Demand for medical interpreters rises as new groups arrive

Sarah Eichberger, a dietitian who works with refugees, faces a diabetic Bhutanese woman who is reluctant to listen to her medical advice. Eichberger speaks no Nepali nor does she possess extensive knowledge of Bhutanese culture.

Good thing she's with Uma Devi Mishra, a Bhutanese medical interpreter and health promoter who works with Eichberger at Refugee Health Education and Promotion, a Heartland Alliance program.

"Uma can communicate with this woman that the info I'm giving her is research-based, science-based," Eichberger said. "Having Uma with me adds trust."

As a medical interpreter, Devi Mishra provides refugees with language translation and cultural interpretation.

"They're a link between myself and the family," Eichberger said. "It makes it a lot easier for me to go. It's a way for me to introduce myself to them. They serve as a translator and cultural broker.”

Though Devi Mishra is still completing her medical interpreter training, she studied English and took a medical course during her years at a refugee camp in Nepal. After arriving here in May as part of the second group of the recent wave of Bhutanese refugees resettled in Chicago, she worked three months as a chambermaid at the Palmer House, a downtown hotel, before World Relief connected her with Refugee Health. 

Now, as Chicago receives an influx of new refugees that also prominently includes Burmese and Iraqi refugees, the need for medical interpreters who speak their languages, like Devi Mishra, is rising.

Refugee Health employs two health promoters, which are medical interpreters that provide health and nutrition education in addition to lingual and cultural translation. The other, Ernest Pyaohn, is Burmese. Combined with the continuing flow of Burmese and Bhutanese refugees, that has meant a number of requests for their services from local hospitals and refugees.

"Ernest will get a call from a hospital asking him to interpret over the phone because they don't want to pay the telephonic charge,” said Eichberger, referring to a type of commonly used telephonic translating service generally not preferred to in-person interpreting. “A lot of people in the community will ask him to go with him to the hospital. He's caught in a situation where he doesn't want to let them down. Ernest just wants to do the best he can for his people. That's what he says, literally. So it doesn't matter to him whether or not they pay him, even though it's not his job."

Devi Mishra too is “very much in demand,” said Refugee Health Associate Director Judith Weinstein. As part of her job, Devi Mishra sometimes offers her services at a clinic in Uptown and plans to start going there regularly each Tuesday.

When she goes on a home visit, Devi Mishra looks for things like the type of food the refugee is purchasing or if they are thawing meat incorrectly. She makes sure they don’t miss medical appointments and take medication at the right time and might educate them on hygiene and apartment living.

She also teaches them about counterproductive cultural practices. Some refugees, she said, won’t drink cold water in cold weather, for example, or will put on lots of clothes to go sleep when they have a fever.

Not many organizations are lucky enough to have interpreters like Devi Mishra and Pyaohn. The Kovler Center for Treatment of Torture, another Heartland Alliance program, shares a building with Refugee Health, but has no interpreters on staff. Instead, they rely largely on outreach to community members, volunteers and when necessary telephonic interpreting to overcome language barriers.

"Sometimes interpreters are readily available, sometimes not,” said Sara Daniel, a case manager at the Kovler Center. “Unfortunately we're very limited. We can't provide services without interpreters. Especially in psychotherapy and psychiatry, for someone to articulate their feelings it's not enough to just know the language, they have to know it well enough to interpret.”

Though they rarely contract because they lack the funding, the Kovler Center always tries to use Cross-Cultural Interpreting Services when they must, Daniel said. CCIS draws interpreters as independent contractors from a pool in which membership constantly fluctuates but always stays above 100, with an average capacity to interpret 30 languages on site, according to Director David Murad.

The organization also offers an interpreter training program. Anyone bilingual and older than 18 can apply and to qualify one must complete an oral and written language assessment exam. Training costs $600 and takes 40 hours, which might always not be feasible for refugees short on money and time. But Murad and Tam emphasized dual proficiency as the toughest criteria for candidates to meet.

“You must exhibit a high level of proficiency, not just a familiarity,” said Eddie Tam, a trainer at CCIS. “Being able to carry a daily conversation doesn’t make you eligible alone.”

Some situations that really need interpreters, Tam explained, are when patients don't realize they can choose whether or not to go through a process or that they can get a second opinion. They might also concern cultural issues; in Somali, for example, beckoning with the index finger calls someone a dog, and some cultures don't shake with the left hand, which is considered the dirty one used for cleaning, Tam said.

When medical interpreters aren’t available, Eichberger said she has seen problems arise. Too often, she said, children are asked to translate because the clinic or agency doesn't have an interpreter. That can cause a strain on the child if he or she must be taken out of school to go to their mother's doctor appointment, for example, or if the doctor must ask personal questions.

Eichberger also cited an example where five agencies shared three medical interpreters. Each would have rotations during the week and the agency would have to work around their rotations. All the Burmese would come on Monday when the Burmese interpreter was there, for example.

"Resettlement is a huge issue and they can't do their work without interpreters,” Eichberger said. “It's just a matter of money and advocating that it be funded. Hospitals and clinics need to do a better job of using their resources."

It’s a human right to receive such crucial services in one’s own language, Tam said.

“People think it's a small portion, but it's really a must have portion,” he said.