Mom and Baby wearing medical masks

Swine Flu (H1N1)

Mom and Baby wearing medical masks
No swine flu, please. Photo by Austin Keys.

In 2009 the outbreak of disease in people caused by a new influenza virus of swine origin (H1N1) became a pandemic globally.  In 2010, the World Health Organization declared an end to the pandemic, but expect that the H1N1 virus will continue to spread for years to come, like a regular seasonal influenza virus. The following resources were developed as a response to the 2009 outbreak.


Immigrant and Refugee Health Resources - CDC
CDC’s page with flu information produced in languages common among the refugee communities in the US.

Flu Resources in Multiple Languages - MedlinePlus
This site has a variety of flu resources in multiple languages.

Public Health – Seattle & King County

Influenza Fact Sheets available in Chinese, Korean, Russian, Spanish, Somali and Vietnamese.

Preparedness comic book - Pandemic Flu
Targeting readers of all ages, this story tells the tale of a family’s experience with the 1918 influenza pandemic. It also explains what to expect in a severe pandemic and offers tips to help households prepare. The comic book is available online in PDF format and free hard copies are available to order. Available in 23 languages.

Swine Flu (H1N1)

In 2009, a new influenza virus of swine origin circulated in the United States and internationally. According to the Centers for Disease Control and Prevention (CDC), the H1N1 virus that caused that pandemic is now a regular human flu virus that continues to circulate seasonally worldwide.  The current flu vaccine provides protection against the H1N1 strain.

For more information about this flu, please see the CDC website .

Harborview Medical Center – Swine Flu Videos

In an effort to reach the immigrant and refugee populations during the 2009 H1N1 pandemic, some video resources were created to provide information in languages other than English.  These videos were done by Harborview Medical Center and narrated by medical interpreters at HMC.  These videos are provided for reference purposes and they are approximately 5-7 minutes in length (see sidebar).

The following is the English translation for the Swine Flu videos:

Hello I’m ________, an interpreter here at Harborview,

Many of you are aware there is a new cough/illness that people are talking about and calling “swine-flu” and sometimes “H1N1″. You may be confused about this and we want to tell you a few key points.”

For those of you who avoid pork and pork products the name seems misleading. This flu has nothing to do with contact with pigs.  You cannot get this from eating pork. The virus normally infects pigs, but somehow changed and was able to infect people. That is why it carries that name.

The sickness is caused by a virus that is very similar to the regular flu and often difficult to distinguish. The person can have cough, sneezing, sore throat, fevers, chills, and in some case nausea and vomiting or diarrhea. If you have these symptoms it could be swine flu or it might be regular flu or even just be a bad cold. The only way to tell is to do special tests, but not everyone needs these.

The infection is passed from person to person by coughing, sneezing and breathing in the virus. You could also spread it by getting it on your hands and touching your mouth or nose or eyes without realizing it.  Therefore, washing your hands and covering your cough are the most important things you can do to prevent getting sick or giving it to your family and friends.

This can not be emphasized enough. Tell your family and friends to:

  • wash hands frequently
  • cover their mouths when coughing and sneezing or cough into your elbow like this,
  • keep sputum in tissues and in the trash,
  • keep sick family in rooms away from others. Especially keep sick people away from babies, old people, and people who are chronically ill. 

Theses are the reasons to come to see the doctor:

  • If you are having trouble breathing
  • If you have a cough and a high fever
  • If you are extremely, unusually tired
  • If you are unable to eat food or liquids without throwing up or having diarrhea

These symptoms are most dangerous to people over 65 or people who have diabetes, kidney, liver or other medical problems.

It is very important that you do not come to see your doctor for an unscheduled appointment unless you are seriously ill.  If many people who are not seriously ill come to the doctor, the doctor will not have the time she needs to take care of very sick patients. 

In order to protect you and others when you come to clinic, we would ask you to do the following things:

  • If you have a cough now, identify yourself to the front desk and put on a mask.
  • You will be asked to have your temperature taken quickly. Please let the staff known if you have been feverish at home.
  • Please do not be offended if you are asked to sit in isolation until we can evaluate you thoroughly.
  • We do not treat mild cases or cases that have been ongoing for several days. In this case we may give you medicine for comfort and then ask you to go home and stay as isolated as possible to allow your body to recover. Return only if you are unable to eat or drink, are having difficulty breathing, or are very ill.
  • Make sure we have a current phone number or means of contacting you so that we can tell you your test results or other information you need to know.
  • Send family or a designated friend to get you refills and Tylenol.

Most cases of swine flu in this country have been mild, and if we are careful we can limit the spread.

Thanks for your attention.

Related Websites with Translated Swine Flu Resources

ECHO - Minnesota Department of Public Health has created video, audio, print and other resources on H1N1 and Flu in multiple languages. 

Click on Health Topics to find H1N1 – currently only have Spanish translation.

