It seems fitting to address ways of dealing with foreign language communication as part of this OJIN issue on "Nursing around the World." Our relationship with professionals in other lands is changing by virtue of being linked through the World Wide Web into a global communication network. Yet, clearly "it is a multilingual village without a common language" (Large & Moukdad, 2000, p.43).

Non-English can be seen as a growing factor in the profile of both Web content and Web users. OCLC, the Online Computer Library Center, serves as a worldwide bibliographic service utility for libraries. Among its activities, the OCLC Web Characterization Project strives to measure the structure, size, usage, and content of the Web. Included is an assessment of what non-English languages are represented on publicly accessible Web sites. In 1999, 29 different languages were represented, compared with 24 languages in 1998. Multilingual sites comprised 8% of the total. 80% were English-language sites, but this was down from 84% in 1998 (OCLC Office of Research, 1999). At the same time that non-English content is increasing, use by non-English speakers is growing faster than that by English speakers. An estimated 48.7% of current Internet users have a language other than English as their first language, up from 20% in 1996 (Global Reach, 2000).

The growing presence of the Internet increases the communication potential of health professionals across national boundaries. There is evidence of this already. ONS Online (www.ons.org/), managed by the Oncology Nursing Society, provides an example of an online nursing community working to develop supporting relationships with nursing groups in other countries (Uhlenhopp, Fliedner, Morris, & Van Boxtel, 1998. Germenis, Kokkinides, and Stavropoulos-Giokas (1997) report on the increased readership of a non-indexed medical journal, Archives of Hellenic Medicine, when it moved from a limited, national medical audience to one available on the Web.

Murray and Anthony (1999) report usage of Nursing Standard Online (NSO) to be predominantly from English-speaking countries with a growing readership from the Far East and continental Europe. They observe that the countries accessing are those with high Internet connectivity. Similarly, OJIN statistics for November 1999 showed 7.71% of the user sessions were from non-U.S. sites. Forty countries were represented. The most active countries, each with over 150 user sessions, were the United Kingdom, Canada, Australia, Hong Kong, and Japan

The goal of this column is to describe the various types of foreign language resources that are currently available on the World Wide Web. This is largely from an English-speaking perspective, although many of the sites could be useful to other Web users trying to cross language barriers. Obviously, these resources are coarse aids only and no substitute for the language proficiency required in direct patient care of those with a different native language or cultural background.

Search Engines

Some search engines provide links to their counterparts in other nations. This is true of InfoSeek (www.infoseek.com), which links to its GO International network with ten national partners (Brazil, Denmark, France, Germany, Japan, Mexico, Netherlands, Spain, Sweden, United Kingdom). Choosing France, for example, allows you to search in French for local sites as well as for everything else on the Web. Similarly, Yahoo (www.yahoo.com) provides links to "Local Yahoos" in Europe, Asia Pacific, and the Americas.

A feature of some search engines is support of searching in other languages. This is offered, for example, both by Google (www.google.com) and by Lycos (www.lycos.com). Ixquick Metasearch (www.ixquick.com) is a megasearch engine that supports the use of German, Spanish, French, Italian, and Portuguese when searching the fourteen available search engines and directories.

Translation Services

One of the biggest Web events in the past several years was the advent of free, online translation services. Two major sites are available: one through AltaVista (www.altavista.com) and the other through FreeTranslation.com (www.freetranslation.com). These offer machine translation and typically are not effective in dealing with synonyms, grammar, idioms, nuances of language use, or correct word order. However, they are a useful means to get the gist of e-mail messages and Web pages and to search foreign language document archives.

These services provide several translation approaches. It is possible to type a text to be translated (or cut and paste from an e-mail message) into a query box or to type the URL of a Web page to be translated. Also, AltaVista offers the option "translate" after each document summary displayed as part of a search result. AltaVista supports five languages (French, German, Italian, Portuguese, and Spanish) along with English. Translation, however, is offered only with English (in either direction). That is, it is not possible to translate between non-English languages. FreeTranslation.com translates FROM English to French, German, Spanish, Italian, and Portuguese and TO English from French, German, and Spanish. It can handle approximately 1,300 words of text at a time. An example of the translation capabilities of these services is given below under the section on "CINAHL and MEDLINE."

Dictionaries

The major finding tool for foreign language dictionaries on the Web is the yourDictionary.com (wwww.yourdictionary.com) which purports to be the "web's most authoritative and comprehensive language portal." Links are provided to more than 1,000 dictionaries in 200 different languages. Several dictionary resources exist of specific interest to health professionals. The Medical Foreign Language Electronic Phrasebook provides translation for simple phrases used by clinicians, specifically anesthetists, in German, Hebrew, Italian, Polish, Portuguese, and Spanish. The Multilingual Glossary of Technical and Popular Medical Terms in Nine European Languages (allserv.rug.ac.be/~rvdstich/eugloss/welcome.html) was commissioned by the European Commission and created by Heymans Institute of Pharmacology and Mercator School, Department of Applied Linguistics, University of Gent. It is possible to browse by language.

Language Tutors

An increasing number of resources are available on the Web for learning a language. This can include interactive exercises and audio clips of native pronunciation. The University of South Florida offers an extensive listing of foreign language resources, including American sign language (webgerman.com/languages/). Another useful selection is provided by the Library of Congress (www.loc.gov/nls/foreignlanguage/index.html). The Yamada Language Center at the University of Oregon (http://babel.uoregon.edu/) offers WWW Language Guides to 115 languages, links to language-related news groups and mailing lists, and an interactive language resource guide.

