Camila, not her real name, struggled for five years in the U.S. without knowing English. As an immigrant from Guatemala, her native language is Mam, a Mayan language spoken by indigenous people in the country and rare to find in the U.S., much less Bremerton.
The greatest challenge was when she was pregnant with her daughter last year.
“I couldn’t understand the doctors and I couldn’t understand the language,” Camila said through an interpreter, Martitha May, chairwoman of the Kitsap Immigrant Assistance Center in East Bremerton. Camila agreed to share her story on the condition her real name not be printed. “I wanted to know about my baby.”
An even greater burden was she was alone. As a victim of domestic violence, she moved into women’s shelters when she was eight months pregnant and with May’s help, eventually moved in with an American couple who spoke only English.
Since the birth of her daughter, Camila has been learning Spanish and English to make her life easier.
But Maria Ines Gutierrez-Brown, an orthopaedic nurse at Harrison Medical Center and a student in Olympic College’s four-year nursing degree program, wants to make sure Guatemalan mothers like Camila get the information they need in their own language. She is creating DVDs in both Spanish and Mam that would teach new mothers and mothers-to-be how to breastfeed their babies and would be available at both the Kitsap Immigrant Assistance Center and Harrison. It’s an endeavor that could be expanded to other medical subjects, such as hypertension, diabetes, cholesterol and nutrition.
Gutierrez-Brown distributed a survey among Guatemalan mothers in Kitsap and found that most did not receive enough information about breastfeeding, but would like to know more.
“They are willing to learn. They’re receptive to everything that’s available,” Gutierrez-Brown said. “There’s just a language barrier.”
Kathy Bowers, a lactation consultant at Harrison, said many Guatemalan patients try to conceal their confusion out of politeness, which detracts from their learning.
“A lot of the moms I work with, in their culture, it is rude to question a medical authority and so they may agree or appear to agree with instructions,” she said.
Illiteracy is also an issue among many of the non-English-speaking patients, something that Gutierrez-Brown keeps in mind when putting together the instructional DVDs. The 20- to 30-minute videos will make heavy use of pictures along with the narration to help ensure they are understood.
Though Gutierrez-Brown hopes to distribute the DVDs to as many local hospitals as possible, the goal is to teach the mothers before their babies are born. At the Immigrant Assistance Center, May will use the DVDs to teach classes for the expecting mothers who come in.
“It’s important that there is no mistake with the language when it’s about the little ones,” May said. “Mothers need to provide all the needs for their babies.”
Camila, who is assisting in the project, wishes she had such help when she was pregnant.
“The new mothers would be really, really happy having the video in Mam because they’re going to be receiving the right directions in the language,” she said. “It would be really helpful.”
A hidden problem
The Immigrant Assistance Center, which helps immigrants through counseling and classes, has served people from 29 countries from Russia to Germany to Japan, May said. But Mam-speaking Guatemalans are by far the largest client base, making up about 75 percent of the center’s visitors. About 480,000 people in Guatemala speak Mam, according to a 2002 census by the Guatemalan government.
“I really focus a lot on Guatemalans because they have more barriers than any others,” May said, adding that Mam is rarely spoken in the U.S.
Gutierrez-Brown said the barrier – and the language itself – are unknown to most people.
“It’s something that no one really knows about,” she said.
Case in point is the Guatemalan patients in the hospital. Bowers said she doesn’t encounter them frequently – maybe every two or three months – but it’s often enough that Gutierrez-Brown’s services are needed.
Some written instructions at Harrison are available in Spanish, but that’s not helpful for those who don’t speak Spanish or can’t read at all, Bowers said. The hospital’s main phone-based interpreter service doesn’t offer Mam, so it must contact a social worker who finds an agency with a Mam interpreter. That interpreter comes to the hospital at a certain time, when the doctors and nurses involved in the patient’s care give all the instructions and information to the patient at once. That can be overwhelming for a new mother who takes in a barrage of direction.
Bowers uses dolls to communicate breastfeeding instructions to Mam-speaking mothers, but even then, the experience can be vexing.
“When there’s this void of information or inability to communicate with the mom, it really isolates the mom,” she said. “I feel very frustrated in not being able to communicate enough information for her to feel she’s comfortable and confident in what she’s doing.”
Minerva Holk, an Olympic College nursing instructor and a maternity nurse at Harrison Medical Center in Silverdale, said mothers are usually most comfortable communicating through a friend or family member who knows English or Spanish, if they have one. There are also a number of nurses who know Spanish, which some Guatemalans can speak – but the hospital can still do more to serve non-English speakers.
“I’ve been impressed by how many patients we have that fit that category,” Holk said. “There’s just room to do a much better job.”
In addition to the language barriers Guatemalan mothers face, there are also cultural barriers. Many immigrants view the U.S. as a society that promotes formula-feeding, so they want to emulate what they think is popular, Bowers said.
But Holk said that teaching proper breastfeeding to immigrant mothers is best not just because of the health benefits to the baby – including reduced chance of ear infections, juvenile diabetes, cancer and obesity – but also because it would save poor families the formula expenses.
Meeting in the middle
May and the volunteers at the Immigrant Assistance Center offer services and classes in different languages, but May and Gutierrez-Brown said it’s hard for immigrants to access services elsewhere in Kitsap.
“Finding resources is a big barrier for them,” Gutierrez-Brown said. “There’s just so much that needs to be done.”
Larry Eyer, executive director of Kitsap Community Resources, said foreign-language services and materials vary among the agency’s different programs. The most-demanded language outside of English is Spanish, so some staff members are in Spanish language training. The agency does contract with call-in interpreter services, as Harrison does, where Mam-speaking interpreters are available, he said.
“It’s a bit of a mixed bag, but we’re getting there,” Eyer said.
May is trying to help immigrants do their own part in the absence of foreign language services. The Immigrant Assistance Center sends tutors to families’ homes to teach them how to make doctors appointments, shop and use the library with English. The center also teaches English classes and helps people earn their GED.
Carrillo is learning more English and Spanish all the time, making it easer for her to communicate and understand others. She doesn’t expect the world to cater to her limited language skills.
“It’s good if I can learn English,” she said. “If I want to work, if I want to go to my doctor’s appointment, I don’t expect them to know my language because they speak English.”
Though she is happy that Guatemalan mothers in Kitsap will get better instructions in their native language, most of all, the immigrants want to help themselves.
“They’re not expecting having interpreters all over the place,” she said. “They want to do their part because they know they’re in this country and they have to learn the language.”
