Access to healthcare is a fundamental human right, but what happens when medical information is lost in translation?
Australia is a vibrant and diverse country with roughly 30 per cent of its population born overseas. Yet, many people living in Australia experience language barriers when communicating with health services. Solinary is a software platform with a mission to address this gap by enabling culturally safe, multilingual health communication. Launched by Good Hood, the product is one of six initiatives selected for the inaugural Humanitech Lab Innovation Program to be supported through mentorship and funding to scale up their innovation. We spoke with Solinary’s Founder, Emma Koster, to explain how we can utilise digital technology to enable equitable access to good health.
Emma, can you tell us about the project you are undertaking in the Humanitech Lab Innovation Program?
I’m building out a use case for a product I’ve been developing over the last 18 months called Solinary, which is essentially a software platform that enables safe, simple and equitable access to good health. Solinary is a product from Good Hood, and we specialise in tech for social impact. We’re looking at some of the divides in the provision of health care and the challenges around health inequality across culturally and linguistically diverse communities here in Australia. There’s a gap between people who have and people who have not — those with lower health literacy and health equality who also experience things like poverty and various other forms of discrimination, with English often a second, third or fourth language. So, that’s where we’re focused.
“We’re looking at some of the divides in the provision of health care and the challenges around health inequality across culturally and linguistically diverse communities here in Australia. There’s a gap between people who have and people who have not.” Emma Koster, Founder of Solinary.
Sounds very equitable and like it should already exist. Could you explain how it will be implemented?
So for Humanitech, the use case we’re looking at is in a hospital context — specifically emergency departments (ED), though this can be extended out into general practice as well — translating the triage process in real time.
When someone comes in and presents to ED, they are asked about 20 questions around their health history, the symptoms they’re experiencing and medication. That kind of stuff is really essential to know to be able to provide great care. But if we’re not capturing that in people’s language, then it’s really hard for them to be able to access that same level of care in that same kind of timeframe. Translators might be required and there can be a significant delay in getting those translators, or people will simply fudge the answers because they’re concerned about asking for help.
“All of Solinary’s translations are workshopped with community, so it’s not just a literal translation: we’re also looking for cultural translations and translations of concepts, which vary from culture to culture.”
There can be all sorts of reasons and drivers behind people not being as fulsome in their disclosure as is required in that situation. So with Solinary, we’re providing that system in language in real time, and then translating it back into English for the healthcare worker to be able to triage them effectively.
So, assisting with the document creation process- and then also the translation process?
Yeah, exactly. All of Solinary’s translations are workshopped with community, so it’s not just a literal translation: we’re also looking for cultural translations and translations of concepts, which vary from culture to culture. We are providing that extra layer of intelligence, I suppose, to make things culturally safe.
What led you here? What sparked you to pick up this problem and jump on it?
The last five years, I’ve really been devoted to developing a product called Hello Cass, which is an anonymous, SMS-driven chatbot for people experiencing or affected by family and sexual violence. The challenge there was twofold. Firstly, there was a practical challenge at the time. In 2016 in the sector, the websites were in need of some updating, and many people didn’t know who to call when there was a situation of family violence or sexual violence. It was really hard to get that information out there, and also hard for people to feel like the service they were calling was the right one.
“I’m really interested in making sure that our technology and what we’re doing with Solinary is focused on closing that digital divide and making sure that digital inequality is something that we’re really conscious of and not contributing to. You don’t really get into impact tech to not include people, but we do need to be cognisant of the fact that it’s so often what happens.”
The other challenge was that people found it difficult to disclose their situation — there are barriers to disclosure, such as fear and shame. So my idea was that if we’re using a text message and we make it feel as simple as texting your friend, it might help people access support sooner. With all of the technology that was available, what we could come up with was something very, very simple.
Another issue around family and sexual violence is that First Nations women and women from ethnically diverse backgrounds are overrepresented in the figures and statistics around violence. And often, there are different language groups associated with that.
There’s also a really technical problem, which is that if we want to improve the tech stack and incorporate the exciting, very marketable AI technologies such as natural language processing, there is an inequality around who we develop for. If it’s just going to be in English and some of the big European languages, no problem. But where the issue really gets concentrated is with people who are already marginalised based on their ethnicity and their language groups. The digital divide becomes another form of discrimination, and I was interested from that perspective.
That really paints a good picture of how you have landed there. And then does this feed into Hello Cass?
Kind of the other way around. Hello Cass started as a Good Hood project as well. I had some funding from the Myer Foundation through the Myer Fellowship and some other bits and pieces, and then I realised that to get funding, I had to sell the data. That felt really uncomfortable for me as it’s people’s trauma and I don’t like the idea of commodifying violence against women. Alternatively, I knew I could make it a not-for-profit. The idea of the paperwork that goes into nonprofits and boards was also rather uncomfortable, but I thought I would get more support from the philanthropic sector and donations and that kind of thing.
So, I’ve created Hello Cass as its own charitable not-for-profit. Having said that, I’m not a great not-for-profit leader. I’m very much an innovator, and it’s decision- time in terms of what we do now with Hello Cass and where the impact can be best felt, because the problems have changed. A lot of the sectors reorganised their websites since we’ve been around, which has had a positive impact, and it’s a lot easier to find support. Also, the #metoo movement has happened. I think there’s been a massive shift in the conversation.
Is it fair to say that Hello Cass has really highlighted the problem of forgotten voices in the development of new technologies, or languages that aren’t spoken so much?
