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Finding Common Language of Care

Inova Fairfax Hospital works to remove language barrier between foreign patients, healthcare providers.

When Elita Christiansen, vice president of Community Health and Cultural Competence at Inova Fairfax Hospital, received a call that her father had suffered from a stroke, she rushed to the hospital in Florida to be with him.

Her father, an immigrant and a doctor of 30 years who became nearly fluent in English, came out of the stroke with only the ability to speak in his native language, Spanish. His doctors could not communicate with him because of the language barrier. Subsequently, he was evaluated at a lower level for his rehabilitation because no interpreter was present during the assessment.

This story is an all too familiar situation for families who don’t speak English but need medical care.

On Friday, June 1, Inova and Language Line Services offered a forum to address the cultural needs of the rapidly changing population in Northern Virginia.

"Hospitals cannot provide care if patients and providers cannot communicate," Christiansen said.

In 2006, Inova treated approximately 48,000 Limited English Proficient (LEP) patients system wide, said Martine Charles, director of Cultural Competence and Community Health Division at INOVA and director of the forum.

Janet Erickson-Johnson, director of Interpreter Certification at Language Line University, defines Limited English Proficiency as, "Those who have a limited ability to read, write, speak, or understand English."

Life and death decisions are being made without the patient being confident on what they have been told, Charles said.

Language barriers and the lack of medical comprehension often leads Limited English Proficient respondents to report problems in understanding medical situations and comprehending the use of medication, according to a study by Elisabeth Wilson published in the August 2005 Journal of Internal Medicine.

STORIES OF misinterpretation of directions and diagnoses litter hospital floors. Tina Arcidiacono, South Jersey Healthcare Patient Relations Manager, told of a LEP patient who was diagnosed with a fatal disease. When he died, his wife informed hospital officials she had no idea he had ever been that sick.

"Facilities’ efforts to improve communication with LEP patients are hampered by little or no resources," Erickson-Johnson said.

"Bilingual friends and family members, even children, continue to be used to interpret for LEP patients because of lack of readily available interpreters in a wide variety of languages," she said.

Risks associated with family members interpreting for their sick relatives include limited knowledge of medical language, emotional and psychological trauma resulting if the patient is in a critical situation, misinterpreting directions and translating a statement incorrectly, Erickson-Johnson said.

Because of these risks, hospitals, such as Inova, have put in place several levels of interpreter services, which vary in location based on the need, Charles said.

"All locations have access to telephonic interpreter services, contracted on-call interpreters in 70 languages and trained bilingual staff," she said.

LANGUAGE LINE, which has been partnered with Inova for the past two years, provides language services throughout the entire Inova system, said Jeanette Anders, Healthcare and Business Manager of Language Line Services.

Language Line supplied Inova with approximately 400 dual handset phones. These phones allow the provider to pick up one phone and the patient to pick up the other with an interpreter on the other line. Direct dial buttons on the phone allow for easy connection to an interpreter on the other line.

Inova also employs interpreters to work at the hospital.

Interpreters from the OB/GYN unit at Inova attended the forum to support the use of interpreters for LEP patients.

Maria Teresa Lemus, a medical interpreter in the unit, was currently working with a woman who is pregnant with quintuplets and is in the high-risk unit.

"It is going to be difficult for her to bring her pregnancy to term, and she doesn’t speak any English to talk with the doctors," Lemus said.

The medical interpreters carry telephones connected to their belts and whenever an interpreter is needed in their unit they receive a call, said Barbara Perez, medical interpreter.

"We just began having 24-hour coverage for women’s services," Perez said.

The doctors, nurses and the interpreters work as a team when helping LEP patients. Perez said that the doctors were the ones who lobbied hard for having interpreters in the OB/GYN unit 24 hours.

THE FORUM also included other technologies that are used at the hospital such as live video interpreting which can be essential when dealing with a deaf patient. The patient and doctor can see and hear the video screen, while the interpreter, who could be anywhere in the country, can translate.

"Our population continues to grow and become more diverse," said Karen Gilnooly of Language Line Services.

"Today are the beginning steps of making a change," she said.

We still have a long way to go to assure adequate language access to care," said Cynthia Roat, consultant and trainer, "but at least we’re on the road."