Going to the hospital is almost always a stressful process—navigating through the labyrinthine hallways, filling out infinite nit-picky forms, processing the medical jargon from test results. And for many Americans, this is all done in their native language—English. But for many others, English is not their most comfortable language. It’s bulky, unfamiliar, haphazard. None of which are helpful in understanding the critical information given by the physician. So when the doctor and patient speak different languages, their relationship weakens. Not only are they unable to communicate about the patient’s health but also the feeling of trust and comfort also disintegrates. More plainly speaking, the language barrier denies non-English-proficient patients quality healthcare in the United States.
In every facet of daily living, the assumption is that the general public can read, speak and understand English—and the healthcare system is no exception . Some options are available within larger organizations to foster interlanguage communication, such as translation and interpretation services. However, the demographics of Americans who speak non-English languages at home is rapidly increasing. The Center for Immigration Studies found that “as a share of the population, 21.9 percent of U.S. residents speak a foreign language at home.” They further report that “of those who speak a foreign language at home, 25.6 million (38 percent) told the Census Bureau that they speak English less than very well.” As the percentage of these foreign-language speakers continues to grow and the number of those who are not proficient in English, the demand for translation and interpretation services rises .
In addition to the increasing demand, a study by the Joint Commission in 2015 found that limited English proficient (LEP) patients “are at a higher risk for adverse events than English-speaking patients. Language barriers significantly impact safe and effective health care… The study found that 49.1 percent of LEP patients experienced physical harm versus 29.5 percent of English-speaking patients.”  As the LEP demographic grows, ending this trend is critical to bridge the divide in quality healthcare based on English language proficiency.
Yet this split in care is already rampant throughout the American healthcare system, and in March 2020, when the COVID-19 pandemic reached the continental US, its amplified effects were devastating. The New York Times reported that by April, “At Cambridge Health Alliance in Massachusetts, nearly half of the 126,000 patients in its primary care system have limited English proficiency. The Alliance has 100 staff interpreters who usually work in its emergency rooms and community clinics.” This disproportionate ratio between LEP patients and the resources available to them has shifted the burden onto interpreters, who have had to cope with both an overwhelming number of cases and the shift to remote work. The New York Times elaborates, “Communicating through [an] interpreter doubles or triples the length of a medical exchange, adding new confusion and anxiety to situations that are already stressful for patients and their families . And the conditions of COVID-19 care—the novelty of the virus and its possible effects, the desire of hospital workers to limit the duration of their exposure to patients and prohibit non-patient visitors (who often can serve as interpreters for the patients)—create numerous obstacles to effective interpretation.”  Without proper language services, non-English-proficient patients suffer from confusion about their situation and their physical health ailments.
Outside of the hospital, the language barrier has been hindering COVID-19 public health efforts. Contact tracing, an essential practice for curbing the spread among immigrant communities, has proven to be extremely difficult to maintain due to mistrust in the government and the lack of non-English-proficient tracers. Contact tracers proficient in Polish, Spanish, Arabic, Vietnamese, Chinese and Hindi, to name a few, are needed throughout the country to adequately meet the needs of local communities . Without them, the fear of being monitored for purposes apart from COVID-19 position these communities at greater transmission risk.
Furthermore, translated information about the pandemic, mainly via public health announcements and updates, has been slow to update. Often when it is updated, it is in lesser detail than in the English versions. Denying non-English speakers the opportunity to fully understand what is happening and how they should best protect themselves. During an interview with Dr. Julia López, from Washington University School of Medicine’s Division for Infectious Diseases, she elaborated on the lack of timely public COVID-19 translations .
“That puts people at a disadvantage… already, just in the ability to understand what’s
happening. Even for English speakers… what people are reading and hearing is already confusing, and they’re reading it in their language. What can we imagine it feels like for people who already feel restricted? Now things have picked up, and now there are systems in place but this kind of shows and highlights that when push comes to shove, we’re not ready to provide the context of information in a timely way or at the same time. That there’s always a lag, and that lag can, and it often is, detrimental, unfortunately. What we see [here] kind of ties into also the disparity of health in these groups” López said.
Inadequate translation services only reinforce the health disparity trends so prevalent in the United States. To protect their communities, grassroots organizations have led the effort to provide equitable access to translated COVID-19 information. After meeting with local health clinics, Harvard Medical student Pooja Chandrashekar recognized the harm of the language barrier and rallied fellow students to compile a website with updated information sheets in over 30 languages called the “COVID-19 Health Literacy Project” .
Another example of this is in St. Louis, Missouri, where a small grassroots organization, STL Juntos, was created after its founders recognized the absence of Spanish COVID-19 information from the local and federal health departments. Starting from only translating the medical information as new announcements were made, STL Juntos now also serves the community though legal and rent assistance and food distributions . In an interview with co-founder Lourdes T. Bailon, she emphasized how there continues to be a real need in the community for these Spanish-oriented organizations. Since the group posted their initial Facebook translations, there’s been an overwhelming positive response from the Spanish-speaking community.
“[The] need to create a bond, or that trust, with the Latinos, or the Hispanics, because
that’s how we work. We create a bond, a trust, and then we stick there,” Bailon explained.
Dr. López echoed this sentiment in her interview as well, stating the value of having a medical practitioner who not only understands and can communicate with a patient in their most familiar language, but also understands the patient’s cultural background. The understanding and empathy that can only develop from being immersed in a specific culture provides a layer of comfort and intimacy that navigating the standardized system could never have. Regarding the responsibility of eliminating the language barrier, Dr. López recommends a multilevel perspective.
“The ideal combination is that you have grassroots organizing community members who
Represent, or are the voice of a group of people, and, in doing so, there is a listening ear from the healthcare institutions and in a truly collaborative way, the institutions recognize the needs and focuses of the community,” López stated.
Acknowledging that the language barrier is real is the first step towards eliminating it. During the interview with Bailon, her message to those with a limited understanding of the breadth of this issue is one calling for empathy and respect for the variety in languages and in proficiencies Americans have:
“There are way more people with a language barrier than we can even imagine. I think
we all know that to a certain extent, but most people or at least more organizations that I have spoken to, they assume that these people understand- that they’re bilingual- that they understand the English. And maybe they do, but they would much rather hear it in their own language and even if they understand the English, they’re not going to understand it completely and they’re not going to be comfortable. So it’s critical, I think, not just for Spanish, but for every other language as well,” Bailon said.
Language transforms and broadens the lens in which the world is viewed. It is an integral part of a patient’s identity, and the language a patient is most comfortable with should be treated with the same level of respect as any other aspect of identity. Healthcare organizations must address this barrier immediately: listening to the needs of the local community and working together to ensure equitable access to quality care, in every language.
Edited by Isaac Murdokuvic
Illustrated by Haley Park