Beyond words

 WSU Vancouver students are learning how to help Spanish speakers navigate clinical experiences and forming strong partnerships with community health-care providers.

As as one of the WSU Center for Civic Engagement’s inaugural Faculty Fellows in 2017, Cassandra Gulam and her colleagues learned how to incorporate the principles of community engagement into their courses. Gulam, clinical associate professor of Spanish language and culture, used this training to design and teach Spanish 362: Spanish for Health Professions in spring 2018. The course was offered again in fall 2019 and will be offered every other spring, beginning in 2021.

What makes this class special is the relationship it establishes between the university and the sites where students practice what they are learning. “Community engagement goes beyond traditional ‘service learning’ to treat sites not just as placements, but as partners,” said Gulam, who also serves as a program leader for the School of Languages, Cultures, and Race. “You make sure you take their needs and feedback into consideration and prioritize these, whenever possible, over your own. Our goal is not to be a burden to them, but an asset in fulfilling their institutional mission.”

A key partner, in this case, is the Free Clinic of Southwest Washington, which was founded in 1990 to address the health-care needs of uninsured and underserved residents of Southwest Washington. As a “safety-net clinic,” the clinic provides free, basic walk-in health, dental, vision and specialty care. It is volunteer-run and locally funded, with only eight paid staff members and 300 active volunteers.

When Spanish for Health Professions was in session, some of those volunteers were WSU Vancouver students. So far, 26 students have taken the class.

In fact, some of those students continue a relationship with the clinic once the class is over. Irina Chizh spent more than 80 hours interpreting and translating as an intern at the Free Clinic after completing the course. “Volunteering at the clinic was probably one of the most rewarding experiences I have ever had,” she said. “I was learning the language, practicing it, improving my grammar by hearing native speakers using it, and helping people, all at the same time.”

Another student said volunteering helped her grow in confidence while gaining experience with different medical professionals. “It was also an amazing cultural experience because we learned about cultural norms that differed from my own,” she said. “Being aware of these differences helps us as interpreters to have a better understanding of what patients want to say to the medical team. I learned that interpreting is more than just the words being said, but the meaning behind certain words and phrases as well.”

Catherine Bean, volunteer coordinator at the Free Clinic, praises WSU Vancouver’s students. “We are always in need of Spanish interpreters,” Bean said. “We wish it were more often! And I think having students exposed to this demographic and what we do here is invaluable.”

After the class was first offered in 2018, the Community Engagement Institute at Gonzaga University recognized Gulam with its Excellence in Community-Based Learning award. One reviewer noted that the project offered “well-demonstrated community need, application of skills to problem-solving, clarity of measurable outcomes, replicability and a strong intercultural competency component. I love this project and the way it addresses one of the biggest challenges (and virtues) in American health communication: our diversity!”

Classroom and community curriculum
Students are required to spend at least 10 hours volunteering at a medical facility during the course of the class. “Most end up contributing well over that,” Gulam said. Initially, they shadow another volunteer. As they gain confidence, they do more. A big part of the experience is learning how to manage stressful situations—such as a provider who is impatient or a patient who rambles. “The course helps students gain the confidence to stop people and ask them to repeat, and to practice strategies when they don’t know a word or can’t understand an accent,”
Gulam said.

The classroom portion covers medical vocabulary, such as dentistry, illnesses and symptoms, lab testing, internal organs and parts of the body. In all, students learn about 800 new words. They study the ethics of interpreting and how these play out in case studies. They also discuss community demographics, under- and uninsured rates, and the importance of free clinics in helping certain populations. Throughout, students frequently submit reflections on their volunteer experiences and their progress as learners of Spanish and novice interpreters.

“It is important for interpreters to act as an advocate for the patient, without crossing the line into being a ‘friend’ of the patient,” said Gulam, who is also a certified medical interpreter in the state of Washington. An effective, ethical interpreter must be a neutral party who facilitates communication without judgment, so that both patient and provider can confidently share even the most delicate information. Through real-world scenarios, students learn how to implement these principles.

In addition to the Free Clinic, community partners include the Firstenburg Dental Hygiene Education and Care Center, and Battle Ground Health Care. According to Gulam, the diversity of health care-related experiences and the community capacity to host students are key to the success of the class.

“We have wonderfully suitable partners for this,” Gulam said. “We wouldn’t be able to offer students this kind of supported practice in other, less-urban settings, and we recognize how lucky we are to have these community relationships. They’ve given us good feedback, and we’re excited to continue working with them.”

Not all students who complete the class are qualified immediately to be medical interpreters, Gulam said, nor is that necessarily the course’s principal objective. Even students who are native or heritage speakers of Spanish must also learn how to hold complicated information in their working memory and make split-second decisions about communication.

Still, the community experiences add a special incentive to learn the vocabulary, embrace the ethics and practice these skills. Student Renee Perrine said, “Having the community partners encouraged me to engage more with the vocabulary and general course concepts than a traditional classroom-based course would have. I was not just working toward a grade; I was working toward making a difference in someone’s medical—and thus whole—life.”

Top image: Health care worker, courtesy of NW Crimson & Gray magazine.

Originally posted at WSU Vancouver for NW Crimson & Gray magazine.