Patient Education Materials

Language barriers are not limited, of course, to those encountered when crossing national boundaries. Issues surrounding transcultural nursing and multicultural health often include, but certainly are not limited to, the limitations presented by language. The following is a listing of several Web sites providing foreign language patient education materials in Spanish:

• NOAH: New York Online Access to Health www.noah.cuny.edu/. This award-winning site is sponsored by the New York Academy of Medicine and New York Public Library, as well as other institutions.
• HealthFinder  www.healthfinder.gov/htmlgen/HFKeyword.cfm?
  Keyword=foreign+language+resources. This is the major consumer health directory provided by the U.S. Department of Health and Human Services
• National Institutes of Health www.nih.gov/about/hispanic/salud/publicaciones/
• Patient Education Resources for Clinicians (www.ohsu.edu/bicc-Library/patiented/links.shtml). Resource listing by the Oregon Health Sciences University Libraries.
• Less prominent are health sites with patient education aids for languages other than Spanish. One example from the Food & Drug Administration is the site for Asian Language Health Screening Information (www.apanet.org/~fdala/), which offers materials in Samoan, Cambodian, Chinese, Thai, Laotian, Vietnamese and Korean.

CINAHL and MEDLINE

It is worth remembering that CINAHL and MEDLINE can provide valuable information with regard to foreign language material. MEDLINE has a significant percentage of non-English records. CINAHL began coverage of some foreign language journals only a few years ago. Here are some searching tips to remember when searching CINAHL or MEDLINE:

1. For any foreign language article indexed, the article title is translated into English in addition to being provided in the original language. (note: this is true in MEDLINE only)
2. If an abstract of the article is provided, it is always in English.
3. The subject headings always provide additional information as to the article's content, even when no abstract is available.
4. It is possible to limit a search retrieval to a specific language (such as to Spanish). This can be a means to identify the foreign language terminology used for a given concept.

Sample Medline Record of a Spanish Language Article

Identifier Number: 20226853

Author: Velasco Hidalgo P; Garcia Romanillos E; Abad Corpa E; Lorente Balanza JA; Arevalo Velasco JM; Casado Buendia S

Institution: Unidad de Grandes Quemados, Hospital Universitario de Getafe, Madrid.

Title: [Nursing care for patients with toxic epidermal necrolysis]

Original Title: Cuidados de enfermeria en el paciente con necrolisis epidermica toxica.

Appears In: ENFERMERIA INTENSIVA. vol. 10, no. 4 (1999 Oct-Dec): 174-83.

Journal Info Abbreviation: Enferm Intensiva.

Journal Subset: N..

Country of Publication: SPAIN.

Abstract: Toxic Epidermal Necrolysis (TEN) is a severe skin disorder characterised by separation of the dermal-epidermal junction, as it is observed in second degree superficial burns, and it may also involve any mucosal surface area (otic, buccal, conjunctival, respiratory, genital). This condition is generally induced by the ingestion of drugs, particularly certain antibiotics, nonsteroidal antiinflammatory drugs, and antiepileptic drugs. Mortality has decreased over the last decades, from 80% to about 25% in recent series. This improvement in survival rate has been related to early diagnosis, management in specialized burn units, proper immunosuppressive treatment and intensive specialised nursing care. The main nursing diagnosis include abnormalities in the skin and mucose membranes integrity, risk of infection, loss of blood volume, risk of hypothermia, acute pain, upper airway insufficiency and anxiety. We here review the nursing care of patients with TEN. We emphasize the daily skin and mucose membranes care, and the prevention of conjunctival sinequiae, including daily conjunctival cleaning and debridement of necrotic tissue and fibrin debris using a handle needle.

Subjects: *Epidermal Necrolysis, Toxic / nu [Nursing] *Intensive Care / mt [Methods] *Skin Care / mt [Methods] *Skin Care / nu [Nursing] Burn Units / Debridement / mt [Methods] Debridement / nu [Nursing] English Abstract / Epidermal Necrolysis, Toxic / et [Etiology] Epidermal Necrolysis, Toxic / mo [Mortality] Nursing Diagnosis / Survival Rate / Human.

Publication Type: JOURNAL-ARTICLE. REVIEW. REVIEW-TUTORIAL.

References review article: 23 refs.

Language: spa.

ISSN 1130-2399

Example of a Machine Translation

In the above MEDLINE example, both the original Spanish language article title and its English translation are given. The following is a demonstration of the translation produced if that Spanish language title is input into each of the two machine translation services mentioned earlier (AltaVista and Freetranslation.com):

Original Spanish Language Title: Cuidados de enfermeria en el paciente con necrolisis epidermica toxica.

MEDLINE's Translated Title: [Nursing care for patients with toxic epidermal necrolysis]

AltaVista's Machine Translation: Taken care of of enfermeria in the patient with toxica epidermica necrolisis

FreeTranslation.com's Machine Translation: Cares of enfermeria in the patient one with necrolisis epidermica toxica

CONCLUSION

It is encouraging to see the degree to which resources are already available on the Web to aid us in dealing with other languages. However, it can be only a start. Many of us need and will benefit from more development in this area. Also, the world is more diverse than today's Internet usage statistics reveal. We must be concerned that those people now excluded by geographical or language limitations are not overlooked.

Author

Barbara F. Schloman, PhD, AHIP
Director, Library Information Services
Libraries & Media Services
Kent State University
Kent, OH 44242
Email Address: schloman@kent.edu