When the parents of a Chinese college student in Oakland learned he was dying of a terminal disease, they quickly booked a flight from China to see their son. At his bedside at UCSF Benioff Children's Hospital Oakland, they met staff interpreter Yunica Li who grew up in China. Li interpreted critical conversations between doctors and the couple. After they made the decision to withdraw their son's care, Li helped them grieve - interpreting stories of their son's childhood and passions from Mandarin into English for the staff who had taken care of him.
"It was incredibly powerful. We can make a big difference in people's experiences with the health care system," Li says. "We're not only making sure families understand what clinicians are saying, but also that their voice is heard."
In Oakland, nearly 40% of people speak a language other than English at home, and more than a quarter were born outside the United States. In San Francisco, the numbers are much the same, if slightly higher. That diversity in culture and language is why UCSF Benioff Children's Hospitals is a national leader in providing around-the-clock interpreter services in more than 200 languages. At UCSF Benioff Children's Hospital Oakland, 19 in-house staff interpreters offer in-person interpretation in Spanish, Cantonese, Mandarin and Mam; agency interpreters, trained in health care, work both in-person and remotely to interpret other languages. UCSF Health's three campuses in San Francisco - Parnassus, Mission Bay and Mount Zion - share 17 in-house interpreters who serve pediatric and adult patients in Spanish, Cantonese, Mandarin and Vietnamese, as well as agency interpreters who interpret in-person and remotely for other languages.
"We want the community to know that everyone is welcome in our facilities," says Hilda Diaz, manager of UCSF Benioff Children's Hospital Oakland's Interpreter Services. "Regardless of your color, your country of origin or your language, we will accept you."
Interpreter within minutes
Diaz knows first-hand how daunting it can be for non-English speakers to navigate the American health care system and understand medical terminology. She immigrated to the U.S. as a child and, while learning English, began interpreting conversations for her Spanish-speaking parents.
"What I experienced growing up was a lot of very serious conversations in chopped-up, broken English," Diaz says. "In the health care setting, that can lead to family members not trusting each other and not trusting their doctors because they don't understand what's being said and feel like they're blindly agreeing to health care decisions."
Diaz doesn't want others to feel that tension and fear. So, across UCSF Benioff Oakland, everyone from doctors and nurses to social workers and therapists can request interpreters to help them communicate with patients and families. The full-time Interpreter Services staff responds to nearly 200 requests a day; last year they covered 62,482 patient encounters. If in-person or on-call staff aren't available, Diaz and her support staff coordinate either an in-person interpreter who works through a contracted agency or a remote interpreter who joins conversations via video chat on a tablet computer.
"The interpreters are absolutely essential to my job because we serve such a diverse population," says UCSF Benioff Oakland social worker Misty Schultz, who works in the neonatal intensive care unit. "If a non-English-speaking family shows up unexpectedly to visit their baby, I can usually have an interpreter either physically or virtually in the room within minutes to get their needs met."
Culture brokers
Interpreters can act as a bridge for not only language barriers but cultural differences as well. Traditional Chinese medicine, for instance, generally avoids using ice on the body. While interpreting for Chinese families, Li has found herself pulling clinicians aside to gently explain this cultural nuance when families balk at the idea of putting a cold compress on an injury.
"This kind of cultural difference can really ruin a patient-provider relationship just when patients are starting to develop trust," says Li. "So, in a sense, we act as cultural brokers."
Diaz adds that interpreters also frequently offer institutional knowledge - where to park, for instance - to patients' families. In some cases, it's easier to have these kinds of casual, helpful conversations when there's no language barrier.
... By having someone in the room as often as possible, we're showing our families that we care."
As Oakland's population changes, Diaz and her team are evolving. Mam - a Mayan language spoken by half a million people, mostly in Guatemala - was added several years ago, after Oakland's Mam-speaking population soared. More recently, an influx of Yemeni families has led Diaz to start a search for an Arabic interpreter.
While most hospitals in the U.S. offer interpretation to some extent (it is required by the Civil Rights Act for all health care facilities that receive federal funding), many either only offer the service for a few languages or only with remote interpretation.
A recent study found that for children treated in emergency rooms, interpreters were used only about one-third of the time throughout the visit when health care professionals spoke with patients and families not fluent in English.
UCSF Benioff Oakland is trying to defy these statistics. In addition to taking requests from around the hospital through an on-demand service, Diaz's staff consistently scan the hospital's dispatching-appointment system and emergency room roster, flagging patients who have been marked as having a first language other than English. The team prides itself on its breadth of languages and large number of in-person interpreters.
"We're on our feet a lot," says Diaz. "All in-house language requests for interpretation are coming through to our team first before they go out to an outside vendor. We're the ones who know our patients and who know the hospital."
Schultz, who has worked with interpreters at other hospitals, says the strength of UCSF Benioff Oakland's interpreter services helps to build trust across the Oakland community.
"I think our in-person interpreter services make a huge difference. Phone and video are just not the same, and by having someone in the room as often as possible, we're showing our families that we care," Schultz says.
