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Hospitals Look to Overcome Language Gaps
Associated Press
September 1,  2003

WASHINGTON (AP) -- 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 some 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, Hmong.

About 21 million p eople in the United States speak limited or no English - 50 percent more than a decade ago - and health workers are struggling to care for them.

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 complex 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 hard-hit 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. The government this month proposed an updated set of guidelines to help sort that out. Nor are there good statistics on how often or how well translation services are

But studies show many non-English speakers go without an interpreter - and thus shun health care until they're so sick 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."

Indeed, research by Flores, of the Medical College of Wisconsin, suggests that avoiding risky errors requires professional interpreters with more than 100 hours of health training. Yet one survey suggests just a quarter of hospitals train interpreters; how much varies widely.

Often children do the interpreting, even if a parent or sibling is being diagnosed with a serious disease. Legislation under consideration in California would ban child interpreters.

Then there's false fluency - health workers who think they understand a word but don't. Flores recounts a 2-year-old who fractured her collar bone. "Se pego," her mother told the doctor, who thought that meant the child had been hit and reported possible abuse. The mother lost custody for 48 hours until interpreters clarified that the girl had fallen from her tricycle and struck - se pego - her shoulder.

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 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.


EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Copyright 2003 Associated Press. All rights reserved.