Coronavirus Patients Who Don’t Speak English Could End Up ‘Unable to Communicate in Their Last Moments of Life’

At the University of Louisville hospital in Kentucky, dozens of patients each day need the help of an interpreter to understand their medical conditions and make informed choices about their care. Before patients in the area showed COVID-19 symptoms, medical interpreters provided translations for as many as 30-40 people each day in Spanish or Amharic—a language spoken primarily in Ethiopia.

Like the estimated 100,000 interpreters who work at hospitals across the country, their services — translating word-for-word between doctor and patient, maintaining patient confidentiality and accounting for cultural nuances — can mean the difference between life or death. “Any good doctor is only as good as how they are understood by the patient,” says Natalya Mytareva, executive director of the Certification Commission for Health Care Interpreters (CCHI), one of the national certifying bodies for medical interpreters. “If the doctor is basing the diagnosis on the wrong information because they didn’t have an interpreter, then what good is that doctor?”

As Jefferson County, which includes Louisville, becomes one of the hardest hit counties in the state (42 people have died there of COVID-19 as of Monday morning, the most of any Kentucky county so far, according to data by Johns Hopkins University), the number of patients in need of care at the hospital is even higher. But the hospital’s nine medical interpreters are mostly gone. On March 21, the hospital gave them two options: continue to work face-to-face as an interpreter or take vacation time and unpaid leave.

“At this time [University of Louisville] will NOT be offering any work from home options for language services,” an email, obtained by TIME, said. “It will also NOT be an option to interpret over the phone.” (In an emailed statement to TIME, University of Louisville Hospital spokesperson David McArthur said all members of the interpreting staff still providing face-to-face services are provided with personal protective equipment.)

It’s a dilemma gripping hospitals across the country that, in order to receive federal assistance, must make their services available to the 65 million Americans who speak limited English. But as health care systems become overwhelmed with cases of COVID-19 and states implement stay at home orders, more than a dozen medical interpretation professionals who spoke to TIME from New York City, Boston, San Francisco, Minnesota, Kentucky, Wisconsin, Ohio and Idaho say their industry is being upended during the pandemic. Unemployment is increasing while hospitals attempt to quickly adapt to remote interpreting services. And they say that could have a negative impact on patient care, particularly as the pandemic has disproportionately affected minority communities that require interpretation in many cities across the country.

Will Coronavirus Ever Go Away? Here’s What One of World Health Organization’s Top Experts Thinks

Dr. Bruce Aylward was part of the WHO’s team that went to China after the coronavirus outbreak there in January. He has urged all nations to use times bought during lockdowns to do more testing and respond aggressively.

“This really comes down to it being a public health concern and a safety concern,” says Dr. Lucy Schulson, a primary care physician and research fellow at Boston Medical Center who studies health disparities, particularly in immigrant populations and people who speak limited English. “Study after study has demonstrated that access to professional interpreters is critical for the care of patients with limited English proficiency.”

As a solution, many hospitals like the University of Louisville have turned to third-party companies that offer remote interpreting services such as LanguageLine Solutions. Another remote service, Certified Languages International, has seen a 70% increase in interpreters inquiring how to work for the company. Other hospitals have set up call centers, where interpreters can keep a distance from each other and still provide interpreting services through phone call or video. Hospitals are required by law to maintain the privacy of their patient’s medical history, so hopping on a call with a medical interpreter using FaceTime or Zoom, platforms that do not offer proper end-to-end encryption, isn’t an option.

Face-to-face interpretation with a certified professional is ideal, says Mytareva. However, amid the COVID-19 outbreak, more and more hospitals are attempting to establish remote services, but not all have the infrastructure to transition quickly, she says.

Salome Mwangi, 50, who is from Kenya and moved to Boise, Idaho, through a refugee resettlement program, is a medical interpreter for patients who speak Kiswahili. About three weeks ago, Mwangi was told to cancel all her appointments. The clinics and doctors’ offices she interpreted for would instead utilize a third-party vendor to provide phone and video interpreting.

Mwangi says that the in person part of interpretation is important because of dialectal nuances and how much of communication is non verbal. “If I’m talking to you over the phone, there may be body language you’re exhibiting that I might not be able to read,” she tells time.

“Patients may not say, ‘I have no idea what you just said,’” she says. It’s the patient’s body language that gives Mwangi the cue that a patient may not understand what she’s saying. She worries an interpreter in another part of the country who can’t see the patient in person might not be able to understand those cues.

