Corona Daily 106: Does Your Doctor Speak in Your Language?

Lourdes Cerna, 58, goes to her desk in the living room at 5 am with a hot mug of tea. She lives in Los Angeles. As soon as she logs in, the calls start. That day, the first call is from Texas. The doctor on the other side speaks about the lady patient who is struggling to breathe.

Please tell her if she doesn’t agree to go on a ventilator, she will not survive the day, says the doctor. Cerna faithfully translates it in Spanish. You may use your own words, the doctor says. Cerna asks the lady about her family, and tells her that her grandchildren will be happy to see her back. The lady is determined. This is the end; she doesn’t wish to go back. Cerna says bye to her, translates everything to the doctor. Moves to the next call in line.

Cerna is a professional medical interpreter. Before the pandemic, she would be in the hospital room talking face-to-face with a patient. She misses it now. But for a whole year, she has been working fifteen hours a day. USA’s different time zones make the working day longer. For many patients, she was the last person they spoke to. She also often needed to call the relatives to deliver the worst possible news.

Professional interpreters are expected to do their job keeping emotions aside. But Cerna has a handkerchief and a bottle of solution to clean her glasses next to the computer. There have been dozens of days at the end of which she sat there drained, crying alone.

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Dr Alister Martin faced his patient, a Hispanic man who spoke no English. Speaking clearly, he told him he would be intubated. He asked the patient, a bus driver and a father of three, to call his wife, give her his love and say goodbye. Then Dr Martin held the phone closer to the patient’s ear. The interpreter translated everything Dr Martin had just said.

At the Boston hospital, the quality of care for non-English speaking patients has deteriorated. “Someone’s oxygen is dropping, I have to get an interpreter on the phone, put in an access code, tell them where I am.” Dr Martin said. “It’s hard for the patient. Imagine you’re in a loud room with a mask blowing oxygen in your face at fifteen liters a minute and you feel crummy. You can’t comprehend things much.”

Normally, non-English speakers have some family members who can speak English. They hold hands, help with translation. But in covid times, family visits are barred.

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In nations with a single language, this problem rarely arises. But in countries such as the USA or Canada or Australia, with a large number of immigrants, not having a common language with the doctor or nurse can spell the difference between life and death. USA has 65 million people who speak limited English. The language discordance undermines communication and trust, and leads to suboptimal care, less understanding of the diseases and treatments, and difficulties in joint decision making. Patients end up staying longer at the hospital, and more likely to return there.

In a detailed study one hospital found something shocking. Even among the Hispanic covid patients, those speaking only Spanish had a 35% greater risk of death.

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USA has a legal requirement to have medical interpreters. But it is what is called an “unfunded mandate”. The certification is not strict, and remuneration is not specified. Once the pandemic began, the role of medical interpreters was so underestimated that initially no PPEs were ordered for them. Many of them now work from home, like Lourdes Cerna does. It’s not easy, because many patients are breathing with effort, coughing or their voices are muffled. Richer hospitals are trying to get i-pads and microphones for the patients. Some hospitals are consciously employing Spanish speaking doctors to attach to each medical team.

The relatively lucky patients speak their last words to the interpreter on an i-pad in their own language before dying. Others who have no common language with the attending doctors die silently.

Ravi