로컬 번역업체 ‘즐거운 비명’

최근 모기지 융자 서류를 대출자가 사용하는 언어로 준비하는 것이 의무화되면서 로컬 번역업체들이 바빠지고 있다.  koreaninterpreters.net에서 저렴한 가격에 융자서류의 영한번역을 제공한다.

30일 LA비즈니스저널이 전한 바에 따르면 모기지 융자에 있어 대출자가 영어에 익숙하지 않을 경우 은행을 비롯한 렌더들이 융자관련 정보를 대출자가 사용하는 언어로 제공해야 함에 따라 이에 대한 서류 또는 설명을 번역업체에 번역을 의뢰하는 일이 늘고 있다.

캘리포니아주에서는 모기지 대출자들이 융자를 하면서 영어 사용에 어려움으로 인해융자에 대한 정확한 정보를 숙지하지 못했다는 불만이 많아지자 지난해 영어외에 한국어와 스페니시, 중국어, 필리핀어(타갈로그), 그리고 베트남어로 된 융자 조건에 대한 내용을 설명하는 것을 의무화하는 법안(AB 1160)이 마련됐다.

이 법안은 지난해 10월 아놀드 슈워제네거 주지사가 서명을 했으며 지난달 1일부터 본격적인 시행에 들어갔다. 이 법안은 이들 언어 사용자가 모기지 융자를 할 경우 주요 내용을 대출자 사용언어를 사용해 서류 또는 구두로 융자조건을 정확히 알려주도록 하고 있다.

은행들이 융자에 있어 새로운 언어로 서류를 준비하거나 설명해야 하면서 이들 서류 및 정보를 제공하기 위해 번역회사들에게 번역을 맡기고 있어 번역업체들은 불경기 속에서 적지 않은 수입을 올리고 있으며 늘어나는 일감으로 인력채용을 하고 있다.

노스할리우드지역에 위치한 번역회사인 ISI 번역서비스의 조지 리마로어 사장은 “새 법안 시행으로 인해 번역 주문이 늘어나 4개의 스페니시 번역팀을 새로 만들었고 직원수도 17명에서 21명으로 늘었다”고 말했다.

엘에이 동시통역대학원 부설 통역번역센터는 각 은행에 한국어, 중국어, 베트남어, 스페인어, 필리핀어로 모기지 융자서류를 번역하고 있다.

One out of four New Yorkers doesn’t speak or understand complex sentences in English. But at some point in their lives, every one of them will need to see a doctor. Language barriers can result in misdiagnoses, medication errors, and potentially fatal mistakes that are costly for both patients and providers. For this reason, hospitals in New York are required to provide “meaningful language access” to all patients. But in a city where more than 140 different languages are spoken, this is no easy task.

Slideshow: Medical Translation in a City of Immigrants

When Inocencia Nolasco landed in the Wycoff Hospital room with phlebitis, an inflammation of the veins, she knew exactly how she felt, but couldn’t explain it to anyone there.

“When I arrived the doctor didn’t know Spanish. We didn’t understand each other, and finally I called a friend who could come and be my interpreter,” Nolasco says.

Nolasco was lucky that she had a bilingual friend who could come to the hospital, but excruciating hours were wasted. “Time was passing and I was in pain. It was really horrible,” she says.

Nolasco was in the ER a decade ago. Until quite recently it was common that patients had to wait for hours for language interpreters at hospitals. Dr. Danielle Ofri, an internist at Bellevue hospital in Manhattan, says it was a confidentiality nightmare ripe for miscommunication and error.

“We rely on whoever is available, whether it’s a clerk who’s bilingual, a cousin, a six-year-old kid, an uncle in a taxi cab calling from their cell phone. There are so many things that are highly inappropriate, but we would do that,” Ofri remembers.

In 2003, with immigration levels rising, health advocates began filing complaints against hospitals in the state attorney general’s office. They argued that without language services, immigrants couldn’t get equal medical care.