Selected Patient Information in Asian Languages (SPIRAL) - Swine Flu: This site has a some additional links to Asian language resources.

Female nurse taking blood pressure of female patient in a hospital bed

Translated Nurse-to-Patient Communication Pages – Harborview

Female nurse taking blood pressure of female patient in a hospital bed
Photo by UW Medicine

Pages developed with nurses and interpreters to aid caregivers in communicating basic information to their patients. Use of the pages requires no prior knowledge of the patient’s language, but requires that a patient be able to read and point to a written response.

These pages are not meant to be a substitute for using a qualified interpreter. Rather, they are a basic communication aid for nurses providing comfort and care to patients. For more complex communication needs, always use an interpreter.

The Greek and Polish translations have not been reviewed. Thanks to Camelia Ades, RN, MSN, MPH for contributing the Romanian translation

Language expert Mekonnen Gebretsadik and Benji Perin discussing Tigrigna phrases.

Phrases of Courtesy in Nine Languages: A Tool for Medical Providers


Note: A production error mixed up two of the Vietnamese phrases, update is pending.

This language learning tool (see resource in sidebar) features videos of native speakers saying phrases of courtesy in nine languages. These phrases of greeting, introduction, acknowledgment, departure and for emergency situations in a clinical setting can be played at a normal speed and at a slow speed.

In the provider-patient relationship, the path to positive health outcomes begins with a human connection. Developing rapport lays the foundation for each successive stage of the visit — from agenda setting and gathering information, to sharing information and involving patients in creating their treatment plan.

Language expert Mekonnen Gebretsadik and Benji Perin discussing Tigrigna phrases.
Language expert Mekonnen Gebretsadik and Benji Perin discussing Tigrigna phrases.

Language barriers make each one of these steps more difficult. Professional interpreters play a crucial role in helping providers and patients communicate, but the important work of making a connection still falls to the caregiver. Nevertheless, we often fall short. In his sociolinguistic analysis of the interpreted encounter, Aranguri reports that there is “virtually no rapport-building or ‘small talk,'”1 a finding corroborated by other studies.2

The goal of this tool is to provide a jumping-off point for developing rapport in the interpreted health encounter. Using phrases of courtesy in a patient’s own language shows interest and respect, allows at least a few moments of direct connection between patient and provider, and hopefully sends the conversation for a brief sojourn into social waters with the interpreter as navigator. Making a connection in this way is not just courtesy, but lays the foundation for the highest standard of care, a standard we wish to see extended to all patients, regardless of their English proficiency.

Using This Tool

Phrases of Courtesy in Nine Languages is a tool to help providers develop rapport during the interpreted visit. I suggest you start with a couple of phrases in just one language for patients and families you see in clinic or in the hospital. Once you’ve had a chance to practice on your own in front of the computer, the ideal situation is to have a chance to practice once or twice with an interpreter who speaks the target language, or another colleague on staff.

Some have asked how these particular nine languages were chosen; they are the most commonly interpreted languages in Washington State.

As you use the tool, EthnoMed would love to hear from you. How have you been using it? When has it been most useful? What have your experiences been? Send us a comment.


After a the creation of a pilot site, the first discussions on which phrases to use took place at Seattle’s Harborview Medical Center between Eliana Lobo, Yetta Levine, and Benji Perin. With these preliminary phrases, we contacted various clinical staff, including nurses and physicians who work at Harborview Medical Center, to get feedback and ask for more ideas.  These providers gave us many insights.  Firstly, we dropped any phrases that could prompt an entry into conversation, such as “How are you?”  In the case of a language barrier requiring an interpreter, we agreed that reciprocal conversation and information gathering should take place through the professional interpreter.  Also, more than one provider suggested including the phrase, “an interpreter has been called.”

Once we decided on the phrases, we met with three experts for each language, one after another, allowing each consultant to build upon the previous interpretation.  On numerous occasions we sent the final interpretations back to the first two interpreters for comment. Twice, with Amharic and Tigrigna, after an initial meeting to work on the phrases, three interpreters collaborated as a group on a final set of interpreted phrases. 

Throughout these iterative discussions, we wanted there to be room for interpreters to add a phrase if one seemed like a great fit, or throw one out entirely if it didn’t feel culturally appropriate.  In both Russian and Vietnamese, “It’s good to see you again” was cut, and there are a variety of phrases specific to only one language, for example, “Welcome” in Oromo and “Pleasure to work with you” in Spanish. 

In one case, Tigrigna, we faced an unexpected challenge: we had to create interpretations that would be perceived as nationality-neutral, as Tigrigna is spoken in both Ethiopia and Eritrea.  The expertise offered by the team of interpreters on this issue was invaluable.

A final note on “interpretation” vs. “translation”: throughout the process, we encouraged interpreters to choose phrases in their languages that communicated the message and meaning of the original phrase in a way that would sound natural to the listener.  For this reason, we consider the resulting phrases more interpretations than direct translations.  In cases where the interpreted phrase in the target language diverges from a direct translation, we have made a note in parentheses so that a user knows exactly what he or she is saying. 

