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Health Horizons : Care Also Means Knowing the Patient's Language : The Southland's polyglot population has created a great need for bilingual health professionals.


A Laotian couple, unable to understand their doctor's instructions, put oral medicine in their children's ears and wonder why their infections won't heal.

A pregnant Latina arrives in a hospital emergency room frightened, alone and deep in the throes of labor. With no Spanish speakers on the staff, hospital workers try to calm the woman by dialing a telephone-company interpreter thousands of miles away.

A Chinese immigrant, suffering from cancer, is forced to wait days for critical hospital care because no interpreters are available.

Many factors inhibit the relationship between health care professionals and their clients, but none more so than the inability to understand one another. Language differences can complicate everything from filling out admission forms and establishing a patient's medical history to prescribing treatment or even finding out just where it hurts.

As a result, hospitals and medical centers throughout the area are trying to build work forces as culturally diverse as the areas they serve. So for those seeking a career--or career advancement--in the competitive health care field, the ability to speak a language other than English has become a highly marketable skill.

"Ideally, we'd like our staff to mirror our patient population," said Felice Klein, director of nursing quality management for Kaiser Permanente, the nation's largest health maintenance organization. "Having representatives of different cultures among the health providers helps us not only understand [those cultures], but it educates us as well."

Each year, for example, Kaiser Permanente's home office in Oakland hands down to each of its 10 Southern California medical centers specific recruiting goals reflecting the demographics of surrounding neighborhoods.

Other health care providers, although less aggressive, also are trying to diversify their staffs.

"It's already in the interview process in a lot of areas," said Stephanie Chatoff, president of the California Assn. of Nurse Practitioners, which represents 1,400 members statewide. "If it's an area that needs a bilingual person, that's on the application. That's definitely taken into account."

But, she added, "if you wanted to be bilingual, it would be hard to choose which language" to study.

In Los Angeles, for example, where English-only speakers make up only about half the city's population, there are sizable numbers of residents who understand only Spanish, Tagalog, Korean or Chinese.

Health professionals agree that the number of multilingual practitioners is nowhere close to meeting the demand, and clinics and hospitals have developed several temporary strategies to deal with the polyglot clientele they serve.

At UCLA-Olive View Medical Center in Sylmar, where nearly three-quarters of the patients speak a language other than English, staff members with particular language skills are made available to assist co-workers in other departments. In addition, Sidney W. Helperin, who recently retired from the hospital's department of anesthesiology, compiled lists of commonly used phrases in Spanish and Armenian.

And Mercy Hospital in Sacramento, where Chatoff has worked for 10 years, is one of many health centers that uses AT&T's Language Line Services, which provides over-the-phone interpretation in 140 languages.

But these systems have their flaws. Hospitals experimenting with language lists similar to the one at Olive View have found that pulling employees away from their assigned jobs to assist in other parts of the hospital placed extra demands on those left behind. And phrase books, even one as complete as Helperin's, are helpful only in specific situations.

Telephone interpretation services are expensive and can prove unwieldy where they may be needed most, such as in operating rooms. Moreover, recent studies have shown that interpreters unschooled in medicine make mistakes such as omitting crucial information, substituting inaccurate terms and misunderstanding the patient's message. (In response, AT&T has begun providing its Language Line interpreters with courses in medical terminology.)

But perhaps most important, being unable to communicate intimately with patients makes it nearly impossible to deliver the kind of warm, personalized health care most professionals strive for.

"It's people that count," Chatoff says. "You have to treat the people; you can't treat the disease. I would like to have the medical profession really look at the patient rather than treat them piecemeal."

In the long run, experts in the field say, the best solution for hospitals and clinics is obvious, if hard to achieve: Hire a multilingual, multicultural staff. As a result, medical schools are increasingly adapting curricula not only with respect to languages, but also to the issue of cultural sensitivity.

Master's candidates in UCLA's nurse anesthesia program, for example, are urged to develop at least a conversational ability in Spanish, and graduate students in other health disciplines can choose from courses such as "cross-cultural studies" and "society and health issues in the Middle East."

"The reality of the place in which we work is that more than 50% of our clients speak [another language]. If we can't communicate with them, it's going to be a big problem," says Wynne Waugaman, director of UCLA's nurse anesthesia program.

Sometimes, the specific words aren't as important as simply making an attempt to say them.

"Even if the accent is bad, when the patient hears that the person taking care of them cares enough to try a little bit of their language, that is better than medicine," Helperin says.

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