Communication Barriers facing Indigenous Speakers

Communication Barriers Facing Indigenous Speakers during the COVID-19 Pandemic

“Look for interpreters who speak Mixteco”

Simply put, communication is an essential part of life. It is how we give and learn information, provide essential facts about ourselves and our families, and navigate through life’s opportunities and challenges.

Perhaps no time is as important for effective, easy to understand communication as it is now, in the middle of a worldwide pandemic, the most devastating to afflict the United States and many other nations in more than 100 years, since the immediate aftermath of World War I.

Although we may recognize the objective necessity of emergency communication, for many people who speak indigenous languages and their health care providers, the devil is surely in the details of identifying the languages that indigenous people understand.

According to a February 2021 California Health Report, indigenous language identification and assistance are significant barriers to health care, exacerbating already prevalent health inequities and disparities facing indigenous peoples.

As the Report states:

“Tens of thousands of Mexican and Central American immigrants in California speak Mixteco and other indigenous languages. Like the Hernandez’, many don’t speak or understand Spanish well. These immigrants, who work mostly in agriculture and other essential jobs, have long struggled to get medical information and services in their languages, despite laws requiring medical facilities to offer interpretation in-person or through a dial-in service, advocates said. Now, with COVID-19 disproportionately impacting these immigrant communities, the language disconnect is creating major challenges for patients and their families as they try to navigate virus-related medical care…

Indigenous Californians have had difficulties getting information in their languages throughout the pandemic. At testing sites and medical facilities, there is often no translation available, according to community organizers. At MICOP, people have turned up at the organization’s offices in Oxnard asking for help translating their COVID test results, potentially exposing staff members to the virus, Lopez said. 

In Monterrey County, the Centro Binacional para el Desarrollo Indígena Oaxaqueño (CBDIO), which serves indigenous immigrants from the Mexican state of Oaxaca, noticed community members were struggling to get tested for COVID-19. Staff members called 15 testing sites in the county’s farmworker-heavy Salinas Valley to ask if they offered Mixteco interpretation. Only one said yes.”

Indigenous Language Assistance – Often Not Provided

The problems are often twofold – providers may assume that people from Mexico and Central America who speak indigenous languages, such as Mixteco, also speak Spanish. They often do not.

In addition, federal laws, such as the Affordable Care Act and Title VI of the Civil Rights Act of 1964 are indisputably clear in requiring federally subsidized health care organizations to provide effective language services to people who speak little or no English. The legal obligation includes widely spoken languages such as Spanish as well as languages such as Mixteco that are spoken by much smaller populations.

While the California Hospital Association denied awareness of an indigenous language assistance problem among member hospitals, at least one facility acknowledged that such assistance is currently lacking. According to California Health Report:

Jan Emerson-Shea, a spokesperson for the California Hospital Association, said she wasn’t aware of any problems with language interpretation at hospitals, and was not familiar with Mixteco specifically. She said hospitals do provide language interpretation.

‘All of our hospitals provide those services,’ she said. ‘California is a large and very diverse state with lots of languages that are spoken, and hospitals make arrangements to make sure they have language services available to meet the needs of their communities.’

In an emailed statement, Chad Burns, a spokesman for Dignity Health, which Bakersfield’s two Mercy Hospitals are affiliated with, acknowledged the lack of Mixteco interpretation at the hospitals. 

‘While our interpreter service provider includes more than 200 languages to assist patients and staff when there are communication barriers, some languages such as Mixteco are not included,’ the statement said. ‘We recognize the challenges this poses for our Mixtec patients and their families, and we are evaluating how we can expand our interpreter services for our culturally diverse community…’

Even when indigenous language speakers do ask for an interpreter, they frequently don’t get one, or the interpretation is inadequate, advocates said. Mixteco, the dominant indigenous language in California, has several variants that are mutually unintelligible. A patient may be matched with an interpreter who speaks the wrong variant, rendering the service useless. And commercial over-the-phone interpretation companies, which many hospitals use, often don’t have Mixteco interpreters available at all times of day, said Arcenio Lopez, executive director of the Mixteco Indigena Community Organizing Project (MICOP) in Ventura County, home to an estimated 20,000 people who identify as Mixtec…

On other occasions, interpretation services are available, but hospital staff aren’t trained on how to access them, Lopez added. He cited a recent example in which a Mixtec woman reported visiting two hospitals in Ventura County that have contracts with MICOP to provide interpretation, but she still didn’t get an interpreter.”

Solution – Plan, Plan, Plan

The U.S. Department of Justice has been unequivocal about planning for emergency and disasters. Such planning helps ensure people have equal access to emergency, life-saving services and information in languages they understand. It’s not just sensible advice, it’s the law.

“… complying with [federal legal] requirements becomes even more important during emergencies and disasters in order to ensure that no one is unjustly denied the services and support they need during times of crisis, when their physical safety or well-being are often at greatest risk, and when many of the resources they might otherwise have drawn upon for support may not be available.

Proper planning to comply with Title VI requirements avoids complications imposed by the exigencies of emergencies and disasters.”

As California Health Report related, emphasizing the federal admonition:

“You need to proactively plan,” she said. “You’re not going to do a great job serving people if what you’re doing is reacting three minutes (after) someone told you they had a language need and you’re scrambling to figure it out, said Marisa Christensen Lundin, legal director of an outreach and legal advocacy program for indigenous immigrants at California Rural Legal Assistance.

After a two-week hospital stay, [a Mixteco speaking patient] was released this week to continue his recovery at home in Arvin {CA]. The worst is over, said his wife, Hernandez Lopez. But she worries that others Mixteco speakers in her community will face the same anguish they did.

She said she had a message for the hospital: “Look for interpreters who speak Mixteco.”

© Bruce L. Adelson 2021. All Rights Reserved The material herein is educational and informational only.  No legal advice is intended or conveyed.

Bruce L. Adelson, Esq., is nationally recognized for his compliance expertise.  Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney.  Mr. Adelson is a faculty member at the Georgetown University School of Medicine and University of Pittsburgh School of Law where he teaches organizational culture, implicit bias, cultural and civil rights awareness. Mr. Adelson’s blogs are a Bromberg exclusive