Trisha Williams(Host 1): Hi guys. Welcome to the third season of the Advanced Practice Perspectives podcast. I'm Trisha Williams.

Tobie O’Brien (Host 2): And I'm Tobie O'Brien. This is a podcast created by Advanced Practice Providers for Advanced Practice Providers. Our goal is to provide you with education and inspiration. We will be chatting with pediatric experts on timely key topics and giving you an inside look at the various Advanced Practice roles at Children's Mercy.

Trisha Williams(Host 1): Today, we are so excited to host Paul Spacek. Paul is a Senior Medical Interpreter at Children's Mercy Hospital. I am so excited to speak with you, Paul. Thank you so much for joining us. Why don't you tell our listeners a little bit about yourself.

Paul Spacek, Senior Medical Interpreter: Thank you guys very much for having me. I'm excited to talk with you as well. So my background is typical for this area of Kansas City, but not very typical for my department. So I'm not a native Spanish speaker, and I've never lived abroad. However, I'm still a Spanish interpreter. So I am originally from Topeka, Kansas. Born and raised there. Studied Spanish at the University of Kansas at KU. So I initially started out at KU as a business major, so it's kinda a roundabout way of getting there. My first love is music. I've always been passionate about music. I still play, record, sing, but I quickly realized when I was in high school that I wasn't talented enough to be a professional musician.

So I thought maybe if I studied music business, that would be my way in. So I started out as a business major at KU and I absolutely hated it. So then I thought, well, what do I actually like so far? And I'd always liked Spanish in, in high school, and I'd taken a Spanish class so far in college and I liked it.

So I thought, well, I'll study Spanish and I can hopefully come out of college bilingual, and then I have no idea what I'll do with that, but I'll figure something out. So I graduated in 2010 with my Bachelor's degree in Spanish. And then my first job out of college was working through AmeriCorps program, for a place in Lawrence that was called Centris Bonna Resource Center, where we worked with Spanish speaking families, mostly women and children helping to do a variety of things. We were a walk-in, drop-in center and that was my first exposure to interpreting cause sometimes I would take clients to clinical appointments and things like that and then I would show up and they would say, oh, well you came with this person and you speak Spanish, so great, you can interpret for us. And back then I didn't know enough to say, no, I'm not actually trained to do that, but that was my first exposure to it. So then after a year of working that program, I took some time off. I thought maybe I might go to grad school or go into academia, so I traveled and did some things like that, but it was pretty tough at that time to get into academia.

So I applied to several schools, didn't get anywhere, and I kind of came back, talked to my old boss at the community center and said, I have no idea what to do with myself. And she said, hey, one of my best friends runs the medical interpreter training program at Johnson County Community College. You should go talk to them and look into them.

So I did, and then I signed up for the program and within a couple months of taking that program, I thought, wow, this is where I was meant to be. I just absolutely love this. Here, I can use my language skills to be able to help people. This is a very exciting field, something that's very interesting. I feel like I can do this, and that just the moment when everything clicked for me.

So, finishing that program, I interviewed with Children's Mercy and I had no experience. I wasn't a native Spanish speaker. I didn't have the typical background of most interpreters, but they were willing to take a chance on me and I'll be forever grateful for that. So I was hired originally, part-time nights back in 2013.

And just over these last 10 years, I've worked my way up to now being a senior medical interpreter in our department. Just two years ago, I finished my master's degree from K State in adult learning and leadership that the hospital was able to support me through, and I'm just so grateful for every opportunity that the hospital has given me.

I absolutely love my job here at the hospital, being able to help children and help families. It's been kind of a roundabout road of getting there, but I absolutely love where I'm at now.

Host 2: Oh, I love your story, Paul. I definitely would never have guessed. I've worked with Paul many, many times in the ENT clinic. He has come and helped me and I would've never guessed that you hadn't spent time abroad just by how good you are. So that is a cool story. Thanks for sharing that.

Paul Spacek, Senior Medical Interpreter: Well, thank you. Yeah, yeah, yeah. I mean, I've traveled abroad to several different Latin American countries, but never for more than two weeks at a time.

