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Listening sessions held with Spanish-speaking patients, their families, providers and interpreters showed shortcoming to health care access in languages other than English.

Veronica Mireles knows from personal experience the perils many Kansas Latinos face navigating health care in Kansas without English fluency.

When Mireles arrived at a hospital in Wichita with her ill son, she received a bilingual staff member rather than a qualified interpreter. The staff member provided some basic translations, but it was insufficient.

“My son’s appendix burst as a result of misdiagnosis because they didn’t understand what was happening,” said Mireles. “Unfortunately, because we could not express ourselves, my son had to go through that.”

Latinos across the state face this critical language barrier regularly, often resulting in misdiagnosis, misinformation and uncertainty over what often is an intimate and sensitive situation.

A 2017 Kansas Health Institute study looking at racial and ethnic health disparities in Kansas found indicators suggesting Latino Kansans were disproportionately impacted.

One of those indicators was health literacy or “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”

“Unfortunately, many Kansans face barriers with access to health care, including affordability, one’s geography and certainly language,” said Kristi Zukovich, a spokesperson for the Kansas Health Foundation. “KHF has invested in helping health care clinics, including mental health clinics, with bilingual materials, translation services and multi-lingual technology in an effort to remove barriers to care and provide language access to those who need it most.”

This spring, Wichita State University Spanish professors launched a series of community engagement projects, as part of a larger Patient-Centered Research Institute project. They spoke with Spanish-speaking patients, their families, interpreters and health care providers to discuss their experiences with language assistance.

Issues that emerged indicated Kansas health care providers do not always provide adequate care in the patients’ preferred language, despite Title VI, a law that mandates recipients of federal financial assistance take “reasonable steps” to provide access to those with limited English proficiency.

“We go to clinics or the hospital and they assume we understand because in our second language we say, ‘OK, OK.’ They do not ask if we want an interpreter,” said Marisol Andrade, a Spanish-speaking patient, of her experience at GraceMed Health Clinic in Wichita. “So, I am left with questions. What did I understand? What are they going to do? And how am I going to pay for it?”

Rachel Showstack, an associate professor of Spanish at Wichita State, helped lead the project, which culminated with a testimonial video meant to educate legislators. The video included Andrade’s and Mireles’ story.

In the video, Showstack said the urgency for change has been elevated by the pandemic. The spread of pertinent health recommendations and information regarding COVID-19 in languages other than English has been lacking in Kansas.

Additionally, a rapid transition to telehealth has left language access behind in situations where interpretation is not built into the provider’s platform, Showstack said.

“Interpreting can be a major undertaking. They are meant to be a clarifier, a cultural broker and sometimes must serve as an advocate for the patient,” Showstack said. “So often when it takes more time, providers may feel rushed and not focus on covering all the patient’s health needs.”

Even when provided some form of interpretation, Spanish-speaking patients often find themselves stuck with an under-qualified interpreter — a family member or bilingual staff member in some cases — representing them.

Showstack said this may be due to the fact Kansas reimburses health care providers for interpreter services associated with Medicaid but does not currently have interpreter competency requirements.

“Some patients we spoke to said they felt providers and the interpreters were ‘cortante,’ curt or terse, and expected a sense of ‘confianza,’ which refers to a sense of trust or familiarity,” said Showstack. “These are often life or death matters, and you shouldn’t be provided someone who is underqualified in these sensitive situations.”

At most, Showstack said, language access policies in Kansas allow these federally funded facilities to meet minimal standards. She suggested a series of changes be made from onsite interpreters to more standardized training, or even further enforcement of Title VI.

The testimonial video was sent to legislators this month with a short survey attached. They hope to gather more information on how legislators view and plan to address this issue.

Showstack and colleagues hope the video will help state and local legislators, as well as health professionals, focus their attention on improving systems of providing language access for a more equitable health care system in Kansas.

“We need to ensure that those with authority do not allow injustices against speakers of languages other than English to continue in health care,” Showstack said.

