Photograph by Steven Higgs

As the Latino population in Indiana grows, the need for interpreters for health care and other critical areas of citizenship becomes more acute. Data suggest that 57 percent of Indiana's Latino immigrant population speaks English "not well" or "not at all."

It's a basic horror story: due to an unfortunate episode, you find yourself in need of urgent medical attention. You are throbbing with severe pain, the worst you've ever felt, and you don't know why. All you need is help.

The problem is you're in a foreign place where no one understands what you are saying because they do not know your language. You can't explain what is wrong, where it hurts, how it happened, and the frustration and fear -- in a world where no one understands you -- deepens.

The Latino and Hispanic population in Indiana grew by 31 percent between 2000 and 2005, according to a study in the July 2007 issue of InContext. Among the most recent Latino immigrants to enter this country and live in Indiana mentioned in the study, 57 percent either speak English "not well" or "not at all."

This language division could be problematic and is concerning, says Indiana Department of Health worker Ann Hamel.

"This is clearly a civil rights issue," she says. "Hospitals have to accommodate not only Spanish speakers, but all languages."

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Public agency institutions may not be prepared for the large influx of non-English, Spanish speakers, especially in towns the size of Bloomington. Many metropolitan cities with larger Latino and Hispanic populations are better equipped with the services and necessities to address this rising issue.

Melissa Britton, a representative of Bloomington's Latino and Hispanic Outreach Program, says most public service places should be ready.

"If a hospital or some sort (of public agency) is federally funded, then they need competent language assistance accommodations," Britton said. "It is a law under Title VI of the Civil Rights Act."

One factor under the Civil Rights Act of 1964 is to "prevent discrimination in federally assisted programs." This is where Britton says people of LEP (limited English proficiency) are protected, under section 601. If health care facilities are private practices, however, they are not under these same guidelines.

But some private hospitals are federally funded, like Indianapolis's St. Vincent's Hospital. A phone call to the walk-in clinic of the Internal Medicine Association found no designated person or strategy to deal with non-English speakers. Staffer Megan Silvers said if administration is working toward these efforts, she has not been informed of it.

Britton says hospitals and public agencies alike need competent language assistance of some sort under this law, for very important reasons. People with LEP can often experience disparities in health status and care, many times because of compromised communication with a doctor or nurse, Britton says. That is something she has urged Bloomington hospitals to work on, as should hospitals around the nation.

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About three years ago, a national program titled Bridging the Gap aimed to train community bilinguals to be effective interpreters in Bloomington health care facilities.

"(Community members) who took this program would get certified and be basically on call for when the hospitals needed them," Britton said. "They were given unbelievable amounts of vocabulary and information in these big manuals. It was intensive."

Bridging the Gap provides an art to interpreting that empowers the patient. If non-English speakers are in rooms with their health care providers, they should stand face-to-face and talk looking in one another's eyes while the interpreter stands behind the patient, not in between the two. This way, she says, patients know they are being recognized as legitimate patients, regardless of LEP.

The only problem for Britton with this interpretation program is it has been roughly three years since it's been offered. Interpreters need practice to keep that information fresh in their minds, or they lose interpretation abilities, which could be a liability for hospitals, Britton said.

Many times, families are encouraged to bring friends or family members who are fluent in both English and Spanish (or in another language) to translate what the doctor is saying.

This could put pressure on family members and put them in tough spots, especially if the news they are delivering is complicated or grim.

"You lose professionalism," Britton says. "It's inappropriate, especially if it is a young child doing the interpreting. You don't want (them) to explain or summarize how to take medication when an interpreter is trained to be familiar with medical terms."

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Although Bloomington hospitals and the police department have a list of about 15 of the interpreters who were certified through the Bridging the Gap program and are fluent in Spanish and many Asian languages, among others, the interpreters are often unavailable at urgent times or, like Britton mentioned, uncomfortable when they haven't used their bilingual skills for long periods of time.

