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Stereotypes and semaphore, leave them coming back for more, pieces missing, nothing fitting, complications galore
  1. Elspeth Webb
  1. For correspondence:
    Elspeth Webb
    Department of Child Health, University of Wales, 67 Plymouth Rd, Penarth, Vale of Glamorgan, CF64 3DD, UK;

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A girl presented to an accident and emergency (A&E) department at 7 pm. A woman of Middle Eastern appearance wearing a hijab, and an older man, also of Middle Eastern appearance, accompanied her. He spoke a few words of English but the woman spoke none. The child appeared confused and did not respond to questioning. The woman was greatly distressed and anxious. The A&E staff managed to establish that the girl was 11 years old, that her name was Mariam Abdullah, and that the adults were her parents. It appeared from what little history they were able to elicit that she had complained of pain in her left leg and had then fallen and been unable to stand since.

A thorough examination found nothing of significance. She was in early puberty, had a normal blood pressure, and no abnormal neurological findings. However, her very subservient demeanour and passivity with staff and parents was noted. With some encouragement she was able to stand. The kind and caring staff told the family that there was nothing serious about which to be concerned, and that Mariam had perhaps fainted. No follow up was arranged.

The staff felt frustrated that they were unable to elicit a full and accurate history because of communication problems. No interpreters were available. Nevertheless, they were reassured by the normal examination. In the circumstances they thought they had done their best.


  • Staff at this unit had had no training in antidiscriminatory practice or cultural competence. Their attitude, in respect to non-English speaking patients, was for staff to manage as best they could; consequently they were unable to elicit a full and accurate history. They were not in the habit of accessing Language Line1 (box 1), although it was available in their National Health Service trust, as it had …

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  • Conflicting interests: The author provides cultural competence training on a commercial basis on behalf of her academic department