Recently, I went to a gynecologist to hear the results of a screening test. I was worried and nervous, because several of my friends have recently been diagnosed with breast cancer. But the gynecologist — with silver hair and kind eyes — stunned me with her very first question: "Are you Estonian?" Hearing that sentence, dozens of thoughts ran through my mind — whether I now had to explain my identity, family migration history, and the background of my Slavic first name.

Thinking back later, I realized the doctor actually wanted to ask which language I preferred to hear the results in. Presumably, Russian was also an option. The doctor wanted to reassure me and ensure I understood the results.

Of course, even patients without language barriers may not always understand what the doctor tells them — especially when discussing a newly discovered serious diagnosis. Medication side effects on an information leaflet or terms on a surgical consent form may also be unclear. For people living in Estonia whose mother tongue is neither Estonian nor Russian, inadequate understanding of health information is an everyday reality. As my doctoral research shows, the problem of overcoming language barriers is systemic, and healthcare workers are left to solve it alone.

Translating written texts

Healthcare workers in the study agreed: translating written health materials is crucial for non‑Estonian‑speaking patients. Ninety percent of respondents considered medication leaflets the most important document to translate for successful treatment. Texts explaining patient rights, consent forms, and treatment guidelines were also seen as essential.

Although translation agencies are preferred for written translations, healthcare workers believe they should review and edit the translated output themselves to ensure quality.

Translating spoken communication

While there is clear consensus on written translation, opinions on spoken translation are more complex. Healthcare workers rarely prefer professional interpreters; instead, they rely on colleagues, administrators, family members, or even other patients. This is unsurprising: unlike in policing or the court system, healthcare translation is not funded in Estonia as required by EU directives. Healthcare organization is the responsibility of each member state.

Interestingly, nurses and doctors prefer different solutions. Nurses tend to rely on colleagues; doctors prefer professional interpreters, especially during consultations. This difference reflects hierarchy and responsibility in the healthcare system. But doctors' preference often goes unmet — Estonia has no professional, certified medical interpreters. The last master's program in interpreting at Tallinn University closed three years ago, meaning such interpreters are no longer trained in Estonia.

Which languages matter?

Estonia is a multilingual society with people from diverse language backgrounds, but many speak English as a foreign language. The study shows English is the most commonly suggested target language for written medical texts, followed by Russian. In spoken communication, both languages are similarly important.

The study also found resistance among healthcare workers to Russian‑language signs and labels, citing historical and political sensitivity. Thus, practical needs — the widely recognized necessity of translation — clash with language‑political attitudes about which languages are valued in society. Healthcare policy cannot ignore this.

A systemic gap

Estonian healthcare policy does not address health inequality caused by language barriers. Translation services are not funded in public healthcare, except for targeted support for international protection beneficiaries. Although the need for translation is acknowledged, it is unclear who provides translation for refugees, how, and to what extent.

The study shows the current system functions largely thanks to the goodwill and improvisation of individual healthcare workers, in a situation where responsibilities and resources for translation are undefined. This is concerning, because improvised solutions are neither reliable nor safe.

Language barriers in healthcare are a broader societal issue. Tens of thousands of people in Estonia have limited Estonian‑language skills — older urban residents, recent labor migrants, international students, and refugees. When misunderstandings endanger their health, the entire society is affected — through the solidarity‑based healthcare system, social taxes, and public health.

What should be done?

The study proposes solutions: determine which documents and communication situations require translation; divide responsibility for organizing and funding translation services; and adopt a broader translation policy that considers both practical needs and societal context.

Health is a fundamental right. Language barriers should not prevent access to medical care in a system where health insurance is mandatory. Estonia's healthcare system is world‑class in many areas — it is time to give equal attention to linguistic accessibility, based on deliberate translation as an effective way to overcome language barriers. Everyone benefits from this.

Maadla discusses the results in more detail in the article "Who translates what? Language mediation in Estonian healthcare."