Letters to the Editor


Muy Enojado About Translation Comments
I write in response to Lia Walther’s letter regarding the article “Lost in Translation” [Clinician Reviews. 2010;20(4):2; see also Clinician Reviews. 2010; 20(2):cover, 10, 12, 14]. She stated that the article was enough to make her “blood boil.” Her response made my blood boil. Talk about cultural insensitivity!

Ms. Walther feels it is the patient’s personal responsibility and burden to learn English. In a perfect world! Not everyone is going to behave like her and learn another language. This country is a melting pot of people of different cultures who speak different languages. We need to be sensitive to the needs of everyone, even if they do not speak the English language.

I pose this question to Ms. Walther: If you were on vacation in a non–English-speaking country and became ill and were hospitalized, would you expect someone to interpret for you? My guess is yes. Please put yourself in someone else’s shoes before making such derogatory and insensitive comments.
Maria Rivera, ANP, Yonkers, NY

Regarding Ms. Walther’s letter, I guess it is all about perspective. With great pride, I showed the same article, “Lost in Translation,” which made Ms. Walther’s “blood boil,” to my daughter, who is a Spanish major in college and is seeking a career in medical interpretation.

When I signed up to be a health care professional, I desired to care for those who really needed help, regardless of race, religion, gender preference, financial ability, and yes, language barriers. I have learned to speak Spanish and am able to assist with patients in our clinic when the official interpreter is not available or a Spanish-speaking patient appears in clinic without previous arrangements for interpretation.

Yes, the health care system gets abused in many ways, and interpretation services can be one of them. Maybe Ms. Walther’s perspective will change if she is placed in a difficult situation where no one speaks English, and she struggles to have her need understood or she can’t understand the help that is being offered.

Would Ms. Walther welcome a visit from the federal auditors about whether her clinic qualifies for federal (Medicare/Medicaid, etc) money because of her policy on providing language services for her patients? While my guess is that she is familiar with the US government’s policy of Title VI, Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, and that she can prove evidence of compliance, her attitude, which I’m sure her patients perceive regardless of any language barrier, is anything but compliant.

I hope Ms. Walther is as “hard” on her tobacco-using, alcohol–overusing, overeating, underexercising, caffeine-consuming, prescription drug–abusing patients as she is on those who can’t speak her language when they come seeking medical help. Patients who don’t take “personal responsibility” to live healthy lifestyles and set themselves up for continued medical problems that “require precious health care dollars,” that’s what makes my blood boil!
Steve B. Fisher, MHA, PA-C, Lexington, KY

I generally am not the type of person to have a knee-jerk reaction and then quickly respond to comments or articles of interest to me as an NP. However, as I glanced through the April issue of Clinician Reviews, I was amazed by the words of Lia Walther in the “Your Turn” section.

HIPAA regulations clearly state that we, as providers, are obligated to provide translators to our foreign language–speaking families and that, to protect their privacy rights, these are not to be members of the family or community. Ms. Walther states that she and her husband, a hospital-based physician, have seen the “abuse” of requesting interpretation due to a patient’s comfort level. I applaud any provider who encourages the use of an interpreter where understanding and expressing medical terminology, therapeutic interventions, and need for follow-up, related to the patient’s health, may be misunderstood, misrepresented, etc, due to a language barrier.

Beyond the regulations under which this NP practices (again, HIPAA being one set), where is her sense of cultural diversity? In all our continuing education programs at Kaiser Southern California, cultural diversity is a required goal and objective to be addressed and evaluated in every CE course offered. We live in a blended, ever-closer world that would be healthier if we respected cultural beliefs and needs.

I suggest Ms. Walther read The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman. It has become required reading for entering medical/dental school and many nursing programs nationwide. Hopefully, her perspective will grow from reading.
Susan R. Opas, RN, MSN, PhD, CPNP, Woodland Hills, CA

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