Language Access Part 1: Why Language Access Matters for Health, and Where We Are Today - WNC Health Policy Podcast Ep. 4
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Under federal law, language access is a legal obligation for all recipients of federal funding. However, because “many healthcare providers are not aware of their responsibility, have not prioritized the issue, or have not been held accountable through consistent enforcement of these laws,” language barriers remain a significant challenge for many Western North Carolinians.
Home to over 70 different languages and high levels of illiteracy, communication barriers in healthcare facilities make accessing healthcare difficult for a large portion of Western North Carolina.
Between differing spoken languages, cultural contexts, physical means, and literacy, language access is one tool that can improve health outcomes in WNC. To learn more about language access in our region, NCCHW's audio producer, Andrew Rainey, speaks with Buncombe County’s Language Access Coordinator, Aaron Vidaurri, the Health Access Programs Manager at the WNC Medical Society Interpreter Network, Rosalia McHattie, and co-founder of the Cenzotle Language Justice Cooperative, Monse Ramirez, in 'Part 1' of this WNC HPI podcast miniseries.
Resources
Download references to the clinical studies featured in this podcast (pdf)
Transcript
WNC HPI Podcast: Language Access Part 1: Why Language Access Matters for Health, and Where We Are Today
2/8/2024
AR: Andrew Rainey
RM: Rosalia McHattie
MR: Monserrat Ramirez
AV: Aaron Vidaurri
AV: Because the consequences of the care that’s being administered can have a massive impact, we need to make sure that we understand what the person is experiencing, why they’re there and that they understand what’s happening to them.
Introduction
AR: You're listening to the Western North Carolina Health Policy Initiative podcast. I'm Andrew Rainey. In each installment we’ll speak about different public health strategies for improving health and well-being in Western North Carolina (WNC).
Recorded between the studios of AshevilleFM and the mountainous internet waves of Appalachia, in this installment, we begin a series exploring language access and healthcare.
INTRODUCTIONS:
AR: When it comes to our health, we can underestimate the impact of language.
I remember from my first 7th grade Spanish class, one classmate, thinking he said he was embarrassed, said “estoy embarazado.” Our class howled when the teacher told us he had mistakenly said he was pregnant. While a miscommunication like that may make a group of middle schoolers laugh, language misunderstandings, however small, can have big consequences.
A 2015 Smithsonian Magazine article recounts how language mistakes can lead to both tragic and preventable outcomes in healthcare.
In one instance, a worried mother explained that her daughter was in a tricycle accident, hitting her shoulder on the ground. She told the healthcare provider “se pegó se pegó” (‘she hit the ground’ or ‘he/she hit him/her’ or ‘it stuck’) The provider misunderstood her, thinking that someone at home had hit her daughter. . . As a result, the Department of Social Services took custody of both of her kids.
In another situation, a teenager told paramedics that her boyfriend had been experiencing nausea and an upset stomach before losing consciousness, using the word ‘intoxicado,’ which in the Cuban dialect of Spanish means becoming ill due to consumption of food or drink, poisoned, to describe his symptoms. The paramedics thought she meant ‘intoxicated’ according to the English understanding of ‘being affected by a chemical substance,’ and treated him for drug abuse. The nausea should have been an important indicator of the brain aneurysm the teen was having. From not getting prompt care, the teen spent days comatose and became quadriplegic. And the hospital ended up with a $71-million-dollar malpractice lawsuit.
In this installment of the HPI podcast, we begin a series exploring how language access impacts health in WNC. We’ll begin with a big picture of language access, what it means for healthcare, its legal basis, and some of the tools available.
In follow-up installments, we’ll hear about who’s requesting services in WNC, what’s working well, and regional challenges, and in the 3rd part, we’ll hear recommendations and resources to learn more on how to improve services in your organization.
To learn more across this series, I’m joined by 3 guests working in the language access field in WNC.
AR: Thanks for being here. Could I have you each introduce yourselves?
