Jan. 18When Dr. Steffen Brown examines Albuquerque resident Noily Alvarado at University of New Mexico Hospital, they aren't alone. A video monitor shares the room in the Women's Health Clinic, where a UNMH medical interpreter pops up on screen to translate every word. Alvarado, who is from Costa Rica, makes sure to ask for an interpreter.
"I speak a little English," she says, in Spanish. "But I prefer to have someone who understands everything."
Patient encounters with interpreters range from billing questions to mental health assessments conversations that, without interpreters, can have dramatic impacts on health.
A 2002 study by the Access Project at Brandeis University of uninsured patients nationwide found that 27 percent of people who needed but didn't receive interpreters didn't understand their prescriptions. Two percent of those who had an interpreter or didn't need one said they didn't understand instructions.
By federal law, facilities that accept federal money must provide the same care for patients who do and do not speak English. But services are often a work in progress.
Guadalupe Reyes, education and staff development specialist for UNMH's Interpreter Language Services, became an interpreter nine years ago after she saw how language barriers affected her family.
Fifteen years ago, Reyes' sister, who spoke only Spanish, died in a New Mexico emergency room and the family was never told how she died. They believe the language barrier was a factor in her care.
A growing program
In New Mexico 36.5 percent of the population speaks a language other than English at home, according to the 2000 Census. At UNMH, 16 percent of visits involve interpreters. Spanish speakers make up 14 percent of the patients who use interpreters, followed by Vietnamese speakers (1 percent).
Other languages, like American Sign Language, Navajo, Mandarin and "emerging languages" such as Swahili and Arabic, make up the rest, says Kristina Sanchez, executive director of ambulatory business operations at UNMH, who oversees interpreter services.
UNMH has 15 staff interpreters for Spanish and three who work in Vietnamese, as well as four administrative staff. Most interpreters can also translate written documents.
The program has grown since 2005, when UNMH had three interpreters and was sued for not having enough language services for non-English speakers. Early on, Sanchez says, people sometimes ended up with bilingual staff who weren't qualified medical interpreters. Just because a staff member speaks Spanish doesn't mean he or she can convey sensitive medical information in an appropriate way, she says.
"What I have seen change over the years is that that is not enough," she says. "It's not just about providing language but about whether the patient understands."
Errors can happen even with qualified interpreters, although they may be less significant than those made by untrained people. A 2003 study in the journal Pediatrics analyzed 13 patient visits with trained and untrained interpreters and found an average of 31 errors, mostly omitted words. With the untrained interpreters, the errors were more substantial. They included leaving out allergy questions and giving incorrect drug dosages.
UNMH has moved toward standardized testing to ensure patients have the same quality of interpretation, Sanchez says. In addition to staff interpreters, UNMH has trained 300 bilingual staff using the national Bridging the Gap interpreter training program, which teaches bilingual people about the role of an interpreter, cultural awareness, medical terms and communication styles. They earn an extra $35 a week, she says.
In 2008, UNMH added 55 video monitors. To use them, staff press a code to connect to Spanish, Vietnamese and American Sign Language interpreters. The monitor also connects to phone interpreters in 180 languages.
Lovelace and Presbyterian Hospitals offer similar telephone interpreter services, as well as bilingual staff who receive interpreter training. Neither hospital has dedicated staff interpreters.
At Presbyterian, about 3 percent of patients used interpreters in 2009, says Johanna Stiesmeyer, director of nursing, professional development and clinical effectiveness, who oversees interpreter programs.
At Lovelace's West Side emergency department, three to four patients need interpreters every day, says department director Michael Garey. Bilingual staff are called first and phone interpreters are used as a backup.
Training staff in how to use interpreters is important, hospital administrators say.
On a recent Friday morning, UNMH medical interpreter Ian Holmes picks up a phone in his cubicle. After introducing himself, he switches quickly between Spanish and English to help a patient asking about records. A few feet away, Vietnamese interpreter Lan Dai uses a video monitor to interpret for an older man with blood pressure questions.
The most difficult calls are endof-life discussions, interpreters say. Bad news may come from a doctor but families look to the interpreter to break the news.
"You're the voice," Spanish interpreter Maria Kearney says. "They're looking at you."
Interpreters say it all, "even the bad words," Kearney says. They use the first person and try to reflect patient and physician tone and demeanor, as well as words.
"If the patient stutters, you stutter," Dai says.
Interpreters have multiple roles they are conduits for information, cultural brokers, patient advocates and information clarifiers but they don't assist in medical care and have strict confidentiality rules.
"We're not there to give a second opinion," Reyes says. "We're just there to make sure the barriers of communication do not hinder the quality of care."
While language services have improved at UNMH, there is still room for change, says Sireesha Manne, staff attorney at the New Mexico Center on Law and Poverty.
In 2005, the center sued UNMH on behalf of five community groups, citing discrimination because of insufficient interpreters. In a settlement, UNMH agreed to bring in an expert to improve access, says Gail Evans, legal director of the Center on Law and Poverty.
In addition to hiring more interpreters, UNMH now collects data on language needs and how they are met. UNMH can be proud of the video program, Manne says.
For language services, UNMH is ahead of other state agencies and hospitals, Evans says. But more should be done to translate documents and provide interpreter service at all clinics, Manne says. "It's a work in progress," she says.
More work is needed across the state, says Paul Romero, director of the New Mexico Department of Health's Office of Health Equity. In 2006, the department added training for staff and community health providers, using a $160,000 grant from the Office of Minority Health to train 250 Spanish and 90 Navajo medical interpreters.
"We recognized that this was a need," he says. "We have lots of bilingual people but they're not trained."
Romero says the department also focuses on training staff to provide culturally competent care. Romero uses the example of diabetes educators working with Navajo patients. Instead of asking patients to cut out traditional foods, a better approach would be help with healthier preparation.
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