Speaking a common language: Translators provide critical role with COVID-19

Aneli Ruiz, a multingual nurse at La Red Health Center, triages patient Gusson Guillen, 10, and his mother Yorleny Guillen during an appointment. Special to the Delaware State News/Ariane Mueller

When Sintia Rodriguez came to the United States from Guatemala as a child, she had to learn English.

Now, she’s a nurse who makes use of her bilingualism to help other Spanish-speaking immigrants navigate the health care system in the COVID-19 era.

Sintia decided on her profession after watching a nursing team care for her baby brother, who was born with a heart defect and had to have surgery.

“The pre-op and then the aftercare for my baby brother, who was like less than 6 months old, was amazing,” she said. “I decided that’s what I wanted to do.”

Today, at 34 years old Sintia is a behavioral nurse who works the night shift at Beebe Healthcare’s Lewes Campus with her sister, Enma Rodriguez, who is a patient care technician and three years younger.

“Beebe provides translators throughout the day. (But) at night, it’s usually us that provides the translation,” Sintia said.

“Even though I work in the emergency department, more with the COVID patients — my sister also does this — we go up to the different floors to translate for the entire hospital at night,” she said. “They call us if they need help communicating with a family or communicating with patients.”

Enma recalled one of the first times she translated for a COVID-19 patient. The man, who was relatively young — about Enma’s age — was screaming for the hospital staff to save him. Enma knew he thought he was going to die.

“The man was yelling. He felt like we couldn’t hear him or that we couldn’t understand him,” she said. “I could tell he calmed down when he knew I could understand him.”

As she held the man’s hand and interpreted for him, she saw his vitals begin to shift.

“I felt like that touch — that we have you, we got you,” Enma said, “that calmed him down and helped him a lot.”

Translating nurses educate about virus

When Beebe began organizing free COVID-19 testing at various locations across Sussex County, Sintia volunteered her time to translate at several events, including at a walk-up location in Georgetown for those who didn’t have driver’s licenses or access to a vehicle and, therefore, couldn’t participate in drive-thru testing.

“The locations that were picked were to target the Hispanic populations because they were the ones that had higher numbers of infections, like in Georgetown at the chicken plants,” Sintia said. “I feel like the testing makes it more tangible, more real for that community, especially since the majority of the community is younger, so their symptoms are not as severe as the ones who are older.”

Georgetown has remained a notable hotspot for COVID-19. In the town’s ZIP code, 1,289 people have tested positive for the virus, which is a rate of 703.7 people per 10,000 people. That’s much higher than the Milford area’s rate of 314.7 cases per 10,000 people.

Dalisely Andrade, a patient services representative at La Red Health Center, schedules patients’ appointments. Special to the Delaware State News/Ariane Mueller

The rate of cases within the the Georgetown area’s Latino community, 1,585.0 per 10,000 people, is much higher than for the local white population, which has just 131.4 cases per 10,000.

Sintia was focused on the educational element of these operations, which she said was a big part of minimizing the number of people from this community who got infected.

“The education was monumental in decreasing the numbers at the hospital,” she said. “A lot of patients weren’t aware of the importance of wearing a mask, getting tested, isolation and quarantine. They didn’t understand why that was vital to their health and everyone else’s health.”

Now, Sintia said, awareness in those communities is much higher.

Nanticoke doctor reaches out virtually to Spanish speakers

The Beebe nurse is not the only local medical professional who has been focused on educating Delaware’s Spanish-speaking community about COVID-19.

Dr. Sandra Palavecino came to the United States from Venezuela in 2009 to complete an internal medicine residency in Connecticut. In 2012, she and her husband settled in Delaware to escape the cold weather and be near the beach.

Although she’s employed as a weight-loss specialist by Nanticoke Health Services in Seaford, in recent months, her focus has shifted toward educating other Spanish-speaking immigrants about COVID-19.

“In our county, in our hospital, the majority of our patients were Spanish-speaking and Spanish-speaking only,” she said. “We quickly understood that this community needed more information about what’s going on.”

Back in mid-April, Dr. Palavecino hosted her first Facebook Live event in Spanish, during which she discussed basic information about the virus. Not long after that, she teamed up with the local Spanish radio broadcaster Kevin Andrade, who helped expand her audience.

“All the media was all in English, so quickly, we decided we needed to establish some degree of communication with the community that was Spanish-speaking,” Dr. Palavecino said.

As more information about the virus came to light, she said her focus shifted to sharing practical information about masks, social distancing and how to stay safe in the COVID-19 era.

Dr. Palavecino said she and her colleagues were “targeting two different kinds of audiences” within Delaware’s Latino community.
“Those who are on the way to food-processing plants or construction or something like that will listen to us at 6 in the morning on the radio,” she said. “Those who are at home taking care of the kids or not being able to work, they would be our 3 p.m. audience that is listening to our Facebook Lives.”

Beebe president: Translation services are critical

Dr. David Tam, president and CEO of Beebe Healthcare, also praised Facebook Live as a good way to reach non-English-speaking communities. Back on May 9 at the walk-up Georgetown testing site, Sintia translated information into Spanish for him as the two livestreamed onto Beebe’s Facebook page.

Dr. Tam, who is himself an immigrant from Japan, stressed that when reaching out to non-English-speaking communities, it’s important to be multicultural, not just multilingual.

“Multilingual just means that I have a flyer and I translate the words from English to Spanish,” he said, “Multicultural communication is a little more specific, where we actually look at what we’re trying to say and work with the different cultural representatives in the community,” like churches and immigrant-centric health care agencies.

