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CO: Interpreters break language barrier: Integrated Community serves medical community, Spanish speakers

Sunday, July 19, 2009

Steamboat Springs — Nine-month-old Marc Rodriguez sat wide-eyed on an exam table Friday, grabbing at stethoscopes and pens as his mother learned how his height, weight and head circumference were changing.

Nurse Megan Armstrong and later Dr. Ron Famiglietti explained the baby’s growth to Ivonne González. They spoke directly to González, pausing occasionally so interpreter Karina Craig could repeat their words. González later said that without an interpreter, she’d have struggled to understand the details of Marc’s growth.

“There are words that I cannot understand,” González said through Craig. “The words that we use in Mexico are different than the words in English, so sometimes you don’t understand very well what is being said.”

Craig is the interpreter program manager for Integrated Community. Her interpreters are doing about 10 medical appointments a week, compared with four or five a week six months ago. The numbers are increasing steadily, Craig said. The service is free for patients and for the doctors, dentists and other health professionals involved.

Craig attended Marc’s ap­­­pointment to work with Fami­glietti’s staff and González to make sure the mother walked out with full knowledge about her baby’s health. The child was in for a checkup and also so his mother could ask about swelling in his eye.

“Interpreters are the best,” Armstrong said. “They really are.”

Soft jokes flowed between the doctor and the patient’s mother, through Craig. A few-second time delay didn’t seem to hinder communication.

Famiglietti is a doctor with Pe­­d­iatrics of Steamboat Springs and has used Integrated Com­munity’s interpreters for months. He said he knows enough Spanish to get through an exam but could run into problems if there were a health issue or of the patient had questions.

“I never could explain allergies to the mom or the significance of those little birth marks to the mom without an interpreter,” Famiglietti said, referring to conversations he had with González while examining Marc.

During the appointment, Craig repeated comments made in English to González in Spanish. Part of her goal as an interpreter is to try to create an environment where it seems as though everyone is speaking the same language, she said. Interpreters will take notes and sometimes repeat conversation between a nurse and doctor, for example.

“The medical provider wants to provide excellent medical care to a patient, but that’s not possible if there’s not good communication,” Craig said. “We believe everything the physician says is important and everything the patient wants to say or ask is important.”

Although she is adamant that the interpreter be a voice and not a presence in the room, sometimes it’s necessary to help with explanations. For example, when Famiglietti and González miscommunicated about baby formula, Craig asked questions and cleared up the confusion.

Community stake
Tatiana Achcar, executive di­­rector of Integrated Com­munity, said interpretation services are part of the larger issue of access to health care. People deserve to know and understand information about their health, and clear communication creates a healthier society, she said.

“Just because you’re poor doesn’t mean you get the paraphrased version,” Achcar said.

Without an interpreter, a non-English speaker could have trouble understanding diagnoses and following treatment. The person also could be hesitant to go to the doctor and could wind up in the emergency room, Achcar said.

“We have laws in this country that say you can’t deny services to a person who walks into the emergency room,” she said. “What happens if they don’t have preventive care? They’ll hold off until it’s an emergency.”

That cost then comes through to the community, Achcar said. That makes everyone a stakeholder in the interpreter program. Integrated Community is able to provide it for free because of grants. Interpreters get paid for their services, she said.

Patients are asked to call In­­tegrated Community when they make a medical appointment, and the agency can book an interpreter.

During the past six months, Integrated Community has done about 62 percent of its interpretation in Routt County and 38 percent in Moffat County. That doesn’t represent need, and the agency is seeking more interpreters in Moffat.

Finding interpreters can be challenging. Integrated Com­munity is seeking French speakers to help the French-speaking population.

“The first thing you need is to be fully bilingual,” Craig said. “To interpret, it’s not enough to have some knowledge or to be fluent.”

Using friends, family
Craig, Achcar and doctors agreed that it’s far better to use interpreters than family members or other people who aren’t fully bilingual.

Dr. Jim Summers, an ob­­stetrician and gynecologist, said he has used Integrated Community for at least 1 1/2 years. Having a family member interpret for the doctor doesn’t cut it, he said.

“When family members are here, it just seems like the information I’m trying to get them, it seems to me it must get watered down,” he said, “because I’ll spend five minutes talking to them, and the family member will talk for 10 seconds.”

Famiglietti shared the sentiment.

“Having an interpreter who’s objective is better,” he said. “Fa­­mily members kind of summarize a bit.”

Also, Craig said, people have the right to keep personal information private. If a Spanish speaker takes a neighbor to an appointment to interpret, that person receives the medical information first. And a family member can wind up in an unpleasant position if there’s a problem, Craig said.

“If your doctor has some bad news for you, who’s going to receive that information first?” she said. “It’s going to be your child, or it’s going to be your spouse.”

Medical interpreters follow a code of ethics and are trained to keep patient information confidential.

“One of the key things taught in training is everything — everything that is said in a medical environment — is confidential,” Craig said.

Summers praised Integrated Community’s medical interpretation service.

“I think it’s an asset to the community,” he said.

González, Marc’s mother, also said through Craig that she was pleased.

“Yes,” she said with a smile. “It’s very good.”


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