(13) comments

cropduster1

Try moving to a different country and going to their public education system (if they have one) and having teachers that will teach you in your language and not theirs. My ancesters had to learn English. No one brought in a German speaking teacher. How much money do you suppose it costs us each year to have dual language teachers, court reporters etcetera, etcetera? Have you looked at a voting ballot lately? I couldn't believe how many different languages were on there the last time I voted. This is the USA. If you should at least be able to vote in English. But ohhh well. Let's keep giving everyone welfare, social security, health insurance, unemployment no mater weather they're legal or not, "ASIMILATE' that's the first English word any body wishing to live here should learn.

esustudent

Interesting points, cropduster1. (1) Go to a different country and you will see that the kids learn and master more than 1 language, unlike the USA. (2) German immigrants were forced to assimilate. Study the letters Germans wrote to their relatives oversears in German. Study newspaper reports on how Germans were lynched in the USA during WWII for speaking German and being suspects of treason, and for calling themselves German-Americans. (3) Oh, is it a matter of money? Sadly enough, this pandemic has shown how economically necessary non-English speaking workers are for the economy, particularly, but not exclusively, in the food production chain and the manufacturing sector. (4) Oh, it is a matter of being or not being legal? African-Americans were brought to the USA against their will and slaved, they lost their native language, learned English and assimilated, and they still are treated as second class citizens. What about Native-Americans? Finally, your idea of having to "ASIMILATE"[sic] "weather" [sic] they are legal or not, contradicts the USA most beautiful principle of FREEDOM for all.

esustudent

Correction: WWI

cropduster1

So kids in a different country learn more than one language. Do they teach you a non native in your language or theirs? I wasn't here when the Germans and Japanese were lynched but things happen in wars whether they are right or wrong. Doesn't make it right but that's history. Should I, since I'm of German decent, be protesting the events of 80 years ago and demanding we do away with the flag and tear down statues? No I shouldn't but hey let's rewrite history like they do in Russia. Slavery was and is an abomination. There is still a problem with the way black people are treated no argument there. And Native Americans they got the worst deal of anyone. Now about the money. Yes it is about the money. I'm not a politician so I can't just go and print some more have to earn it. When you graduate from college and get out into the REAL WORLD maybe you'll figure out after working your butt off for 40/50 years and you look at your paycheck and pay your taxes. You may also ask where is this money I worked for and got taxed on and what is it being used for. As for the freedom for all that also includes me being able to have freedom of thought and speech. Therefore I see no reason at all to force people to assimilate if they want all of the freedoms we have.

Ril

What I don't understand is how someone can live here 20 or 30 years, and still can't speak any English. I am sure it isn't ignorance, so it must come down to simply not wanting, or caring enough to put out the effort to learn English. If I were to relocate to a foreign country, I would immediately find someone to tutor me in the language so that I could fit in with the locals, as I know that they would respect my efforts.

esustudent

This is a very good question and I am glad that you recognize that you don't understand the problem. How does your comment "live here 20 or 30 years" relate to the story here? "Not wanting or caring enough...." Any evidence to support your assertion? Using yourself as an example you argue that if you relocate to a foreign country "I would immediately find someone to tutor me...." So, you assume that the people in the story haven't tried that route. You also assume that they don't speak any English at all. A person can master the fundamentals of a foreign language well enough to get by in their everyday life affairs. When it comes to technical and professional (e.g., medical, legal) language you are talking about a high level of mastering of a language that sometimes not even English speaking people have developed.

cropduster1

agree

cropduster1

Well said Ril

esustudent

To cropduster, in case you believe in God: Jeremiah 7:5-7: "For if you truly amend your ways and your doings, if you truly act justly one with another, if you do not oppress the alien, the orphan, and the widow, or shed innocent blood in this place, and if you do not go after other gods to your own hurt, then I will dwell with you in this place, in the land that I gave of old to your ancestors forever and ever." Not speaking English should not be an obstacle to having empathy and compassion for those in need.

Aim_High

He probably worships Republican Jesus and not classic Jesus.

cropduster1

ESU student. I believe God and I have plenty of empathy for people. But you can't help people that won't help themselves. There is not a reason in the world not to learn the language of the country where you live. Except maybe here in the US where we have so many bleeding heart liberals that want to give everyone everything. Show me the effort and then talk to me about God and empathy.

cropduster1

Prime example of if you want to live here learn to speak english

Concha

Not nice. Sounds like you should step in others' shoes to experience the why people are where they are at

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