By Lizeth Vela and Samantha Rosengard, Urban Health Media Project
“Cuídate, cuídate, por favor, abuelita; yo puedo ayudarle,” Alicia Cole told the elderly woman in the hospital bed next to her. “Be careful, please, grandma; I can help you.”
Cole was in a California hospital recovering from surgical complications and the woman sharing her room, who had Alzheimer’s disease, kept getting up in the middle of the night.
Cole was the only person on the hospital floor who spoke Spanish.
“What if I had not been there?” asked Cole, who worried the woman could have hurt herself.
Language barriers in health care have long been a problem for the Latinx community, said Dr. Elizabeth Jacobs, vice president of research at the Maine Medical Center Research Institute, and contribute to health disparities at almost every level, from access to insurance to end-of-life care.
The problem has become more acute as COVID-19 has spread across the country, disproportionately sickening and hospitalizing African-American and Latinx people and moving many doctor visits online or over the phone, where interpreter services and patient advocacy, if available, gets far more complicated.
Even at in-person doctors’ visits, COVID-19 restrictions often make it impossible for patients to bring an interpreter or advocate to the appointment.
“My number one advice to people is: Never go into the hospital alone,” says Cole. “Always have someone there to help you. At this time, you can’t do that.”
¿CUÁL ES EL PROBLEMA?
Even before the pandemic, the Latinx community faced persistent problems in navigating healthcare due to language barriers.
A big problem: the U.S. has such a “large, integrated Latinx community” that many people wrongly assume all Latinx individuals – especially young people – are bilingual, said Cole.
That can be a dangerous miscalculation, especially when health care is involved.
According to the 2018 Census survey, almost 11% of the Latinx population in the United States have limited English proficiency, and over 5% do not speak English at all.
“When I go to the hospital, I can't tell the doctor all my symptoms because it is hard for me to communicate with them,” said Yanira Azar, a Latina cleaning business owner who lives in Lynn, Massachusetts. “I cannot explain myself to them.”
Cultural issues often work alongside language barriers in creating health disparities for non-English speaking populations, Jacobs said. When she was working with the Hmong population in Wisconsin, she learned that their culture did not have a concept of cancer.
“If it’s not a concept in their mind, it’s hard to get them to understand why they would need to do something to screen for it or prevent it,” Jacobs said.
When patients have a hard time communicating with their healthcare provider, they often rely on hospital interpreter services or a family member with more English fluency. Under Title VI of the Civil Rights Act of 1964, healthcare providers that receive federal funding are required to provide language access services for patients.
But in practice, hospital interpreter services are often telephonic or by video, rather than in-person, Jacobs says. This creates an additional layer of distance between the patient and an interpreter whom they do not necessarily know or trust, she said.
Relying on a trusted family member for interpreting, however, brings its own set of problems because being fluent in two languages does not necessarily mean that someone can act as an interpreter. A non-professional interpreter may be able to translate from one language to another, but may struggle translating in the reverse direction.
Additionally, many times the family member relied upon to interpret a conversation between a healthcare provider and a patient is not a native Spanish speaker as they grew up in the United States and learned Spanish at home from their family. These “heritage speakers” as they are called, have never thought about how to explain a medical condition or answer questions related to it, said Jacobs. “They don’t have the words, and they don’t have not only the vocabulary but the way to think about how to explain it,” she said.
Finally, there is a chance that the information being provided by the healthcare provider is not necessarily what is being relayed to the patient by their family member.
“It’s out of their love for an individual or it might be a cultural difference, but family members can have their own motivations and beliefs that could then interfere with a person really understanding what’s happening,” said Jacobs.
For all of these reasons, she says, errors are more likely to occur when hospitals rely on an interpreter who has not been trained and certified.
After she developed life-threatening infections following fibroid surgery, Cole started a group for survivors of medical errors. She had 2,500 people following her on My Space and sharing their stories within a week.
“They did not feel ‘heard,’ they did not feel ‘listened to,’ or like their concerns were being taken seriously,” she said. “They especially don’t listen when you're a woman. They especially don’t listen when you’re a minority.”
¿CUÁL ES LA SOLUCIÓN?
Alba Cabral is a Latina psychologist at Montefiore Medical Center in the Bronx, where she is a member of the Behavioral Health Integration Program, which works to make mental health treatment an essential component of primary care.
She also works with the HealthySteps program at the hospital, which connects new parents with specialists who work with a child’s primary care physician to provide guidance and assistance in the health, well-being, and school-readiness of babies and toddlers.
Cabral says communication is critical in the medical world, between doctors and their patients as well as between doctors and their colleagues.
Healthcare providers should listen to what patients are saying and observe what they are communicating with their body, she says. They also should talk to their patients’ other healthcare providers, as it will increase their awareness of the patient as a whole. If there is more communication, particularly between healthcare providers addressing mental health and those addressing physical health, there is a better chance that a patient will get the help they need.
One of the problems with interpreters is that “there’s something that gets lost, especially when you are talking about your emotional life,” Cabral says.
There are many benefits when patients and healthcare providers are able to fully communicate.
“What it looks like when we are actually communicating with a patient is…understanding,” said Cabral.
Cole agrees: “The only way to overcome language barriers is to start from a common ground of understanding and trust.”
Lizeth Vela, a Salem State University freshman, is a former Urban Health Media Project summer intern. Samantha Rosengard, a Boston University College of Communications graduate student, is currently a UHMP intern.