Tell me where it hurts

Boston's demand for bilingual health care workers grows

Inside a Boston-area Emergency Room, a mother arrives with a crying baby. As the nurses examine the young patient, they ask the mother questions about the child's symptoms, but the mom's language barriers make it difficult to communicate.

This scenario plays out often because 30 percent of the Boston-area population speaks languages other than English. The cultural and language diversity led to state and federal laws requiring every hospital have medical interpreters available in ERs. But the demand for health care workers with the ability to speak more than one language has expanded beyond the hospital to acute care facilities and clinics, says Peter Holtgrave, director of the Boston Area Health Education Center, which is part of the Boston Public "We get state and federal funding to train adult learners, and we often get students who already have some relationship to a hospital, like records keepers, x-ray technicians, or someone in medical billing," Holtgrave says.

Specific training in both medical terminology and mediation is important, Holtgrave adds. "By encouraging people who are already in the health care field and are multi-lingual, we hope to help them increase their salary and support the health professions," Holtgrave says.

Medical interpreters work in a variety of settings: hospitals, clinics, doctor's offices, and, mental health and psychiatric facilities. They are also needed in quasi-legal proceedings, such as those involving medical-legal evaluations for workers' compensation claims or personal injury lawsuits or hearings to determine mental competence or eligibility for benefits. Interpreters can encounter a wide range of subject matter and terminology in these different settings, and many choose to specialize in one.

Holtgrave's center offers Certified Medical Interpreter training, but if a student wants to study full time or go for a more advanced degree, he or she is referred to a degree program at a nearby college.

"Our certificate program in medical Spanish came from nurses who realized they needed a second language as part of their nursing skill set," says Jean Weyman, assistant dean at the Connell School of Nursing at Boston College (BC). "Nurses are responsible for reaching out and connecting with their patients. To help nurses do that, we offer a series of three classes for adult learners that cover history and culture, medical terminology, and we provide opportunities to shadow other nurses in clinical situations. In addition to using the university's language lab, we are very concerned with cultural sensitivity. Spanish may be the language of many cultures and countries, but the Hispanic community varies widely in its traditions, and it's important to be respectful of differences."

While BC focuses on Spanish for nurses, Cambridge College covers a wider range of languages. "We did a survey a few years ago and identified Spanish, Portuguese, and Haitian as the priority languages," says Diane Lolli, associate director of Cambridge College's Institute for Lifelong Learning.

"Students have to demonstrate fluency in English, but then we focus on anatomy and physiology, and medical terminology," says Lolli. "But there are lots of ethical issues medical interpreters need to be aware of, and that's why we call them interpreters, not translators. The idea is to be the least visible person in the room, the 'conduit.' But frequently, there's some confusion between what a patient may be trying to get across and what a doctor is hearing. Then the interpreter checks in with both parties to make sure they both understand each other. We call that the 'clarifier.' And finally, if there is a need, the interpreter acts as an 'advocate.'"

Through UMass-Amherst's Translation Center, students can study medical interpreting online. The web-based class, offered by the Division of Continuing Education, is multilingual, with most major languages offered. All materials are in English, but course requirements include an advanced knowledge of one language other than English, a general knowledge of scientific concepts, and the desire to improve interpretation skills.

Although Cambridge College started out focusing on those three primary languages, it quickly discovered there were many more communities that needed help. "As we got a grant for it, we started training in other languages," Lolli says.

Adults who study at Cambridge College are often immigrants who are disenfranchised when they get to the United States, Lolli says. "We have students with advanced degrees from other countries who have something to offer, but no credentials. If we can take underemployed newcomers and get them into a health care situation, they can increase their salaries with a certificate as a medical interpreter and move on in their career."

With the seemingly insatiable demand for skilled workers in this field, it's a win-win scenario for students, patients, and the health care community.