Dr. Morgan is a fine cardiologist, and most patients find her kindly bedside manner comforting. Today, however, the woman in her office wants to bolt.
In this fictional scenario, played out by students at Howard Community College, Mrs. Naran gave birth just a week ago, and now an electrocardiogram has revealed that the baby has a congenital heart defect. Dr. Morgan — speaking to Mrs. Naran through an interpreter — is trying to tell the new mother that baby Nomin needs surgery, ideally when she is between 4 and 6 months old.
Dr. Morgan tells the mother that surgeons have been performing the procedure for 15 years with a very high rate of success, but Mrs. Naran is having none of it.
“This is just insane,” she tells the interpreter, played by student Mervat Sewilam. “How can she expect me to let them cut my baby when she is only 4 months old? I’m going to ask the monk to read some mantras and pray over Nomin so she can recover. Just tell the doctor that I understand everything so we can leave right away!”
At this point, Sewilam wants to grab Mrs. Naran by the arm and plead with her to reconsider.
“This is her baby’s life,” Sewilam says.
She and the other students in Room 115 of HCC’s Health and Sciences Building have been practicing the scenario in groups of three. It has challenged not just their bilingual acuity but their ability to bridge two very different cultures.
This group of a dozen students are the first ever at HCC to enroll in a one-course certificate program specifically designed to train interpreters for work in health care settings.
As the number of people whose primary language is not English continues to rise — 23 percent of county residents speak a language other than English at home — the need grows for people who can help doctors and patients understand one another.
The task often falls to the children of immigrants, says Nikki Highsmith Vernick, president and chief executive of the Horizon Foundation. Sometimes, however, those children are too young to translate medical discussions, and patients often are asked for sensitive personal information that they might not be inclined to share with their children, no matter how old those children are.
Horizon, a Howard County philanthropic organization that offers seed money for health-related initiatives, awarded a grant of $166,691 to the college to launch the health care interpreter program.
“We have such a diverse community,” Vernick says. “Language barriers can prevent a lot of people from even seeking care.”
Dr. Mindy Kantsiper, medical director for hospitalists at Howard County General Hospital, stresses the importance of precision in translating in the medical setting. “You need to hear it in the patient’s own words,” Kantsiper says. “If you can’t communicate accurately, you can’t develop the proper therapeutic environment. And it must be terrifying for someone who’s sick.”
A professional interpreter, she adds, can do more than a family member to ensure a thorough exchange of information in the formation of a treatment plan.
“She’s really able to probe and read body language and make sure the patient doesn’t have more questions,” Kantsiper says. “That’s hard to tell even with an English-speaking patient.”
She recalls an elderly Korean man brought to her by distant relatives. An interpreter gave the physician insight that the family couldn’t.
“In translating his answers, they were able to see he demonstrated signs of dementia. Not to diagnose, of course, but they could tell me, ‘This is more than a language barrier.’ You’re not going to get that through Google Translate.”
Agencies now hire bilingual people to translate in doctors’ offices, clinics and hospitals. Some of the big ones keep interpreters on staff. The U.S. Bureau of Labor Statistics puts the annual mean wage for health care interpreters at $47,210, the hourly wage at $22.70.
Johns Hopkins Medicine, which includes Howard County General Hospital, employs 18 full-time interpreters for Spanish, Mandarin, Korean, Nepali, Arabic, Russian and American Sign Language. That only accounts for about 40 percent of the work. The other 60 percent goes to contracted interpreters, according to Susana Velarde, administrator of the system’s Language Access Service.
The service, which furnishes interpreters to Bayview Medical Center in Baltimore in addition to Hopkins and Howard County General, took 90,000 requests for in-person, over-the-phone and video translation in fiscal year 2016, she said. The previous year’s figure was 76,000, up from 50,000 in 2014.
“We’ve seen continuous growth, and the mix of population in the Baltimore region is getting more and more diverse,” so not only are there more requests for translation services, but the number of languages represented is growing, Velarde says. “There is a huge need.”
Iranian-born Afsoon Kelarestaghi works in inventory management at Howard County General Hospital and reports being pressed into service as a translator there on occasion. Peru native Marietta Chipana, also an employee at the hospital, says completing the course will give her skills that will help people and improve her own life.
“I can do this work, and they need people to do it.”
To take HCC’s health care interpreter class, a student must first pass a language proficiency assessment to demonstrate that they speak at least two languages fluently.
Latin isn’t one of them. The class does spend time on medical vocabulary, but the terminology doesn’t go much beyond what the average person already knows in his native language.
“It’s very general,” says Lisette Albano, who teaches the class along with Maria Reed. Both speak Spanish as their first language and are part of the HCC language department. “But you do have to be familiar with diseases and procedures.”
The City College of San Francisco developed the program upon which the HCC course is based, and trained Albano and Reed.
In addition to vocabulary, much of the class during the early weeks centered on role-play scenarios such as the one with the newborn and her heart problem.
About half the students of the inaugural class come from Latin America — Nicaragua, Puerto Rico, El Salvador, Peru — and speak Spanish as their first language. Hyon Lee, the only man in the class, is Korean but speaks Spanish, too. The class also has two Arabic speakers.
When the instructors can’t find “language partners” for the students who are the only native speakers of a particular language in the class — Farsi and Japanese in this initial group — they stand in themselves.
“This approach is not ideal because it doesn’t really allow us to verify the correctness of their interpretation into the target language,” Reed says.”However, it does allow us to check some things like memory skills, interpreting skills, etc.”
After the first of the year, students will begin their field practice, interpreting in real-life situations in the Columbia clinic of Chase Brexton Health Services and at county-sponsored health fairs.
In the debriefing following the heart-defect scenario, Reed addresses Sewilam’s impulse to argue with the new mother in favor of the surgical procedure.
“If you take sides, you look unprofessional,” and thus endanger credibility and effectiveness, Reed offers. “But does the well-being of the patient override that concern?”
Sewilam’s classmates say that the interpreter should convey the mother’s concerns, then step aside and let the doctor do the arguing.
An interpreter should strive to convey the intended message — a task that idiom and cultural differences complicate — without editorializing, “even if you think the patient is an idiot,” Reed says.
“Ethical dilemmas don’t have a perfect solution,” Reed says, but the course gives students the tools to tackle them quickly and effectively.