Teaching
Student interpreters hone skills, help patients at New Brunswick health centers
An unusual nonprofit program is helping Rutgers students polish their Spanish skills, while making sure that New Brunswick doctors and their Hispanic patients understand each other. As a result, health care is improved at a well-used community health center, and students get work-study funds for a part-time job that relates to their major – while teaching them about the lives and varied cultures of immigrants.
“It’s almost like study abroad,” said Hank Dallmann, coordinator of the New Brunswick Community Interpreter Project. For eight years, the Interpreter Project has recruited and trained Rutgers students to translate English to Spanish and back again for medical staff and patients, mostly at the Eric B. Chandler Health Center on George Street and also at other local hospitals and clinics.
“We have patients from all over the Americas,” said Juliana Nannarone, the assistant coordinator and a recent graduate of the Rutgers master’s degree program in Spanish translation offered through the Department of Spanish and Portuguese. “We have a student whose family is Dominican and is familiar with that culture, but we also have patients from Mexico, Honduras, Cuba, and Puerto Rico.”
Every country has different terms for medical conditions, home remedies, and food, Dallmann said. “The other day, we came up with six or seven ways to say ‘baby bottle,’ and there are probably six or seven more we don’t know about.” The result is a constant learning curve for students and staff, he said.
As a federally qualified health center, the Chandler center can treat patients on a sliding fee scale based on federal poverty guidelines. Dallmann estimates that 60 to 70 percent of the patients at Chandler are Hispanic, many of them recent immigrants with limited English-speaking skills and no health insurance. Neither federal nor state funds pay for translators, so the Interpreter Project, part of the Office of Community Health at the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, fills the gap.
Thirty to 35 Rutgers students work for the project each school year. Most receive federal work-study funds, while others get academic credit for a class or internship status. Most of the students are undergraduates, but a few each year come from the master’s degree program in Spanish translation.
The students are first screened to make sure their Spanish-speaking and interpreting skills are up to snuff, Dallmann said. They are given a classroom orientation, vocabulary list of helpful terms to learn, and at least eight hours of on-site training.
“Students often think they have to know a lot of medicine and science, but we help them as they start working,” Nannarone said. “The Latin terms – like pancreatitis – are the same in Spanish anyway, but we tell them what that means so that they can interpret ‘inflammation of the pancreas’ instead of the bigger term. We try to be as communicative as possible.”
Students generally sign up for two or three, four-hour shifts per week. When they arrive, they check an assignment board to learn where to report to in the health center; a busy area like pediatrics might get two interpreters. The encounters, which could include intake interviews as well as doctor-patient discussions, can last from a few minutes to a half-hour. During a busy shift, a student may interpret for up to 20 patients.
The work can be draining, especially during a long session, but it is always rewarding, said Angelica Cardenas, a volunteer in her second year who is finishing her bachelor’s degree in public health and Spanish literature. “Interpreting for someone who receives diabetes training makes me feel happy that I have helped get a message across that will help them in the immediate future,” she said.
Cardenas was born in Bogotá, Colombia, and raised in a bilingual household in Newark’s Ironbound District since age 4. Still, the patient interviews help keep her Spanish skills sharp, she said, and have directed her toward a career in medical translation after graduation.
Joan Arango, a junior majoring in communication and Spanish, also came to New Jersey from Colombia, when she was 12. “I used to interpret for my mom when she would go to the doctor, and I still do sometimes,” she said. A volunteer with the project since October 2006, she works two shifts a week, at Chandler and at the high-risk obstetrics clinic at the Robert Wood Johnson University Hospital where some health center patients are sent.
As a result, Arango said she also is considering work as an interpreter or translator after college. “It has helped expand my vocabulary, both in English and Spanish, and I’ve learned a lot about medicine as well,” she said. Arango believes the project benefits the local community by removing one of the barriers to good health care. “Many people know that we can interpret for them, so it encourages them to come to the doctor when they feel something is wrong with their health,” she said.
Usha Ramachandran, a pediatrician who has worked at Chandler for almost 10 years, said the project “has made a huge difference in helping me provide appropriate care for my patients.” Before, many of the physicians and staff who didn’t speak Spanish tried to get by with a few words of Spanish mixed with English, or pulled bilingual employees away from their jobs for help. Now, physicians are much more confident about communicating with their patients, she said.
Ramachandran tells a story about a teenage patient whose mother brought her in repeatedly. The mother didn’t speak English; the daughter, who spoke English but was shy, was not forthcoming. Finally, when an interpreter explained that the mother feared that her daughter was pregnant, Ramachandran could tell the mother that her fears were unfounded. “There are so many instances of patients, or their parents, saying things that had just been missed, that people had misunderstood,” she said.
The alternative to face-to-face interpreters is a telephone service: The doctor and patient talk and listen on a phone with two headsets after the doctor dials up a fee-for-service translator. “Everybody we talk to has a story about the telephone,” Dallmann said. “There’s a lot to be said for eye contact, for having the person who speaks your language right there in the room. Patients are more likely to ask more questions and open up.”
Dallmann believes that the New Brunswick project is unique. When it started in 1999, it was based on a similar project at Hunter College in Manhattan that has since folded. The program has expanded gradually over the years, sending interpreters to the high-risk OB clinic at the Robert Wood Johnson Hospital, St. Peter’s University Hospital, and the Cancer Institute of New Jersey. The modest budget is funded with the help of grants from Johnson & Johnson and New Brunswick Tomorrow.
Dallmann was a volunteer himself while a graduate student at Rutgers. As coordinator, Dallmann recruits the student volunteers, many from the medical translation and medical interpreting class he teaches at Rutgers. Nannarone also was a volunteer while she was in the master’s program. They both work as interpreters, especially during semester breaks and whenever a particularly sensitive case comes up – for example, having to deliver bad news, Nannarone said.
Both say they enjoy a job that lets them help students, patients, doctors, and the community in a very concrete ways. “I love being able to provide a service that makes a difference,” Dallmann said.
Nannarone especially likes the “a-ha” moment during an interpreting session when a patient says, “ ‘Oh, I get it … so I’m supposed to stop taking this other medication because it’s dangerous and take this new one instead.’ That information was not going to get across without an interpreter.”