Author’s Acknowledgements

First and foremost, a huge thanks to Yetta Levine, EthnoMed’s former student-author program coordinator, and Eliana Lobo, former Supervisor in Interpreter Services at Seattle’s Harborview Medical Center. They provided unflagging encouragement and support for this project from start to finish. 

When I came up with the idea for this website, I knew that it would be valuable only if the quality of the translations was excellent, in the right register, and tailored to the professional setting of the medical encounter.  Achieving this depended on the expertise of three experts per language to create a culturally appropriate interpretation of each phrase that was as easy as possible to say.  In short, this tool was possible only because of the thoughtfulness and insight of the excellent interpreter staff at Harborview Medical Center, in addition to several other language experts in the community.  Our language experts: Anab Abdullahi, Gammada Abraham, Tina Chang, Bogale Demse, Mekonnen Gebretsadik, Araceli Gonzalez-Medel, Tsehay Haile, Esther Hung, Jennifer Huong, Rodwell Kov, Larry Liu, Kim Lundgren, Barbara Mazina, Cuong Nguyen, Loan Nguyen-Phan, Anna Putsima, Daniel Sparler, Sam Verkhovsky, Rosa Villalobos, and Tsega Woldetatios.

Thanks also to Linda Golley, Manager, University of Washington Medical Center Interpreter Services Department, for valuable feedback and connections to interpreters.  She has long been using the term “Phrases of Civility” to describe the aims of this website in her work with interpreters and providers. 

Thanks also to Patrick Roberts at the University of Washington’s Student Technology Fee Loan Program for arranging the use of video equipment, to Martine Pierre-Louis, Director of Interpreter Services, Harborview Medical Center, and to the rest of the EthnoMed team for their support: Ann Marchand, Christine Wilson Owens, and Dr. Carey Jackson. 

About the Author

Benji Perin is currently a second year medical student at the University of Washington.  The seeds for the idea of “Phrases of Courtesy in Nine Languages” were planted while he was working part-time as a DSHS-certified Spanish interpreter at Seattle Children’s.  Like many interpreters, he observed that when a provider made an effort to introduce him or herself and say hello in the patient’s language, it often created a very positive, warm, and welcoming environment.  It became clear that such a linguistic gesture was a powerful way to begin developing rapport with patients who don’t speak English. 

Later, as a volunteer in the Emergency Services Department at Seattle’s Harborview Medical Center, Benji saw how patients could seem terribly isolated by their limited English proficiency.  Often he wished he could say a few crucial phrases in Vietnamese, Amharic, or Somali to a patient waiting anxiously for the results of a test on the medical side, or to a scared patient surrounded by medical personnel and strapped to a backboard on the trauma side.  What he wanted was a website with a carefully edited selection of phrases in the most commonly interpreted languages, including audio, with interpretations made specifically for the professional medical encounter. Not finding what he was looking for, he decided to build it.


  1. Aranguri C., Davidson B, Ramirez R. “Patterns of communication through interpreters: a detailed sociolinguistic analysis.” Journal of General Internal Medicine. 2006 Jun;21(6):623-9.
  2. Ngo-Metzger Q, Sorkin DH, Phillips RS, Greenfield S, Massagli MP, Clarridge B, Kaplan SH.  “Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use.” Journal of General Internal Medicine.  2007 Nov;22 Suppl 2:324-30.
purple cancer cells

What is Cancer?

Basic explanation of cancer, its causes and warning signs.

Available in Amharic, English, Khmer, Oromo, Somali, Spanish, Tigrinya and Vietnamese. See PDFs in sidebar.

Adapted from the American Cancer Society pamphlet “What You Need to Know About Cancer” by Harborview Medical Center, AANCART and House Calls programs. Translation made possible by The Accessing Health Information Project, funded by the National Library of Medicine.

purple cancer cells
Photo by Darryl Leja, NHGRI (cc license).
Cambodian women feeding babies.

Preventing Rickets in Breastfed Babies

Cambodian women feeding babies.
Photo by Charles Pieters (cc license).

Information about preventing Rickets in breastfed babies, including signs of the condition and suggestions for getting sufficient Vitamin D.

Available in Amharic, English, Khmer (Cambodian), Oromo, Somali and Tigrinya. See PDFs in sidebar.

Materials provided by the Community House Calls program and Children’s Clinic, Harborview Medical Center, University of Washington.


Exercise and Diabetes

These materials were developed at Harborview Medical Center (Seattle, WA) for use in a multicultural diabetes class for patients and family members. The materials were translated into Khmer (Cambodian), Oromo, Somali, Spanish and Vietnamese. Each PDF includes both target language and English. Several of the handouts have audio narration (about 3 min).

Audio and PDFs are available in the sidebar.

Photo by Garen Meguerian (cc license)