In the Salinas Valley, small farm towns like Soledad and Greenfield dot highway 101. Most farmworkers here are from Mexico, and an increasing number are indigenous people from Oaxaca and other Mexican states. In fact, almost one quarter of all indigenous Mexicans in California live in this region. They speak languages like Mixteco, Zapoteco, and Triqui. If they speak Spanish at all it's as a second language. That can create complex language barriers in work, school, and healthcare.  

Petra Leon lives in Castroville and picks strawberries for a living. She's one of more than 20,000 indigenous people from Mexico who live in the Salinas Valley. She says, at the medical clinic closest to her, no one speaks her language, Mixteco, and she doesn't understand a lot of the things her doctor says.

But at Natividad Medical Center in Salinas, Leon is joined by Angelica Isidro. Isidro speaks Mixteco and Spanish, and is a key part of the hospital's new language interpretation program.

Petra Leon is pregnant, and she's planning on giving birth at Natividad. Dr. Peter Chandler shows her the labor and delivery unit.

"I'm the director of the unit here," Chandler says, "and I'm just really happy you chose to have your baby here."

To bridge the language gap, two interpreters join doctor and patient: Mixteco speaker Angelica Isidro, and Language Access Coordinator Victor Sosa. He oversees all interpretation at Natividad. These four do sort of a language relay: Dr. Chandler speaks in English, Sosa interprets that into Spanish, Isidro interprets that into Mixteco. When Leon answers in Mixteco, the relay goes in reverse.

Chandler says interactions like this help build trust. He can answer any questions -- and address potential emergency situations like Caesarean sections -- well ahead of delivery.

As a safety-net hospital, Natividad cares for patients regardless of their ability to pay. Indigenous Mexicans make up only about 2% of the hospital's patients, but Chandler says when he came here six years ago, every once in a while he'd be in an emergency situation with an indigenous patient, with no way of communicating.

"You can imagine how stressful that is," Chandler says. "It really pushed us to say we need to do something."

Many hospitals will pull in people with language skills when they can, but what Natividad started a couple years ago is unique: they collected specific data about patients and language use, they made real ties with indigenous community leaders, and they gave indigenous speakers 40 hours of formal training in interpretation. Now they have a network of 35 trained indigenous interpreters, and have 30 more people they can turn to in a pinch.  

Funding for the program comes from community and family foundations, and from the area's successful farm families. John D'Arrigo is a third-generation Salinas Valley farmer. He's been noticing a greater influx of indigenous Mexicans over the last decade.  On a tour of Natividad, he learned of the need for medical interpretation in indigenous languages.

"I had never even heard of some of these languages," he says. "Now I'm finding that they're actually thousands of years old."

Standing in his vineyard outside of the town of Soledad, D'Arrigo says there's a major labor shortage here, with the children of his farmworkers aspiring to more lucrative jobs. He rallied other farmers to fund indigenous interpretation training and services.

"They are our future," he says. "We survive on the work that they do for us.  We have to take care of them, it's a social responsibility."
 
Because these indigenous languages are regional, when a patient comes to the hospital's registration office, they can point to where they're from on a map of Mexico, and staff can narrow down what language they might speak. It can get even more complicated, though: each language can have dozens of different dialects.  Interpreter Angelica Isidro worked with other indigenous interpreters to map out which townships might speak which dialects.

"When the patient was identified as being from a certain town, she says, "we'd have a pretty good idea of what dialect they spoke."

According to Victor Sosa, the program is as crucial for cultural interpretation as it is for language. He remembers going to labor and delivery with an interpreter to check on a young Mixteco mother. The nurse was worried that the mother wasn't bonding with her child, and was hesitant to discharge them.  The new mom would hand the baby back to the nurse as soon as she breast-fed, and didn't soothe the baby when she cried.  The Mixteco interpreter stepped in to explain.

"In their culture, when new mothers deliver, they're treated like queens," he explained. "The mother-in-law and extended family comes to cook for the new mother and care for the child. She's in bed all the time."

The hospital staff is learning about their patients' traditional healing practices. Other medical centers are recognizing Natividad's work. Victor Sosa says he gets calls from hospitals in New York, Indiana and Florida, hoping to find someone who can help doctors communicate with their indigenous patients from Mexico.
 

Salinas Hospital Trains Interpreters to Serve Immigrant Population by KQED_News