An arrow traced the gnarled forms of arteries on a projector inside Lang Auditorium at the New York Hospital of Queens. “Craniotomy,” “burr hole,” and “micro surgical clips” were among the only English words said from behind the podium. On a rainy Saturday morning, a group of fifteen had gathered to hear the day’s lecture on stroke prevention.
Anita Co, a local resident of Filipino-Chinese descent, sat in the audience. Co regularly attends the monthly lectures, part of the hospital’s Community Health Initiatives program, launched in 2014. The series is tailored to native Chinese speakers, most of whom lack Co’s English skills. New York Hospital of Queens says this population makes up 30 percent of its patients. The hospital is located in Flushing, part of Queens Community District 7, where 55.7 percent of residents are foreign-born and 42.8 percent speak English “less than very well,” according to the Department of NYC Planning. Limited English proficiency remains a problem in the neighborhood—both on streets and in hospital rooms.
Co can attest to this. As a volunteer at New York Hospital of Queens a couple of years ago, she helped resolve an argument between doctor and patient, the result of miscommunication. “The doctor said the patient was yelling and had a bad attitude,” said Co. “So I asked the patient, what did you say?” The patient told her, “‘I was not swearing. I said I was in a lot of pain—I’m in pain!’ They just didn’t understand each other.”
Co’s experience is one example of hospitals’ ongoing struggle to meet the linguistic and cultural needs of the communities they serve. And it is not an isolated case.
New York City is home to over 1.8 million speakers of limited English proficiency, according to the Mayor’s Office of Immigrant Affairs. The city’s largest LEP minorities speak Spanish, at 50.4 percent of all LEP speakers, and Chinese, at 16.5 percent. A recent NYC Planning report shows New York’s foreign-born population has risen steadily in the last decade, hitting a new high in 2011, when foreign-born citizens accounted for over 3 million in of the city’s 8 million residents.
Yet, these groups continue to be underserved in the most critical of areas. Between 2003 and 2006 alone, combined costs of health inequalities and premature deaths in the United States have cost 1.24 trillion dollars in economic burden, according to a study by the Joint Center for Economic and Political Studies. During these years, the study found that an estimated 30.6 percent of direct medical care expenditures for African Americans, Asian Americans, and Hispanics were caused by health inequalities.
“Organizations, leaders, and decision makers really need to understand that language access is a business imperative, not a minority issue,” said Gayle Tang, Senior Director of National Diversity and Inclusion at Kaiser Permanente. This problem does not discriminate, Tang said, and we all pay the cost.
This need explains why local leaders have applauded the lecture series, the first of its kind in the area. Flushing Council member Peter Koo commended the hospital in an email, saying, “The fact that they have taken steps towards meeting those goals is a shining example of the importance that New York Hospital of Queens places on patient care.” Cindy Brach, a senior health policy researcher at the Agency for Healthcare Research and Quality, agreed. “The hospital is going beyond whatever they perceive is their requirement or liability exposure,” Brach said, “doing something that is going to benefit the community.”
Still, advocates say the city does not have enough programs like Community Health Initiatives.
“If you want to educate people and they don’t understand, it’s a waste,” said Alice Lee, who works for Amerigroup insurance and also runs a Flushing-based non-profit group. She worries that hospital programs often fail to reach their intended audience. Lee said that she is aware of services for Chinese people, but not ones that serve the Korean population, a community she thinks could use more attention from health care providers.
Kwang S. Kim, president of Korean Community Services, also said that language-specific hospital programming would be useful to the city’s Korean population. He thinks organizations have improved at serving this community, but says cultural issues remain a real concern.
Even so, programs like the one at New York Hospital of Queens are only a part of the solution. “Doing patient education in another language is one prong of a culture competent strategy,” said Brach. Such an approach includes multiple prongs, she said. For instance, hospitals must have easy-to-understand materials in other languages to be distributed, provide language interpretation services and discharge documents in other languages.
While a 2006 New York State law required hospitals to provide free interpretation in the city’s top six foreign languages, the quality of and access to interpretation still varies greatly, experts said. Hospitals often use dial-through vendors to provide translation services or give their employees dual roles as interpreters.
Patient education programs must be placed in the overall context of language issues in healthcare, an area that still needs much work, said Claudia Calhoon, Health Advocacy Senior Specialist for the New York Immigration Coalition. Getting health care providers to consistently use interpreters is a challenge, as is oversight, since many hospitals self-report, she said.
Rebecca Peng, a volunteer at New York Hospital of Queens, is one such interpreter. Peng is training to become a physician’s assistant, where she uses her language skills daily. Her native knowledge of Mandarin and Cantonese have served the hospital well. “They send me everywhere because I speak Chinese,” she said. Peng is not a certified translator, but neither are many of the nurses at the Ambulatory Surgical Unit, where she spends much of her time. Although many of the nurses there speak Mandarin fluently, Peng said there is a disincentive for them to get certified as medical translators, since “once you get certified, the hospital knows about it and will drag you off to different places.” Certified translators are in demand, and frequently get called to other units.
This approach to translation is problematic, according to Dr. Jane Delgado, president and CEO of the National Alliance for Hispanic Health. “Interpreters need to be trained to be health interpreters. You can’t just train anyone and say ‘you’re trained,’” said Delgado. Unfortunately, speaking foreign languages is often frowned on in the US, said Delgado. As result, organizations often fail to build on the skills their clients or employees already have, the languages they speak, in order to communicate with them, she said. This means hospitals may take documents and simply translate them, but fail to adapt materials to a given community.
There is some good news: in recent years, hospitals have become more aggressive in outreach, a function traditionally associated with community centers, said Delgado. Hospitals are making an effort to reach their communities, and for a reason. Just as patients need on hospitals to make them better, hospitals rely on a diverse pool of patients to conduct studies, according to Delgado. “If you’re doing clinical research you need a diverse population,” she said, pointing to a 2013 study that illustrates the importance of collecting medical data with regard to race and ethnicity. The study’s results varied greatly between ethnic groups; researchers found a correlation between vitamin D and coronary heart disease in Chinese and white patients, but not among blacks and Hispanics.
Although hospitals now receive Medicaid reimbursement for medical interpretation, they are not paid to institute programming like Community Health Initiatives, experts say. Lack of funding is a great obstacle, but Gayle Tang remains hopeful. “There are ways we can approach for language health programs for consumers that do not drain any particular health system,” Tang said. “It’s a matter of people getting together and being able to leverage each others’ resources.”
Dr. Ning Lin of Community Health Initiatives shares her enthusiasm. “The hospital has broad plans to engage in all communities,” Ning said, “and I as a Chinese-speaking neurosurgeon am happy to be part of this.”