Host 2: Okay, well you certainly do a great job. So we, we love, having you help us in ENT. So I'm super excited to have this conversation with you. We have so much to cover. So I thought we could start by you just telling everybody a little bit more about the Children's Mercy Interpreting services. Like, remind everybody what languages we have in-person interpreters for, and a little bit more about the department.

Paul Spacek, Senior Medical Interpreter: Yeah. Great. When it comes to language access, we are very lucky here at Children's Mercy that we've had support from our leadership to be able to have a large, robust department and to be able to offer lots of different types of services. I always talk about language services for institutions. It's both an obligation. But also an opportunity. So all medical institutions that accept federal funds are legally obligated to provide access to their services in other languages. And that stems from the Civil Rights Act of 1964 Title VI that states in healthcare field, you cannot discriminate based upon a number of protected classes.

Of course, that's race, religion, gender, but then also national origin is one of those protected classes, and that's been further found to include language. So that's the legal obligation that we as an institution and really all healthcare institutions have to provide some sort of language access to people that speak languages other than English.

However, the degree to which you try to meet that bar varies from institution and that's when the opportunity piece comes in. So again, I feel very grateful here that at Children's Mercy, we've really embraced that opportunity aspect to think how can we best serve people that speak languages other than English or have limited English proficiency.

So in our department, that starts with our in-person interpreters. So we have at my last count, 24 Spanish interpreters on staff, and that's between the Adel Hall campus, Broadway campus, Kansas campus, and we staff Monday through Sunday, so seven days a week, 6:00 AM to 11:00 PM and then currently on staff languages other than Spanish, we only have Somali.

In the past we've had Arabic, Burmese, and Vietnamese, but those people have kind of since left. And then especially with the pandemic, we kind of didn't rehire those positions and now we support those languages with video and phone and, and also agencies that bring people in. We have our in-person interpreters that try to respond to as many in-person appointments when possible.

We also have video services and phone services. The phone services are through an agency that we contract with that's called Propio. So they are outside of the hospital. They're a contract agency, so that's when you call the phones and then select the language that's working through that third party agency. For video services, we have a couple different ones. The main one that you guys might be familiar with is one called Marty. And the way that Marty works is in our office at Adel Hall in the DMTC building on the fifth floor, we have what we call little micro call center. So we've got several desks that we try to staff daily, three to four people at.

So in our department, we kind of all have to take five days a month. We've got a very complex calendar that states this all out about who's going to sit at the desk at what days, and those people answer the Spanish calls. So when you have a Marty device, a tablet, and you press Spanish, your call will first go to one of our staff that is sitting in the language services office. And if none of our staff is available, if everybody's on a call or nobody's available, then your call will roll over to a third party agency. So the company Marty, they have interpreters that they contract with all throughout the country and all throughout the world, really. That's been a big trend for a lot of these countries as hiring people international.

That's why we want to try to do as many calls as we can within our department, but then we want to make sure we have that capacity to help everybody that needs it, even if someone is not available.

Host 1: That's a lot of moving parts to provide all of those services. And I, we have some families that speak very unique native languages and to be able to connect with those families, you know, when, I've never heard of the language before, but using that Marty service is a huge benefit for our patients and family.

I would love for you to touch on the importance of access to language interpreters in a healthcare setting. I think as living in the United States and having English as our first language, I think that we are very at least I should speak for myself, very naive to what it means to receive healthcare or services in a language that, I don't know.

I think a lot of people across the world speak English, and so it's just. I would love for you to touch on that, on what that means for our families.

Paul Spacek, Senior Medical Interpreter: Definitely. You know, I think for a lot people as a, as Americans, we tend to speak only one language. The joke I always make is, what do you call a person that speaks three languages? Trilingual. A person that speaks two languages. Bilingual, a person that speaks one language, American. So a lot of us, we have a hard time understanding what it's like from our patients' and families' perspectives, because we've never really been in that position ourselves. But I think especially for parents with children, when it's your child, it's just so different and you really, it's even more important for you to understand what's going on and to be able to communicate what your concerns are, what your worries are to understand what's going on with your child and their medical care.

And then I think for you guys as providers too, it's very important to have an accurate medical history, to know exactly what's going on with the patient. Are they taking the medication? How are they taking it? What's been going on in order for you to correctly diagnose and treat the patient that's in front of you, and without having a trained interpreter there to be able to help in those situations, you're not going to get that adequate history that you need. The other thing we talk about in our profession a lot of times is, it's almost like you're trying to perform veterinary medicine at that point.

