Navigating toward understanding
This month, I had the pleasure of speaking with a board member of the Austin Asian Community Health Initiative (AACHI) to learn more about the mission and pain points they experience while trying to create equitable care. The member grew up in a strict Korean home, has non-English speaking parents and is fluent in English and Korean. Her tales of navigating the American healthcare system with both non-bilingual parents and the Asian community she serves were inspiring, educational, and moving.
In 2018, AACHI was born out of the AARC, which was a nonprofit set to provide resources to the Asian American community. Some of the services offered are patient advocacy, health navigation education, insurance/government program application and finally, interpretation/translation support. The organization uses what are called “navigators” to physically provide translation aide for patients accepted into the program. As part of this job, they walk clients from start to finish from scheduling the appointment, filling out paperwork, translating the visit, picking up medicine from pharmacies, and managing post-op care.
I was initially so excited when I heard about this program because, how wonderful is it that they can receive as normal of an experience as humanly possible while not speaking the language. I learned that they had seven “navigators”, one for each language, with some language positions being unfilled. She explained that the largest request they receive, and the biggest need, is hands down for language services. AACHI navigator numbers break down as such:
One Vietnamese navigator for 42 clients
One/Two Korean navigators for 71 clients
One Burmese Navigator for 51 clients
One Nepali Navigator for 50 clients
One Arabic Navigator for 45 clients
When I heard the numbers, I was blown away thinking of all the people it helps. My next thought was - What an amazing service... I wonder how we can enhance it. The reality of this information is that many people still don’t have their translation needs met within the Asian community, and often the solution is to call a family member a state away or use a live-person translation service. One of the largest revelations to come out of this interview was that in the Asian community, trust in people is huge - Trust that the person they are seeing has their best interest at heart. This means that during the use of in-person translation services, many in the Asian community don't feel comfortable because they don’t know the interpreter. In fact, they can shut down and not want to speak freely, sometimes never returning to that service, solution, or environment. She also highlighted the trouble faced by the community when navigating government call lines that require five different numbers punched in order to speak with someone. Yes, there are systems in place to provide aide, but they accomplish nothing when people can’t ask for help.
The reality of translation services was visited when she talked about how they cannot go online to request services as the websites are all written in English. She touched on how app downloads for one of the many middle-of-the-road medical translation apps are not possible because they do not know how to even search for the name or read the descriptions as they are all in English. At the end, I sent her a picture of the translation service pamphlet posted at the front desk of a large hospital in San Antonio. She read the literal translation to be “Is Korean you want? Korean is what you want?”. There was no other context about what this was referring to, just those words. We finished our interview listening to her speak about the prevalence of her community doing the “smile and nod” when a doctor talks, catching what she describes “would be lucky to understand one out of every 15 words”. This community deserves better.
I can’t tell you how much I enjoyed learning about the mission and ethos of AACHI and the community they serve. This interview is one of many discussions I've had in and around at-risk communities where English proficiency can be a barrier to health equity. Whether discussing the Asian, Hispanic or any other immigrant population, the message is loud and clear… we need better translation services and better access to them. What we have isn’t working. How is it that in 2022, we still have a different healthcare system for those who don’t speak English? Equitable care is preached but clearly continues to not be practiced. We should talk.
If you would like to learn more or donate to AACHI, please visit https://aachi.org.