RM: Thank you Andrew, its a pleasure to be here. My name is Rosalia McHattie. I’m originally from Peru. My role at the Western Carolina Medical Society is Health Access Programs Manager and with WIN interpreter network, we are very well known in the area, so facilities contact us and they request for interpreting services. . recently, we received a grant and our goal is to be able to provide training to people that speak more than one language, like if they are bilingual in English as well. We can also provide with training for them to become interpreters and spread in the area.
MR: Hi my name is Monserrat Ramirez. I’m one of the founding members of Cenzontle Language Justice Cooperative. Cenzontle is a worker cooperative and we offer language services: simultaneous interpretation through zoom for online meetings and in person. . we also offer written translation services and then we also offer consulting and training services. So this is more for organizations who really want to dive a little deeper into why they want to have multilingual spaces. We do more in depth training on the history of language loss and the resistance that has happened and then also get into the basics on how to create multilingual spaces where people are able to share and connect and organize regardless of the languages that they speak. And really, it’s to support connection and a space where people can express themselves fully.
AV: My name is Aaron Vidaurri. I am the Language Access Coordinator for Buncombe County Health and Human Services. Ive worked with the county for a little over 17 years, and the bulk of my time prior to this role was with Economic Services, working with Medicaid and feeding/nutrition services in various roles. . . An opportunity came or this position was created and I took the opportunity to apply for it as I'd spent most of my time when I was in Economic Services working in Spanish, and when I was a supervisor I had a team of a Spanish caseworkers. . . so it just seemed like a natural transition to grow and kind of push my interest in language access. . .
*as a disclaimer, all three guests were recorded at separate times! While everyone is featured in each installment of this series, different sections will feature different guests more heavily.
DEFINITION
AR: So with a perspective from a county government, an interpreter network, and a language justice cooperative, we’re ready to start looking at language access. Aaron, as a language access coordinator, what would you say language access means?
AV: So to me, at its core, language access is giving people who have preferred languages other than English or speaking ASL or have communication challenges for any other reason to have equitable access to all of our services without any barriers. . . to feel comfortable speaking in their preferred language when they come in, to feel safe, and to not feel judged.
AR: Typically, when I think of language access, spoken languages come to mind. However, you mentioned ASL, or American Sign Language, and other communication challenges being important to language access too. . .
AV: Yea. As you were saying the most obvious people think of is like “hey this person is coming in and they’re speaking Spanish or they’re speaking German or there’s two individuals that are speaking different languages so how are we going to get them to understand each other? But language access is going to cover wide areas, you could have some that’s coming in that is hard of hearing, you could have someone that is blind and unable to access how to get around through the facility. . . could just have limited reading ability, or they could be completely illiterate and how are you going to get those messages across? especially when so much of what goes on is like “here fill out this form, you’re applying for this or this consent form,” so taking the time to check with the people, to make sure they’re understanding what’s happening. . . it may mean that that process is going to take longer, cause you may have to bring in an ASL interpreter, or it could be a situation where the person doesn’t understand ASL, so then, they might be more comfortable like in a speech-to-text setup.
Just making sure that whoever is coming in in these very complex and sometimes intimidating situations, they can understand what’s happening, whether that’s receiving English spoken more clearly and maybe with less technical terms, using ASL speech-to-text software for people that are hard of hearing, or having interpreters and documents translated.
HEALTH CONCERN
AR: Ok, so we heard a little at the beginning about anecdotal health issues with language that points to why language is important to healthcare, but as part of the DHHS, could you speak a little more as to why this is a health issue?
AV: Yeah. You know, it's crucial for us to provide these services especially in healthcare ,as it's going to impact care that they receive. If they're not fully understanding what we're asking. . . or what the purpose of the interaction is, it can limit the outcome of their health care, which would ultimately impact their quality of life. . so whether they're coming in to Health and Human Services to apply to get Medicaid, or if they're coming in through our clinic for immunization purposes, or any of the services that we provide, we want to make sure that they understand what they're receiving what's being asked and to make sure that they have the same access to services and that their outcomes are going to be the same, that their health care is not going to be impacted or they're going to have any adverse effects due to a miscommunication or misunderstanding. We don't want someone to come in and try and tell us that they have an allergy that might impact the shot and us not understand what's being told that could lead to some sort adverse affect when their receiving their immunizations.
