More than 68 million people living in the United States speak a language other than English at home, according to the U.S. Census Bureau. Of that number, 25 million speak little or no English and are considered to be Limited English Proficient (LEP), also according to Census data.
It is axiomatic that if one does not speak or read English, navigating through daily life in the U.S. can be extraordinarily difficult. Such difficulty is magnified when an LEP person has an encounter with healthcare providers who may not provide vital language access to their patients.
The language barrier can be difficult to breach. Often, informed and enlivened community involvement can significantly increase the chances of breaking that barrier down.
Wichita, Kansas features such significant community involvement in language access.
The state’s Spanish speaking population has increased dramatically in recent years. Indeed, the Voting Rights Act requires six Kansas counties, Finney, Ford, Grant, Haskell, Seward, and Stevens, to provide election materials and ballots in Spanish. Such requirements are implemented by the Census Bureau and Department of Justice when they determine that a municipality or county meets the following criteria:
“A jurisdiction is covered under Section 203 where the number of United States citizens of voting age is a single language group within the jurisdiction:
- Is more than 10,000, or
- Is more than five percent of all voting age citizens, or
- On an Indian reservation, exceeds five percent of all reservation residents; and
- The illiteracy rate of the group is higher than the national illiteracy rate.”
See: https://www.justice.gov/crt/about-language-minority-voting-rights#langguide
In Wichita, Kansas’s largest city with a population of approximately 400,000 people, a college professor has founded a local community organization that is active in breaking down that language barrier.
According to the Wichita Eagle:
“Rachel Showstack is an associate professor of Spanish at Wichita State University and the founder and president of Alce Su Voz, which translates to “speak out.”
It is a coalition of Spanish-speaking LatinX families, interpreters, healthcare providers, community leaders, university faculty and students whose mission is to improve health equity for Spanish speakers and speakers of indigenous languages in Kansas, the organization’s website says…
Alce Su Voz hosts community workshops on topics that include the right to professional medical interpreting services and understanding public health information.
The group also has expanded their mission beyond Wichita to parts of rural Kansas.
We want to collaborate with these healthcare entities because we know they’re having a hard time, Showstack said. There are issues and a lot of it is systemic, not just the hospitals… it’s the system..
The coalition formed after a series of community meetings at which attendees shared their health experiences in spring 2020.
Through these meetings and research, Showstack realized there was a need. I learned about how so many young people had grown up serving as interpreters for their parents all over Kansas, Showstack said. I also learned that many bilingual nurses and other clinicians were being pulled away to interpret when that wasn’t a part of their job.”
Showstack said using informal interpreters does not equal health equity. She used Mireles’ experience as an example.
They never received a professional interpreter, Showstack said. So, the outcome was that they had an $85,000 medical bill and her son was not able to work for several days or go to school. It had a real negative impact on their family…”
Veronica Mireles’ experience with a Kansas health care provider that does not have a language access program, including trained, qualified interpreters and translators, is both tragic and all too common. In 2019, her 18-year-old son Angel was hospitalized after his appendix ruptured. Butt before this occurred, Angel had experienced severe pain that became unbearable.
The Wichita Eagle recounts the story:
“Mireles, who does not speak English fluently, recalls arriving at the hospital and not receiving an interpreter or knowing if one was called by hospital staff. She did her best telling her son to explain to the doctor what was happening.
Angel, along with his parents and two brothers, migrated from Juarez, Mexico, to the U.S. in 2018. No one in the family spoke English well at the time.
After running tests, the doctor diagnosed Angel’s abdomen pain as a sexually transmitted disease. Mireles said she did not know what or how many tests were done.
Over the phone, Angel said medical staff had done blood and urine tests. After all the exams and everything they said they needed to talk to me,” Angel said. They told me that I have a sexual disease.
He was prescribed medication for STD treatment. Two days later and with the pain getting worse, Mireles took Angel to GraceMed Health Clinic, where a different doctor accompanied by an interpreter told her to go to the emergency room immediately.
Angel had appendicitis. I remember her telling me, Go now, because this child’s appendix is ruptured, Mireles said. Her son was admitted to the hospital, where he underwent surgery and remained for five days, Mireles said.
After all was said and done, I couldn’t shake the fact that all this happened because we got the wrong diagnosis because of not being able to communicate properly, Mireles said. Angel, now 22 and working as a diesel mechanic, still reflects on the experience.
Both Mireles and Angel told an Eagle reporter that they were not asked if they needed an interpreter at Wesley [the first hospital they visited.,]”
Showstack investigated the language access needs of Kansans and produced with three co-authors, an analysis entitled, Language Access in Kansas Healthcare A Policy Brief for KDHE and Kansas Legislators.
The analysis opines that
“As Kansas becomes more linguistically diverse, studies show that language access services are necessary to maintain the highest possible level of health in our communities. Based on research that centers the experiences of patients and their families, healthcare providers, and healthcare administrators, this policy brief focuses on the need for more qualified interpreters in Kansas health systems and for health information dissemination in languages other than English.”
Alce Su Voz is also introducing the importance of language access plans to Kansas communities, LEP people, and health care providers. As the Eagle reports,
“Showstack and her Alce Su Voz hospital and clinic engagement team are working with healthcare institutions across Kansas on their language access plans.
The team has developed a survey that they’re currently administering to different healthcare entities across Kansas, Showstack said. About how they are providing language access services, and how it’s going.
Research gathered from the surveys will be a part of a report that Showstack and her team will present at a state language access policy summit later this year.
With this information, the state may be able to make adjustments to streamline the system, Showstack said. It’s kind of an initial draft to discuss next steps.”
Indeed, language access plans are an integral part of providing language assistance services and complying with federal law. The upcoming final Affordable Care Act Section 1557 health care regulations may well require that federally subsidized health care providers have legally compliant, effective plans in place as part of an overall language access system.
“Interpreting veteran Marixendra Alvarezis … serves as an interpreter and is on the advisory board for Alce Su Voz.
She too wants to see healthcare institutions in Kansas have a good language access plan where interpreters are licensed/certified.
This is a very challenging profession but very rewarding when you can actually create a positive impact. Alvarez said. When I found them [Alce Su Voz], I was like wow, I’m not just one person trying to change this whole system.”
© Bruce L. Adelson 2023. 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.