Craig Editor's note: The following is the second story in a six-part series examining the impact of a growing Spanish-speaking community in Moffat County. It will look at social ramifications from those on both sides of the issue.
Ada Jaquez's son, Angel, weighed just 2 pounds when he was born five months ago.
The doctors said Angel might live for two days. But the little guy received intensive care at a hospital in Denver and after two and a half months was sent home with his parents, where he was kept on oxygen and monitored by nurses from the Visiting Nurse Association in Craig.
He had a couple of tough months starting out, but now nurses say his weight is where it needs to be and he is a healthy baby.
"He has received excellent care here and in Denver," said Ada Jaquez, beaming as she holds her son. "We're really appreciative of what the hospital and nurses have done for him."
But when Jaquez expresses her appreciation, she can't say it directly to the nurses. She needs an interpreter.
And during a recent check-up at the VNA, nurses gave her Angel's weight in pounds, then, to her satisfaction, told her what that equaled in kilograms.
Jaquez, a Spanish-speaking Craig resident originally from Mexico, said dealing with health officials who do not speak the same language she does has not been a problem throughout her situation with her newborn.
But the VNA and hospital, with predominantly English-speaking staffs, have had to make adjustments to meet the needs of people like Jaquez.
When Jaquez wants to schedule an appointment to have her baby's health checked, she can do it only certain days of the week when interpreters are at the VNA days when Emma Mascarenas is available.
Every room that Jaquez walks into in the VNA, Mascarenas is by her side.
Jaquez looks in the eyes of the nurse when asked a question about her infant, but those eyes immediately peer over to Mascarenas, who relays the message to Jaquez in Spanish.
The nurse types into the computer the information about how often the baby is eating then asks another question about what the child is eating.
Mascarenas listens intently then relays the question to Jaquez.
And so the entire appointment goes Mascarenas serving as a go-between as mother and nurse discuss what is best for the infant's health.
Toward the end of the interview, after the nurse has given Jaquez some advice on how to properly care for her child, Jaquez smiles and responds in Spanish.
Mascarenas then smiles and interprets Jaquez's words.
"She said she just wants to do everything right so her baby will be fine," she says.
Emma Mascarenas has lived in Craig since 1948.
She grew up listening to her parents and grandparents speak Spanish in the home.
What she learned as a child has now become a valued skill in a predominantly English-speaking community that has seen a significant increase in the number of Spanish-speaking residents in recent years.
From 1990 to 2000, the Hispanic population doubled in Moffat County.
Mascarenas said she gets calls from public agencies and Spanish speakers asking for her to interpret or translate.
"My son comes over and jokes that my phone rings constantly," she said. "It's one thing or another. It might have something to do with church or to make them an appointment. Sometimes they'll come over with papers for Medicaid."
Mascarenas said she has spent several nights in the hospital at the bedsides of non-English-speaking women who are in labor.
Marilyn Bouldin, director of community care at the VNA, said the community is indebted to people like Mascarenas.
"These are the angels that help this community adjust," she said.
Mascarenas volunteered as an interpreter at the VNA for many years but because of an increased need for her services was hired last year as a part-time interpreter.
While most public service agencies in the community have come to rely on the services of people like Mascarenas, administrators at most facilities will say that just having a part-time person on call is not enough.
Pat Tessmer, director of the local Advocates crisis support service, which provides support for battered and abused women and children, said Advocates has three bilingual volunteers but said it is not meeting the current need.
"We feel inadequate at this time," she said.
Tessmer said the staff at Advocates is currently putting together grant applications to hire a "Latino Outreach Coordinator."
She said they don't just want to hire someone who is bilingual but who is "bicultural."
A bicultural person doesn't just speak Spanish but has an "inherent understanding of the culture," she said.
"We have an obligation to do that," she said. "It ties into our mission that is based on empowerment. We have to realize that we have a big chunk of the community that we can't provide service to at the same level and it's an injustice. It's our community and we're not serving them at the same level."
Tessmer has been with the local Advocates since 1990 and said the need to have staff who can meet the needs of Spanish speakers has increased significantly during that time.
"It was one of those things that if someone could speak it, it would be nice," she said of the situation 10 years ago. "Anymore it's essential. We average about one client per week who is non-English speaking."
The situation has been a difficult one for Tessmer and the rest of the staff.
"There's an overwhelming sense of frustration in that the options are so limited," she said. "It's really difficult to see people return to abusive situations. It's the saddest when you see they have to return because of a lack of options. That's been hard."
Tessmer said those at Advocates have an obligation to become more accessible.
"We've been negligent in making that simple outreach," she said. "Now it's a priority."
The Memorial Hospital Administrator Randy Phelps said he was recently in the lobby at the hospital getting his mail.
"A gentleman came up and was saying something, but the receptionist and I weren't sure what he wanted," Phelps said. "He started to walk out but we were able to stop him."
Phelps said they were able to figure out that the man wanted to see a doctor, but it took some time to figure out what the man was saying in Spanish.
"We were trying to accommodate him but we didn't know what his need was," he said. "Sometimes they get frustrated when they can't communicate with the hospital staff."
The situation described by Phelps is not uncommon.
"This was nonexistent when I came here in the '80s," he said. "Now it's an everyday occurrence."
