AS AN INTERPRETER at Massachusetts General Hospital, Laura Cantera enables physicians to do their jobs by allowing them to communicate with their Spanish-speaking patients.
A native of Uruguay, the 47-year-old Cantera works at the hospital but because of COVID-19 infection concerns spends most of her time interpreting doctor-patient interactions by phone. She often finds herself walking patients, who often have never used the video feature or apps on their phones or computers, through the technology. “It’s like a strange language to them, being on a video call,” she said.”
The remote interactions are also challenging for Cantera because normally she would be in the room with the doctor and patient picking up on body language and personal dynamics. “Some of that has been lost,” she said. “Not the empathy, not the compassion, not the linguistic experience, but, you know, something is lost.”
Medical interpreting has taken on much greater significance during the COVID-19 crisis in some parts of the state, largely because of a dramatic shift in patient mix. Many of the areas hardest-hit by the virus are minority and immigrant communities where English is not the primary language.
At MGH, 9 percent of patients typically needed language help pre-COVID-19; now the percentage is 29 to 35 percent amid an influx of patients from such hotspots as Chelsea, Everett, Revere, and East Boston.
At Cambridge Health Alliance, on-staff medical interpreters handled 700 requests on a typical weekday pre-COVID; now they handle 1,200. In March alone, they provided 3,300 hours of translation services.
Interpreter services are mandated by federal law, but health care systems can’t charge for the work. Some states allow Medicaid and Medicare reimbursements for translation services, but not Massachusetts.
“Access has always been an unfunded mandate. Nobody funds medical interpreting. It’s really a commitment of your health system to the community,“ said Vonessa Costa, the director of multicultural affairs and patient services at Cambridge Health Alliance, which operates facilities in Cambridge, Somerville, and Everett.
Social worker Zarita Araujo-Lane helped Cambridge Health Alliance found its interpreter program in 1979. “She went to City Hall in Cambridge with two dictionaries in hand, one Spanish and one Portuguese to prove to the city council that they were not the same language and asked for funding to hire interpreters,” said Costa.
The program has grown since. Last year, 43 percent of the system’s patients needed non-English language assistance, resulting in 360,000 encounters, or individual instances where an interpreter was needed. Ninety percent of patients had an interpreter within 90 seconds of their provider making a request–which only requires hitting a four-digit extension on the phone.
Mass General uses 39 staff interpreters, 40 per diem interpreters, and a backup call center for services in 12 languages and American Sign Language. At Cambridge Health Alliance, Costa heads a team of 100 medical interpreters – 57 of them on staff and the rest per diem.
Spread out over three hospitals, the interpreter services division has a skeleton crew on-site, with four people at its Somerville branch, four in Everett, and 10 at the flagship Cambridge Hospital. The other interpreters are deployed remotely.
For medical interpreting, patients are on the phone with a doctor and an interpreter from their first interaction onward. Where visual interactions are needed, the three engage in video chats with the patients directing the camera to their injuries as the interpreter and provider take a look. Interpreters relay anything the patient says in their chosen language to the provider. They also tell patients what providers say—if they want them to go to the hospital, get medication, or other recommendations
To get mandated certification so they can work in hospitals, medical interpreters are certified by the National Board of Certification for Medical Interpreters or the Certification Commission for Healthcare Interpreters There’s an exam, written and oral, and previous schooling and training are expected.
Jean Adam, 58, is Cambridge Health Alliance’s hospital interpreter supervisor.
An immigrant from Haiti with three degrees, Adam began interpreting 20 years ago. “I liked the joy that I get when I help the Haitian patients, and that keeps me going every day,“ he said.
His patients, mostly Haitian, know him well, calling him by first name. “And the older patients they always call me ‘my son.’ I know it comes from the heart,’ he said chuckling. He said it’s not that hard to speak with a mask on, but sometimes he has to raise his voice a little to be heard through the cloth. While donned with personal protective equipment, he said he’s interpreted for one person wearing coronavirus. His wife is also a medical interpreter but works from home.
“She gets worried that I will catch it,” he said. So after work, he changes his clothes and shoes in the car before going indoors, and washes the pile once a week.
At Massachusetts General Hospital, around a third of all patients who have tested positive for COVID-19 are native Spanish speakers who need interpreter services. “It’s an incredible amount. We do a lot of service to Chelsea and Revere and that’s where they are coming from,” said Chris Kirwan, MGH’s director of medical interpreter services.
Those interpreters service MGH healthcare centers in Chelsea, Revere, Everett, and Charlestown, along with the main hospital in Boston. At the Chelsea branch, 50 percent of patients are Spanish-speaking.
Kirwan said the hospital’s interpreter services are running about 68 percent of all encounters, and the three private vendors he has retained handle the other 32 percent. The volume of requests, he said, has gone up between 50 to 70 percent, but it’s too soon to have exact numbers.
When the Centers for Disease Control and Prevention was first beginning to navigate the pandemic, the hospital was re-translating the agency’s guidances weekly into 10 languages. As cases rose, the hospital began issuing translations daily. “The number of requests for written translation went way up,” he said.
Interpreting in person for COVID-19 patients requires the interpreter to dress in full personal protective garb, so those interactions are limited to cases where someone who is hard of hearing or is unable to speak easily. Interpreters are also used for communications between doctors and family members.
“For the ventilator patients, fielding calls from families on how their loved ones are doing is a lot of what they’re doing,” Kirwan said.