Because of those complications, a phone service called The Language Line has been implemented in these public agencies, a valuable source, says Communications Manager for Monroe County Central Emergency Dispatch Jeff Schemmer.

"It's a struggle to secure one individual to interpret," Schemmer says. "We have not gotten rid of these interpreters completely, but we are slowly phasing them out because they aren't very consistent."

The Language Line is a service with 175 language options, according to its official Web site www.languageline.com. There are operators on the other end of the line who are certified business, consumer, health care, and government interpreters and can help with interpretation problems with a person of LEP.

For example, if a Spanish speaker needed health care assistance, emergency or not, and an interpreter was not available onsite, the health care provider would dial the Language Service and have the patient on the phone as well.

According to Schemmer, it's much like a conference call. The speaker phone is on, and the patient can press whichever number corresponds to his or her language option.

The options are translated, of course, and once a language is chosen an interpreter gets on the line and mediates the conversation between the patient and the health care provider.

"We (Dispatch) use the service quite a lot, and it's easy," Schemmer says. "It was cost-prohibitive for a while, but it's been very nice to have."

Schemmer says the state pays for the service since emergency dispatch is a public agency. Bloomington dispatch has 14 languages available on its line. If for some reason none of those lines matches a person's language, he or she can be directed to an operator to speak with, and they are able to pinpoint which language the person speaks.

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Bloomington Hospital, private and not-for-profit, is also armed with the Language Line because it is mandated by the Civil Rights Commission. Mavis Anderson, a social worker at Bloomington Hospital, praises its value.

"I still maintain a list of interpreters (those who went through the Bridging the Gap Program)," Anderson says. "But the Language Line comes first."

Unlike Bloomington's Emergency Dispatch, Bloomington Hospital has designated interpreters. Anderson is fluent in French and knowledgeable in the "art of interpretation" and in medical terms, although she did not take the program.

Bloomington Hospital would not provide the list of interpreters due to privacy issues. Social worker Jennifer Christophel, a coworker of Anderson's, however, is fluent in Spanish and uses her language skills often when dealing with Latino patients, which Anderson says has been a great help for Bloomington Hospital.

"Although I was not trained specifically for medical terms, my Spanish when dealing with Spanish-speaking patients can be very useful and needed," Christophel says.

There is a sign in Bloomington Hospital's triage section that is translated into 30 different languages and reads, "You're entitled to an interpreter at no cost to yourself. Please point to your language."

Anderson says that once a patient of LEP points out their language, the nurse or staffer present can call the Language Line and get an interpreter on the line in a matter of seconds. She says there are mobile phones in the Emergency Department and emergency rooms, so it's available right away for patients.

The Bloomington Hospital also pays a fee for the Language Line, paying $1.29 per minute along with a base fee. The hospital has customized its line to provide 77 languages.

Although Anderson claims the Language Line is a wonderful option, many times an interpreter is preferred.

"For meetings and short term things, we want the Language Line, and for more in-depth and intensive care, interpreters are preferred, especially natives speakers, who you can't replace," she says. "The most important thing is that there is some sort of interpreter there for the diagnosis, prognosis, and discharge."

Anderson explains that Bloomington Hospital is doing the best job it can with what is available and is trying to better its services, even looking into adopting a more advanced phone line with video.

"We very much understand how important this is," she says. "We are trying to make it (interpretation services) speedy and efficient. And when push comes to shove, IU is always there to help provide language services."

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Latino Outreach and Programs' Britton also believes Bloomington is doing its best, even though the town is scraping for more interpreters.

"But of all Indiana, Bloomington is doing a stellar job," Britton says. "There are far fewer sources in bigger Indiana towns, and I'm amazed by that."

With services like the Language Line and other technologies coming onto the market, things are looking to improve, and Britton strives to start by outreach.

"It's one thing to have the resources, and one thing to have it known," Britton says. "We need to take all of our funding and become more organized to come together."

Monroe Hospital did not comment.

Anne Purcell can be reached at .