The founder of Language World Services, William Glasser, now dispatches roughly 170 interpreters to assignments at health care operations in San Francisco, Walnut Creek, Sacramento and other Northern California cities. They speak dozens of languages, from Spanish to Urdu, from Hmong to Polish.
When Glasser started the company in 2000, it was a two-man operation, and he was one of the two men. He called the business Spanish World back then because Spanish was the only language they could interpret. They worked out of the garage of a house he rented in Oak Park. Two or three weeks into their business cycle, Glasser said, two game-changing things happened.
Was it three (tres) pills or 13 (trece) pills?
William Glasser, on the effects misinterpretation can have on health care
“Someone called me up and said, ‘Bill, do you have Punjabi?’ ” Glasser said. “I didn’t even know what that was, let alone have someone. But … I said, ‘Of course, I do.’ ”
Glasser said he knew that if he didn’t find someone who could translate Punjabi, his client would look for another service that would and that service also might supply Spanish interpreters. So, he found someone to do the work.
“The second big thing was when Kaiser Point West … called me, and they said, ‘Bill, we need a Korean interpreter for a women’s health exam,’ ” Glasser said. “I said, ‘No problem, I know one.’ Finally, I actually knew an interpreter.”
Glasser called his friend, who was a court interpreter, and asked her to help him out for the 20-minute appointment, he said, and after she told him she could do it, he asked her what she charged. Glasser gulped when he heard her “half-day rate.” It was $400.
“I said to myself, ‘Well, the doctor isn’t making $400 for that,’ ” Glasser said. “So, lesson to myself again: ‘You can’t use court interpreters to do health care because you won’t make any money.’ ”
Glasser had to create his own workforce from scratch. Up until 2009, he worked with independent contractors or freelance interpreters around the region to serve his clients, he said, but he wanted to more closely monitor whether the interpreters’ credentials and health screens were up to date and to gain greater control over the quality of the service. The California Healthcare Interpreting Association had issued a pamphlet with the industry standards for practice in 2002.
William Glasser has licensed his online platform, known as Fluency, to health care providers nationwide.
“The health care sector is highly regulated and very careful about who provides direct patient care,” Glasser said. “We need to have direct control over quality.”
The health care interpreter, Glasser said, provides a critical link between doctor and patient for not only communication but also for cultural understanding.
“You can have two patients, both equally educated, both equally of the same socioeconomic status,” Glasser said. “One speaks English; one doesn’t. They go in for the same procedures, same illness. They’re the same age. … The English-speaking patient, working with the doctor, figures out what will produce the best outcome for their condition. The other patient doesn’t.”
Often, Glasser said, patients rely upon their school-age children to interpret for them. That can turn the family’s power structure on its head, said Glasser, because children become the gatekeepers of information. Also, he noted, they don’t always have the linguistic knowledge to properly convey or interpret information.
“One of my earliest interpreters, Mercedes, she … said she was a child interpreter and they went to Kaiser,” Glasser said, “and the doctor said to the little 11-year-old Mercedes, ‘Tell your mom that your brother has an acute ear infection.’ So she told her mother, ‘El hermanito tiene orejas lindas,’ which means ‘Little brother has cute ears.’ That’s what an 11-year-old hears.”
Misinterpreting one word can have devastating results in health care, Glasser said: “Was it three (tres) pills or 13 (trece) pills?”
Language World Services sends interpreters on an average of 200 assignments a day, said Lisa Spagnoli, director of client relations and operations. They schedule them with an online platform that Glasser had developed for his agency. Clients can request interpreters online or call into the scheduling staff. The staff can see client requests in the system, and once they make assignments, interpreters can see where they’re going and read any special instructions.
Glasser has licensed that online platform, known as Fluency, to health care providers nationwide.
“I have about 62,000 transactions every month from Buffalo, N.Y., to Nashville, Tenn., to Texas,” Glasser said. “They’re booking all their interpreters through our online system.”
At one time, Glasser also did language testing for potential interpreters through a program under the Fluency brand, but now that national certification exams have been instituted, Language World uses those to tests job applicants.
Glasser has found that Language World gets the greatest number of calls for Spanish-speaking interpreters, but the demand can vary from Sacramento to Vallejo to Oakland to Santa Rosa. And, in some cases, there are a large number of Mexican immigrants who speak indigenous languages such as Mixtec or Nahuatl. While patients may speak some English, he said, they often revert to their dominant language when they’re sick, under stress or tired.
Language World is always on the hunt for interpreters. Many come from the ranks of college students all across Northern California, Glasser said, and they often are studying for careers in the medical field.
“Some of them start out in one major, and they end up wanting to become something else – a therapist or a social worker,” Glasser said. “They had a whole vision of themselves, and it goes out the window because they went to Kaiser and Dignity Health and Sac County and saw other possibilities.”
Typically, before a student would ever get into an exam room, Glasser said, they would have to go through years of school and amass a lot of student loans. But because they’re in the interpreting role, they get to participate in a moment that would otherwise be forbidden to them.
Often, Glasser said, interpreters don’t fully realize the value of their language skills until they hear the gratitude of the doctor or the patient. Glasser also impresses upon job applicants the difficulty of walking into medical situations that may be gory, pose moral dilemmas or reveal the depths of human despair and anguish.
They’re not calling us for the easy things, Glasser said, and these moments are often filled with nuances that the interpreter will understand fully only if they are physically in the room.