By Patrick J. Javid, MD, Guest Blooger
Published: 06 November 2013
This week InterpretAmerica welcomes guest blogger Dr. Patrick J. Javid from Seattle Children's Hospital. In this articulate and insightful article, Dr. Javid outlines the critical importance of timely access to qualified interpreters in all settings and languages. His words parallel the thoughts I shared in my latest blog The Time is Now For Healthcare Interpreting 2.0. My article highlights the critical role interpreters play for families. This article beautifully expresses how interpreters empower providers to give their best care, even in very challenging linguistic circumstances. Many thanks to Dr. Javid for allowing us to reprint his article, first shared publicly on the NCIHClistserve.
Interpreting Surgery: A Doctor's Perspective
By Patrick J. Javid, MD, Seattle Children’s Hospital Patrick.firstname.lastname@example.org
A few weeks ago, as the Surgeon-of-the-Week, our team structured its entire set of morning rounds around a single individual. This person was not actually with us on rounds and she was not even in the hospital that day. But her expertise was instrumental to the care of one of our patients.
She was an interpreter. A Mixteco Bajo interpreter, to be exact. And she was one of the most important members of our team that day.
Victor was a 3-year-old boy who presented with ruptured appendicitis. He went to the OR on the night he arrived and then required 5 days of intravenous antibiotics in the hospital. He was recovering nicely, but his family only spoke Mixteco Bajo. They didn’t speak or understand any English, and very little Spanish. So on each of his five days in the hospital, the only way to communicate with Victor and his parents was through a Mixteco Bajo interpreter. This uncommon language is native to an area of south central Mexico with over 50 different individual dialects that vary from town to town. It is estimated that the language is spoken by a total of only 500,000 people in the world today. And we needed one of these unique individuals to help us discuss Victor’s plan of care with his parents.
I don’t have hard numbers here, but I am told that there are very few Mixteco Bajo interpreters available at any one time. That makes sense to me. So our team’s care coordinators went out of their way to coordinate a morning phone call with a Mixteco Bajo interpreter on each day that Victor stayed with us in the hospital. Essentially, we had made a recurring appointment with a phone interpreter and we dared not stand her up! So, no matter where we were on rounds each morning, we headed to Victor’s bedside at 9:30 a.m. for an audio rendezvous with our cherished Mixteco Bajo interpreter.
Once we reached our Mixteco Bajo interpreter, things went smoothly. We discussed the boy’s upcoming discharge, his pain medicine regimen, and the indications to return to the emergency room. But the entire scenario made me think about the importance of language – and communication – in surgical practice.
I took French all throughout middle and high school. Of course, here in the Pacific Northwest, all those years of conjugating French verbs have not helped me very much. Apart from English, the most common language we encounter is definitely Spanish. On weekdays during business hours, we have Spanish interpreters all throughout the hospital, ready to help a provider communicate to a patient or family member. In the Emergency Department, an in-house Spanish interpreter is available until at least midnight every night. In the OR, in fact, many of us have gotten to know our peri-operative interpreters very well. They have a hard job – all day long, as they literally run from the pre-op zone to the family waiting room, they are getting constantly paged to join a conversation with people they don’t know on subjects they may not be familiar with. I am always amazed that they don’t lose their voices and wits by the end of the day!
It gets even more interesting when a real, live interpreter is not available in the hospital. For example, last month I met a young girl who needed urgent abdominal surgery for a bowel obstruction. She was experiencing intense pain and her family was obviously stressed and upset. The parents spoke Vietnamese fluently, and their comprehension of English was clearly very limited. The chances of finding a Vietnamese interpreter in the hospital on a Friday night were small. But the next thing I knew, a computer was wheeled into the room, complete with a large monitor, a webcam, and a microphone.
This device, it turned out, was our interpreter! On the screen, in front of the family and me, sat a young woman named Marie. She introduced herself as our Vietnamese interpreter and she could see the patient’s parents as she interpreted by wireless video conference call. We had to adjust the microphone a few times, and I had to ask the parents to repeat themselves once or twice, but otherwise the process went amazingly well. It makes quite a difference to have your interpreter right in front of you, whether she is a product of wifi access on a computer screen or standing right next to you in real life. Skype to the rescue!
These online computer interpreter stations are available in the ED, the OR, and the ICU. When neither a real live human nor a wireless computer is available, we have something just as simple to use: the SPEAK line. From any hospital phone, dialing SPEAK will connect you right to an interpreter hotline. After providing some basic information about the patient, you are connected almost instantaneously with an interpreter over the phone. We used to use speaker phones for these types of conversations but recently the hospital built dual phone systems in all patient rooms. So, now, every room on the floor and in the ICU has a phone with a handset for the provider and a handset for the parent. It’s very easy to use.
With all of these resources, we essentially have 24-7 access to interpreters of any language or dialect. And I mean 24-7. There have been moments where I thought I would stress the system. For example, take my 3:30 am call to the SPEAK line looking for a Somali interpreter after a laparoscopic appendectomy. Or the time I needed a Mandarin interpreter on Saturday morning rounds. Then there was my request for a Sunday afternoon Tagalog interpreter as I consulted on a patient with a choledochal cyst.
Each time, the operator didn’t blink an eye (I think) as she gently replied: “Thank you and please wait for your Somali/Mandarin/Tagalog interpreter”.
(And at the precise moment when the interpreter comes on the line, part of me always wants to say something like: “You are amazing! It’s 3:30 am on a Tuesday morning! And not only are you awake but you speak Somali!” I have held back, so far.)
The one time I couldn’t get an interpreter in the middle of the night? That would be another night I needed another Mixteco Bajo interpreter after another child’s appendectomy at 2 a.m. Those Mixteco Bajo interpreters are indeed hard to come by, and on this particular night, I think they were all asleep. So we tried a Spanish interpreter and muddled our way through a conversation. The real discussion would have to wait for 9:30 am the following morning when our prized Mixteco Bajo interpreter would call into the room.
I was talking with my wife (also a surgeon) about the crucial role that interpreters play in the medical setting, and she told me about an interesting experience she had last year. She was taking care of a hearing-impaired patient who needed an operation. Not only did the sign language interpreter accompany the patient to her clinic visit with my wife, but she was also there on the day of surgery. For those who have never needed general anesthesia, there is a lot of communication that goes on when you first lie down on the operation room table and prepare to go to sleep. Adults are being told what is happening each step of the way. And the kids at our hospital are reassured and cajoled and praised.
On the day of this patient’s operation with my wife, the sign interpreter stood right next to the OR table as anesthesia was being induced. Dressed in the standard surgical “bunny suit,” the interpreter signed the entire conversation with the anesthesiologist so that the patient would understand what was happening as she drifted into sleep. The interpreter continued to sign until the anesthesiologist gave her the final signal to stop.
My wife added one more interesting tidbit. She liked the fact that I had written about the Mixteco Bajo language and that it is only spoken by half a million people around the world. But she had recently met a patient who spoke an even more exclusive language: Marshallese, the native language of the Marshall Islands. It is spoken by all of 44,000 people on our planet. And my wife needed a Marshallese interpreter in clinic one day. After a few minutes of preparation, the Marshallese interpreter was ready and waiting on the phone. Amazing.
Whether they are in person, online, or on the phone, our interpreters are vital members of our team here. Without our interpreters, we simply could not deliver quality medical and surgical care to our children and their family.