Image: Carmen Diaz interprets for Romualdo Rivera
Bradley C. Bower  /  AP file
Medical interpreter Carmen Diaz, right, interprets for Spanish-speaking patient Romualdo Rivera at Temple University Hospital in Philadelphia.
updated 11/29/2004 2:02:00 PM ET 2004-11-29T19:02:00

Romualdo Rivera arrives at the emergency room with what seems to be a complaint of chest pain. But it’s hard to be sure — he doesn’t speak English.

He’s a pale but solidly built man with thinning, gray hair, and his face reddens as his shirt is removed, his pant legs are pushed up and electrodes are attached to his calves and chest.

As nurses and technicians come and go from the small, curtained examination area, his eyes dart from one person to the next, hoping for a familiar phrase, even a word.

Unlike TV portrayals of frenzied big-city emergency rooms, the scene slows in real-life hospitals when a doctor and patient can’t communicate. It becomes like a game of charades, as one doctor put it, with lots of pointing and gesturing.

Nationwide, the approach to care for non-English-speaking patients is hit-or-miss. Fewer than a fourth of U.S. hospitals have professionally trained interpreters, a study found. In some places, hospital employees with no medical training are called in to interpret. In others, relatives, neighbors or acquaintances do the job.

In the worst cases, the patient’s problem gets lost in translation.

Interpreters needed
Hospital officials realize they need interpreters, but most haven’t figured out how to pay for them. The Temple University Health System took action when two hospitals had a surge of Spanish-speaking patients.

Now, Temple and nine other medical institutions nationwide are taking part in a program that could show why hospitals can’t afford to be without formally trained medical interpreters.

From 1990 to 2000, Philadelphia’s Hispanic population rose from roughly 89,000 to 129,000, or more than 44 percent. Many settled in neighborhoods around the two Temple hospitals in north Philadelphia.

In a relatively short time, patients from Puerto Rico, Mexico, Dominican Republic, Central and South America were accounting for 20 percent of all admissions, said Charles Soltoff, a Temple executive.

“Because so many of them spoke little or no English, we weren’t able to serve their needs as well as we wanted to,” he said.

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So this past spring, Temple hired four interpreters with an $850,000 grant from the Robert Wood Johnson Foundation and began sending them to medical classes.

Temple and the other hospitals getting grants must develop a comprehensive medical interpreting program. They’ve also been asked to document how trained medical interpreters affect patient care and hospital costs.

Shorter stays, lower costs
Health care advocates are convinced that having no interpreters means longer stays, unnecessary tests, more repeat visits and even medical mistakes.

Hospitals have long relied on friends or relatives of patients to help translate, but it’s an arrangement that comes with risks.

Patients sometimes hide details from children or friends filling in as translators. And sometimes family members want to shield patients from unwelcome news from their doctors, said Marbella Sala, who manages medical interpreting services at University of California-Davis.

“We had a case where a patient was being treated for a venereal disease and asked the doctor how she could have contracted it. The doctor explained it, but her husband, who was interpreting, told her that she got it from a public toilet,” Sala said.

The doctor suspected something was amiss and an interpreter later cleared things up.

UC Davis has one of the nation’s largest and oldest medical interpreter programs. Established in 1987 with a staff of seven, it now employs 42 people who speak 19 languages — from Spanish and Russian to Hmong and American Sign Language.

“It has made us the place of choice for many patients,” Sala said.

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