A long line of East Asian Americans wait against the gray wall of the Taubman Health Sciences Library in Ann Arbor, Michigan at 9:00 a.m. on a Saturday morning. The Asian American Health Fair, held annually by the United Asian American Medical Student Association, takes a different approach to reeling in patients on a weekend morning: they advertise the event in Chinese, Japanese, Korean, Hindi, and English. Spoken consultations, along with translated documents, questionnaires, and information pamphlets are available in the languages listed. Toshiyuki Shinotsuka, a Japanese citizen now permanently living in Michigan, is one of the many patients lined up for this event. Shinotsuka says in Japanese, “This (health fair) is great – I really worry because even understanding what services are available to me is hard. I don’t think I have ever gone, and could go now, to get a check-up without an interpreter nearby.”
Currently, public hospital systems such as the Beaumont Health System and the University of Michigan Health System have interpreters readily available, whether it be through fully employed interpreters in the hospital system or through contracts with interpreter agencies. However, when it comes to interpretation and translation of medical documents in rare languages, it still requires “a hunt to find somebody”, Patricia Avery, Office Manager of the Nursing Resource Office of Beaumont Hospital – Royal Oak, Michigan says.
Dr. Michael Fetters, director and founder of the UM Japanese Family Health Program, explains that the difference between medical ‘interpretation’ and ‘translation’ is an important one – interpretation focuses on spoken words, and translation focuses on written materials. It is required under US law for all public hospitals to provide interpreters for patients when requested under the Civil Rights Act Title VI and Executive Order 13166. Individuals who have a limited ability to write, speak, or understand English can be ‘limited English proficient’. These individuals may be entitled to language assistance for services, and in the medical world are referred to as limited English proficient patients. According to the 2014 U.S. Census Bureau, there are nearly 22 million foreign born people living in the United States speaking English less than ‘very well’ that would be qualified to be a limited English proficient patient.
Shinotsuka says at the health fair that he feels safer for himself and his family, especially with children who are 12 and 14 years old, when this language assistance is possible to fully understand what the status of their health is like. Shinotsuka notes the growth in quality of interpreter services in hospitals and health fairs since he first arrived in the US in 2002. Interpretive services were still growing then. Fetters says about the growth of the profession of medical interpretors: “In the old days, people couldn’t figure out what doctors were saying. There were horror stories of kids interpreting for parents where the mother had cancer, to tell her that her baby just died, or a husband interpreting for his wife, asking issues about domestic violence.” Mariko Lezotte, a former medical interpreter, said on the past status of interpretation that “it was difficult for patients… some interpreters put their own interpretation of the situation into the medical interpretation and they wouldn’t keep it objective enough.”
Fetters explains how medical interpreters are important for quality of care of patients with limited English proficiency. Not only do interpreters provide conversions from one language to another, but they also many times become “almost like a patient advocate or doula, and in certain circumstances can be a source for the physician.” This is because under the partnership model of interpretation, the interpreter will try to work with the physician to point out cultural notes and differences that the physician may not be aware of. Fetters explains that the importance of cultural competency also applies to medical translation. As an example, Fetters says: “For a patient who has diabetes, source material in English is predicated upon the association that people eat a certain way and certain foods. If the source language is organized around assumptions around what people do in their daily lives because they are Americans, there isn’t going to be culturally appropriate content.”
Patricia Avery, Office Manager of the Nursing Resource Office of Beaumont Hospital in Royal Oak, explains that for Beaumont – Royal Oak, many of the common materials for patients are already translated in the top five languages. Avery explains that if something new needs to be translated for a patient, Beaumont contracts translators to do this. Patients do not have to pay for this service at Beaumont. The top five languages at Beaumont – Royal Oak spoken by limited English proficient patients currently are Arabic, Chaldean, Russian, Spanish, and Cantonese. “Limited English proficient, and deaf and hearing impaired patients make up under 5% of the patient population (at Beaumont – Royal Oak).” Avery says. “Each year the need for interpreters grows.” Avery says. The percentage of limited English proficient patients is considered annually to make decisions on whether to hire interpreters as full-time employees or to continue using contract translators through interpreter agencies.
If there is a patient that speaks a rare language, such as Swahili, several agencies are used to find someone. When asked about if there has been a recent time where interpreter and translation services were completely unavailable, Avery said: “it’s been a long time since I can recall, especially with limited English proficient patients, we haven’t been able to find somebody.” The care for limited English proficient patients has been improving significantly. As the need for interpreters grows, what’s important is having interpreters speaking different languages available, even the rare languages. When it comes to translation and untranslated documents, learning about who is responsible to provide materials that is culturally appropriate is important, according to Fetters. Fetters says that while the medical interpretation and translation fields have grown over the past 20 years, now what is important is “to understand how cultural values are appropriate and how it’s important to provide culturally appropriate linguistic interpretations.”