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Immigrants and Health Care: Newcomers, New Challenges

Speaking Their Own Language

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By Sue Anne Pressley Montes
Washington Post Staff Writer
Tuesday, January 22, 2008

Lilian Diaz, an emergency room technician, used to feel apprehensive when a doctor or nurse at her Takoma Park hospital would ask her to interpret for a Spanish-speaking patient. She knew she was chosen because of her Spanish surname, but what if she told someone the wrong thing? Her Spanish was fine for everyday matters, but was it really good enough, she wondered, to explain a life-threatening illness to a fearful patient?

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Now Diaz and a dozen of her co-workers have new confidence in their skills. They are the first graduates of a program at Adventist Health Care Systems that trains already-bilingual staff in the technical terms and cultural nuances of interpreting in a hospital setting. It is one way area health-care providers are trying to meet the demand for qualified interpreters to help inform and reassure a growing community of non-English-speaking patients.

"Coming here, I was surprised how much my Spanish was needed," said the Guatemalan-born Diaz, 25, who has worked at Washington Adventist Hospital for less than a year. She is called on, she said, "every day, multiple times a day."

Communicating with patients who speak little or no English is an urgent priority at area hospitals. In Virginia, the Inova Health System has trained 400 employees since 2002, according to Martine Charles, Inova's director of cultural competence. The District's largest hospital, Washington Hospital Center, relies largely on eight people specifically hired as Spanish interpreters, with Chinese, French and Vietnamese interpreters also available, said Brian Miller, the hospital's manager of international services. At Suburban Hospital in Bethesda, about 50 employees, with varying degrees of Spanish fluency, recently attended Spanish classes provided by Montgomery College, where they learned health-care-related terms, senior vice president Dennis Parnell said.

The Adventist program, offered through the system's year-old Center on Health Disparities, was born of necessity. There never seem to be enough trained interpreters on site, and the alternatives -- using telephone interpreting services or enlisting a patient's relatives -- are sometimes problematic.

"When family members, for example, interpret for patients, many things could be omitted," said Marcos Pesquera, the center's executive director. "If the son is interpreting for the mother, the son might be embarrassed by certain things. "

Pesquera started out by training six employees to be teachers, and by October 2007, the employees had settled in for the three-day program. Since 80 percent of Adventist's requests are for Spanish interpreters, the first course was in Spanish, but Pesquera hopes to hold sessions in Mandarin, Korean, Vietnamese, French and Russian, languages that are also in demand locally. Employees who complete the course receive extra pay for their services.

Elfred Deynes-Morales, a respiratory technician who has worked at Washington Adventist for 20 years, said he jumped at the chance to attend the class. He used to be asked to assist with interpreting once or twice a week, he said. As the number of non-English-speaking patients has increased, requests have risen to 10 to 12 a day.

"One of the reasons I took the class is I didn't think I knew it all," he said. "Before, it was an impromptu type of scenario, where I walked in, not knowing what was going on with the patient, and moved right along. Now by introducing myself and talking to the doctor, it gives me an idea what the doctor is looking for, and I can build a little bit of trust between me and the patient."

A native of Puerto Rico, Deynes-Morales said his training came in handy recently when two members of a Salvadoran family drove up to the hospital from North Carolina, searching for a lost brother. The two spoke little English. After talking with them in Spanish, Deynes-Morales determined that the man they sought was not an Adventist patient. Then he began calling other area hospitals. Finally, he contacted police and helped the family fill out a missing-person report.

He does not know whether the two ever found their brother -- "We are taught not to get too caught up emotionally," he said -- but he said he was glad he could relieve some of the stress they were feeling by helping them work out a plan of action.

Participants in the class, who are tested for proficiency in both Spanish and English, also are taught to be "cultural brokers," Pesquera said, understanding that many of the patients are frightened and may have had minimal contact with doctors or hospitals in the past. They learn how to handle terms like "gallstones" and "blood thinners" that have no exact Spanish translations, and how to blend into the background to allow the patient to feel as if he or she is conversing directly with the doctor.

"It could be as basic as 'I need you to take your medicine,' to 'You're having bypass surgery and this is what that means,' " said Vashti Mann, 43, a registered nurse in intensive care, who was raised in a Spanish-speaking home. "Instead of rambling on . . . I learned to let the doctors talk to the patients -- I'm the vessel."

Lilian Diaz said she has come to think of her role as "the voice."

Now she feels more qualified to help out in an exchange between doctor and patient. "I took a test. I can do this," she said.

And at the end of the workday, she said, "I can say, 'Okay, I did my job, I helped someone out' and walk away with a smile." ¿

Comments:pressleys@washpost.com.


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