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Overcoming Language Barriers Faced in Health Care


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By E’Louise Ondash, RN, contributor

It’s a busy day at your hospital or clinic and suddenly you have a Hispanic patient who doesn’t speak English. Or perhaps the patient is an elderly Vietnamese woman, a visitor from Slovakia or a conventioneer from Japan. What do you do?

Out of desperation, you corral the first bilingual person available: a friend of the patient, a young relative, or maybe a hospital housekeeper. On the surface, this spontaneous, temporary solution seems to work, but the consequences of inadequate interpreting could endanger the patient’s life.

“What happens is that there is an assumption that the patient speaks English—an assumption that the patient understands, but often he or she doesn’t,” said Kevin Hendzel, spokesman for the American Translators Association, based in Alexandria, Virginia. “So the nurse will grab a relative—it may be a younger child—but there is a huge problem with this. For one thing, the information is confidential, and you don’t really want a seven-year-old son discussing the subtleties of a hysterectomy. And children are not knowledgeable about medical terms, diseases, medications and dosage levels.”

According to the U.S. Census Bureau, there are 48 million people in this country whose primary language is not English and who may have problems with speaking and comprehending English. Sadly, stories of problems caused by the lack of good interpreters abound, according to Mary Esther Diaz, a translator, interpreter-trainer and co-founder of the Austin (Texas) Area Translators and Interpreters Association.

“There is the infamous story in Florida in which a Spanish speaker had a medical problem and called an ambulance,” she related. The paramedics assessed the patient while an untrained interpreter assisted. “The patient was describing what was going on and used the word intoxicado. The patient meant he felt dizzy, but the translator used the word ‘intoxicated.’ The ER staff did not check further and treated the man as a drunken person and didn’t realize he was having a cerebral hemorrhage. He’s now a quadriplegic and he sued the hospital for 72 million dollars.”

Potential lawsuits are not the only reason why proficient medical interpreters are needed, according to Diaz, a medical translator for 30 years. There are other potential risks and losses when language services are not provided, including:

• Patients are unable to access eligible services or programs, understand informed consent and advance directives, and comply with requests of a medical provider.
• Productivity of medical professionals is affected.
• There is increased frustration for provider and patient.
• Patients’ faith in the hospital’s staff and programs decreases.
• Opportunities to reach communities on important health issues are lost.
• Hidden costs due to unnecessary testing, diagnostics, over-prescribing and repeat visits result.

Many nurses and other medical providers are not aware that the Civil Rights Act of 1964 requires the use of interpreters and translators in all institutions that receive federal funding. This includes any hospital or clinic that receives reimbursement from Medicare or Medicaid. Providing the required interpreters has been problematic, however, because of the increased numbers of non-English speakers and the major shortage of qualified medical interpreters and translators.

Few studies have been done to quantify the problems caused by a lack of adequate interpreters, but a small study that was published recently in the journal Pediatrics illustrated what errors can occur in hospitals and clinics. Researchers found that, on average, 31 errors occurred in each of 13 recorded doctor visits. About one in five patients who had an untrained interpreter experienced errors in translation. This compared to about one in eight errors that occurred with those who used an office staff interpreter.

The study also found that less than one-fourth of all hospitals have interpreters, and most have not received formal training. Part of the reason for the low compliance rate is that the federal legislation requiring interpreters is an unfunded mandate which has left the matter of how to pay for translation services a matter of dispute.

Diaz also pointed out that translators and interpreters should not be used interchangeably. “Translators work with documents; interpreters work with people,” she said.

Currently there is no national standardization for educating, training or testing interpreters, but interested parties are working on it. What they want health care providers to understand, though, is that interpreting requires more than just being bilingual.

“It’s not about words,” Hendzel said. “It’s about what the words are about and concepts. You have to understand facial expressions and hand gestures. There are many subtleties that medical interpreters must learn about, as well as the medical terms and some understanding of medicine.”

Additional resources:

National Council on Interpreting in Health Care
American Translators Association
Limited English Proficiency promotes the importance of language access to federally conducted and federally assisted programs.

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