For about a week, Tricia Nguyen’s 93-year-old grandmother spent most of her time alone in her hospital bed, abstaining from drinking water to avoid soiling her diapers and having no way to ask for help.

The only time she met with medical staff was when her two grandchildren came to visit and communicated with them in English.

With 46% of Orange County residents who can’t speak English, hospitals, such as Fountain Valley Regional Hospital, have introduced iPads for translation services. The tablet connects patients, doctors and translators from around the country to help with interpreting medical information. (File photo by Jeff Gritchen, Orange County Register/SCNG)

New devices, such as iPads, are being used in Fountain Valley Regional Hospital to help break the language barrier between doctors and patients. (File photo by Jeff Gritchen, Orange County Register/SCNG)

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New devices, such as iPads, are being used in Fountain Valley Regional Hospital to help break the language barrier between doctors and patients. (File photo by Jeff Gritchen, Orange County Register/SCNG)



“There was only one nurse that was able to speak Vietnamese,” Nguyen said, months after the ordeal. “I think out of the seven or eight days, she was lucky to get two days to communicate with the nurse.

“We were thinking, ‘Oh my gosh,’ luckily she has family members that speak English,” Nguyen said. “But we’re not there the whole time.”

The hurdle of providing comfort and care when language is a barrier is not new in health care and is an issue being address across the nation. It is especially pertinent in communities such as Orange County’s Little Saigon, home to the largest concentration of Vietnamese outside of Southeast Asia. Almost 200,000 residents who can only speak Vietnamese are seeking care from area hospitals and health care providers.

“Limited English proficiency is a large reason as to why Asian American groups, such as Vietnamese Americans, don’t receive timely primary care and even behavioral health care,” Joe Lee, training and technical assistant director of the Association of Asian Pacific Community Health Organizations, said.

The group advocates for improving health care services in community clinics and health centers in under-served Asian and Pacific Islander communities.

There is a shortage of health care providers that meet the linguistic needs of immigrants and refugees, he said. “When you have zero trust and zero communication, the patient is often discouraged to follow up on medical care.”

But it is the caregiver’s obligation to make sure patients have a quality translator available to them, said Keith Monzon, director of rehabilitation at Fountain Valley Regional Hospital.

“It is a challenge throughout the nation,” he said. “These are barriers.”

In Orange County where 46% of residents are non-English speakers, hospitals have started augmenting their own staff and locally available translators with online translation services. Fountain Valley Regional Hospital and Orange Coast Medical Center, for instance, now use iPads to connect patients with live translators from across the country. By streaming in help, Fountain Valley is able to provide translation in more than 200 languages.

Still, Monzon said he can understand when patients struggle to connect with people over the phone or on a screen. “You don’t get that warm feeling.”

Now some 10 years into his career, Dr. Danny Vo, a primary care doctor for Hoag Medical Group, said he’s experienced the complication of language barriers in health care. He is fluent in Vietnamese, but when his patient speaks another language, Vo said he has to depend on talking about symptoms and treatments through translators.

“I generally don’t recommend to use family members to translate,” Vo said.

Desires to not embarrass or even scare a family member when talking about health issues can lead to pertinent information about symptoms or personal medical history being left out or misunderstood in translations by a well-meaning family member, he said.

But there’s more to just not understanding a spoken language.

“Language needs to be relevant,” Lee said, describing how cultural differences can also pose a hurdle in providing effective medical care.

He recalled how an elderly Vietnamese patient used an online tool to translate during her visit with her doctor. The translation, however, was not culturally sensitive and used a Vietnamese dialect associated with communist Vietnam, adding to the patient’s discomfort during her treatment.

“A lot of physicians may not be aware of that,” Vo said, adding they can be better trained to recognize situations concerning culture.

Not sharing a language with their caregiver can isolate people, said Paul Hoang, a licensed clinical social worker.

He said one elderly patient he encountered was showing signs of depression because her assisted living residence didn’t have Vietnamese-speaking staff. There were no activities held in her language; there was no transportation available so she couldn’t travel to events in her Vietnamese community.

“The facility doesn’t understand the challenges of the seniors, from what she’s reported,” Hoang said. “The facility should be more proactive in reaching out and connecting to those seniors.”

Through his Viet-CARE nonprofit – an organization that works with, and advocates for, those struggling with mental and behavioral illnesses – Hoang said he plans to organize art, meditation and music classes for the facility’s non-English speaking residents, and help staff lead support groups for the elderly.

Those who don’t speak English need to know there are a variety of services available to help them communicate with those providing them care, Lee said of his concern about recent proposals by President Donald Trump’s administration to roll back parts of the Affordable Care Act.

“There are policies that are attacking important regulations that support language-accommodating services,” Lee said, adding about 19 million people with limited English could be affected by the changes aimed at reducing costs, from not being able to understand how to access medical information in their language to even knowing about their right to receive services.

Notices on documents specifying in various languages that translation services are available may not longer be required. Standards of interpretation in medical offices could also be affected, according to some accounts.

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Orange County officials say move to less-restrictive orange tier could happen Sept. 29 To help advocate for the preservation of language services and assist with mobilizing the community, Lee said the Association of Asian Pacific Community Health Organizations is collecting data on the use of translation services from health centers, including the number of minutes spent translating.

“It’s a patient’s right to have language-interpreting services,” Vo said. “Communicating with patients is one of the main jobs as physicians. If we can’t get an accurate history or if our patients can’t understand, it makes providing good care challenging.”

After recalling her grandmother’s experience, Nguyen said the community needs to speak up in demanding services.

“The problem is our Vietnamese community, they don’t complain,” Nguyen said. “That’s the sad truth. They don’t know the system. They don’t know their rights, so they don’t complain.”