“What we have seen is a shift in the need to have [interpretation] fast and at a higher level of safety for the people involved,” says Enrica Ardemangi, president of the board of the National Council on Interpreting Health Care and a medical interpreter for Spanish.

That need for fast interpretation is better met at some hospitals that already had been utilizing some type of telephonic or video interpreting service, Ardemangi says. In those locations, the time it takes to connect to a remote interpreter might not be as great a factor playing into the quality of care limited English speaking people receive. But if a hospital had been primarily utilizing face-to-face interpreters and had to suddenly switch to remote interpreters, “it could create delays in having interpreting services available.”

For that reason, one interpreter at the University of Louisville Hospital—who asked TIME to conceal her first and last name because she feared professional repercussions for speaking candidly and could be easily identified given the small size of her team—worries about COVID-19 patients there.

As cases continue to grow, she worries about hospitals across the country competing for interpreters who may already be occupied on third-party digital platforms, especially when it comes to rarer languages. “And when those wait times become prohibitive, providers won’t wait for them,” she says.

“What I think the pandemic highlights is the actual preparedness to serve patients who don’t speak English,” Mytareva adds. “If a hospital didn’t have [language access] set up pre-pandemic, now it would definitely be at a loss, grasping for how to coordinate.” While hospitals attempt to establish those remote connections amid a pandemic, limited English speaking patient’s health outcomes are jeopardized. Under unprecedented circumstances in overcrowded facilities, tough decisions about health care have to be made.

But, Mytareva says, the coronavirus pandemic can make hospital systems aware that it probably never provided proper language access to begin with. “They never were equipped,” she says. “And of course, now everyone is scrambling.”

Dr. Ramon Tallaj has seen first-hand the way COVID-19 has impacted immigrant populations and people who speak limited English. On the evening of April 4, Dr. Tallaj and his partners at SOMOS—a nonprofit that created a network of health care providers who work to improve access for New York City’s immigrant populations—worked to recover the body of an undocumented man whose primary language was Spanish. The man shared on Facebook before he died that he had heard he could be fined for attempting to get tested for the virus as an undocumented person, according to SOMOS co-founder Henry Muñoz, and so he didn’t seek medical care.

“Our limited English proficient communities deserve the same level of care as everybody else,” says Shiva Bidar-Sielaff, chief diversity officer at University of Wisconsin Health, who oversee’s the hospital system’s language access programs. “Take a moment and think about how it must feel to be a limited English proficient person with no visitors and no other ability to communicate.”

That scenario is one the interpreter in Louisville is very concerned about. “If our system continues this course of action,” she says, “it’s very possible that all those people will be alone and unable to communicate in their last moments of life. It’s terrifying.”

By Jasmine Aguilera April 13, 2020

Source: Coronavirus Patients Who Don’t Speak English Could End Up ‘Unable to Communicate in Their Last Moments of Life’

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Calling All People Who Sew And Make: You Can Help Make Masks For 2020 Healthcare Worker PPE Shortage

Rally is probably not the right word. A significant movement, perhaps even a revolution of epic noble intentions, is underway in hackerspaces, makerspaces, and sewing groups to come together and solve a problem to save lives at risk with the Coronavirus.

You can help. Today, right now. Are you sitting in your apartment or house in some sort of state-wide lockdown? You can do something to help others. People of all ages and walks of life are diving in to make a difference. Check out some of these amazing initiatives, both small and large:

Joost De Cock (Old Dutch for “The Cook”) started the FreeSewing Open Source Project from his home in the Netherlands to provide free sewing patterns. Recently, his wife who is a surgeon started seeing potential shortages in personal protective equipment (PPE). Joost knew what to do, so he posted it to FreeSewing in late February. People thought he was being silly as a handmade mask would never be used by professionals. (I love the brand for FreeSewing.org, by the way.)

But he was onto something when he posted: Calling all makers: Here’s a 1-page PDF facemask pattern; Now go make some and help beat this thing. I took inspiration from Joost’s call for help in the writing of my headline. Shoutout also to Katelyn Bowden who shared Joost’s post. It is her workshop photo above and she has been cranking out the DIY masks. She calls herself a “reluctant hacker” and also runs a nonprofit to help image abuse victims. She pointed me to a bunch of different resources.

