How medical interpreters break down language and cultural barriers in health care

By Roxanne Cooke

For administrative assistant Irene Losoya-Orozco, becoming an interpreter at work was a no-brainer. She speaks Spanish in addition to English and has been informally interpreting for years for her parents, who are from Mexico.

“Growing up, your parents take you everywhere to help them understand the language,” says Losoya-Orozco, who works at the MultiCare Regional Cancer Center at Tacoma General Hospital. “I’ve been interpreting since I was a kid.”

MultiCare now offers an interpreter certification program for employees like Losoya-Orozco who speak a second language. Through the Qualified Bilingual Staff (QBS) program, certified employees can be called upon to act as interpreters between providers and patients.

To become certified, employees attend a three-day training and must pass a language proficiency test. The training covers not only language, but also cross-cultural communication skills and the ethics of interpreting.

The QBS program adds to existing interpreter services offered to MultiCare patients: Staff members can formally request an interpreter in advance. If an in-person interpreter is not available through the vendors MultiCare uses, either remote video interpreting or telephonic interpreting is offered.

In the Puget Sound region, MultiCare receives an average of 250-300 requests for interpreters daily.

Where do QBS interpreters come in? They can be called upon if an interpreter wasn’t ordered in advance, or if an interpreter fails to show up to a scheduled appointment.

“It’s best practice not to use family members,” says Deborah Rader, MultiCare’s interpreter services manager who coordinates the QBS program. “We try to get patients a separate qualified or certified interpreter.”

QBS interpreters remain in their home work area and can only be asked to assist during their scheduled work hours, so they won’t have to travel far. Many are working in clinical roles, but it’s not a requirement. Employees are paid a regular stipend for their services.

Through the combination of third-party and employee interpreters, about 30 languages are covered, Rader says. The top language requested: Spanish. The second-most requested language varies month to month, but Russian, Korean, Vietnamese and Arabic are common.

But it’s about more than language, as demonstrated in the cultural competency portion of the QBS training, Rader says.

“A lot of cultures have different belief systems and ways of communicating,” she says. “So you can miss a lot of information being conveyed if you don’t study the cultural aspect of communication.”

QBS interpreters often act as “cultural brokers” in addition to language interpreters, Rader adds.

For example, in the Vietnamese culture, a person may believe they’re sick because someone has bad feelings toward them, she says. A provider may not understand this, so an interpreter could explain.

“If people don’t understand a culture, they’re not going to pick up on some of those cues and nuances that someone who is from that culture would understand,” Rader says. “Part of having the QBS program is to connect with our community in a way that makes them feel safe and comfortable when they come to an appointment. If they know that someone in that clinic speaks their language and knows their culture, that’s going to put them as ease and make them more willing to come back.”

Michelle Ponce, a scheduler for the Tacoma cancer center, takes great pride in helping her Spanish-speaking community.

A native Spanish speaker, Ponce had a difficult time learning English as a child — and now wants to pay it forward. She had a “rude awakening” when an unkind teacher gave her a hard time.

“I can relate to families who don’t speak English,” she says. “You don’t have to be demeaning or talk loudly. Most people understand what you’re saying but can’t express it back to you. Helping them to get their point across and get their needs met makes me feel useful.”

Ponce faces some challenges gaining trust from her community because she doesn’t look Hispanic, she says. It’s helped her be more forward with her intentions and in demonstrating that she’s there to help — and as a result, her community spreads the word about her. She even gets recognized by her voice now.

“I think I’ve gained more than I’ve given,” Ponce says. “When people allow me to step in and interpret, I feel selfish because I get to see things others don’t see — how doctors treat patients and how they break bad news. It’s a big impact in my life, getting to see everything behind the scenes. It’s a privilege.”