Interpreting the Health Care System
Title VI of the Civil Rights Act of 1964 says "No person in the US shall on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance". 'National origin' applies to immigrants and refugees and 'denied the benefits of' means that all patients need to understand all that is being said in a hospital, doctors office or clinic. That is where the interpreter comes in, a service that is growing exponentially in the state and in line with the growing number of immigrants and refugees calling New Hampshire home. Exchange Executive producer Keith Shields spent time with one such interpreter helping patients navigate the system.
Its early morning at Dartmouth Hitchcock Clinic’s Neurology department in Manchester and a patient named Nora has come in. She complains of spasms on the right side of her face as well as a numbness in her left arm...
But Nora hardly speaks English, she’s an immigrant from El Salvador and that’s where Alexanndra Behr comes in. Alexandra is one of 130 interpreters employed by the New Hampshire Language bank, part of Lutheran Social services...
For 10 years, Behr has been interpreting for Spanish and Portuguese clients in New Hampshire. Over that time, she’s been witness to the growth in demand for the service, not only because of a growing number of immigrants and refugees in the state but also due to an increased awareness on the part of foreign born Granite staters that these services are available.
We have those people who speak no English what so ever. We have those people that understand everything that is going on. They just feel more comfortable having an interpreter to make sure they understand 100 percent of the message and we have those people that actually speaks the language and is for the benefit of the provider and for their own sake that they request to have an interpreter just to make sure that the patient is indeed is understanding what the message is being put across
The New Hampshire language bank has been in service for nearly a decade. Interpreters are available in over 60 languages and before one can go out in the field they need to go through an intensive training process that teaches them everything from short term memory exercises to their strict code of ethics.
“Confidentiality, that’s a #1, the other code of ethics are boundaries, maintain neutrality for the whole session, we’re not supposed to advocate for the patient unless it’s a life or death situation. And accuracy and completeness, all the elements of the message have to be transmitted to the patient or the provider. And personal growth, medicine is anonstop growing profession and there’s always going to be terms that come up, new procedures, new medication and we need to be up there with that so we are familiar with them and we feel more comfortable as interpreters when we go and interpret at the hospital”
But there’s more as well... New immigrants and refugees bring new beliefs, that may not be understood by a health professional. Likewise, certain newcomers may not understand the culture of western medicine. So who better to communicate those cultural miscommunications than a person who straddles both worlds, the interpreter. Alen Omerbegovich is the program manager for the Language Bank. He’s a Bosnian interpreter as well as a refugee.
“I went to interpret for a client who had an appointment in local hospital. They were doing some testing to see if he had a cancer or not. He had no idea that that’s what they were doing until I came there. For all of his appointments before I came, his children were interpreting for him and they were afraid to tell him that he has a cancer. Because in my culture, cancer is something you don’t talk about, because it’s almost, if you say ‘you have a cancer’, it’s like, , you don’t’ have a long time to live. It’s like there’s no treatment for it. So his children refused to interpret that for him, he had no idea.”
There’s other confusions as well. For example, hospitals may not understand the dietary concerns of Muslims or Hindus or the fact that Somali Bantus who speak the Maay Maay dialect may not want a person who translates in the national Somali language. So there’s still admittedly a learning curve for all sides of this service...from the patient to the interpreter to those health professionals in New Hampshire who are treating more and more patients who don’t speak English. Keith McAvoy is an attending neurologist at Dartmouth Hitchcock Clinic and was the doctor who treated our patient Nora...
"First of all it slows you down a little bit. I have to speak and then there’s a pause for the interpreter, to ask the question again and it has to go back to the interpreter and relay back to me. SO in general it takes anywhere from 30-50 percent increase time to have a typical visit with a patient. The other issue is that I’m somewhat dependent on the interpreter, so I’m asking a question; I have to hope that it’s presented to the patient, in the way that I’m presenting it to the interpreter. And likewise when the patient speaks back to me, so I think for the most part that works but there’s the possibility of some degree of miscommunication."
But despite the growing pains, the service continues to grow. In ten years the New Hampshire language bank has expanded from a few appointments a month to over a thousand. Each appointment means another teaching moment for all involved. And its interpreters like Alexandra Behr who hopes that over time, they can be the ones that bridge the gap between doctors and patients... not only in language but also in understanding and trust.
"The majority of the providers are getting to know more and more what our role is as an interpreter. But there is still some people in the medical field that still don’t understand our role and maybe they don’t know why we do things the way we do. I feel that as I do my job, I’m also a teacher and I’m also trying to put out there to providers and other people what we do. So that’s one of the major things is kind of just teaching the providers on this is what we do and this is the why."
For the Exchange I’m Keith Shields