You’re sitting in the middle of an unfamiliar room. Everything is wrapped in plastic. There’s a bright spotlight shining down on you. You feel exposed and vulnerable. You look to your right and see an array of sharp, pointy metal tools lined up on more plastic.
A stranger walks in. They’re speaking a language you barely understand. You try asking them for help, telling them what’s wrong, but they look confused. They start talking again. You understand some of the words they say here and there, but the only words you can hear clearly in your head are “pain, pain, pain.”
This is an experience that is common among many non-English speaking patients in dental offices, and a retelling of a story that was shared with me by a patient about a previous dental examination without a translator. In 2019, data collected by the Migration Policy Institute showed that 20.7 million immigrants in the United States had limited English proficiency (LEP). Yet, despite government mandates, only 68.8% of hospitals offer language services to their patients. Similarly, although Section 1557 of the Affordable Care Act requires that dental practices provide meaningful access to care for patients with LEP, most of them do not offer language assistance or translation of written consent to their patients.
Some immigrants have to resort to using their children as their interpreters or translators to get the help they need. In fact, based on immigrant experiences, Vikki Katz named immigrant children “brokers of their immigrant families’ health-care connections” in her article for the Social Problems Journal published by the Oxford University Press. Not only is this a huge title to place on immigrant children, but the situation also poses risks and ethical concerns for the patients — their parents. Perhaps the most concerning point is that many of the children acting as translators are underage and untrained, and, thus, they might not be able to translate important technical terms and could be influenced by their emotional involvement. This can lead to further problems in doctor-patient communications and even lead to procedures being performed that were not fully understood by the patient. Without proper understanding of their diagnosis and treatment options, these patients cannot give informed consent.
Another possible concern is that when proper tools for communication are not offered to patients with LEP, they’re more likely to have unsatisfactory experiences during their visit. Such experiences arising from limited communication can cause patients to avoid going back to their dental provider. Avoiding oral cleanings or checkups can allow the progression of oral pathology or existing oral problems. Various studies have found an association between poor oral health and systemic problems such as diabetes or heart disease. Knowing the systematic issues associated with poor oral health, we can’t let the barrier of language differences put patients with LEP at such risk.
However, the concerns caused by language barriers don’t stop with the patients. As an immigrant who had to be a translator for my mom, I’ve seen and experienced the ways limited language services can also harm the children of patients with LEP.
After immigrating to the United States, my mom’s existing oral problems became worse. Since I was in school most of the day, my mom tried to find a dentist by herself, but she struggled with getting appointments with her limited English. So, I had to start calling dental offices during my lunch breaks or sneak out from class to make calls in the bathroom. When I was finally able to get an appointment for my mom, I had to miss school to accompany her to her appointments. While my classmates were busy with school and all the things teenagers think about, I was at doctors’ offices or on the internet trying to teach myself medical terms and reading PubMed articles.
Hospitals and dental offices can act so that patients with LEP are not put at unnecessary risk, and minors are not burdened with ensuring access to care for their non-English speaking parents. There are many options available for language assistance, including services offered over the phone. Aside from these third-party services, clinics can use their diverse staff to communicate with their patients. Although this isn’t the best option, it is one that can be implemented the easiest.
KinderSmile Foundation is an example of a clinic that uses its diverse staff to accommodate patients with LEP. KinderSmile community clinics serve largely uninsured and immigrant patient populations. The staff and volunteers are diverse, most speaking at least two languages. Having staff that are fluent in English, Spanish, Arabic, Turkish, Hindi, and many other languages, who are also trained to work in a dental office allows these community clinics to bridge the service gap that language barriers create for immigrant communities.
I will never forget the first time I was able to assist an immigrant family while volunteering at KinderSmile. This family had traveled far to come to our office with their two children. The mom knew very little English, and the patient was too young to speak for herself. Apparently, the family had tried to get their other daughter to translate for them during their first visit, but she was too scared to go into the exam room. So, they left the clinic with some worries. However, I was volunteering during their second visit and offered to translate for them. Knowing I was able to help this family get all their questions and concerns addressed, and seeing them walk out with smiles instead of worries, was such a rewarding experience for me.
Access to dental care has come a long way in our country, but a long stretch remains ahead of us. As we are trying to combat barriers in access to care, we must also think about how to support underserved communities once they’re sitting in the exam chair. Diversity in offices and offering comprehensive language assistance could be a starting point for establishing culturally sensitive and inclusive practices.
~Zeynep Akpinar, New York ‘23