AR: Potential poisoning, I mean death. . .
AV: Yeah, it can be super extreme as far as the outcomes, you know, like I said death, mistreatment. . . if the dosage is wrong. . . or it could be like with a frequency, having it misread where it's like ‘3 times a day’ vs ‘3 pills once a day. . . .’ it could really impact the benefits they’re seeing from a medication, or they could have some adverse effect if they’re taking way more than they need to. .
Whenever, you know, we’re in trainings with interpreters or learning about language access, you always hear about stories. There was a mistranslation where they thought the person was drunk but it ended up they were trying to say they were poisoned. . so it completely impacted how they were being treated. . .
Because the consequences of the care that’s being administered can have a massive impact, we need to make sure that we understand what the person is experiencing, why they’re there, and that they understand what’s happening to them and what we’re trying to do.
It could be smaller instances that don't seem that impactful, but it could lead to mistrust and then them not wanting to use health systems.
AR: It's maybe not too difficult to imagine the variety of challenges and complications that not having language access could cause. Still, for studies detailing ways that an absence of language access negatively impacts health outcomes, you can find 17 recent studies on our show notes page wnchealthpolicy.org. Special thanks to MAHEC’s librarian, Elisabeth Wallace, for finding and sharing these with the HPI!
LAW
AR: Now that we’ve heard why language is central to healthcare access and quality, let’s take a look at where language access sits in the law. What legal right do patients have to an interpreter and other language access services?
MR:. We know from Title VI that it is a requirement for most all places that have and receive federal funding to be able to provide access by law for language.
AR: Title VI of the Civil Rights Act of 1964 states that “no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.”
It’s a mouthful, but basically, in it, language serves as a proxy for national origin. . . that means that for anyone receiving federally funding, folks who use other languages are entitled to treatment equal to that of English speakers. . .
RM: and then we have the ADA, which is the disability act,
AR: This extends language services to cover folks who may be deaf, hard of hearing, or blind. . so its not just spoken languages. . but may include visual languages, like American Sign Language, or tactile languages, like braille.
While literacy is not considered a disability under the law, the overlap with physical abilities, such as sight, suggests that patients struggling with literacy could receive special accommodations in most cases.
RM: I would also mention HIPPA, which is the Health Insurance Portability and Accountability Act that helps us to work with confidentiality. .
AR: HIPPA and a handful of federal policies also expand on Title VI, with an executive order signed by Bill Clinton in the year 2000 being the most influential. There, we get the phrase most seen in language access plans: limited English proficiency, or LEP. This is also a category on the census and how language access services are frequently identified in a region. . .
AV: How many people say that they speak English “well, not very well, or not at all.” LEP.gov is the government website that has all the information on language access.
AR: On the website, we see that pretty much every hospital, clinic, government office, nonprofit, and physician has to provide reasonable language services, meaning anything related to Medicaid, CHIP and Medicare .. . However, it’s unclear what reasonable means. .
In a 2007 article called “The Legal Framework for Language Access in Healthcare Settings: Title VI and Beyond,” authors Chen et al. write that the legal compliance with Title VI is “a somewhat haphazard patchwork of legal obligations which vary from state to state, from language to language, from condition to condition, and from institution to institution.” One clinic might have a bilingual cardiologist but no family medicine physician, another might only have phone interpretation but bad service, or translated forms about lung cancer but nothing about payment plans. It’s not consistent. . . and doesn’t necessarily meet the needs people have. . .
MR: Really just checkbox kind of things going along with that access: forms translated, provide interpreters when needed. . . But a lot of the time it's mostly because they're required to, they have to follow a law. . .
AR: A Policy Guidance to this law offers a little bit of structure on how to provide language access. Unfortunately, as Chen et al write, “many healthcare providers are not aware of their responsibility, have not prioritized the issue, or have not been held accountable through consistent enforcement of these laws.” Still though, the guidance has resources for communities like ours to improve our population’s health:
AV: They have sample plans so it’s a great resource to tap into. It talks about the 4 factor identification for your languages to help you really be able to identify what are the languages that I really need to be assisting? what are the primary languages that we encounter? Theres loads of resources to figure out how to just start this whole journey in language access, so definitely a site to visit. . .
