Directions For Prescriptions In English A Problem For Some

The Philadelphia Inquirer - October 7, 2003

The directions on the bottle of blood pressure pills read simply enough: "Take once a day until finished."

But a Mexican immigrant, still wobbly in her English, misreads just one word. In her native Spanish, 'once,' means 11.

The pills, with too many taken at a time, make her dizzy - or worse. They could kill her.

It's the kind of risk 21 million people in the United States, who speak English "less than very well," face everyday.

Many who depend on prescription medicine don't always understand what's typed on their bottles. Some end up getting sicker, costing the health care system more than $50 billion a year in unnecessary doctor visits, hospitalizations and longer hospital stays. This accounts for people with issues like illiteracy, vision problems and dyslexia, but also an increasing number who simply don't read English well.

Retail pharmaceutical giants like CVS Pharmacy, Eckerd, Albertsons and Publix, recognize the growing consumer power of such groups and have turned to new technology that translates drug prescriptions into Spanish. Walgreens has filled more than one million prescriptions in Spanish as well as 10 other languages including German, Polish, Italian, Vietnamese and Tagalog, a Filipino language.

Some say the service is overdue.

"We live in a multicultural society and we simply can't ignore the needs of other Americans who have language challenges because English is their second language," said Aaron Liberman, a healthcare professor at the University of Central Florida.

The needs are indeed great.

Nearly 30 percent of people surveyed in three major metropolitan areas in March guessed at the proper dosage of their drugs because they weren't sure what their prescription said. More than half of the Spanish-speaking participants said they found it "impossible" to fully understand their prescriptions because of language difficulties.

Participants - 592 people who speak English as a second language - were interviewed when visiting drug stores in New York, Chicago and Los Angeles.

"A lot of them will guess or sometimes they'll ask somebody else who's around, who's not necessarily a professional translator," said Liz Elting, president and CEO of TransPerfect Translations, the New York-based company that conducted the survey.

Sergio Ortega, 44, a small business owner in Lake County's Eustis, Fla., who immigrated from Mexico with his family in 1989, said he usually takes his 15-year-old daughter, Saharai, along to translate when he goes to the doctor or pharmacist.

Ortega can speak some English, but some medical language on the prescription labels can be confusing.

"Sometimes you make a mistake because it's not a normal word," he said.

Dr. Ramon Sueiro, a family physician in Clermont, Fla., said Spanish-speaking patients often call his office looking to double-check their understanding of prescription drug labels.

Some have come in because they've experienced problems after misreading their medication.

"That's the problem sometimes. Hispanics are used to taking a medication in the past. They have a medication with a different name in this country and they get completely confused," Sueiro said.

Retailers recognize the need for translated prescriptions because they see the potentially lucrative immigrant consumer base. Hispanics alone spend $4 billion a year on medicine.

In Florida, Hispanics claim 13.1 percent of the state's buying power, 4.4 percent more than their 8.7 percent share in 1990. That population will funnel $60.8 billion in disposable income into the state economy this year, according to some estimates.

"If you're looking for fast-paced growth in the domestic consumer market, the Hispanic market is pretty much where you look," said Jeffrey M. Humphreys, director of the Selig Center for Economic Growth, an economic think tank at The University of Georgia.

To keep up, many major pharmacies employ bilingual pharmacists who help patients understand their medications. It's a strategy independent pharmacies have used for years.

Walgreens now gives pharmacist job applicants extra points during the interview process if they speak another language in a neighborhood where that's needed. The company, which also launched a Spanish language Web site in August, has more than 2,200 pharmacists who speak more than one language; 575 of them speak English and Spanish. Eckerd encourages pharmacists to call a translator hotline when they need help translating for a patient.

Where people fall short, though, computer programs sometimes fill in.

Translation software, which labels medicines in a customers' native language, is becoming more popular. Walgreens' bilingual pharmacists worked with the company's computer programmers to add common prescription terminology into translation software. CVS' system works the same way, based on pre-loaded terminology.

But computer software doesn't catch onto every regional dialect's idiosyncrasies. And there's not always a pharmacist on duty that speaks the language translated onto each label.

"Assuming the translation is perfect, definitely it's going to provide better information for the consumer and better use of prescription drugs. But how are we going to do this translation? You may see the translations for Mexicans may be different than a translation for someone from Colombia," said Antonio Trujillo, an assistant professor specializing in health and public affairs, at the University of Central Florida. Trujillo emigrated from Venezuela 10 years ago.

Some experts say the computers should be used with caution.

"From the point of view of a translator, I've seen horrible translation from machines. Say 95 percent is accurate, but 5 percent is inaccurate," said Cornelia Brown, executive director of a medical interpreters association in New York. "Well, if you're talking about patient treatment instructions, you want to be 100 percent accurate."

Elting at TransPerfect Translations said a better system would be one that had a bilingual pharmacist checking each translated script.

"This is not going to be a perfect solution that will completely solve the problem of translations in medical information," said Michael Polzin, Walgreens spokesman. "But it's probably a 100 percent improvement on the information they were getting before."

Still, even the skeptics, many whom are paid to translate in person, agree the idea is a good one.

For people like Ortega, who runs a small jewelry and clothing store and can't afford medical insurance, reading drug instructions in his own language would be a major comfort.

"If you write it out, it's much better because then people understand directly - not through other people translating," he said.

—Andrea Perera

About TransPerfect
With revenue of over $250 million, TransPerfect is the largest privately held language services provider in the world. From offices in 66 cities on 5 continents, TransPerfect offers a full range of services in over 100 languages to multinationals worldwide. With a global network of over 4,000 linguists and subject-area specialists, TransPerfect is the largest translation company to be fully ISO 9001:2008 and EN 15038:2006 certified. TransPerfect is headquartered in New York and has regional headquarters in London and Hong Kong. For more information, please visit our website at www.transperfect.com.