Nisha Agarwal, an attorney with New York Lawyers for the Public Interest, says, “When language access isn’t provided, it’s like doing veterinary medicine, just guessing randomly what they needed to do instead of having a conversation with the patient.”

In 2006, New York State passed regulations requiring all hospitals to provide free interpretation for patients within 10 minutes of arriving in the ER, and 20 minutes elsewhere in the hospital. The city has taken additional steps — in 2008, Mayor Michael Bloomberg ordered all public hospitals to have a language access plan. This fall, major pharmacy chains were required to translate prescriptions into the top seven languages spoken in the city.

Map by Neil Freeman.

Maps: Languages of New York City

Many hospitals now rely on telephone interpreters to be the crucial link between patients and doctors. By dialing a central number, within a minute doctors can be connected to someone who speaks one of 180 languages. Each room at Bellevue now has one of these special phones installed.

One day recently, Dr. Ofri visits Tong Woo Lee, a Korean American patient who is isolated in a room at Bellevue. They speak to each other while holding telephones to their ears. Dr. Ofri wears a mask and she tries to maintain eye contact, but it’s difficult.

“Can you tell me a little bit about when you first started to feel sick?” Ofri says into the phone, while looking at Lee. There’s a slight pause. Lee listens to the interpreter’s voice, and looks away. He responds in Korean. Line-by-line, their sentences are translated. The conversation takes twice as long as it would if they were speaking the same language.

Through the telephone interpreter, Lee tells his doctor that he called an ambulance because his back hurt so much he couldn’t walk. He assumed it was because he had lifted something heavy. But Ofri tells him that he has a more serious problem — an infection in his spine.

Tong Woo Lee at Bellevue Hospital (Photo by Sarah Kate Kramer).

On this day, Ofri has 20 patients to see, and can only spend a few minutes with each one. She tells Lee — through the interpreter — that he may have tuberculosis, which is why he’s in isolation with an IV in his arm, being subjected to tests.

According to Ofri, the interpretation phone is much better than the old ad-hoc system of hoping there’s a native speaker nearby. But she still finds it a frustrating and awkward tool. Her bedside manner goes by the wayside because there’s no possibility of chitchat, and the interpreters speak in neutral voices that don’t always transmit her tone. Ofri is always worried that details about her patients are lost in translation.

“I don’t always know what they’re saying and I think vice versa. It’s like speaking underwater; everything’s a little bit blurry. It’s the sensation that we’re doing pretty well, but I can’t be completely confident, and it’s frustrating and it’s frightening. I imagine it’s frightening for the patient. I’m nervous I’m going to miss something or do something wrong, but it’s also the best we can do,” she says.

When a person walks into one of the city’s public hospitals now, they are greeted by signs with directions in 12 different languages. In fact, so many immigrants rely on Bellevue that it has become a leader in the interpretation field. Bellevue has built a remote simultaneous medical interpreting center for the hospital’s top eight languages right on site, similar to the system used at the United Nations. On the fifth floor of Bellevue, 28 people are sitting at stations waiting for their phones to ring. They’re grouped by language. There’s an area for Spanish, Mandarin, Cantonese, Russian, Polish, Bengali, French, and Haitian Creole.

Simultaneous interpretation means the workers translate each word as they hear it, so the two ends of the conversation don’t have to wait for each sentence to be repeated. The workers were trained to create the illusion that doctor and patient are speaking directly to each other.

On average, this in-house system, called TEMIS (Technology Enhanced Medical Interpreting System) receives almost 6,500 calls a month, and more than half of them are for Spanish speakers.

Walking through the cubicles, the eight languages mingle together, creating a cacophonic soundscape that mirrors the city’s diverse population.

Evens Jean, a French and Haitian Creole interpreter who has language maps taped to the walls of his cubicle, says the stakes are high — patients are essentially trusting their lives to his voice. And even using this innovative system, he knows there are communication gaps.

Evens Jean translating at Bellevue Hospital (Photo by Sarah Kate Kramer).

“Not every single patient is going to see things from the American perspective, they come from their own culture with their own baggage, they have a way of seeing and understanding health care,” Jean says.

