When Mailu Lor translates for a Hmong patient, she can’t just repeat the doctor’s orders, word for word. That’s because the Hmong language often doesn’t contain advanced medical terminology, or names for diseases, like diabetes.
“Hmong language is a very difficult language,” Lor said. “We don’t have any dictionary for medical terminology.”
Lor has been providing medical interpretation to Hmong and Lao patients for about 30 years, and in Merced for the past decade. Even with her years of experience, she says it can still be challenging to communicate a doctor’s message to a patient, in a clear and culturally sensitive manner.
“Even now, when the doctor tells me something, I kind of go around for the patient to understand exactly what he’s talking about,” she explained. “It’s harder for me to think, what do I say, what do I explain to the patients?”
Medical interpreters like Lor play an important role in the culturally diverse Central Valley. They explain patients’ conditions and doctors’ recommendations. They act as a cultural liaison between patients and doctors, and often between two worlds. Studies and anecdotes have shown that a trained medical interpreter can have a positive impact on patients’ health and sometimes, literally, be the difference between life and death.
Experts predict there will be an even greater demand for their services when the Affordable Care Act is implemented in 2014. The California Pan-Ethnic Health Network estimates that of those people eligible for the expanded Medi-Cal program, more than one-third, or about 500,000 people, will speak English less than very well.
“We are going to have a lot more limited English-proficient speakers, people who do not speak English very well, come into the health care system with the implementation of the Affordable Care Act,” said Ellen Wu, executive director of the California Pan-Ethnic Health Network. “I think it’s a great time to make sure that language services are provided to these patients.”
Wu said patients already have the right to ask for a trained medical interpreter, at no cost. But many patients and doctors don’t request their help.
That’s one reason her organization “supports in concept” Assembly Bill 1263, authored by Speaker John Perez. The bill would provide medical interpretation services to limited-English speakers enrolled in Medi-Cal, and reimburse their providers for the service using federal funds.
“I think that because a lot of people don’t know about it, either the patient doesn’t ask, or the provider doesn’t ask for it,” Wu said. “This bill will bring attention to that right, but also set up a more centralized system for requesting such an interpreter.”
Perez’s bill would create the Medi-Cal Patient Centered Communication Program, or Communi-Cal, at the state Department of Health Care Services. It would also establish a certification process and registry of certified medical interpreters.
“We have a real crisis of access to adequate health care because of a communication failure,” Perez said. “So we’re trying to address that issue by making sure we have a broad-based structured program for medical interpretation, so we get the best health care outcomes, and the most affordable health care outcomes, that come with good, real time communication.”
The bill has faced pushback because it allows for collective bargaining for certified medical interpreters. In a recent editorial, the Fresno Bee criticized the bill, saying it would increase financial pressures on the health care system.
Perez doesn’t think that will be a sticking point, though. “The idea of making sure that interpreters have access to collectively bargain if they choose to, is just consistent with my broad based view that all workers deserve that basic right of democracy,” he said.
Candice Adam-Medefind, executive director of a group called the Healthy House Within a MATCH Coalition in Merced, is very familiar with the intricacies of medical interpretation, and the Valley’s need for well-trained interpreters.
“Merced County is one of the 10 most ethnically diverse in the county,” Adam-Medefind said. “Without adequate understanding of the diversity and rich cultures in this area, we can see serious health disparities and serious problems arising in the health care arena.”
Her organization created a training program for medical interpreters. It focuses on the Valley’s major ethnic groups – like the Hmong, Latino and Punjabi communities. The course features medical terminology, including names for diseases that didn’t exist in patients’ home countries. For example, she said, Hmong medical interpreters have developed the term “sweet blood” for diabetes.
The course also highlights culturally appropriate care and patient advocacy.
“We had a Hmong patient, he was a new refugee, and the nurses were writing in red pen on a chart that was up on the door of his room, and that really frightened him, because back home in his culture, red writing could mean you’re being accused of something terrible, or that kind of thing,” she recalled.
Mailu Lor, the Merced interpreter, says her job is fulfilling. She says her role goes beyond explaining a medical condition or prescription.
“I like to help people,” she said. “I like to talk the way that I like, not to hurt anybody, not to make them sad, not to make them scared of the doctor. I really like to comfort them, talk to them, tell them not to be afraid.”
Speaker John Perez’s bill is awaiting a hearing in the Assembly Appropriations Committee. No matter the outcome of the bill, health care interpreters like Mailu Lor will have many more opportunities to connect patients and doctors in the years to come.