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For many immigrants, a mastery of everyday English doesn’t mean they feel comfortable in all settings, like doctors’ offices. That’s where medical interpreters play a crucial role — but access to these highly skilled professionals isn’t guaranteed for many Asian American and Pacific Islander communities. Ali Rogin reports.
Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.
For many immigrants a mastery of everyday English doesn't mean they feel comfortable in all settings like in a doctor's office. That's where medical interpreters play a crucial role. But as Ali Rogin reports, access to these highly skilled professionals isn't guaranteed for many Asian American and Pacific Islander communities.
Bea Hwang, Owner, B Jewelry:
This one is good luck and happiness.
In San Francisco's Chinatown Bea Hwang sells jewelry and other Chinese goods as she has for the last 30 years.
She calls her English halting but she's fluent in salesmanship.
It's Chinese assemble me meaning is a money.
I think the key to my success is my warm and welcoming service. I try to be inviting to my clients and I don't pressure them to buy anything.
In her shop, she strings English together as easily as beads on twine. But outside it's different. Even routine doctor's appointments can feel foreign. So B usually requested interpreter to speak her native Cantonese, a language spoken by over 85 million people worldwide.
They want to call it is essential to have someone who is able to translate for me while attending medical appointments. If there's information I don't understand, it can be pivotal to my health.
Bea is one of about 148,000 or 18 percent of San Franciscans who speak a form of Chinese at home. Almost 90,000 of them have limited English language proficiency or LEP. But B is one of the lucky ones. Many immigrant communities don't have access to the same types of language services.
San Francisco's Chinatown is one of the oldest and largest in the United States dating back to the 1850s. To this day, it's a central hub for Chinese American culture and life. But there are also many resources and services available to this community outside these gates.
Northeast Medical Services or NEMS provides many of those services. At 14 clinics in the Bay Area, 90 percent of their patients are Asian, most are low income and prefer to speak their native language.
NEMS offers culturally relevant care like acupuncture, and routine screenings for conditions that are particularly prevalent in Asian American communities like hepatitis B.
Dr. Amy Tang is the director of Immigrant Health at NEMS. She says screening for and treating hepatitis and other common health care issues here reduces the risk of patients failing to follow up with specialists because of language barriers.
Dr. Amy Tang, Director of Immigrant Health, North East Medical Services: It's really important that we train our providers to manage it in the primary care setting and not have to refer out to specialists every time since it's so common.
Dr. Tang speaks Mandarin and many staff members are at least bilingual. Most of the patients at this NEMS location are Chinese American.
We can also probed further about maybe reasons for reluctance or understand some of the cultural background norms of why they've may be reluctant to try this medication or their fear about a side effect, or their concern about a vaccine.
When doctors and nurses can't speak a patient's language they'll use one of these devices which connect to interpreters over video or the phone but calls can get dropped and wait times for interpreters can drag on past the appointment time.
For instance, I had a patient yesterday who spoke Indonesian. And she of course wanted an interpreter rightly so. There wasn't one available they said they would call back in 20 minutes with an update, and they finally did of course, our visit was already over.
But even patients who speak everyday English can miss out on medical nuances. Melody Schiaffino is a professor at UC San Diego School of Public Health.
Melody Schiaffino, University of California San Diego: If your doctor can't understand you, you can't communicate with them, then you're more likely also not to be able to adhere to the treatment regimen. And so what could be something that we can easily manage or manage with proper care ends up becoming catastrophic in many cases.
That's why the gold standard is in person medical interpreters. Alyes Wong is a staff interpreter at U.C. San Francisco hospital and a certified in both Mandarin and Cantonese.
So I'm going to look in your ears first.
Today she's helping a Cantonese speaking patient get fitted for a new hearing aid. Wong was born in Hong Kong. As a child, her family moved first to England and then to Hawaii. They spoke Cantonese at home.
Alyes Wong, UCSF Interpreting and Translation Services: I think a lot of immigrant kids go through this, where you have to, you know, ad hoc interpret for your mom or your dad, I realized, wow, I think I could help people that way.
She says interpreters have to convey both the words and the intentions and desires of the patient and the doctor that can at times be hard on the interpreters.
You tend to develop something that we'll call vicarious trauma. And that becomes quite, you know, emotionally heavy for me. It's worth it when I realized oh, I was there to provide that communication, that information to them so they can make better decisions.
Wong went through 40 hours of training to get certified as a medical interpreter. But that doesn't account for years of language and medical study.
As a doctor you may be, you know, you go into a specialty and you're you know that specialty inside out. For interpreters, we go to different specialties. We jump from one to the other from maybe, you know, neonatal, and then now we're going to cardiology. And so we have to learn all the basics of those terms.
Natalya Mytareva, Certification Commission for Healthcare Interpreters: It takes pretty much as much time as it takes a person to become a qualified nurse or doctor or in other healthcare.
Natalya Mytareva is the executive director of the Certification Commission for Healthcare Interpreters, which administers the program that certified Alyes. Mytareva says recruiting interpreters is difficult, but it's even harder to retain them.
As they get involved more with healthcare. They see the attraction of becoming nurses, physicians, other health care providers and they just move out after being, you know, in the field of interpreting for three five years.
That helps explain why there are so few highly skilled interpreters in the United States. For example, there are 388 certified Mandarin medical interpreters and 177 Cantonese nationwide for more than 900,000 Chinese language speakers who do not speak English well or at all.
Several laws mandate that all federally funded health care programs provide meaningful access to linguistically appropriate health care. But those are loosely defined terms with few enforcement mechanisms.
We really only get a count of self-reported hospital data that indicates yes, we are offering some level of linguistic and translation services. But the quality of those linguistic and translation services is not necessarily clarified. The problem, I think a lot of times is that the onus and the burden is on the patient. And that is inappropriate because this is already a vulnerable and marginalized population.
Only 16 states directly reimburse providers for language services provided to Medicaid and children's health insurance program enrollees. In 2009, California became the first state to require health insurance companies to cover interpretation services. Schiaffino says more states should follow suit.
I think considering something like that I think would be very beneficial because third party payers are able to really take advantage of these systemic benefits and economies of scale to really organize and deliver these opportunities.
But unless those changes are made interpreters like Alyes play a crucial role in this patchwork system.
You have to be really passionate to do this.
Yes. It's the passion for language. It's for me, it's the passion for language. The passion to you know, also to remember where we came from, and thinking about, you know, how we came — when we first came here, the struggles we had, how do I help the new people come in.
I'm going to look in your ears first.
Because when language isn't a barrier, doctors can focus on their primary job up taking care of their patients.
For "PBS News Weekend," I'm Ali Rogin in San Francisco.
By Ali Rogin, Andrew Corkery
By John Yang, Maa Leni Buhre, Mori Rothman
Ali Rogin is a correspondent for PBS News Weekend and a foreign affairs producer at the PBS NewsHour.
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Maea Lenei Buhre is a general assignment producer for the PBS NewsHour.
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