Definitely. There’s so much stuff around tech that’s fad-based. We had big data, then AI has been a big thing, then blockchain, and everyone’s like: “There must be an application for every new technology — you’re just not thinking hard enough if you haven’t found it yet!” One danger can be who we are missing out on when we’re just going doing big data, or we have this dataset that makes something a rule when it’s just not the case. So I’m really interested in making sure that our technology and what we’re doing with Solinary is focused on closing that digital divide and making sure that digital inequality is something that we’re really conscious of and not contributing to. You don’t really get into impact tech to not include people, but we do need to be cognisant of the fact that it’s so often what happens.
If Solinary could dream the biggest it could dream, and bring that dream into fruition, what would it look like?
I think it would be that no matter where you are in the world or what language you speak, accessing good health is not a problem. And that’s it. I mean, there are so many challenges, and I’m not naive in thinking that it’s all language based, because then we have barriers around literacy and access to connectivity. If we can at least understand each other though, that’s a great first step in addressing those other barriers, because once people feel like they can communicate, we can also find out what those other challenges are. It would be helpful to know how people arrived at the hospital, for example, but that might not be a question that gets asked when you’re struggling through a translator. It would also be helpful to know how many people are at home. I think language access is something that could really remove that first barrier.
Does Solinary exist when you are online and trying to find health answers as an individual who might speak a minority language? Or does it just exist at the space when you first enter triage, a hospital or a healthcare provider’s office?
For now, we’re looking at it from a structural perspective. Hospitals are scary places; it’s really confusing. You don’t know how much it’s going to cost… all that kind of stuff. If you can provide that support there with Solinary, that’s the first step. Who knows though — it could also be something that exists at a consumer level online, but I think in terms of equity, not everyone is connected or has a device. So where they’re interfacing with some sort of system, it would be great if that system understood them.
What are some of the biggest challenges of implementing Solinary within those systems?
All of them [are big]! One is doing work with big organisations and bureaucratic institutions. I’m working with the Department of Health — who have been really great — in another use case for Solinary for their health alerts, but it really is tricky in tech, because we build to move quickly. We iterate and prototype and design and scrap and keep moving. But when you’re working in an organisation, like a hospital or with the Department, then things have a process they must undertake. This can be really hard for start-ups, because although we are ideas rich, we’re cash poor. So, you’ve got to stay alive, you know what I mean? That can be challenging.
“If we can at least understand each other though, that’s a great first step in addressing those other barriers, because once people feel like they can communicate, we can also find out what those other challenges are.”
Also, particularly in health, any given hospital has up to 60 or 70 different software solutions, so that’s a mess, obviously! No one loves learning new software, so Good Hood is trying to work out the best way to fit in with the processes and not hinder the medical team, and to make sure that we’re supporting them as well, because ultimately, everyone’s trying to do the best thing and people are trying to access good health. Medical teams are there because they really care about their patients and they’re wanting to provide that support. Hopefully Solinary can do that and help the medical practitioners to feel like they’re doing the best thing by their patients.
What are you hoping to take from the Humanitech Lab Innovation experience? What do you want to use this time for?
I’m fresh out of a workshop with some of the Humanitech team, and that was really great in terms of defining the hypothesis and what we’re really looking at for a pilot. For this part of the Lab, I want to get everything ready for a pilot, which involves working with the community and getting as much community engagement as we can, because at Good Hood, we’re really focused on being culturally sensitive and informed.
We know that there are 20 odd questions a triage nurse will need answered, but how can we posit those questions in a way that is going to be easily understood by the community members in that particular language group? And how can we gather insights that will help us to provide that kind of support? What I think is so great about the Lab is that I’ll be able to do a lot of community engagement and research watching people in emergency departments.
In 10 years, how is Solinary going? What does it look like?
Hopefully it looks nothing like it does now, because that means I haven’t been able to update my tech! The dream in this stuff is that your problems shift because you’ve addressed one of them, so hopefully people are accessing healthcare sooner. From that, we’re seeing the burden of poor health across culturally and linguistically diverse communities lower — and we are starting to see more inclusion at that level. Also, I think it would be great to think about how we can be smart about this data set we’re amassing and use it to address some of the other digital inequalities that exist in the developed world in regard to language bias online or in anything connected.
What are some of the biggest lessons you’ve learned on this journey so far that you’d like to share in terms of helping push you further to develop solutions?
Before I was building things, I was a project manager in software. That was my last gig and I was always like: “De-scope, de-scope, de-scope.” I have the opposite problem now and have no self-control. So, I think the biggest lesson is to de-scope — just do it!
It’s tricky when it’s your own thing, because you lose that confidence and ask: “Is this flashy enough?” The tech industry is so full of #@%^ sometimes and it really loves a buzzword, loves a marketing slide deck, loves to over-promise and under-deliver and inexplicably large sums of money. I sometimes lose confidence in asserting a path that I think is the most effective for what we need to do, because it just doesn’t sound as flashy as people want it to. I think keeping my cool and holding the line on that is a big lesson, because otherwise you just bite off more than you can chew and it’s a real problem.
Has that stood you well in stormy waters before?
Yeah, I always bite off more than I can chew with my own stuff. The whole idea of Hello Cass was ridiculous to try and do as a one-woman show — that’s not scalable — I can’t do that again. I have to be clever about piecing the work into segments that make it attainable.
Another thing I’ve learned is that when you’re building something and you’re the founder you can get very protective of your work. That’s great, but I’ve already had that with Hello Cass… all my work is very values driven and I like to have a clear ethical framework that I operate from. But it also helps to bring in support, because it means you get to have more impact, but to also stay values aligned. I think that’s the other essential thing: don’t work with people you wouldn’t have lunch with, because otherwise there’ll be problems when your values aren’t matching up — particularly when you’re working with populations who experience vulnerability in some way. You’ve got to really respect your partners.
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This article is part of a series detailing the innovations taking place to support technology start-ups that focus on social impact, supported by Humanitech’s Lab initiative. Learn more about other organisations pioneering the use of frontier technology for social good here.