient understands her oral or written communication. But when the patient speaks the same language and is of the same culture as the clinician, too often the clinician assumes that the patient—in the absence of questions—understands. Many clinicians have belatedly discovered that a patient is functionally illiterate: the patient cannot read or write (general literacy), let alone understand the clinician’s medical jargon or complex instructions (health literacy). In an increasingly multilingual, multicultural society, providing safe, high-quality health care requires overcoming these 3 barriers to effective communication with patients and their families. When the Joint Commission first developed standards that required an organization to address the language needs of patients, it was in the context (subsequently bolstered by federal regulations) of the patient’s right to be fully informed about his or her care. Later, the need to communicate effectively was recognized as an element of the quality of patient care. Today, effective communication—which takes into account language, cultural differences, and health literacy—is seen as a prerequisite to safe health care. Communication problems are the most frequent root cause of serious adverse events reported to the Joint Commission’s Sentinel Event Database,3 and a Joint Commission study found that when patients suffer adverse outcomes from medical errors, the outcomes are more serious in limited English proficiency patients than in English-speaking patients.4 Patient rights, quality of care, and patient safety each in itself is sufficient to justify a commitment to effective communication. Together they make effective communication in health care obligatory— it is a critical component of the health care itself. Yet often those health care organizations that are struggling to implement practices to reduce language, culture, and health literacy barriers to communication do not know which practices are most effective.1 And even when effective practices are known, their implementation in a reliable, sustainable, and efficient manner is challenging. This JGIM Supplement begins to provide some evidence-based solutions to this challenge. But more is to be learned, and the solutions that have been identified often must be adapted to individual organizations. “Adaptation” does not adequately represent the challenge of implementation. Too often, evidence-based practices are simply bolted onto the existing system, thereby adding expense, increasing complexity, and potentially compromising existing work processes. Instead, an evidence-based practice should be incorporated into a redesign of the work processes of the system or subsystem of which it is to be a part. For example, it is more effective to incorporate a language interpretation service (an evidenced-based practice) into redesigned work processes in the emergency department (a subsystem in a hospital), rather than to simply graft it onto the department’s current system of operations and expect it to integrate itself smoothly and efficiently without interfering with other work processes. A health care delivery organization, even a clinician’s office, is a complex system. Among the characteristics of a complex system are self-adaptation and nonlinear effects. That is, if the inputs to a complex system are changed, such as the addition of an interpreter service, the system itself will self-adapt—it will change to accommodate the new input. However, the selfadaptation may not achieve the goals desired by either the treatment team or the patient, but may instead lead to outcomes that are neither expected nor desired by the 361 treatment team and the patient. The treatment team, patient, and patient’s family need to anticipate and be alert to the probability of these unintended consequences. And because changes in complex systems have nonlinear effects, even the smallest change in 1 part of the system can lead to a large change elsewhere in the system. This can be an advantage when it is used to leverage the effect of a small change; it can also be a disadvantage if the large change is unexpected and adverse. As a physician’s or other clinician’s office, clinic, hospital, or other health care delivery setting focuses its attention on improving the safety and quality of patient care, these observations generate a set of principles: & & & & & Providing safe and high-quality patient care is dependent upon effective communication between health care professionals, patients, and patients’ families. Effective communication requires the recognition and amelioration of 3 key barriers: language differences, cultural differences, and low health literacy. There is a growing body of evidence-based practices that address these 3 barriers (and of evidence that certain practices are ineffective or unsafe). For the implementation of these practices to be effective, reliable, and sustainable, the practices should be incorporated into the redesign of the relevant work processes in the health care delivery site (e.g., physician’s practice, hospital), not just bolted onto the current system. Changes in the site’s systems and processes are likely to produce unintended consequences; a prospective identification of these potential consequences should be undertaken before implementation, and vigilance for these consequences