January 23, 2004

Interpreters ensure patients, doctors understand each other

Featured Image

Johannie Resto, left, interprets the questions of Nurse Practitioner Mark Young to Maria Torres, center, before her son, George, has a procedure. Photo by Dana Johnson

Interpreters ensure patients, doctors understand each other

There’s no denying that communication is key in patient-doctor relationships. And communication becomes essential when the patient speaks little or no English.

Take this real-life snafu for example: When one Spanish-speaking patient came to Vanderbilt University Medical Center, a staff member who spoke some Spanish attempted to communicate pre-surgery instructions to the patient. Unfortunately, the patient understood that he was not to eat or drink for two weeks prior to the surgery. After several days of not eating and sneaking food at night, he couldn’t keep up with the fasting orders. On the way to his surgery, he stopped and ate. Once he arrived at the hospital, the surgery had to be cancelled because he was only supposed to refrain from eating several hours prior to the surgery, not days.

It’s the job of Johannie Resto, coordinator for Interpreter Services, to make sure such incidents don’t happen.

“Just because someone speaks another language, it doesn’t mean they can be an interpreter. You can’t just use anyone,” said Resto. “It’s more than just communicating word for word — it’s interpreting the message.”

Resto said language barriers and cultural factors often make a difference in communication between a doctor and a patient. Sometimes the interpreter needs to clarify or educate patients and patient families on a particular subject. The job requires good listening skills and sometimes even becoming an advocate for the patient.

When the Office of Interpreter Services was created in March 2001, Resto became its only staff member, a number that has just barely increased with the recent addition of a part-time and full-time interpreter.

For the past four years, she’s provided more than just an essential service to those who speak little or no English— she’s gone beyond the “call of duty” to build relationships with patients in order to help ease at least one aspect of a very stressful situation.

Vanderbilt University Medical Center is the only hospital in Tennessee to provide interpreter services 24 hours a day, seven days a week. And it’s free of charge.

On this cold day, one of her dozens of rounds with patients happens to be 2-year-old George Cruz, who is waiting to get a central intravenous line replaced. Resto is a very familiar face for George and his mother, Maria Torres. For the past year, George has made numerous visits to VUMC for problems ranging from kidney issues and intestinal problems.

“At first, I didn’t have an interpreter. I used to get very frustrated because it was difficult for me to understand the doctors,” said Torres, who traveled to the United States from Vera Cruz, Mexico with her husband a few years ago, before George was born. Cruz and her husband moved to Tennessee in search of better jobs.

Resto, who moved to the United States from Puerto Rico 13 years ago to attend college and pursue a career, has been present to see George and his mother through almost every visit. While waiting for the nurse practitioner to go over the pre-surgery paperwork, Resto joked with Torres and jiggled toys in front of George, who smiled and played.

When Torres was asked how Resto had helped her, she laughed, in acknowledgement of the times she has called Resto at home when George needed some sort of medical assistance — be it a doctor’s appointment or a prescription refill. Resto has even helped Torres, who relies on Vanderbilt to maintain her son’s delicate health, learn some words in English.

“[Vanderbilt Medical Center staff] takes care of him very well, very good,” Torres said. “I trust this hospital.”

Mark Young, the nurse practitioner who met with Torres, sees immense value in using interpreters with patients with little or no English skills.

“Interpreters provide comfort and safety to patients and family, and makes sure information is accurate,” said Young.

While Resto and her newly hired interpreter can provide only Spanish interpretation and translation, the office has an agency they can call on to provide on-site interpretations for any language needed. The language line can be utilized and has more than 140 languages available for phone interpretation.

“But it’s much better to provide the service on-site, obviously.” Resto said. “The language line is good for check-in patients, appointments, or last minute requests.”

She said the most frequent requests for interpreters are for Spanish, Vietnamese, Kurdish, Arabic, Somali and Bosnian. These requests usually come from pediatric, orthopedics, trauma, cardiology, and obstetric patients. About one third of the pediatric population are foreign born, she estimates, and said Tennessee is ranked sixth in the United States for this.

Resto is working to educate as many people in Vanderbilt’s medical community as possible. She already teaches medical Spanish to doctors and staff members for no fee. As part of the class, she teaches “common sense” practices such as telling doctors and staff members to make sure they look directly at the patient instead of looking at the interpreter, to make them feel more at ease.

“Many of the undocumented patients we see are even scared to give their real name for fear that we may tell [the Department of Immigration and Naturalization], but we reiterate to them that we are here to solely help,” said Resto, who tries to be as informal as possible with patients and their families to make them feel at ease. That approach has led many to not only trust her but to rely on her even after normal office hours.

She remembers a 12-year-old, Spanish-speaking patient that she helped a few years ago. The girl had leukemia. She talked the girl and her parents through appointments, chemotherapy and radiation treatments for more than a year, and even gave them her home number in case something came up after hours. There were many times when the family would call asking for help late at night and on weekends — and Resto graciously provided whatever assistance was needed.

“They get to know you and you get to know them,” she said, remembering that the girl, who would ask for her specifically, would often offer to baby sit Resto’s future children.

Tragically, the girl died two years ago.

“Her body just couldn’t take it anymore,” Resto recalled sadly. “Her family stills keeps in touch, and they appreciated what I could do for them.”

Though it is painful when a patient doesn’t recover, Resto says it’s worth the heartache to get to know them.

“It just makes me feel nice if I can help people,” she said. “They are appreciative; they’ll even bring you food or small gifts as a token of appreciation. And they love it when you can crack little jokes and make them laugh.”

For information on the free “Spanish for Medical Professionals” class, call 936-0837.