Han Moe, a refugee from Burma, has been in the United States for 15 years. He’s fluent in English, so he accompanied a neighbor, also a refugee, to a local hospital, where he tried to explain to staff the medical and language situation.
The staff told Moe they didn’t need him.
“They said they had their own system,” Moe said.
But that didn’t last too long.
“Two hours later they come back out,” Moe said. “‘Can you help us, Mr. Moe?’ They think everyone from Burma speaks Burmese.”
The hospital had run into a problem many others now face as more immigrants settle in the Buffalo area: not knowing what language to try to interpret.
Refugees from Burma, for example, speak Burmese and several dialects of Karen. No one on the hospital’s telephone interpreter system could figure out which one Moe’s neighbor spoke.
A new wave of immigrants has arrived in Buffalo over the past 15 years, and now 7 percent of the city’s population consists of resettled refugees from places like Iraq, Bhutan, Burma, Somalia and Sudan.
More than 60 languages are spoken in homes that send their kids to Buffalo Public Schools.
It’s no surprise, then, that as refugees and locals try to adjust to the new demographics, they run smack into the same obstacle confronting Moe’s neighbor: the language barrier.
Social workers, police, government leaders and refugees agree that, of all the challenges of assimilation, language is the most difficult.
Moe, who has served in the U.S. Naval Reserve, works as a medical assistant and interpreter at Jericho Road Community Health Center. Even so, he said at a recent conference on refugee health, it can be hard to communicate with some medical professionals.
Beyond language, there also is the basic problem of adjustment to the American way of life, from public school schedules and weekly trash collection to how the smoke detector works and what it means to have a paycheck direct-deposited.
“Most new arrivals, we need to teach them how to survive here,” Moe said. “You have to educate them about how to live in Western New York, how to clean, how to cook.”
Hard to find words
The language barrier is not insurmountable, and it is being tackled on many fronts.
But those like Mandari Magar, who do not speak English well, rarely venture out by themselves.
Magar keeps her West Side home neat and clean for her large family. It is where she spends most of her time when her children and their spouses go to work.
The family has been in Buffalo for about a year, after spending nearly 20 years in a Bhutanese refugee camp in Nepal. Magar can understand some English when she hears it, but she says it is hard to find the words to respond. She waits until her daughter or daughter-in-law can go with her if she wants to shop.
“When somebody from the family goes, it is easier. But by myself, it is hard,” she said through an interpreter.
She also attends the Nepali church regularly, which she likes.
“Everybody speaks Nepali,” she said.
Outside her church, efforts are being made to make Buffalo an easier and more welcoming place to live for immigrants.
Mayor Byron W. Brown created an Office for New Americans. Its director started work April 1. County Executive Mark Poloncarz is forming a New Americans Advisory Committee and also is supporting an initiative to hire more county workers fluent in immigrant languages to better serve the community and to save money on interpreters.
Courts and other public services are required by law to provide language access to people of limited English proficiency. The police, who find themselves on the frontlines of the communication struggle, give lessons at cultural centers on how to call 911. Health care providers have interpreters available through telephone or video conference.
Getting the dialogue going is the first step, Moe said. Understanding what is going on can be equally difficult. Communicating takes a lot more than “this-word-for-that-word” if it is to be done effectively.
“(The refugees) don’t like answering questions, and they don’t always want to talk about the past with so many people in the room,” Moe said.
Moe has seen first-hand the trauma suffered by those who fled the Burmese civil war.
“They can’t describe what they’ve been through,” he said. “Some have had their whole village burned. Some have lost their whole family. They are fragile.”
Moe participated in a University at Buffalo-sponsored WNY Refugee Health Summit last month. The event’s goal was to work toward “culturally engaged health care,” which means taking the time to find out more about the patient than “where does it hurt?”
“Please spend a little more time on the initial visits. I know you only have 15 minutes,” Moe told attendees.
“When you ask, ‘You have any questions?,’ they will always say ‘No,’” Moe said.
That “no” is automatic for Karen refugees from Burma, who are culturally expected to consider others above themselves and consider talking about personal problems to be impolite. The reluctance is compounded by the pain and shame of sexual assault, torture or imprisonment and an unfounded fear that revealing any illness might result in deportation.
Tasked with finances
Govinda Subedi, who learned English while growing up in a Bhutanese refugee camp in Nepal, works for Jericho Road as a community health worker and interpreter. He makes home visits to help new arrivals get resettled.
Subedi said he explains a lot of “why” along with the what, where and how of daily life. Much of what Americans consider routine is brand new to families from refugee camps, where thatch houses had dirt floors, water was carried in and food rations were handed over as needed. He’ll warn families with young children about lead paint dangers and show them how to store food and use trash containers for rodent and pest control.
“People here say, ‘I have a sofa, chairs, tables,’” Subedi said.
Then he makes a sweeping gesture – “Nice walls. How could anything be a health hazard in such a house?”
