Ohio medical students train with interpreters to improve minority care

By Susie Shutts
Feb. 25, 2008

 “In Mexico, my grandmother delivered the kids,” said Anabella Sanchez, interpreter services program manager at Nationwide Children’s Hospital in Columbus.

When Sanchez moved to Texas from Mexico at 21 she was pregnant, and she prepared for childbirth not through prenatal checkups, but by drinking cumin tea, a natural labor inductor used by Hispanic midwives. During her delivery – her first U.S. hospital visit – Sanchez did not understand a word; she spoke no English.

Sanchez represented a growing minority. The most recent U.S. Census figures, from 2000, estimate that 21.4 million Americans (8.1 percent of the population) speak English less than “very well.”  And, like Sanchez, these individuals often take different approaches to wellness – for example, through the use of traditional home remedies.

To help future doctors serve such patients, Sanchez visited the Ohio University College of Osteopathic Medicine (OU-COM) on Jan. 22 and Jan. 31. There she led the college’s third annual medical interpreter simulation lab. All second-year medical students attended one of four sessions. In May, all first-year students will participate.

“The state of Ohio isn’t homogenous,” said lab coordinator Pat Burnett, Ph.D., OU-COM’s director of student affairs and multicultural programs. “We want to train student physicians for the future, and the future includes a diverse population.”

For medical professionals, miscommunication can have dire consequences. In 1984, a 22-year-old man told his girlfriend he felt ‘intoxicado’ and collapsed. When she repeated the term, non Spanish-speaking paramedics took it to mean intoxicated, though the intended meaning was nauseated. His brain clot was misdiagnosed as a drug overdose, and he later won a $71 million malpractice settlement against the South Florida hospital.

“Que molestias tiene?” –What seems to be the problem?

Sanchez taught herself English through books and daily conversation (supplemented, she says, by English-language soap operas). She mastered her second language, and years later after moving to Ohio, Sanchez started a medical interpreter program at Children’s. She now oversees 28 interpreters – 20 for Spanish and eight for Somali – who facilitate more than 6,000 encounters a month. Sanchez keeps a contingent staff for 12 other languages, including French, Cantonese, Swahili and Arabic.

For certification, Sanchez requires 60 training hours and a verbal language proficiency test, but there are no hard and fast state or federal rules concerning medical interpreter training.

The Civil Rights Act of 1964 and the U.S. Department of Health and Human Services mandate that physicians accepting federal financial assistance such as Medicaid must provide free interpreter services. But the obligation can be met in a variety of ways, including community volunteer services.

Although the Office for Civil Rights guidelines suggest that a patient “may feel more comfortable when a trusted family member or friend acts as an interpreter,” untrained individuals are more likely to err. The provider must inform patients of their right to a provided professional translator without charge.

“Tiene preguntas?” – Do you have any questions?

During the OU-COM simulation labs, Spanish-speaking simulation patients were assigned either hypertension or diabetes, and they spoke solely in Spanish, aided by one of six interpreters from Children’s.

With five people crammed in the examination room, student Jess Nordin was forced to stand. It made her uncomfortable to look down at a patient, but “the interpreter made a big difference.”

Students were instructed to direct all speech and eye contact to the patient and treat the interpreter as “a floating voice.”

“Even if I don’t understand, it’s uncomfortable if you aren’t paying attention to me, because I’m sick,” said Rocio Perez, a simulation patient, during a debriefing following the lab.

Sanchez later taught Spanish medical terminology basics at a workshop sponsored by OU-COM’s Student National Medical Association chapter. She showed slides on body parts, illnesses and greetings, noting that a doctor’s use of Spanish greetings, even with an interpreter present, helps build trust and rapport with the patient.

The golden rule: while being mindful of cultural differences, “treat patients the same as if they are speaking English,” Sanchez said.