In Interpreting

COVID-19 Hit Hard for Onsite Healthcare Interpreting

For healthcare facilities, COVID-19 hit from all angles. At the onset of the pandemic, not only were medical staff in a frenzy to ensure they had enough personal protective equipment (PPE) to care for their own, but they were also feverishly trying to hold on to sufficient numbers of staff to effectively manage the sudden, alarming spikes in emergency room visits and admissions. As if that wasn’t already enough to juggle, what about the more than 25 million US-limited-English proficient (LEP) population? How would healthcare practitioners continue to communicate with this patient population without interpreters at hand?

Healthcare facilities that had — up until the onset of COVID-19 — relied heavily on bilingual staff and onsite interpreting (OSI) services, were suddenly at a loss. With severe staff shortages and a strict “no visitors allowed” policy immediately in place, many healthcare institutions went without interpreting services while others found themselves being forced to adopt either over-the-phone (OPI) or virtual remote interpreting (VRI) service alternatives practically overnight. And while these interpreting services are certainly beneficial, they have also posed some unforeseen complications during this healthcare crisis.

Unforeseen Complications

Being forced to find the best OPI or VRI services in the midst of a pandemic distracts attention from caring for the patient, yet without effective communication, patients’ lives are inadvertently put at risk. Having a very limited supply of onsite interpreters and scarce bilingual staff at best is like adding fuel to an already out-of-control fire. However, even for those facilities that did manage to organize OPI or VRI services amid the chaos, healthcare providers soon found other obstacles to overcome.

Specialized telephones and video equipment must now be added to the high-touch hospital surfaces, but are they being properly and regularly disinfected? How can the distanced interpreter clearly hear the medical staff and patients when masks are covering up their faces? And for patients who are in critical condition, how can the interpreter properly hear their questions and responses if they are speaking with a weakened voice?

But it doesn’t end there — not by a longshot. Most COVID-19 cases evolve at an alarming rate. So, while having to hold on the phone, for instance, for OPI services, or having connectivity issues with VRI wouldn’t pose that much of a problem in non-emergency situations pre-COVID, now there isn’t a minute to lose. “The hospital rooms are loud, filled with buzzing oxygen tanks and urgent staff conversations. Everyone is masked, their voices muffled. Medical workers are trying to stay six feet away from their patients whenever possible.”1 Simply put, there is just no room (or time) for error nor is there patience for further complications. Even the most responsibly crafted risk mitigation strategies might not have been able to predict these bizarre, almost otherworldly complications. Nonetheless, here we are. 

But even pre-COVID-19, there have been ongoing debates within the language services industry (and within the healthcare sector) regarding which type of interpreting to use. As you will see in our next section, there are benefits and drawbacks to each one.

The Drawbacks of not Using Onsite Interpreting

In the following table, Araceli Z. Murphy, an experienced and certified healthcare interpreter located in the Los Angeles area, shares the potential drawbacks of not using onsite interpreting.

