Gia Lam’s death should force us to confront the conditions that make missed diagnosis more likely, including rushed communication, inadequate interpreting, unclear discharge instructions, weak follow-up and a system that continues to treat language as peripheral to care, writes Dr Yinghua Yu and Professor Azadeh Dastyari.
Gia Lam, a 32-year-old new mother should have been celebrating life with her newborn baby. Instead, as reported by ABC news, the Vietnamese national who moved to Sydney in 2010 died three days after giving birth from sepsis caused by a urinary tract infection (UTI).
The coroner found there were multiple missed opportunities to diagnose and treat Lam’s infection and highlighted repeated failures to provide interpreter services despite Lam’s limited English proficiency.
The tragic fate that befell Lam should concern us all, not as an isolated incident, but as what it reveals about the systemic failures in our health system. It is alarming because our health system is designed with an assumption that patients can navigate birth, pain, infection, discharge instructions and follow-up care in English. Communication is a patient safety issue. A misplaced assumption of English proficiency, with insufficient support for people who may need additional language assistance leads to a heightened risk of delayed diagnosis, missed deterioration, unsafe discharge and preventable harm.
Lack of language support in maternity care is particularly dangerous because pregnancy, birth and the postnatal period involve repeated interactions with health professionals at moments of heightened risk, recovery, transition and uncertainty. A woman may move between GP visits, antenatal clinics, hospital triage, birth suites, postnatal wards, child and family health services and emergency departments. At every point, communication shapes what symptoms are disclosed, what clinicians hear, what tests are ordered, what warnings are understood and whether a woman feels safe to come back.
Research consistently shows that patients from migrant and refugee backgrounds face additional barriers within Australia’s maternity system.
A synthesis of 27 Australian studies involving women from 42 countries identified issues such as interpreter access, structural barriers, trust in healthcare, discrimination, experiences with health workers, and conflicts between traditional cultural expectations and the Australian medical system. And specifically, limited English proficiency made it difficult for women to communicate during appointments and hospital care, understand maternal health education, ask for services, and know what was happening to them. An inability to give informed consent because of an inability to understand the language is a safety issue. Reliance on partners or relatives to interpret sensitive symptoms, medication advice or worsening pain, can raise concerns about privacy, accuracy and informed decision-making.
Research in NSW has found that culturally responsive care requires organisational commitment, targeted resources and accountability to meet the needs of refugee and migrant communities.
Australian health policy already recognises these challenges. Australia’s National Maternity Strategy emphasises safety, respect, choice and access, while the NSW Women’s Strategy 2023-2026 recognises women and girls from culturally and linguistically diverse communities as a focus community. NSW Health’s standard procedures set out the use of professional interpreters where communication cannot occur adequately in English.
The Australian Institute of Health and Welfare has similarly identified that a woman’s cultural and linguistic background can shape her experience of pregnancy and maternity care, while access to appropriate interpreters, targeted services and continuity of carer can improve outcomes.
Despite this understanding, there is strong evidence that concerning gaps between policy and practice continue to exist. Interpreters were frequently absent during appointments and hospital care, leaving women confused, distressed, and unable to participate fully in their care.
What the tragedy of the preventable death of Gia Lam shows us is that we need practical and pragmatic change.
The need for interpreters should be identified early, documented clearly and treated like a clinical safety flag throughout pregnancy, birth and postnatal care. Professional interpreters should be routinely available for critical conversations involving diagnosis, consent, treatment decisions and discharge planning.
Additionally, maternity services in diverse communities should invest in bicultural/bilingual workers, multicultural health staff, maternity liaison roles and community partnerships. This is particularly concerning in Western Sydney, where Lam lost her life, one of the most linguistically diverse regions in the world, with people from more than 170 countries speaking over 100 languages.
Gia Lam’s death should force us to confront the conditions that make missed diagnosis more likely including rushed communication, inadequate interpreting, unclear discharge instructions, weak follow-up and a system that continues to treat language as peripheral to care. Australia often celebrates multiculturalism in public life. But multiculturalism in healthcare cannot stop at posters in waiting rooms or translated brochures on a website. Cultural responsiveness must be embedded in every stage of our health system. Gia Lam’s tragic death should be a wake-up call, reminding us that communication failures in healthcare can have devastating, even fatal, consequences.
Dr Yinghua Yu is Postdoctoral Research Fellow at the Centre for Western Sydney at Western Sydney University, with expertise in health services research, patient safety, social policy, and community engagement.
Professor Azadeh Dastyari is Director at the Centre for Western Sydney at Western Sydney University, where she leads research and engagement focused on the opportunities, challenges and future of Western Sydney.