AR: The 4-factor identification Aaron mentioned is the sort of first measure for how far an organization has to go with language assistance. . . Let’s look at each of the 4 factors:
1) The first factor is the amount of LEP persons served or eligible to be served: We’ll take a look in the next installment about what data we have on the number of people with profound language access needs in WNC. . .
2) The second factor is frequency of contact: so, if you’ve got more folks speaking Spanish than Korean, you’re gonna need to put more money into Spanish services.
3) The third factor is the importance of the service: We’ve already heard that healthcare is about as important a service as you could hope for. . . this means that a clinic or hospital needs higher scrutiny in their language access plans than, say, a military museum.
4) The final factor is about resources and costs. , basically, the feds don’t want to put a huge logistical weight on a small medical practice, whereas bigger ones might have to offer more. . .
In this series, we’re going to look at these questions broadly for WNC, see whats already been happening in the region, including strengths and challenges, and then at strategies to improve health outcomes for our region, regardless of language spoken, literacy, age, or ability.
After a break, we’ll come back to look at some of the general tools used on the ground for language access, so that when we look at WNC, we’ll have a clearer picture of our strengths and challenges. . .
BREAK
Hi everyone, Andrew here on the WNC HPI Podcast, the show that looks at public health strategies to improve health in WNC. We’ve been talking about language access as a tool to improve health outcomes with Aaron Viduarri of Buncombe County’s DHHS, Monse Ramirez from Cenzontle Language Justice Cooperative, and Rosalia McHattie of WIN.
Be sure to check our website at www.wnchealthpolicy.org for the transcript or to listen again. We’ll return to that conversation in just a moment. . . .
That was Asheville-based Appalachian ballad singer Saro Lynch-Thomason humming the old shape note styled ballad, Lady Margaret. You can learn more about her work and regional music traditions at sarosings.com. And now back to the show. . . .
LANGUAGE TOOLS
AR: So language access impacts a lot of kinds of folks: most notably people speaking different languages, but also folks who are deaf, hard of hearing, and blind, as well as people with literacy challenges. . . . To finish up this first installment, let’s take a broad look at some of the tools of language access – the in the field items that help facilitate understanding. These language service tools are sometimes employees, contractors, pieces of technology, or even physical infrastructure. .
The two maybe most heard about are translators and interpreters. Rosalia, could you describe the basic difference between interpretation and translation for our listeners?
RM: Definitely. Interpretation is the verbal part, for example, if you’re talking in a conversation or a medical visit, it's verbal communication. . . . And the translation is more in the paper area, for example, like a birth certificate, that would be a translation.
AR: So active communication is interpretation, while written words and text is translation. . . .
RM: And there is something in between, like if you have to read a consent for a patient, that would be a sight translation, because you have the document in your hands and you are reading it and you are informing the patient about what he’s about to sign. . .
AR: For folks who haven’t worked with an interpreter before, could you describe what in-person interpretation looks or sounds like?
RM: Yea, mm, simultaneous interpretation is more used for conferences, because there’s one speaker, and in this case one interpreter, and the interpreter is going to interpret for a whole bunch of people. So its going to be almost at the same time, just a few seconds behind.
AR: For listeners out there, let’s hear an example: We’ll hear a phrase in Spanish and then offer English as you might hear it from a simultaneous interpreter:
SPA: Imagina que tienes unos auriculares puestos junto con un pequeño transmisor. El transmisor está configurado en el canal del intérprete que dice, en este caso, inglés. Tal vez están ustedes en un evento o escuchando algo en la radio en un idioma diferente. Ahora volvamos a Rosalía con una otra formas de interpretación hablada. .
ENG: So imagine that you have a headset on, along with a little transmitter. The transmitter is set to the interpreter channel that says, in this case, English. Maybe you’re at an event or listening to something on the radio in a different language. Now back to Rosalia with another form of spoken interpretation. . .
RM: We have consecutive interpretation, the consecutive one is more used for interviews, or you know, banks, things like that. Because it gives the chance for the interpreter to listen to the sentence and then render the message for both parts.