Challenges when onsite interpreting is not used
Machines/technology monitors are not personal, potentially causing the patient to hold back on engagement Interpreter might be interpreting from another country and might therefore not have adequate training in the subject matter or might lack knowledge of the country’s healthcare system
Sometimes OPI and VRI require a longer duration of clinical sessions to ensure clarification Elderly patients are often apprehensive or distrusting when speaking to machines — generational challenge
Patients with mental illness, strokes, Dementia, and/or Alzheimer’s often rely on body language, facial expressions, demeanor, composure, and/or gestures, which renders much more complicated in remote interpreting sessions Interpreter might also be at a disadvantage and might not capture subtle body language like fidgeting, sweating, becoming clammy, etc…
A remote interpreter is further challenged if additional people enter the hospital room (therapists, social workers, family members, friends, chaplains, etc.) Patients with chronic illness might not be forthcoming over the phone or via video when describing pain, emotional state, or when discussing sensitive subjects 
When video communication is lost, bilingual staff might need to be pulled away to interpret and/or in desperation, a family member might be asked to interpret, which violates US language laws and regulations The interpreting session might encounter technical difficulties, temporarily interrupting communication during critical moments in patient care
Remote interpreting sometimes creates increased difficulty understanding providers with accents or patients with heavy colloquial dialects or speech impediments Interpreter might not be local or familiar with patient demographic, background, or country of origin
Interpreters in a remote setting are unfortunately unable to provide simultaneous interpreting services Very difficult to demonstrate body exercises or body movements as required by the physical therapist or the medical provider, or when the patient is in traction, incapacitated, or hard of hearing
Benefits when onsite interpreting is used
Onsite interpreting is generally a more personable experience than technology-based interpreting An onsite interpreting environment makes it generally easier for interpreter to follow protocols on roles and interventions such as converter, clarifier, cultural bridge, and if needed, they can assist with patient advocacy
Patients generally feel comforted when the interpreter physically enters the room Even the physical positioning of the interpreter during the session can foster patient comfort and trust, opening up the communication between the provider and the patient.
Onsite interpreters can find the best possible positioning to ensure proper communication flow between the provider and the patient who might be deaf or hard of hearing, or who might speak softly or have difficulty seeing Generally faster and clearer communication during the session, building trust with the provider and the patient
Onsite interpreters can better assess the session and transfer to different modes of interpretation as needed (simultaneous, consecutive, and/or sight translation) Local interpreters can help with providing local resources (location of nearest hospital, client, pharmacies, rehabilitation centers, senior centers, etc)
Onsite interpreters are in a better position to help patients understand how to schedule follow-up appointments and can explain the processes for referrals, follow-up scheduling for tests, completing patient satisfaction surveys, etc In an onsite setting, interpreters are better equipped to immediately remove themselves from the room and re-enter when necessary in order to preserve the integrity of the encounter 
Onsite interpreting is more conducive to pre- and post-encounters to provide better communication and understanding, and to ultimately better serve the patient With the help of onsite interpreters, health plans can quickly verify patient information via patient surveys and make necessary adjustments
Onsite interpreters are better equipped to work with combative patients. Often, just their physical presence can make a difference Onsite interpreters are in a more advantageous position to interpret the proper use of medical devices (ex. glucose meter, blood pressure meter, etc.)

Source and Opinions of: Araceli Zamora Murphy, Certified Healthcare Interpreter (CCHI #002671)*See References for more information

Benefits of OPI and VRI

In the same vein, however, there are a great many benefits to adopting OPI and VRI for healthcare interpreting which cannot be overlooked. 

Convenience

For healthcare institutions that are located in remote settings, OPI or VRI often makes the most sense. Especially in emergency situations, hospitals in rural settings cannot afford to wait for the arrival of an onsite interpreter. 

Interpreting Pool

For healthcare providers in larger urban settings, interpreting services are often in high demand.  Not only do OPI and VRI offer virtually any language regardless of how rare the language might be, but unlike OSI, both OPI and VRI also provide almost immediate access to an extensive interpreter pool. Beyond this, using OPI or VRI for less critical cases frees up the often scarce onsite interpreters, allowing them to handle more serious cases that need onsite assistance.

Price

Depending on the distance that onsite interpreters must travel, sometimes OSI can prove to be more costly than OPI or VRI. In fact, a one- or two-hour minimum for onsite interpreters is standard across the industry, whether their services are needed for 15 minutes or 2 hours. 

Privacy

Deaf and Hard of Hearing communities are often small and tight-knit, as are many cultures, especially within refugee communities. Patients therefore, might personally know the onsite interpreter, placing the patient in a potentially uncomfortable situation. In these scenarios, it might be best to adopt either OPI or VRI solutions to further protect the patient’s privacy. 

Onsite Healthcare Interpreters Weigh In

In order to remain proactive to our colleagues and clients, Vocalink Global ran a quick survey on this very subject. We wanted to see what healthcare interpreters (primarily working in the United States) had to say about the state of onsite interpreting and what the future might hold. Our survey responders interpret in doctors’ offices, hospital in-patient settings, as well as hospital emergency rooms, public health clinics, comprehensive health systems, ambulatory settings and more.

Here is what they had to say.

  1. Since COVID-19 hit, what portion (if any) of your in-person interpreting job has been cut?

While nearly 29% of respondents reported not having lost any income since the onset of the pandemic, an equal percentage of respondents reported having lost 75% to all of their income, and nearly 43% of respondents reported having lost 50% – 75% of their pre-COVID-19 income.   

 

  1. If your employment as an in-person healthcare interpreter was negatively impacted due to COVID-19, have you left the profession entirely?

The survey revealed that 40% of respondents had not officially left the profession. However, while 20% of respondents indicated they had left the profession entirely, another 40% of respondents indicated shifting away from onsite to remote interpreting (although many shared that they were only able to recover a portion of their pre-COVID-19 employment even with VRI assignments).

