Cipriana Lopez has been out of work for a year, and her employment prospects seemed dim until she learned about a medical interpreter training program in Buffalo.
It was a perfect fit for Lopez, a native of the Dominican Republic who easily switches between Spanish and English.
She was one of 38 people – many of them immigrants – to complete last month the free, medical interpreter training from the International Institute of Buffalo.
With a round of classes now over, the institute is now working with program alum, like Lopez, to help them study for a certification exam.
Lopez said she plans to study for at least a month before taking the exam. She wants to make sure she's prepared so she can pass on her first try. The income she could make from interpreting would help her reach a bigger dream: to open a Dominican restaurant in Buffalo.
"I just want them to succeed," said Emily Brady, director of language services at the institute.
Brady's goal is for Buffalo to become one of the cities with the highest concentration of health care interpreters in the United States. Among the students at the institute's classes, there was fluency in more than 52 languages. Buffalo has potential to be the only city with certified interpreters for languages like Chin, Fante, Patois and Sissali — spoken by at least one person in the institute's class.
Normally participants pay between $600 and $1,000 for training to become medical interpreters, but the training was free at the institute, thanks to a $37,000 grant from the New York State Department of Labor, Brady said. Students received double the required training — 80 hours rather than 40 hours.
"We wanted to make sure that they got substantive training, not just the minimum," Brady said. "That way we were able to build in additional practice sessions and skill building so they could leave confident in what they'd learned."
The curriculum was adapted from the institute's parent agency for refugee resettlement, the U.S. Committee for Refugees and Immigrants, and supplemented with presentations by local experts including nurses and interpreters.
In the classroom
At the front of the classroom sits a doctor facing a patient and an interpreter.
It's a simulation of scenes that happen at hospitals and medical offices. The doctor introduces herself and then there's silence. The interpreter forgot to translate for the patient.
The class giggles at the mishap and lets out laughs as the three choppily continue their performance.
The patient dramatically pulls out a napkin and starts dabbing his face, complaining about having to get up to use the bathroom in the middle of the night and not being able to sleep.
As the doctor asks for more details the interpreter politely interrupts. "Please look at the patient rather than me," the interpreter said.
The patient tells the interpreter that he broke his diet and had his wife cook him hot peppers. "But don't tell the doctor that." She does. It's her job to interpret everything that is said.
All three actors are students in the interpretering class. It's practice for how to handle the intricacies of the job.
Classmates give feedback after the exercise.
"Too much eye contact between doctor and interpreter," said one person. "The interpreter didn't explain their role," chimes another.
A need for interpreters
Officials expect the number of interpreter jobs to grow by 29 percent between 2014 and 2024. Average job growth projected across all occupations is 7 percent, according to the Bureau of Labor Statistics.
In 2016 the bureau said the median salary for an interpreter was $46,120 per year and $22.17 per hour.
To participate in the institute's training, students needed proficiency in English and another language, a high school diploma — most participants had college or post-graduate degrees — and classification as a dislocated worker through the Department of Labor, Brady said.
Of 38 participants in the class, about a quarter had prior interpreting experience. But most had only done it informally for family members and friends.
To be a medical interpreter, it's not enough to speak a second language. Under the Affordable Care Act of 2010, health care institutions must provide "qualified interpreters" who hit two other standards: fluency with medical terminology and familiarity with ethical principles.
Certification is available through two organizations, the National Board of Certification for Medical Interpreters and the Certification Commission for Healthcare Interpreters, but is not required under the law.
Between the two certifying organizations' registries, there are three interpreters listed in Buffalo, all certified for Spanish. In New York State, out of 113 interpreters, 73 speak Spanish, 25 Mandarin, eight Russian and four Cantonese. Those numbers don't match the language demographic in Buffalo.
The top 15 languages interpreted at Buffalo's Kaleida Health locations last year, in order, were: Spanish, Arabic, Burmese, Bengali, Nepali, Somali, Russian, Karen, French, Vietnamese, Swahili, Chinese, Tigrinya, Urdu and Italian, according to a report provided to Kaleida by CyraCom.
There's a need for interpreters in Buffalo, where 16.6 percent of people 5 or older spoke a language other than English at home during 2016, according to census data.
Interpretation as a civil right
The Affordable Care Act requires patients be given access to medical interpreters.
Programs receiving federal financial assistance, like hospitals and practitioners accepting Medicaid, must provide limited English patients with language assistance services under Title VI in the 1964 Civil Rights Act.
Danielle Becker, a staff attorney at Kaleida Health, said their hospitals provide interpreters. Throughout their locations there are designated tablets for video interpretation since it's how the hospitals most commonly provide translation. Kaleida also provides interpreters for in-person or over the phone conversations.
Though patients have the right to interpretation services, they can't be forced to accept them, said Andrea Parsons, a certified medical interpreter in Buffalo, recalling her own experiences.
Once, Parsons was requested by a medical provider to translate, but the patient didn't want her there.
"I can see where they don't want anyone outside of their provider knowing their story," she said. "At the same time I feel that they don't quite comprehend one hundred percent the importance of having a trained individual familiar with the medical terminology."
In 2012, when Parsons was seeking certification, the closest testing site to Buffalo was in Ohio, she said.
She drove there, but failed the oral exam.
"It was too fast," Parsons said. "The speed they want you to go at just isn't realistic."
The next year, a certification testing site opened in Rochester, and Parsons took the test twice before earning her certification.
This year, the International Institute of Buffalo received permission to be a temporary testing site for six months after their class ended. For graduates of the interpretation training program there, their first written and oral exam is free, covered by the institute's grant.
Brady said she will work with students to make sure they're prepared and know what to expect going in.