AR: So now we’ll hear an example.
ESP: Estás en un lugar con tu proveedor que habla español monolingüe y tienes un intérprete en persona.
ENG: You’re in a room with your provider who is a monolingual Spanish speaker, and you have an in-person interpreter.
ESP: A diferencia de la interpretación simultánea, note que en la interpretación consecutiva, hay una pausa.
ENG: Unlike simultaneous interpretation, notice that in consecutive interpretation, there is a pause
ESP: Entonces esos dos ejemplos son cómo podría ser la interpretación en persona.
ENG: So those two examples are what interpretation might be like in-person.
AR: Ok, so when someone is interpreting, this could look 2 different ways: it might be happening almost at the same time with simultaneous interpretation, or depending on time, resources, it might be a bit more staggered, with consecutive interpretation. What else should our listeners know about working with an interpreter?
AV: Just making sure that you’re speaking directly to your patient or your client and you’re not saying “hey interpreter, can you ask them this?” In those situations, it's best to just kind of pretend like the interpreter is not really there. . . you're just having that conversation directly with the individual, regardless of whether that is over the phone or in person, they’re just kinda there in the background relaying your message back and forth.
AR: As a quick aside. Speaking with Aaron and Rosalia, it became clear that there're at least 4 kinds of folks that might get called on to interpret, although not all of them are appropriate to use as interpreters in a medical setting. . These include 1) bilingual staff, 2) bilingual friends or family of the patient 3) trained interpreters and 4) certified medical interpreters. . . . .
AR: Lets start by hearing about bilingual staff . .
AV: There is a difference between an interpreter and bilingual staff. My recommendation is they should be used to provide direct service in their role. Like if you have someone in an intake sort of position, they shouldn’t then get pulled to help out in a medical procedure. . .
RM: Something that I have noticed is that sometimes facilities hire people that are bilingual, but they don’t know the ins and outs of interpreting. . . so they might summarize, they might omit, or they might be so literal that the sense of what the doctor was saying has gotten lost.
Even though we do the outreach and explain, I still see facilities hiring bilingual people and when they don’t have an interpreter, they call this person. . . and as I mentioned its not 100% perfect but it could help, but sometimes could get in trouble . . .
I understand facilities hiring bilingual people, but that is an opportunity to provide them with interpreting training so they will become not only your staff member for any task that you assign them, but also to become an interpreter.
AR: Ok so bilingual staff are an important section of the workforce because they can offer services in 2 different languages. However. . . they shouldn’t be used to interpret. . .
AV: Its a different skill set and there’s different training involved, and they might make a mistake and that could impact the patients’ health or cause them to, if it’s a situation where they’re applying for a benefit, maybe there’s a misunderstanding. Different things could go wrong. . .
RM: Basically, because when you take the training for being an interpreter, you learn about confidentiality, accuracy, neutrality. . .
I don’t know if I can share a personal experience but in my previous job, I remember there was a nurse that was bilingual. I was interpreter at that office and I remember during my vacations, she was the one that covered for me. Luckily, she was a nurse, so she knew the medical terminology, and she was aware of HIPPA and other things. . . but I mean, I don’t know exactly about her neutrality because she was very well known in the area.
Sometimes you are going to interpret for a family member even though you're at your job, or maybe a friend, like who we call a co-madre, you know, a very close friend in the neighborhood. What happens if she doesn’t really want to share what is really happening in that medical encounter because she doesn’t feel comfortable, or if it's social services interpretation? And that is part of the principles of being an interpreter. . there’s also boundaries, role boundaries. Because once you get in touch with someone that speaks your same language, you feel like there’s a connection, right? Because it’s the first thing you do to communicate, you need to speak, so this is the first connection. . but you cannot go talk a lot about personal stuff, so it happens with the pre-session, for example: you’re sitting out there in the waiting room with the patient and you introduce yourself and you explain how this is going to be. . .sometimes I feel like “but like I mean I cannot share I cannot talk to you or?” I mean you can, but it does not mean I can give you advice, because that’s not my role. the doctor has to give you the information that you need. But then, could be other type of approach like for example “this is my phone number. can I contact you? or can you give me your phone number so I can call you anytime I need to go somewhere else?”
