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“May I borrow you for a second? The patient over there speaks Mandarin,” the emergency room doctor kindly asked me. I would always encounter a couple of Chinese immigrants when volunteering at the Emergency Department at Bellevue Hospital in New York City before the coronavirus swept the whole city.
Most of the immigrant patients at the ER don’t speak English, let alone intricate medical terms. Amid a medical emergency, the patients would have already been in physical distress.
Yet, the language barrier further obstructs the building of trust in the intense and high-stakes clinical setting. With 4.4 million immigrants living in the Big Apple, how many of them have shied away from seeking medical help? How many of them have felt clueless and disoriented in the ER? How many of them have been silenced and lost the autonomy of their own body?
The overarching concept of “immigrants” often makes people overlook the heterogeneous makeup of the immigrant community. Different socioeconomic positions coexist among the people who speak the same language. First, let us define the term: immigrants.
The Immigrant Demography
Immigrants often refer to those living in a country other than their birth country, including naturalized citizens, permanent residents, refugees or asylees, those with twilight statuses such as DACA, and unauthorized immigrants. In 2018, 24% of the 27.9 million nonelderly uninsured residents were noncitizens, and 6% were naturalized citizens across the entire country.
Source: KFF analysis of 2018 American Community Survey.
The uninsured immigrants do not have regular access to primary care doctors. They use the ER as their primary care. Building an immigrant-friendly ER will tremendously improve their health and promote the healing process.
Having an on-site interpreter team residing in the hospital would be the first step to address immigrant health. When interpretation is needed, in-house interpreters can be physically present with the patients.
Data has shown that 64.47% of the New York area population speak English; 19.4% speak Spanish, and 3.10% speak Chinese, including Mandarin and Cantonese. The percentages almost perfectly align with my volunteering experience at Bellevue Hospital. Thus, having an on-site interpretation team consisting of one interpreter speaking in Spanish and one speaking in Mandarin or Cantonese would suffice.
Immigrant-Friendly Ers Won’t Be Able to Get By on Just Over the Phone Translation
People may say that having translation phones would be enough to fix the problem. But in reality, that’s not the case:
If you step into the emergency room at Bellevue Hospital, you would see many blue phones with two headsets connected to the telephone keypad, evenly spaced out over the entire counter.
To use the phone, the physician and the patient hold each handset simultaneously. Then the physician would dial the number to invite a medical interpreter to the conversation. Unfortunately, the big weird-looking blue phones with two handsets and having three stranger parties speaking at the same time are not living up to healthcare workers’ expectations. They describe the phones as “funky”. The patients often appear clueless when talking to the faceless interpreter over the phone and rarely look at the physician.
Scientific research has shown that nonverbal communication plays a more critical role in interaction. People can pick up gestures, facial impressions, and body language to establish trust so that sales are closed, intimacy is built, and even a political election can be won.
Moreover, the existence of translation phones can, in fact, negatively impact the delivery of healthcare in some way. When the doctor and the patient engage in a conversation, they no longer make eye contact but look down at the floor or in other directions. Most of the time, the translator has trouble hearing the other two parties, and ambiguity is a huge problem when a doctor makes inquiries about a patient’s medical history. Without being physically present between the doctor and the patient, the conversation’s nonverbal aspect disappears. There is no trust or mediator agency within the doctor-patient dyad, which results in a lose-lose situation for all parties.
On the one hand, the patient is entirely silenced and blindly trusts the institution would do him or her good as they are unable to advocate for their health. On the other hand, the doctor experiences frustration and impatience because they cannot clearly understand the patient.
That’s Why…
Having a small team of translators available to make an appearance is the first step to building an immigrant-friendly ER. A paid medical interpreter’s hourly rate is about $30.74, a worthy investment to improve the quality of care, patients’ satisfaction rate, and productivity to mitigate the drastic health disparity.
As in many private healthcare services, many international medical travelers speaking another language would have a personal interpreter accompanying them throughout the entire process from landing at the airport to signing consent forms. More importantly, it’s just a humane gesture, which should lie at the core of the healthcare industry.
