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For Faiza Aziz, one moment at work earlier this year encapsulated the confusion going on in the first weeks of the COVID-19 pandemic. It also underscored both the importance of her position as a medical interpreter and the industry’s uncertain direction.
Faiza, at the time, interpreted for Somali-speaking medical patients at Hennepin Healthcare in downtown Minneapolis. An elderly man on his third day of hospitalization with a suspected COVID-19 infection needed her help. Safety restrictions prevented her from being in the room with the man. But Faiza could still pick up some of his visual cues while interpreting for him through the camera during an online video visit.
She noticed the man wasn’t talking much to the nurse during a routine conversation. “He was very weak, very lethargic, and didn’t seem like he wanted to answer any questions,” Faiza said.
Picking up that something was getting lost in translation, Faiza asked the nurse if she could interject. After getting the OK, Faiza asked the man if he felt all right.
The patient subsequently opened up to her, telling her he had not eaten all day. He told her he felt that his blood sugar was dropping and that he felt very tired. He explained that nobody had asked him if he wanted to call his family.
“‘’I feel like I’m just going to die in this place,’’” Faiza recalled him saying. “‘‘I don’t want to die in here. If I’m going to die, just discharge me and let me die at home with my family.’”
“It really touched me because this is someone who is elderly,” Faiza said. “This is when they need their family the most.”
It’s these nonverbal cues that medical interpreters like Faiza fear they’ll miss as online and phone interpreting replaces in-person interactions. Faiza, who recently left her job to pursue medical school after working at Hennepin Healthcare for more than 15 years, said she still prefers in-person medical interpreting for patients, even during the pandemic.
“Language in itself is nuanced and communication is nuanced,” she said. “Hospital visits are highly sensitive and nervous times for patients, no matter what language you speak.”
The medical interpreting industry was already headed toward more video and audio meetings even before COVID-19. But the pandemic has dramatically accelerated that transformation. Now, several interpreters say they’re worried that the changes could leave some patients behind.
Medical interpretation now feels ‘more like a call center’
Roughly 3,000 professional interpreters work with immigrants and other medical patients who don’t feel comfortable communicating with caregivers in English, according to the Minnesota Department of Health. The majority of them interpret one of the 20 most common languages spoken in the state, a list that includes Hmong, Somali, and Spanish—and also Russian, Karen, and Oromo.
Most health interpreters in the state work as contractors for third-party companies like Kim Tong and Intelligere, according to MDH. A smaller number work directly for health care providers.
Hennepin Healthcare, formerly known as HCMC, is one of the few providers that employs unionized medical interpreters. Santiago Morgan, one of those interpreters, has been translating for patients for the past 23 years. As unit chair for the unionized medical interpreters at the Minnesota Newspaper and Communications Guild, he’s also a strong advocate for in-person interpreting.
Before the pandemic hit, Hennepin Healthcare guaranteed its interpreters at least four hours of in-person interpreting per shift. COVID-19 changed that.
Morgan, for example, now does all of his interpreting for Spanish-speaking patients remotely from his unfinished basement, where he just added a space heater to keep warm. He went from interpreting for roughly 10 to 12 patients each shift to twice as many now. The result—more minutes spent interpreting per shift—may be pleasing to his employers. But Morgan said he worries that patients are losing part of their care.
As an example, Morgan recalled recently interpreting over the phone for a COVID-19 patient whose doctor was asking him whether he wanted to be put on a ventilator.
“The patient was struggling to breathe, and the doctor was having, it seemed, an end-of-life discussion with him,” Morgan said.
He worried that the human element of such an important conversation could have been getting lost over the phone.
The change in work can also be hard on interpreters. Hennepin Healthcare interpreters doing in-person appointments would get roughly five to 10 minutes between each patient to regroup and prepare.
“The style now is it’s more like a call center,” he said. “Before I finish documenting my last call, the phone is ringing again.”
‘We would be the perfect vessels of infection’
As far back as five years ago, hospitals and healthcare clinics began pushing for remote interpreting to fill growing demand from patients seeking these language services. This prompted providers and third-party interpreting agencies to establish remote interpreting networks to share resources and costs across the country, according to a 2015 MDH report.
Idolly Oliva, director of language services at M Health Fairview, said healthcare companies established remote access for interpreters to meet a section of the federal Affordable Care Act that prevents discrimination against patients. Language falls under this section of the law, she said.
The increase in remote technology extended interpreting services to patients who may not otherwise have received them—especially in rural areas. But the shift also drew concern from interpreters.
Interpreters, according to the 2015 report, worried about technology malfunctions and elderly patients running into trouble using the technology. For their own part, they worried about missing nonverbal communication from patients and medical providers.
Oliva, however, suggests that overall, the introduction to remote interpretation has worked in patients’ favor because they now face fewer barriers to health care.
“When you look at overall accessibility, certainly the benefits outweigh the risks,” Oliva said.
She acknowledges that the rapid switch to remote work during the pandemic presents challenges for interpreters. To help them deal with the new normal, Oliva said Fairview works with interpreters to make sure they take breaks, encourages them to voice concerns during “department huddles,” and provides resources for self care.
As for whether the future will include increased remote interpreting work after the pandemic, Oliva said it’s too early for health systems like Fairview to decide. The next six months, she said, “will be telling.”
During the start of the pandemic, Morgan said he felt conflicted about switching completely to phone and online video interpreting. At one point, a nurse instructed him on how to wear personal protective equipment while working with COVID-19 infected patients.
“She said, ‘I can show you how to do this, but if there’s any way you can avoid going into those rooms, you should,’” he said.
Soon, he found himself reporting to the office and then being sent to a cubicle to do his interpreting remotely. He caved to circumstance and decided to work at home.
To Mauricio Montes de Oca, who’s been translating for Spanish-speaking medical patients for 19 years, the current workplace situation feels like a dilemma. He believes patients benefit most when the interpreter visits with them in person. He also understands the need for current restrictions and doesn’t want to catch COVID-19 and spread it to medically vulnerable people.
“That’s a recipe for disaster,” Montes de Oca said. “We would be the perfect vessels of infection, especially if any of us happen to be asymptomatic.”
Before the pandemic, Montes de Oca conducted about 10 percent of his interpreting on the phone or through online video. That rate jumped to three-quarters of his work now. During the most restrictive days of COVID-19 earlier this spring, he conducted his work exclusively online or over the phone.
Now working mostly out of his home in Woodbury, Montes de Oca worries about missing visual cues that can make a difference for patients. A simple facial expression, he said, can reveal whether the patient is understanding information coming from the doctor. Even using video, Montes de Oca is usually only seeing one face.
If a medical provider and a patient don’t speak the same language, he said, it can lead to a disconnect between the two. Interpreters help bridge that gap, and in-person interpreting helps interpreters develop a rapport with doctors and nurse practitioners over time.
“It doesn’t have to be a friendship where we’re hanging out outside of work, but we have a relationship,” he said.
This in turn prevents situations where the medical provider is disrespectful to the patient, Montes de Oca said.
From six appointments to 25 appointment a day
As with Morgan, more phone and online video work means interpreting for more appointments. Before the pandemic, Montes de Oca said he’d interpret for five or six in-person appointments each day. Now, he does between 20 and 25.
Like Morgan, the increase means less time for Montes de Oca to recharge between appointments. Montes de Oca said he worries about a future where interpreters won’t have time to decompress between, say, interpreting for a dying patient and interpreting for a mother about to give birth.
“Now they are laughing and you were just crying,” he said.