Queens Hospitals Focus on Language Access

This is a great story... and indicative of why I love Queens... each of the interpreters they mention speaks at least 3 different languages!

New York Times
April 15, 2005
Queens Hospitals Learn Many Ways to Say 'Ah'
By COREY KILGANNON

lmhurst Hospital Center is not the kind of hospital depicted on most television dramas. Its lobbies, hallways and waiting areas could illustrate an encyclopedia of world attire.

There are men in turbans and women in flowing saris - and that is just the staff. Patients include Mexican day laborers in dusty work clothes, Sikh cabdrivers with flowing beards and Muslim women in full robes with their faces hidden behind scarves.

The hallways and waiting rooms are a babble of languages and reflect Elmhurst's location in one of the country's most ethnically diverse neighborhoods. Elmhurst gets more than 500,000 patient visits a year, and roughly half the visitors speak so little English that they need some language help.

Officials at Elmhurst and the other city-run hospital in Queens, Queens Hospital Center in Jamaica, have long sought to improve their language skills. In the past, hospital workers would comb the waiting rooms or staff lounges for interpreters, and there were constant pleas over the public address system.

To defray the expense of hiring full-time interpreters and the rising cost of telephonic interpreter services, hospital officials have found a resource right under their noses, if not on the tip of their tongue: the diversity of its own staff.

The two hospitals have formed translation teams drawn from their nurses, clerks, orderlies, housekeepers and counselors. They are authorizing them to be official hospital interpreters who may be pulled off their normal jobs to translate for a patient.

For example, a hospital clerk at Elmhurst Hospital's primary care center, Faina Kokoreva, of Brooklyn, is an immigrant who speaks Russian, Yiddish, German and Ukrainian. "If someone speaks those languages, they're usually sent to me," she said recently while helping a Russian-speaking patient fill out a form.

At the managed-care center at Queens Hospital Center, a female clerical associate named Munawar Khan, a Pakistani immigrant living in Flushing, said on Wednesday that she was often called on to translate for Muslim women, or simply to make them feel more comfortable during a visit. Ms. Khan, a Muslim, speaks Urdu, Pashto, Punjabi and Hinko, a Pakistani dialect she said was similar to Punjabi.

In past years, the two hospitals have experimented with a corps of volunteer interpreters drawn from hospital staff members and local residents, but few of them had extensive training in medical interpreting. So officials at the two hospitals hired Stefanie C. Trice, a specialist in training medical interpreters.

Ms. Trice, 34, helped start the Cultural and Linguistic Diversity Development program, which has trained about 115 staff members at both hospitals, including nurses, clerks, counselors and housekeepers as medical interpreters in languages that include Bengali, Urdu, Hindi and Haitian Creole.

In the medical interpreting field, she said, working in hospitals in Elmhurst and Jamaica is "the ultimate challenge."

"I have friends working in California hospitals who say 75 percent of their patients don't speak English," she said. "Yes, but most of them are speaking Spanish. In Queens, you have to serve the whole world."

Indeed, there are more than 150 languages spoken in the borough. "Elmhurst and Queens Hospital face among the greatest challenges in the city, being in the most diverse communities on the face of the planet," said Alan D. Aviles, acting president of the Health and Hospitals Corporation, which runs the city's public hospitals. "For sheer total numbers of languages, Elmhurst is unique. In the course of a year, it probably deals with more than 100 languages and dialects."

"If your hospital staff reflects its community, then the variety of languages also mirrors the community," he added. "If you can harness that and set up language banks with employees, you have an added benefit."

As part of the hospitals' linguistic program, signs and hospital documents were ordered in additional languages.

Ms. Trice began surveying the staff for multilingual employees and encouraging them to take a 40-hour medical interpreter training course that includes medical ethics, biomedical culture and vocabulary as well as role-playing. After a graduation ceremony, the participating workers are considered official hospital interpreters and receive medical interpreter identification cards. They are not paid extra for interpreting work.

Ms. Trice said that the Health and Hospitals Corporation had adopted some of the practices citywide.

Because the group of in-house translators is relatively small, the hospitals still rely on freelance interpreters or a contracted phone translation service offering 140 languages, including Swahili, Amharic, Tagalog, Hmong, Basque and Navajo. Given the expense of the service - a total of $100,000 a month for the two hospitals - hospital officials say they are anxious to put more workers through the interpreting program.

"Having a cadre of certified interpreters already on staff is more cost-effective and gives you interpreters 24-7," said Dario Centorcelli, a spokesman for the Queens Health Network, the branch of the city's hospitals corporation that runs Elmhurst and Queens Hospitals.

It also makes good business sense, he said. In Queens, the competition among hospitals for immigrant patients is keen, and extensive linguistic services are a big selling point, as is making it clear to patients lacking full immigration documents that federal authorities will not be alerted to their status.

When it comes to crucial medical information, relying on a patient's relative or an untrained patient or hospital worker to translate, even if the translator is fluent in the language, could lead the doctor to miss certain nuances of a patient's story.

Young Mexican immigrants, for example, often use slang terms for ailments that might confuse the average Spanish speaker, Ms. Trice said. A French translator might not understand Haitian immigrants from Elmhurst or eastern Queens, whose own versions of Creole differ depending on what part of Haiti they are from.

The most common foreign languages at Elmhurst Hospital are Spanish, Mandarin, Korean, Bengali and Hindi. On a recent weekday at Elmhurst Hospital, a Chinese immigrant walked up to the main information desk with a confused look. Ms. Trice quickly excused herself and approached the woman and began chatting with her in Chinese.

Ms. Trice beamed and reported that the woman, Yun Qian Hu, 54, of Corona, said she had come to Elmhurst Hospital because at "the other hospital she went to, it was hard to get a Chinese interpreter."

Ms. Trice, who speaks Mandarin, French, Spanish and Portuguese, introduced the woman to Fernando Lee, 31, of Woodside, one of Elmhurst Hospital's multilingual patient representatives assigned to entrances and waiting areas. Mr. Lee's mother is Japanese and his father is Chinese, and he speaks both languages. Raised in Brazil, he also speaks Portuguese and Spanish.

Language barriers can hinder immigrant patients from informing doctors about remedies that they still may be using from their native countries and culture, said Debra J. Brennessel, a doctor at Queens Hospital. Those might include acupuncture among Chinese patients, elixirs from botanicos among Latinos, spiritual healers among South Asians or voodoo among Haitians.

"Whether they take herbs or use hot rocks on their back, we call it complementary therapy, not alternative medicine," Dr. Brennessel said. "You can't dismiss it. My Italian grandmother used to say the best cure for a headache was to go into a dark room and put a clove of garlic on your forehead."