Medical system working to meet Hispanics’ needs

By Timothy Pratt

Monday, June 21, 2004 | 11:14 a.m.

Ariana Juarez, an 18-year-old with a quick smile, knows what it's like to feel stupid in a doctor's office.

A year ago, when the teen from Morelos, Mexico, had difficulty breathing, her mother took her to an urgent care center, part of the University Medical Center system.

She arrived at 3 in the afternoon, but when she got back to her downtown home after 9 p.m., Juarez still had little idea what was wrong.

"The doctor told me, 'Why don't you learn English? In this country, that's the language we speak,' " she recalled Wednesday, sitting in the lobby of UMC Women's Center.

"I felt real bad," she said.

No one knows how frequently the Las Vegas Valley's tens of thousands of Spanish-speaking residents find themselves in that situation -- they get sick, but can't communicate with those who would make them well.

But several developments on the horizon may help reduce what experts say are not only uncomfortable situations, but potentially dangerous and illegal ones.

Those developments include a first-ever federal grant for interpreting and translating services at UMC and the Clark County Health District, and a pilot project testing a video conference interpreting system at the pediatric department of the UMC Lied Ambulatory Care Center.

Additionally, the state's first school for medical interpreting will soon have its first graduating class.

All these events will come to pass within weeks, but Sylvia Vasquez, who works in marketing for UMC, said the moves are overdue and "only the beginning."

With the Hispanic population growing, there are a lot of government agencies that are beginning to understand the importance of providing health care services for people in the language they speak, Vasquez said.

"This is important both to reduce liability for health care workers and the hospital ... and because it's the ethical and moral thing to do," she said.

Of the Health and Human Services Department grant for $450,000, 80 percent, or $360,000, will go to the hospital and 20 percent, or $90,000, will go to the county.

The money is to allow UMC to go from three interpreters paid on an hourly basis to four interpreters who will be hospital employees. It will also help pay for translating signs throughout the hospital system as well as forms patients use, Vasquez said.

At the health district's Shadow Lane office, two half-time interpreters will be hired and translations will also be done, said Maria Azzarelli, who runs the district's tobacco control program and serves on a committee that plans for the valley's immigrant patient population.

Suzanne Dessaints, director of the Lied Ambulatory Care Center, said the pediatric department will benefit greatly from the video technology it will be piloting in the coming weeks, since about 1,750, or 80 percent, of the 2,200 patients that seek care at the department each month are Hispanic.

The technology allows the interpreter to speak, hear, see and be seen via the Internet, though the company offering the service is located in Salt Lake City.

Dessaints said not being able to communicate with the increasing numbers of Spanish-speaking patients often frustrates her and her staff.

"The most terrible feeling is when someone walks up to you and you don't understand them and what's wrong with them -- and when it's a child it's even worse," Dessaints said.

A few miles south, on South Spencer Street and Flamingo Road, Nestor Wagner is preparing for the future, with an eye to what he's seen during a decade of running schools for interpreters in California.

Wagner just opened up the School of Interpreters and English as a Second Language in January and his first class of nine interpreters will graduate June 26. His school is the first in Nevada to train interpreters specifically for working in hospitals and clinics.

Looking over the situation facing the valley's hospitals, clinics and health care district, Wagner said, "Basically, you're 20 years behind ... I don't think the state as a whole is ready for what it needs when it comes to Spanish-speaking patients."

Nevada, he said, "has absolutely nothing in terms of training or standards." In California, for example, the state personnel board certifies medical interpreters and large hospitals build the cost of hiring interpreters into their budgets, he said. That doesn't happen here, he said.

Wagner's school provides a 40-hour course for hospital employees and a six-month course for interpreters.

He said his students have told his staff that the idea of using interpreters is still not accepted in the valley.

"Doctors get upset because it takes more time ... and tell ad hoc interpreters, 'Why are they coming to this country? Why don't we call immigration?' " Wagner said.

But Vasquez points out that it's the law to provide interpreting for anyone who needs it when a hospital receives federal funds, as UMC does.

Additionally, she said, earlier waves of immigrants also needed some time to learn the language, "including those of Ellis Island. What do we do in the meantime?"

UMC's Women's Center has made do with whatever resources have been available to acquire and train as many bilingual employees as possible.

Juarez, now in her eighth month of pregnancy, is glad of that fact, since she has been going to the center for prenatal care since February and has usually been seen by someone who speaks at least a little Spanish.

Sandra Stoika, manager of the center, says she's "been pretty aggressive" about getting bilingual nurses and office staff, on seeing the percentage of Hispanic patients go from about 20 percent to above 70 percent in less than a decade.

Of 12 nurses currently on staff, she said, eight speak Spanish, two of whom have taken the 40-hour class at Wagner's school.

With 15,000 obstetric care patients a year, however, there is still some need for additional help, so the center also uses an interpreting service over the phone.

Stoika said that many immigrants come to UMC because word spreads about Spanish-speaking staff. "Once patients know, they tell their friends and family," she said.

Juarez said she came to the center because her older sister had also gone there when she was pregnant.

The trend in recent years has led to what Stoika called a reversal in roles, when a former minority -- Hispanic patients -- have become the majority.

This reversal played out in the waiting room not too long ago, she recalled, when English-speaking patients complained about the television overhead being tuned to a Spanish-language channel.

The solution? Since there are two televisions in the waiting room, one now shows programming in Spanish, and one, in English.

But the challenges posed by a growing Hispanic population are not always as easy to face, she said.

"It's a whole can of worms ... how much UMC can continue to absorb the whole Hispanic population," Stoika said.

Eventually, she said, "I think it's something our politicians will have to deal with" -- naming issues ranging from creating standards for interpreters to setting aside funds to hire them.

Vasquez said that politicians will come to address the issue as the Hispanic population's political voice grows.

Juarez is of two minds when it comes to the whole issue.

"I think, the United States is the country where English is spoken, but at the same time, in an emergency, what are they going to do, let you lay there and die because you don't understand what's going on?"