This Wichita group wants you to know your health rights — and possibly save lives
Veronica Mireles sat inside Wesley Medical Center in 2019. Her 18-year-old son, Angel, had been hospitalized after his appendix burst.
Days earlier, Mireles’ son had been in pain. Without knowing the cause, she gave him over-the-counter pills. When the pain became unbearable, she googled Angel’s symptoms and thought something was wrong with his appendix.
Mireles, who does not speak English fluently, recalls arriving at the hospital and not receiving an interpreter or knowing if one was called by hospital staff. She did her best telling her son to explain to the doctor what was happening.
Angel, along with his parents and two brothers, migrated from Juarez, Mexico, to the U.S. in 2018. No one in the family spoke English well at the time.
After running tests, the doctor diagnosed Angel’s abdomen pain as a sexually transmitted disease. Mireles said she did not know what or how many tests were done.
“Since he was 18 years old he went in alone,” Mireles said. “I was never told what had happened.”
Over the phone, Angel said medical staff had done blood and urine tests.
“After all the exams and everything they said they needed to talk to me,” Angel said. “They told me that I have a sexual disease.”
He was prescribed medication for STD treatment. Two days later and with the pain getting worse, Mireles took Angel to GraceMed Health Clinic, where a different doctor accompanied by an interpreter told her to go to the emergency room immediately.
Angel had appendicitis.
“I remember her telling me, ‘Go now, because this child’s appendix is ruptured,’” Mireles said.
Her son was admitted to the hospital, where he underwent surgery and remained for five days, Mireles said.
“After all was said and done, I couldn’t shake the fact that all this happened because we got the wrong diagnosis because of not being able to communicate properly,” Mireles said.
Angel, now 22 and working as a diesel mechanic, still reflects on the experience. “After the surgery I felt bad because I had it in my mind that I actually thought that I had an STD,” Angel said. “It’s not a good feeling.”
Both Mireles and Angel told an Eagle reporter that they were not asked if they needed an interpreter at Wesley.
ALCE SU VOZ: ‘SPEAK OUT”
In the U.S., more than 68 million people speak a language other than English at home, according to theU.S. Census Bureau.
Of that number, 25 million don’t speak English at all, a study from the American Translators association said.
This language barrier can cause a disconnect with healthcare providers.
Rachel Showstack is an associate professor of Spanish at Wichita State University and the founder and president of Alce Su Voz, which translates to “speak out.”
It is a “coalition of Spanish-speaking LatinX families, interpreters, healthcare providers, community leaders, university faculty and students whose mission is to improve health equity for Spanish speakers and speakers of indigenous languages in Kansas,” the organization’s website says.
Health equity is when everyone has a fair and just opportunity to attain their highest level of health, according to the Center for Disease Control and Prevention.
The coalition formed after a series of community meetings at which attendees shared their health experiences in spring 2020.
Through these meetings and research, Showstack realized there was a need.
“I learned about how so many young people had grown up serving as interpreters for their parents all over Kansas,” Showstack said. “I also learned that many bilingual nurses and other clinicians were being pulled away to interpret when that wasn’t a part of their job.”
Showstack said using informal interpreters does not equal health equity. She used Mireles’ experience as an example.
“They never received a professional interpreter,” Showstack said. “So the outcome was that they had an $85,000 medical bill and her son was not able to work for several days or go to school.”
“It had a real negative impact on their family,” Showstack said.
EFFECTIVENESS OF INTERPRETING IN WICHITA
Wichita’s two major hospital systems – Wesley and Ascension Via Christi – say their hospitals ask every patient if they need an interpreter.
“We always ask no matter who it is,” said Dave Stewart, Wesley Medical Center’s director of marketing and public relations.
In order to ensure each patient is asked about language, Wesley follows a specific process for patient admissions that complies with ADA requirements.
“Our team uses iPads equipped with admission software that includes all of the questions we must ask each patient, including questions about any speech or hearing difficulties that would require them to have assistance,” Stewart said in an email. “This includes language barrier challenges that would require translation services.”