should follow implementation. As the Joint Commission focuses the spotlight of its standards and accreditation process on patient safety and quality of care, these principles will guide its approach to removing communication barriers related to language, cultural differences, and low health literacy, as well as communication barriers arising from physical factors such as hearing, speech, and vision, and from health care interventions such as intubation. But do not await Joint Commission actions—if the goal of providing safe, high-quality care is to be achieved, the obligation of health care professionals and organizations to address linguistic, cultural, and health literacy barriers to patient communication is immediate. Corresponding Author: Paul M. Schyve, MD; The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181, USA (e-mail: pschyve@jointcommission.org). REFERENCES 1. Wilson-Stronks A, Galvez E. Hospitals, Language, and Culture: A Snapshot of the Nation. Oakbrook Terrace, IL: The Joint Commission; 2007. 2. The Joint Commission. ‘What Did the Doctor Say?:’ Improving Health Literacy to Protect Patient Safety. Oakbrook Terrace, IL: The Joint Commission; 2007. 3. The Joint Commission. Root causes of sentinel events. Available at: http://www.jointcommission.org/NR/rdonlyres/FA465646-5F5F-4543AC8F-E8AF6571E372/o/root_cause_se.jpg. Accessed August 27, 2007. 4. Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in U.S. hospitals: a pilot study. Int J Qual Health Care. 2007; 19:60–67. Correspondence Overcoming language barrier in healthcare settings using information and communication technologies To the Editor We read with interest and congratulate Dr. Almutairi for the recent publication of his article entitled “Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia.1 Dr. Almutairi expressed his strategies to improve educational and orientation programs regarding the culture and language in Saudi Arabia to address the language barrier issue in healthcare settings. In fact, we are also confronted with a similar situation in Taiwan. As Chinese is the main language of communication in the Taiwanese healthcare system, foreign residents (2.3% of the total population) often face communication-related difficulties in explaining their health problems to Taiwanese care providers’ sites.2,3 Thus, we wish to share our Taiwanese experience where we found the use of simple information and communication technologies (ICT) tools, such as Skype, Google Hangouts, Google translator, and mobile phone camera that was found to be quite useful in settings explained by Dr. Almutairi. We have observed several foreigners in Taiwan using smartphone to type-in English text and translate into Chinese for explaining their health-related problems, or condition to care providers. For instance, recently, we found a family who visited a clinic for the treatment of their 6-year-old girl’s rash on her chest. The girl was diagnosed with ‘herpes zoster’ by a dermatologist. However, due to the language limitation (as the care provider was Chinese speaking), the dermatologist could not clearly explain to the girl’s parents about the problem and its effects on others. The girl and her parents planned to travel to Vietnam on the following day after the problem was discovered. Being worried, they took a picture of the affected skin area and sent 328 Saudi Med J 2016; Vol. 37 (3) www.smj.org.sa it to an English-speaking doctor in Australia for his opinion. The girl’s parents and the doctor discussed the girls’ condition through Skype. The doctor advised them not to travel Vietnam for 2 weeks, as ‘herpes zoster’ is contagious. The family canceled the Vietnam trip to avoid potential problems that may arise. As we can see, in the above situation, the use of simple technologies, such as Skype and Smartphone camera proved to be of immense use. These modern IT gadgets can provide users with useful tools for the outreach of the healthcare facility despite language and geographical barriers. Therefore, we advocate to promote the use of ICT tools among healthcare stakeholders, in addition to educational and orientation programs regarding language as suggested by Dr. Almutairi. Ajit Kumar Goa Institute of Management Ribandar, Goa India Sanjeev Maskara The Practice PLC Amersham, Buckinghamshire United Kingdom Reply from the Author No reply was received from the Author. References 1. Almutairi KM. Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi Med J 2015; 36: 425-431. 2. Lee FH, Wang HH, Yang YM, Tsai HM. Barriers faced by Vietnamese immigrant women in Taiwan who do not regularly undergo cervical screenings: a qualitative study. J Adv Nurs 2014; 70: 87-96. 