‘Excuse me doctor, this is your interpreter speaking’

The demand for medical interpreters is increasing.

Laurie Albritton, left, checks whether any clinicians need an interpreter at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Jessica Mayer, right, is studying to be a medical interpreter and Albritton evaluated her skills on April 24, 2018. Photo/Holly Fletcher

The nurse practitioner chatted with a mom about how often an 18-month-old girl eats and plays. She’s a little heavy for a child her her age so the nurse practitioner wanted details about how much milk, juice, protein and snacks she eats.

The discussion turned to what color top is on the milk jug — red or blue — and the nurse practitioner surmised she probably drinks low fat milk because her mother answered blue.

The ordinary conversation in the exam room between the mother, who brought two kids, and the nurse practitioner, Merrill Stoppelbein, flowed through an interpreter, Jessica Mayer who relayed between the English speaker and the speaker.

“Now that the days are beautiful — better — (the kids) spend time outside,” Mayer said after the mom commented on how much outside time her daughter got.

“I love they are getting exercise,” Stoppelbein, who works at Vanderbilt University Medical Center, responded looking at the woman who sat holding an inquisitive 18-month-old with a small ponytail.

“The things you are doing I really like — are really good. We don’t really put babies on diets. Just don’t overfeed her.”

Mayer spoke and the mother nodded. The conversation turned to routine topics around milestones in speech and motor control.

At one point, Mayer, who is studying to be a certified interpreter, interjected herself saying, “excuse me doctor, this is your interpreter.” She had a clarification.

By the time Stoppelbein was asking about weight gain and whether the little girl was putting on her own shoes — just sandals at this point — through Mayer, she’d already used a Portuguese interpreter at an earlier appointment in the day.

Increasing demand for the voice to bridge languages

Interpreters involved in health care are keeping busy these days.

Some days, clinicians at VUMC’s Pediatric Primary Care Clinic at Children’s Hospital use interpreters for 60 percent of their appointments, Stoppelbein estimated.

At VUMC, interpreters watch a live updating spreadsheet and float between floors interpreting conversations about cancer treatments, emergency care, routine appointments and other general paperwork.

As a medical interpreter, “you’re just the voice,” said Laurie Albritton, an interpreter with VUMC who evaluated Mayer.

Demand for interpreters is increasing across the U.S. — and has been for many years in a row, said David Fetterolf, president of Stratus Video in Clearwater, Fla.

Not only are people moving to the U.S., but if hospitals accept money from the government, they need to offer language services at no cost.

The law isn’t new, but enforcement has increased in recent years as The Joint Commission spotlights it as a way to improve quality of care. If a patient has access to a quality interpreter, then the length of stay could fall, which lowers costs, Fetterolf says.

VUMC’s manager of interpreter services, Hope Collins, said that beyond the federal law, health systems struggle with the care they can provide if there’s not a way to bridge the language gap.

If someone shows up in the emergency room there’s a need to both understand what happened but communicate with the patient as well as their family.

“You see it in their faces when you enter the room — a sense of relief,” said Albritton.

Spanish is by far the most commonly interpreted language in the U.S. and Nashville, followed by Arabic. There are regions where other languages such as Swahili or Vietnamese might be in demand locally depending on the diversity of the population.

VUMC has 20 Spanish-language interpreters and five Arabic interpreters.

Siloam Family Health Center has a volunteer staff of 50 people and tries to have at least one Spanish and one Arabic interpreter on site for each shift.

For other languages, the facilities use phone or video connections. VUMC is part of a nationwide cooperative, Healthcare Interpreter Network, that relies on staff interpreters from hospitals around the country.

Collins’ bosses told her “we want you to work on creating a pipeline — not just for us.”

So she worked with Janice Snow Rodriguez, executive director of the Tennessee Foreign Language Institute, to develop a two-semester class that trains students on the rigors of being a medical interpreter and includes a practicum where they get to work in a clinical setting and be evaluated.

There’s demand for quality interpreters and the TFLI has been training court interpreters for years, said Snow Rodriguez. The program would train, at most, 20 a year.

Rebecca Pryjmak, a nurse practitioner at Monroe Carell Jr.
Children’s Hospital
at Vanderbilt, uses a video interpreter to speak with parents about their son’s weight and milestones at an appointment on April 24, 2018. Photo/Holly Fletcher

Medical interpreters have to understand a complex vocabulary and be aware of the limitations of what they know so they can ask for clarification. They can be native speakers of any language but have to pass fluency exams in both English and their second language.

Sometimes people bring family or friends to translate but Collins, clinicians, interpreters and Snow Rodriguez all talked about the pitfalls of having someone without training or familiarity with the vocabulary passing on messages.

“We want to see people not use their children as interpreters or get subpar care. That’s the bottom line,” said Snow Rodriguez.

The TFLI graduates are prepared to get a certification from one of two national organizations. They may find themselves as on-site interpreters but there is a strong chance they will be on contract or work remotely.

Fetterolf estimates the company hires 50 interpreters a month. Stratus has about 1,000 full-time salaried interpreters and 1,800 on contract that work with solo practitioners on up to health systems, including Intermountain Healthcare or Kaiser Permanente, which are both clients, he said.

“We need more interpreters in the country,” Fetterolf said.

Every so often they straddle cultures or a knowledge gap between patient and clinician, said Albritton, recalling a situation when a young boy needed a catheter and the mother was worried he’d be circumcised in the process — which she didn’t want.

“I might have positions open for a long time,” said Collins. “I can’t just hire anyone. This is really tough work. It’s not just a starting out skill level. The pool is very small.”

Interpreting so the essence doesn’t get lost  

Interpreters gave parents on April 24 the ability to pipe up with observations, and wanting reassurance, that being a picky eater was normal and get answers about what to do or when to worry.

The on-site interpreter as well as the one via video were a lifeline to both the clinician and the parents, each relying on an accurate message.

A father laughed at the wording of a response about pickiness — introducing foods now he won’t like could widen his palate in the future, even if it’s a headache when he throws the food.

A mother looked relieved when the nurse practitioner said she liked what she was doing.

Not only did the words travel, but so did the tone and the essence.

“I can’t imagine needing to go to the doctor and not being able to communicate important information for you or your children,” said Mayer.

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