An everyday occurrence that the hospital has taken steps to remedy.
"Communication is so vital in providing appropriate health care," he said. "If a person wants to see a doctor, we have a responsibility to make sure it happens."
The hospital staff has a phone list of about 15 to 20 people it can call in cases where interpretation is needed.
Some are employees and some are local residents.
But in an effort to lessen the reliance on those interpreters, a new phone service was implemented last fall.
It's called the Language Line Service and costs the hospital about $150 per month, Patient Care Planner Beka Warren said.
A total of 148 languages can be accessed with the line.
Posters are displayed throughout the hospital with different languages printed on them that say "Point to your language and an interpreter will be called."
The nurse or physician then calls an 800 number and they have immediate access to an interpreter on the other end.
The hospital employee briefs the interpreter about the situation and then the non-English speaker is added to the conversation. Phones have been put in place with three-way capability in the emergency room and other areas in the hospital.
Warren, who was responsible for getting the service installed, said the phone service is more convenient than using a family member, which often was what was done before.
"What's helpful is we know the quality of what is being said," she said. "We don't have to rely on a family member to interpret. Especially when the interpreter is a child."
Many of the hospital forms are now available in Spanish, including discharge forms, X-ray test results and medication instructions.
Forms that require the signature of doctor and patient have one column in English and another in Spanish, Warren said.
"That way the witness and the person signing know exactly what they are signing," she said.
So far the new system is adequate, Warren said.
"The patients seem to be OK with it," she said. "They always tell the interpreter to thank us."
Warren, who has been at the hospital for 14 years, said serving Spanish-speaking patients is a challenge that is still relatively new for most at the hospital.
"It used to not be too much of an issue," she said. "In the ER we had a list of different people we could call in the community, but it was highly informal."
But with a Hispanic population that continues to increase in the community, she said it is important hospital employees be patient and understand not only the language differences but also the cultural differences.
"I do not believe you can be culturally competent," she said. "But I believe you can be culturally sensitive. It's important for everyone to be culturally sensitive."
Susan Bowler, a nurse at the VNA, said staff at the VNA must also be aware of cultural differences.
U.S. physicians would not encourage some practices in the Hispanic culture, Bowler said.
"It's very traditional for Spanish babies to get herbal teas," she said. "We try to educate them on what's best for a baby, but I'm not going to criticize and tell a mother she's doing something bad."
Another example of differences in cultural beliefs given by Bowler involved the weight of young children.
"Hispanics see nothing wrong with having a nice little round child," she said. "They see that child as happy and healthy."
In the past, the VNA has also relied on local residents who are bilingual, but it now pays three part-time interpreters.
"At first we had patients bring somebody in to interpret for them," Bouldin said. "But then when you get into professional medical situations, it doesn't work when the interpreter is 10 years old."
She said there's also confidentiality issues that come into play when someone other than a hired interpreter is used.
"After having family members come in we went to volunteer interpreters that we would call at home," she said. "But then we decided it would be better to pay interpreters."
Dr. Gregory Roberts, a physician at Moffat Family Clinic, began taking Spanish in junior high school and continued taking Spanish classes in high school and through college.
"I took it because I thought it was fun," he said.
After medical school, he decided he could use his ability to speak Spanish in his practice.
When he began looking for a place to start a practice in 1994, he said he was looking for a community that had many people who spoke Spanish.
While he decided to set up a practice in Craig, one factor that played against his decision was the fact that there weren't more Spanish speakers in the community.
"Craig really didn't have as many Spanish speakers as I was hoping for," he said. "Back then, I saw somebody every other day or every third day. I was hoping for more."
He got his wish.
Now Roberts says he averages about two or three Spanish-speaking patients a day.
Being able to speak the same language is beneficial for both a doctor and a patient, he said.
"Every time you go from one person to another, the content changes a little," he said. "If you're talking to someone about abdominal pain, you want to talk directly to the person. There's no argument people receive better care when they can speak directly to their physician."
The Craig Police Department has one officer who can speak Spanish, Sgt. Bill Leonard said.
But there is a need for more officers who have that ability, he said.
Right now, the police department, in conjunction with the Moffat County Sheriff's Department, is exploring several ways to beef up its abilities in communicating with the Spanish-speaking population in Craig.
These ideas include implementing the Language Line used at the hospital, trying to hire more bilingual officers and providing additional training and education for officers already on staff.
Right now the department relies on Officer Bryan Gonzalez in situations where interpretation is needed.
"If the one officer is available, we try to get him to assist us," he said. "But doing that can turn a short time period into a very long time period. We're definitely trying to get as many officers trained as we can."
It's necessary the department do so, he said.
"We need to make sure that the rights of Spanish-speaking people in the community are protected," Leonard said. "If they get pulled over, they need to understand what they're being stopped for. If they don't understand English, it's difficult."
The training now is necessary, he said, because there is a need to speak Spanish on a daily basis.
Ten years ago, it was once a month, he said.
"We need to make sure they can understand the processes just like anyone else," he said.
The police department has an obligation to be able to properly handle every situation, even if there is a barrier in communication between the officer and citizen, he said.
"We need to meet their needs because they're part of the community," he said. "Anybody that is in the community should be provided service like anyone else."