Veronica Mireles knows from personal experience the perils many Kansas Latinos face navigating health care in Kansas without English fluency.
When Mireles arrived at a hospital in Wichita with her ill son, she received a bilingual staff member rather than a qualified interpreter. The staff member provided some basic translations, but it was insufficient.
“My son’s appendix burst as a result of misdiagnosis because they didn’t understand what was happening,” said Mireles. “Unfortunately, because we could not express ourselves, my son had to go through that.”
Latinos across the state face this critical language barrier regularly, often resulting in misdiagnosis, misinformation and uncertainty over what often is an intimate and sensitive situation.
A 2017 Kansas Health Institute study looking at racial and ethnic health disparities in Kansas found indicators suggesting Latino Kansans were disproportionately impacted.
One of those indicators was health literacy or “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”
“Unfortunately, many Kansans face barriers with access to health care, including affordability, one’s geography and certainly language,” said Kristi Zukovich, a spokesperson for the Kansas Health Foundation. “KHF has invested in helping health care clinics, including mental health clinics, with bilingual materials, translation services and multi-lingual technology in an effort to remove barriers to care and provide language access to those who need it most.”
This spring, Wichita State University Spanish professors launched a series of community engagement projects, as part of a larger Patient-Centered Research Institute project. They spoke with Spanish-speaking patients, their families, interpreters and health care providers to discuss their experiences with language assistance.
Issues that emerged indicated Kansas health care providers do not always provide adequate care in the patients’ preferred language, despite Title VI, a law that mandates recipients of federal financial assistance take “reasonable steps” to provide access to those with limited English proficiency.
“We go to clinics or the hospital and they assume we understand because in our second language we say, ‘OK, OK.’ They do not ask if we want an interpreter,” said Marisol Andrade, a Spanish-speaking patient, of her experience at GraceMed Health Clinic in Wichita. “So, I am left with questions. What did I understand? What are they going to do? And how am I going to pay for it?”
Rachel Showstack, an associate professor of Spanish at Wichita State, helped lead the project, which culminated with a testimonial video meant to educate legislators. The video included Andrade’s and Mireles’ story.
In the video, Showstack said the urgency for change has been elevated by the pandemic. The spread of pertinent health recommendations and information regarding COVID-19 in languages other than English has been lacking in Kansas.
Additionally, a rapid transition to telehealth has left language access behind in situations where interpretation is not built into the provider’s platform, Showstack said.
“Interpreting can be a major undertaking. They are meant to be a clarifier, a cultural broker and sometimes must serve as an advocate for the patient,” Showstack said. “So often when it takes more time, providers may feel rushed and not focus on covering all the patient’s health needs.”
Even when provided some form of interpretation, Spanish-speaking patients often find themselves stuck with an under-qualified interpreter — a family member or bilingual staff member in some cases — representing them.
Showstack said this may be due to the fact Kansas reimburses health care providers for interpreter services associated with Medicaid but does not currently have interpreter competency requirements.
“Some patients we spoke to said they felt providers and the interpreters were ‘cortante,’ curt or terse, and expected a sense of ‘confianza,’ which refers to a sense of trust or familiarity,” said Showstack. “These are often life or death matters, and you shouldn’t be provided someone who is underqualified in these sensitive situations.”
At most, Showstack said, language access policies in Kansas allow these federally funded facilities to meet minimal standards. She suggested a series of changes be made from onsite interpreters to more standardized training, or even further enforcement of Title VI.
The testimonial video was sent to legislators this month with a short survey attached. They hope to gather more information on how legislators view and plan to address this issue.
Showstack and colleagues hope the video will help state and local legislators, as well as health professionals, focus their attention on improving systems of providing language access for a more equitable health care system in Kansas.
“We need to ensure that those with authority do not allow injustices against speakers of languages other than English to continue in health care,” Showstack said.