A recent incident at the North Estonia Medical Center's emergency department, where a doctor allegedly refused to talk to a patient in Russian, has reached the public eye through a one-sided account, but the full context behind the situation is unlikely to be fully unraveled. What must now be confronted, however, is a long-standing issue quietly growing in hospital corridors: the language barrier between doctors and patients is widening.

"This problem has definitely worsened in recent years. It's clearly related to increased immigration, and I've also noticed it became more apparent with the arrival of Ukrainian war refugees," said Marit Märk, head of the emergency department at the North Estonia Medical Center.

According to Märk, older medical staff tend to speak Russian but struggle more with English, whereas for younger staff, it's the other way around — English comes easily, but Russian is more difficult.

Language challenges in healthcare are not unique to Estonia. According to Ilmar Tomusk, director general of the Language Inspectorate, even the World Medical Association's code of ethics notes that the main issues between doctors and patients are either cultural or linguistic. These issues must be addressed, he said, because the Estonian Constitution guarantees everyone the right to health protection.

"And 'everyone' really means every individual here — not just Estonian citizens or residents. A foreign tourist who doesn't speak Estonian, Russian, German, Latvian, Lithuanian or English could also end up needing medical attention and must be helped," Tomusk said.

"The official language in Estonia is Estonian. Just as German is the official language in Germany and Finnish and Swedish in Finland, here it's Estonian. That means patients have the right to request communication in Estonian from a doctor — but not in other languages. Of course, if a patient who doesn't speak Estonian sees a doctor or nurse who can communicate in another language, then naturally, that person will be helped," said Chancellor of Justice Ülle Madise.

Basic conversational skills in a foreign language do not guarantee the ability to provide thorough and high-quality medical care. Johanna Rõigas, board member of the Estonian Young Doctors' Association, said that breaking through the language barrier cannot rest solely on doctors' shoulders.

"People try to cope. They turn to colleagues for help or even to fellow patients in the same room. But that raises questions — if a colleague is helping, they're taking time away from their own duties to do someone else's job. And if it's a fellow patient, then confidentiality is compromised — they might not need to know another patient's medical history or complaints," Rõigas said.

She emphasized that in emergency care, a quick solution is usually found, but the bigger issue lies with scheduled treatment. Hospitals are not able to provide translators.

"At the moment, the hospital doesn't have the capability or resources for that, and the Health Insurance Fund doesn't cover it either. So for now, we recommend that patients bring someone with them who can help communicate with staff in a language both parties understand," Märk said.

"We can't require doctors to know their patients' language. At the same time, we can't require patients to know the official language. That's why an intermediary is needed. In many countries, this is solved by having a state-coordinated network of interpreters in major healthcare institutions," Tomusk added.

Digital solutions are also an option. While general translation apps are already being used in some situations, mistakes can occur, which in turn reduce the quality of care. What's really needed is a translation tool specifically designed for healthcare, such as Sweden's Care to Translate.

"We're planning to implement a digital solution in our emergency department because we're seeing issues with the incoming generation of staff. Even during recruitment, I often get asked: what should I do if I get a Russian-speaking patient?" Märk said.

"For years, we've been hearing that apps are just around the corner — apps that allow taxi drivers and passengers to communicate, or bus drivers and riders, or sales clerks and customers. But we haven't seen any functioning ones. And if a patient is in the emergency department, how capable are they of using such an app, entering information or saying something into it? That's a whole issue in itself," said Tomusk.

There's also the question of how willing people are to take additional steps when they've gotten by without doing so before. Foreign languages are still very present in public spaces. For instance, audio ads in shopping centers often feature Russian.

"There are areas where Russian-language information dominates, and that can create the expectation that if I can get by in Russian here, why should I bother using Estonian elsewhere? That likely also reduces motivation to learn Estonian," Tomusk added.

According to him, foreign-language information is justified when it concerns health or security. But in other areas of life, there's no need to always provide a translation alongside Estonian-language text.

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