Demand surges for translators at medical facilities

Harold F. Schiffman haroldfs at
Sun Jun 3 13:22:14 UTC 2007

Demand surges for translators at medical facilities

Updated 7/20/2006 12:20 AM ET
By Elizabeth Weise, USA TODAY

SAN FRANCISCO Once upon a time, when a patient walked into the San
Francisco General Hospital emergency room speaking a language no one there
knew, the staff headed for the Yellow Pages. "We used to call
restaurants," says Alan Gelb, chief of the hospital's emergency
department. "If we had an Ethiopian patient, we'd look in the Yellow Pages
and find an Ethiopian restaurant and get them to interpret over the
phone." Today, doctors at "the General" have access to interpreters who
work in 31 languages, including nine Chinese dialects and five Filipino
ones. And when a patient shows up speaking yet another language, they call
a telephone language service that works 24 hours a day in 130 languages.

But while interpretation has gotten better, the need is growing even
faster. By 2004, the number of U.S. residents who speak a language other
than English at home grew to almost 50 million, 19% of U.S. residents. And
there were 22 million residents that year with limited English
proficiency. Very few states even have interpreter-certification programs,
says Maria Michalczyk, former co-chairwoman of the National Council on
Interpreting in Health Care. That's resulting in higher costs and worse
medical care, says Glenn Flores, a professor of pediatrics at the Medical
College of Wisconsin-Milwaukee. His analysis of language barriers to
health care in the USA appears in today's New England Journal of Medicine.

Making do with semi-fluent medical personnel can lead to trouble.
Oncologist Arturo Molina remembers one incident from his tenure at City of
Hope cancer center near Los Angeles. A frantic colleague called Molina,
who is fluent in Spanish and English, to ask him to talk to a patient who
was about to have a bone-marrow transplant. The procedure makes the
patient sterile, so the doctor had tried to explain that she could freeze
the patient's semen to preserve his fertility after the cancer was cured.
But the physician's Spanish was limited. "What (the patient) heard was
that they were going to freeze his testicles," says Molina, who calmed the
patient down.

Having family members translate can be problematic. In California,
Assemblyman Leland Yee has proposed a bill to prohibit children under 15
from being required to translate for their parents Yee, who grew up in San
Francisco's Chinatown, was called upon to translate for his mother at the
doctor's office when he was 6 years old.  "You were never sure as to what
you were translating was accurate. And the doctor never knew. And my
mother never knew, so it was all up to me," he says.

"It's probably one of the worst situations you can put a child in and one
of the worst situations you can create clinically in terms of getting good
treatment," Flores says. Children don't understand the terminology and
don't want to admit when they're scared or don't understand the question,
he says. Spanish speakers make up about two-thirds of the U.S. residents
who speak another language at home, Flores says. But less common languages
can pop up as international crises bring in new refugee groups or as older
populations shift. In Washington, Oregon, California and Minnesota, large
Hmong communities exist. The Hmong are a hill tribe from Laos who came to
the USA after the Vietnam War ended.

In San Francisco, Geld says he has seen an influx of Mongolian speakers.
Berkeley, Calif., has a big Tibetan community. Michigan has a growing
group of Somali refugees, who speak Bantu and Maay.  Lexington, Ky., has a
small Arabic community, and in Oregon, a colony of Old Believer Russians
numbering in the thousands speak an archaic Russian dialect, Michalczyk
says. But the need for translators is hitting hardest in communities that
have up until now been entirely English-speaking. "A lot of rural
communities have never seen that kind of diversity. Tennessee and North
Carolina they're seeing really high growth rates of Latino populations.
That really brings the issue to the fore," Flores says.

Federal rules require that any medical provider receiving Medicaid or
Medicare offer interpreters. But in general, the rules have not been
enforced, Flores says. Forty-three states have one or more laws about
language access in health care, up from 40 in 2003, according to a survey
by the National Health Law Program. But while some laws are detailed,
others say only that access is important. Some have suggested that people
who come to the USA to live should simply learn English, says Wilma
Alvarado-Little, co-chairwoman of the National Council on Interpreting in
Health Care. But foreign-born patients who otherwise do fine speaking
English may need help in an emergency room because they're too worried and
lack the vocabulary, she says.


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