How COVID-19 Has Changed an Already Remote World
By Sarah Stockler-Rex, CHITM andTatiana Cestari, PhD, CHITM

This piece is the sixth in a series, written by Cloudbreak Health’s quality, training and advocacy leaders, that discusses medical language access and related topics.

In our last installment, we discussed the many elements that go on behind-the-scenes to make a Video Remote Interpreting (VRI) session possible. As a pioneer in VRI, Cloudbreak Health is uniquely qualified to take on changes in remote communication, but the last year has presented so many rapid changes that the industry itself has had to quickly adapt. If one detail of VRI changes, such as the provider’s location, it can and will affect the rest. During these unprecedented times we’ve seen all support systems being impacted by the rise of, and changes in, video remote interpreting. In this volume, we will explore the new normal in VRI and how COVID-19 has changed an already remote world.

Who’s remote?

Gone are the days of remote interpretation encompassing a single configuration. In this context, configuration refers to where the healthcare professional, the patient, and the interpreter are physically located with respect to each other. In the past, the interpreter was likely the only participant remotely joining a VRI session. Now, patients and providers often remotely join VRI sessions as well, maintaining safe distance from one another. Enter the telehealth solution: all parties have the option to join remotely from different sites, even if this means the provider is joining the video session from just down the hall .

The healthcare provider is no longer the only party who may join from “down the hall.” As our new normal takes shape, we’ve seen new opportunities for collaboration. One example is our partners’ ability to monitor patients remotely using our inpatient platform, Cloudbreak Telemed. Another example is our partners’ onsite interpreter teams utilizing our platform to interpret at a safe distance. Cloudbreak’s inpatient platform not only allows language access at every point on the continuum of care, it preserves the place of the valuable onsite interpreter who has already built rapport with their patient community and hospital staff (more details here https://www.cloudbreak.us/2020/12/14/developing-inpatient-virtual-care-strategy/ and https://www.cloudbreak.us/2020/12/04/inpatient-virtual-care-2/ ).

A Shift in Modalities and Perceptions

 More patients who are culturally and linguistically diverse and who may need language services, including Deaf/Hard of Hearing communities, are requesting a remote interpreting modality specifically to avoid the risk of exposure to pathogens. We know that certain ethnic minorities in the U.S. are disproportionately affected by COVID (NYC Health, 2020), therefore, remote language access solutions are more important than ever for Limited English Proficient communities.

Remote Spanish interpreter, Ana B., has noticed a shift in perceptions since the start of the pandemic: “...interpreting services via remote access have been more accepted. Before the pandemic, once the [onsite] interpreter arrived, a provider will end the session after asking the patient. Now, if possible, they’ll try to keep the session with us as it is safer.”

Ana also shared about interpreting for a couple whose baby would be stillborn:

The providers were patient with repetitions and pauses between sentences to, in the end, make the process of such loss as best possible for them [parents]. It was like a mutual unspoken understanding between me and them to help the patients. And one of the reasons why I love this job.

Changes in an Already Remote World

Going remote is not a one and done solution. COVID-19 has brought with it new challenges for participants such as sound quality issues created by outdoor, open air, or drive-through testing sites. Additionally, there are a myriad of settings from which patients may answer virtual visits, some less ideal for interpreting than others (per our interpreters: laundry mats, while driving, or simply at home with the noise of household members, human or otherwise). Despite these challenges, patients, providers, and interpreters have adapted and are grateful to have access to remote communication in these settings.

Ana went on to share her own experience of gratitude:

The other day, I was able to provide [remote interpreting] service to an older man who was anxious to go home after surgery and with the Third-Party call option, we were able to call his wife and give him peace of mind while updating his wife on his condition. The providers didn’t know about this feature, which made communication easier and clearer. In the end, everyone was appreciative for the smooth process, which in return I was grateful for.

COVID-19 may have been a novel topic less than a year ago, but it is now present in almost every interpreted session. Consequently, interpreters have had to have more and more debriefing sessions to deal with the toll of the pandemic. Some of our interpreters shared how the new normal has impacted them and the patients they work with.

Natasha D., remote interpreter, comments: “I interpreted for a pregnant mom who was told that she had COVID-19 the same day she was delivering the baby. The father of the baby had to leave as soon as the baby was born; therefore, mom was going to spend the first hours of postpartum without dad present. I felt for them because I’ve been in these calls before and during this time is when they take pictures, they are told about the weight and they start bonding with the baby.

Another interpreter, Mariana N., shared her experience interpreting for a daughter whose father was going to be disconnected from the ventilator due to COVID having worsened his other preexisting conditions. “If he was disconnected from the ventilator, he was going to die… there was nothing else left to be done.”

The pandemic deeply affects interpreters. We have heard comments like “I don’t feel comfortable hugging my parents because after interpreting so much about COVID, I’m afraid to risk their lives.” But as time progresses, interpreters are also becoming increasingly desensitized to COVID’s impact.

Our body is designed to protect itself with a variety of responses, including desensitization and resilience: “Resilience involves active and unique biological processes that buffer the organism against the impact of stress, not simply involve a reversal of pathological mechanisms” (Feder et al., 2019). While some desensitization is natural, it shouldn’t be taken lightly. Interpreting is an emotional endeavor, and interpreters share the same mental toll as other frontline workers during the pandemic. It’s important to develop self-care strategies and coping mechanisms when you’re immersed in emotionally heavy interactions. Some of our interpreters shared that they set times for themselves in which they won’t tune into the news, they enjoy hobbies and activities such as board games, or simply talking to loved ones about topics other than COVID.

If there’s one thing COVID has confirmed, it’s that we can adapt and continue to innovate no matter the scenario. Though there is hope of a return to life before the pandemic, many of these changes are here to stay. At Cloudbreak, we believe language access should be anywhere patients are, and VRI has made that the new normal.

References

Feder, A., Fred-Torres, S.M., Southwick, S., & Charney, D. S. (2019). The Biology of Human Resilience: Opportunities for Enhancing Resilience Across the Life Span. Biological Psychiatry, 86(6), 443-453. https://doi.org/10.1016/j.biopsych.2019.07.012

NYC Health. (2020). Age adjusted rate of fatal lab confirmed COVID-19 cases per 100,000 by race/ethnicity group. Retrieved 16 April 2020 from: https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-deaths-race-ethnicity-04082020-1.pdf