 

  1. In your professional opinion, do you feel that OPI and/or VRI for the healthcare field will completely and permanently replace in-person interpreting?

Interestingly, while nearly 57% of respondents either disagreed or strongly disagreed that OPI and/or VRI would completely and permanently replace in-person interpreting, over 43% of respondents agreed or strongly agreed that it would. 

Recent reporting from the Common Sense Advisory (CSA) certainly seems to mirror the results of our mini-survey. According to the CSA, shortly after the onset of the pandemic, OPI services almost doubled and VRI services more than tripled. However freelance interpreters “now earn 72% less from spoken language services than prior to the pandemic.”2

Will Onsite Interpreting Return in a Post-COVID-19 World?

First, let it be said that regardless of the type of interpreting, professionally-trained healthcare interpreters provide an invaluable service to patients and medical providers. And, during unprecedented times such as these, healthcare interpreting services should most definitely be regarded as “essential.” In fact, over the years, several studies have reported that “the use of an interpreter increases patient satisfaction, decreases adverse outcomes, and improves adherence and positive outcomes.”3 Often acting as both cultural and linguistic liaisons between medical staff and patients, healthcare interpreters ensure that limited-English proficient (LEP) patients receive the same quality of care that is afforded to all patients. 

We don’t know what will happen in the months to come. But as we all brace ourselves for a possible round two of COVID-19 this fall, it is likely to be some time before onsite interpreting returns again, at least at the same level of availability as it was pre-COVID-19.

It seems the jury is still out on this one so we will just have to wait and see. 

Looking for professional healthcare interpreting services? Vocalink Global offers onsite, over-the-phone, and video remote interpreting services provided by linguists with expertise in the medical field. Our OPI option gives you access to over 275 languages and our VRI solutions provides you with a pool of thousands of professional linguists based in the United States and abroad. And, when OSI makes its full comeback, we have you covered.

Our onsite interpreters are employees, not contractors. They must all undergo a rigorous series of prescreening tests and a comprehensive interpreter selection process, and must submit complete legal and medical documentation. They are then shadowed by senior interpreters before ever providing interpreting solutions on their own. Our linguists have access to one of the best training programs in the industry. Recognizing that our clients rely on attentive and accurate interpreting to meet the needs of their customers,Vocalink Global is pleased to go the extra mile. In fact, we staff certified trainers for “The Community Interpreter,” a nationally recognized 40-hour training program that delves deeply into ethics, protocols, strategies, cultural mediation, and other critical skills that define effective interaction across languages and cultures.

Simply put, Vocalink Global is here for you. Be Heard. Be Understood. Reach out today.

REFERENCES

1 Goldberg, Emma. “When Coronavirus Care Gets Lost in Translation.” The New York Times, The New York Times, 17 Apr. 2020, www.nytimes.com/2020/04/17/health/covid-coronavirus-medical-translators.html

2 “The Shock That COVID-19 Caused to the Interpreting Market.” CSA Research, csa-research.com/Insights/ArticleID/633/covid19-shocks-interpreting-market

3 Tonkin, Emily, et al. “The Importance of Medical Interpreters.” American Journal of Psychiatry Residents’ Journal, 1 Aug. 2017, ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2017.120806

In addition to:

Jie Zong, Jeanne Batalova Jie Zong and Jeanne Batalova. “The Limited English Proficient Population in the United States in 2013.” Migrationpolicy.org, 20 July 2020, www.migrationpolicy.org/article/limited-english-proficient-population-united-states-2013

“5 Overlooked High-Touch Hospital Surfaces.” Infection Control Today, www.infectioncontroltoday.com/view/five-overlooked-high-touch-hospital-surfaces

Data and Research · by Slator On September 12, et al. “Slator 2019 US Healthcare Interpreting Report.” Slator, 13 Apr. 2020, slator.com/data-research/slator-2019-us-healthcare-interpreting-report/

TECHNOLOGY: Danilo Formolo, David Fetterolf. “Carolinas Healthcare System Saved $1.5M Annually by Using Remote Interpreter Technology.” Hfma, www.hfma.org/topics/article/57149.html.

*”The Drawbacks of not Using an Onsite Interpreter” – Araceli Zamora Murphy, a Certified Healthcare Interpreter (CCHI #002671) has been providing face-to-face interpreting to the LEP (Latino) community in southern California (Los Angeles, Orange and San Bernardino counties) since 2013. For more information or to contact Ms. Murphy, email: araceli.murphy04@gmail.com

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