Language Policy in medical interpreting

[Harold F. Schiffman]

>>From the NYTimes, April 15, 2005

Queens Hospitals Learn Many Ways to Say 'Ah'
By COREY KILGANNON

Elmhurst Hospital Center is not the kind of hospital depicted on most
television dramas. Its lobbies, hallways and waiting areas could
illustrate an encyclopedia of world attire. There are men in turbans and
women in flowing saris - and that is just the staff. Patients include
Mexican day laborers in dusty work clothes, Sikh cabdrivers with flowing
beards and Muslim women in full robes with their faces hidden behind
scarves.

The hallways and waiting rooms are a babble of languages and reflect
Elmhurst's location in one of the country's most ethnically diverse
neighborhoods. Elmhurst gets more than 500,000 patient visits a year, and
roughly half the visitors speak so little English that they need some
language help. Officials at Elmhurst and the other city-run hospital in
Queens, Queens Hospital Center in Jamaica, have long sought to improve
their language skills. In the past, hospital workers would comb the
waiting rooms or staff lounges for interpreters, and there were constant
pleas over the public address system.

To defray the expense of hiring full-time interpreters and the rising cost
of telephonic interpreter services, hospital officials have found a
resource right under their noses, if not on the tip of their tongue: the
diversity of its own staff. The two hospitals have formed translation
teams drawn from their nurses, clerks, orderlies, housekeepers and
counselors. They are authorizing them to be official hospital interpreters
who may be pulled off their normal jobs to translate for a patient.

For example, a hospital clerk at Elmhurst Hospital's primary care center,
Faina Kokoreva, of Brooklyn, is an immigrant who speaks Russian, Yiddish,
German and Ukrainian. "If someone speaks those languages, they're usually
sent to me," she said recently while helping a Russian-speaking patient
fill out a form. At the managed-care center at Queens Hospital Center, a
female clerical associate named Munawar Khan, a Pakistani immigrant living
in Flushing, said on Wednesday that she was often called on to translate
for Muslim women, or simply to make them feel more comfortable during a
visit. Ms.  Khan, a Muslim, speaks Urdu, Pashto, Punjabi and Hinko, a
Pakistani dialect she said was similar to Punjabi.

In past years, the two hospitals have experimented with a corps of
volunteer interpreters drawn from hospital staff members and local
residents, but few of them had extensive training in medical interpreting.
So officials at the two hospitals hired Stefanie C. Trice, a specialist in
training medical interpreters. Ms. Trice, 34, helped start the Cultural
and Linguistic Diversity Development program, which has trained about 115
staff members at both hospitals, including nurses, clerks, counselors and
housekeepers as medical interpreters in languages that include Bengali,
Urdu, Hindi and Haitian Creole.

In the medical interpreting field, she said, working in hospitals in
Elmhurst and Jamaica is "the ultimate challenge." "I have friends working
in California hospitals who say 75 percent of their patients don't speak
English," she said. "Yes, but most of them are speaking Spanish. In
Queens, you have to serve the whole world."

Indeed, there are more than 150 languages spoken in the borough. "Elmhurst
and Queens Hospital face among the greatest challenges in the city, being
in the most diverse communities on the face of the planet," said Alan D.
Aviles, acting president of the Health and Hospitals Corporation, which
runs the city's public hospitals. "For sheer total numbers of languages,
Elmhurst is unique. In the course of a year, it probably deals with more
than 100 languages and dialects." "If your hospital staff reflects its
community, then the variety of languages also mirrors the community," he
added. "If you can harness that and set up language banks with employees,
you have an added benefit."

As part of the hospitals' linguistic program, signs and hospital documents
were ordered in additional languages. Ms. Trice began surveying the staff
for multilingual employees and encouraging them to take a 40-hour medical
interpreter training course that includes medical ethics, biomedical
culture and vocabulary as well as role-playing. After a graduation
ceremony, the participating workers are considered official hospital
interpreters and receive medical interpreter identification cards. They
are not paid extra for interpreting work.

Ms. Trice said that the Health and Hospitals Corporation had adopted some
of the practices citywide. Because the group of in-house translators is
relatively small, the hospitals still rely on freelance interpreters or a
contracted phone translation service offering 140 languages, including
Swahili, Amharic, Tagalog, Hmong, Basque and Navajo. Given the expense of
the service - a total of $100,000 a month for the two hospitals - hospital
officials say they are anxious to put more workers through the
interpreting program.

"Having a cadre of certified interpreters already on staff is more
cost-effective and gives you interpreters 24-7," said Dario Centorcelli, a
spokesman for the Queens Health Network, the branch of the city's
hospitals corporation that runs Elmhurst and Queens Hospitals. It also
makes good business sense, he said. In Queens, the competition among
hospitals for immigrant patients is keen, and extensive linguistic
services are a big selling point, as is making it clear to patients
lacking full immigration documents that federal authorities will not be
alerted to their status.

When it comes to crucial medical information, relying on a patient's
relative or an untrained patient or hospital worker to translate, even if
the translator is fluent in the language, could lead the doctor to miss
certain nuances of a patient's story. Young Mexican immigrants, for
example, often use slang terms for ailments that might confuse the average
Spanish speaker, Ms. Trice said. A French translator might not understand
Haitian immigrants from Elmhurst or eastern Queens, whose own versions of
Creole differ depending on what part of Haiti they are from.

The most common foreign languages at Elmhurst Hospital are Spanish,
Mandarin, Korean, Bengali and Hindi. On a recent weekday at Elmhurst
Hospital, a Chinese immigrant walked up to the main information desk with
a confused look. Ms. Trice quickly excused herself and approached the
woman and began chatting with her in Chinese. Ms. Trice beamed and
reported that the woman, Yun Qian Hu, 54, of Corona, said she had come to
Elmhurst Hospital because at "the other hospital she went to, it was hard
to get a Chinese interpreter."

Ms. Trice, who speaks Mandarin, French, Spanish and Portuguese, introduced
the woman to Fernando Lee, 31, of Woodside, one of Elmhurst Hospital's
multilingual patient representatives assigned to entrances and waiting
areas. Mr. Lee's mother is Japanese and his father is Chinese, and he
speaks both languages. Raised in Brazil, he also speaks Portuguese and
Spanish. Language barriers can hinder immigrant patients from informing
doctors about remedies that they still may be using from their native
countries and culture, said Debra J. Brennessel, a doctor at Queens
Hospital. Those might include acupuncture among Chinese patients, elixirs
from botanicos among Latinos, spiritual healers among South Asians or
voodoo among Haitians.

"Whether they take herbs or use hot rocks on their back, we call it
complementary therapy, not alternative medicine," Dr. Brennessel said.
"You can't dismiss it. My Italian grandmother used to say the best cure
for a headache was to go into a dark room and put a clove of garlic on
your forehead."

 http://www.nytimes.com/2005/04/15/nyregion/15hospital.html