3. Kumar A, Maskara S, Chiang IJ. Health care satisfaction among foreign residents in Taiwan--an assessment and improvement. Technol Health Care 2014; 22: 77-90. doi: 10.15537/smj.2016.3.13706 OPEN ACCESS News Bridging the language divide in health While the English language dominates much of the world’s public health information, several initiatives are underway to provide such information in other widely spoken languages. Patrick Adams and Fiona Fleck report. WHO “A close relative had been diagnosed with a rare disease. We searched for information on it in Arabic and found websites that were unstructured or were essentially chat forums,” recalls Dr Majid Altuwaijri. “But when we searched in English we found a wealth of good quality information.” As co-founder of the Saudi Association for Health Informatics, Altuwaijri was well placed to help his relative, given his expertise in information technology and fluency in English. However, globally only an estimated 600 to 700 million people have English as a second language, like Altuwaijri, in addition to some 335 million native English speakers, with varying degrees of fluency. That leaves most of the world’s population – some six billion people – with little or no access to a large body of public health information because it is in English. Language can be a barrier to accessing relevant and high quality health information and delivering appropriate health care – an unmet need that is amplified on a global scale. Cover of World Health Statistics 2015 – one of the WHO publications that is published in all six official United Nations languages. “The trend towards monolingualism is far from decreasing, with the hegemonic use of one language, English, over the other five United Nations (UN) languages,” the UN Joint Inspection Unit concluded in a 2011 report on implementation of multilingualism in UN organizations. As part of the UN system, the World Health Organization’s (WHO) six official languages – Arabic (242 million native speakers), Chinese (1197 million), English (335 million), French (76 million), Russian (16 million), and Spanish (399 million) – are the first languages of only 2.4 billion people, according to Ethnologue: Languages of the World, 18th edition – less than half the world’s population. In addition, German (78 million native speakers) is an official language in WHO’s European Region and Portuguese (203 million) in WHO’s African, European and Americas Regions. For native speakers of other languages, such as Hindi (260 million native speakers) and Bengali (198 million), the unmet need for health information may be great. English has long been the lingua franca of scientists – including those working in public health – and while more WHO publications and web pages are produced in English than in any other language, WHO publications appear in more than 70 languages. All WHO’s official documents, such as World Health Assembly reports and resolutions, are translated into the six official languages, but this is not the case for the rest of WHO’s publishing output, including technical reports and clinical guidelines. Moreover, WHO launched its six-language multilingual website in 2005, but most of its web content is still in English. While Portuguese is the world’s sixth most spoken language (after Chinese, English, Hindi, Spanish and Arabic), most Portuguese-speaking scientists seek to publish their work in English to gain wider circulation, according to a study published in a report for the European Molecular Biology Organization in 2007 by Rogerio Meneghini. In public health, the linguistic disconnect between those providing health information and those who need Bull World Health Organ 2015;93:365–366 | doi: http://dx.doi.org/10.2471/BLT.15.020615 that information affects everyone from clinicians and patients to public health managers and policy-makers. One of the most popular health information websites, Wikipedia, collaborates with Translators Without Borders to bridge that divide. With the help of the global network of translators, Wikipedia Medicine has built a large collection of articles in more than 100 languages and has at least some medical content in more than 250 languages. “ The trend towards monolingualism is far from decreasing, with the hegemonic use of one language, English, over the other five United Nations languages. UN Joint Inspection Unit ” “We did a lot of work for the Ebola outbreak with Translators without Borders and others because most information on Ebola was in English, which is only spoken by 15–20% of the population in West Africa,” says Wikipedia editor Dr James Heilman, adding: “Now we have content on Ebola in around 115 languages.” In addition, some United Statesbased websites provide multilingual health information, such as the Health Information Translations collaboration and the National Network of Libraries of Medicine. While a few projects are making more multilingual public health information available in many widely spoken languages, the overall dearth of such information produces a divide between the health-information haves and havenots that is exacerbated by poor internet connectivity and unreliable electrical supplies in developing countries. For Dr Alfredo José, director of the national library in Mozambique, health professionals in this Portuguese-speaking country – where half the population 365 News in local languages, including 30 centres across the European region alone; WHO works closely with governments and collaborating centres on an ad hoc basis to translate its publications into local languages. The documentation centre in Moscow, established in 1994, has played a key role in providing WHO publications in the Russian language online and in print, as part of a collaboration with the Russian government. A recent analysis showed that 70% of the 880 251 people, who used the centre’s online library between October 2009 and May 2014, were from the Russian Federation, 10% from Ukraine, 6% from Kazakhstan and 3% from Belarus, while users