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Parlez? Habla? Sprechen? Flisni? In New Hampshire?

Any hospital that accepts federal funds must provide translators for patients with limited or no proficiency in English. That's a hard enough requirement for hospitals in urban areas to meet. But for DHMC—one of the country's few rural academic medical centers—it takes more than a little ingenuity.

DHMC's Office of Care Management is regularly called on to find translators for non-Englishspeaking patients, says Michele Blanchard, a senior care manager. The department maintains a list of local speakers of languages ranging from Arabic, Bosnian, and Croatian to Farsi, Swahili, and Turkish. (The title above includes the second-person plural form of "speak" in French, Spanish, German, and Albanian.)

Biggie: "It's becoming more common for us to need a Laotian speaker," Blanchard says, "in addition to Spanish, Italian, and Polish, as well as Chinese, German, Hindi, and French. French is a biggie," she adds, due to the sizable Franco-American and Franco-Canadian population in northern New England.

DHMC recruits translators from all sorts of sources. "Usually, the care provider calls us, and I fax them a list of available translators," Blanchard says. "Everything depends on the circumstances. We first try to find an employee. . . . If that doesn't succeed, our next option is Dartmouth College—we call and ask if there are any students from the patient's home country."

In one case, a DHMC employee has become an integral part of an overseas patient's health-care team. Angela Hall, a researcher in the DHMC development office, is a native of Rome. Last year, an Italian cancer patient came to DHMC to see radiation oncologist Eugen Hug, M.D., who had overseen her care at Loma Linda Hospital in California before he joined the Dartmouth faculty.

The patient "followed Dr. Hug to Dartmouth," says Hall. "Now that she's home in Italy, she has all her follow-up tests— MRIs, body scans—done there. Her doctor in Italy writes a report and sends it here. I translate the report for Dr. Hug, and then I translate Dr. Hug's response back to [her] and her doctor."

Case: In another case, Hall served as translator for a woman from southern New Hampshire who came to DHMC for a consultation. "The woman's husband spoke English, but the doctor thought it was very important to make sure the woman herself understood the importance of certain things," says Hall, who also speaks German.

Any other languages? "Only three," Hall responds in faultless English. When someone as linguistically adept as Hall is not available—and not even the melting pot of an academic community can provide the appropriate skills—Care Management uses a commercial language line, an 800 number that connects callers with a translator.

Megan McAndrew Cooper

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