Translating COVID-19: The Importance of Bilingual Treatment
By Joseph Gaccione
Accurate communication is understandably critical for medical treatment, particularly COVID-19, which could easily be misdiagnosed as another ailment, like a cold or the flu. It can become more difficult for a patient speaking a different language if the healthcare provider isn’t properly trained or doesn’t have the adequate resources to interpret what’s wrong.
Faculty at the Clinical Simulation Center of Las Vegas (CSCLV) are currently translating two different COVID-19 cases, not only to promote bilingual diagnoses, but also bring more awareness to cultural sensitivity. The first case is for undergraduate medical students. The second is intended for interprofessional education among medical residents and nurse practitioners.
The Clinical Simulation Center is located at UNLV’s Shadow Lane Campus. The 31,000 square-foot facility emphasizes hands-on education for nursing and medical students. Faculty employ low and high-fidelity manikins, standardized patient interactions, simulations, and surgical labs to give students a practical and realistic training.
At the center of these translations are Gigi Guizado de Nathan, the Standardized Patient Coordinator at CSCLV and Brenda Lopez, a simulation technician at CSCLV. Guizado de Nathan oversees any simulations that involve human patients. Lopez runs the Objective Structured Clinical Examinations, which are critical evaluations that assess a health care student’s knowledge and skills in a clinical setting - students examine and treat Standardized Patients (SP) with a specific medical issue.
I recently sat down with both on several topics related to this COVID-19 translation project as it enters the final stage. We discussed how it originated, the challenges with bilingual medical translations here in Las Vegas, and how to retain cultural understanding among different groups.
A Background in Translation
Teaching students in bilingual communication is nothing new for Guizado de Nathan. She started as an SP at Stanford University. She was brought in to do a simulation teaching medical students how to work with interpreters due to her bilingual skill – the cases were written in English and they had to come up with their own translations. From here, Guizado de Nathan focused her career path as an SP Trainer, ultimately leading her to Las Vegas, where she founded the SP Program at the CSCLV. She says once she was asked to provide SPs for a student session on working with an interpreter, she started translating these cases into Spanish. “It was because I could recall the challenges of having to translate medical jargon on the spot and navigate differences in dialect with the other SPs I was paired with. I wanted to pave the way for the SPs in my program.”
Guizado de Nathan says around the same time, Lopez showed interest and initiative to become more involved in SP training, so she involved her in these translations as well. Lopez’s career started in medical assisting, but she worked her way into nursing simulation.
COVID-19 Project Origins
This project relating to COVID-19 came about when UNLV transitioned to remote education. Guizado de Nathan reviewed the available resources through UNLV School of Nursing and the CSCLV. She noticed nearly all the information and resources were in English and assumed the patient would be fluent in English.
Guizado de Nathan: “That's not unreasonable at a university where instruction takes place in English, in a country where English is the official language. However, UNLV is one of the most diverse universities in the nation, Las Vegas' population is one third Hispanic, and 20% of Las Vegas' annual 42,116,800 visitors are international. This led me to think about COVID-19 triage and imagine what would happen when a person, who's primary language is other than English, comes down with symptoms and needs medical attention.”
Guizado de Nathan then started working with Lopez to combine this scenario with SP-based education they previously provided in person, on how to conduct a medical interview with the use of an interpreter. They translate the patient’s symptoms, what the patient says, for the SP to say in Spanish, and what the doctor says, so the interpreter can translate that back in Spanish to the patients.
Lopez says one of the challenges of translating a medical case to Spanish here in Las Vegas is finding the words that people understand, but not just the technical terminology. “I could translate it to medical terms easily in Spanish, but everyday folk, they’re not used to that. They don’t know what certain words mean in Spanish, even though they speak Spanish a little differently.”
In addition to varieties in slang, Lopez says the Spanish dialect may depend on where you are from. “You live here now, but you came from Mexico City versus coming from a different state in Mexico. Or you come from Central America or any type of Latino heritage. Everyone has their own slang, and that’s what makes it kind of difficult to break down in Spanish to what our city uses.”
Afraid to Speak Up
Another potential roadblock to treating bilingual cases that ties into translation is fear of going to the doctor. Lopez says she’s noticed in our local Hispanic population, many are afraid to come forward and ask questions. She says some of that comes from pride within the Mexican culture and a preference to home remedies, but there is also a concern of asking for help. “I feel like they’re afraid they are not going to have a translator, someone to understand what they’re saying.”
Lopez added that even though Las Vegas has a strong, multi-cultural population, our community is so big, there are not many Spanish-speaking doctors available, and when there are, the wait times are too long. Lopez said as a medical assistant, many Hispanics would admit to her they were afraid to go to the doctor.
One of Guizado de Nathan’s goals as a Standardized Patient Coordinator is promoting cultural sensitivity in her teaching. “I always strive to provide Standardized Patients who are representative of the racially and culturally diverse community we live in, so that when learners transition into actual patient care, the diversity is nothing new and potential biases have already come to light. The SPs themselves do some implicit bias awareness training as well.”
Guizado de Nathan also found she can make a difference just by asking questions. She cited an example of receiving demographic information on cases, and the default was the patient was Caucasian. “I asked the faculty who provided me with the case, or the case author, ‘Is there a reason why this person with abdominal pain couldn't be Asian? Black? Hispanic?’ The answer was consistently, ‘No.’ So I changed ‘Race: Caucasian’ to ‘Race: Any’ and hired the SPs based on their skills instead of their skin color. It is a simple question to ask, and a simple edit to make. I've never regretted it.”
Guizado de Nathan says she hopes to pilot these cases in different settings in the future, in order to try it out realistically and alter based on feedback from students and colleagues. “Imagine a theatre company taking a brand-new script, an untested play that the ink is has barely dried on, and without any rehearsal performing it live onstage in front of a paying audience. The rehearsal process exists for a reason.”
Regarding COVID-19, both Guizado de Nathan and Lopez agree the pandemic will change our culture, both in and out of the classroom. Guizado de Nathan: “I see infusing the curriculum with coronavirus simulation scenarios and more simulation taking place online with telemedicine encounters for example, being near future impacts. In the long term, I suspect many of the things we're trying online for the first time will become permanent as we discover which ones are more efficient, less costly, and more productive.”
Lopez: “There’s been a change in the way we do things, not just in the medical community. Now people are realizing ‘Wow, you’re right. That refrigerator at the grocery store I opened does have a lot of germs on that handle.”
Guizado de Nathan says she feels like translating these cases is the first step toward being more prepared for the next major outbreak. “Between the threat of resurgence and the trend of schools allowing medical students to graduate early to become front-line providers, my goal is to help prepare our students to care for everyone, regardless of nationality, without seeing language as a ‘barrier’".
For more information on the Clinical Simulation Center of Las Vegas: https://www.unlv.edu/nursing/facilities/simulation-center