UTICA, N.Y. — The man from Bosnia was just not understanding. His wife was in labor at a central New York hospital and the doctor was trying to explain in English the need for a Caesarean section.
Horrified, the man translated incorrectly and told his wife the baby was dead, and it would have to be cut out of her. The woman went into shock. Though the baby was healthy, she couldn’t take care of it for a week.
Almost one in four American births is now to a foreign-born mother, according to a recent report by the Center for Immigration Studies. The result, medical experts and advocates say, is a growing pressure on American health care centers to not only deliver babies, but deliver them in more languages than one.
The Civil Rights Act of 1964 says hospitals that get federal money must provide interpreter services. It just doesn’t say how. Most hospitals reach out with phone-based interpretation services. But critics say the phone has limitations, especially during childbirth.
“What, are they going to pass the receiver back and forth while the doctor is catching the baby?” asked Dr. Francesca Gany, director of the Center for Immigrant Health at the New York University School of Medicine. “Health care facilities are definitely feeling the heat.”
Few patients receive language help
The Joint Commission on Accreditation of Healthcare Organizations is studying the link between medical error and interpretation issues, Gany said. And the National Health Law Program is looking at how small health care providers can offer language services. A report by the Washington-based Institute of Medicine said 56 percent of such providers surveyed had received no language training.
Though studies are underway, there are no national numbers for access to, or use of, interpreter services in health care. But there are some telling samples.
One hospital in Madison, Wis., said requests for interpreters more than doubled, to more than 4,000 requests a year, between 2000 and 2003. In Columbus, Ohio, Children’s Hospital in 2002 had almost 8,000 requests for interpreters.
A survey of New Jersey’s hospitals shows that in a largely urban state where 11 percent of residents have limited English, just 3 percent of hospitals have a full-time interpreter. Eighty percent of hospitals offer no staff training on working with interpreters, and 31 percent have no multilingual signs.
Cost is a barrier and most hospitals told the New Jersey survey that reimbursement for translation services is needed. A 2002 study by the National Association of Children’s Hospitals found interpreting costs at 22 hospitals ranged from $1,800 to $847,000 per year.
The alternatives to a trained translator can be, and have been, a Spanish-speaking janitor pulled into the delivery room, said Dr. Portia Jones, an assistant professor at Albany Medical Center in New York.
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Jones oversees a pilot interpreting program for the center’s medical students. In a city of just under 100,000, the program includes about 30 volunteers who speak Russian, Spanish, Arabic, Farsi, Japanese, Polish and other languages.
“This seems like such a no-brainer,” Jones said. But change comes slowly.
Nancy Kohn, field coordinator for the Boston-based The Access Project, said some people have told her that if they don’t speak English at hospitals, they don’t get seen. The project focuses on improving health care for underserved populations.
When all else fails, children themselves have stepped in. One interpreter group does a presentation titled, “Can my 7-year-old interpret for me in the delivery room?”
Utica’s number of refugees per capita, 10,000 in a city of 60,000, is one of the highest in the country. The Multicultural Association of Medical Interpreters in Utica contracts with about 40 interpreters in 14 languages and arranges about 600 interpreting sessions a month, triple the number in 2002.
Even with such numbers, the lack of interpreters at Utica-area hospitals brought complaints less than two years ago, but in unusually polite terms.
Translated from Russian, one woman’s letter reads, “I appeal to the employees of the maternity ward, please be so kind in the future as to provide all non-English-speaking women giving birth with a trained interpreter, especially during their hour of their greatest need and trial. Again, thank you very much for all your care and concern.”
The woman had consented to an operation on her fetus, but without quite understanding why.
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