If you're not able to ask questions, get the information that you need, hear the patients and family's concerns. Just having the interpreter there to be able to bridge that gap and to make sure that all the questions get asked and answered and that everybody understands everything, that the parent knows what the plan of care is, can carry it out, can follow through.

That's just going to result in so much better outcomes for the patients, for the families, for you guys as providers. So we really take a lot of pride in our role of trying to help you guys do the wonderful work that you do here in the best way possible for the benefit of the children and their families.

Host 1: I think it's important to note that when we work with interpreters, like you have to say, directly everything that we say back and what the family says. You have to interpret everything. But what I love with our in-person interpreters is that a lot of times you guys are very consistent with working with the same families.

Like, oh, I've worked with this family before, so you can catch those nuances when the family's not really understanding what we're saying and then kind of help us, you know, oh, I don't know if they're really under. And then you would say that to the family. And then I think that we work together collaboratively to help the family really understand.

So I really appreciate that aspect that I think a lot of people don't maybe appreciate or understand.

Paul Spacek, Senior Medical Interpreter: Definitely. And you know, that's one of the wonderful benefits of being on staff at an institution because, unfortunately throughout the country, a lot of hospitals don't necessarily have interpreters on staff. And this is a trend throughout the country that I've heard when I go to interpreter conferences that there are institutions that are laying off their language services department and switching to an all phone model or an all video model where they're utilizing all agency interpreters because it's cheaper.

It's cheaper in a lot of cases, and sometimes it's easier to outsource that. They're only looking at that bottom line thinking about it that way. But for us, working for the institution and being a part of the care team, it's makes such a difference because, you know, I'm coming up on 10 years here.

A number of my colleagues have been here 10, 15, 20 years. Even if you guys know Jorge, you know, he's been here over 20 and it just gives us such an opportunity to establish relationships with the families, with the patients, but also with the providers and build that level of trust. So if we're in a room with you guys and one of us, says like, I'm sorry, I don't think the family's understanding this, can we maybe try to explain this a different way? You have that relationship with us to trust me when I say that and go, okay, yeah, if he's saying that, it's probably something that he means. And to be able, willing to do that. That's a hard thing to quantify. That's a hard thing to explain sometimes to our bosses or to our higher ups. I'm sure you guys have seen it in the room. It really does make a difference and can make a huge impact.

Host 2: It absolutely makes a big difference.

Host 1: I love that you said that you're part of the medical care team. Because you are, and that is a very, strong statement that I love that everybody needs to realize that our medical interpreters are part of the medical care team.

Paul Spacek, Senior Medical Interpreter: Yes, definitely. And, that's why again, why I love working here is because I feel like we are treated as such versus, being treated like a tool or even not as human. So that's why I really appreciate having that respect and feeling like we're incorporated.

You know, we're still a relatively young field. We've been really pushing over the last 20 years to become more professionalized as medical interpreters. It's tough because there's still not a lot of requirements like state requirements or even federal requirements about what it takes to become a medical interpreter.

So we're just constantly pushing to kind of raise that bar to become more professionalized, to get more training, more experience. That way we can provide, the highest level of service and care possible to kind of really show the importance of our role.

Host 2: Well, I love how you opened this conversation talking about kind of why we need access and kind of the law or the background behind how most hospitals that are federally funded, sort of are obligated to offer those services based off just having equal access to care. And I think that that's so important.

 I feel so spoiled. It doesn't really bother me. I love having Spanish speaking families because we have such amazing interpreters to help us. But I will say like, I guess I understand how you have to consider the bottom line and the costs and everything, but gosh, I just think we miss so much when we don't have our in-person interpreters.

 I wanted to give this example because I hadn't had this happen very often, but I had a, a Swahili speaking family, but they spoke a certain dialect and I was trying to use the Marty and, I mean, there was so much lost in translation. I think it's the most difficult visit I've ever had with a family.

