Lack of Language Access in Hospitals during the Coronavirus Crisis

I may be hammering on this subject a bit, but I do find it important because not only is the pandemic still raging with no end in sight, but also because it is revealing the inadequate care LEP patients are receiving in hospitals.  There is a disproportionate rise infections in black and brown communities and how many are falling victim to the coronavirus.

This disparity within the Latino communities is largely attributed to language access, accessible information in their native language, and access to healthcare in general.  Language access is particularly lacking in most hospitals in normal times much less in this new normal.  Communication barriers between patient and doctor  is a  subject I discussed on an earlier post, but  still needs discussion because the pandemic is not over and the need  for interpreters  is still great nationwide.  The number of COVID-19 hospitalizations and the mortality rate among Latinos is primarily their lack to proper healthcare and language access is a contributing factor.  The inability to communicate effectively with the doctor is a major factor when they are treating you in a life and death situation and the time it takes them to get a remote interpreter on the phone or on video, it is wasted time spent on the patient.  Additionally, the noisy background of ER rooms, and ventilator noises and muzzled voices through surgical masks, makes just adds stress to both.  When doctor have life or death decisions it is simply difficult and the language barrier just makes it worse.

As I discussed on my earlier post, the need is there, there are interpreters willing to do the job, but the lack of accessible equipment, and the hospitals need to reduce costs, and the contagious nature of this disease, interpreters are either left to work at a reduced pay as a remote interpreter or as video conference interpreter or not at all.  This type of remote interpreting although better than nothing, does not   not allow them to stay in the patient’s bedside where a patient’s body language and other nonverbal cues help in the communication between t doctor and patient.  An in-house interpreter does improve by la large margin the care the patient receives in the hospital or doctor’s office.

Remote interpreting then is at a great disadvantage to the patient because they are the language conduit that would and does on normal occasions; improve by a large margin the care the patient receives in the hospital or doctor’s office.  The language barrier is a big problem in helping these patients get the care they need.

On the other hand, written time sensitive information that can inform the people on the current state of the pandemic is only found in English.  This leaves immigrant and other communities that are limited in English left out.  Although there are, organizations that is dedicated in providing translated material for them and provides language access, these are very small organizations with limited funding and resources and despite that, these are few and far between to get the help most need.

There is no easy solution particularly in a time when immigration, Immigrants or any immigrant help and language access is not at all a priority and sadly, these are the communities that have more to lose with this virus.


Language Access in Immigrant Communities during COVID-19 Pandemic

I have already written on the disconnect of healthcare workers and interpreters when patients with limited English proficiency are treated when they enter the hospital in dire need of assistance.  This is somewhat the same in immigrant communities and in immigration shelters.

This is true in particular; the latter those are still in process of getting their immigration hearing and are still in limbo on what they are allowed and not to do.  Because of this pandemic, authorities have stopped the  search operations  in healthcare facilities, doctor offices or near hospitals because they do stress as attorneys as well , during Covid -19  seeking medical care as an undocumented immigrant will not go against the  ‘public charge “rule.

However, when it comes to language access for these communities and the undocumented alike, the nonprofits that serve the needs of these communities do not have a centralized place where they can get information and most of the information supplied is in English.

In addition, when it comes to interpretation resources, most of them that arrive are fluent in indigenous languages spoken in Guatemala not necessarily Spanish.

During this pandemic they feel lost and confused about services and information about  the disease and we already know that by federal law, language access is supposed to be provided.  However, states and local governments also have a say as to how far they can and will comply with the federal law.

Clearly everything boils down to economics and money, although the service is needed and  highly so, state governments put language access and interpretation services in the back burner because there are far more pressing issues where that money can be allocated therefore minimizing the ability to acquire these services.  When they do supply it, they use over-the phone interpretation where the cost is less but have an available supply of interpreters and languages.


However, from a translation and interpreters point of view, when an interpreter works OPI they are paid by minute and the minutes they are on the phone with the speaker only.  Wait times are not paid and this leaves very little incentive for the interpreter, who to be qualified as a certified interpreter has to pass rigorous and expensive certification to be able to work as a medical interpreter.

All of this as communities suffers the inability to get informed, get help and assistance whenever it is available to them.  However, understanding the need, there is also large reasons for the disconnect here.  There are companies that do not value translation as a profession it seems and they all want you to volunteer your services.  Why?  I understand that most people that help these immigrants are nonprofit organizations but although we love the craft, we also life of our craft and hence we do have to refuse their absurd request of per minute interpretation or worse yet, volunteer.  I have volunteered my time but it is time they valued our profession as much as we do.


