I first met B at a Thai restaurant, where I worked as a server and she was a cook in charge of the appetizers, grills and curries. I didn’t know her very well, but one day she asked me if I could come to the hospital with her.
It’s for a general check up, she explained. I just need someone to interpret for me.
She told me she had an interpreter during her previous appointment, but that she still struggled to understand what was going on.
“I didn’t know what any of the forms said, and it took me an hour to fill them out,” she told me in Thai. “It took so long that someone actually came over and asked me if I needed help.”
I decided to go.
B is 37, with a soft face and an easy smile that belies her age. Like many Thais in New York, she lives in Elmhurst, Queens, and works in a Thai restaurant. Despite living here for two years, she says she’s had few opportunities to learn English.
“I can never understand the subway announcements,” she said. “When they announce a change and I don’t understand it, I just go back to where I started.”
Still, she manages to navigate her way through the city – she often relies on friends and keeps screenshots of directions on her phone.
“I’m not shy about admitting when I can’t do something,” she added. “If I don’t understand something, I don’t understand it.”
When I met her at the hospital for her appointment, B was wearing a puffy jacket and red lipstick. We went straight to the third floor, where a sign in English, Spanish and Chinese announced that we had entered Women’s Health.
“She’s here for her internal exam?” The nurse at the counter asked.
I asked B if she knew that she was coming in for an OB/GYN appointment. She shook her head. “They told me to just make another appointment, so I did.”
I tried to find the words to explain what an OB/GYN appointment was – though I grew up in Thailand, I rarely found myself using Thai in a hospital setting. I settled on something along the lines of, “this is about women’s stuff.”
The nurse gave us a form to fill out – it was in English. The first question asked for the age when she got her first period and the date of her last period. B looked it over, furrowing her brow.
“Is this where I put in my age and birthdate?” she asked.
In New York, hospitals are required to provide free interpretation services to all patients – part of legislation introduced in 2006 called the Hospital Language Assistance Law. And though hospitals are certainly making strides to provide those services, I was beginning to see that for patients like B, who didn’t speak one of the three dominant languages spoken here, there were clear gaps in some of the services available to her: All of her interactions before entering her appointment were in English. All the forms provided to her were in English. And if she brought her own interpreter, there was really no way for the doctor to know if the interpreter was actually doing her job right.
I did not think that I was a very good interpreter. No one seemed to question why I was there, but as the appointment went on, I felt increasingly unqualified to serve as one – when the doctor asked B questions about her medical history, I struggled to find the Thai equivalent for a range of terms, some common, others not: cancer, high blood pressure, hypertension, chlamydia.
When it came time for B’s internal exam, I awkwardly stood outside the curtain, trying to keep up with translating the doctor’s instructions. I wasn’t sure if I was getting everything across.
We were told that B needed to get some blood work done, as well as an HIV test – B thought she had one at her last appointment, but the nurse couldn’t find it in her records. The doctor said she would call to let her know the results.
Once the checkup was over, the doctor asked me to sign my name on a form – just my first name, no phone number needed, no questions asked about who I was.
“So what should I do when they call?” B asked me. “Should I give the phone to someone nearby who speaks English? Most of the people I know don’t speak English very well.”
I didn’t really know what to say.
A few weeks later, B sent me a photo of a letter from the hospital telling her to make another appointment. She asked me if I could translate it for her and come for her next appointment.
This time, our appointment went more smoothly – we met with the same doctor, and I saw that a form noted that B’s last appointment had been “translated by PT’s girlfriend: Kanyakrit.” But we encountered again some of the gaps in our previous visit: when the doctor handed B her test results and a flier explaining some of her health conditions, all of the material was in English.
“We only have forms in English, Spanish and Chinese,” the doctor explained.
Later, I asked B about how she navigated her way through her first appointment and why she wanted me to be there as opposed to a qualified medical interpreter.
The answer to the second question was simple. She told me that her interpreter knew all the terms, but that he wasn’t very clear.
“His accent was worse than yours,” she said. She also said that she preferred having someone she knew be there in person, so she could feel more comfortable asking questions.
As for the rest of the appointment, she told me that a lot of it, for her, was guesswork. When she went up to the counter, she immediately said that she needed a Thai interpreter. But interpretation services were only available once she met with her doctor. In the meantime, she had to fill out forms on her own, which she did by taking pictures of the information and sending them to her roommates. When nurses asked her questions about insurance and other preferences, she said she didn’t really understand the questions, so just said “no” to everything.
“I felt that it was better to say ‘no’ than ‘yes,’” she said.
Her first visit had taken much longer than she expected. B arrived at 11:00 and only left at 4 p.m., in large part because of the stretches of time in between her appointments – when she had to fill out forms or find her way to the next procedure.
“They would tell me to go to the lab, but they didn’t tell me what to do at the lab, or what to do after the lab,” she said. “I felt tired by the end.”
I felt torn. It was disconcerting to me that B was guessing her way through most of her hospital visit, but I could also understand that to a certain extent, she had to be responsible for her own health. And she had made the choice to live in a country where she didn’t know – and wasn’t learning – the language.
At the same time, B is just one of thousands of other New Yorkers who have limited English proficiency. And if the city has made it a law that they should have access to interpretation services, then it should keep to its promises.
I asked B if she thought that the hospital had done enough to provide her with interpretation services.
“In general I felt like people were trying to help me, but there needs to be someone who can translate for you at the first point of contact,” she said. “I wasted a lot of time filling out the forms.”
She admitted, too, that she needed to do more to learn on her own. “I do worry that I’m a burden to my friends, and I’m trying to be better. I try to help myself as much as I can, but when others can’t, I try to do things on my own.”
But it seemed that the hospital could also do more as well. Even when B had an interpreter on the phone for her first visit, she says there were moments when she didn’t fully comprehend what was being asked of her.
At one point during her checkup, her doctor asked her if she wanted to get a flu shot. The interpreter asked her the question in Thai, but kept “flu shot” in English.
“I didn’t know what a flu shot was, and I felt like I didn’t know how to pronounce it right so I could ask him about it,” B said.
So B resorted to her usual answer that day.