American Dreams

As the influx of immigrants into Bowling Green continues, local hospitals and other health care providers are struggling to make sure they meet the legal requirements to provide proper care to all patients, no matter their ability to speak English. An executive order signed by President Bill Clinton in 2000 declared that all health care organizations that receive federal funds must provide language assistance services, but the order does not specify what qualifies as proper language assistance.

In Bowling Green, neither of the two major hospitals-The Medical Center or Greenview Regional Hospital- have a formal language access plan or medical interpreters on staff. The closest hospital that offers these services is T.J. Samson Community Hospital in Glasgow, more than thirty minutes outside of Bowling Green. The Medical Center and Greenview both offer language assistance through a telephone-based interpreting service.

Kentucky, and specifically Bowling Green, has a growing immigrant population for whom English is not a native language. In 2000, when Bowling Green had 3,429 foreign-born residents, 75 percent described themselves as being able to speak English less than very well, according to U.S. Census Bureau data. The most recent Census data shows that the city has a population of approximately 4,420 foreign-born residents out of the total population of 54,244. There is also an uncounted number of illegal immigrants, who could number two to three thousand, according to local advocates.

An inability to speak English can be hazardous to one’s health, according to federal research. A 2004 report by the Agency for Healthcare Research and Quality found that low English proficiency was linked to more frequent emergency room visits and hospitalizations.

Local immigrant advocate David Coffey, the Director of Educational Enhancement Programs at WKU, said he is called approximately once every six weeks to accompany Hispanic immigrants going to the emergency room or to the doctor for a check up. Coffey interprets despite his lack of interpreting training or knowledge of medical terminology. Even when a health care provider can offer forms in Spanish, Coffey said many local Latinos can’t read.

“I’ve tried to work with the hospitals in Bowling Green to have someone who speaks Spanish to be on call,” said Coffey. “…They could do a lot better, but a lot of it is liability.”

Rather than hiring medical interpreters, Greenview Regional and The Medical Center use the Language Line provided by AT&T. The service works similar to a conference call, where the doctor calls the line and requests a language. Then the doctor and the patient both get on the line at the same time, speaking with a trained interpreter.

“We can find an interpreter for just about any language,” said Brooke Brizendine, a social worker at The Medical Center.

The Medical Center also sometimes uses members of the community, such as staff from the International Center, or family and friends of patients, to interpret for them, Brizendine said.

At Greenview Regional Hospital the staff relies mainly on the AT&T Language Line, according to Alan Palmer, Greenview’s director of marketing. All the signs in the emergency department are also posted in Spanish as well as English. Palmer said the hospital is looking to expand to other languages.

Greenview staff tries to stay away from using family members as interpreters.

Normally we try to use the Language Line because family members don’t always translate what we want because they are not objective, said Merry Hardin, a registered nurse who has worked at Greenview for three years.

While they can usually get an interpreter immediately, Hardin said that recently she had to wait over an hour to get a Swahili interpreter for one of her patients. Hardin estimated that Greenview sees less than three non-English speaking patients daily, and the languages they see are usually Bosnian or Spanish, with a few Swahili recently. The hospital has quite a few staff members who speak other languages, and each department keeps a list of the bilingual staff, Hardin said.

Professional medical interpreters do not appear to be in Greenview’s plan anytime soon. CEO Mark Marsh said that financially, the hospital cannot afford to hire interpreters because there are not enough patients coming in that need the language services.

“I think we’ve got a good process in place that works pretty well for us,” Marsh said.

T. J. Samson is the first hospital in the South Central Kentucky region to establish a formal language access plan. That involved evaluating the size of the immigrant patient population and working to provide health resources for those patients.

Juan Gutierrez, a health programs specialist at Western Kentucky University and a trained medical interpreter, was hired to develop the plan for the hospital. He has trained staff to be medical interpreters and also “patient navigators,” to lead patients to the cheapest and most effective health care for their needs. T.J. Samson hired four professional medical interpreters, but Gutierrez said it wasn’t enough.

Finding properly trained medical interpreters in all the necessary languages is challenge, according to Gutierrez, who was a practicing physician in Colombia before he immigrated to the U.S. in 2002. Medical interpreting requires not only an extensive everyday knowledge of both languages, but the interpreter must also be well-versed in specialized medical terms. Gutierrez has been developing a semester-long medical interpreting certificate program at WKU to help meet that need. 

Some WKU Spanish majors provide informal interpreting services at an annual free Hispanic health fair in Horse Cave sponsored by local churches. 

Jennifer Dooper, a senior double majoring in English and Spanish, volunteered to help interpret at the fair last October. Although Dooper considers herself almost fluent, she does not have any background in medical terminology. When the doctor gave patients diagnoses that she didn’t fully understand in English, she couldn’t translate the words into Spanish. Dooper said she could properly interpret if given training in medical terminology.

“It was really eye-opening as far as immigrant health care,” Dooper said. “These people have little to no access to health care.”

Gutierrez thinks it will help to have a medical interpreting program at Western, but he can only provide the training in Spanish, since that is the only other language he speaks.  All the local free health clinics, such as the one in Horse Cave, also only provide Spanish interpreting. Gutierrez said that he hopes medical interpreting programs in other languages can be developed.

“We should be able to take care of people with all disparities, not only one group,” Gutierrez said.