You are in a foreign country. You really have to use the bathroom. You ask the man next to you on the street where to find the nearest restroom. You understand the general direction he pointed, but he is speaking in his native language, and your grasp of that language is rudimentary at best. You don't want to appear dense, so you say a quick "Thank you" and hurry off in the direction he pointed, hoping to figure it out on your own.
It's a situation that almost everyone can relate to. The failure to understand or communicate with someone causes a temporary inconvenience
But what if that communication breakdown took place in a more life-altering location where even the slightest miscommunication could mean the difference between life or death? Like a hospital.
With such a large Hispanic population in a predominantly English-speaking city, it happens all the time.
The Norm in Pima County
Tucson medical facilities have taken a number of steps to provide translation services to Spanish-speaking patients.
Although there is no requirement in Pima County for medical facilities to provide human interpreters, devices such as CyraCom and volunteer medical students from the University of Arizona and Pima Community College help with non-English-speaking patients.
Some speculate that because of the county's proximity to the Mexican border, there is a higher likelihood that nurses or doctors will be Spanish speakers, therefore eliminating the need for paid translators.
However, administrators at Tucson Medical Center decided in 2003 to no longer take Spanish-speaking nurses or doctors away from their duties but instead have trained personnel deal with translation responsibilities, according to Shawn Page, TMC administrator of international services and relations.
"It's very important that patients understand what the physicians are saying," said Julia Strange, vice president of community benefit at TMC. "These decisions are going to affect the rest of their lives."
TMC is the only major hospital in Tucson that employs Spanish translators on a consistent basis. TMC's international services department also has a relationship with the UA and allows students who study foreign languages and are interested in careers as interpreters to shadow and observe professionals at TMC.
"TMC sees the Spanish-speaking community expanding, and we are trying to meet those needs," Page said.
CyraCom
While there is a nationwide program to train certified legal translators, there are no programs backed by the U.S. Department of Health and Human Services to train certified medical translators, Strange said.
That meant TMC had to create its own program.
Spanish is the most common language translated, Page said, but Farsi, Arabic and Russian are other popular languages that need translating.
That's why TMC also uses CyraCom, which translates more than 100 languages.
CyraCom is a device where two phones are connected to a base. The health care provider picks up one and the patient the other. The patient speaks into the phone in any language. The call is then directed to a translator in CyraCom's call center. The translator from the call center speaks the English version of what the patient said into the phone for health care workers.
The average CyraCom translation takes seven minutes, Page said.
Although CyraCom is an efficient way of translating quick questions or comments between patients and doctors, it's used more as a backup device at TMC. Their international service department prefers to schedule face-to-face sessions with patients when dealing with more serious medical situations, Page said.
"Even English-speaking patients sometimes don't understand the discharge instructions," Strange said. "We do anything we can to make sure they understand, because if you don't understand, there's a high likelihood you'll be readmitted, and that spikes health care costs, or even worse."
The UA College of Medicine and Clinica Amistad
Although the majority of large hospitals, including TMC, University Medical Center and St. Mary's Hospital, use CyraCom, not all of Tucson's smaller clinics can afford such equipment.
That's why doctors Tracy Carroll, Alejandra Zapien and Oscar Beita of the UA College of Medicine started an English-Spanish medical translation class for pre-medical students two years ago through the Office of Outreach and Multicultural Affairs.
In addition to class time, students are required to volunteer 30 hours per semester at clinics, usually smaller ones that do not use CyraCom.
"It's all about communication," Beita said. "Describing the symptoms, when they began—it's all vital."
Earlier this year Carroll started working at the University Physicians Healthcare Hospital at Kino Campus. She said the pain intensity scale and body chart sheets at triage were not available in Spanish, so she took copies of the English versions and gave them to her students to translate. She then brought them back to Kino.
"Wherever I work, the first thing I see is that there are no Spanish documents," Carroll said. "It's so frustrating."
Carroll said she has never met a post-heart attack patient who didn't have fear or depression.
As such, the class also trains students about what to expect in terms of emotions patients experience and how to reassure them by being well-versed in background information about recovery.
One of the clinics where students volunteer is Cinica Amistad, 1631 S. 10th Ave. The clinic is open Monday nights and doctor visits are free. If medication needed is in stock, it is provided at no cost. Otherwise, a prescription is given that the patients can fill at a pharmacy.
The clinic is funded by private donations. Everyone who works there is a volunteer, including doctors. But the clinic has been hurting financially, said Carole Spackman, a volunteer coordinator.
A $10,000 grant they normally receive from the Southern Arizona Community Foundation did not come through this year.
"We thought we were going to have to close," Spackman said. "Doctors used to come every week. Now they come once a month because they're too busy with their own practices."
A Day at Clinica Amistad
Ashley Rigas is a 20-year-old junior enrolled in the UA College of Medicine's translation class. She is one of the few students in the class who is not a pre-med student, but there are reasons why a non-medical student would take the class, she said.
"I really wanted to keep my Spanish in practice after getting back from Chile [where I studied abroad last semester]," Rigas said. "I figured if I could help people while utilizing my Spanish, getting experience and be exposed to the health field in general, then the class was a perfect fit."
On a recent Monday night at the clinic, Rigas spent most of her time acting as an interpreter for Patricia Holland, dean of students at the Cortiva Institute School of Massage Therapy, who was volunteering at the clinic that day.
"Is there any specific part that she wants worked on today?" Holland asked Rigas.
"¿Tiene algún dolor específico que usted le gustaría trabajado en hoy?" Rigas asked the patient.
"Mi brazo," the patient said.
"Her arm," Rigas said to Holland.
"What kind of pain?" Holland asked.
"¿Qué tipo de dolor?" Rigas asked the patient.
"Es muy duro aquí," said the patient, pointing to the back of her shoulder.
After the patient received massage therapy, she said her shoulder felt much better. She walked around the room, thanking everyone individually.
"Mi dolor está aliviado," she said with a smile.
"Tell her that she can use a tennis ball at home to simulate the treatment I just gave her," Holland said. "She can put the ball between her shoulder and the wall and slowly roll with it."
"Puede poner una pelota de tenis entre usted y la pared para similar lo que su codo hacía al hombre así," Rigas said as she demonstrated slowly moving up and down the wall of the massage room.
The patient nodded her head, said another round of thanks, and presented Holland with a gift. It was a green, knitted cover for the spray bottle used to wipe down the massage chair.
"That's why I love doing this," Holland said. "They're so grateful."
