In the San Gabriel Valley, language barriers to healthcare still steep for many Asian Americans

USC Arcadia Hospital staff, Leticia Brizuela-Rodriguez, Volunteer Services and Mimi His, Patient Relations Rep display translation devices used to bridge communication barriers with their patients on Thursday, September 22, 2022. (Photo by Dean Musgrove, Los Angeles daily News/SCNG)

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Linda Chang is determined to break through barriers – language barriers to healthcare, in particular.

Growing up in the San Gabriel Valley, Chang, whose family speaks Cantonese, saw first-hand the impact of linguistic barriers on her family’s care – often resulting in a hesitance to get help only at the last minute.

To this day, members in her family often don’t go to the doctor’s office until something needs to get checked out. They often minimize symptoms until they worsen, and even then they wait until someone — Chang or one of her siblings — who speaks English can go with them.

For Chang – who has decided to become a doctor– the health literacy struggles and the language barriers her family faces, makes her want to become a provider who can better understand medicine, and better communicate it.

“That’s one of the reasons why I am pursuing medicine,” she said. “To learn it and to understand. To see how I can explain it better to my family.”

The San Gabriel Valley is home to more than half a million Asian Americans, one of the country’s fastest growing racial and ethnic groups. But the region’s healthcare delivery is experiencing the fallout of a system struggling to provide sufficient language resources for the almost half of the Asian American population in the Valley who speak limited English.

Filling the gap

Several services throughout the San Gabriel Valley have been working to address this gap and need for cultural and linguistic competency.

The Herald Christian Health Center is one of them.

Carolin Eng, CEO of the Herald Christian Health Center, started the center in 2007 to provide quality and affordable health care to underserved populations, especially to new immigrants who are monolingual.

By hiring staff that are bilingual and staff that understand the culture from which the patients are coming from – some by also being from that same country – it helps the center provide linguistically and culturally competent care for their patients, Eng said.

The center has earned the trust of patients who have faced language barriers to healthcare.

Enter Mr. Liang.

Liang, who asked that his first name not be used for privacy concerns, uses Herald Christian Health Center for multiple services, such as dental and assistance in applying for state services. He feels more relief being a client at HCHC, and trusts them to help him, he said.

He added that when he first came to the U.S., the only place he could go to for assistance was nonprofits like the Herald Christian Health Center, where people spoke the same language.

Before he could find a healthcare provider that could communicate with him in his language adequately, he felt that the service he was receiving at another clinic wasn’t thorough enough.

Even though some of the staff at the health center spoke the same language as him, they weren’t ready to accommodate the questions he had, and he didn’t receive any detailed answers to his questions.

“The lack of access to language support has really limited healthcare options,” said Mairelise Robinson, program manager for Asian Americans Advancing Justice Southern California’s Health Access Project.

Liang’s situation is similar to many people living in the San Gabriel Valley who don’t speak English or have a limited English proficiency.

When Chang’s aunt went to get surgery to remove a tumor from her breast, she didn’t know which side she was supposed to get the surgery on.

The Chinatown Service Center in Alhambra on Thursday, August 18, 2022. (Photo by Dean Musgrove, Los Angeles Daily News/SCNG)The Chinatown Service Center in Alhambra on Thursday, August 18, 2022. (Photo by Dean Musgrove, Los Angeles Daily News/SCNG)

Chang added that sometimes with language barriers and patients’ lack of health literacy, healthcare teams don’t know how to explain health situations in a way that allows them to truly understand what is happening.

For instance, when the physicians wanted to do a MRI scan on her grandmother, the medical professionals explained it in a way that her uncle didn’t understand how the process was actually going to work. They explained that the scan would be opening her skull, which made him resistant to allowing the physicians to go through with it, Chang said.

However, not everyone has access to health centers that specialize in providing language resources when getting care or family members to assist them, and turn to clinics and centers where they live to get their needed care.

According to state law, all hospitals and health plans are required to provide a medical interpreter when the patient asks for one.

Not everyone is aware of these services though, which affects whether people decide to seek out care or not, said Mireya Muñoz, program director for Pacific Asian Language Services for Health, which works toward and provides interpretation and translation services for those who are limited English proficient in Southern California.

