Hospitals struggle with growing language barrier - (Speak English or Die)

AP ^ | September 2, 2003 | LAURAN NEERGAARD

[Damocles]

Posted on Tue, Sep. 02, 2003



Hospitals struggle with growing language barrier
Inaccurate translation leads to medical errors

LAURAN NEERGAARD
Associated Press


WASHINGTON - The nurse ordered an oral antibiotic to clear up the 7-year-old's ear infection. But the mother spoke no English -- and a bystander pulled in to translate told her to pour the drug into the girl's ears.

It was one of dozens of dangerous translation errors Dr. Glenn Flores uncovered when he taped exams of 70 Spanish-speaking children in Boston emergency rooms and clinics.

And that's just examining the nation's most common foreign language -- imagine the difficulty when a hospital encounters its first patient speaking, say a Hmong dialect of the Miao-Yao language of Southeastern Asia.

About 21 million people in the United States speak limited or no English -- 50 percent more than a decade ago -- and health workers are struggling to cope.

Hospitals "are reeling from the major change in the number and diversity of languages they're encountering," says Ellen Pryga of the American Hospital Association. "The reality is ... if someone shows up who needs services and doesn't speak English, you have to figure out how to communicate with them. It doesn't matter if they're the only one you've ever encountered who speaks Swahili."

Unable to hire an interpreter for every language, they're trying creative methods: volunteer translator clubs, telephone interpreters, teaching foreign phrases to doctors, and hiring bilingual nurses, clerks, even janitors who can translate in a pinch. 

But the question is what works. Special training is probably crucial because general fluency in a language seldom guarantees knowledge of medical terms, says Yolanda Partida of Hablamos Juntos, a program started by the Robert Wood Johnson Foundation to improve Spanish health communication.

Hablamos Juntos is funding 10 experiments around the country to find innovative solutions, especially in rural areas like central Nebraska.

Six counties where the Hispanic population more than tripled in the 1990s are preparing to test a videoconferencing system that would let emergency rooms and maternity wards share 24-hour access to Spanish-speaking interpreters -- and train additional translators long-distance.

Doctors generally can't turn away sick patients because of language barriers. Civil rights law requires health facilities that accept any federal funding to make provisions for non-English speakers.

Just how many languages different facilities must be able to tackle, and using what methods, the law doesn't make clear.

But studies show many non-English speakers go without an interpreter -- and thus shun health care until they wind up in the emergency room -- or use untrained bystanders.

"The default position of many providers is to rely on family members and friends because that's what's convenient and the provider doesn't have to worry about how to pay for it," says Mara Youdelman of the National Health Law Program. "The end result is there are significant medical errors."

Interpreter services are supposed to be free to patients, but health workers report paying from $7 an hour to $50 an hour for professional interpreters. Medicaid [tax payer] allows states to draw federal matching funds to help cover the costs but only nine -- Idaho, Hawaii, Maine, Massachusetts, Minnesota, Montana, New Hampshire, Washington and Utah -- so far do. Pennsylvania and Kansas are preparing to.

"Ultimately this is costing the system more" to skip an interpreter, says Flores, citing research that found access to interpreters increases cheaper preventive care.

[dagnabbit]

Open borders are good for you. Now shut up and take it.

Love,
Karl Rove

[Kenton]

This sounds like a wonderful opportunity for the various ethnic communities to perform a valuable volunteer community service that would be of benefit to themselves and their (former) countrymen.

[raybbr]

They should just do like I do at work. Explain it to them and when give you that stupid look and nod their heads just walk away because they acknowledged my explanation. If they do something wrong and get hurt I know that I did what I was supposed to. If they can't/won't learn english, too bad, so sad.

[Mamzelle]

Listening, lawyers? While the hospitals struggle with this mess, caused by elites who won't mow their own d&mn lawns...they are also responsible for errors. Great opportunity to step up and take a piece of this action. Punish the hospital admin and all those who pay insurance premiums and taxes--make 'em pay. A fine opportunity for lawyers to enrich themselves. Yet another item of discussion for the hospital boardroom--a big motivation for shutting down the ER entirely.

Bet those lawyers can't speak Spanish, much less Hmong.

[kittymyrib]

Of course not, WE are here to take care of THEM....that's why they sneaked into the country in the first place. In the case of the Mexicans, may I ask why the Catholic Church doesn't provide this service to the hospitals since they are one of the main groups that lobby for more Mexican immigration?

[Feckless]

Here's an idea. Learn the language! Or, better yet, go home where they understand you.

[Apple Pan Dowdy]

I can tell you that the language barrier is a problem on the other end too... not only when the patients don't speak English, but ALSO WHEN THE NURSES DON'T SPEAK ENGLISH.

Recently my Dad was in the hospital in Atlanta (the last week of his life). Because he was on kidney dialysis there was a note posted above his bed that said "no sticks or blood pressure tests in left arm". I was sitting with him during the night and a nurse came in to do the routine blood pressure reading. I was distracted for a moment as my brother was coming in to relieve me. Returning to the bedside I saw that the nurse had taken the blood pressure on his LEFT ARM! I pointed to the sign and asked her why she had used that arm. She did not speak English and did not understand what I was saying..... I assume that neither did she understand the posted warning note either.

