Translating health care for immigrants

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For immigrants living in the US, understanding health care and accessing services can be a big challenge, especially for those not proficient in English. Elana Gordon reports from Kansas City on how medical interpreters can play an important role in bridging that communication and cultural gap.

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MARCO WERMAN:  The health care overhaul passed by Congress this year is supposed to expand coverage.  In other words, it should mean a lot more care for a lot more people.  But for immigrants trying to access health care in the U.S., big obstacles remain.  Elana Gordon of station KCUR has more from Kansas City.

ELANA GORDON:  Ocean themed murals cover several walls at Children’s Mercy’s pediatric center in Kansas City. The place is also filled with bilingual signs.  Nowadays about one in three patient visits to the hospital involves families who primarily speak another language.  Most commonly, it’s Spanish.  Isela Cruz is here with her two year old son Esteban who has an eye infection.  Cruz says it can be scary going to a doctor who doesn’t speak your language.  That happened when she had some pregnancy complications.  Cruz also says the U.S. system is totally different from where she came from.

INTERPRETER:  Here, when you are arrive at the doctor, they don’t do tests right away or analyze you on everything.  When you go to Mexico, they do.

GORDON: Dr. John Cowden meets with Cruz and her son this morning.  Dr. Cowden, show is fluent in Spanish, has been working to make the hospital more accessible to immigrants, especially those who don’t speak English very well.  He says doctors need to be more aware of cultural differences for the safety of their patients.

DR. JOHN COWDEN:  Just basic assumptions of quality, about understanding the medicine you’re supposed to take and why, are things we take for granted as physicians when we tell the family “here’s your medicine”, and that’s dangerous.

GORDON: Dr. Cowden’s helped spearhead an expansion of the hospital’s language services program.  But he says just translating is not enough.  He recalls a time when he was treating the child of an Iraqi family.  He says their daughter was sick and needed a feeding tube placed in her stomach.  The family wasn’t interested.  But Dr. Cowden says it wasn’t because they didn’t understand what he was saying.

COWDEN: The idea of putting a tube into the body in the way we were talking about simply didn’t fit in the family’s understanding of the integrity of her body.  And once we were able to talk about that, we were able to break through and understand that on a larger scale we could see the health of her in a different way than their assumption and my assumptions held.

GORDON: Just a few blocks east of the Children’s Hospital, Truman Medical Center is dealing with similar issues.  Gaby Flores is head of interpreter services.  Along with coordinating about two dozen interpreters, she says she spends a lot of time training clinical staff about how the U.S. health care system can seem alien to someone not originally from here.

GABY FLORES:  In the United States we’ve been taught from a young age to ask a lot of questions and to, informed consent, it’s a concept that’s not known throughout the world, it’s very American.  If I was that same patient back in Guatemala, I would never challenge or ask a question to my physician.  He’s the doctor, he should be telling me what I need to know.  I shouldn’t be asking questions.

GORDON: Hospitals across the U.S. are increasingly recognizing the role that language and culture play in helping people get the care they need.  Mara Youdelman is senior attorney with the national health law program.

MARA YOUDELMAN:  There has been a growing awareness by health care providers that need to meet the increasingly diverse patient population.  But unfortunately providing competent language services has been something that is still a long time coming in many parts of the country.

GORDON: Youdelman says a poorly qualified interpreter can jeopardize a patient’s care.  Federal law does require health care providers who accept tax dollars to provide language services.  But the mandate has no funding.  Efforts are underway to develop a national certification system for interpreters.  And the federal health legislation that President Obama recently signed also includes some new provisions to address language and cultural issues.  It also requires the Department of Health and Human Services to collect data on race, ethnicity and language.  Youdelman says that’s a good thing.

YOUDELMAN:  The importance of data collection is really critical to help providers identify which of their patients will need language services so that they can appropriately plan and not wait until a patient walks in the door and have to scramble to find a way to communicate with that patient.

GORDON: The new law also includes language requiring some insurance and public information documents to be language appropriate and culturally competent.  Youdelman says this is a good first step for immigrants, but how it plays out remains to be seen as officials implement the law over the coming months and years. For The World, I’m Elana Gordon, in Kansas City.

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