Tuesday, May 16, 2006

When language is critical


It's hard enough to explain medical terms and procedures in plain English. Try plain Spanish. Or Arabic, Russian or Korean.

This is the critical challenge North Jersey hospitals face as its population becomes increasingly diverse.

"Providing really good language interpretation is crucial to make a person feel comfortable and to educate them," said Michael Pietrowicz, an administrator at Englewood Hospital Medical Center. "It's a part of the healing process."

In addition to providing forms and educational materials in languages spoken by at least 10 percent of their patients, Englewood and many other hospitals maintain databases of the languages spoken by employees. As a backup, they subscribe to services that provide phone- or video-based live translators, 24/7.

"Some of our staffers are trained specifically as translators," said the Rev. Martin Rooney, director of mission services at St. Joseph's Regional Hospital and Medical Center in Paterson.

"We also have a Spanish-speaking chaplain, a Polish-speaking chaplain and full-time patient representatives who speak Arabic and Spanish."

But the subscription service often comes in handy. Recently, nurses used it to find translators for Hungarian and Vietnamese patients.

"It took just three or four minutes to get somebody on the phone who spoke the language," Rooney said.

At any given time, about 30 percent of the 792-bed hospital's patients are not English speakers. Some speak Indian or Asian dialects. Most prefer Spanish, and a growing number speak Arabic.

"Many of our nurses speak Spanish or Arabic, so any kind of education or orientation can be done by a bilingual nurse," said Pam Schaefer, nurse-manager for the labor and delivery unit. "A lot of the [medical] residents and midwives speak Arabic as well."

In the past, hospital personnel would ask patients' relatives to translate. That's no longer a reliable option since the 1996 Health Insurance Portability and Accountability Act (HIPAA) privacy laws went into effect.

"We need to be careful not to assume we can use family members to translate," said Rooney. "We always ask. And if they say yes, we allow it. But some patients don't want their family to know [the details of their condition]."

Outpatient and support programs must also be accessible to non-English speakers.

At Barnert Hospital in Paterson, nurse and Lamaze instructor Julie Melendez has taught classes for expectant and new mothers in Spanish since 1989.

Spanish childbirth classes are given at Holy Name Hospital in Teaneck, St. Mary's in Passaic and Englewood Hospital Medical Center. Englewood also offers Lamaze instruction in Korean and plans to add a Russian-language childbirth class soon.

Its Visiting Hearts program, which pairs former cardiac patients with people who've just had heart surgery, has Korean- and Spanish-speaking volunteers, said Pietrowicz.

The hospital's speaker's bureau includes physicians fluent in a variety of languages, and its diabetes educators have translated protocols and instructions into Korean.

A variety of health-care institutions are discovering that serving patients of other cultures involves much more than the spoken word.

Because most Arabic-speaking patients are Muslims, St. Joseph's has banned pork products from its menu and respects the wishes of female Muslims not to be touched by males.

Alameda Center for Rehabilitation and Care in Perth Amboy has dedicated units for Hispanic and Indian patients featuring culture-specific decor and cuisine, media services and religious and social activities. Staff members on these units all speak their language.

"We believe that being in a culturally adapted environment promotes physical and emotional well-being," said Sidney Greenberger, CEO of Garden State Healthcare Group, Alameda's parent company.

Food a key component

Just months after the Indian program was implemented last July, its director reported that Indian patients, many of whom hadn't liked the standard fare, all reached a healthy weight on their native cuisine and were generally happier.

Diet is emerging as a key component in caring for non-English-speaking patients.

Since 65 percent of the patients at Barnert's Women's Health Center are Latina, prenatal nutrition counseling is offered in Spanish.

"We see a very high percentage of Hispanic women with gestational diabetes and obesity," said Leny Lopez, a registered dietitian at the center.

Using a Spanish version of the Department of Agriculture food pyramid, Lopez teaches patients to balance their diet and avoid fried and sugary foods.

After they give birth, they may choose nutritious Latino entrees from the hospital menu, such as chicken breast adobo with coconut sauce.

Several other hospitals also have ethnic specialties available.

"The Korean community's cultural beliefs include serving seaweed or miso soups to moms who just gave birth, and we provide that," said Pietrowicz.

Your language spoken here

According to the 2000 census, 67 percent of the families in Bergen County speak English at home, while 10 percent speak Spanish and 4 percent speak Korean, said Richard Fitzpatrick of the Language Access Network, an Ohio-based company that provides video and audio translation services for health-care institutions.

"The country's largest proportion of Korean-speaking people is in Bergen County," Fitzpatrick said, "and there are 80 languages spoken in North Jersey homes. Italian, Polish, Tagalog, Russian, Chinese, Greek and Arabic are next in order of prevalence after English, Spanish and Korean."

Some U.S. hospitals, he said, have 20 or 30 interpreters on staff. About 18 percent of the population -- some 47 million people -- specifies a language other than English as its native tongue.

"If you have just a Spanish interpreter, that won't be enough to meet the needs of people coming into a health facility," Fitzpatrick said.

-- Abigail Leichman


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