Trinity Student Finds Lack of Interpreters a Health Care Impediment

Ayiti Maharaj-Best’s Senior Project shines light on Major Problem in Hartford

HARTFORD, CT, May 13, 2013 – Community Learning is among the best educational experiences that Trinity can offer in that students work in community settings with public, private or nonprofit partners to find real-life solutions to real-life problems.

To that end, Ayiti-Carmel Maharaj-Best ’13, has done the Greater Hartford region a great service by virtue of her yearlong senior project, “A Study of the Communication Between Nurses and their Spanish-Speaking Patients in Labor & Delivery.”

What Maharaj-Best discovered is that the paucity of interpreters at a hospital in the Hartford area has a detrimental effect on the care provided to Spanish-speaking women who are in the labor and delivery unit, about to have a baby, and in many cases unable to comprehend what the nurses are telling them. 

After spending two to three days a week in the maternity ward of the hospital from February through April (75 hours in total), and after interviewing 17 nurses, a staff interpreter and a high-level administrator, Maharaj-Best reached the following conclusions:

  • A disparity exists in the care of Spanish-speaking patients compared with English-speaking patients;
  • Interpreters serve as surrogates for nurses when communication is restricted because of the language barrier. However, the hospital does not employ full-time interpreters. Other personnel who are fluent in Spanish can become certified and be used on a catch-as-catch-can basis but only if they are available and willing;
  • Insufficient monetary incentives exist for on-site staff interpreters; and
  • Legal and financial pressures severely restrict the effective use of interpreters.

A native of Trinidad, Maharaj-Best will graduate with a self-designed interdisciplinary major, Health and Society, and is headed to medical school in the fall. Her senior thesis was conducted as a Community Learning Research Fellow under the direction of James Trostle, Charles A. Dana Research Professor of Anthropology and Sociology Professor Theresa Morris.

“Ayiti did her project in the best tradition of ethnography, using her prior hospital experience to develop her questions [and] then observing and interviewing to answer them” said Trostle. “She was a joy to advise, both in constructing her independent major and in designing her thesis. I feel lucky to have encountered her combination of intelligence, intellectual maturity, and fearless pursuit of knowledge, combined with a great sense of humor.”

Maharaj-Best set out to determine how nurses in the labor and delivery unit of an urban hospital overcome the English-Spanish language barrier to communicate with limited English proficient patients. She said that she selected a senior project related to a hospital because she has always been interested in health and particularly in women’s health. 

She got the idea for this specific project after taking a course with Morris in which she had to spend 20 hours at the hospital. “I noticed a lot of patients were not English speaking and it struck me that it was an issue that I wanted to learn more about,” said Maharaj-Best. “It’s particularly relevant in Hartford, which has such a large Spanish-speaking population.”

Maharaj-Best said that before she embarked on her project, she needed to get the approval of Trinity and of the hospital’s institutional review board. Both approvals were given, and she also had to obtain the consent of the women whom she observed in the maternity unit.

Although some of the nurses have a limited understanding of Spanish, only one is certified as being fluent. To qualify as an interpreter, a staff member must pass a fluency test. As a result, when the Spanish-speaking nurse is not available, the nurses seek out other hospital employees. However, the financial incentive offered to staff to be interpreters is so small that few are willing to volunteer.

“The amount they get paid is just not enough,” said Maharaj-Best. “It sends a message that the role is not valued.”

Maharaj-Best said there are times when telephone interpreters are used. But most of the nurses said they found that system to be insufficient and largely ineffective because of the lack of social interaction. The result, said Maharaj-Best is that “nurses are not able to care for their patients the way they should and there is a high degree of dissatisfaction.”

At the conclusion of her project, Maharaj-Best presented her findings to about a dozen nurses in the unit. She said the nurses supported her conclusions and “agreed that they were representative of the issues that they face with regard to the use of interpretation services.”

“The experience of caring for limited English proficient patients is often frustrating for labor and delivery nurses,” said Maharaj-Best. “The obstacles to achieving effective communication makes nurses unable to carry out some of the elements of their job [that] they find most important and rewarding."​​