Language Assistance for Migrants in US Healthcare: The Impact of Interpreters in Hospital Outpatient Clinics

This paper explores the role of interpreters in healthcare for migrants in two outpatient clinics at one hospital in Maine, USA. The paper is part of a larger project that contributes to understanding the complex and urgent global health issue of how to care for increasingly diverse and mobile patient populations. The analysis is based on a hospital ethnography. The patients are “New Mainers,” people who migrated to Maine since the mid-1970s from East and Southeast Asia, Latin America, Sub-Saharan Africa, and the Middle East. I observed interactions between clinicians (physicians, nurses, and physical therapists) and adult patients. Most clinicians were white and English speaking. Three quarters of the interactions were interpreted in-person or remotely (by telephone interpreters). In the US, federal civil rights law and regulations require recipients of federal aid, including hospitals, to provide language access for people who do not speak, read, write, or understand English at all or very well. How does adding an interpreter change the clinician-patient dynamic, introduce further complexity to scheduling, and situate participants in treatment rooms that were not originally designed or configured for this triad? In addition to adding a third person, how do structural factors shape healthcare for New Mainers, such as immigration patterns, national and international politics, health care policy, and the organization of work as well as participants’ racial, ethnic, and immigration histories? The paper introduces the concept of “interpreting assemblage” – a configuration, ensemble, or arrangement of heterogeneous elements that work together for a period of time and then disperse – to describe and explain the dynamics of interpreting in clinical environments that are fluctuating and highly diverse, with patients drawn from communities characterized by a complex interaction among race, ethnicity, immigration, culture, and geographical mobility.