The Herald Christian Health Center in El Monte on Thursday, August 18, 2022. (Photo by Dean Musgrove, Los Angeles Daily News/SCNG)

The Herald Christian Health Center in El Monte on Thursday, August 18, 2022. (Photo by Dean Musgrove, Los Angeles Daily News/SCNG)

People avoid getting healthcare services because they can’t communicate with their providers, added Mairelise Robinson, program manager for Asian Americans Advancing Justice Southern California’s Health Access Project.

“The lack of access to language support has really limited healthcare options,” she said.

Karthick Ramakrishnan, a professor of public policy at UC Riverside, said groups such as Chinese Americans, Korean Americans and Vietnamese Americans are less likely to get a health care appointment in a timely manner because of the lack of language access.

“Asian Americans and Pacific Islanders are among the fastest growing racial groups in the state, including in regions of Southern California, but the services have not caught up with the need,” he said.

Additionally, being bilingual is not always sufficient enough to be a medical translator.

There are many complex medical scenarios and terms that have to be conveyed correctly, since a lot of things can go wrong if the person doesn’t know how to translate the information accurately between the patient and provider, Muñoz said. Thus, bilingual staff need to have the language capacity in order to be qualified as medical interpreters, she added.

Another reason for the gap may be due to centers not having enough staff who are able to meet the cultural and language competency needs of their patients, Ramakrishnan said.

In 2020, 32% of active physicians in California were Asian/Pacific Islander, according to the California Health Care Foundation.

USC Arcadia Hospital staff, Leticia Brizuela-Rodriguez, Volunteer Services and Mimi His, Patient Relations Rep display translation devices used to bridge communication barriers with their patients on Thursday, September 22, 2022. (Photo by Dean Musgrove, Los Angeles daily News/SCNG)

USC Arcadia Hospital staff, Leticia Brizuela-Rodriguez, Volunteer Services and Mimi His, Patient Relations Rep display translation devices used to bridge communication barriers with their patients on Thursday, September 22, 2022. (Photo by Dean Musgrove, Los Angeles daily News/SCNG)

Nationwide, there is also a shortage of certified medical interpreters, where in 2015, California had only 738 people certified as medical interpreters, according to the AMA Journal of Ethics.

Besides the struggle of translating information between provider and patient, documents and applications are not always translated.

Some government websites use Google Translate to help with translation, however it’s not always accurate, said Li Xu, program coordinator for Asian Americans Advancing Justice Southern California’s Health Access Project.

“Asian Americans and Pacific Islanders are among the fastest growing racial groups in the state, including in regions of Southern California, but the services have not caught up with the need,” said Karthick Ramakrishnan, a professor of public policy at UC Riverside.

In addition, documents are not always translated to many Asian languages, such as the application for Covered California, which often leaves people calling the Asian Americans Advancing Justice Southern California Language Hotline to get help to fill out the documents, Xu said.

AJSOCAL has a hotline where they provide translations – for multiple Asian languages including Chinese, Vietnamese, Korean, Thai, Tagalog, Hindi and other languages – for people who need it.

They have been working to address some of these gaps by going through the government websites and flagging things that Google Translate mistranslated and also by working on creating documents to help explain the terminology used in the healthcare system so that those who are not used to the American healthcare system are able to understand it and the terms used, she added.

Culturally competent care

The issue of language access also conveys to members of the AAPI community seeking out behavioral and mental health services.

The AAPI community tends to seek out behavioral health services the least, said Marielle Reataza, executive director of National Asian Pacific American Families Against Substance Abuse.

Compared to other racial groups, Asian Americans are 50% less likely to seek out mental health services, according to a 2021 article by UCLA Health.

This low number in seeking out care is due to language being a barrier, as well as there being a cultural stigma around using such services, Reataza said.

The increase in racial and ethnic discrimination towards the AAPI communitiy during the COVID-19 pandemic is also linked to higher rates of emotional harm, stress, depression, anxiety and other mental health impacts, according to a 2021 report from Stop AAPI Hate.

Almost 75% of the adults in the San Gabriel Valley are born outside the United States, so when language becomes a barrier for them and for people wanting care, they won’t seek those services out, she added.

