Elia Zarate hovered close to her 4-month-old son’s hospital crib as the nurse explained an infection baby Omar had developed just a few days before Thanksgiving. Omar, with tubes in his nose and clad in a white and orange striped onesie with monkeys on the hands, laid quiet and composed in his bed.
The 27-year-old mother is fairly calm for not understanding a word Jenny Weber, a nurse with University of Iowa Hospitals and Clinics, was saying. Zarate moved to Des Moines from Mexico three years ago and doesn't speak English.
Zarate learned how Omar was doing after his heart surgery, thanks to Adrian Silva, UIHC coordinator of interpretation and translation services, who is there to translate Weber and Zarate’s conversation.
Area hospitals are seeing an increase in non-English patients, and to provide good medical services for every individual means communicating on the patient’s terms through interpreting verbal communications and translating documents and other forms of written communication.
“What’s important for me is the fact I feel good and more confident knowing everything is explained to me and I understand,” Zarate said, translated by Silva. “It’s good to have that reassurance.”
Once Silva finished with the Zarates, he returned to the emergency room where he was earlier that morning. Silva, who's worked with UIHC since 2011, said it’s difficult to estimate how many interpretations he does daily but he’s hardly ever in his office.
Spanish is the No. 1 language of non-English-speaking UIHC visitors, and their numbers are climbing. In fiscal year 2013, more than 13,500 requests seeking Spanish interpreting services were made, up from almost 10,000 in fiscal year 2010.
The need for all other non-English languages increased from 1,800 patients in fiscal year 2010 to more than 3,000 in fiscal year 2013.
The UIHC has three full-time interpreters, including Silva, all of whom are fluent in Spanish and English. The hospital also provides a language bank staffed with part-time interpreters who collectively can communicate in about 30 languages including Vietnamese, Arabic and Somali, as well as American Sign Language. Silva's department also translates documents for patients into their preferred language.
UIHC’s interpretation and translation services was the first of its kind in the United States when it began in 1975 and assists many departments throughout the hospital including the business office, surgery, the emergency room and scheduling. A few interpreters also are on-call after normal business hours.
If a patient speaks a language not staffed at UIHC, the hospital contracts with a medical phone interpretation company, CyraCom, which has an office in Cedar Rapids.
UnityPoint Health- St. Luke’s Hospital in Cedar Rapids also relies on similar phone interpreting services. Sarah Corizzo, media relations specialist at the hospital, said interpretive services are needed about five times a day, with Spanish as the most requested language, followed by Swahili.
Not for everyone
Interpreting and hospital officials said having these services is vital for providing safe and accurate care, and the idea of professional interpreters and translators is still a developing field.
Ernest Nino-Murcia, Iowa Interpreters and Translators Association vice president, said an interpreter’s job is to repeat exactly what is said — without adding opinions, paraphrasing, giving advice, or leaving something out.
Nino-Murcia, a certified legal and medical interpreter, said years ago hospitals and court rooms didn’t have strict standards for who can interpret and would call on a bilingual staff member, family or friend.
“Saying that anybody who speaks two languages can interpret is like saying anyone with hands can play a piano,” he said. “It’s what you call a necessary condition but not sufficient.”
Nino-Murcia said having professionally trained interpreters avoids family members leaving out sensitive information or misinterpreting what is being said. That could affect the medical attention a patient receives or, in a legal situation, the information provided to determine a case in court.
Silva, who’s been at the UIHC since 2011, noted that he’s been an interpreter for his family since they moved from Michoacàn, Mexico, when he was 10. But that didn’t prepare him for the daily challenges of being a professional interpreter in which ethical, cultural, linguistic and emotional challenges often call for quick decision making skills.
A normal day can range from a routine doctor’s visit for a child with a cold or the joyous birth of a baby to a patient hearing a diagnosis of terminal cancer.
“As interpreters, we’re challenged in various different ways,” Silva said. “You’re hearing all this information in one language and on the spot you’re saying it in a different language. After a period of time it can be taxing on you.”
These challenges are one reason Linda Joyce, testing director at the National Board of Certification for Medical Interpreters in Walton, W.Va., has sought to promote national certifications for interpreters and translators. The National Board's certificate and testing program launched in 2009 and is one of two national organizations that provide certifications.
Joyce said there are 900 certified medical interpreters in the United States and Canada. Iowa is home to nine of those certified individuals.
The UIHC doesn’t require national certification, Silva said, but interpreters go through training to ensure they’re qualified for the medical setting. Silva isn’t nationally certified, but there are interpreters at the UIHC who have received certifications and licenses.
“It’s a skilled job because you have to be able to take a language from a doctor and immediately put it into another language and do this over and over again and have it accurate and complete. It takes a lot of training,” Joyce said.
As national certification is a few years old, Joyce said broad, across-the-board requirements on the federal or state level don’t exist. A few states and health organizations are taking a closer look at certifications, and she envisions being certified will be a regular part of the process for all medical interpreters and translators in the future.“It’s an art, and when you can do that properly and proficiently it’s a wonderful thing,” Joyce said. Patients "can have an encounter almost as seamless as if you were (speaking with) your own doctor.”