You see, there’s a lot of things as an interpreter, you have to respect and tell the patient that they cannot cross that line. . .
AV: You don’t want to be in a situation where all of a sudden, that patient or that client feels like “hey something going on I’m gonna reach out and see if I can get a hold of this interpreter and ask them a question,” because the interpreter is not a doctor, they’re not a nurse, they’re not a social worker, or a caseworker, or whatever the position that they’re interpreting for is- that’s why we have medical interpreters, you’re going to have different testing to be able to function in those roles. . .
RM: Now you can get trained as an interpreter, but to become a certified interpreter, that’s another step. And in some cases, you can work as an interpreter not being certified, but it’s not exactly what we look for. You can get a training, but if you don’t know all the terminology, or you don’t know the principles and ethics and standards, that is not good. . .
AR: What happens when folks bring in someone to do interpreting who isn’t an interpreter or a staff member, like a friend or family member?
RM: That is not good because number 1) is confidentiality and number 2) is sometimes they bring minors with them. . because they don’t have any other one to trust. . . but what if the encounter is for something really difficult to share and is very personal? A child is not prepared for that. So an interpreter will give you that neutrality, that confidentiality, to give you this information in a way that is like an echo. The interpreter is going to render the message as if she or he is like the doctor or the patient. But, yes, the challenge there is the confidentiality, the accuracy, and medical terminology as well. . .
And that brings me to another topic: the fact that in, for example, in Spanish, there’s a bunch of different dialects and also different slang words according to the country of origin, you know? So, in Mexico, for example, there are some words that are not used in South America. And when you become an interpreter, you need to learn this so you can differentiate these words. And
in my personal experience as an interpreter, I try to identify what’s the country that the patient is from, so I would set my mind, you know, in ok, this is Cuban, for example, because they tend to speak very fast, so I try to catch it up very fast when I speak to the doctor as well. So, you know, there are a lot of things we have to consider when interpreting. That’s why I was saying its not the same to be bilingual then being an interpreter. And I would say for medical interpreting, its challenging because the medical area is mostly the terminology, which is going to be very important to learn and understand. . .
AR: So we’ve talked about the folks who you should use for interpretation in a medical setting: trained interpreters. . . certified medical interpreters, and folks that you shouldn’t rely on for interpretation in a medical setting: which might include untrained bilingual staff members or a patient’s friends or family. So all of that might be in an in-person environment, but with technology growing, what does interpretation look like remotely?
RM: Then, over the telephone is more used for scheduling appointments, giving results for tests or financial screenings for a procedure. .
AV: and now there’s more use of the video remotes. . . so we can have video set-up, which does add a little bit more personal layer to it; the interpreter can see the individual and sometimes that just makes the setting go by a little bit better when we can work that in.
RM: I would say that in this area, ‘in-person interpretation’ is preferred for the patients, but facilities are using, lately, remote interpretation . It is not as expensive as having an in-person interpretation, but there are some issues about it. Patients feel like there is no personal contact number 1. And number 2 that if there is any issue with connectivity, that communication has not been complete. Because sometimes remote interpretation or telephone can have also that hearing issue. . . and we don’t always work with young people, you know I am talking about interpreters and patients and even providers, so if they cant hear well, that would be an issue. But. . . even using remote interpretation is already gaining something because at least it shows that a facility is interested in providing the patients with whatever tool they have to communicate with them.
AV: You know, if over the phone is going to be one of the main ways that we have available, whether its what we can afford, or you're running into languages that its harder to find in-person for, or even, you just don’t have enough staff to cover the amount of Spanish or Russian that you’re seeing, or all of it at once. . . making sure that you can make that service be as effective as possible.
So what that could look like is if you have an exam room set up, be mindful of ‘where is that phone placed?’ Either optimized to where you can have a phone that’s nearby, maybe get some sort of an intercom / speaker microphone set up to amplify. . . can you call in via your computer and just have that closer? or a tablet that’s set up? . . . in which case a lot of them, you can do video on the tablet as well. But just making sure that the exam rooms are just laid out as effectively as possible to make the best use of the technology that you have available.