I felt like I couldn't understand why they were there to see me, and I know that the family was frustrated because they couldn't understand what I was asking them. And, it was really difficult. And so I think that I can't imagine being in a different country trying to talk about what's going on with my child and then the doctor, the nurse practitioner not understanding what I'm saying, and, and oh goodness, how scary would that feel? So I think it's important to stop and really understand that when we're working with these families.

Paul Spacek, Senior Medical Interpreter: Yes, definitely. One of the things I think about a lot of times when I'm interpreting, especially from Spanish into English, is, it's very important for me to make my patients and families sound human and sound like real people. Because I often think that when somebody looks different from us, maybe has a different skin color, wears different clothes, speaks a different language, we have a natural tendency to see them as just very different as an other. But you know, what I've learned now in working here for 10 years and getting to work with so many people from so many different backgrounds is ultimately, we're all the same. Everybody has the same hopes, fears, dreams for their children. To me, it's just so important to make people sound like real people.

So when I'm interpreting, I try to use colloquial language. I try to use slang. I try to make my patients and families sound like people that the providers are used to interacting with, to kind of help break down that barrier in their minds of, oh, this person's so different. There's no way I can connect or understand this person, and make them start to go, oh, this person's just like my friends and my family.

And be able to kind of break down those barriers and help forge that connection and that empathy, that's going to result in, in better care. And those are the types of things that I try to think about is just creating those human connections and, and humanizing those interactions.

Host 2: I know we mentioned when we are working with families and I know I have benefited so much from having you guys in-person to kind of help me when I have had, I've tried to joke before and thankfully I've been able to trust the interpreter I was working with and they had said to me, I don't think they're understanding your joke.

And so it's been really helpful to have you guys be so honest with us as a provider, just saying to other providers who are listening, I think, you know, I would trust that and really kind of ask interpreters possibly before we go into the room, like if there's certain cultural aspects to consider.

So I wondered if you could talk a little bit about that cultural awareness or I know you had been involved with some cultural and language coaching, so I didn't know if you could speak to that a little bit.

Paul Spacek, Senior Medical Interpreter: Sure. So I guess on the cultural thing, I will say like jokes and sometimes those types of phrases, turns of phrase, can be the hardest things to interpret. So I'll give you an example like, Hold your horses. Being able to think of like, how to say that in Spanish, like, takes me a second. You know, and you think it's like such a simple phrase, but those types of things can be difficult to interpret.

And you know, like the idea of cultural misunderstandings or cultural things, one of the roles that we talk about as medical interpreters is that of a cultural broker. So I can think of lots of times when they're just like little cultural misunderstandings that sometimes I have to step in and clarify in order for things to make sense.

So one I think about a lot is meal progressions. In our very American minds we think of breakfast, lunch and dinner, eight o'clock, noon and six o'clock. Right. But for a lot of our Hispanic families, they tend to eat in kind of a different progression. So they'll often have like a late breakfast or brunch like around 10, and then their big meal of the day around like three, and then kind of like an evening snack around like eight. So a lot of times when I'm interpreting for nutrition clinic and we're trying to do a diet recall and they're asking the parent, you know, what do you give your kid for afternoon snack when they get home from school? Well, I know from my experience in a lot of cases when the kids are getting home from school, they're not always having an afternoon snack.

They're often then having their dinner. So I can kind of jump in and clarify, before I interpret that, ask the family like, now do you give your kids a snack or do you give your kids dinner before when they come home? And if they say dinner, then I can help clarify to that, to the nutritionist so that she has a better understanding of what's really going on with that family.

So those are those kinds of like little things that we know from our experience of working with families that's that cultural broker aspect of we can kind of help navigate in order to make sure that we get the best responses and the best information in order to provide the best care. And then you also asked about culture and language coaching.

I'm not sure how many people are aware of the Chicos program that exists within the residency program. So that's operated out of the Yellow Clinic and was started by Dr. John Cowden, several years ago, over a decade ago. And Dr. Cowden, if any of you guys don't know him, he's just an amazing doctor and just a pioneer in the fields of language access and you know, culturally and linguistically appropriate healthcare. And he originally started this program within the residency for residents that come in with like an intermediate level of Spanish that want to improve their Spanish throughout their residency to then be able to hopefully practice bilingually upon graduating. This program's been built up over the years. It's now run by Dr. Jody Dickmeyer, who I think was a former Chico's resident herself. And the head language coach of this program now is Paco Martinez. If any of you guys know Paco, he's just an absolutely wonderful person to talk to. That program is well established within the Chicos clinic, but now we're kind of working on growing and expanding beyond just the Chicos program to be able to offer language coaching services.

