Mutual Unintelligibility: A Personal Letter on Medical Interpretation and Healthcare Equity

Student’s contest-winning essay documents a grandmother’s experience in a healthcare system where no one spoke her language.

SCOHP winner Elaijah Lapay

By Elaijah Lapay

Published September 30, 2021, last updated on October 1, 2021 under Commentary

This essay won first place in the healthcare opinion category of the Student Collaborative on Health Policy summer writing competition.


I do not know if you remember falling in the kitchen in late March this year anymore, but the days and weeks that would follow your near-fatal fall trying to open the fridge door still burn in my mind like it was yesterday. Ma updated me then from my dorm as you deteriorated more and more, limped more in your walking, seemed to make less and less sense with your words in Bisaya, the only language you know. Ma knew something was wrong, but voiced her reluctance bringing you to the hospital: COVID was still raging, but even more so, she was worried about how you would — how you could — be cared for, not speaking English and worried about the cost of being uninsured in this country. Then, a few days after your fall, Ma said she looked into your eyes, saw the bruises developing underneath your eyes, and realized she could not wait any longer. She had to bring you to the hospital, and face what may come.

When I came back home temporarily to help take care of you after your discharge, Ma crumbled, crying about you, mixing between English and Bisaya sobbing about you and your treatment.

It was ironic to me how even though Ma worked in the same hospital as a nurse, it was difficult to take care of you the way you deserved. Yes, COVID precautions made things difficult, but even from the very beginning, it became evident that language and cultural barriers were going to be the hardest thing for you and Ma to face, communicating among doctors and nurses about you and what happened. Ma made clear early on that you only spoke Bisaya, a language the doctors and nurses had ever even heard of before; it took too long to get a Bisaya medical interpreter. Ma had to provide the best interpretation service she could for you at that moment.

Even from the very beginning, it became evident that language and cultural barriers were going to be the hardest thing for you and Ma to face.

I love Ma, but even though she is a nurse here in America and was in the Philippines, she is your anak, your daughter, first. I felt the release of trauma Ma felt — simultaneously stressing over your health and interpreting for you — when I finally got back from college and she collapsed into my arms and cried. She did not deserve this. You did not deserve this.

As your stay in the hospital progressed, eventually qualified medical and non-familial interpreters were paired with us over the telephone, but none spoke Bisaya. They first paired us with a Spanish interpreter, the only qualified non-English medical interpreter in the hospital, because you “looked the part,” then after realizing the mistake, they gave you a Tagalog medical interpreter over the phone. However, even though Tagalog may be the “majority dialect” of Filipino spoken in the United States, it is not mutually intelligible with Bisaya, which you speak. During your entire stay, you were never given a medically qualified Bisaya interpreter; Ma would provide all your interpretation in the end.

One thing that no over-the-telephone interpreter could help with, though, was the isolation you endured when care partners and nurses simply had no way to communicate with you over when and what to eat, when and where to use the bathroom. I remember Ma feeling like she had to have her phone ready 24/7 in case someone called her to interpret to tell you what the food was, why you had to eat, what the latest doctor was telling you, and so on. If Ma was not a nurse and was able to visit your room periodically to feed you herself, caressing you, whispering to you comfort in Bisaya as she fed you — like you did when I was sick as a child — I do not know how you would have been able to make it. You have been through more than I could ever endure, and none of it you deserved.

You came to this country to raise me while Pa and Ma worked to support us. I am the reason you have had to endure years in a place that does not know how to handle you, simply because you happen to come from a place where the language you speak — your lived experience — is not one stored in the interpretation services catalogue in Eastern North Carolina. I feel guilt for the same reason Ma felt guilt caring for patients in a hospital knowing her own mother was not able to be held to the same standard of care as other patients simply because she did not know English: that your autonomy, your humanity, was unable to be recognized beyond a language barrier that the hospital — not Ma — had a legal responsibility to care for. You are, after all, entitled in this country to language assistance services which are “accurate and timely, protect patient confidentiality, and...provided by qualified interpreters.”2

What you experienced in March of 2021 clearly did not meet this policy promise. But even current health policy in language equity seems not to address beyond the need for equitable care beyond verbal conversations, and into the sort of cultural competency care for patients like you who are not used to “American food” or being surrounded by those unlike yourself culturally. The current de facto system of relying on family members like Ma places more stress and trauma than ever should be expected of a family already going through the worry of placing a loved one in the hands of a hospital. Furthermore, just because you are of a “minority” language and culture in this country, that does not mean that you should lose equitable care or your autonomy. I hope to use my voice to help those like you, Lola, the immigrants and migrants in this country whose struggles live on, silently in hospital beds, in trauma of worried family members, and in words only we seem to understand.


Imong apo3

Your grandson



1Lola is the Bisaya term for grandmother.

2Ensured in part by Title VI of the 1964 Civil Rights Act, Executive Order 13166, and Section 1557 of the Affordable Care Act (ACA). For more, see Jacobs, B., Ryan, A. M., Henrichs, K. S., & Weiss, B. D. (2018). Medical Interpreters in Outpatient Practice. Annals of Family Medicine, 16(1), 70–76.

3Bisaya for "Take care"