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Found in Translation
JHM International has an array of programs designed to help patients with limited English skills. The latest experiment: a Spanish-speaking robot.

Juvenal Reyes, seen on the robot’s screen, interprets for an injured Hispanic patient in the Emergency Department. (Photo: Jon Christohersen)

A 35-year-old Mexican laborer was working with a chainsaw when it fell to the ground, ripped through his shoe and tore into his right foot. Now he’s in a treatment room in the Emergency Department, in pain and frightened, for he does not understand a word of English.

Down the hall, to the amazement of waiting patients, comes a robot, smartly rounding corners and purposefully entering the treatment room.

Operating the robot remotely using a special laptop outfitted with a joystick, Juvenal Reyes, a translator with Johns Hopkins Medicine International, expertly drives the robot directly to the patient’s bedside. Pivoting the robot’s 15-inch video-screen “head” from patient to physician, Reyes interprets. Soon, the injured man understands that if there are no broken bones, his wound will be treated and he’ll be on his way home.

Here, as in hospitals elsewhere, physicians are using robots to round on patients and mentor trainees in the operating room. But this is the first time in the United States a robot has been used for translation.

The pilot program is emblematic of JHM International’s success in meeting its obligation, as mandated by federal law, to provide programs for those with limited English skills. Title VI of the 1964 Civil Rights Act states that any program receiving federal funding should be free of racial and ethnic discrimination. “You must have a system in place to assist patients with limited English proficiency,” says Raffaella Molteni, director of patient services at JHM International.

International’s array of programs and activities ranges from interpreting services, to courses in medical Spanish and cultural differences, to community outreach, complete with a new Hispanic community liaison coordinator.

The robot-as-translator concept arose out of a discussion between Reyes and Alex Nason, Hopkins Medicine’s director of telemedicine, about problems faced by interpreters, especially at night.  “After driving to the hospital, you might have to wait for hours before your services are really needed. Or, you might find that the patient has already been sent home,” says Nason. “Talking over the phone, you miss the nonverbal and the ability to connect visually.”

Seeking a more efficient and effective way to deliver help, Nason decided to press the robot into service. Interpreters on call take home the special laptop. “Now, within minutes, an interpreter can be at the patient’s bedside. The robot can move with the patient through the system and talk to the family.”

The robot-as-interpreter shows how International’s translation service has evolved as Baltimore’s demographics have changed. Up until a year ago, any patient who did not speak English was assisted by a patient service coordinator. Today, that’s no longer the case. “The volume of local, non-English-speaking patients grew so much that we brought on interpreters for them,” says Molteni. Roughly 30 interpreters speaking everything from Farsi to Russian now provide translation services on a case-by-case basis.

The growing number of Hispanic patients visiting Johns Hopkins have the most impressive need. Last year, out of 9,345 requests for interpreters (about 2,228 more than in 2005), over 55 percent were for Spanish interpreters. To meet that demand, five full-time Spanish translators work specifically with in-state patients.

Their work helps prevent the kind of mishaps dramatized on TV medical shows, the difference here being that the danger is real. “It did happen to a patient in another state who had been prescribed medication to take once a day and ended up taking it 11 times in a day,” says Molteni, explaining that the English word once means eleven in Spanish.

International’s new Hispanic community liaison coordinator, Sonia Hoffman, hopes to relegate stories like that to the historical dustbin. She believes expanding Hopkins’ involvement beyond the hospital hallways and into the Hispanic community will help bridge more than just the language gap. “We’re trying to develop a system to keep in touch with these patients after their first contact with Hopkins,” says Hoffman. “I’m hoping to be a social resource for different community centers.”

Hoffman, who is Peruvian and previously worked at Hopkins as an interpreter, will be working with organizations such as Casa de Maryland and Adelante Familia, as well as the Hispanic liaison in the mayor's office. She has already set a number of short-term goals, like developing a guide to Hopkins services and programs for the Hispanic community and a job bank to attract qualified workers.

“This is a very proud and strong community,” says Hoffman. “They want us to provide services, but they also want to play a part in them. We are going to do our best to listen and work with them.”

Sarah Richards



Johns Hopkins Medicine

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