Language differences spark fear amid the coronavirus pandemic


When the pandemic began in China in late December 2019 and as it began to spread across borders it also spread a lot of fear, racism, and hate.  Given its high rate of infection and death coupled with very little knowledge of the virus itself, people as a whole began to hate and resent those that were the supposed culprits of this whole mess.  This lends to high dis with high rates of infections, death, the Chinese became the focal point of blame and responsibility for what happening in the world, and everything and everyone associated with China or of Asian origin became the subject of hate, ridicule, and public shaming.

This of course, stems from great fear and the reinforcement of government leaders stating that this pandemic was to blame because of the Chinese and going as far as referring to it as the “Chinese virus” in international conferences and meetings.  This of course spurs rage to those that believe it but these incidences have not been just solely here in the US but globally.

This discrimination does not happen only by the perceived look but also how the person speaks and the language they speak.  Again this is nothing new however, when misinformation about the origin of the virus spreads it is sometimes worse than then spread of the virus itself it seems.  People have been denied entry to restaurants, and other public places because they are foreigners and perceived as ‘carrying the virus”


What do you learn from this behavior? Plenty.  Above all that informs yourself and do not let a lot of perceived and preconceived notions dictate your behavior.  It is your reality but is not necessarily true. Get informed and if you see behavior like this, please make a conscious effort to stop it.

In the world we live in today, these presuppositions are more prevalent than ever.  This  divisiveness  towards everything really, not just people of a different nationality or language but belief systems or even if you wear and not wear a mask  have been seen as “you are not one of us:” They  limiting and racial divides have always existed, I just have not seen them to such extremes.


I wrote a post last year on a similar subject and although at that time, we were not in a pandemic and the nerves and fears were not at the all-time high but the discrimination on what they speak, how they speak it and what they look like was and is always there.


The following article notes this, sometimes people’s accent and language difference that is the greatest form of discrimination because it automatically sets them apart as “strangers’ and foreigners’.  What is not often seen can be heard.  This of course is telling when we have a global pandemic and the accent or language is associated with either the country of origin or the highest rate of infection.

In conclusion then, this type of fear and discrimination will not probably end any time soon and although there is nothing new here, it has just been exacerbated by the pandemic.





Half of Americans listen to music in languages besides English




The fact that Reggaeton, Latin, K-pop among others are music are hitting the airways in the US should tell you that there is a cultural shift happening.  Not only are radio stations playing them but streaming channels such as YouTube and Spotify (which are uploaded and created mostly by the listener), have largely been Latino artists.


Why the shift?


As it pertains to Reggaeton specifically, it could be associated with the growing Latino population in the US and globalization.  Although raggaeton began, in Panama, it was actually in Puerto Rico where it really took off and now it has exploded to all of Latin America.

Like hip-hop (where much of reggeaton style is mixed in) where it spoke of social problems, raggaeton mostly is about poverty and class inequality in Latin America.  Although most singers do hail from Puerto Rico, it was in the urban areas of Puerto Rico where they would talk about street violence, struggles of urban life and machismo.  It has now turned into very sexual and explicit lyrics and objectification of women.

Although this music is a fusion of reggae, ton and other Latin rhythms the result of this globalization of pop culture and music does stem from American influence.   


Yet, beginning in 2016 and 2017, Latin music specifically reggateton and trap have become mainstream and overtaking English songs .Now they are the ones reaching out to the reggaeton artists


Reggaeton took a while to reach Latin America but it has exploded particularly in Colombia.  Latin America because of its social and economic inequalities, the listeners resonated with it, Colombian artists have risen to the top of American, and international pop charts via the streaming sites such as YouTube and Spotify.

Although raggaeton itself is a musical fusion of reggae and rap and hip-hop mixed with Latin and Caribbean beats is what makes this style so irresistible to dance to and listen to.

All this coupled with very sexual and suggestive lyrics is a mix that has captured the attention of the urban youth. 

Lyrically speaking is another matter altogether.

Given that most are recorded in Spanish, most did not mind not understanding it, since the music is good.

Per YouGov, a market research firm conducted a study in Hispanic music in 2018; they found that 47% of 1210 millennial respondents listened to music in a different language other than English.  Of the total respondents 52% stated that Spanish was their language of preference and among Hispanics, it was 89%.  (No surprise there)

However, when asked if they have to understand the lyrics to enjoy the song, half of them said they do not need to because they enjoy the rhythm and its fun.



In 2018, the three most views and streamed videos were all Latino reggaeton singers with nearly billion views per video.  In addition, if last year’s Despacito was any indication well yes, I can vow for that.


This is quite telling because the US has always been and is for a large part the main exporter of pop culture, movies, music, and sports.  Because  there are   three major companies controlling  80%   of the music industry  the  output through radio stations and charts, music was and is of course mostly  in English.

