This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.
You can find the current article at its original source at https://www.nytimes.com/2020/04/17/health/covid-coronavirus-medical-translators.html
The article has changed 24 times. There is an RSS feed of changes available.
| Version 5 | Version 6 |
|---|---|
| When Coronavirus Care Gets Lost in Translation | When Coronavirus Care Gets Lost in Translation |
| (about 16 hours later) | |
| Recently Dr. Alister Martin faced his patient, a Hispanic man who spoke no English, and broke the news that he would have to be intubated. Struggling to keep his voice calm, Dr. Martin, of Massachusetts General Hospital in Boston, suggested that the man call his wife. And he told the patient, a bus driver and a father of three, that he should give her his love and say goodbye, just in case. | Recently Dr. Alister Martin faced his patient, a Hispanic man who spoke no English, and broke the news that he would have to be intubated. Struggling to keep his voice calm, Dr. Martin, of Massachusetts General Hospital in Boston, suggested that the man call his wife. And he told the patient, a bus driver and a father of three, that he should give her his love and say goodbye, just in case. |
| This exchange is now part of the fabric of Dr. Martin’s daily routine, but it never gets easier. Making it all the more difficult is that each piece of information is repeated at least twice: Most of Dr. Martin’s Covid-19 patients don’t speak English, so he communicates through a language interpreter on the phone. | This exchange is now part of the fabric of Dr. Martin’s daily routine, but it never gets easier. Making it all the more difficult is that each piece of information is repeated at least twice: Most of Dr. Martin’s Covid-19 patients don’t speak English, so he communicates through a language interpreter on the phone. |
| Because personal protective equipment is in short supply in hospitals across the country, few clinical interpreters are able to work in person with Covid-19 patients, as they normally would. Most language interpretation is done remotely. Communicating through an interpreter doubles or triples the length of a medical exchange, adding new confusion and anxiety to situations that are already stressful for patients and their families. And the conditions of Covid-19 care — the rapid pace at which cases evolve, the desire of hospital workers to limit the duration of their exposure to patients — create numerous obstacles to effective interpretation. | Because personal protective equipment is in short supply in hospitals across the country, few clinical interpreters are able to work in person with Covid-19 patients, as they normally would. Most language interpretation is done remotely. Communicating through an interpreter doubles or triples the length of a medical exchange, adding new confusion and anxiety to situations that are already stressful for patients and their families. And the conditions of Covid-19 care — the rapid pace at which cases evolve, the desire of hospital workers to limit the duration of their exposure to patients — create numerous obstacles to effective interpretation. |
| “We are seeing an overall degradation in the quality of care given to patients who don’t speak English as their first language,” Dr. Martin said. | “We are seeing an overall degradation in the quality of care given to patients who don’t speak English as their first language,” Dr. Martin said. |
| Dr. Martin said the coronavirus outbreak has multiplied the logistical barriers for medical interpretation. The hospital rooms are loud, filled with buzzing oxygen tanks and urgent staff conversations. Everyone is masked, their voices muffled. Medical workers are trying to stay six feet away from their patients whenever possible. | Dr. Martin said the coronavirus outbreak has multiplied the logistical barriers for medical interpretation. The hospital rooms are loud, filled with buzzing oxygen tanks and urgent staff conversations. Everyone is masked, their voices muffled. Medical workers are trying to stay six feet away from their patients whenever possible. |
| “Someone’s oxygen can be dropping and I have to get an interpreter on the phone, wait on hold, put in an access code, tell them where I am,” Dr. Martin said. “It’s hard for the patient. Imagine you’re in a loud room with a mask blowing oxygen in your face at 15 liters a minute and you feel crummy. You can’t comprehend things as much.” | “Someone’s oxygen can be dropping and I have to get an interpreter on the phone, wait on hold, put in an access code, tell them where I am,” Dr. Martin said. “It’s hard for the patient. Imagine you’re in a loud room with a mask blowing oxygen in your face at 15 liters a minute and you feel crummy. You can’t comprehend things as much.” |
| Typically, he explains to patients the precise medical process before intubation and instructs them to think of their happiest memories, what he calls “the vacation before sedation.” With an interpreter on the phone, he and his team are pressed to use their words more sparingly. | Typically, he explains to patients the precise medical process before intubation and instructs them to think of their happiest memories, what he calls “the vacation before sedation.” With an interpreter on the phone, he and his team are pressed to use their words more sparingly. |
| Interpreters, too, say, that their quality of work suffers when they communicate with patients remotely instead of in person and can’t use body language or read facial expressions. “Little things like a tap on the shoulder or holding the patient’s hand usually makes a big difference,” said Cinderella Lee, a Cantonese interpreter for Sutter Health in San Francisco. | Interpreters, too, say, that their quality of work suffers when they communicate with patients remotely instead of in person and can’t use body language or read facial expressions. “Little things like a tap on the shoulder or holding the patient’s hand usually makes a big difference,” said Cinderella Lee, a Cantonese interpreter for Sutter Health in San Francisco. |
