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"Health Advocate: Language barrier to blame for
poor care"
by Barbara Ferry
The New Mexican
February 5, 2006
Over a long career as a health-care administrator in New Mexico, Linda Armas
tried to understand the reasons for the well-documented health disparity between
Latinos and other populations.
After years of watching Spanish-speaking patients struggle to communicate with
doctors, nurses and medical social workers, she thinks she has hit upon an
answer: the language barrier.
Armas, a native of Laredo, Texas, who ran health clinics in Albuquerque for 20
years, believes non-English-speaking patients' inability to communicate with
health-care providers - even more than poverty, lack of insurance or lack of
education - explains Latinos' higher rates of chronic disease and other health
problems.
"In health care, communication is vital," Armas said. "With poor communication,
the quality of health care diminishes."
And Armas said she saw plenty of poor communication during her career.
"I saw just anyone being grabbed and pulled in to interpret, from the janitor
mopping the hall to children," Armas said. "I heard people trying to speak
Spanish and mixing up words in a way that made me cringe."
Armas' view that New Mexico is facing a crisis over the lack of competent
medical interpreters led her to change careers. She has a created an intensive
course at New Mexico Highlands University's Rio Rancho Campus to train those who
are already bilingual in medical interpretation.
The first weeklong, 40-hour course will begin Feb. 27. Tuition is $360.
Armas and her husband, Jose Armas, the publisher of Imagen magazine, also are
lobbying the Legislature to establish a task force to create standards for a
certified medical-interpreter program. Currently, people have to travel out of
state to take courses to get certified, Linda Armas said.
She said there is often a misunderstanding about who can interpret. Just being
bilingual doesn't cut it, especially if you don't know medical terminology in
both languages, she said.
Alma Olivas, an advocate with the Community Coalition for Health Access in
Albuquerque, said in one instance, a patient's daughter tried to interpret a
doctor's explanations of the possible side effects of the medication he was
prescribing. The daughter understood the doctor to say a possible side effect of
the medication was that her mother could explode.
"The daughter went home crying and wouldn't tell the mother anything. She was
just overwhelmed," Olivas said.
Such experiences led a coalition of community groups to file a lawsuit against
University Hospital last April. The lawsuit contended the hospital's lack of
interpreters violated the 1964 Civil Rights Act.
Gail Evans legal director for the Center on Law and Poverty, said
her organization filed the suit on behalf of the community groups after years of
efforts to improve access to the hospital for non-English-speaking patients
failed.
The plaintiffs had bad experiences going to University Hospital, Evan said.
"There were no signs in Spanish, no interpreters in the emergency room, and
people were getting discharge orders they didn't understand and prescriptions
they didn't know how to take."
The lack of interpreters resulted in one patient receiving the news that he had
brain cancer from his own child, according to the center.
The lawsuit was dismissed after the hospital agreed to improve services,
including providing signs in Spanish and Vietnamese and audio and video
installations in Navajo. The hospital also agreed to hire an outside expert to
review interpretation services at the hospital.
Evans said University Hospital has gone from zero to eight staff interpreters
and created an interpretation committee with community input. But she said
the signs and audio and video installations still haven't been put up, and the
center could refile the lawsuit if the hospital doesn't act soon.
Sam Giammo, spokesman for University Hospital, said the center has "come a long
way" in providing interpretation for patients. More than 100 staff members have
signed up for local training in interpretation, he said.
Linda Armas said she finds it ironic that University Hospital was sued. "They
have probably done more to work with community groups and improve interpretation
than other hospitals," she said.
Evans said that by filing the suit, her organization wasn't judging University
Hospital's interpretation services as worse than other hospitals'. "We started
with UNM because it's the statewide public hospital," she said. "We are
intending to approach other hospitals. "
We're not looking to sue them, but we do want them to get compliance with
federal law," Evans added.
Spokesmen for both St. Vincent Regional Medical Center and La Family Medical
Staff said they have adequate bilingual staff to provide interpretation for
Spanish speakers. For languages other than Spanish, St. Vincent uses a
telephonic interpretation service, said spokesman Arturo Delgado.
Maria Bueno, a member of the city of Santa Fe's Immigration Committee, said when
she worked as a nursing assistant at St. Vincent, she often was called on to
interpret for patients. She said she sometimes observed some patients struggling
to understand other staff members used as interpreters.
"For example, they would tell a patient they needed to take fotografias instead
of saying rayos-x (x-rays), and the patient would get confused. It didn't really
cause a problem, but there was confusion."
With public hospitals seeing increased numbers of uninsured patients and being
forced to absorb the costs of more charity care, medical interpretation might
seem like an unaffordable luxury.
But Cynthia Roat, a Seattle-based consultant who was hired by University
Hospital to review its translation services, says there are financial as well as
humanitarian reasons to provide good interpretation.
"If you can't get a good case-patient history, as a provider, what can you do?
"You can order a lot of expensive tests or you can guess. It's cheaper to care
for non-English speaking patients than to pay for return visits or unnecessary
tests, and we're not even talking about the human suffering involved."
There are legal ramifications as well, said Roat, who was formerly co-chairwoman
of the National Council on Interpreting in Healthcare.
"Any hospital that get federal funds can't discriminate on basis of race, color
or national origin, and the courts have ruled that language is an aspect of
that," Roat said. "So (University Hospital) can't ignore this issue."
Roat agreed the situation at University Hospital has improved. But she cautioned
other hospitals not to rely too much on untrained interpreters.
"(Untrained interpreters) add, they delete, they change the message. They get
too involved. Interpreting is a learned skill. If you're not using trained
people, it's highly likely there's a lot of misinterpreting going on," she said.
For more information about the medical interpreting course, contact Linda
Armas at (505) 730-1950 or write to
larmas@swcp.com.
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