Breaking Down Barriers Hospital Interpreters Translate More Than Just Words

Tim Moriarty says some patients who don’t speak English want to bring their own interpreter — a friend or family member — into the examination room. But that’s usually not a good idea.

“They tend to withhold information from the patient. They might not know some vocabulary. And they often provide opinion, and you don’t know that they’re saying, ‘your cousin Bill had this same procedure last year, and he died, so you shouldn’t have it,’” said Moriarty, manager of Interpreter and Translation Services for Baystate Health.

Better to use one of the professional interpreters that hospitals are required by law to provide patients who don’t speak English.

“One of the standards of practice is transparency, to relate what’s said without adding or omitting anything,” he told the Healthcare News. “Interpreters actually speak in the first person: ‘I feel pain today.’”

And when speaking for the doctor or nurse, they address the patient in the same way, as if they were the provider.

Ramona Quintana, who coordinates interpreter services at Mercy Medical Center, said it’s all about becoming a conduit, as if the third person in the room doesn’t exist.

“As an interpreter, I am not me,” she explained. “I’m trying to be as invisible as I can become, and my words and even my gestures become that of the patient, so the provider gets an idea of what’s going on so he knows how to treat that patient — not just medically, but also with other issues that might be present.”

Quintana said some people have the impression that interpreting in a medical setting is easy work, simply reciting back and forth. “But it’s not just repeating words; it’s interpreting meaning.”

And it’s complex work, which is why a national certification for hospital interpreters has been established, starting with Spanish speakers this year; other languages will follow.

This month, the Healthcare News examines how interpreter services are implemented at area hospitals, and why such programs are so necessary. After all, at such a critical moment in someone’s life, it’s important to have someone speaking not on their behalf, but directly in their place.

Beyond the Law

While most hospitals in Western Mass. have had interpreter services available from at least the mid-’90s, if not before, such programs were not mandated by state law until 2001. The law requires hospitals to provide ‘competent,’ trained interpreters, not family members. It also requires hospitals to designate a coordinator or director of such services; to post notices in emergency rooms, psychiatric units, and registration areas advising patients of their right to an interpreter; and translate relevant documents into languages commonly encountered at the hospital.

“Patients have a right to an interpreter, and that’s posted,” Quintana said, a standard document that outlines that right in dozens of languages. Quintana said Mercy sees not just Spanish speakers, but also Russian, Polish, Portuguese, Vietnamese, and Chinese speakers, among others.

“It’s quite a diverse community we serve as we try to meet these needs. And the languages we don’t speak, we reach through agencies in the area,” she explained, adding that interpreters need to be aware of vocabulary and cultural differences even within the same language group. “There are so many different cultures that speak Spanish, and South America is different than Mexico.”

While Massachusetts is among the states that have been responsive to the need for interpretive services, others cannot make the same claim, which is why national certification is a good idea, Moriarty said.

“Right now there are no national minimum requirements for interpreters,” he noted. “Some states have instituted testing and certain requirements, but most states don’t have that. National certification will require the interpreters in the field to demonstrate their knowledge or functional understanding of their practice, their knowledge and fluency in English and a second language, and their knowledge of medical terminology in both languages.”

Those requirements, he continued, will make it much easier for managers doing the hiring, because they can make assumptions that someone has a high skill level prior to being hired and not just count on someone’s education and state certification, if any, the requirements for which can vary widely from state to state. “Now, interpreters, will have to prove their skills before we bring them on board, and that minimizes the risk, especially to the patient. It ensures that communication between the patient and provider will be very clear.”

Because of Baystate’s size and the fact that about 80,000 patient visits require language translation each year, it boasts a wider range of interpreting skills in house than other regional hospitals, Moriarty said. Its staff of 45 can interpret Spanish, Vietnamese, Polish, Arabic, and Mandarin, and it works with two local agencies to provide services in Swahili and Khmer, among others. “Then, if a really unusual language comes up, which sometimes it does, we have telephonic interpreting with a company that assists us with more than 100 languages in less than 30 seconds.