He added, “They get mice and rats, cockroaches, because they never had to store food before. They never have a sink, they never have a refrigerator. Before, think about vegetables: You go to the market, you buy it, you eat it tonight, maybe tomorrow. That’s it. Now people go to the grocery and get so much food, but aren’t used to how to keep it put away.”
The hardest topic to interpret for his Bhutanese clients involves money, Subedi said.
“Finances,” he said. “Paying bills. They don’t understand it. They never ‘paid bills’ before.”
They don’t know how to pay bills because, until coming to Buffalo, they never had bills. There were no banks, checking accounts or credit cards in the refugee camps, and even when living free in Bhutan, Subedi said, most people did business face to face with money.
Putting one’s money in a bank, and spending it by writing checks or swiping plastic cards requires more trust than many displaced people have developed.
“They are comfortable using cash,” Subedi said. “That’s what they know.”
The role of children
Children are known to learn a new language faster than adults, and it is the same in the refugee community. They spend their days in school, immersed in English, and most pick up at least conversational English within a year or two. If they become the main interpreters for the family, however, it can disrupt the dynamics between parents and children.
“It gives the kids too much power,” said Mary Prentice, Holistic Homes Program coordinator at Jericho Road.
“Parents can’t help with homework because they need the kids to translate, and all of this upsets the family balance,” Prentice said. “The (school) letters come home in English. (Parents) don’t know what they say. Then the kids translate, and they say whatever they want. There’s a big disconnect between what parents are hearing and what kids are doing.”
Subedi, who works with Prentice, said parents bring him school messages that their children have thrown out.
“The parents take papers out of the trash and bring them in. They ask me, ‘What does this say?’” he said. “We get report cards, lots of things.”
The language barrier is just part of parents’ difficulty in raising children in American culture. Some also discover that the discipline that was common in their native countries, including physical punishment, isn’t acceptable in the U.S.
Family Court Judge Lisa Bloch Rodwin has helped lead a collaborative effort to help immigrant families who land in the justice system. She sees cases of physical abuse, neglect and other forms of mistreatment of women and children, and says it has been eye-opening for all involved.
“In none of those countries is it illegal to use force against your wife or child,” Bloch Rodwin said. “They use it for discipline, and if it is deemed ‘too much,’ the only recourse there is to go to an elder. We need to educate people that no, you can’t cut a branch and beat your child, or take a belt and beat your child.”
One case required a different kind of explanation. A mother had arranged a marriage for her 15-year-old daughter in exchange for a substantial dowry. The girl, who did not want to get married, told a teacher and the mother was charged with neglect.
“She didn’t know it was wrong, that she couldn’t do that here,” Bloch Rodwin said. “We were able to use the court system in a way that would protect the child and not impact the mother’s immigration status.”
Bloch Rodwin said overall, the African and Asian communities are working well with the legal system. Lawyers and legal aide workers have held programs for caseworkers so they can better inform their clients about their rights and their responsibilities for their families.
It was enlightening in both directions, Bloch Rodwin said.
“When we had the training, one of the leaders of the Somali community said to us, ‘You do realize that nobody in our community here knows what a school bus is,’” Block Rodwin said. “Where do the children go? Who are they with? (The parents) only know they’ll be in trouble if they don’t have their kids by the yellow bus in the morning.’
“That’s what we have to deal with.”
‘Face to face is best’
Catholic Health Systems in March rolled out a new video conferencing system to bring interpreters’ faces right to patients via laptop computer, starting in the emergency department.
“If you have an emergency, you have an emergency,” said Heather Telford, director of nursing for emergency and critical care services at Kenmore Mercy Hospital. “The doctor needs that information now, and if you don’t have the tools to get it, you do need to rely on someone (a family member) who is standing there.”
Because of privacy issues and because they often don’t know the terminology, family and friends are considered interpreters of last resort.
With Catholic Health’s new Language Assistance Program, the patient, trained off-site interpreter and physician can see one another while they talk, although the image can also be screened for patient privacy during an exam.
Telford said that the doctor and interpreter can also write to each, a huge asset to verify accuracy on such things as medication, and patients still can have family members with them if that’s their choice.
“The first day we had it, we had two pediatric cases, a 4-year-old girl from Iran – nobody could speak anything to anyone in the ER – and right after that a Burmese family,” Telford said. “It worked beautifully. Having that language barrier taken down, it keeps everyone safer and more connected about their care.”
Locally, the International Institute of Buffalo has been responding to immigrants, asylum seekers and refugees for years, leading classes in interpretation and translation of written communication for dozens of languages, with expertise in community concerns, medical settings or legal situations.
Emily C. Brady, director of language services at the institute, said the institute can provide interpreters in more than 80 languages. Last year it connected people about 9,000 times.
Most of its interpreters are in the area and provide their services in person.
“For opening a bank account or buying and selling real estate, ideally an interpreter would be present for so many reasons,” Brady said. “Immigrants and refugees are learning English, but it takes time. It is 2015. We need to provide a welcoming contact, to be a Buffalo we are proud to live in.”