Critical Connection

Language isn't the only thing getting lost in the translation as Hispanic patients struggle to communicate with English-speaking ER doctors

"This happened over a year ago, and how many hospitals have this program in place?" Flores says. "As a community person, as a Latina whose parents do not speak English, I think it should have been more of a wake-up call. Why don't these other hospitals have quality trained interpreters?"


Raquel Gutierrez has worked at the Phoenix Memorial ER since 1966. She comes in for two shifts a month these days to stave off retirement boredom. She speaks Spanish fluently, but for the other triage nurses, who do not, there is a single page of Spanish glossary words taped to a cabinet in the triage room.

Maria Burruel must keep records of the patients she interprets for during her shift.
Paolo Vescia
Maria Burruel must keep records of the patients she interprets for during her shift.
Lucy Alday, an interpreter at Good Samaritan, stands at the bedside of a patient to help the woman and her mother understand what is happening and to interpret for the doctor.
Paolo Vescia
Lucy Alday, an interpreter at Good Samaritan, stands at the bedside of a patient to help the woman and her mother understand what is happening and to interpret for the doctor.

"You make do," she says. "Some of the doctors and nurses speak some broken Spanish. Eventually they get the point across."

For the staff here, the idea of a full-time, paid interpreting team at this small community hospital seems laughable in the face of more pressing matters. Like the most dramatic nursing shortage Arizona has ever seen, they say. The ER is overrun with patients, and although beds sit empty upstairs for those who need to be admitted, there are no nurses to cover them. Still, Gutierrez admits that lack of bilingual services can be troublesome.

"If I'm an English-only health-care provider and the patient is Spanish-only, there is always a danger of misinformation," she says, explaining that she has seen charts written by English-speaking nurses that had nothing to do with the patient's complaint. "It will say 'hip.' And I'll ask the patient, 'What's wrong with your hip?' They say, 'Well, it's not my hip.'"

Gutierrez gestures to the page of glossary words.

"These words may sound really nice on paper, and a patient may be shaking their head in agreement but not understanding a word. Three days later they're back in the ER with the same problem."

Dr. Robert Laney is the only ER doctor who speaks fluent Spanish. He picked up the language while doing a Mormon mission in Bolivia. He says the Phoenix Memorial ER handles monolingual patients in a variety of ways. Some bring their own interpreters with them, or sometimes the hospital pulls a Spanish-speaker from housekeeping or registration.

"We get someone to explain on the most basic level what's going on," Laney says.

Phoenix Memorial estimates nearly two-thirds of the emergency room patients are Latino, and public information officer Laura Toussaint-Newkirk says interpreting services are in place to take care of them. The hospital has a grant that provides volunteers from Arizona State University. Their schedules vary depending on availability, and the grant money runs out in December. The hospital also uses staff with other duties and estimates that it uses the telephone service about twice a month.

Neither Laney nor anyone else during a six-hour visit in the emergency room mentioned the telephone services or ASU interpreters.

Hospital officials may think translation services work fine here, but 21-year-old Esmerelda from Zacatecas, Mexico, disagrees. She says there was no one to interpret on her behalf. Esmerelda is pregnant with her first child and had her first experience with American health care at the Phoenix Memorial ER. She was suffering from hyperemesis, a condition in which a pregnant woman is unable to eat and vomits constantly. It leads to dehydration and can be fatal if not treated.

The first time Esmerelda showed up in the ER, she was hospitalized for three days, and because she had no insurance, she was concerned about the bills. As an undocumented person, she wasn't sure what the state would cover for her, and no one could explain it to her clearly.

"I would talk to one office, and one person would tell me one thing; I'd talk to another office, and they would tell me something else. I don't know what to do," she says.

Worried about the cost, she left the hospital after only three days and ended up back there two weeks later, her condition worse. This time she was unable to bring her sister-in-law to interpret, and the hospital had no one available, either.

The doctor wanted to put in an intravenous tube that goes from the arm all the way to the heart. Esmerelda didn't understand what was happening.

"I was weak, almost fainting, and they wanted to put that tube in me. I didn't want to sign anything because I wasn't sure what they were doing to me. I was very scared, I felt like vomiting and I couldn't breathe when I saw the knives and needles they wanted to put in me."

Lack of interpreters can be a legal violation when it prevents staff from getting informed consent from a patient.

"I hardly ever knew what I was taking or what they were doing to me or my baby. There was no point in asking, because they wouldn't understand my question or know how to answer me."

At this time, Esmerelda's bilingual sister-in-law, Christy Junker, was working every day and could not be with her in the hospital.

"I would call to check up on her over the phone, and they didn't know me so they wouldn't give me information," Junker says. "To me this was curious. I know it's a rule of the hospital, but she doesn't know what's happening to her there. She can't communicate with them, and she doesn't have experience in the hospital. Things are different in Mexico."

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