Laura Cranston CHI, CMI-Spanish, is the Supervisor of Interpreter Services for CentraCare Health in Minnesota. After studying biology and Spanish in college, she went on to work as a Spanish interpreter for 12 years. Her passion for overcoming disparities and creating positive experiences for minority communities led her to take a role at CentraCare where she could make an even bigger impact. We sat down with Laura to discuss unique challenges for the Minnesota health system, equity challenges in vaccine distribution, and how care should be brought to patients, not the other way around.
CBK: The pandemic has really challenged your team to change the way you provide language access. Can you talk more about that?
Laura: This pandemic has really struck a chord in central Minnesota, and we had so many LEP patients who needed interpreter services. Back in March, zero interpreters wanted to come into the hospital or clinic. We already struggle to get in-person interpreters sometimes and due to the pandemic they were scared to get the virus. We have eight hospitals. Some of them are smaller town hospitals, but those are critical access hospitals because they’re often the closest hospital within an hour from the patient.
CentraCare is really technologically savvy, for being rural Minnesota, because our system is so spread out. Each of our units has bedside iPads, and we worked to get Cloudbreak Martti onto those devices. Even in our clinics we worked to get the Martti video services up and running for our virtual visits so providers in the clinics could bring in interpreters.
CBK: So you had to change not only how you provide language services inside the hospital, but also start providing services outside of the hospital with things like telehealth visits?
Laura: Yep! In the beginning, I had interpreters on site at our COVID testing locations. At our regular testing location in St. Cloud we had an interpreter there daily for the first six months, and now we have a Martti there because we can access an interpreter for any language. It’s hard to pay somebody to be there all the time if there isn’t a need for their language. At the vaccine clinic we also have a Martti so that as patients are coming in for the vaccine they’re able to get information and ask any questions.
CBK: CentraCare recently also leveraged their existing digital infrastructure to support language services with Martti at the bedside. How has that helped the patient experience for your LEP population?
Laura: We added Martti to something like 240 devices. Each unit has bedside iPads that allow patients to log in to their MyChart to review test results. There’s also entertainment like Netflix and Hulu. Being in the hospital for 5 days it can get really boring, especially if you don’t speak English you can’t watch the basic cable that’s available on the hospital TV.
Now with Martti, if a patient needs something, even at 2 am, they can call the nurse and then use their bedside iPad. Before, they’d be waiting for an in-person interpreter, and we wouldn’t know if one would even come to the hospital at 2 am. And sometimes it’s something simple like “I’m cold, can I get an extra blanket?” So it’s made that barrier almost disappear honestly, because there’s somebody available 24 hours a day. Instead of only having interpreters available for provider initiated communication, Martti gives patients the ability to communicate what they need at any time.
CBK: It’s so important to have interpreters available, especially during a scary time like this.
Laura: In our patient communities there’s a lot of misinformation about the virus and vaccines. Many of our patient communities are made up of immigrants and misinformation spreads quickly. We’re trying to derail any misinformation that’s coming out. I sent out information that our population health worker put together to our interpreter agencies so that interpreters are just as informed as our staff when it comes to the vaccine.
CBK: And you said your minority populations have been heavily impacted by the pandemic.
Because we’re in central, rural Minnesota, there are a lot of meat packing plants and that type of work that’s historically migrant work. That’s the kind of job you can do without having to speak English. When those plants were hit, it was 500 people at a time that were coming down with COVID from going to work one day. And those factories couldn’t shut down because they’re providing food. That was one of the hard things. That population was hit so hard because they don’t have jobs that you can work remotely. In those industries workers don’t have the luxury to take two weeks off to protect themselves.
CBK: And many minority populations have a historic distrust of the healthcare system. Has that been a barrier for you, too?
Laura: Oh for sure. Our biggest minority population is the Somali population. Overall they have a huge distrust in the healthcare industry, which has been a huge barrier. Our hospitals were pretty overwhelmed in the beginning. Many people, especially if they didn’t have insurance, waited until it was too late to go to the hospital. So they wouldn’t necessarily get tested, but once they were too sick to work then they would go to the hospital, and ended up in the ICU. The mortality rate has been crazy.
Editor’s Note: St. Cloud experienced one of the worst COVID outbreaks in the nation. You can read about it here.
CBK: Wow, that’s really difficult to overcome. How have you been addressing that barrier of distrust and misinformation in your community?
Laura: To try to re-educate after all the misinformation was super difficult. We provided education at the mosque, so we could kind of talk to more of the community than just trying word of mouth. We also had a provider go onto the Somali radio station. Any English local news channel wouldn’t necessarily reach that population. For our Spanish speaking population we also had a community health worker reach out to the population at her church and answer any questions. The people we send out are actually members of those communities. So then it kind of heightens that trust they have in the information provided. And I think that’s really helpful, when it’s somebody you might see at the Mosque every Friday. I think that makes the information more believable. So we’ve been working really hard to make sure those populations have that information.
