By Kibkabe Araya
California Health Report
Almost 7 million Californians speak limited or no English, and many of them may become insured soon thanks to federal health care reform. Medical interpreters are preparing to be outnumbered by this population while still fighting language barriers.
Of the 2.6 million expected to enroll in California’s Health Benefit Exchange in 2014, 1 million will speak English less than well, according to a study by the California Pan-Ethnic Health Network, UCLA Center for Health Policy Research and UC Berkeley Center for Labor Research and Education.
Medicaid, or Medi-Cal in California, will accept recipients with incomes up to 133 of the federal poverty line. Nationwide, 34 percent of the 11 million future Medicaid enrollees may need an interpreter, the PricewaterhouseCoopers Health Research Institute reported.
“Every area has a shortage of medical interpreters,” said Bill Glasser, CEO and founder of the Carmichael-based Language World Services, California’s largest interpreting and translation agency, which manages 200 appointments a day with almost 150 interpreter employees speaking 45 languages. “For example, there are refugee populations in San Diego County from Iraq, Somalia, Ethiopia. We have people from all over the world but just not that many trained interpreters for this.”
Spanish remains the most requested language in California, followed by Chinese languages like Cantonese and Mandarin, Vietnamese and Korean, the Census Bureau reported.
Los Angeles County, for example, has more than 6,000 board-certified physicians who speak Spanish with 1.7 million Spanish speakers who speak limited English. In Alpine County, the county with the smallest population, there are 12 Spanish speakers with limited English and one out of the two physicians there is fluent in Spanish. The other 56 counties have varying multilingual populations with a varying number of interpreters.
“What happens is you get a concentration of a particular population,” said Ellen Wu, CPEHN executive director. “In the Central Valley, there’s the Hmong population. The refugees are there, but it’s hard to get enough interpreters trained.”
Interpreters must pass fluency tests given by language service agencies, health centers, education programs and interpreting and translation organizations. They speak the language with patients while medical translators convert text into other languages for visual materials.
Some medical centers like Kaiser Permanente and Dignity Health have interpreters, but sometimes there’s not enough bilingual staff to meet the demand of patients, so they still depend on language service agencies.
“The customers I serve are very interested in providing high-quality care between the physician and patients,” Glasser said. “It’s been shown when you don’t have an English speaker, it makes it hard. They become a burden of the system.”
Every day as an interpreter is touch and go, according to Ttzol Lopez, a Spanish interpreter at Language World Services. She could drive to a scheduled appointment in Fair Oaks then go to an unexpected emergency room visit in West Sacramento.
“It could be someone with the flu who needs to take medication and they’re not sure if they should take the medication, or it’s someone who’s dying and you have to tell the family,” she said.
Health care reform, Lopez said, has made some of her clients aware of their rights.
“Before, it used to be people saw an interpreter as a favor. No matter how good or bad the job is,” she said. “They were happy to get it, but now they’re requesting professional interpreters because they know these places have to comply with those services.”
State law requires all health plans to provide an interpreter in-person, by telephone or through videoconferencing. Health plans must also provide translated written materials such as letters stating eligibility.
For now, the uninsured can get free or low-cost care at community health clinics. Some nonprofit clinics can afford to use language service agencies while others have a bilingual staff or create a volunteer database like the Shifa Community Clinic in South Sacramento.
Fifteen patients are expected on a Sunday morning at Shifa, and a third of them will need a Spanish interpreter. That’s where UC Davis senior and interpreter Imran Masood comes in.
“Previously, our clients were South Asian, Indian and Pakistani. People from that demographic were more inclined to come to our clinic,” said Masood, who studies neurobiology and Chicano studies. “But then we started to get more people from other groups. It’s starting to even out.”
Shifa, which means ‘healing’ in Arabic, is the UC Davis School of Medicine-affiliated health clinic for the area’s Islamic community, but a melting pot of religions, cultures and languages defines the surrounding neighborhoods.
While Hindi, Punjabi and Urdu remain prominent in its uninsured clientele, the clinic makes sure there are student interpreters who can speak languages like Spanish, Bosnian and Arabic when needed.
The diverse pool of volunteers helps the clinic with outreach efforts, but the job of an interpreter will always be trial and error.
“It’s never going to be 100 percent perfect. Sometimes, we have patients who don’t know what we’re talking about,” Masood said. “Having the service is to overcome the language barrier. Not only does it help on a comfort level, but it also helps the patient relate a little better.”