Gladys Muñoz, a hero to local farmworkers
By Linda O’Neill
Sun contributor
At 3 in the morning through an August downpour, Gladys Muñoz is on her way to the Munson maternity ward. She is not about to deliver a baby but her presence there is desperately needed. A frightened young farmworker woman who speaks no English is in labor. Gladys will remain with this woman through labor and delivery, interpreting for her all that the doctor or midwife and nurses are saying and encouraging her to ask questions and make decisions.
Providing a sense of comfort and security to a person in need comes naturally to Gladys. Her parents, a pediatric-cardiologist father and a dietitian mother, taught her the challenges of “doing justice”. While stationed at a military base in Japan, Gladys noticed the differences separating people of various religious and cultural backgrounds. She developed a heightened awareness of the communication gap between pregnant American military wives and Japanese doctors. In northwest Michigan these same pervasive problems occur with Anglos and Hispanics, making it hard to communicate across the void of separate languages and cultures.
As Director of Language and Cultural Diversity at Northwest Michigan Health Services in Traverse City, Gladys is faced with the momentous task on being on call as an interpreter 24/7 and also training and placing bilingual interpreters where they are most needed. From NMHS, better known as the
Farmworker’s Clinic, at the base of Morgan Hill (M-72 west), interpreters are sent out into migrant camps, emergency and delivery rooms, and private medical offices in the five counties this health entity serves. In 2009 the clinic responded to 174 people (some with multiple visits), resulting in over 500 hours of interpretation. In a Michigan network of 31 federally funded health centers, NMHS is the only center to teach medical interpretation.
Northwest Michigan Health Services has been the medical home to the farmworking community for over 40 years. During the growing season the Farmworker’s Clinic is open five days a week. On staff are a nurse practitioner, two midwives, a pediatrician, and an internist. Fees are on a sliding scale to ensure affordable services. “It is a misconception that you have to be Hispanic and migrant to be seen at our facility,” said Gladys. “Anyone who has worked in the past two years in seasonal agriculture, together with his or her family members, may utilize services.”
With her years of teaching experience and University of Arizona training as medical interpreter, Gladys has organized basic training sessions for NMHS staff and offered medical interpretation classes through NMC Extended Education program. This spring she taught two courses. One was a 10-hour Basic Skills in Medical Interpretation class, which focused on national standards, ethical dilemmas, medical terminology and cultural sensitivity. The second class was a two and a half hour refresher course for those who had already had some interpreter training but wanted an opportunity to practice more, meet other interpreters and share ideas and concerns while sharpening their skills.
Cultural sensitivity is critical to healthy outcomes. This sensitivity not only refers to ethnic differences but is multi-faceted and is necessary to understand a person’s reality of life. Gladys reminds her students to “Always ask for clarification”. She shared a few examples. “A basic word like “angina” is widely used by the Mexican community to describe a sore throat whereas among our medical practitioners the word refers to heart pain. Imagine the havoc that can be created by the misunderstanding of a simple word.”
In another example, Gladys explains, “A patient with a serious wound was about to be discharged from the hospital. Instructions on how to keep the wound clean were clearly explained, but until the interpreter broached the subject, the doctor as well as the hospital personnel did not understand that the man’s wound would certainly become infected if he were sent back to the inadequate migrant housing where he was staying. The Farmworker’s Clinic, together with a social worker, was able to arrange for clean housing with running water for the patient to live in while healing.”
On yet another occasion, a woman was told by a doctor that she needed surgery to remove her gallbladder. Her brother was used as an interpreter. The family was too ashamed to say they did not have money for the surgery. The patient did not return to the doctor’s office. Two weeks later this woman ended up at the ER needing emergency surgery. Gladys was called to interpret. “When I asked why she had not returned to the doctor’s office, the woman explained to me the problem of payment. With help from the hospital social workers, a payment plan was set in motion, cheaper or generic medication was offered for the prescriptions, and a better understanding of the medical condition, follow-up, and care was explained. An opportunity was given for the patient to ask questions and receive appropriate answers. Respect for her confidentiality was also assured.
“Without a properly trained medical interpreter it is enormously difficult to assist and support the most underserved population in our midst.”
One story poignantly illustrates the pressing need for cultural sensitivity. Some time ago, Gladys was assisting a young woman with her doctor’s appointment at Munson Hospital. After an initial consultation, this woman was handed a hospital gown and asked to remove her clothes. The patient, who had fled for her life from the civil war and death squads of her native country in Central America, quietly turned to Gladys and asked in Spanish “Are they going to kill me?” In her country, victims’ clothing was removed before an execution so that it could be reused. Gladys assured her that the hospital was a place of healing, not harm.
It is intimidating for most of us to visit a doctor in the first place. Add a language barrier and the need for patient advocacy is clear. This service assures that a provider will explain all aspects of the medical condition and follow-up, while allowing the patient the opportunity to ask questions without pressure and with confidentiality maintained. Dr. Robert Foote, O.D. says. “Gladys and her volunteer interpreters are frequently invaluable in my proper diagnoses of patients and in the precise prescribing of medications. With their help we are assured of a positive outcome.”
Many migrant workers are disheartened when they cannot find a ride to a clinic. In 2008 Michigan passed a law forbidding non-Michigan residents to obtain a driver’s license. This law was eventually changed for out-of-state students but not for migrant workers. When necessary, Gladys and the farmworker clinic can help to coordinate rides.
In the face of many difficulties, Gladys remains upbeat and optimistic. The medical community is grateful for her services, as are the laborers who help harvest Michigan’s abundant produce. These workers help foster the survival of agricultural, Michigan’s second largest industry.
Gladys Muñoz has a commitment to and solidarity with the farmworking community that remains ever strong. As a professional woman with a Bachelor of Science plus a Masters of Science in Administration, Gladys strives to represent the Hispanic community with dignity and pride. To contact Gladys about services or volunteering, call (231) 947-1112, ext. 221, or email jpac3(AT)juno.com.