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Interpreters help heal through communication by Tim Gehret Public Relations In a small office space, seven floors above the commotion of the North Tower lobby, healing happens through spoken words.   Those who work here don’t wear white coats. They don’t diagnose illnesses or write prescriptions. The walls of their cubicles are not lined with medical degrees. But to the patients with whom these men and women come in contact, they are beacons through the all-too-often complicated world of health care offering comfort and peace of mind.   These patients speak little-to-no English. Most of them are of Hispanic descent. The recent immigrant population boom in the Lowcountry has caused MUSC to expand its translation service to bridge the communication gap during often critical times.   “When someone comes in and can’t communicate with the health care provider, the interpreter shows up and they (the patient) are so happy to see them,” said Karen Rankine, R.N., MUSC’s coordinator of Patient/Family Education and Interpreter services.   Suyapa Germain, a bilingual administrative assistant originally from Honduras, is one of 13 approved Spanish interpreters at MUSC. Each day, at 8 a.m. sharp with a headset strapped to her head, arms herself with a pen and notepad and positions herself in front of a computer screen surrounded by clusters of Post It notes. The demands of the job provide little downtime.    “Usually I have people trying to make appointments or speak with a doctor,” Germain said.   The first official interpreter at MUSC was hired in August 2001. Until then, “Language Line,” a telephone interpretation service that provides a three-way conversation via speaker phone, was sufficient to handle the needs of the Spanish-speaking patients. At that time, the number of patients using this MUSC service was not tracked.   “It used to be that the Hispanic community consisted primarily of seasonal migrant farm workers,” Rankine said. “Now they’re permanent residents.”    And like the rest of the region’s population, this segment also is growing along with its needs for health care. To meet that demand while assuring quality care, MUSC is hiring more interpreters, who make around $30,000 a year depending on education and experience.   In fact, the number of Spanish-speaking patients seen monthly at MUSC has more than doubled, increasing from 792 in January 2004 to 1,979 in March 2006.   Jason Roberson, a doctoral candidate at Penn State University, taught college-level Spanish for 11 years and now, in addition to teaching Spanish at MUSC’s College of Nursing, works 16 hours a week as a medical interpreter and the hospital’s cultural competency coordinator. “I taught college for 11 years and I enjoyed my job,” he said. “But with this, you really feel like you’re helping people in the moment.”   Roberson said that when it comes to addressing a person’s health, hospitals can no longer rely on the employee or student who took a few years of Spanish in college.   “Communication is the key diagnostic tool in medicine,” Roberson said. “It’s becoming a legal liability. There have been several lawsuits in other states where an interpreter was not used or an unqualified interpreter was used.”   Clear translation also is a significant patient safety issue, Rankine said. For that reason, MUSC has the following policy on foreign language interpretation services: The MUSC Medical Center will provide foreign language interpreter services 24 hours-a-day at no cost to limited English proficient (LEP) patients during their course of medical treatment. All health care professionals discussing care, treatment or services with an LEP patient or family must use MUSC approved interpreter services. The use of an interpreter must be documented in the patient’s medical record at every visit or hospitalization. Persons under the age of 18 are not qualified as interpreters. Only employees, medical staff (including physician assistants, nurse practitioners and certified registered nurse assistants) house staff, students and volunteers who have successfully completed the competency screening for Spanish or the approved Foreign Language Competency Letter of Disclosure for any language may communicate with LEP patients in the patient’s native language. The only exception to this policy may be in a life-threatening situation in which the patient/legal surrogate is unable to participate in the use of the language line.   One of the policy’s primary functions is to prevent miscommunication. “A lot of people think they speak well and they do speak well; they just don’t have the necessary medical terminology,” said Roberson.   To complicate matters, at least 20 different dialects of the Spanish language exist. And, in some cases there are no direct Spanish-English translations. For instance, sickle-cell anemia, a disease that is not prominent in Hispanic populations, has no direct English-Spanish translation. “The translation is ‘anemia de celulas falciformes,’ which means ‘anemia of malformed cells,’” Roberson said. “We aren’t afraid to carry our medical dictionaries with us.”   Germain recalls difficulty communicating chicken pox to a parent. The Spanish term, varicela, is the word generally used to translate chickenpox.     “[But] varicela is not a literal translation,” she said. “You either know it or you don’t.”   MUSC follows the National Council on Interpreting in Health Care’s (NCIHC) national standards of practice. The council’s primary function is to improve communication and access to health care for LEP patients through a combination of public and private funds. Their standards of practice emphasize accuracy, confidentiality, impartiality, respect, cultural awareness, role boundaries, professionalism, professional development, and advocacy.   Despite the NCIHC standards for qualifying interpreters, no national certification exists. MUSC approves interpreters with a language competency screening so that interpreters are able to meet the NCIHC standards. MUSC’s policy A-30 requires that bilingual staff take the language competency screening.   Spanish isn’t the only language needing interpretation. Portuguese, the native tongue of Brazil as well as Portugal, has emerged with greater regularity. Because Portuguese interpretation needs are growing, interpreter services is seeking a part-time interpreter for this language.   For information contact the department of Interpreter Services at 792-5078 or visit http://www.musc.edu/interpreter.     Friday, July 7, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.