Interpreting Health
By Rhonda Mullen
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When Eduardo Garcia was growing up, in El Paso, Texas, he often went with his grandmother to her doctor's appointments to help interpret for her.
Having recently emigrated from Mexico, Garcia's grandmother was still learning English, and her young grandson would give her the highlights of what the doctor was saying. However, these years later as a chemistry major at Emory, Garcia realizes that his attempts at interpretation were flawed. "I should have translated word for word," he says. "And some things were too personal to communicate. The situation needed an unbiased third party who could interpret."
Garcia's insights come after more than two years of working to help establish the Emory University Volunteer Medical Interpretation Services (EUVMIS). One of the first service-learning programs in the country to train graduate and undergraduate students as medical interpreters, EUVMIS grew out of observations by medical students and undergraduates who volunteered at free clinics in Atlanta. There never seemed to be enough medical interpreters to go around at these primary care clinics that serve a diverse and international community of the working poor.
The medical students who ran the clinics played catch as catch can and drew in anyone with foreign language skills—particularly in Spanish—to help. But untrained, ad hoc interpreters have error rates that average between 50% and 75%, according to Howard Chiou, an MD/PhD student who banded with other students from throughout Emory's graduate and undergraduate schools to see if they could marshal the resources to meet the big need.
These two years later, after two pilot phases, hours of consulting with legal counselors, developing partners with professional training groups and local clinics, fundraising for program support, and overcoming what the students say was a "huge learning curve," EUVMIS is officially launched. Supported by a three-year seed grant from the Office of the Executive Vice President for Health Affairs in the Woodruff Health Sciences Center and funding from the anthropology department's Global Health, Culture, and Society program, the EUVMIS also has formalized a three-year commitment by Grady Memorial Hospital's Department of Multicultural Affairs to give the student volunteers practical training in medical interpretation.
"The EUVMIS project is a much needed program," says Sandra Sanchez, who directs multicultural affairs at Grady. "It will address language barriers and especially benefit those health organizations that serve low-income, uninsured, and homeless patients in Atlanta."
Beyond literal translation
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The EUVMIS has proven popular (and competitive) among students. Its leadership core is made of students from medicine, business, anthropology, chemistry, and Spanish. Volunteers—both students and faculty mentors—come from across the university and the health sciences. The multidisciplinary focus is intentional, says business major Kristin Rebescher, one of the leadership team. "We are all on the same team to play on people's strengths to minimize social disparities in health care."
The participation of undergrads also lends continuity and sustainability to the program, says Duncan Wilson, a third-year medical student who got involved with the program specifically because he wanted to work with the undergraduates to harness their passion. "This is an energized group that is investing their time for all the right reasons," he says. "It's nice to hear their take on things and a refreshing break from medical school."
To be chosen for one of the training slots each semester, students start the application with a panel interview that assesses commitment and performance. They also are asked to pay for a portion of their tuition ($200) to help cover the costs of training.
The first semester involves a series of Saturday classes through Cultural Connect, a nonprofit organization that fosters cultural fluency and has a long track record in training interpreters. Led by Executive Director Alexis Dalmat, a current Executive MBA student at Emory, Culture Connect also offers a language services program that is contracted by Emory Healthcare. Classes go well beyond literal translation to cover communication skills, cultural norms, patient safety, and professionalism, among other topics. In the end, students receive certificates of proficiency accredited by the International Medical Interpreters Association.
Next, students progress to coaching and practical training from professional interpreters in Grady's Multicultural Affairs department. They start with shadowing an interpreter, then progress to first a supervised practicum, then unsupervised interpretation encounters with patients, all followed by debriefing and coaching sessions with the professionals. On completion of their training, they will be ready to help staff community partner clinics with quality interpreters.
The participants say that being part of the EUVMIS group has been transformative. Trisha Patel, a fifth member of the leadership team and an anthropology and Spanish major who is applying to medical school this year, says, "I thought before that poverty was the main barrier to access to care, but I've come to realize that linguistics can be a big hindrance too. No matter where I end up in the future, I want to address linguistic barriers to care and do my part to minimize social disparities in health care."
Chiou never anticipated how long it would take to jump all the hurdles inherent in getting a new organization up and running. But from working for nine months with Emory's legal counsel to get agreements just right to navigating the hurdle of getting identification badges for students at Grady, he'd do it all over again. "This is one of the most rewarding things that I've ever worked on," says Chiou. "I've learned so much about improving health care and how to create the care structures that we so desperately need." EH
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