Also, culturally, Asian Americans don’t want to speak about their mental health struggles because they don’t want to stick out, especially since many eastern societies favor a collectivist society, Reataza said.

Culture als plays a role through the wording and ways western societies discuss behavior and mental health. Sometimes western behavioral models talk about these types of health in a way that is not identified in many eastern countries’ languages or culture. That can make it hard for people to understand the struggles they are facing, Reataza said.

Eng added that from the work she does, people don’t want to talk about their mental health problems and they don’t want to tell other people about it, which limits how many people reach out for care.

At Herald Christian Health Center, they have been working to help clients realize the signs of mental health problems, if they may have a mental health condition and that it’s okay to reach out for help.

Parsing out the data

The way data has been collected for the Asian American Native Hawaiian and Pacific Islander communities also affects services.

Oftentimes, the AANHPI are grouped under the same label. There are more than 50 different ethnic groups that fall under the label.

However, the Asian American Native Hawaiian and Pacific Islander community is such a large and diverse group, so the one label makes it harder to get precise data and specialized services, Reataza said.

“Our communities have really largely been ignored or misunderstood, and a lot of that is this belief of the model minority,” Reataza said. “Just because we don’t show up in the numbers or we don’t speak up that doesn’t mean that there’s not a problem. The issue is that we haven’t developed really good techniques historically to collect the data.”

Data disaggregation is important to truly understand the needs of the many communities under the umbrella term: AAPI, said Riti Shimkhada, a senior research scientist at the UCLA Center for Health Policy Research.

“You can take that information and start to drive community action or interventions to address those very specific needs,” she said.

It allows specialists to come up with solutions, so that issues – such as lack of language access support – are solved.

Looking to the future

Other work is being done to help ensure a more equitable healthcare system for those with limited English proficiency.

At PALS for Health, Muñoz said the organization has been working to provide greater access, by providing training and education for people looking to become medical interpreters and translators, and helping patients understand their right to having an interpreter.

USC Arcadia Hospital is also using interpretation devices to serve clients and patients who don’t speak English, said Darlene Burge, director of service excellence at the hospital.

A device – which interprets more than 230 languages – is used to explain anything that is clinical and that deals with how someone should take care of themselves, such as explaining the type of care and explaining disease processes, she added.

“In order to really be able to give equity of care and equality of care, we have to be able to communicate in a language that is meaningful to the patient,” Burge said.

One of the IRIS translation devices used to bridge communication barriers with their patients at USC Arcadia Hospital on Thursday, September 22, 2022. (Photo by Dean Musgrove, Los Angeles daily News/SCNG)One of the IRIS translation devices used to bridge communication barriers with their patients at USC Arcadia Hospital on Thursday, September 22, 2022. (Photo by Dean Musgrove, Los Angeles daily News/SCNG)

Inspired to break through

Chang said her experience, where she and her family didn’t know how to navigate mental health conversations with one of her family members who experienced depression, has inspired her to encourage her to break mental health taboos when she becomes a physician.

“It makes me want to be the physician that’s going to be super direct and just super honest, versus like dancing around and trying to sugarcoat things or not even say things because it’s stigmatized or it’s taboo to ask,” she said.

Even though there are some services and resources being used to help the Asian American, Pacific Islander and Native Hawaiian community with their physical and mental health needs, gaps still remain.

Chang added that when trying to get mental health care services for herself and her family, it wasn’t possible because there weren’t enough services that had a therapist who could speak the right language. There was often a waitlist to receive those services as well, she said.

Ramakrishnan said it’s important to pay attention to fast growing communities – like the Asian American and Pacific Islander population – to figure out better ways to serve them.

“If our government agencies are not able to serve them, especially as these communities are feeling under threat and under attack, that’ll be harmful,” he said. “Not only for the Asian American and Pacific Islander communities in California, but also for California more generally.”

Saumya Gupta interned for the Southern California News Group in the summer of 2022, reporting on San Gabriel Valley news for the Pasadena Star-News, the San Gabriel Valley Tribune and the Whittier Daily News. A recent graduate of UCLA and staffer at the Daily Bruin, she is pursuing graduate studies in journalism at UC Berkeley.

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