Since the days of ancient Greek physician Hippocrates, doctors and nurses throughout world history have been bound by the ethical responsibility of “doing no harm” to the patients under their care. In the United States, the law also mandates that healthcare professionals provide for the needs of their patients to the best of their abilities.
Often, language stands as a barrier that hinders a healthcare provider from performing the tasks that need to be completed to ensure the wellbeing of their patients. Hospitals and clinics across the country face this problem routinely, and LUNA Language Services is in the frontlines of helping providers overcome this challenge every day.
But what happens when a patient speaks a language so rare that it becomes nearly impossible to find an interpreter who can assist them? What can a doctor or nurse do when all avenues and resources to communicate with a patient have been exhausted?
Variety in Indigenous Languages
Over the last few years, the United States has seen an influx of immigrants and refugees from the lands once known as the Mayan Empire. Due to economic, environmental, and often political instability in their communities, many Indigenous people from Guatemala and southeastern Mexico have made our state of Indiana their new home.
Oaxaca is the tenth most populous state in Mexico and is demographically unique due to having one of the highest concentrations of Indigenous peoples in the country. Nearly one third of all Oaxacans speak an Indigenous language, and half of that group are unable to speak Spanish, Mexico’s national language. The second-largest group of Indigenous peoples in Oaxaca is the Mixtecs, whose language is divided into two main branches: Mixteco Bajo (Lower Mixtecs) and Mixteco Alto (Upper Mixtecs).
Life as a Hoosier
An elderly gentleman from a tiny Mixtec village tucked in the western mountains of Oaxaca is now living as a Hoosier in a suburb near Indianapolis. He is due to have an elective but serious procedure done at the local hospital. His family has been taking care of administering his medications and transporting him to and from doctor appointments. They speak mostly Spanish and some English, but not much Mixteco. These upcoming procedures will be invasive and will require the man to be sedated under general anesthesia.
Providing effective communication for hospitals
Ethically and legally, hospital staff must ensure their patient understands the need for this procedure, what steps the procedure entails, and all the risks associated with it. People with non-English speaking parents can attest that growing up, at some point they were probably asked to interpret or translate language above their comprehension level.
Imagine being an elementary-school child having to explain a tax form that came in the mail for your mom! Adult and minor children of immigrant parents are often thrust into the nerve-wracking position of interpreting for what can be high-stakes interactions.
Adult and minor children of immigrant parents are often thrust into the nerve-wrecking position of interpreting for what can be high-stakes interactions.
Fortunately, this Indiana medical facility knows LUNA will take the challenge to find the right resource for this rare language. The providers can rest assured that the highest ethical standards are met as a trained, medical interpreter delivers language access.
Mixteco’s Complexity
Complicated problems require thought-out, nuanced solutions, but these rarely come easily without a few roadblocks along the way. Sure enough, LUNA arranges a joint phone call between doctor, patient, and a Mixteco interpreter. But the first obstacle soon becomes noticeable. Our interpreter and the patient only have 20% understanding; it is here that the complexity of this community’s language variants poses a challenge. The facility staff does not and should not feel comfortable in proceeding with such an invasive procedure that though necessary, realistically poses risks to the patient. Such a procedure can never be undertaken if the patient is unable to give full, informed consent. The procedure is postponed, and the patient must wait.
Finding the right variant of Mixteco
Beyond the “Upper” and “Lower” branches, Mixteco has up to eighty-one variants. These variants are not always mutually intelligible. Even members of the same broad Indigenous group are often unable to communicate with each other. We must now learn more about the patient; the variant of Mixteco he speaks depends on his village or municipality of origin. We secure a new interpreter that speaks a variant more closely related to that of the patient. Not willing to leave anything to chance, we arrange a test call between patient and this interpreter to verify mutual understanding. The call is coordinated, and it is a success!
From English to Spanish to Mixteco
Now the real work begins. The new Mixteco interpreter does not speak English. He can communicate with the patient just fine and can speak with me in Spanish, but he cannot understand the doctor or nurses. Layered interpreting is required. The nurse speaks in English, I repeat her words in Spanish, and the interpreter repeats my words in the patient’s variant of Mixteco. When the patient responds, the same process begins again but in reverse. It is like a choreographed dance between the three of us.
Explaining the Procedure and Easing Fears
We arrange a preliminary Zoom call between all participating parties: the patient and his family, the nurses at the hospital, the Mixteco interpreter, and me. After friendly introductions, we jump right into the matter at hand to discuss the patient’s medical history, family health background, medications, and allergies. We cover every relevant detail about the patient to arrive at a crucial conclusion.
“We need you to understand what is going to happen,” explains the nurse. The term for this upcoming procedure doesn’t exist in the patient’s language, so she describes it in step-by-step details.
The term for this upcoming procedure doesn’t exist in the patient’s language, so she describes it in step-by-step details.
In his language, the patient agrees to undergoing the procedure. “It needs to be done. It’s what I have to do to be healthy.” The nurse continues, “You will be under general anesthesia; you will breathe on your own, but you won’t be aware of what’s happening.” The patient hesitates, “I’m a little worried I won’t wake up.” She eases his fears. “It is normal to feel that way, and though these risks always exist, the possibility of anything going wrong is very unlikely.” She reassures him the doctor performing the procedure is one of the best in the state and even this entire region of the country. The date and time of the actual procedure are set a few weeks afterward.
Ensuring Informed Consent
When we are all once again connected, the discussion begins much like before. The patient is ready to go: “I trust the doctor and I know this is something we need to do.” A consent form is read, and he is asked to sign it. “I cannot read or write,” the patient informs us. “Can my wife sign it for me?” We verify his informed consent again; this time the nurse asks him to explain why he is there in his own words: “the doctor needs to know that everything inside me is working right.”
The doctor enters and explains the steps and risks one last time but assures the patient: “I will be very careful.” The patient agrees without hesitation. “I’m putting in your IV now,” says the nurse. “It’s going to pinch you a little, and you’ll fall asleep soon.” She’s now speaking just to me and the other interpreter: “He’s out now, so I’m going to let you go. I’ll give you a call when he wakes up again.”
After the Procedure
I get the call about an hour later. “Welcome back! We’re right back where we left off.” The nurse greets the patient as she checks his vitals. He is in good spirits. The doctor now speaks: “Everything looks good. So far, I’ve seen nothing alarming. How do you feel?” He replies sleepily but succinctly: “I feel good. Thank you so much for seeing me today. I’m so thankful you helped me understand everything and for all your hard work!”
* Disclaimer: Names and identifying details have been changed to protect the privacy of individuals and organizations.
Visit the United Nations, to learn more about the International Day of the World’s Indigenous Peoples.
To learn more about our Interpreting Services, visit our Phone Interpreting page and our On-site Interpreting Services page.
About the Author: 
David Gonzalez’s role has continued to grow at LUNA from Spoken Language Coordinator to Client Care Representative on our Marketing and Sales Team. His experience as a Staff Spanish Interpreter brings real hands-on experience as he helps clients navigate their language needs. He has been working at LUNA for over two years and continues to bring a great perspective on language access.