| Ms. Lee said that under normal circumstances, patients who aren’t English-language proficient have family members help with translation and serve as advocates. But because hospitals have barred visitors, patients are on their own. Some patients Ms. Lee works with are elderly and “don’t understand why their loved ones don’t visit them,” she said. | Ms. Lee said that under normal circumstances, patients who aren’t English-language proficient have family members help with translation and serve as advocates. But because hospitals have barred visitors, patients are on their own. Some patients Ms. Lee works with are elderly and “don’t understand why their loved ones don’t visit them,” she said. |
| David Velasquez, a medical student at Harvard, said he has often been called on to translate for Spanish-speaking patients while on clinical rotations. Having witnessed lapses in communication with patients who are not proficient in English, he fears for his immigrant family members outside Los Angeles, one of whom has already contracted the new coronavirus. | David Velasquez, a medical student at Harvard, said he has often been called on to translate for Spanish-speaking patients while on clinical rotations. Having witnessed lapses in communication with patients who are not proficient in English, he fears for his immigrant family members outside Los Angeles, one of whom has already contracted the new coronavirus. |
| “Most doctors don’t speak their language,” Mr. Velasquez said. “I’d worry about the discharge process. It’s one thing letting them know what they have to do in the hospital. But it’s another thing to educate patients on precautions to take after leaving, and how to protect their loved ones.” | “Most doctors don’t speak their language,” Mr. Velasquez said. “I’d worry about the discharge process. It’s one thing letting them know what they have to do in the hospital. But it’s another thing to educate patients on precautions to take after leaving, and how to protect their loved ones.” |
| The challenges in treating Covid-19 patients who are not English-proficient are especially troubling to physicians because of the disproportionate hospitalization rates for blacks and Hispanics. | The challenges in treating Covid-19 patients who are not English-proficient are especially troubling to physicians because of the disproportionate hospitalization rates for blacks and Hispanics. |
| Hispanics make up 34 percent of the coronavirus deaths in New York City, according to data released by the city last week, but just 29 percent of the city’s population. City leaders have suggested that this partly reflected Hispanic overrepresentation among essential workers; a study from the city comptroller found that minorities make up 75 percent of the front-line work force, including grocery clerks and janitors. | Hispanics make up 34 percent of the coronavirus deaths in New York City, according to data released by the city last week, but just 29 percent of the city’s population. City leaders have suggested that this partly reflected Hispanic overrepresentation among essential workers; a study from the city comptroller found that minorities make up 75 percent of the front-line work force, including grocery clerks and janitors. |
| Massachusetts has released only limited racial and ethnic data on the virus, but large clusters of infection have been reported in immigrant-heavy Chelsea and in Boston’s predominantly black, Latino and immigrant communities, including in Hyde Park and Mattapan. Roughly 40 percent of Covid-19 inpatients at Massachusetts General Hospital are Hispanic, according to hospital officials, 80 percent of whom are primarily Spanish-speaking. | Massachusetts has released only limited racial and ethnic data on the virus, but large clusters of infection have been reported in immigrant-heavy Chelsea and in Boston’s predominantly black, Latino and immigrant communities, including in Hyde Park and Mattapan. Roughly 40 percent of Covid-19 inpatients at Massachusetts General Hospital are Hispanic, according to hospital officials, 80 percent of whom are primarily Spanish-speaking. |
| “This has become a black and brown epidemic across the country,” said Dr. Joseph Betancourt, chief equity and inclusion officer at the hospital. “That’s all the more reason we have to pay attention to language.” | “This has become a black and brown epidemic across the country,” said Dr. Joseph Betancourt, chief equity and inclusion officer at the hospital. “That’s all the more reason we have to pay attention to language.” |
| At Cambridge Health Alliance in Massachusetts, nearly half of the 126,000 patients in its primary care system have limited English proficiency. The Alliance has 100 staff interpreters who usually work in its emergency rooms and community clinics. Vonessa Costa, director of multicultural affairs and patient services, said that roughly 99 percent of the interpreting work is now remote, with the interpreting staff fielding upward of 1,300 calls per day. | At Cambridge Health Alliance in Massachusetts, nearly half of the 126,000 patients in its primary care system have limited English proficiency. The Alliance has 100 staff interpreters who usually work in its emergency rooms and community clinics. Vonessa Costa, director of multicultural affairs and patient services, said that roughly 99 percent of the interpreting work is now remote, with the interpreting staff fielding upward of 1,300 calls per day. |
