Cutting The Health Language Barriers

June 4, 2004
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GRAND RAPIDS — Carlos Sanchez says one the biggest rewards in his work comes when people heave a sigh of relief as he introduces himself as the interpreter.

Sanchez, a native of Mexico City who speaks nearly accent-less English, is one of the full-time staffers at Voices For Health, a firm that helps ailing people from overseas communicate with doctors and nurses.

According to Sanchez, Voices works with Spectrum and St. Mary's to fill in when both organizations' own multi-lingual staffers are tied up with other patients. Voices also supplies interpreters to clinics and physicians' offices.

"Spanish is probably about 50 percent of our work," Sanchez said. "Vietnamese is second. And then comes Bosnian and Croatian."

Originally, the firm's work was probably 90 percent Spanish and that's the reason its founder, Michelle Scott, gave it the name Spanish Translations Etc. when she founded the company in 1997.

But as Sanchez pointed out, the need for specialty interpreting in health care soon forced the firm to broaden its services and Scott to change its name. Today, through full-time, part-time and contract interpreters, it can help people in 36 languages, American Sign Language included. In 2003 Voices received the Small Business of the Year Award from the Grand Rapids Area Chamber of Commerce.

Scott is an honors graduate with bachelor's degrees in Spanish and nursing from Michigan State. Voices' COO, Carlos Prava — a native of Bogotá, Columbia — also is an MSU grad.

He and Scott both train new interpreters from differing standpoints: she in health-care lingo, he in the techniques that are critical to professional interpreting.

Sanchez points out that professional interpreting has a strict code of ethics that steers practitioners past the many pitfalls of interpreting.

He points out that the first and probably worst problem that interpreters face is a very natural busybody tendency to become personally involved in a case and to unconsciously take over the interview between health-care worker and patient.

Second, the interpreter must hold confidential doctor-patient conversations that the law protects as confidential. Confidentiality also is critical, Sanchez said, in order to get patients to be at ease.

"If someone happens to be an illegal alien," he said, "they've got to understand that the conversation is completely confidential and that all we're going to do is interpret for the doctor and them.

"The patient has got to feel that 'Now I can talk freely. You're not going to ask about my status.' And we tell them, too, 'If you don't understand something, please ask.'"

"The real professional is there just to facilitate," Sanchez stressed, indicating that an ideal interpreter acts like a machine that impersonally renders into Spanish what another says in English and vice versa. 

"The professional is not to give his or her opinion," he added. "And we're not allowed to touch the patient. If a nurse says, 'Can you hold her hand?' or something like that, we cannot do it.

"And if, after we're done, the patient asks for a ride home, we can't do that."

Maintaining a sense of impersonality, he added, isn't always easy because health-care questions can be so intimate and also because of the transparent gratitude patients display when the interpreter arrives.

Scott — who, incidentally, has taken up the study of Arabic — cited one Voices case in which remaining impersonal became almost impossible. A man from Voices was in a labor room studiously keeping his eyes on the wall as he interpreted for an obstetrician and a woman in childbirth.

But there was a distraction.

"It was very, very hot in the room," Scott said, "and the interpreter could tell from the conversation that the patient was pulling away her gown and the nurses kept replacing it to preserve her privacy. But the patient could have cared less. She finally just yanked off the gown entirely and threw it against the wall." The interpreter had difficulty maintaining his professional poise and not breaking out into laughter.

In another setting, a distraught mother explained to a pediatrician through an interpreter that she had dropped her baby more than a week ago. The doctor found the baby to be uninjured and asked why she hadn't told him about the incident during the previous week's examination.

She reminded the doctor that her husband had interpreted during that examination and she didn't dare bring up the subject in his presence.

"That's the kind of thing that makes it important to use a professional interpreter in health care," Scott said.

Sanchez says the attraction in interpretation comes in the breakthrough when doctors or nurses in an ER or a clinic grasp — thanks to the interpreter — what the patient was trying to convey with gestures and half-understood words.

"Suddenly," Sanchez said, "they'll say, 'Ohhhhhhhh, okay!' and everything's fine. And now the patient can relax knowing that the doctors and nurses understand the pain is in his stomach, not his heart."

He said he believes about 60 percent of the company's work happens in office diagnostics and 40 percent in emergency rooms where Voices primarily provides backup to hospitals' own interpreters.

But because of that emergency component to the work, Voices interpreters are on call 24/7, even though its new headquarters at 1000 Monroe Ave. NW maintains ordinary hours.

From his own perspective, Sanchez said the major challenge in interpreting is that someone from, say, rural Guatemala or the mountains of Columbia might use local slang or even Indian health terms that are unfamiliar to a Mexican.

"But that doesn't take long to work out," he said. "And the medical terms are the same in all languages."

When Voices bills its hours — Scott will say only that the fee is below $40 an hour — the invoice goes either to the hospital or the clinic where the interpreting takes place. Sanchez says he finds the arrangement puzzling because he understands that in most other states, the patient's health insurance covers the cost.

"I don't like taxes or bills any more than anyone else," he said, "but it seems to me that insurance ought to cover this." He said it's his belief that Spectrum, for instance, must absorb $1 million or more in interpretation fees during a year.    

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