Gloria Estela Ortiz Ramos doesn't speak English, so when she became ill in 2006 and needed medical care, she had to rely on her ten-year-old son for help. He translated a list of medication prescribed to her from the Eastmont Wellness Center, an East Oakland clinic that serves low-income people. But the El Salvadoran immigrant said she expressed concerns to her medical provider, because her son had just started to learn English himself.
"There was a video interpreter present when I requested the instructions in Spanish, but it didn't really change the interaction — the doctor would still say, 'We don't have these in your language,'" Ramos told me through Jose Uribe, who works for Interpreting for California, a nonprofit dedicated to improving communication between medical providers and patients. Medical providers in California, like the one at Eastmont Wellness Center, often provide interpretation services via video-conferencing or phone — or sometimes not at all — a practice that can heighten the risk of miscommunication.
Ramos decided to leave Eastmont for La Clinica de la Raza, a medical clinic in the Fruitvale district, where her current doctor is fluent in Spanish and her medication labels are translated, too. But she said she still suffers from problems associated with being over-medicated for too long, including chronic pain, poor circulation, severe headaches, and muscular degeneration — symptoms she never experienced before the start of her care. "I've been on varying doses of pain medications for months," Ramos said. "My condition has worsened since taking these medications at the start of my treatment."
Under Title VI of the federal Civil Rights Act, patients like Ramos who are not fluent in English are supposed to have access to qualified interpreters. And in a diverse state like California, the number of non-English speakers is substantial. According to US Census data from 2010, nearly 20 percent of California residents over the age of five reported that they speak English "less than very well." In addition, about 281,000 low-income patients in the state's Medi-Cal program said they had difficulty understanding their medical practioners, while 135,000 parents of children in the program reported having the same problem, according to state officials. Yet in California, the medical interpreting system is disorganized and mismanaged, forcing many patients to rely on friends and family to translate when they require medical attention, thereby increasing the chances for misdiagnosis, injury, and unequal standards of care.
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