In many cases — for both doctors and patients — cultural interpretation is equally important as word-for-word translation. Many interpreters report they hear patients saying yes, even when they don’t really understand.

Dr. Ofri, the internist at Bellevue, has seen this many times.

“It’s a different cultural experience to be at a doctor’s at other countries. So many of my patients are extremely respectful, they say yes to whatever I say no matter what. So I don’t know if they know what I’m saying and agree, or they have no idea what I’m saying and say yes because that’s what they’re supposed to say and be polite. So, yes can mean any one of a hundred things,” she says.

That’s why Ofri says it would be ideal if every immigrant patient could have a bilingual and a bicultural interpreter at the hospital. But she says that’s not realistic given the hospital’s budget. For her, the true connection often begins after she and her patient hang up the interpreter phones and the physical exam begins. It’s the age-old non-verbal conversation between a sick person and their healer.

“When you touch someone, it’s an intimacy, an unromantic intimacy, but an intimacy nonetheless, and sometimes in that setting the patients can really tell you what’s going,” Ofri says. “So that’s when our connection is formed.”

Dr. Ofri at Bellevue Hospital (Photo by Sarah Kate Kramer).

Bellevue hospital alone spends $2.5 million a year on interpreting. And Maribel Castillo, the hospital’s language access coordinator, says she sees the need rise each month. But Castillo maintains that even though the service costs the hospital a lot of money, it’s a necessity.

“This kind of service helps the patient adhere to treatment and for them to get better, and that’s what ultimately matters the most,” Castillo says.

But even with the hospital’s efforts, a 2008 survey by the New York Immigration Coalition and Make the Road New York showed that one out of five limited English proficiency patients in the city felt their medical care had been compromised by language barriers. Almost half said they wanted to ask a question but couldn’t.

Theo Oshiro, director of health advocacy at Make the Road, says even if hospital administrators may understand the regulations, information about language services doesn’t always trickle down to caregivers, like nurses, aides, and receptionists with whom patients interact.

“A lot of front-line staff have not been trained. [They] don’t know how to access the system of the hospital to get an interpreter quickly. Just a couple of years ago I was talking to a hospital resident, he was saying, ‘I can’t understand a lot of people at my hospital, I don’t know what they’re saying, I don’t know what their complaints are,’” Oshiro says.

Advocates agree the 2006 language access regulations have had a big impact, like ending the practice of using bilingual children to interpret sensitive topics for their parents. But patients say the quality of interpretation still varies widely across the city. In September, the New York State Department of Health issued a citation to St. Barnabas in the Bronx because of its failure to provide an interpreter to a Spanish speaking patient.

Nisha Agarwal, the attorney with New York Lawyers for the Public Interest, represented that patient in court. “She did not get an interpreter at all, and when she did get interpreters, in the hospital, it was usually somebody who had been pulled in from somewhere else who was actually not trained to be an interpreter. So half the time they couldn’t even do a good job,” Agarwal says.

A good medical interpreter is much more than just bilingual. The interpreter must know medical terminology, and never insert her own opinions into the translation. But one problem is it’s up to the hospitals to train their own staff — and to figure out how to pay the interpretation bills. Language access is an unfunded mandate in New York.

“New York has been quite good in terms of language access issues. Our state regulations are very strong. Some of the ways New York has not been as much of a leader has been in terms of funding language services,” Agarwal says.

The language of medicine is difficult to understand, even for native English speakers. The names of diseases, medication instructions, and general hospital systems are confusing, especially when people are worried about their health. When these issues are compounded by language and cultural barriers, many immigrants are lost and can’t make informed health decisions. There’s no question that language access in hospitals has improved since Inocencia Nolasco landed in an emergency room where no staff spoke Spanish. But hospital administrators across the city say the need for trained interpreters outweighs the supply. And with an ever-growing immigrant population, the need is getting acute. Listen to part two of Interpreting Health: Cultural Barriers at New York City Hospitals

---

This story was produced as a project for The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School for Communication and Journalism.