| Those circumstances place tremendous stress on the medical interpreters, Ms. Costa said, especially those who live in Boston’s immigrant communities hard-hit by the outbreak. Last week, she heard from a distraught interpreter who had just spent 45 minutes on the phone helping a young Spanish-speaking woman communicate with hospital staff about two critically ill family members, her partner and her mother. | Those circumstances place tremendous stress on the medical interpreters, Ms. Costa said, especially those who live in Boston’s immigrant communities hard-hit by the outbreak. Last week, she heard from a distraught interpreter who had just spent 45 minutes on the phone helping a young Spanish-speaking woman communicate with hospital staff about two critically ill family members, her partner and her mother. |
| Updated June 16, 2020 | Updated June 16, 2020 |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| “There is a trauma in interpreting trauma,” Ms. Costa said. “Quite a few interpreters in our department have family members who have been hospitalized too. They’re shell shocked by the situations they’ve had to interpret and the devastation in their communities.” | “There is a trauma in interpreting trauma,” Ms. Costa said. “Quite a few interpreters in our department have family members who have been hospitalized too. They’re shell shocked by the situations they’ve had to interpret and the devastation in their communities.” |
| Dr. Jorge Rodriguez, a physician at Brigham and Women’s Hospital, said that the coronavirus pandemic is exposing, and exacerbating, a pre-existing condition in the country’s health system: disparities in care for non-English-speaking patients. A 2015 study from the Joint Commission showed that patients with limited English proficiency experienced adverse health outcomes at markedly higher rates than English speakers. | Dr. Jorge Rodriguez, a physician at Brigham and Women’s Hospital, said that the coronavirus pandemic is exposing, and exacerbating, a pre-existing condition in the country’s health system: disparities in care for non-English-speaking patients. A 2015 study from the Joint Commission showed that patients with limited English proficiency experienced adverse health outcomes at markedly higher rates than English speakers. |
| “We knew that limited-proficient-English patients had decreased access to care, more emergency department visits, longer inpatient stays and worse clinical outcomes,” Dr. Rodriguez said. He added that he hoped the pandemic’s disproportionate impact on Hispanic populations would push medical institutions to consider the ways that language barriers affect patient care. | “We knew that limited-proficient-English patients had decreased access to care, more emergency department visits, longer inpatient stays and worse clinical outcomes,” Dr. Rodriguez said. He added that he hoped the pandemic’s disproportionate impact on Hispanic populations would push medical institutions to consider the ways that language barriers affect patient care. |
| Some medical institutions have already begun to rethink their interpreting services amid the coronavirus outbreak. Dr. Betancourt said that in the last month Mass General has created a registry of front-line staff members who speak multiple languages. The hospital now aims to assign a Spanish-speaking doctor to each medical team whenever possible, so that patients can rely on their physicians to interpret rather than having to use remote services. | Some medical institutions have already begun to rethink their interpreting services amid the coronavirus outbreak. Dr. Betancourt said that in the last month Mass General has created a registry of front-line staff members who speak multiple languages. The hospital now aims to assign a Spanish-speaking doctor to each medical team whenever possible, so that patients can rely on their physicians to interpret rather than having to use remote services. |
| Ms. Costa said that Cambridge Health Alliance has identified all patients who require in-person rather than remote interpretation, such as individuals who are hard of hearing and do not use American Sign Language, and has allocated personal protective equipment for their on-site interpreters. The health care provider has begun offering discharge instructions in Arabic, Nepali and other languages, expanding beyond the Spanish, Portuguese and Haitian Creole translations already on offer. And they are considering distributing microphones to patients when necessary to amplify their words for interpreters. | Ms. Costa said that Cambridge Health Alliance has identified all patients who require in-person rather than remote interpretation, such as individuals who are hard of hearing and do not use American Sign Language, and has allocated personal protective equipment for their on-site interpreters. The health care provider has begun offering discharge instructions in Arabic, Nepali and other languages, expanding beyond the Spanish, Portuguese and Haitian Creole translations already on offer. And they are considering distributing microphones to patients when necessary to amplify their words for interpreters. |
| But as Ms. Costa’s organization races to better its interpreting services, she worries about the millions more patients across the country who are non-English-proficient and struggling to access care. “A pandemic is not the time to build working systems,” she said. | But as Ms. Costa’s organization races to better its interpreting services, she worries about the millions more patients across the country who are non-English-proficient and struggling to access care. “A pandemic is not the time to build working systems,” she said. |
| [Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.] | [Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.] |