I’m writing this post in Coffeyville, Kansas, where I just spent three days meeting with Mayan families, community leaders, and healthcare administrators, as part of our Increase the Reach (ITR) vaccine equity project. Coffeyville is a town in the southeastern corner of the state, only a few miles from Oklahoma, with a population of around 9,000. According to the U.S. Census, Coffeyville’s population is about 15% Latino, but this percentage is likely to be vastly undercounted. While the town is home to individuals from many different Latin American countries, including Mexico, Columbia, and Puerto Rico, there are at least a few hundred residents from the Huehuetenango region of the western highlands of Guatemala, where various Mayan languages are spoken. The majority of the Mayan community members who live in Coffeyville speak Akateko or Q’uanjob’al, which belong to the same Mayan language sub-group and are mutually comprehensible with each other.
Because many people refer to Mayan languages as ‘dialects,’ there is a tendency for outsiders to mistakenly assume that they are varieties of Spanish. In reality, Mayan languages were spoken in the regions we know now as southern Mexico, Guatemala, and Belize for thousands of years before the colonization of the Americas. Many of the Mayan residents of Coffeyville speak Spanish as a second language; Spanish is taught as a subject in school in Mayan communities and is used to communicate with individuals who speak other Mayan languages, like K’iche’, which is not mutually comprehensible with Akateko or Q’uanjob’al.
We learned from our Mayan partners here that in both Guatemala and Coffeyville Mayan language speakers sometimes choose to negate their Mayan identity and language because of the history of genocide and discrimination against this community. Due to the dearth of Mayan language interpreters in Coffeyville and the tendency of some Mayans to say that their language is Spanish, interpreting services for Mayan community members in Coffeyville are often provided in Spanish. Blanca López, a local Spanish-English interpreter and community leader, told me that the Mayan patients for whom she interprets sometimes nod their heads when a doctor is speaking to them in an interpreted encounter even though they do not understand what is being said. To ensure understanding, she utilizes the teach-back method, meaning that she asks patients to explain to her in their own words what they need to know about their health. Our interpreter adviser Francisco “Paco” Martínez from Children’s Mercy Kansas City, explained to me that the teach-back method is a skill that doctors learn in medical training but often do not implement in practice. As an interpreter, Blanca should not have to initiate the teach-back method, as clinicians should take the responsibility for utilizing it.
Providing equitable healthcare for Mayan communities in the U.S. requires a unique set of resources and skills. In addition to the language barrier that is created when Mayan language interpreters are not available, some Mayan community members have not learned to read before they arrive in the U.S., and cultural views of health in Mayan communities may be vastly different from the biomedical model favored within the U.S. healthcare system. To respond to these challenges, clinicians, medical interpreters, and administrative staff need to be educated to engage in interactions with Mayan community members in a culturally and linguistically sensitive manner. Unfortunately, in regions like Kansas where Mayan populations are relatively new, such training is not always easy to access.
My ITR team members Monique García, Denise Romero, Raúl Rangel, and I visited Coffeyville this past weekend to work toward building a coalition to improve healthcare access for the Mayan community here. Our collaborator Blanca López, and Vice Mayor and City Commissioner Justin Doane have helped us to learn about the town and connect with local residents. Guillermo Miguel (“Memo”), who was born in Alabama and learned Akateko from his mom, talked with us about his experiences working to support the health of Mayan families here. We have also had the privilege of spending time with two Mayan families (speakers of Akateko and Q’anjob’al) and learning from them about their languages and their experiences in Guatemala and in Coffeyville. Jilberto, a partner from San Rafael La Independencia, Huehuetenango, even taught us some words and phrases in Akateko! “Yu wal Dios” means “thank you,” and when we were in the local coffee shop Terebinth, Jilberto explained that “Thank you for receiving us with your whole heart in this place,” is a gesture that he would use in Akateko to thank us because he can tell that our actions come from a place of love.
On Monday, I visited the Coffeyville Regional Medical Center, the Community Health Center of Southeast Kansas, the Boys and Girls Club, the Health Department, and the Coffeyville Public Library; these visits helped me to learn more about the town’s language access landscape. One of the most exciting parts of the day was when Raúl and I met with Pilar Davis, the Senior Director of Quality Improvement, Risk Management & Compliance, at the Coffeyville Regional Medical Center and learned that the center recently acquired five carts with iPads for video remote interpreting with Propio Language Services. Ms. Davis informed us that in addition to ASL and Spanish, Propio is able to provide interpreting services in Akateko, Q’uanjob’al, and hundreds of other languages. I recently learned that Genesis Family Health in Southeast Kansas also uses video remote interpreting services but instead of Propio, they contract with another agency called Maarti.
While the availability of video interpreting services is an immense advantage, many patients prefer to work with an interpreter who is physically present with them, because the physical presence facilitates communication and can lead to greater comfort for the patient. In-person interpreters in Spanish and Akateko are also needed here, and for that we hope to provide support by linking local interpreters with opportunities to participate in a 40-hr. interpreter training that covers interpreting protocols, ethics, and the multiple interpreter roles.
Before we do any of this, however, we need to continue to build a coalition with Coffeyville’s Mayan community and learn from community members about which issues need to be addressed and how it should be done.
Alce su voz is a community-based coalition whose mission is to improve health equity for Spanish speakers and speakers of indigenous languages in the United States, with a focus on Kansas and the Midwest. For more information or to get involved, please send an email to email@example.com. You can also join our email list and follow us on Facebook.
(Pueden leer esta publicación en español aquí.)