We also ended up doing COVID testing in the parking lots of some of the businesses with large migrant worker populations like those meat packing plants. One weekend they tested 900 workers just in the parking lot.
CBK: Diversity in your staff is a really important part of working with a diverse population, to create those kinds of connections and representation.
Laura: Yes. We made sure to work with the imams at the mosque. And one of our nurses is Somali, so she’s been going out into the community to educate. We had a measles outbreak four or five years ago because of vaccine distrust. Now, we’ve had even more Somali providers come out and say “I’ll help with this because this is really important.” It’s been nice to see everyone grouping together to make sure the population is aware of what’s going on and trying to help.
CBK: It’s great to hear that your whole team is so involved with the community. They’ve had to adapt with a lot of change over the last year. Have you seen attitudes change around how you provide things like language access and education?
Laura: A lot of providers who previously had an aversion to video services or phone services were like “We still need an interpreter. So how do we use Martti, how do we get these interpreters into the COVID rooms with us?” It’s definitely helped our providers feel more comfortable using the virtual aspect of interpreters. You know sometimes it’s hard to find an in-walk interpreter in rural Minnesota. So you know when you need somebody you can get them over video, and that’s really great and our providers have really appreciated the ease of use of all the products offered. The app is super user friendly, so that’s been really helpful too.
CBK: What I hear again and again when I do these interviews is that the most important thing when you’re advocating for diversity and inclusion, for language access, is that you have to have buy-in from upper level leadership and cultural buy-in.
Laura: Yeah, we definitely do have buy-in. I’m technically in the Workplace and Patient Diversity department, so my director is obviously very passionate about it. My leadership is all definitely onboard with trying to decrease health disparities not just in our immediate area but throughout Minnesota. Just yesterday we had a meeting about trying to deliver vaccines into the more diverse population. A lot of current vaccine distribution rules don’t really apply to our communities and then those patients don’t have a chance to get vaccinated. For example, their birthdate on their paperwork is different from their actual birthdate, so it might be that their documentation says they are only 50 but they’re actually 60. Or, a lot of the patients might not have a picture ID which is also one of the requirements for the vaccine. So we’ve been trying to work around those guidelines to make it more equitable for everyone in the area. We have a task force working on it, just because we want to make sure that that community is not left behind like it was when COVID hit.
CBK: There are so many barriers to overcome to provide equity in care. And the inequities of the pandemic are definitely still present as we move into vaccine distribution. What other disparities have you had to address?
For our diverse community, many people don’t have access to a computer or internet, which means they can’t sign up for a vaccine waitlist online. We’re trying to set up a phone line that people can call to get on the waitlist. You have to realize that you might not reach everyone in the places you used to. Patients might not be able to get the information at their doctor’s visit if they’re avoiding the clinic. So that’s where we’re at too, trying to educate the community on the vaccine but also how do we get them on a waiting list, and then how do we get them into the vaccine clinic.
CBK: It must help to have interpretation available on-site in those vaccination clinics now. Has your job changed now that you’re supplying VRI in so many places in your system?
Laura: I feel like it made my job easier, honestly. It was really difficult to find in-person interpreters during the pandemic. Now, I have more time to focus on other important things because I don’t have to worry about sourcing interpreters. We’ve rolled out 30 new devices since July. It made my job less stressful. Now, I don’t have to try to find a Mandarin interpreter in 15 minutes in rural Minnesota.
CBK: Your job definitely sounds hectic, but I can tell you’re very passionate about your work. Your community is lucky to have you.
Laura: I feel like if I was in another country and I had to go to the emergency room, I’d want to be able to communicate. Being able to provide that for so many patients was really rewarding for me. That was something that made me really interested in continuing with this as a career. I’m a Spanish Interpreter by trade, but as a Supervisor I’m able to help even more communities. I feel like I can push harder for all those communities and be able to help more people than those who I interpreted for on a daily basis. It’s helped me in being able to think outside the box, but also in bringing those outside the box ideas to the organization.
CBK: Do you have any advice for other language access or diversity programs who are looking to make a big impact like you have?
I think the most important thing is to recognize the disparities exist. Just because you don’t deal with disparities on a daily basis doesn’t mean they aren’t there and aren’t a problem. I also encourage everyone to use all available communication channels. You have to reach your communities where they are instead of trying to make them come to you.
CentraCare Health utilizes Cloudbreak Health’s Martti to provide video remote interpretation. They have dedicated Martti devices available on-site in their hospitals, at COVID testing sites, and in their vaccination clinics. They’ve also pushed the Martti app to more than 240 of their bedside devices.