So they're currently, they have some contracts with some community agencies, some community mental health agencies to try to, they really recognize the gap in bilingual mental health providers. So they've been working with some community partners to try to help build capacity of bilingual mental health providers. But now we're also looking to see how we can continue to expand within Children's Mercy. So I did kind of a pilot program where I worked with them. I went through their training program and then I've been able to use my master's degree in adult learning and leadership to kind of do some of this coaching work with providers.

So I've worked with, you know, some providers here in the Broadway building to who kind of had that intermediate level of Spanish, haven't quite been able to pass the QBS test. So I'm working with them to try to help get them to that level where they can pass the qualified bilingual staff test and speak Spanish directly with patients.

So when I'm working in the capacity of language coach, I go in with a provider during their appointments and basically I just let them speak directly to the family in Spanish, but then I'm there to help them if they don't know how to explain something, if they don't have a particular word, if they don't quite understand something that the family says back to them, I can be there to kind of help facilitate that communication.

And then I'm taking notes the entire time and then I'll give them feedback verbally and then try to create some written materials based upon what we saw to try to really help them be able to have that focused study that they need to be able to increase their skills and get to that next step. So that's something that we're hoping to be able to continue to expand within the hospital, offer to perhaps more people so we can continue to grow our capacity of bilingual and culturally competent providers.

Host 1: That is a fantastic program. I see growth within our Advanced Practice Providers as well. That is amazing. Your job is so multifactorial. I don't think that I understood quite the complexity of everything that, you know, the language services department offers.

Paul Spacek, Senior Medical Interpreter: Yeah, I've been so blessed that the hospital's given me so many opportunities to do different things. Another thing that I do within my senior medical interpreter role is also working with students and new hires. So the same program that I did at Johnson County Community College 10 years ago, we now have a contract with them and they send medical interpreter students to us to do their shadowing and practicum, and I really enjoy that aspect of just being able to train the next generation and give back to students. And so having students with me to shadow and then they actually get to do practicum where they interpret and then I'm there in the room to be able to help them if they need and then give them feedback afterwards.

 I really enjoy that aspect of my job too. So there's so many different things that I get to do and, and I really enjoy and am rateful for all those opportunities.

Host 1: Very important for sure. I would really like for you to touch base on the appropriate etiquette of using an interpreter. And I hate the verbiage using, but I think it's important for you to shed some light on it since we had already talked about, you know, you guys are part of the medical care team, but shed some light on appropriate etiquette because I feel like some of us miss the boat a little bit. So I would love for you to talk about that.

Paul Spacek, Senior Medical Interpreter: Thank you. And I'm glad that you used the term using an interpreter because it is something very common that people will say to us a lot of times. There's something we talk about among ourselves. Some people really don't like that because they say, you know, I'm not an instrument or a tool to be used. I'm a person or professional to be worked with. As someone whose job is linguistics. You know, I would say that words matter and the words that we use do matter. So, that's why we encourage that phrasing of like, Hey, can I work with you? Hey, can you help me over here? Versus like, Hey, can I use you? You know, and, and people say that all the time, but it's just something I encourage people to kind of think about of like you use your stethoscope, you work with an interpreter, right? Some other things to think about is, if you're working with an interpreter over the video, especially, I know when I'm working my shift on the video, sometimes it can get to be a little bit demoralizing because people start to treat you just like you are an AI or a computer program rather than an actual person.

Whenever you work with an interpreter in-person or over the video, they will typically the first thing, introduce themselves and I would encourage you to try to take note of the person's name when they introduce themselves, and then try best as you can to address them by their name. Because, it can get a little demoralizing when people keep calling you interpreter, interpreter, thank you, interpreter. And then we're like, I have a name, I am a person. You know, I, I don't know if you guys have felt that over your careers if people just call you nurse versus, you know, calling you by your name.

