A trip to the emergency room is never planned, and it's rarely pleasant.
For those who don't speak English, however, it can be downright bewildering.
Imagine trying to communicate the details of your pain or ailment to a nurse or doctor when you can't find the words, or deciphering an important document that needs your signature before treatment can begin.
Fortunately, Indiana hospitals and other medical facilities have access to interpretation services-be it through full-time staff members or a dial-up language line. In most cases, non-English-speaking patients are treated in a timely manner and never have to face the life-or-death consequences of a language barrier.
But Hoosier health care providers can do better, according to members of a new entity that seeks standards for medical interpretation and translation.
"Health care providers do not do any type of screening and there are no requirements for interpreters and translators. They're hiring people without testing writing or reading skills, their ability to do research, or look up terminology. We need a system in place," said Enrica Armendagni, co-chair of the Indiana Commission on Health Interpreters and Translators and professor of Spanish at IUPUI.
The stakes are getting higher every year, particularly for Spanish-speaking patients. Nationwide, the Hispanic population increased 50 percent from 1990 to 2000, and it grew from 1.8 percent to 3.5 percent in Indiana.
With those demographic changes in mind, the Indiana General Assembly last year authorized the commission to take a look at the state of medical interpreting and translating. The result was a 65-page report that, among other things, recommends a statewide certification program be implemented by 2010.
Though changes are still five years away, Indiana is taking a leading role on the issue. So far, only Washington state has implemented standards for its interpreters and translators, while Massachusetts, Oregon and California are close to doing the same.
"I am confident that we are very advanced at this point," said Carolin Requiz, director of the Hispanic and Latino Health division for the Indiana Minority Health Coalition, a not-for-profit entity that pushed for the recent legislation at the Indiana Statehouse. Requiz also serves on the commission.
In addition to putting patients in potential danger, poor interpretation can hurt hospitals' bottom lines, Requiz added, noting that patients with limited-proficiency English often have to undergo more tests than necessary to reach a diagnosis.
"Hospitals that cannot communicate cannot be cost-effective," she said.
Ultimately, however, advocates say patients' civil rights are at stake. The basis for that argument goes back to the Civil Rights Act of 1964, which provided that "no person on the grounds of race, color or national origin shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance."
President Clinton issued an executive order in 2000 that federal agencies, including the U.S. Department of Health and Human Services, provide guidance on access to services for those who don't speak the language. According to the commission's recent report, HHS deemed that simply identifying oneself as bilingual isn't enough to qualify as an interpreter or translator.
Such an interpreter, even a well-intentioned one, can make matters worse, said Wilma Alvarado-Little, co-chairwoman of the board of the National Council on Interpreting in Health Care.
"Right now, if somebody is interpreting and they haven't had any training, they might be more of a hindrance than a help," she said.
Often, a relative will step in-another situation that is fraught with problems.
"It's hard for a family member to remain objective and not be embarrassed." Alvarado-Little said.
Santa Rosa, Calif.-based NCIHC started as an informal working group in 1994 and became an official entity four years later. Its work has helped blaze a trail for the Indiana group, which is relying on much of NCIHC's research to chart its own course.
According to Requiz, Indiana may end up adapting the national standards developed by NCIHC, which includes standards of practices, a code of ethics and standards for language skills.
"We don't want to reinvent the wheel," she said.
The group has also taken cues from the Massachusetts Medical Interpreters Association, a not-for-profit group founded in 1986 that provides interpretation services in more than 70 languages. MMIA officials were consulted as part of the Indiana commission's work, Armedagni said.
For now, the commission has outlined a tentative set of requirements for interpreters, who facilitate communication orally, and translators, who convert written text from one language to another.
Requirements include proficiency in two languages, an understanding of two or more cultures, knowledge of specialized terminology, excellent note-taking skills and excellent writing skills.
Now that its report has been submitted, the commission has legislative authorization to continue functioning and implementing its recommendations for two years.
It plans to hold a forum on the subject for health care providers March 11 in Logansport.