Ascension Via Christi, follows a similar procedure.
“The patient’s preferred language is one of the questions in our electronic charting system,” said Shelly Sawyers, Ascension’s manager of business operations. That “is filled out during admission and, like other other quality indicators, audited by the hospital’s quality department.”
Both Ascension and Wesley contract interpreters through interpreting agencies. They use video interpreting devices if an in-person interpreter is not available.
Showstack said using a remote interpreter is fine, but depending on the circumstances of a visit, an in-person interpreter would be more effective.
“In a sense it’s a step forward, but it still remains true that patients do feel remote interpreting is less personal and harder to create a trusting situation,” Showstack said. “It can also pose a challenge of conveying information because it does have its limitations.”
Although remote interpreting is easily accessible, some disadvantages include unstable internet connection, visual limitations and busy emergency room distractions, according to Multilingual Content Solutions.
“Having that human component can make a really big difference for patients,” Showstack said.
IMPROVING HEALTH EQUITY IN KANSAS
Federally funded hospitals and clinics are required to provide someone who has limited English proficiency with a medical interpreter based on Title IV of the Civil Rights Act of 1964, according to the U.S. Department of Health and Services.
Some states require interpreters to be certified or licensed, or to have completed hours of training. Kansas does not, according to a policy briefwritten by Showstack and her colleagues.
Alce Su Voz wants to change that by professionalizing the interpreter role in Kansas and making sure healthcare institutions have a good language access plan in place.
Alanguage access plan is a “document that spells out how to provide services to individuals who are non-English speaking or have limited English proficiency,” according to the Centers for Medicare and Medicaid Services.
Showstack and her Alce Su Voz hospital and clinic engagement team are working with healthcare institutions across Kansas on their language access plans.
The team has “developed a survey that they’re currently administering to different healthcare entities across Kansas,” Showstack said. “About how they are providing language access services, and how it’s going.”
Research gathered from the surveys will be a part of a report that Showstack and her team will present at a state language access policy summit later this year.
“With this information, the state may be able to make adjustments to streamline the system,” Showstack said. “So kind of an initial draft to discuss next steps.”
Earlier, Showstack had worked with Kansas Rep. Susan Ruiz, D-Shawnee, on a bill to professionalize the interpreter role. So far, the legislation has not gained any traction.
The group is hoping its new report will help language access across the state without legislation.
Showstack said an effective language access plan could avert another instance like Angel’s situation – as could community education so patients know about their legal right to an interpreter.
Alce Su Vozhosts community workshops on topics that include the right to professional medical interpreting services and understanding public health information.
The group also has expanded their mission beyond Wichita to parts of rural Kansas.
“We want to collaborate with these healthcare entities because we know they’re having a hard time,” Showstack said. “There are issues and a lot of it is systemic, not just the hospitals… it’s the system.”
Interpreting veteran Marixendra Alvarez, founder of CJS Translation Services based in Wichita, is helping with that mission. She serves as an interpreter and is on the advisory board for Alce Su Voz.
Alvarez requires her interpreters to be fully fluent in the language they speak. She also created a medical workshop where her interpreters learn professionalism, ethics and terminology before they are sent out on assignment.
She too wants to see healthcare institutions in Kansas have a good language access plan where interpreters are licensed/certified.
“This is a very challenging profession but very rewarding when you can actually create a positive impact.” Alvarez said. ”When I found them [Alce Su Voz], ‘I was like wow, I’m not just one person trying to change this whole system.’”
Reporting for this story was done by Eduardo Castillo. Castillo covers crime and breaking news for The Wichita Eagle. His previous work experience includes stints at KWCH 12 Eyewitness News, the local CBS affiliate in Wichita, and as a marketing manager for a local real estate team. In addition to writing, Eduardo also enjoys still photography and cinematography. News tips? email at Edcastillo@wichitaeagle.com or call 316-268-6213.
This article was produced for The Wichita Eagle as part of the Wichita Journalism Collaborative, a partnership of 11 media and community partners.