Spanish interpretation needs in healthcare

The language of doctors is difficult to comprehend, and this is relevant when more than 46 million people in the United States do not speak English as their first language. Few facilities offer bilingual staff, and only bigger healthcare companies can afford to provide translation services. In rural southern Appalachia, healthcare services for Spanish-speaking patients are limited.

Will Rhew is a translator for Ensemble Heath, contracted with Ballad Heath in Johnson City, Tennessee, and he has worked with Ensemble for five years. Ensemble provides clerical translations for financial situations in Spanish, such as helping uninsured patients who cannot cover their hospital bills.

“Quite simply, the biggest issue that nurses and myself face with interpretation services are just lack of availability,” said Rhew.


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Ensemble Health and Ballad Health announced their strategic partnership in May of 2020 with the hope of providing more opportunities and better customer service for their patients, including those who struggle to afford insurance and need a more personalized service of language translation. Ballad Health offers communication and language assistance through various sources of aid to ensure effective communication throughout their facilities. Their services are free of charge, and interpreters can be requested at any time.

Larger hospitals that have greater needs and finances to provide usually have one or two on-site interpreters. In smaller medical centers, doctors and nurses use a language interpreter cart that allows a translator to appear on a screen and provide it live. Many healthcare providers do not provide adequate interpreter services because of the financial burdens these services impose.

This suggests that Spanish-speaking Latinos may be at increased risk of lower quality care and poor health outcome. In a survey of 123 Latino immigrants, 48 percent reported mistreatment while receiving or attempting to receive healthcare services. In a study on Latinos in Southern Appalachia, 82 percent of respondents did not have health insurance which is 2.5 times greater than the rate of the national sample in the U.S. The primary barrier to health insurance is cost. This makes Hispanics more likely to avoid hospital situations where lack of effective communication would be more barring to an already difficult financial burden.

In 2018, Pamela Rubi-Avendaño began translating for the Language and Culture Resource Center who provides translation and interpretation services in Spanish and Portuguese. Avendaño started with RAM (Remote Area Medical) clinics and, following the year of 2020 when COVID caused a healthcare crisis, Avendaño found translation services in high demand. The COVID regulations only caused further strain with new, temporary remote interpreting.

“Imagine doctors and now people who speak Spanish and then everything getting lost in translation,” Avendaño said, “so unless you have someone who proficiently gives you the right info, it’s hard.”

“Pseudo translators” are another issue for patients. This refers to a non-English speaking patient using a friend or family member to accompany them to their doctor and have them relay medical information. This can lead to several problems in translating medical knowledge. It is very difficult for a non-medical person to understand health terminology in general and pseudo-translators may not effectively relay the correct information. It can also be uncomfortable to translate bad news or private information. The message also needs to be precise to protect the practitioner.

Both policy and healthcare providers are unaware of how interpretation services may benefit them and their patients, and providers are reluctant to shoulder costs for what they are not reimbursed.

“The Latin community has to be informed that it’s an option,” Avendaño said. “Doctors also need teaching on in the case of this, this is how you approach the situation.”

The practice of translating for a doctor and patient requires a certification. Subsequent orders and laws require hospitals and other facilities that provide medical services to provide meaningful access to language translation to patients so that they can in return make informed decisions about their health.

A 2016 survey of 4,586 hospitals by the American Hospital Association suggested that only 56 percent offered some type of linguistic and translation service. To counter this significant percentage of inadequate service, another survey suggested that 97 percent of physicians witness patients who have difficulty understanding English. The issue is that today’s medical school students appear to be receiving messages that language-access problems are not important and will be forgiven easily in the healthcare field.

The solution is complicated, but most interpreters have faith that the need for translation services will always remain, and therefore create more jobs with gaps to be filled. While lack of available services seems to be evident, there is work being done to help address the problem. Technology is a big aid to the language barrier and allows translators to work remotely. However, it is not always a perfect interpretation of languages exchanged. On-site translators provide the best solution to ensuring the doctor’s message is communicated accurately to the patient.

“I believe it will get better, especially now that equity and inclusion is so important,” Avendaño said. “It just takes time and people just have to learn to be more culturally aware.”

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