Interpretation of the law has evolved to include the provision of language assistance to LEP (limited English proficient) persons. The federal Office of Civil Rights' Web site, in fact, states:

 

"In the health and human service context, a recipient's failure to provide appropriate language assistance to LEP individuals…may have an adverse effect on the basis of national origin, in violation of Title VI."

 

The responsibility for fulfilling Title VI's promise at UW Hospital and Clinics falls to the Interpreter Services department. It's a group of seven full-time interpreters headed by manager of cross-cultural care Shiva Bidar-Sielaff (pictured).

 

Bidar-Sielaff, who speaks four languages, says the federal requirement is not the only reason UW Hospital and Clinics makes available language assistance.

 

"The reason we do it is because it's the right thing to do," she says.

 

Interpreter Services staff serve not only the hospital but also all 52 UW Health clinical locations. Sixty percent of the language requests are for Spanish but on average interpreters translate 30 or so different languages every month.

 

And if one of those requests falls outside of the 31 languages spoken by the full-time interpreters, Bidar-Sielaff turns to a stable of 120 contract interpreters. When a face-to-face interpreter is not available, over-the-phone interpreter services through Language Line Services or Pacific Interpreters are summoned. Factoring in the over-the-phone services, Interpreter Services can translate 140 languages.

 

"We're very collaborative," says Megan Wagner, who started as a contract interpreter before she was hired full-time last year. "We all have talents and we're good at finding each other's strengths and plugging them into certain situations."

 

The group's goal is to make patients aware of interpreter availability at every point in their health care experience, be it in a patient's room, during registration or when they are calling for test results. And over the past few years the number of patient education documents, including clinic maps, patient rights and responsibilities and "Health Facts for You," translated into Spanish has increased markedly.

 

Cross-cultural care, however, encompasses more than just language.

 

"Regardless of language, patients have different expectations because of their culture and religion, their backgrounds," says Bidar-Sielaff. "It's become part of our way of operating to make sure we are respectful of our patients' culture and belief systems."

 

She uses the concept of family as an example. For most people reared in the United States the definition is fairly restrictive - mother, father and siblings. But for others the meaning of family might be more expansive and include grandparents, cousins, aunts and uncles, even close family friends.

 

"We try to understand that (members of the extended family for one patient) are as important as the four people (for another patient), and we try to be respectful of that," says Bidar-Sielaff.

 

"I try to put myself in the patient's position and understand where they're coming from," says Wagner. "There is an anxiety (for people in hospital settings). When you're able to bridge (communication and cultural issues), it makes it so much easier for everybody."

 

Reliable communication. It's not something Bidar-Sielaff takes for granted. She was born in Iran but her family moved to Spain when she was young, and she hasn't forgotten the difficulties inherent in encountering an unfamiliar language.

 

"You realize how important it is to communicate with people," she says. "It makes a huge difference and it's a basic part of what we all want to do every day, especially when you're dealing with health care."