Music at some time was very homogeneous these companies did not believe that a song would not be sellable or likable if the content was non-English.  A good example of this was 1984 Nena has hit   99 Red Balloons.  This song was already a hit in Europe but before it was released in the US and UK it was translated to English for the American listener.

Yet, beginning in 2016 and 2017, Latin music specifically reggeateton and trap have become mainstream and overtaking English language songs.  In addition, they have the streaming companies to thank for that.


Just for fun, I decided to link aa Reddit forum because I thought it was interesting to read what type of music and why they like about foreign music and it is not just about language and lyrics.







The  Disconnect Between Medical Interpreting Services and  LEP Patients During the Pandemic


Although it is a law that you have to provide language interpreters to the patients that need it, and some hospitals do have staff interpreters,  it is too far from the norm in many hospitals. Yet, despite being a law not to mamy are aware that is a responsibility and have not implemented and enforced it due to varying state laws , changing demographics and state reimbursement practices. Most importantly however,  most facilities  cite costs and time constraints as a reason.  Rather they rely on  interpretation from  either their hospital personnel that  is not qualified to interpret,   or family members (usually young children) to interpret for them.

Why is this important?

By law, if  you receive federal funds through grants or through Medicare and Medicaid, you are supposed to  provide language access to the patient that needs it but  that  means that you have to file a physical claim  and wait until you are reimbursed  and depending on the state, the state is not obligated to reimburse the provider for such services, therefore incurring the cost. It  is mandatory to be free to the patient but with their contract with the language provider, the language provider bills them then bill via claim.


There is no federal requirement to be certified as an interpreter  but  it is highly requested  and desirable that one is. Many errors can and do occur when someone interprets outside their field of expertise but  because of these requirements and certifications, the availability of a certified and qualified interpreter  is  difficult to attain.  The use of certified interpreters also  command a higher rate  than a freelance  uncerrtified interpreter  and charge per hour even if  it is 10 minute  consult with a patient. For reasons already stated, many forgo the practice of using them.


besides being a law,   Is its very important particularly now that we are going through a global pandemic and patients with limited English proficiency are less likely to get the proper and lifesaving  care they need. Granted that  during this pandemic hospital workers are burned now and have to act  immediately to save lives and having a language barrier only adds to their inability to provide immediate care.


In person interpretation or face-to-face  is more desired by both patients and doctors alike.  it is not always feasable and under  the recent outbreak  it is not desirable or recommended.


Because the coronavirus is so contagious even  with PPE  ( proper protective equipment)  many hospitals are releasing their in house interpreters because  they are keeping ‘essential personnel”  but rather opting for third party services which are less costly so  they resort to over the phone interpreting (OPI) and Video Remote Interpreting (VRI).

Given the new normal, even if you are qualified and certified  hospitals only request to have OPI or VRI interpreting  and not within their  regular place of employment  either In some  hospitals the inhouse staff interpreters are given the option or stay in as a full-time interpreter or take unpaid leave but without the possibility of working from home.  This option puts them in a serious situation it is either your job or your health  because no one other than medical personnel is allowed in the room or emergency room with them, not even when critical.

However, that is not the true reason, they are opting for OPI and VRI for cost. Many hospitals because of the pandemic are losing revenue because all other procedures that normally get billed are not being performed and the revenue stream to supply for these services is low.

OPI and VRI are billed by the minute and paid for as long as they are needed compared to the full hour of service.

So not even the most qualified interpreter can’t be personally there to help and assist linguistically and LEP patients are literally left to die. There is so much need  and urgency at the same time for the  doctors  that they have to be “efficient before effective communication”that patients  are suffering  grave consequences.

Getting in touch with  OPI interpreters takes seconds but that also depends on the language  requested.  Spanish is a relatively easy language to request but  depending on the language, it may take minutes to find and locate an interpreter with that language requested and some say that they have to wait up to 10 minutes for an interpreter. Also, many hospitals do not have the proper video equipment to provide video interpreting and because of privacy laws and patient confidentiality  the use of Zoom and other video conferencing is not a feasible option. That is valuable time waiting when you have others that are  just as severe.

Studies and stats already show the disparity in care for non English speakers and minorities  Mostly  because there is such a rush of patients where all of them are in need  of lifesaving care.


Despite this, there is a very disturbing  reality when it comes to the healthcare system and that is that  healthcare is business and most agencies, facilities and healthcare organizations are looking at the “bottom line “ to provide services.   When the bottom line is profit, and added costs ( as they believe  interpretation services ) are slashed, patients that rely on these services suffer greatly communicating their symptoms to a doctor.


So not only do you have qualified, certified interpreters ready to work and patients desperate to communicate with the doctor but with a huge disconnect between them.


So here you have two great needs one available and able to provide it, and on the other hand doctors desperate to understand and save patients and having this huge disconnect between the two services and the ones suffering are patients themselves.



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