AR: Ok, so remote interpretation is a tool for language access because it allows the limited workforce to have greater presence. However, it's not preferred by patients and there’s also some tech challenges built in there with the physical infrastructure needed, the quality of the network, reception, and audibility.
Traditionally, interpretation has been a human-powered skill, but with the boom of technology, I’ve seen folks rely on free translation apps for written documents and Speech to Text tools online. What are your thoughts on these tools?
RM: I will share something that I learned with my last training about how to become an interpreters’ trainer. I remember one of our trainers said something like “would Google use Google Translate when they have to sign a contract themselves?” I highly doubt it. Its not to diminish Google translator because it has become a very helpful tool as well, but there are things that need a special person that is dedicated to this and that knows. . .
AR: AI interpretation and translation is not 100% just yet, I guess. And when its used and the quality isn’t very good, that also breaks trust with the patients.
Because some trust is a requirement for a patient-provider interaction to even occur, that leads us to another, maybe less visible role in language access work.
One of the HPI’s partner organizations, the North Carolina Center for Health & Wellness (NCCHW), recently completed an evaluation of MAHEC’s Community Health Worker (CHW) Chronic Disease Initiative. The results included lots of qualitative evidence that CHWs can be a bridge across language and culture in healthcare. While CHWs may or may not be trained interpreters, CHWs work with both patients and providers to get patients the appropriate resources. We’ll hear more from some CHWs across WNC in the next installment of this language access series as well as in a future HPI podcast, covering community health work, but here are a couple clips from interviews conducted with CHWs that may help paint that picture.
DJ: CHWs who are a part of the community or know the community well can really act as a liaison. So, number 1) get them to show up number 2) help an interaction with the physician. . . .
LZ: We’re that trust piece right between a lot of the resources- specially the health systems. . . and the communities. . . there's a lot of fear in the community still to go to the doctor - especially Hispanic/Latino Community because of the language, because they don't know their culture, and they don't have access sometimes to health insurance, so they don't even want to try to go to the doctor because they cannot afford bills. . . so having the CHW who knows how the health system works, and where are the barriers of the community, and being that bridge, I think that's what makes us special, because somebody that I've been helping for over a year. . . I went with him to medical appointments, I was there with him when he was getting surgery. . . because the place where they're doing, they didn't have interpretation- nothing. And if I hadn’t been there, he probably wouldn’t have had his surgery. . . and even on the day of the surgery, when we were looking for interpretation, I told him “I don't know if I'm going to be able. . I'm going to see if the hospital has an interpreter,” and he's like “can you please be there with me? I'll feel safer. . . ” So he said that and it's like “wow!” that made me like really realize how important it is. If not, he would still be struggling.
AR: Thanks to Dr David Johnson, CHW, Laura Zapater Urrea, and the NCCHW for these segments. To learn more about the 2023 NCCHW CHW Chronic Disease Initiative, check out their website at NCCHW, linked on this show’s blog spot.
AR: So we’ve heard about interpreters and other language access personnel like bilingual staff and CHWs, are there other general tools used in a brick-and-mortar healthcare facility providing language access?
AV: Yea, so having “I speak” cards available when someone comes in to check in. Those are generally like a sheet that has a list of languages and it says, “I speak X language” written in that language and they can kinda point to it and say “Hey, Spanish, Mandarin, Arabic, Dari,” whatever.
And just advertise. Have multilingual signs that are up that say: “interpreter services will be provided free of charge, whatever the top languages in the area are. Have your signs be multilingual. And if you can use symbols or images that, you know, that just takes the language out of it, having people be able to come in and know where to go, whether they speak English or not.
AR: Thinking of advertisements, I guess that includes public messages too right? Like events or alerts that folks may need to know?
AV: Yeah! You want everyone to be able to understand the alerts and not just one portion of the community. if there’s an event going on. . . whether its a fire, it could be an active shooter or whatever sort of situation is happening, that you can get out alerts. .
AR: Are there any other physical tools for language access services that you’d like to mention?
