Amanda Wheeler-Kay has been a Spanish-English freelance interpreter in the Portland metro area for 15 years. Like most freelancers, she said it’s not unusual for her schedule to look mostly blank a week or two out. But last month was different.
“By mid-March, I had a bunch of appointments that canceled,” Wheeler-Kay said. “I'm now getting between five to 10 appointments a week as opposed to six a day.”
She and other interpreters, who have been classified as non-essential workers during the COVID-19 pandemic, say the crisis has decimated their industry. Work that interpreters could usually count on from hospitals, schools and conferences has dried up, leaving them worried about their future — and the health of people who have the hardest time accessing American medical care.
Normally, most of Wheeler-Kay’s interpreting work takes her to local medical centers and it’s done face-to-face. But that stopped after Oregon Gov. Kate Brown ordered all non-emergency procedures, like elective surgeries and routine check-ups, to cease last month.
And that means the barriers to health care for patients who speak minimal English have become even higher.
“We know how hard it is for information to get out there,” Wheeler-Kay said. “This whole crisis is making [it] so clear how social determinants really do have a significant impact on people's lives.”
Interpreters play a vital role in the health care system, but many have been laid off entirely from their jobs.
More than 570,000 Oregonians speak a language other than English at home and nearly 40% of that population say they do not speak English very well, according to the 2018 American Community Survey.
Breaking it down further, the survey showed that Spanish was the top language spoken at home among households with limited English speakers, followed by Chinese, Vietnamese and Russian.
Interpreters working in the health care industry provide a way for patients who speak no or limited English to get vital services. So far, the coronavirus pandemic has hit Oregon’s Hispanic community disproportionately hard.
Medical institutions that receive federal funding have to make a reasonable effort to provide their services to people who have limited English skills. A similar measure under the American Disabilities Act covers individuals who are deaf or blind.
Maria Michalczyk, president of the and a retired nurse, said this federal law ensures equal access to health care for everyone, no matter what language you speak. Interpreters served a crucial service even before the pandemic heightened the need to make health information broadly available.
She said a lack of understanding between doctor and patient can lead to poorer health outcomes.
“If the provider doesn't understand the patient, then the patient's not going to get the care they need,” Michalczyk said.
Michalczyk helped pioneer the health care interpreter programs at Oregon Health and Sciences University and Portland Community College. She was also instrumental in constructing SB790, Oregon’s health care interpreter certification law that passed in 2001.
She said health care interpreters work in a variety of medical settings. So in addition to being fluent in more than one language, interpreters also have to have a good understanding of medical terminology.
“It's enormous in regard to what [interpreters] do,” Michalczyk said. “[They] could be in a suite interpreting for eye surgery, and then they could be in an area where babies are being delivered or they could be in a clinic doing a routine health exam.”
To reduce the risk of spreading COVID-19, many medical providers in Oregon have switched to telephonic or video relay interpreting.
Yasmeen Al-Barghouthi is an Arabic-English health care interpreter who lives in Beaverton. She does most of her interpreting over video calls with patients across the U.S and has also seen her workload reduce drastically.
“Most of the interpretation I'm doing now is canceling,” Al-Barghouti said. “We're just calling patients, telling them that their appointments were canceled.”
The language agency she works for has asked all of their interpreters to take voluntary time off.
Although telephonic and virtual interpreting is safer for everyone involved, Al-Barghouthi said the pandemic has also changed these modes of communication. She said calls have gotten difficult to decipher because both patients and providers wear masks.
“We can't hear them well because of that mask,” Al-Barghouti said. “The sound is muffled and they can't take off the mask. This is a real problem for us.”
Deaf interpreter Colleen Thayer, who is based in Salem, also said face masks are making it harder to communicate. Thayer said American Sign Language, as well as many other languages, rely heavily on facial expressions. These cues are harder to pick up now.
“To prevent each other from getting sick, we have to wear masks,” she said. “Because it's health first, communication and understanding have actually dropped in priority.”
Thayer said she’s also been put into the difficult position of explaining to some patients that a global health pandemic is occurring.
She said some deaf patients, like those who reside in senior living facilities, are completely unaware of the pandemic because staff don’t sign and shelter-in-place orders have cut them off from friends and family members who can communicate with them.
“They're seeing staff changing their work process, with gloves and masks being added,” Thayer said. “That's triggering for a senior citizen. It makes them scared.”
The lack of meaningful language access that’s available to deaf and limited-English speakers is troubling to many in the interpreting industry.
David Brackett is the owner of the Portland-based language agency . His company specializes in health care interpretation and translation, connecting local interpreters with medical centers.
“Unfortunately language access is one of the last things that's on people's minds when you’re experiencing something like COVID-19,” Brackett said. “And then what is the ripple effect? They get left out. Their voice doesn't get heard.”
Brackett said he’s trying to fill some of these gaps by helping his face-to-face interpreters transition to remote interpreting. Still, he said, the amount of work available to his interpreters has dropped by about 75%.
The Oregon Health Care Interpreters Association has compiled resources to help interpreters get through the pandemic — including links to possible job opportunities, financial assistance and local food banks.
But for some interpreters, like Wheeler-Kay, this type of aid is not enough. She said local health care interpreters should be classified as essential workers and be put back to work as soon as possible.
“This has highlighted for me how little understood the profession of interpreting is,” she said. “If we don't prioritize interpreters now, there may be a huge shortage of us when things go back to normal because we just couldn't keep waiting for [work] to come about. That's going to have a drastic impact on patients and providers who rely on interpreters.”
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