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What it’s like to interpret for coronavirus patients remotely

Medical interpreters have been forced to work from home, but the rise of telehealth may keep many working remotely for good.

A US hospital worker in Stamford, Connecticut, speaks through a remote Spanish translator while treating a Guatemalan Covid-19 patient on April 24.
John Moore/Getty Images
Rebecca Heilweil covered emerging technology, artificial intelligence, and the supply chain.
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Health care interpreter Helen Sweeney is used to acting as a phone-based go-between for doctors and patients, translating intense discussions about people’s medical care into and out of Russian.

Now, many of those conversations are about the novel coronavirus, which has also brought novel challenges to her profession. Sweeney, who works for the remote interpreting service Certified Languages International (CLI), says one recent Covid-19 patient was so burdened by a breathing device that he couldn’t speak back in a conversation about the possibility of intubation.

“We just kind of had him do like a thumb up or thumbs down for ‘yes’ or ‘no.’ And we just simplified the communication,” Sweeney told Recode.

Sweeney is one of many interpreters now working remotely to ensure that patients and family members who don’t speak English fluently — a significant portion of the US population — can still access vital health care information amid the coronavirus pandemic. While some interpreters have for years used phone calls and video calls to communicate with patients, others are still adjusting.

CSA Research, a firm that does research on the language services industry, found in a recent survey that interpreters who do at least some work in health care saw a 40 percent decline in revenue from on-site interpretation. Meanwhile, phone-based interpreting has more than doubled, and video-based interpreting has more than tripled, though CSA cautions that the pre-pandemic baseline for remote interpreting was very low.

While many of these interpreters anticipate returning to work at their hospitals and other health care facilities, not all of them will. Thanks to the rapid transition to telehealth during the pandemic, remote interpretation will likely be needed as long as patients continue to seek medical care online.

Interpreters are at the front lines of the pandemic from afar

Remote interpreters have found themselves in the middle of some of the pandemic’s most sensitive, stressful, and heartbreaking moments. They’re frequently called upon to share the results of a Covid-19 test, and if it’s positive, the interpreter must communicate the next steps, including the rules of social isolation. Interpreters can be asked to help patients in tough times, like being admitted to the hospital or discussing the scenario of going onto a ventilator. More rarely, they can be called upon to interpret the news from a doctor that a family member has died of Covid-19.

But communication can be difficult. Speaking to patients and doctors over the phone or video chat can make it hard to understand those wearing protective masks or breathing devices. Interpreters may also lack full awareness of other stressors affecting Covid-19 patients, including the isolation of those who aren’t allowed to see visitors.

“With the visitor policies restrictions, we need to remember every patient does not have the support of a family member next to them,” Sweeney said. “They don’t have anybody to bounce off ideas for support, for help with the decision-making in real time.”

The result of this physical and emotional distance can be especially tough for interpreters working through the most difficult moments. Kristin Quinlan, the CEO of CLI, said one of her company’s interpreters, who works with Cantonese-speaking patients, had to tell a patient’s wife that he had died of Covid-19. The interpreter was struck by the frigidness of the interaction.

“It was absolutely matter-of-fact,” Quinlan recalled, “and the only question they wanted answered is ‘where do you want the body?’”

In some cases, maintaining a steely exterior is part of the job. One of the most important norms that medical interpreters must preserve is the relationship between the patient and the health care provider.

“You don’t want the interpreter to be especially a very gregarious, outgoing person,” explains Lynn McDermott, who also works as a remote, medical interpreter. “Probably the hardest thing about interpreting in medicine is that you’re trying to [make sure] the essence of the doctor-patient relationship has to be maintained, even though there is an interpreter.”

This is just as true in the positive moments on the job. Lourdes Caban, an English-Spanish interpreter who works with New York’s Mount Sinai Hospital, says she’s now being called in to speak to Covid-19 patients emerging from sedation after being on a ventilator. Those conversations can involve checking a patient’s mental state when the patient may not know or remember that they had Covid-19 or that they were intubated. Some discussions involve walking the patient through what recovery will look like, including what it will be like to sit up for the first time. This also represents a step toward victory in defeating the virus.

“I hear from the voices of the [health care] providers, the care and the love that they feel for the patients, and how happy they are that they have reached that stage in their recovery,” says Caban. “I feel extremely excited every time I’m listening to them.”

Remote interpreting will likely remain popular following the pandemic

John Shaklee, a Spanish-English interpreter based in Ohio, said he hadn’t worked on any Covid-19-related calls, but the pandemic has impacted him in another way. While he’s also worried about finances, Shaklee’s not sure whether it’s safe to return to work when the hospital goes back to live interpreting, so he may opt to keep working remotely. He notes that he’s in his 60s and that the idea of returning to in-person interpretation in the middle of a pandemic worries his husband.

But there has been some opposition to remote interpretation, says Barry Slaughter Olsen, a professor who teaches interpretation at the Middlebury Institute of International Studies. Many interpreters prefer to work in person, where they can pick up other cues about what a patient or health care worker is communicating. Remote interpretation, he says, can come off as cold, and not all types of interpretation — or health care conversations — should be done remotely.

But there are some advantages, Olsen explains. It can be quick to call up an interpreter on a phone or video call, if needed, rather than sending the same interpreter back and forth in a large hospital system. A remote interpreter might be an easier way to get someone who interprets for a less widely spoken language. In the US, he says, that’s usually any language other than Spanish.

Then again, hospitals and health care facilities might see such on-demand interpreting services as a way to reduce costs, potentially to the displeasure of interpreters. To some extent, this has already happened. Some hospitals started to make the switch long before the pandemic hit, and the trend will likely continue. As Walmart scales up its drive-through Covid-19 testing sites, for example, CLI will offer remote interpreting services to patients who don’t feel comfortable speaking English.

The shift to remote interpreting can preserve the most human elements of these often difficult interactions. Sweeney recalls a call with an older, Russian-speaking woman who was stressed about her health care and had symptoms of Covid-19. Later, she ended up being put back on the call with the same woman, who she says remembered her instantly.

“It’s very rarely that you’re interpreting for someone in a very dark situation, and then you’re able to catch them again,” said Sweeney. “She recognized me, not by my face, but by my voice.”

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