AV: One of the things we’re trying to tackle, is we’re trying to do just like a glossary of preferred terms for the two languages that we’re staffed with currently. And that way when we have staff in the future we can refer back to these and just making sure that when we’re having documents translated, we’re consistent with the wording that we’re using. And so when you’re making those documents in English taking plain language into consideration. . . so making sure youre writing them clearly, you try to avoid abbreviations and acronyms and as much as you can, and if youre going to use them, say what they are first before you dive into just having alphabet soup for all these acronyms and whatever thats out there because that can be very overwhelming, and then you might as well be speaking an entirely different language. . .
AR: So language access can use a lot of different tools! Using translations, interpreters, technology, infrastructure, and other bridging personnel. . . . healthcare facilities can support language access for a number of different spoken, visual, and tactile languages, meet federal law, and have a positive impact on health.
We hope you’ll check out the second installment on language access where we’ll hear about what’s been working well and what challenges we’re facing in WNC.
Aaron, Monse, and Rosalia will join us then, but before closing out, let’s learn how you can get in touch with them. . .
AV: Yra, I mean, people can reach out to me. My email is aaron.vidaurri@buncombecounty.org . I'm happy to help and provide any information that I can.
AR: Rosalia, how about WIN?
RM: Number 1 they can look for our website which is mywcms.org, and they can look for language services and thats all the information about what we do about language access. And also if they want to be a part of our interpreters’ group, they can contact us. . .
AR: We didn’t hear a whole lot from Cenzontle Language Justice Coop in this installment, but dont worry, Monse will be joining us in the upcoming installments to share about WNC and strategies moving forward. In the meantime, as she mentioned earlier, Cenzontle is available for a variety of services which you can see at https://www.cenzontle.coop/
MR: We offer simultaneous interpretation through zoom for online meetings and in person. . we work a lot with nonprofits, local grassroots groups, and then we’ve also worked some with the city and the county, and we hope to expand our clients. We also offer written translation services. . . so, organizations who want to have their materials translated and be available in Spanish and English, such as handbooks, worksheets, powerpoints, guides, for their people. And then we also offer consulting and training services- so this is more for organizations who really want to dive a little bit deeper into why they want to have multilingual spaces. We do more in depth training on the history of language loss and the resistance that has happened, and then also get into the basics on how to create multilingual spaces, but really the work that we do is grounded in language justice, and we are definitely different than any other language service provider, we go a little bit deeper and really try to create spaces where people are able to share and connect and organize regardless of the languages that they speak. And really, its to support connection and a space where people can really express themselves fully.
OUTRO
AR: You've been listening to the WNC Health Policy Initiative Podcast through the NC Center for Health and Wellness at UNCA. To listen again or learn more about public health issues in WNC, check out the website @ wnchealthpolicy.org. To find some of the resources mentioned in this show about language access, head to the blog section at the top of the website where you’ll find additional show notes.
If there’s a WNC health issue that you’d like to hear more about, speak about, or comments about anything you’ve heard on an HPI podcast, feel free to send us an email at info@wnchealthpolicy.org.
A big thanks to the AshevilleFM Studios where this installment was recorded.
Another big thanks to Asheville-based Appalachian ballad singer Saro Lynch-Thomason for humming the old shape note styled ballad Lady Margaret in the mid show break. You can learn more about her work and regional music traditions at sarosings.com.
English language voiceover work was provided by Chichi Alcazar, and Coco Rainey-Alcazar.
To find more information about CHWs, see the North Carolina Center for Health & Wellness’s 2023 Community Health Worker Evaluation, as well as the North Carolina Community Health Worker Association’s website.
Other music included in the podcast includes old ballad, Little Margaret, performed on banjo by Cath and Phil Tyler. Found on the FreeMusicArchive, it is licensed under an Attribution- Noncommercial-Share Alike 3.0 United States License.
Additional music includes the tracks Some Nights End, Great is the Contessa, Domina Transit, O Holy Still, When the Guests Have Left, The Silver Hatch & Night Watch by the Blue Dot Sessions; These tracks are found on the FreeMusicArchive under license attribution international CC BY 4.0.
Be sure to check the website for more HPI podcast episodes and other resources @ wnchealthpolicy.org. Thanks for listening.
