When Veronica Mireles’ son complained he was in severe abdominal pain, she rushed him to a Wichita emergency room. No interpreter was provided for the Spanish-speaking family, and the teenager was told he may have contracted a sexually transmitted disease. His doctor sent him home.
But as the pain escalated in the following days, Mireles had no choice but to bring her son back to the ER. This time, a physician accompanied by an interpreter quickly realized what was actually wrong — appendicitis. Because of the delay in treatment, the boy’s appendix had ruptured, resulting in an extended hospital stay and a massive medical bill.
Federally funded hospitals and clinics are required to offer interpreting services for patients. But all too often, the system fails and non-English-speaking patients find themselves in the middle of high-stakes medical conversations without a qualified interpreter.
Rachel Showstack is a Wichita State sociolinguist and Spanish professor. Her research focuses on language accessibility issues in health care.
“One of the biggest issues is people not knowing that they have the right to an interpreter and that they should ask for one,” Showstack said. “Really, the health care institution should be offering them an interpreter and making it extremely clear that those services are available with signage and also verbally at the check-in for the hospital or clinic.
"But that’s not always happening.”
When patients aren’t informed of their right to a qualified interpreter, family members — oftentimes young children — tend to find themselves in the role of de facto interpreter.
“Patients often bring family members with them because they know that they need help,” said Pilar Ortega, president of the National Association of Medical Spanish (NAMS), an interdisciplinary collaborative working to improve health equity.
“Family members should not be burdened with doing the job that they’re absolutely not prepared or trained to do," Ortega said, "and so there’s a very high risk of miscommunication.”
Although bilingual family members shouldn’t have to serve as primary interpreters, they still play an important role from a patient advocacy standpoint. COVID-19 visiting limitations in hospitals have left non-English-speaking patients in an even more vulnerable position without these family members by their side.
Improving language access
Showstack took an interest in health care providers’ interpreting practices when a local clinic contacted her to ask if some of her students could take on interpreting duties.
“That’s why I started to investigate what someone needs to know in order to be an interpreter, and the more I looked into it, the more I found out that . . . the federal legislation that supports health equity for speakers of minoritized languages is really not being upheld in Kansas,” Showstack said.
Unlike many states, Kansas doesn’t mandate that hospitals and clinics provide certified interpreters. Prospective interpreters aren’t even required to log a certain number of training hours before being thrust into real-world situations.
Showstack organized a series of stakeholder meetings with Spanish-speaking patients, who reported inconsistent access to qualified interpreters, resulting in an eroded trust between patients and physicians. In the worst cases, the breakdown in communication turned preventable conditions into life-threatening ones.
The pandemic has left unqualified interpreters even less equipped to help patients and physicians communicate.
“In the situation where you’re wearing masks and you’re wearing face gear and all this kind of stuff, it’s even harder to read facial expressions,” Ortega said. “It’s harder to understand just words and what people are saying, so that definitely complicates things in terms of interpretations.”
Dave Stewart, Wesley Medical Center’s director of marketing and public relations, said the hospital has utilized both electronic and in-person interpretation during the pandemic.
“Interpreters who provide in-person services to our patients are provided appropriate PPE and maintain social distancing to minimize personal risk,” Stewart said. “We rely fully on qualified interpreters, and do not allow staff members or patient family members to act as interpreters.”
But many hospitals and clinics still lean heavily on unqualified interpreters, stunting medical conversations and negatively impacting health outcomes. Showstack says that’s unacceptable.
That’s why she’s advocating for legislation that would require interpreters to obtain professional training before serving Kansas healthcare providers.
She’s also urging lawmakers to require that the state’s federally funded hospitals develop and implement language access plans that describe their language services, the steps they take to inform patients of said services and their procedures for training staff on language policies.
Showstack said she’s partnering with Johnson County Democratic state Rep. Susan Ruiz on the proposed legislation, and hopes to see it introduced as early as next legislative session.
Helping others understand the needs
Health care providers should be prepared to rely on a qualified interpreter any time they enter a potentially language-discordant interaction with a patient, said Ortega, NAMS president.
Language, she says, is no different than any other tool a physician needs to successfully care for their patients.
“If I don’t have the tools that I need — if I don’t have an ophthalmoscope, I can’t examine someone’s eye. If I don’t have the language skills and I can’t speak with that person directly, then I need help with that and I need somebody else to help me achieve that communication, which is a critical piece for me to be able to do my job,” Ortega said.
Showstack and one of her students have started providing seminar presentations for health care providers about how to work with interpreters. They’ve put on three so far but plan to hold more in the future.
Ortega said no physician-patient interaction is so commonplace that it doesn’t need to be properly interpreted.
“I would argue that every medical encounter is potentially a high-stakes encounter because you don’t know what you’ve missed, and that’s the scariest part,” she said.
“When you have a poor interpretation or mistake in understanding, you may not even realize it. There’s no way for the doctor to know, ‘Oh, it was OK that I had the family member interpret this one because this was just about knee pain,’ or something because you don’t know what you didn’t understand that the interpreter didn’t tell you during that encounter.
"Maybe the patient actually said something else that would have changed the course of that visit completely.”
That’s why it’s so important for physicians and all future health professionals to understand how to work with interpreters, she said. It also underscores the need for more linguistically diverse representation in the medical field.
One aspiring medical professional, Jonathan Lozano, came to the U.S. from Durango, Mexico, when he was in the third grade.
“I was 8 years old, and from that moment, ever since I was able to pick up English, I had to translate for my mom,” Lozano said. “My mom was quite often in and out of clinics and hospitals because she has diabetes type 2.
Now a second-year junior at WSU, Lozano is majoring in biological sciences with an emphasis in biomedicine.
“I quickly noticed that there’s a lack of Hispanic representation within the medical field," he said, "and that really inspired me to one day become a medical professional and help out the Hispanic community by providing services in Spanish.”
This story was produced as part of the Wichita Journalism Collaborative, a partnership of seven media companies, including KMUW, working together to bring timely and accurate news and information to Kansans.