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Healthy communication; Translators for patients who don't speak English often are in short supply

By: By Ann Potempa, Anchorage Daily News - March 12, 2002 Tuesday

Chong Vang moved his family to Anchorage because he thought the change in environment might help his wife's diabetes. When the family arrived from California five months ago, Vang and his wife, Ia Vue, went to the Anchorage Neighborhood Health Center. The Hmong couple tried to communicate on their own, but Vue doesn't know any English and Vang knows only small words. After two visits, the health center physicians asked if they wanted an interpreter. Vang and Vue didn't even know that was an option. The next time they came in, so did Mindy Moua, a Hmong interpreter from Anchorage. With Moua present, Vue realized why she'd been feeling so bad.  The label on her bottle of diabetes pills read, "Take one tablet by mouth twice daily." Vue misunderstood and took both pills at once. That made her feel shaky and weak. She struggled to concentrate. She didn't like the side effects, so she stopped taking the pills. Moua helped Vue realize she should be taking one pill in the morning and one at night, which eased the side effects. The Anchorage Neighborhood Health Center clinics in Fairview and Mountain View have only three interpreters other than Moua, speaking Chinese, Russian and Thai, said Lynn Upton, the center's operations director. And it's not a problem only for medical providers. Alaska's public defenders sometimes struggle to find interpreters for their clients. Public defender Barbara Brink has sometimes had to call on church organizations and community groups.  Yolanda Salazar Hobrough, a free-lance interpreter from Vancouver, British Columbia, who translates in Anchorage's federal court system, is surprised by the lack of interpreters here. She said she's worked with interpreters flown in from as far away as Florida. Some medical offices hire doctors who can speak two languages; public defenders use long-distance numbers to get translation over the phone. Sometimes family members, even kids, end up translating. Joan Fisher, executive director of the Anchorage Neighborhood Health Center, said clinics like hers need to do better. To do that, they must have access to medical interpreters who speak Spanish, Tagalog, Korean, Samoan or Hmong. They must find interpreters who understand medical terms and patient confidentiality. Fisher and Salazar Hobrough have teamed up to teach them. People interested in becoming medical interpreters can attend an orientation session Saturday at the University of Alaska Anchorage. Salazar Hobrough will talk about medical interpreting and give a written test. "You really have to be able to read the language as well as interpret the spoken word," Fisher said. Those who pass that test will be invited back to take an oral test. Those who pass both tests will be eligible for a 48-hour training course sometime this spring or early summer.

FOLLOWING THE LAW Medical facilities that receive grants or other federal financial aid must provide equal access to English and non-English speakers or run afoul of the Civil Rights Act of 1964. The Anchorage Neighborhood Health Center, which receives $2.5 million in grant money annually as well as Medicare and Medicaid reimbursements, is required to comply. Fisher admits some doctors consider this law an unfunded mandate. She understands that providing interpreters can get expensive, but there's more to it than money. "We're probably the poorest clinic in town, but it's the law," she said. About one-third of the center's 17,000 patients last year had limited English-speaking skills. Fisher remembers how some of those patients walked into the clinic without an appointment only to discover that no one speaks their language. "This one poor man came five times before we could figure out what language he was speaking," Fisher said. Some who struggle with English end up avoiding the doctor. When Helen Lee moved to Anchorage last fall she got a message from her mother, Wai, who used to live in Hong Kong and now works as a medical interpreter in Minnesota. One of Wai's old clients had moved to Anchorage but kept calling Wai for help, even though they lived thousands of miles apart. "She said she didn't know where to go," Wai said. Wai asked her daughter to call the woman and help her. Lee learned the family hadn't seen doctors because they didn't know whom to call. Hmong families in Anchorage likewise have had to take the initiative. Newcomers seeking translators have searched through the phone book for a Hmong last name. Moua said some have found her that way.

ROOM FOR MORE Health facilities in Anchorage are providing translation in different ways. The Alaska Native Medical Center and Providence Alaska Medical Center say their interpreter programs meet their needs. Indian Health Services pays the cost of hiring three advocates who can interpret for any Yup'ik patient at Southcentral Foundation's Primary Care Center and the Alaska Native Medical Center. Angie Peterkin, support coordinator, said the advocates visit every inpatient room daily and attend doctor appointments when needed. They work full time and carry pagers so an interpreter is available 24 hours a day. Peterkin said the interpreters specialize in Yup'ik because it's the prevalent language among Native patients with limited English. Interpreters also are available to help people who speak Inupiaq. Providence hospital keeps a list of people on staff and in the community who can interpret. If physicians can't find an interpreter, they call a telephone service, said Karina Jennings, hospital spokeswoman. The Anchorage Neighborhood Health Center also uses a long-distance telephone service that offers translation in 120 languages. "That works in a pinch, but that really is not the best way," Fisher said. Translator phone lines can be costly. The health center pays $1.95 a minute for its service, said operations director Upton. Fisher said she'd prefer to use more trained interpreters. During the past eight months, the health center spent almost $ 7,000 to hire interpreters, Upton said. This option is more expensive than using family members who volunteer to help, but Upton believes patients are better served by interpreters who aren't related to them. "Children should never have to be put into a position where they're interpreting for a parent or an adult," she said. Children or other relatives might filter the information, not telling the doctor the whole story. Sometimes they don't know enough medical terms to tell the story accurately. Other times, relatives aren't comfortable talking about health problems in front of family. "If you're talking about something embarrassing, do you want your 9-, 10- or 11-year-old to hear it?" Fisher said. If a Hmong mother was worrying about a lump in her breast, she might not want to tell her child that, Moua said. Even if she did say something, the child could be too embarrassed to translate it. Moua said independent interpreters like her offer something children can't. "I'm an adult," she said. "I will tell them to speak freely. I will translate what they will say to the doctor." Moua said more and more Hmong families are moving to Anchorage; Vang and Vue guessed some of them are suffering without interpreters, just as they did before meeting Moua. Moua admits she could use some help from other medical interpreters. There's room for more, she said.

Reporter Ann Potempa can be reached at or 907-257-4581.

BECOME AN INTERPRETER The Anchorage Neighborhood Health Center is organizing an orientation and training program for medical interpreters. The $35 orientation will be 9 a.m. to 1 p.m. Saturday in Room 101 of the Business Education Building at the University of Alaska Anchorage. A written exam will be given. Those who pass will be invited back for an oral exam. People who pass both exams can attend a 48-hour training course that will begin this spring or summer. The cost for the training course has not been set, but scholarships may be available. The center wants people to register for Saturday's orientation as soon as possible. Forms can be picked up at the center's administrative offices, 903 W. Northern Lights Blvd., Suite 218. For more information, call 907-792-6538. GRAPHIC: Anchorage Daily News Ia Vue, left, and her husband, Chong Vang, have medical forms explained to them by Hmong interpreter Mindy Moua at the Anchorage Neighborhood Health Center in Fairview.Moua, right, regularly helps people whose lack of English skills causes them difficulty in getting health care., Photos By Bob Hallinen