from other countries constituted less than 1% per country. “We were amazed to see we had users from 50 countries, not only from the Commonwealth of Independent States, but also Latvia, Israel, the United States, the United Kingdom and other countries,” says Tatyana Kaygorodova, who runs the WHO Moscow documentation centre. In 2012, WHO established a programme funded by the Russian government to increase the number of technical WHO publications in Russian, such as clinical guidelines, and to establish a mechanism for consulting Russianspeaking public health experts on which publications they needed most. An important part of the project is to improve the quality of translation WHO lives below the poverty line – have often felt linguistically isolated, surrounded by Anglophone countries. In 2005, WHO established the ePORTUGUESe programme, to increase access to health information in Portuguese as part of a collaboration with Angola, Brazil, Cabo Verde, Guinea Bissau, Mozambique, Portugal, Sao Tome & Principe and Timor-Leste. “We started by developing a national virtual health library in each of the eight Portuguese-speaking countries, which can be adapted to local needs and conditions,” says Dr Regina Ungerer, who has led the programme for the past 10 years. “The virtual library allows countries to have their own technical and scientific portal providing a local directory of health events, websites and legislation that can be accessed by anyone with an internet connection,” Ungerer says. The virtual library platform was developed by the Latin American and Caribbean Center on Health Sciences Information best known by its acronym as BIREME, part of WHO’s regional office for the Americas. “With the ePORTUGUESe network, we are empowered,” says José. “Brazil and Portugal contribute documents to the virtual health library, and we’re connected to other Portuguesespeaking countries through the online discussion group.” A network of documentation centres globally provide WHO publications Tatyana Kaigorodova (left) and Katerina Zimina working in the WHO documentation centre archive in Moscow. 366 to reduce the risk of clinical errors by inviting Russian experts in the relevant fields to review the clinical content of the translations before they are published, Kaygorodova says. “If it’s a translation of a press release, for example, then approximation is fine. But translations of guidelines for health professionals must be precise and accurate because mistakes can kill,” she says. What these WHO programmes have done for Portuguese and Russianspeaking countries and people, WHO’s Global Arabic Programme has sought to do for health professionals throughout the Arabic-speaking world. The WHO Arabic Programme aims to disseminate the work of WHO through Arabic publications, make reliable and current health information and research outcomes available in Arabic, and establish networks and knowledge communities in Arabic translation, terminology and publishing. Although Arabic is an official UN language, Arabic speakers still struggle to access reliable health information in their native language. Searching in vain for reliable health information in Arabic “was what triggered the idea for our study,” says Altuwaijri. The study published in 2009 by Altuwaijri and colleagues at King Saud bin Abdulaziz University for Health Sciences in Saudi Arabia, in collaboration with the Health on the Net Foundation and the University of Geneva, found that just over 4% of all Arabic health information websites met international quality standards. In light of their findings, Altuwaijri and colleagues recommended the establishment of an Arabic health information foundation to govern and accredit Arabic health websites and an Arabic health encyclopedia. Initiated in 2010 by King Saud bin Abdulaziz University and the Saudi Association for Health Informatics, the King Abdullah bin Abdulaziz Arabic Health Encyclopedia came together with support from several international partners. Comprised of translations contributed by health professionals from across the Arab world, the encyclopedia is still in its early stages, but Altuwaijri believes it’s already having an impact: “The doctors I’ve spoken with, once they’ve been introduced to the encyclopedia, love it.” ■ Bull World Health Organ 2015;93:365–366| doi: http://dx.doi.org/10.2471/BLT.15.020615 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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Explanation & Answer

Attached.

Running head: OBSTACLES IN HEALTHCARE

Obstacles in Healthcare
Name
Institution
Date

1

OBSTACLES IN HEALTHCARE
Obstacle 1
Language difference is one of the barriers experienced in healthcare. It interferes
with effective diagnosis and treatment of the patient as they do not have a common
language that can be used to explain the health issue (Schyve, 2007). Language barrier
can lead to misdiagnosis thus worsening the health status of the patient.
Solution
Hiring interpreters can be used to solve the language barrier problem. The cost of
implementation will be determined by the number of interpreters required. The average
wage of a Medical Interpreter per hour is 19.65 dollars. Two interpreters can be hired
which means the total cost will be around 19.65*8 hours which is 133.3 dollars per day
...


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