If you think that a handmade mask cannot be used, think again. Even the Centers for Disease Control and Prevention (CDC) has a place for them — in times of crisis, like the one we are in right now. On the CDC page: Strategies for Optimizing the Supply of Facemasks, they explain that as a last resort, a homemade mask is acceptable. Frankly, we are at that stage right now. Here’s how they explain it in the Crisis Strategy section, When No Facemasks Are Available, Options Include:

“Healthcare personnel (HCP) use of homemade masks:

In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.

It is possible that the government and manufacturers will ramp up in a wartime-like effort, but the reinforcement is more likely to come from the people. Millions of masks are needed. People are starting to make them and it is going to be a big deal.

Clearly, there is a shortage of the manufactured N95 respirator. You know this. Healthcare workers know this. If you have been hoarding them, let me cut to the chase — there are people and organizations who need your extras and you can do the right thing and donate them. Get in touch with Holly Figueroa O’Reilly on Twitter — she is organizing the distribution of masks. Karen Booth is another person listing out different projects as she starts making masks herself. Follow the hashtags #millionmaskchallenge and #millionmaskmayday and scroll through and you will find programs and projects around the USA and world.

People like Joost, Katelyn, Holly, and Karen are bringing enormous good into the world. When I asked Joost why he was doing this FreeSewing project, he pointed me to his Pledge page where he explains that all the funds that come into the project are donated to Doctors Without Borders. All of it. Why? He pointed me to that page again: “I don’t know if you’re familiar with the phrase ‘noblesse oblige’ but it essentially means that privilege entails responsibility.” Then said, “I mean every word of it.”

Makers, hackers, craftspeople are awesome. Coronavirus does not stand a chance. Tweet, tweet.


Additional Resources for Open Source or Volunteer COVID-19 Projects:

One of my favorite how-to sites is Instructables. The DIY Cloth Face Mask has almost 100,000 views. It is a step-by-step instruction for those who need it. Kudos to ashevillejm.

In 2006, CDC released a Simple Respiratory Mask design using heavyweight t-shirts in its Emerging Infectious Diseases journal. More of an academic post, but some ideas in it.

A Facebook group was formed last week: Open Source COVID19 Medical Supplies. It is worth a visit — in just a few short days there are 20,000-plus members and volunteers.

If you are looking for some research and street-level testing of various materials for DIY mask-making, this post from Smart Air Filters is exceptional: What Are The Best Materials for Making DIY Masks? It also includes a few great links at the end of it.

Forbes’ editor Amy Feldman just expanded on the developing story of a team in Italy that is 3D printing respirator parts. Read it here: Meet The Italian Engineers 3D-Printing Respirator Parts For Free To Help Keep Coronavirus Patients Alive.

Bloomberg confirms that the workers and communities around them are rising up to meet this challenge: Hospital Workers Make Masks From Office Supplies Amid U.S. Shortage.

If you have a 3D Printer and have been trying out different N95-type designs, then you will want to read this one from 3D Printing Media Network by Davide Sher: Copper3D organizing global campaign to 3D print antimicrobial masks on a global scale. After you read it, you will probably want to order some PLA filament from the folks at Copper3D who are making their patent-pending idea and design open source to help fight COVID-19.

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I’m a Tech and Productivity guy. Do you have #lifehacks, #DIYtips, #HowTO ideas? Click the little “House” icon below to get to my website where you can submit ideas (via a Google spreadsheet). I’d love to hear from you. Thanks for reading and connecting. Sign up for my Tech Tips email. You can find me at the LinkedIn, Facebook, and Twitter link buttons, too. I still also cover a bit of my old beat on 3D printing, hardware, software, and mobile apps, as well.

Source: Calling All People Who Sew And Make: You Can Help Make Masks For 2020 Healthcare Worker PPE Shortage

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This is a translation of the video I made for an initiative by Make in Belgium. Different rules and requirements may exist in your area, so please check with your local health providers before making and donating masks. Download the (Dutch) pattern on http://maakjemondmasker.be A big hurrah for Make in Belgium for organizing this wonderful initiative. And thank you to Henk Rijckaert for involving me in this. Check out his YouTube channel here: https://www.youtube.com/user/henkrijc… INSTAGRAM: http://www.instagram.com/craftswithellen PATREON: http://www.patreon.com/craftswithellen ————————— DISCLAIMER Even though my videos are set up as tutorials, I’m not professionally trained in any of these crafts. The tools that I use can be dangerous. Don’t try a craft if you are unfamiliar with the tools and the necessary safety precautions. Be safe!

 

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