Dr. David Tam, the president and CEO of Beebe Healthcare, and Sintia Rodriguez, a behavioral nurse at Beebe’s Lewes campus, pose for a photo at a testing site. Photo courtesy of Beebe Healthcare

“Communication is receiver-centric,” Dr. Tam said. “I can say all that I want to say, but if the receiver doesn’t understand purely as a language issue of translation or because what I’m trying to say is so culturally foreign, then I’m not able to effectively communicate.”

Dr. Tam said the demand for translation services at Beebe has “absolutely” spiked in COVID-19 times.

“There’s the actual medical translation for patients who are admitted to the hospital and need to have these physicians talk to them about specific issues like whether you’re being put on a ventilator, what does that mean, do I have consent?” he said. But there’s also been an increased need for translators, “answering questions that are more related to process than purely medical interpretation. Both those kinds of services have gone up.”

Facilities coordinate services for non-English speakers

Sharon Harrington, the director of strategic communications for the Peninsula Regional Health System, which includes Nanticoke Memorial Hospital, said that facility has been able to handle its translation needs through the COVID-19 pandemic.

“While COVID changes the diagnosis of the patient admitted to the hospital, the need for translators remained the same,” she said. “We are well-equipped to provide this for patients admitted to the hospital.”

Still, Ms. Harrington said the facility “did see critical need in translator assistance outside the walls of the hospital. For Nanticoke, that meant reaching out to local partners, such as La Red, when providing community screenings.”

La Red Health Center is an explicitly multicultural chain of medical centers with locations across Downstate Delaware.

“Here, they’re really not as uncomfortable,” said Dalisely Andrade, a patient services representative at La Red’s Milford location. “Some of the patients just feel more at ease hearing the information from a doctor who can speak their language. … (But) we do have a shortage of bilingual health workers.”

Dr. Tam identified La Red and La Esperanza, a Georgetown-based social services organization, as key partners in Beebe’s mission to reach the Latino community.

“Equal communication, which requires trust, is a challenge when you’re coming in as Beebe Healthcare,” he said. “They may know our name, but it’s La Red and the doctors of La Red that they trust, so we have to work very closely with La Red and La Esperanza to ensure that people feel comfortable coming to get screened.”

Bayhealth uses translators via phone, video chat

Marianne Foard, the director of patient advocacy for Bayhealth, said that like Beebe, her organization has experienced a higher demand for translation services during the COVID-19 outbreak.

“We have paid close attention to the needs of the community and have been able to respond quickly and efficiently to meet the needs of our patients that speak different languages and come from different cultures,” she said.

Since 2014, Ms. Foard said Bayhealth has worked to minimize the number of in-person translators it uses. Today, most of its translation needs are outsourced to a firm called Cyracom, which provides a wide variety of translators available by phone or video chat who are medically certified in languages from across the globe.

“It provides 24/7 accessibility for us,” Ms. Foard said, and it’s “lower-cost than an on-site interpreter.”

She said it also allows Bayhealth to facilitate communication for its patients who speak less-common foreign languages.

“There’s so many languages that our patients in our community speak, and we may only see them in a small percentage, but we are able to address that quickly,” Ms. Foard said.

In addition to being easy and painless for medical personnel and patients at Bayhealth facilities, Ms. Foard saw the around-the-clock availability of medically certified translators as a way to mitigate both medical and legal risk.

“There’s such a compliancy in the law that mandates language translation services, so obviously, we always want to mitigate risk and provide the (preferred) language for our patients,” she said. “If we have fewer misunderstandings with patients, it leads to fewer risks and health care needs.”

Dr. Tam said Beebe also makes use of remote services like these, but not to the same degree Bayhealth does.

But Ms. Andrade said that the lack of in-person translators at these facilities is what leads many Spanish-speakers to seek out care at La Red.

“We have interpreters that are just hired to do the interpreting part. That’s all they do all day,” she said.

“When going to the hospitals, they have to use a language line,” Ms. Andrade said. “They just feel more comfortable with La Red because when they come here, they know they will have someone to interpret for them.”

In terms of COVID-19, she said some of the patients she interacts with are scared to seek treatment at traditional facilities because they believe the care they will receive as immigrants will be inferior to what native-born Americans are provided.
But she said cost has remained the biggest barrier to treatment for many in the Spanish-speaking community.

“Most of their concerns are usually the expenses they will have,” Ms. Andrade said.

Nurse: Free testing key in Hispanic community

Monetary concern is one of the reasons Sintia identified free testing as so important for lowering the rate of infection in Delaware’s Latino community. She was concerned about the Delaware Division of Public Health and big medical organizations statewide pulling back from these types of events.

“Now, we’re not really providing the amount of testing we were in the beginning, and yet people are still infected and going to work infected,” Sintia said.

Since the May 9 walk-up testing event in Georgetown, the number of positive COVID-19 cases in the ZIP code has risen from 836 to 1,289.

Sintia emphasized the educational aspect these testing sites provided for Spanish-speakers.

“We are opening up, but we’re still dealing with this, and I don’t think we’re providing that kind of education of consistency with infection control and prevention,” she said.

Dr. Tam was more supportive of the move away from that type of event.

“I think that’s fine,” he said. The goal “is to get as many people screened and tested as possible, and I truly believe DPH, the governor and the state are doing that.”

He emphasized the need to increase education surrounding the virus and getting people to comply with mitigation measures like face masks, social distancing and quarantining, but he did not tie those imperatives to the testing sites as closely as Sintia did.

Sintia said that early on, those sites were “vital for bringing down the numbers of critical patients at our hospital more than anything. In the beginning, we were seeing a trend going up, then immediately when the testing started, it was amazing how we saw a huge decrease within the Hispanic population.

“They started tightening up the precautions at home and at work and at these factories,” she said. “I think that was lifesaving for them.”


Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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