Of the nearly 2.81 million people living in the St. Louis metropolitan area in 2019-2021, an estimated 140,000 came from a different country to make St. Louis home. Their nations of origin are spread across the globe: North and South America, the Caribbean, Africa, Asia’s five regions, and Europe (east, west, south and central). The greatest number of foreign-born St. Louisans are from India, Mexico, China, Bosnia and Herzegovina, Vietnam, the Philippines, South Korea, Germany, the United Kingdom and Canada.

The first languages of many of these individuals are myriad. Upon arrival, many don’t speak fluent English, if any at all. Their cultures and backgrounds vary widely. What they have in common, however, is their need for health care.

BJC HealthCare’s Language Services, a department within the BJC Office of Diversity, Equity and Inclusion, provides free, 24/7 access to interpreters for patients and their family members who need help with spoken language or with sign-language communication. In the interview that follows, you’ll meet the service’s director, Christopher Fan, MSW, MPH, MBA, who leads a core staff of interpreters that services the Washington University Medical Campus and Barnes-Jewish Hospital. You’ll also meet Pilar Kellogg, MAIA, and Brandi Evans, BS/ASLEI, NIC, BEI Master, two interpreters who specialize in, respectively, Spanish and American Sign Language, or ASL. I spoke with them recently about the ways interpreter services can bridge communication and cultural gaps that may prevent immigrants, refugees, the deaf/hard-of hearing community and blind individuals from accessing essential medical services.

Q: Christopher, can you provide some background on BJC Language Services?

A: During the 1960s and ’70s, St . Louis experienced a first wave of immigrants and refugees from Eastern Europe, predominantly people from what was then the Soviet Union. When these immigrants required health services, it became clear that the language gap between them and their health-care providers was a critical barrier to good outcomes. That’s when Interpreter Services’ precursor, Refugee and Immigrant Services, was established at Barnes-Jewish Hospital.

Q: How has the service changed over time? The federal government views St. Louis as a desirable location for refugees, and political leaders in both city and county governments are supportive of this assessment because diversity brings energy to the cultural and economic growth of the region.

A: Examples of that benefit include the revitalization of the Bevo Mill area by Bosnian immigrants and the Hispanic business district that has flourished along Cherokee Street in south St. Louis.

In 2006, the original service became Language Services, offering expanded capabilities. Now a part of BJC HealthCare, a nonprofit health-care organization to which Barnes-Jewish Hospital belongs, Language Services has 25 full-time, medically qualified and certified interpreters specializing in languages as diverse as Arabic, Farsi, Spanish, Vietnamese, Swahili, Bosnian and ASL. Since it’s not possible to have staff members who can interpret for every language possibility, we also contract with interpreter agencies across the St. Louis region. These relationships add 300 to 500 additional interpreters and many more languages to our in-person interpreter capabilities.

In addition, we contract with virtual interpreter agencies that provide services over the phone or video. On any given day, we can support approximately 300 different languages and dialects.

Q: How does the service work?

A: First and foremost, we offer language support that is free to all patients and their family members. When a patient’s preferred language is identified as other than spoken English, we receive a call or email from a clinician or other team member with a request for an interpreter. If we don’t have an interpreter on staff for the requested language, we contact the appropriate agency. If someone needs interpreter services at a location other than the medical center, designated staff make arrangements with an interpreter agency.

Q: Beyond interpretation, what does the service offer?

A: We also work to address the differences in customs and cultures. For instance, in many Arabic-speaking Muslim communities the word “cancer” is taboo and should be interpreted as “tumor” or “growth.” And in some cultures, removing shoes before entering an exam room is considered good manners. When we share these kinds of insights into cultural differences with physicians, nurses and other caregivers, we’re helping to ensure patients are comfortable when receiving care.

To aid us in this endeavor, we have completed a pilot program in which we developed formal educational resources focusing on the top 10 language/cultural groups seen in Barnes-Jewish Hospital outpatient clinics. We also covered cultural expectations, the historical traumas some communities have experienced, dietary preferences and differences between the U.S. health system and the country of origin. The resources we developed are proving to be exceptionally useful tools for nurse educators during training sessions.

Q: Christopher, as the director of Interpreter Services, what qualifications do you look for in a good interpreter? And Brandi and Pilar, as experienced interpreters, what are the important qualities that help you do your jobs?

A: Christopher: We look for individuals who are passionate about people. We want interpreters who believe in BJC HealthCare’s aim to improve the health and well-being of the community and who will embrace our values of safety, courtesy, expertise and efficiency.

We also look for experienced medical interpreters who have undergone 40 hours of sanctioned training and have passed an assessment of their linguistic skills. That assessment measures the ability to interpret from English to another language and from another language into English on the spot, in real time.

Pilar: I think there are two essential qualities. The first is effective listening using in-depth knowledge of the language and culture. This is important in transmitting the message accurately, acting mainly as a conduit but, when necessary, as a clarifier. Active listening also includes paying attention to cues like tone, inflection and volume of the message from both the provider and the patient, because there is significance in how ideas are expressed.

The second quality is trust. An interpreter has to trust that the patient will receive exceptional care from every team member, starting at the front desk and moving on to the physicians, nurses, medical assistants, financial counselors and social workers.

Brandi: In ASL, as with any language, there are not always direct translations of words and phrases. An ASL interpreter needs to have an excellent grasp of the English language. Otherwise, it’s impossible to interpret information accurately into the target language.

Patience is another important quality. A good interpreter should take the time required to accurately communicate a deaf person’s concerns to hearing doctors and nurses, and then use the best ASL interpretation to accurately convey the medical professionals’ responses.

Q: Can each of you give me an example of an incident that brought home to you the importance of what you do?

A: Christopher: As a second-generation Taiwanese American, I grew up watching my highly educated parents, as well as friends and colleagues, try to navigate the American health-care system. I completed master’s degrees in social work and public health so that I could focus my career on reducing health disparities. Language interpretation is vital to reaching that goal.

Brandi: For a number of years, I’ve worked with a deaf person who initially had limited sign vocabulary and whose family didn’t use ASL. I needed to meet this person where he was, letting go of any expectation that he had the same language usage I and his providers have. But over time and working with an ASL colleague, I’ve helped this person understand enough about sign language that he can tell us when he is hurting or how he is feeling. He couldn’t have done that 10 years ago.

Pilar: My father died of cancer, and I was diagnosed with breast cancer in 2013. Through these experiences I have a deeper understanding of and compassion for people with cancer who need my services. I’ve been present when patients ring the bell upon completing their last cancer treatment, which is a special privilege because I’ve been part of their journey. At those moments, I know patients have received the care they deserve and achieved their best outcomes. They are ringing the bell of victory.