It's something I encourage people to kind of think of, of recognize that it is a person on the other side and, and try your best to, to address them as such. The other thing is make sure that you give the interpreter the opportunity at the beginning of the appointments to do what we call it our pre-session. So that's when we introduce ourselves to the family and then we just kind of set the ground rules. So the ground rules that I always try to say to families when we walk into a room is that everything said in the room will be interpreted and everything will remain confidential. And it's important for me to set that out because for one, I want them to know it's going to be confidential. That way they feel free to share all the information that they need to share in order for you guys as providers to provide them with the best care, and then also to let them know that everything's going to be interpreted because as you mentioned earlier, everything said in the room will be interpreted.

So if the mom scolds the child in the room in front of you guys or threatens them that they're going to get a shot if they don't behave well, I'm going to interpret that, for you as the provider. Or you know, if there's two providers in the room and they're discussing something that's affecting the patient, I'm going to interpret that for the patient.

So it's just important for everybody to know that everything that is said in the room will be interpreted. And if you don't want it to be interpreted, don't say it in the room. So I think it's just generally that of giving the interpreter space to be able to do their job.

 When you're working with an interpreter, being mindful of trying to keep your sentences short or kind of to complete thoughts, trying to think before you speak rather than think as you speak and kind of reducing some of those colloquialisms or, or turns of phrase that might be lost in translation and just kind of being respectful of knowing that somebody else is going to have to memorize quickly and then repeat what it is that you're saying in the other language.

Host 1: I have some colleagues that will say, tell the family this. And I'm like, you don't need to say that. Just talk to the family. And then they will interpret what you say. Because if you say, tell the family this, then they have to say, tell the family this and interpret it that way. And the other thing that I noticed too is that I feel like I'm pretty good at, you know, doing small short phrases.

I've done this job for so long that I kind of know where to break it up when I am working with an interpreter. But I often wonder if you guys coach the families to leave them in short sentences as well, because I'll have a family like ramble off into a whole this sounds like a page paragraph of things, and I'm like, how does the interpreter remember everything that was just said?

Paul Spacek, Senior Medical Interpreter: Yeah, practice and experience. So like, when I'm ever, I'm teaching new interpreters, I always say when you're listening to someone tell a story, don't try to memorize everything that they're saying, but just pretend that you're talking to a friend and that your friend's telling you a story.

Because often if you're just listening and engaged with someone that's telling you a story and then you were to turn around and try and tell that story to somebody else, you would probably get most of the details of the story if you were really interested in really listening, even though you weren't like intentionally trying to memorize it.

So that's something I think about. And then also just like familiarity with subject matter helps because if somebody's talking about, you know, like, I don't know the general stuff you guys talk about in ENT. Like I've heard it a thousand times, so I know I have schema in my brain for it and then it fits maps onto it pretty easily and I can keep a lot more in my mind at a time.

But you are right, that sometimes we do try to guide families. One, of the biggest ones I think about is like conceptions of time. So I know that, you know, in Western medicine we have very discreet concepts of time. We think in seconds, minutes, hours, days, weeks, and a lot of our families have more kind of abstract conceptions of time.

They think of little bits, a while ago, every so often. So I've kind of learned over the years, when I'm doing newborn appointments and the doctor asks, how often is the baby eating? I know if I say, how often is the baby eating in Spanish? The mom's going say, oh, every so often. So I've learned to kind of adapt and I will instead say in Spanish, how many hours in between feeding. That way they'll tell me two or three because I know that's what the provider is wanting to hear that more discrete answer versus the abstract answer.

Host 2: Oh, that's funny. I often think when you guys are in the room with us, especially the ones of you that I've worked with for years and years, I just, I want to be like, oh, just go and ask them everything that you know, I'm going to ask them because I already know that you guys know exactly what I'm going to ask them. Don't you feel that way sometimes, Paul?

Paul Spacek, Senior Medical Interpreter: Yeah, definitely. I, I've had providers tell me that too, of like, you know, you could probably conduct some of these appointments on your own. I'm like, yeah, the really cool thing about what we do is, you know, I've been a fly on the wall for literally thousands of pediatric appointments over the years. And the other thing is like, I think we're the only ones in the health system that can say this. I've been in literally every clinic throughout this entire health system. So I've been in every clinic here in Broadway, every clinic there in Adel Hall and probably every clinic in Kansas. So I've literally seen and worked with every specialty and, and in every area of the hospital.

