Can you speak my language?
Pittsburgh health officials aim to better serve patients who aren’t proficient in English
“Ten years ago, you’d call a doctor’s office, and they’d say, ‘We don’t see people who don’t speak English,” said Barbara Murock, manager of the Allegheny County Department of Human Services’ Immigrants and Internationals Initiative.
She has witnessed a slew of local “horror stories” because the region lacked adequate language services, required in many federally funded programs: hospital patients left unfed, incorrect diagnoses, children interpreting during parent-teacher conferences.
Other language-access advocates echoed Ms. Murock’s experiences.
“Ten years ago, we had people giving birth without language support, and people who weren’t able to enroll their children in schools because of no language support,” said Mary Jayne McCullough, the founder and executive director of Global Wordsmiths, a local social enterprise providing language interpretation, translation and consulting services.
“We had a dad whose name was Roberto Jimenez, and the birth certificate said Rob as the first name and Erto as the last name,” she said, using a pseudonym to protect the man’s privacy.
This scenario was no fringe case, according to Ms. McCullough, who says she has seen incorrect birth certificates resulting from inadequate language support at least 10 times in her 12-year career in language support services in Pittsburgh.
Marie Teslovich, the manager of UPMC’s International Patient Relations office, noted that many of UPMC hospitals’ interpreters were hired to support overseas patients arriving for transplants rather than domestic limited-English-proficiency, or LEP, clients. Larger hospitals had the interpretation services, but smaller satellite offices lacked these until about eight years ago.
In some cases medical providers permitted family members as interpreters until qualified interpreters were required for hospital accreditation by the Joint Commission on Accreditation of Healthcare Organizations.
“I don’t think it’s a policy of refusing,” said Ms. Murock. “It’s something they weren’t accustomed to, so they had to develop a policy to address it.”
Since then, more federally funded programs in the Pittsburgh area have improved their language resources. UPMC and Allegheny Health Network have opened inclusion centers. Pittsburgh Public Schools also
launched “Nine Line,” which answers questions for LEP parents in 10 languages.
While awareness about language-access obligations has significantly improved in the past decade, there’s still progress to be made, local language-access advocates say.
Pittsburgh’s transformation
Many advocates attribute the absence of LEP resources to lack of diversity in the years following the steel industry’s decline.
“In Pittsburgh, we went from being a diverse town of immigrant steelworkers and miners and railroad workers to the bottom falling out and a lot of that diversity kind of getting lost in history. And now it’s resurging again, but because there was that 75-year, 100-year, gap, we’re just now learning what it’s like to be a diverse city again,” said Ms. McCullough.
From 2010 to 2016, the foreign-born population grew 17.8 percent, from 73,892 in 2010 to 87,078 in 2016. In the same time period, the LEP population grew 12 percent, from 31,796 in 2010 to 35,614 in 2016.
Ten years ago, many service providers were unaware of their obligations to provide language support at the time, said Leslie Aizenman, director of Refugee and Immigrant Services at Jewish Family and Children’s Services. Title VI of the Civil Rights Act of 1964 requires many federally funded programs to provide language support for people with limited English proficiency.
“I’d get doctors calling me, screaming at me, saying, ‘Why didn’t you provide an interpreter, how can I serve this patient?’ — and schools, too,” said Ms. Aizenman. “Nobody knew that that was their role.”
The Department of Human Services’ Immigrants and Internationals Initiative, with Ms. Murock at the helm, began to push for language services in the Pittsburgh area. A language subcommittee worked to establish a nonprofit language bank in the area in 2012, now called the Pittsburgh Language Access Network. Additionally, another subcommittee tackled cultural competency training, including educating service providers about their language support obligations.
Beginning about eight years ago, the Immigrants and Internationals Initiative began to regularly meet with UPMC’s Center for Engagement and Inclusion to best meet the needs of their immigrant patient population. Immigrant representatives would share their concerns, which allowed UPMC to adjust policies, such as adding Arabic and Nepali interpreters to meet the growing demand, according to Ms. Teslovich.
Just last fall, AHN launched its Immigrant Health Program, focused on identifying needs of its immigrant and refugee patients and providing recommendations for improvements.
What’s the situation now?
While language-access awareness and resources have strengthened in the past decade, advocates say that problems still exist for LEP people — beginning at the front desk.
“You walk into one of these hospitals, and they’re so confusing, where do you even go? The welcoming begins there,” said Ms. Aizenman.
She was especially concerned about high levels of turnover leading to lack of awareness among front-line staff. At UPMC, Ms. Teslovich noted that turnover is particularly high among front-line staff, and consistent training is key for quality service.
Kheir Mugwaneza, program manager for the AHN Immigrant Health Program initiative, echoed those concerns.
“The main problem is not that we don’t have the tools — we have the tools,” he said. “But staff need to be aware of the tools available to them.”
Both AHN and UPMC have on-staff interpreters or contracted in-person vendors, video and telephone interpreters, along with translation services for relevant documents. When LEP patients schedule appointments via phone, both AHN and UPMC have methods to ensure interpretation services during the patient’s appointment.
However, after a yearlong assessment of AHN hospitals, Mr. Mugwaneza identified some gaps. For example, despite requesting an interpreter via the AHN language line, interpretation services may not be available during a patient’s appointment. Sometimes, employees on the floor may be recruited to translate in a language they speak, but this approach isn’t appropriate if that person is not a trained interpreter, he said.
During his assessment, he noticed many AHN employees in a range of professions — physicians and nurses, employees in the emergency and patient relations departments, in addition to frontdesk staff — unaware of the resources.
Out of the six AHN hospitals he visited, he said, at least four didn’t have language identification cards, a chart used to identify which language is required for nonEnglish speakers.
For improvements, Mr. Mugwaneza, who is originally from Rwanda, emphasized staff training in cultural humility and language access resources, as well as hiring more diverse staff members. By this fall, he said there should be an implementation plan ready along with a timeline for improving immigrant health care in Allegheny Health Network.
Ms. Teslovich affirmed UPMC’s commitment to ensure quality patient services, including effective language services.