Medical Interpreters

By Elizabeth White

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Immigration has been in the national spotlight for months now. Portuguese speaking Brazilian immigrants constitute about 10% of the Cape's population. US equal rights laws prevent discrimination based on national origin, and hence also native language. So the question is, how does the region provide basic rights, such as the right to emergency health care, education, and legal counsel, to individuals who don't speak English?

Dr. Ed Ruscitti changes the wax paper on his examining table at the Duffy Health Center in Hyannis. Homeless natives and Brazilian immigrants make up the bulk of the free clinic's patient population. Dr. Ruscitti, a chiropractor, volunteers his services once a week.

Dr. Ed Ruscitti: "And yes, we do more than just massage backs, we try and restore integrality to the nervous system through manipulation."

Ruscitti estimates that 70% of his patients at Duffy are Brazilian. Like most of them, twenty seven year old Haenata speaks only limited English. The resident nurse at Duffy, Lucy Lourenco, is fluent in Portuguese. She interprets as Ruscitti examines Haenata.

Dr. Ed Ruscitti: "Is she having any pain or discomfort down here?"
Lucy Lourenco: "She saying today she doesn't have any pain or soreness down there. But everyday she has soreness in her neck and sometimes in her back."
Dr. Ed Ruscitti: "Okay."

Ruscitti knows one word in Portuguese, Healasha, relax.

Dr. Ruscitti: "Tell her to let all her breath out."
Dr. Ruscitti: Healasha.

After the manipulations Haenata's neck feels better, and she leaves with instructions to ice sore areas and return in a week. Dr. Ruscitti says interpreters are essential in caring for patients with limited English skills.

Dr. Ed Ruscitti: "Without the interpretation, you might get all kinds of misinformation, on which you're going to base your treatment. And so, I mean, that's a fool's journey. So you really absolutely have to have the interpreters present if you're going to do the maximum for the patient."

The State of Massachusetts agrees with Ruscitti: in 2000 the legislature passed a bill requiring hospitals to provide medical interpretation for all emergency room patients. Clearly a hospital can't hire staff to cover the world's 5,000 some odd languages, and so the bill states, quote, "each hospital shall use reasonable judgment as to whether to employ interpreters for a particular language or use televiewing services." For example, Cape Cod Health care, with hospitals in Falmouth and Hyannis employs fifteen Portuguese and ten Spanish interpreters, but uses remote televised interpretation for Mandarin and sign language. Ceci Stiles, interpreter services manager at Cape Cod Hospital, says interpreters are made available to all patients, regardless of insurance or immigration status.

Ceci Stiles: "When someone comes to registration you may say 'do you have a social security number?' and if they say no, then that's as far as it goes. The bottom line is if you have an ailment that needs to be treated right away, they will get to it."

Despite the legal mandate, the state provides less than 5% of the $400,000 Cape Cod hospital spends on interpreter services per year. Rosiani Doane is a certified Portuguese interpreter at the hospital. Doan sits in Stiles' office with an on-call beeper attached to her belt. In addition to literally translating the doctor's words, Doane says medical interpreters make sure doctors translate medical speak into plain English.

Rosianai Doane: "Because sometimes they're way out there in the technical stuff, and so what we do is ask them to say that again, to please explain in a more reasonable way if you will, so that the patient knows, really, what's happening, because they tend to just nod their heads, saying, 'oh, okay.'"

Doane gives an example of why exchanges in the mental health field are often the most difficult to interpret.

Rosianai Doane: "The doctor will ask, 'why are you here?' The patient will say, 'my car is broken, I want to help my mother, but, what time is lunch'". I mean the mind is going, and of course it doesn't tell me much because I'm not a doctor. But obviously, the doctor has to get all those glances of communication, if you will."

Reporter: "Yeah, because the incomprehensibility of the speech is a symptom itself, which needs to be faithfully translated."

Rosianai Doane: "Exactly."

Stiles joins the conversation

Ceci Stiles: "Mental health a lot of times it's done simultaneous. Simultaneous interpreting would be, like if right now as I'm talking to you, Rosiani would be interpreting everything to the you. It's done at the exact same time that person is talking."

The medical interpreting profession is in its infancy. Only a handful of states, including California, mandate access to medical interpreters. States usually resist such measures in order to keep budgets down. Bilingual friends or family members are frequently used as interpreters. However, this can lead to costly mistakes and misguided treatment because non-professional interpreters aren't familiar with medical terminology, and are often reluctant to demand clarification or ask intimate health questions.

Broadcast May 25, 2006
Re-broadcast March 29, 2007

Elizabeth White reports for the Cape and Islands NPR Stations.