So that's why I love the job, is it's, it's so fascinating. Every day it's something different. It's something new. Even though I've been here for 10 years, I'm still learning new things every day. I'm seeing new things, encountering new challenges, and it's really exciting to get to be there and, you know, observe so many awesome people here in the hospital doing so many amazing things.

Host 1: You guys hold us accountable too.

Paul Spacek, Senior Medical Interpreter: Yep. Yep. That's a skill that we learn of just like when I'm in the room, I kind of joke that we're like Terminator, that I'm constantly analyzing the situation and trying to see like, is what they're saying, does it make sense for the situation? Is what the parent's saying, is that contradicting something that they said 20 minutes ago?

What are the dynamics in the room between the different people? I'm constantly analyzing and processing and thinking, how can I make sure that what we're saying is accurate? Correct. That it makes sense those kinds of things that maybe someone from the outside doesn't realize, but that's what we're doing constantly.

Host 2: And I think this all leads into why it's so helpful to have that in-person interpreter and how you I know we had wanted to kind of talk about some challenges of future access to language just as we do have so many other languages besides Spanish speaking. So I just wonder if you could talk a little bit about what challenges you see for the future of access to different languages.

Paul Spacek, Senior Medical Interpreter: Yeah, definitely. One of the big trends in medical interpreting is kind of the growth and proliferation of video remote interpreting and phone to some extent. But video is really the big one, and it was kind of already coming, but the pandemic just really accelerated all of that. You know, I feel really blessed here at the hospital that we kind of already had a plan for how we were going to try to integrate video remote interpreting when the pandemic came to pivot and kind of start doing the micro call center where we can really incorporate our staff. That way we wouldn't have been in a position where like some other institutions started laying off staff and then moving towards a more like video only model.

But like any technology you get to when it first comes out, people think, oh, this is the greatest thing and let's use it all the time everywhere for everything. The next step is figuring out when is it appropriate to use what modality or what technology for what types of situations.

In our hospital, we'll get calls from the inpatient unit for video, for Spanish, and sometimes it's just to give a quick update to the family or help the parent, you know, order lunch for their child. And for those kinds of things, it's totally appropriate to, to call over a video because I remember in the past we would walk all the way over to the inpatient unit and then be there for less than five minutes, then walk all the way back to the office.

And that wasn't necessarily the best use of our time. So, for things like that or also allowing us to be able to service all of our satellite clinics, Wichita, Topeka, Joplin, all these different places. East North, Village West, Blue Valley, all of these different places have the Marty devices and we can, field calls from our desk with our staff.

Works great for that type of situation. But now we're starting to get into a trend where sometimes, people will call us on the video for a teaching in the inpatient unit that's planned to last like an hour and a half when there are in-person interpreters available, or sometimes they'll call us from the ER for, you know, a sexual abuse exam over the video when it maybe be more appropriate to have somebody in person.

 It's that next step of figuring out what is the best way to help this patient in this circumstance at this time. And a lot of that is just getting people, providers to be able to think from the family's perspective and think empathetically. I think a lot of times, because I think if you getting an hour and a half teaching about how to care for a trach at home, or how to care for your child's G-tube, you would probably want somebody in-person rather than somebody over a video helping you explain that. But if you've never taken the time to think about what it's like to be in that position, and you're only thinking about, well, if I press the button, it's fast, versus if I push an order, it might take 10 minutes for someone to get there.

That's going to lead you to making a decision that may not be the best for that patient and that situation. So that's what I always encourage providers to kind of take that moment to think about. Given the situation, given the time, given the resources available to me, what's the best way that I can try to help this patient in this circumstance?

And if you ever need guidance for that, you know, you can always call our office and we'll be happy to help you or help troubleshoot. Now to the second part of the question of, you know, incorporating other languages, that can be difficult because before the pandemic, we used to bring in interpreters from agencies, from all sorts of different languages. All the time, we were bringing in interpreters from other languages into the hospital that worked as contract interpreters through these agencies.

