Dr. Richelle Bautista-Azores doesn’t speak Spanish. She knows only “a teeny bit,” by her admission, and she definitely does not speak Vietnamese, Arabic, German or Cantonese.

She might not, but an increasing number of the Sanford Health pediatrician’s patients do.

Sanford, like various other organizations around Dickinson, is working to adapt to the city’s changing population, which, just a few years after the energy boom started, is more diverse than it perhaps has ever been. And with bilingual and multilingual health care providers in short supply, the facility has turned to technology to serve patients who, with growing frequency, might not be native English speakers.

Since the new center opened in February, two iPads equipped with a translation app have become a mainstay among medical staff, who rely on the on-demand three-way translation services for everything from billing all the way back to the exam rooms.

“It facilitates better patient care because then you know that the patient can understand better,” Bautista-Azores said. “Even a simple well visit would be difficult without a translator.”

There are numerous translator apps available, but Sanford uses Stratus Video Interpreting, which brings up a live video chat with a native speaker who appears on screen to translate from doctor to patient, and vice versa; languages readily available at Sanford include American Sign Language, Arabic, Cantonese, Korean, Somali, Spanish and Vietnamese. Translators on the other end are certified in medical interpretation.

“It’s really nice,” Bautista-Azores said. “It’s a person.”

Sanford used a similar translation service in its old facility, but the iPads are a new addition to patient services, patient access manager Anthony Backora said. Doctors have used it to translate German, Vietnamese, Cantonese and Mandarin, but Backora said the majority of use is for Spanish-speaking patients.

“Especially with our population in Dickinson always growing, and lots of people from around the country coming up here,” he said.

He estimated that staff across the facility use the translator app between 15 and 20 times per month, “and that’s a conservative estimate,” he said.

“There’s always a constant email going out of, ‘Where’s the translator?’’’ he said. “Someone’s always looking for it, it seems like.”

Bautista-Azores said she brings the iPad to her office about twice monthly. She came to Dickinson in 2011 from Aberdeen, Wash., where such technology was common in doctors’ offices. She said visits with the translator app “take a little more time, because everything is done twice, in English and in Spanish,” but not as long as they might if the translators weren’t available at all.

“It was really difficult,” she said of communicating with limited English proficiency patients without the aid of the app. “It was tough. Because you’re not sure if they understood you that the child had an ear infection or had pneumonia, or that they’re supposed to lock up all their chemicals, or the Poison Control number.”

Before translation technology, Bautista-Azores said she often relied on family members of patients to translate -- a time-consuming and sometimes stressful experience for everyone involved.

Dilcia Contreras has been bringing her children to Bautista-Azores for about three years.

A native of Honduras, Dilcia speaks English well -- well enough that she doesn’t really need the translator app -- and sometimes acts as a translator for friends during their own doctor appointments.

“This is gonna be a good help to them,” she said. “They are not going to need no more people to be going with them.”

And that will help with scheduling, Dilcia said, as well as confidentiality. She said she’s comfortable speaking to her doctor in front of the translators on the screen because “they don’t know us.” In front of a friend or family member, however, it’s difficult to discuss matters that would normally remain in the privacy of a doctor’s office.

“When you don’t want people to know what is happening, it’s hard to talk to a doctor,” she said. “I don’t want nobody around me to know what is happening to me.”

Dilcia stopped by Sanford on Friday to help demonstrate the Stratus Video Interpreter app with her daughters Sofia, 4, and Mariaceleste, 3.

Bautista-Azores situated the iPad to face the Contreras family. She likes to make eye contact with her patients, she said, and not watch the translator. She wants to know if Mariaceleste is good about brushing her teeth; an interpreter on the screen, Eileen, relayed the message in Spanish to Dilcia, who responds, “Si. Le gusta.”

“She likes it,” Eileen said.

Even if she doesn’t require the app herself, Dilcia said similar translation services would be useful “everywhere.”

“There’s a lot of Spanish-speaking people coming here,” she said.

And translation services are just one piece of serving a more diverse Dickinson. There are cultural differences to take into consideration as well, and what might be acceptable for a patient born and raised in Dickinson may not be the same for one from Vietnam.

“As far as my staff, we always discuss during meetings, there’s a lot of different cultures out here,” Backora said.

There is training offered to employees around cultural sensitivity, but no language training offered yet, Backora said. The clinic tries its best with that they have, he said, and he expects Sanford will roll out more regional changes in the future to implement standard programs that offer a larger option of languages.

“It’s expected to grow quite a bit,” Backora said. “You have a lot of people coming, you’re going to experience a lot of changes. It’s a really good opportunity for our clinic, I think, to be a part of the community, to grow with it. Grow and change.”

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