Babel, Justice, and Democracy: Reflections on a Shortage of Interpreters at a Public Hospital

By Dwyer, James | The Hastings Center Report, March 2001 | Go to article overview

Babel, Justice, and Democracy: Reflections on a Shortage of Interpreters at a Public Hospital


Dwyer, James, The Hastings Center Report


When a doctor sees a patient, answers to a few questions can be crucial. So what to do when no one at the hospital speaks the patient's language? Doctors can often devise creative, makeshift ways of communicating with their patients, but the problem calls ultimately for a creative organizational response.

The public hospital where I work never seems to have enough. It never seems to have enough doctors, nurses, technicians, interpreters, and janitors. It never seems to have enough clinic hours, follow-up visits, and social services. Of all these shortages I want to focus on one in particular: the shortage of interpreters for patients who don't speak English. I want to consider, in a philosophical way, how the hospital should address this problem. But first I need to say more about the problem.

Many of the people who use this hospital and its clinics are working class immigrants. This is not a new development. The hospital has a long tradition of serving immigrants, and it has a mission to serve people without regard to their ability to pay. What has changed at the hospital is the countries that immigrants come from and the languages they speak. Two generations ago, German, Yiddish, Polish, and Italian were common at the hospital. Today, Spanish, Cantonese, Mandarin, and Bengali are much more common.

What has also changed is the number of languages spoken. During an eight-week period, the emergency department saw immigrant patients who spoke over thirty-five languages.[1] I suppose that more languages are spoken at the United Nations, but at the UN people can reliably assume that someone they want to converse with will have a working knowledge of English or French, and they can call on an extensive staff of interpreters. At the hospital, that's not the case. More than one-third of the immigrants have a poor command of English, and the hospital doesn't have enough interpreters.

So how do patients and staff deal with this problem? Some staff members are bilingual. They themselves are immigrants or are children of immigrants. Other staff members have learned to function in a second language, usually Spanish, and keep a bilingual dictionary close at hand. The hospital has hired some interpreters and trained a few volunteers to act as interpreters. And, finally, some patients show up with a family member--a spouse, child, or cousin--who knows enough English to help with the medical encounter.

Although the patients and staff muddle through each day, and the hospital never quite turns into a tower of Babel, problems do arise. Here are three examples:

* A Depressed Patient. Mrs. Chen was waiting to be seen in the primary care clinic. She was sitting quietly with her daughter, who looked to be about ten years old. It was almost six o'clock when Dr. Marsh called Mrs. Chen's name and introduced himself. Mrs. Chen didn't speak a word of English, but her daughter was fluent. Although Dr. Marsh didn't like to use family members as interpreters, he didn't know what else to do. The Cantonese speaking receptionist had gone home at five, and so had the hospital interpreters. He didn't want to send the patient away, so he began the interview through the daughter. He asked a few open-ended questions and took in the responses, all with the help of his ten-year-old interpreter. As the story unfolded, Dr. Marsh realized that Mrs. Chen was seriously depressed. He wanted to ask some pointed questions to assess the risk of suicide, but he felt bad about posing these questions through the daughter.[2]

* The Yellow Pages. The patient spoke Cambodian, two words of English, and one of French. He kept coughing and pointing at his chest. The attending physician was worried about tuberculosis. The answers to a few questions would help to clarify the matter, but none of the staff spoke Cambodian. The attending physician took the whole matter in stride. He asked the resident to get him the yellow pages. …

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