And just a lot of that post pandemic has really dried up and has switched to video and and phone. Now, part of that is because a lot of interpreters maybe for a period of time didn't want to come into hospitals because they didn't want to risk exposure and really doing video was a safer way to be able to provide those services to families.

But now as we start to move into this post pandemic world, and I don't know, it feels weird to even say that, but we need to start thinking about how can we find that right balance of, what are the things that it can be appropriate to use a video for, but then what are the things that, you know, it's really important to try to work with our coordinator, work with our supervisors, and we have those people in our department that can help troubleshoot those problems.

Help you figure out the best way to try to, to help a particular family, in a particular circumstance to see is it worth it to try to get somebody in-person to do a complex teaching for, you know, a family in the NICU or for this follow-up appointment, can it be fine to just set up a phone call or to set up a video in advance, but to make sure that we get the right language or the right dialect for that particular family?

Because sometimes if it's the more rare things, it requires some coordination on our end before time to make sure that someone from that language will be available at that time, when you call. So a lot of times it's just taking that extra time to think about how can we best help this family, rather than just doing what might be quickest, easiest, or most convenient for us in that moment.

Host 1: It's getting that human connection. I think that's what keeps going through my mind and having that, that human connection and really kind of bringing it full circle. And then my head starts spinning into, oh, we need learning modules and we need to get this implemented in different, conferences and educational purposes and things.

So you have provided a lot of information today in my, in a lot of good helpful hints and, and tips that I'm excited to share with the world with our podcast. So thank you so much for your time today, Paul. We've greatly appreciate you.

Paul Spacek, Senior Medical Interpreter: Oh, of course. Thank you guys very much for having me.

Host 2: Paul again, so awesome to hear you talk about so many of the things that you've shared with us and honestly, so many of things I didn't know about or didn't really realize or take the time to think through. So I appreciate it so much. We like to end each podcast episode with the same question, so we're going to ask you this question. We've asked everybody in our third season this question, so it is, in what way do you love to encourage your colleagues.

Paul Spacek, Senior Medical Interpreter: I love that question and again, you know, thank you guys very much for having me. Like I was mentioning earlier, you know, we have the unique privilege of working with so many different providers throughout this hospital system and just that experience has made me so proud to work here because there really are so many just wonderful, passionate, amazing people that do come here every day and do this work. And so I really try to make a point when I work with a provider that I can tell is going above and beyond to maybe after the appointment, make a comment to them or say something to them and let them know, or if I think it's really special, like go on to the scope and do an extraordinary every time for that person, provide that encouragement because, I think for a lot of times it just becomes day to day for a lot of us.

But I can see when someone is, is really passionate about what they're doing and when the work that they're doing is really making a difference. And I think it can be so encouraging to just hear from your colleagues, receive that respect, to be known, to be seen. Because I think about all these little things. Just like I remember one time, several years ago, I was working in the NICU and helping this nurse do a discharge for a very complex family. This baby had microcephaly and lots of other complex things and I remember this nurse was very busy and very flustered. We were trying to discharge the family, and she's like, oh, we need a wagon to take their stuff.

And I didn't have anything else pending at that moment, so I just went up front and I grabbed them a wagon and brought it back. And I didn't realize the impact that that made for that nurse that she'd had such a stressful day. But like a week later, she came by my office and brought me a card and like a candy bar and like, you know, those little moments that makes you realize like, the difference that you can make just by going out of your way to do something little to try to help somebody out, because we're all part of one big team here trying to provide the best care that we can for, for kids and their families. So I think the more that we can do to build each other up and push each other forward and really provide that encouragement, it's just going to amplify everything and, and result in better care for our patients and families.

And, and that's what we're all here for and that's what we're all super passionate about. So I just love being in this environment where we're all like pushing towards that same goal.

Host 1: Paul, it is a true honor to spend my morning with you and, and do this podcast. You are definitely extraordinary and Children's Mercy is blessed to have you. So thank you so much for spending your day with us.

Paul Spacek, Senior Medical Interpreter: Thank you. I really appreciate it.

Host 1: If you have a topic that you would like to hear about or you are interested in being a guest, you can email us at tdobrien@cmh.edu or twilliams@cmh.edu. Once again, thanks so much for listening to the Advanced Practice Perspectives Podcast.