At Holyoke Medical Center, Spanish is the overwhelming language barrier, said Rafael Mojica, coordinator of the Community Outreach Department, of which interpreter services are a part. “Last year alone, we had almost 18,000 visits from Spanish-speaking patients who didn’t speak English, but we also had about 2,400 visits from patients who didn’t speak English but spoke another language, like Polish, Portuguese, Russian, Vietnamese, or Arabic,” he explained. Other patient visits required interpretation of Cantonese, French, Tagalog, Italian, Somali, Urdu, Gujarti, and sign language.

“We have staff in person from 6:30 in the morning to 11:30 at night, and overnight we have telephonic interpreting services that speak about 150 languages,” he said. And because the hospital experience can be confusing and frustrating for a non-English speaker from a different culture, Mojica’s department goes beyond making sure services are provided when patients come through the door during the day.

“We originated what we call daily rounds,” he explained. “Every single morning, we have a medical interpreter visit all the bilingual patients and new admissions, and every morning we get a report making sure they can either speak the language or are informed of our services. And we make sure that, if any provider comes in, they call the interpreter. It’s pretty simple; we carry cell phones around the hospital, and we’re a phone call away.”

Because Cooley Dickinson Hospital, like most all Western Mass. hospitals, also encounters more Spanish speakers than any other non-English language, Dias serves as a Spanish-speaking coordinator, and two per-diem interpreters also specialize in that language. Another per-diem interpreter speaks Portuguese (as does Dias), and the hospital contracts with an outside agency for other commonly heard languages, including Korean, Cambodian, and Chinese.

The hospital ensures that an interpreter stays with a patient who needs assistance throughout his or her visit, leaving when there’s a wait and returning for the next test or meeting with a provider.

Emma Dias, coordinator of Medical Interpreter Services at CDH, said it’s gratifying to see interpreters make a real difference in someone’s hospital experience, which is often an anxious time even without language and cultural barriers.

“It’s very rewarding,” she said. “I was an architect for more than 10 years, and I never felt that rewarded. This is a really great field.”

Beyond the Language

Even without the national certification, New England hospitals have proven to be progressive when it comes to honing interpretive skills. Moriarty serves as president of FOCIS (the Forum on the Coordination of Interpreter Services), members of which meet bimonthly at different hospitals across Massachusetts. They discuss issues including interviewing interpreters, working with interpreter contract agencies, defining patient encounters, and developing a basic assessment tool. The FOCIS model has since migrated across the Northeast and even to North and South Carolina.

And what hospitals are assessing isn’t just how well an interpreter knows the language, but, as Quintana noted, how well they help patients from different backgrounds and cultures navigate an often-anxious time.

“We need to guide patients,” she told the Healthcare News. “We not only serve as interpreters, but we meet different cultural needs. When a patient comes in, we ask that patient through an interpreter if they have any cultural needs that would make their stay more comfortable.”

At Holyoke Medical Center, Mojica said, not only are the interpreters fluent in at least two languages (English and Spanish), have formal interpretive training, and understand medical terminology, but they’ve also received specialized training in the areas of substance abuse, mental health and crisis intervention, domestic violence, oncology and bereavement, cultural competence, and diversity. Recently, interpreters underwent a five-week training course on health interpretation taught with the specific needs of the hospital in mind, reflecting the sort of emphasis on continuing education seen in many Massachusetts hospitals.

“It’s a very rewarding job,” said Mercy’s Quintana. “We do and see it all, because it is about quality of life, and that spreads out to the community when patients leave, and society as a whole benefits.”

Yet, while seeing and hearing plenty during patient encounters, she said interpreters are trained not only to be good listeners, but also “fast forgetters,” due to the obvious privacy issues raised by having a third person in the doctor’s office or testing room.

“We also have to read body language. Different cultures have different body language,” she said, noting that certain gestures that are friendly in one culture are disrespectful in another. “Interpreting is more than words.”

Still, she said she sees herself largely as a conductor of language, like metal conducts electricity, hopefully presenting the meaning unchanged to the doctor, and the provider’s instructions back to the patient.

Her job, and that of other medical interpreters, is like electricity in another way, too, shining a light on what might otherwise be a dark, confusing experience.