Like everyone in the intensive care unit, interpreter César Fernandez-Chavez wore full personal protective equipment — an N95 mask on top of a surgical mask, goggles, a face shield, shoe coverings, a full body suit. The scene could have come straight from a sci-fi movie.
He was there because a Spanish-speaking patient didn’t understand his COVID-19 condition, which was deteriorating. The ICU doctors needed the patient’s consent for intubation, but phone and video interpreters were having a hard time explaining.
So Fernandez-Chavez, program coordinator for the language and interpreter services at Mount Sinai Beth Israel and Mount Sinai Brooklyn, was on the scene, the only in-person interpreter during the spring COVID-19 surge while the rest of his team worked virtually.
The patient had trouble speaking, so he lifted his oxygen mask — and began to cough. Despite his full PPE, Fernandez-Chavez held his breath.
“I will get home, and I will just hug my dog and start crying every day,” said Fernandez-Chavez, who lives in Hell’s Kitchen.
In a city whose residents speak more than 600 languages, interpreters have become even more essential to medical care. In May 2019, 3,770 translators and interpreters worked in New York State; by 2022, the field is projected to become the fifth fastest growing occupation, the Bureau of Labor Statistics has said — a demand caused by the nation’s increasing diversity.
According to a 2016 American Hospital Association survey of 4,586 hospitals, as reported by NPR, only 56% provided language services. Yet another association survey shows that 97% treated patients who had difficulty speaking English.
The coronavirus pandemic has drawn attention to the need for still more language service providers. Interpretation services’ phones have been ringing off the hook.
“People with limited English proficiency were not getting interpreters throughout the major height of the pandemic,” said David Cardona, president of the International Medical Interpreters Association. Health care providers “did the best that they could,” he said, “but at the same time, it was the law of the land to provide interpretation services.”
Interpreters themselves felt the crunch.
A survey of the 3,500-member association found safety a primary concern for those who didn’t have protective equipment, said Cardona. Since many members are independent contractors, they were expected to supply their own, but “they didn’t know who to call or how to get PPE,” he said. Because of the shortage, prices for masks, gloves and face shields — without bodysuits — reached $250, Cardona said.
An association task force began drafting safety guidelines, offered training services and launched a PPE relief fund. As the industry moved toward phone and video instead of in-person interpreting, interpreters were “working maybe 10 or 11 hours, or 12 hours sometimes, over the phone,” Cardona said.
A task force letter to President Trump in April drew no response, though Surgeon General Jerome Adams invited Cardona to participate in listening sessions.
But while interpreters await assistance, fears of COVID-19 have sidelined many.
Soraya Cina, 55, a Spanish interpreter from Auburndale, Queens, felt unsafe as a freelance medical interpreter during the pandemic because her teenage daughter has asthma. Cina described hospitals as “notorious breeding grounds for germs,” and while doctor’s offices felt less risky, much about the pandemic remained unknown.
Cina had begun interpreting at New York-Presbyterian Queens in 2011, left the field briefly to care for her mother who was in poor health, then turned to freelancing in 2015. She receives assignments from agencies such as iLingo2 and International Translation Services, Inc., which provide translation and interpretation to clients.
She withdrew from interpreting around April, a decision she described as a “tug in your heart.” But, “if your job puts you at peril, then it becomes paramount to protect yourself,” she said.
She turned down phone interpreting as well, partly because she feared the pandemic-fueled workload would interfere with her work as a part-time assistant to a children’s minister.
Besides, “I really like to see the person’s face,” Cina said. “A lot is conveyed by the person’s expressions.”
For now, Cina remotely volunteers as an interpreter at Restore NYC, which helps sex trafficking victims. But since her daughter has left for college and Cina no longer has to worry about infecting her, she hopes to return to freelance interpreting soon.
She may have no trouble finding work. Medical interpreting services, already understaffed before the COVID-19 outbreak, have been unable to keep up with the demand.
On a normal weekday, “you could be looking at anywhere between low 40s and mid 50s, in terms of the amount of calls,” said Amado Veloz, 37. Veloz, head chair of the Dominican Republic chapter of the International Medical Interpreters Association, owns Peregrine Interpreters Corp., a Bronx startup offering interpretation mainly by phone and serving larger U.S. and Canadian interpreting companies.
Calls for scheduled doctor appointments decreased by more than half since COVID-19 struck the region, because so many people only showed up for urgent needs, Veloz said. But the number of emergency room calls jumped 50 to 70%.
One spring day, he and his staff interpreted about 70 calls. “When things got really crazy, I just became accustomed to it, to a point where it scared me,” Veloz said.
Peregrine employs 20 Spanish-speaking interpreters, most living in the Dominican Republic. Though it interprets for hospitals all over the United States, 70 to 80% of its clients are in New York, New Jersey and Connecticut.
Peregrine’s peak for emergency room interpretation work came from May to July, not in March or April when the city was suffering most. Veloz theorizes that in emergency rooms, “they were so overwhelmed that there wasn’t actually any time to contact over-the-phone interpreters.” Spanish-speaking doctors and nurses, usually not permitted to interpret because hospitals fear liability, were probably getting pressed into service, he said.
In March, when patients flooded Mount Sinai Hospital, Silvina de la Iglesia, 44, associate director of language services, began stationing interpreters at the hospital security desks to tell family members about visiting restrictions.
Soon, Mount Sinai’s main campus started creating “mobile hospitals,” with beds set up in the atrium and in hallways, leaving the centrally-located language services office at high risk for exposure.
On April 1, de la Iglesia’s team moved to five weeks of remote interpreting. The same day, the charity Samaritan’s Purse worked with Mount Sinai to set up white tents in Central Park to help with the overflow.
“It was very important for us to keep our team safe, as we were learning that doctors, nurses, other staff members were getting infected with the virus,” de la Iglesia said.
During the pandemic, her team’s roles even extended to patient advocacy. “We learned about a 34-year-old, Spanish-speaking young lady who had Down syndrome,” de la Iglesia said. “The mother had already lost two children to COVID in the past two weeks.” Now, her daughter was in the hospital with COVID-19, with visitors barred.
De la Iglesia’s team worked with the nursing staff and management to allow the mother, wearing proper PPE, to visit. “Even though the daughter was heavily sedated and intubated, she responded. Once she heard her mother’s voice,” de la Iglesia said, “she smiled.”
As cases have started increasing again in the city, Mount Sinai’s main campus has begun reducing its in-person interpreters again. But after making it through the first surge and its related problems, de la Iglesia said, “we are much more prepared.”
(Photo by Shanna Kelly)