The hospital had hired her to take blood pressure readings during the night shift.... I guess they didn't think that required speaking of English.

The next morning the hospital found that Dad's left arm dialysis connection had clotted beyond repair. Likely due to the fact that the blood pressure had been taken in that arm.... although they would not admit it. My discussion with the hospital administrator resulted in a bigger and clearer warning sign posted..... too little too late!

[Born Conservative]

They should just do like I do at work. Explain it to them and when give you that stupid look and nod their heads just walk away because they acknowledged my explanation. If they do something wrong and get hurt I know that I did what I was supposed to. If they can't/won't learn english, too bad, so sad.

 

I agree totally  with this concept; however, there is 1 tiny detail that might prevent this from being a viable solution:

LAWYERS

[Damocles]

The docs who don't speak english can also be a bit disconcerting....

[raybbr]

I should say the I am not in the medical field. I work for a commercial printer as a mtce. electrician. If I explain something to one of these !!@$###@s and they nod their head I take that as they understood me. I will swear that they said they understood me because that is what they indicated to me.

My wife is a nurse although this hasn't come up in her practice I will ask her what her hospital's policy is.

[Publius6961]

Let's see.

Legal immigration worked well for 200 years and I can't remember any stories like this.
Multiculturalism and the babel effect has been in force now a generation and we have driver licences and illegal voting in a bunch of languages and this stuff happens.

Might there be a connection?

What is being demanded now?

News flash!
Pieces like this only underlines a huge problem.
There is a rising level of anger. Morons writing stuff like this still don't have a clue.
Our elected morons also don't seem to have a clue.

[Chewbacca]

Here is a thought:

Draw cartoon pictures of the dosage to be given and how much each day.

dosage is four pill a day, twice daily, taken orally.

Following pictures:

1) Two Pills
3) Show a face with mouth open and a hand dropping pills down, with a glass of water next to it.
2) Clock face showing 8:00 with sun shining through window.
3) Clock face showing 8:00 with cresent moon showing through window.

[LoneConservative]

Translation services are a BIG problem. At the Hosp. where I work, the Patient Relatins dept. is responsible. Our population is mostly Spanish, with some Russian and Creole. However, the State and JCAHO doesn't just want to see translators, they want to see COMEPETENCE. For example, I know enough Spanish to give someone directions to a specific office, but I wouldn't know enough to translate medical information.

[FITZ]

People don't realize what a fast growing problem this is in health care. Your life is often in the hands of people who cannot understand English (or much else) --- they'll nod their heads and pretend they do.

[Capriole]

English and Spanish are so very, very similar that I can't understand why an immigrant from a Spanish-speaking country can't take the trouble to learn at least a little English.

Recently I was approached by a beggar who gave me a card explaining in English and Spanish that he had five brothers, yada yada yada. I handed it back to him and, in English, asked him why he didn't get a job to support his perhaps imaginary brothers--after all, he was a healthy guy in his early twenties. He shook his head and said, "No puedo hablar el Ingles." So I asked him in Spanish. He was taken aback and said that he didn't have a job because he doesn't speak English. I laced into him in Spanish. I said first of all that all the other Spanish speakers managed to get jobs, so why was he so lazy? Second, if I can take the trouble to learn his language, why can't he learn English? I added that I objected to being forced to speak Spanish in my own country by worthless louts like him and if he was too lazy to do anything but beg he ought to go back where he came from because this is a country of opportunity for hard-working people. He was astonished because he didn't know that blonde ladies could rip him a new one in Castillian-accented Spanish.

[FITZ]

English and Spanish are so very, very similar that I can't understand why an immigrant from a Spanish-speaking country can't take the trouble to learn at least a little English.

It takes a motivated adult only about 6 months to learn another language. Children take even less time.

[Kozak]

Civil rights law requires health facilities that accept any federal funding to make provisions for non-English speakers.

Provided free of course. Just like the care mandated in the ER by EMTALA. Doctors are free, nurses are free, translators are free, lights, supplies, equipment of course all come free.

Of course when it comes to value,
YOU GET WHAT YOU PAY FOR

[EagleMamaMT]

Read later.

[SpinyNorman]

And that's just examining the nation's most common foreign language -- imagine the difficulty when a hospital encounters its first patient speaking, say a Hmong dialect of the Miao-Yao language of Southeastern Asia.

What a load of crap!! The unspoken fact is that the patient speaking Hmong probably also speaks English better than most Hispanics that have been here a lifetime, coddled by Spanish instructions on everything. It is the Hispanic group that is the problem, not the Southeast Asians, because the Southeast Asians HAVE TO. This whole story is clear, undeniable proof (to those without an agenda anyway) that bilingual programs hold back the people that they purport to help.

It would behoove the so-called biligual ed teachers to do a real service for the community and hold night/weekend/summer classes on speaking ENGLISH, rather than putting people at risk because some immigrants will not learn the language of the country.