EthnoMed has been providing online information for clinicians caring for refugees since 1994. EthnoMed exists to provide clinical support and cultural context to clinicians caring for select populations of refugees. This information is retrieved from a network of case managers and clinicians engaged in ongoing refugee care and in refugee communities. Over the past 22 years we have observed successive waves of refugees entering and adjusting to U.S. health care. This article is intended to summarize common challenges to be anticipated by public health professionals and clinicians who will care for the next wave of arriving refugees. These are challenges for refugee families and therefore must be assessed and tracked for therapeutic success since challenges faced by patients are simultaneously challenges to patient care; from these we identified recommendations for providers.

OBJECTIVE:To assess the comprehensibility of hepatitis B translations for Cambodian refugees, to identify Cambodian illnesses that include the symptoms of hepatitis, and to combine these observations with critical theoretical perspectives of language to reflect on the challenges of medical translation generally. DESIGN:Open-ended, semistructured interviews, and participant-observation of a refugee community in Seattle, Washington. SETTING:Homes of Cambodian residents of inner-city neighborhoods. PARTICIPANTS:Thirty-four adult Cambodian refugees who had each been educated about hepatitis B through public health outreach. RESULTS:Medical interpreters translated hepatitis B as rauk tlaam , literally "liver disease." Unfortunately, while everyone knew of the liver ( tlaam ), rauk tlaam was a meaningless term to 28 (82%) of 34 respondents and conveyed none of the chronicity and communicability intended by refugee health workers for 34 (100%) of the respondents. In contrast, all respondents knew illnesses named after symptom complexes that include the symptoms of acute and chronic hepatitis, but do not refer to diseased organs. The Cambodian words chosen to translate hepatitis B reflect the medical thinking and medical authority that can unintentionally overwhelm attempts at meaningful communication with non-Englishspeaking patients. CONCLUSIONS:To improve comprehension of hepatitis B translations for the Khmer, translators must choose between medical terminology focused on the liver and Khmer terminology which identifies recognizable experiences, but represents important Khmer health concepts. A critical linguistic view of this situation suggests that for these translations to be meaningful clinicians and health educators must first analyze and then monitor the contextual significance of medical language. In cross-cultural settings, this means a partnership with medical interpreters to pay close attention to the experience of illness and social context of the translation.

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