As someone who only speaks Spanish, Arely Andrade knows it can sometimes be hard to communicate in the D.C. region, where English is the dominant language. It’s something she’s learned through her everyday experiences but especially after being diagnosed with stomach cancer roughly nine years ago.

Whether she’s going for a CT scan or scheduled chemotherapy, Andrade says she relies on hospitals to provide medical interpreters through various forms – over the phone, on video, and in-person – in order to understand what care she needs.

But last December, Andrade says she had a medical experience unlike most others due to the language barrier. She went to MedStar Georgetown University Hospital for what she thought was a concerning cyst on her belly. Over the course of her multi-day emergency visit, Andrade says she was mostly left unattended in a hallway, and without access to meals.

“I had been there for three days and they had not given me food,” says Andrade, who is a part-time street vendor and lives in Mt. Pleasant with her 15-year-old daughter.

It later turned out that the hospital had set aside meals for her, says Andrade, but she didn’t know it at the time. According to her, it wasn’t for a lack of trying to ask for them using the English she knows. And she says there was little effort put towards her from staff, most of whom did not speak Spanish, to utilize interpreters.

“Sometimes I would wake up and would want something to eat. And I would say that I need a ‘cookie’. They would say, ‘What is that?’” recalls Andrade. “They didn’t understand what I wanted to tell them.”

MedStar Georgetown told WAMU/DCist in a statement that they offer in-house medical interpretation services (available via video and audio as well). When asked why Andrade would not have been offered interpretation services during her stay, a representative said that because of federal privacy regulations, they “cannot comment on any specific patient or their care.”

The representative also reiterated that “any patient at MedStar Georgetown University Hospital with interpretation needs is always offered interpretive services” through their program.

Andrade remembers her hospital stay vividly – She says she put on her coat and slipped out of MedStar Georgetown to grab a croissant at a nearby Starbucks. Eventually, Andrade told a friend that she thought she was being neglected. She says that her friend proceeded to call Andrade’s cell phone to speak to a physician and lodge a complaint in English on Andrade’s behalf.

Andrade is one of thousands of D.C. area residents who are not proficient in English and struggle to navigate the complex healthcare system alone. Local hospitals, including MedStar Health system, say they employ in-house medical interpreters, although none specified exactly how many they have. Several hospitals also say they contract with companies that offer remote medical interpretation, and so offer 24-hour service in over 200 languages.

But sometimes non-native English speakers fall through the cracks, as was the case with Andrade. Andrade says she’s never experienced anything like her most recent hospital stay, but she’s had previous experiences where she felt like medical workers were laughing at her for being unable to speak English.

“The hospital, the doctors – I think they should know that it’s necessary that every race, every language, needs to have people speaking there whenever a patient arrives,” says Andrade

Inadequate medical translation appears to be a nationwide challenge, but it’s hard to tell how pervasive the problem is, particularly regionally.

The Civil Rights Act of 1964 and subsequent laws require hospitals and other medical facilities that receive federal funding to take reasonable steps and ensure meaningful access to patients, including non-native English speakers, so they can make informed decisions about their health.

Amy Yi, an organizer with the Migrant Solidarity Mutual Aid Network, says hospitals and health centers across D.C. largely fail to provide adequate language access services – at least that has been her experience as she’s supported several dozen migrants who were bused here from the Southern border over the last several months.

“Every person has the right to interpretation. It’s not what happens often,” says Yi.

She says it has been an issue at every step of navigating the health care system, from the moment a patient walks into the facility to ask for assistance – and the receptionist doesn’t speak the person’s language, so the individual confusedly waits – to when a provider sends documents home with the patient – but with medication instructions that are in English.

Yi cites one recent example where a migrant went to the ER but no one there spoke their language. So the migrant calls her, Yi says, and she eventually speaks to the attending nurse by phone. Yi requested an interpreter, but she says the nurse asked her to translate over the phone instead. “‘This is going to be very quick. It’s just triage,’” she recalls the nurse saying.

“Part of it is just issues with inconvenience. The time it takes to do it. Using an interpreter in an appointment takes more time,” says Yi. She also says there are issues of tablets dying or being already in-use, or staff not knowing to request medical interpretation as an option.

While family or friends sometimes serve as the interpreter, it is highly ill-advised. Omissions and inaccuracies are more likely, experts say, putting the patient at risk. Plus, family and friends are biased, due to their dynamic or emotional ties to the patient, which can influence what they translate. Ad hoc interpretation ultimately becomes a liability for the medical facility.

The D.C.-based federally-qualified health center, La Clínica del Pueblo, identified a need among their patients for around-the-clock, in-person medical interpretation. La Clínica del Pueblo offers its licensed medical interpreters to medical facilities that accept Medicaid or Health Care Alliance, and is already partnering with a few local hospitals.

The community health center’s workers will accompany a patient at every step, according to their interpreter team lead, Nicole Sarmiento. She says an interpreter will typically call a patient the day before an appointment to confirm things like the address of the facility and the time they’ll meet there. Interpreters will even offer to wait for a patient outside the facility, she says, and walk in with them if they are unfamiliar with the provider’s office. The interpreter will offer assistance at check-in, during the appointment itself, and afterward when a patient has to traverse insurance claims, follow-up appointments, and pharmacy visits.

“Being an immigrant, interacting with a very intimidating system for the very first time, the interpreter is seen as a relief,” says Rodrigo Stein, the director of health equity at La Clínica Del Pueblo. “We’ve done studies to show that sometimes the interpreter is the key part of the whole health care team.”

La Clínica del Pueblo’s interrupters don’t only translate and clarify what a provider says but also act as a cultural broker and advocate, according to Stein. Sarmiento says this sometimes means arranging a new doctor if the patient is not comfortable with them for whatever reason.

While proud of its 15-year-old medical translation program, La Clínica Del Pueblo has challenges, according to Stein. They only have nine medical interpreters who clock around 6,500 appointments per year.

“Is it enough to have nine interpreters? So, the flat-out answer is no,” says Stein. “We’re losing about $37,000 in what we call ‘unfilled requests’ because we don’t have the capacity to have an interpreter during an appointment.”

Insurance also only pays for the appointment itself, says Stein, but not all the case management that becomes critical to that appointment. This requires the community health center to fundraise a substantial amount to get their program paid for. When a patient experiences insurance interruptions — a common problem with Health Care Alliance, which now requires annual recertification instead of every six months — medical interpreters are unable to offer their services.

Stein says facilities have also become more reliant on remote medical interpretation. “The more these hospitals enter agreements with other interpreting companies that can provide that service, the in-person interpretation, which is a key component, is getting diluted,” says Stein. “Despite our presence being there, sometimes it is diluted or not viewed as essential.”

Sarmiento says she much prefers in-person interpretation. She recalls what happened when she wasn’t able to offer this service to one of her patients, who had cancer. Sarmiento would go to every oncologist appointment with her until the pandemic hit in March 2020. Sarmiento says she then had to stop providing in-person interpretation because of COVID-19 visitor restrictions. While Sarmiento offered some remote interpretation, she was not able to be with her every step of the way. After being discharged from a hospital stay, Sarmiento says the patient did not comprehend the specific instructions they gave her at discharge. Sarmiento says the patient told her information was not translated in a way she could understand.

“She passed away because she didn’t receive the care that she needed,” says Sarmiento. “She wasn’t able to see the specialist that she needed to see. And it was very sad. I mean, it stays with me until today.”