From the Oakville-Mehlville Journal, August 10, 2005 by Shawn Clubb

It had been a common scene only a few years ago in St. Louis for a 10-year-old immigrant child to interpret for his parents at places including banks, hospitals and police stations.

Often times the child, who had been taking English as a second language classes in school and who was surrounded by English-speaking students and teachers, would be proud to be able to help out a parent.

His parents were busy trying to start a new life in a new country with a different culture, while sometimes working two jobs. This meant learning English was sometimes not the first priority.

"It would be nice if one''s need to seek treatment for a heart attack, to purchase a house or to send a child through college could wait until you acquire English, but it can''t," said Barbara Bogomolov, of Barnes-Jewish Hospital''s Refugee Health and Interpreter Services.

Hospitals learned to adapt to the needs of immigrants and refugees with limited or no English language skills and other institutions are following suit. Some banks have hired Bosnian and Hispanic employees. The St. Louis Police Department has one Bosnian officer on the streets and two others at the academy.

Many institutions still lack bilingual staff, so they call for an interpreter from agencies such as the International Institute''s Language Links program or Catholic Family Services'' Language Access Metro Project (LAMP).

Medically speaking
Interpreters are used most frequently by healthcare providers, who use specialized terminology, which even native English speakers might have trouble understanding.

"It takes a while for you to have the kind of skills necessary to understand the esoteric language of health care," Bogomolov said. "That''s why these services are crucial when folks first arrive."

Barnes-Jewish Hospital employs 32 people that collectively speak 27 languages within its Refugee Health and Interpreter Services. The staff interpreted in 53 tongues last year.

Bogomolov said interpreting from one language to another is a good start, but simply hearing information in one language and repeating it in another is not enough. Interpreters also have to bridge the cultural divide.

Interpreters have to know when more of an explanation is needed, she said. They need to be able to talk to a physician and explain that a patient might take information the wrong way, if it isn''t presented in clear terms.

Sometimes the interpreters have trouble understanding and interpreting the medical terms, especially when no linguistic equivalent exists in the target language, said Nicole Lopresti, director of LAMP. This can make interpreting complicated.

"It takes a lot of confidence for an interpreter to tell a doctor either I don''t know what that means or can you explain that for me," Lopresti said.

LAMP provides interpreter services mainly for healthcare providers. It makes about 1,200 appointments per month for interpreters to meet clients at doctor''s offices and interpret information.

Besides being able to speak at least two languages, interpreters must also be trusted by the clients, Lopresti said. Patients don''t want a third party coming into their doctor appointments, so when they must have them they need to be assured of confidentiality.

LAMP teaches interpreter training called Bridging the Gap, created by the Cross Cultural Healthcare Program. The training includes a code of ethics, professional conduct, a history of the U.S. healthcare system and common medical terminology and procedures within its training program.

Interpreters on call
Marcia Wilderman, the Language Links manager at the International Institute, said the service looks for interpreters that are professional, neutral and prompt. She said they have to keep information confidential and they have to be highly proficient in both languages. Language Links has 120 on-call interpreters.

Language Links provides interpreters for employers who want to speak to "limited-English-proficient employees," schools that need them for parent-teacher conferences, attorneys, the courts and agencies including the Missouri Division of Children Services.

But with all the need for interpreters, it is sometimes hard for services like Language Links and LAMP to find and keep them.

The pay for interpreters is low and the work is infrequent, so LAMP and Language Links often share interpreters to help boost their workload.

Two of the biggest challenges to providing interpreter services are coping with an influx of new immigrant populations and handling interpreter turnover, Wilderman said. New populations of Krahn-speaking Liberians and ethnic Turks from Russia have recently come to St. Louis, joining larger groups that include Bosnians, Hispanics and Vietnamese.

Wilderman said there might not already be someone here who can speak English and Krahn well enough to interpret.

"We can''t send somebody who is just going to get by," she said.

Part of the problem arises from the small populations of such groups in St. Louis. For example, Wilderman said St. Louis has relatively few Iraqis compared to some U.S. cities.

The steadiness of the work is also an issue. Even when an interpreter is employed by both LAMP and Language Links, the interpreter might not get used frequently, if the language isn''t widely spoken.

"If they''re not employed, they''ll eventually find other work," Wilderman said.

While new populations of immigrants come to need the interpreter services, other populations begin to need it less.

Wilderman said Language Links does not have half the requests for Bosnian interpreters that it had a few years ago. She said there has been a similar decline in requests for Vietnamese interpreters.

"People are getting integrated. They''re learning English," she said. "Kids are going to school. They''re getting jobs and they''re learning English."

Language barriers
However, for people who still could benefit from having an interpreter to help them understand important information, there are other barriers. The greatest of which is the reluctance of some agencies to use interpreters.

Title VI of the Civil Rights Act of 1964 requires agencies receiving government money to provide an interpreter for people who do not speak English well.

Wilderman said some judges and police officers are reluctant to use interpreters.

Lopresti said some private practice physicians still refuse to use interpreters. She said advocacy for the service is missing or lacking.

"We know it''s a cost, but would you rather have a lawsuit or a misdiagnosis?" she asked.

Some people might think it''s okay to still use children to interpret for their parents, but it''s not, Bogomolov said.

"It''s tempting to use children," she said. "They often are available. They often appear bilingual and they''re often offered by the parents as an interpreter."

But these children, often refugees from a chaotic situation in their home countries, have already been displaced from their childhood, Bogomolov said. They are now being put in a position to make important decisions for their families.

"Putting power and responsibility on a child is not fair to anyone," Lopresti said. "Imagine a 10-year-old interpreting a surgery. They need someone who is professionally trained."

Lopresti said some immigrants feel embarrassed that they can''t speak English and they don''t seek an interpreter. Others don''t know about Title VI and are not aware an interpreter is available to them. She said LAMP has grown as more people find that out.

Bogomolov said some agencies think it "would be nice" if they could provide the service, but they haven''t decided that it''s absolutely necessary.

"It''s an imperative to be able to make that happen," she said.

And it can happen, especially with advances in technology, Bogomolov said. Language telephone services are available through which a firefighter or other rescue personnel could call and almost immediately be connected via cellular phone with someone who could interpret for them.

Doctors have improved in their use of interpreters and so are city agencies and private institutions. Bogomolov said the physicians at Barnes-Jewish would not think of seeing an immigrant patient without a translator.

"We''re definitely seeing improvements," Bogomolov said. "We just have a long way to go."