The patient was sick, alone and barely speaking to the medical team that was trying to help him.
It can be a common problem in North Carolina and across the South as the Latino population continues to grow. The number of medical encounters requiring medical interpreters at Novant Health alone jumped from around 87,000 in 2015 to 157,000 in 2018.
In response, the health care system is revamping its delivery of interpreter services with the launch of its Cultural Ambassadors program. The goal: Take even better care of the communities it serves by helping those with the fewest resources.
Instead of operating as strict interpreters between Spanish-speaking patients and providers, the medical interpreters “step into the role of a cultural ambassador,” said Pedro Mendez, director of language and cultural services at Novant Health. “They become an advocate, educator and navigator for our patients.”
Supported by a three-year, $195,000 grant from the Duke Endowment, the program incorporates cultural ambassadors into the care team to ensure that care is individualized and understood by patients whose primary language is not English, such as Spanish-speaking patients. Cultural ambassadors round on patients regularly and serve as an advocate who speaks their language and understands their culture.
Making a world of difference
Nearly 9 percent of the American population speaks English “less than very well,” the U.S. census found in a 2016 survey. That’s more than 20 million people.
And historically, people lacking English skills are less likely to have a primary care provider and are less likely to receive preventive care. Relying on a family member, friend, nonclinical team member or fellow patient to provide medical interpreter services has also been shown to lead to negative clinical consequences.
When Lydia Flores Cotto, a cultural ambassador at Novant Health Presbyterian Medical Center, met Eduardo*, he was barely speaking to his care team. After a few conversations with Lydia, Eduardo began opening up to her. He discussed his health in detail and revealed he had recently lost his home and everything he owned. He was trying to get across the state to a relative’s house.
Lydia encouraged Eduardo to fully discuss his health openly with clinical team members so that they could get him back on his feet as soon as possible. She then contacted a social worker to find clothes and transportation services for him. This seemingly small interaction made a world of difference in Eduardo’s overall health picture – and in his life.
A necessary shift in delivery
In most standard interpreter services programs, interpreters simply interpret between patient and provider. The problem with this approach is that it does not take into account any additional needs or concerns patients may have. It can also leave them confused about their care plan and less likely to seek follow-up care.
“It’s about making patients feel cared for and understood,” said Mendez. “We want them to know they can trust us, and that we have their backs.”
To be a cultural ambassador, it is preferred for you to possess the national certification for medical interpreting, have a minimum of two years experience in a multicultural health care setting and a bachelor’s degree in education. Ambassadors are trained to successfully bridge the cultural and linguistic barriers that non-English speaking patients may encounter when interacting with the health care system.
Novant Health employs cultural ambassadors at three of its acute care facilities in North Carolina: Seven at Novant Health Presbyterian Medical Center in Charlotte, 12 at Novant Health Forsyth Medical Center in Winston-Salem and one at Novant Health Rowan Medical Center in Salisbury. They rotate throughout the facilities and in all major care areas, including the emergency room, maternity and pediatrics.
“It’s scary enough to be in the hospital, but even worse when you feel like no one understands you,” Mendez said. “I’m proud to be a part of the team that’s helping alleviate that.”
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*Name has been changed to protect patient privacy.
Photo: From left, cultural ambassadors Becky Allman and Pamela Martinez work to bridge gaps with Spanish-speaking patients at Novant Health at Forsyth Medical Center.