Correction to This Article
The article incorrectly said that Inova Fairfax Hospital has several full-time interpreters and 700 full-time staff members trained to interpret in some 35 languages. Those are the numbers for the Inova Health System, which has four hospitals in Northern Virginia.

Language Barriers Complicate Immigrants' Medical Problems

By Eliza Barclay
Kaiser Health News
Tuesday, April 21, 2009

"Devil, devil," the man muttered.

Sabyasachi Kar, a doctor at Washington Adventist Hospital in Takoma Park, shook his head in bewilderment. He was examining a Spanish-speaking patient with the help of a colleague who barely spoke the language, and he was getting nowhere.

"It was frustrating. I couldn't do my job," Kar recalled. Only the next day, when he returned with a bilingual colleague, did Kar learn the man had been saying he felt "debil," or weak.

As immigrant communities swell around the country, hospitals, clinics and health-care providers are increasingly confronted with language and cultural challenges that can discourage people from seeking care and lead to calamitous errors in diagnoses and treatment regimens.

In the Washington area, a sharp rise of the foreign-born population in the past two decades has been met by a patchwork response in the medical field. Many area hospitals have taken steps such as installing phones to connect patients and staff members to interpreters, hiring interpreters or training employees to do the job, and recruiting bilingual staff. But some large physician practices and small primary and specialty care services have not added language or cultural services.

"All providers in this area should . . . have a mechanism to deal with language barriers," said Isabel van Isschot, director of interpretation services at La Clinica del Pueblo in Washington, which supplies interpreters to health facilities. When patients don't have access to an interpreter, she said, "I think that's a form of discrimination."

Hospitals and doctors, however, are wary of the cost of interpretation services, which can run up to $190 an hour; they say the government, not them, should pay these costs.

"Appropriate funding for these services is needed so that patients don't lose access to care," said Joseph M. Heyman, chair of the board of trustees of the American Medical Association, which has asserted in policy statements that "physicians cannot be expected to provide and fund . . . translation services for their patients."

A 45-year-old federal civil rights law requires hospitals and doctors who accept federal funds to offer language services. Some federal funding for interpretation services is available through Medicaid and the Children's Health Insurance Program, state-run programs that serve the poor and children, respectively. But to obtain the money, states have to pitch in some of their own. The District and Virginia have done so; Maryland has not.

California alone has put the funding burden on private insurers for patients who have that coverage. Some other states are considering similar legislation, but the issue is not a political priority in the Washington area, advocates say, even though about 20 percent of residents in the region are foreign-born, according to the Urban Institute, a nonpartisan think tank. Some 110 languages are spoken here, an analysis of 2000 Census data by the U.S. English Foundation found, making the Washington area the sixth most linguistically diverse urban area in the United States.

Though many immigrants speak enough English to get by in their workplace, that may not be sufficient in the doctor's office, where medical jargon and emotional reactions can cloud their ability to communicate.

Norma Chinchilla, 26, a Honduran immigrant living in Silver Spring, has been in the United States for four years but has not learned English. Last year, she ran smack into the language barrier while trying to make an appointment over the phone for her 2-year-old son. When she reached an English-only operator at Children's National Medical Center, the few English words she knew seemed to vaporize as the impatience on the other end of the line grew. She hung up, defeated and without an appointment.

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