Crist Beiler, Pennsylvania Dutch Medical Interpreter

Nearly 37,000 Amish live in the Lancaster County area, most of whom are fluent in Pennsylvania German, popularly known as Pennsylvania Dutch. While they also speak fluent English, these residents are critical to the culture and history of the region, and when they need medical attention, it’s vital that Penn Medicine Lancaster General Health is able to support them.

Enter Crist Beiler, one of a team of registered nurses working the night shift in the Emergency Department at Lancaster General Hospital, who also serves as a medical interpreter to patients from the surrounding Amish community.

It’s a role for which Beiler is uniquely qualified: Not only is he fluent in Pennsylvania Dutch, but he holds life-long familiarity with Amish culture. He’s also one of only two such medical interpreters in Lancaster County. Born and raised Amish, Beiler left the community in his early 20s, but maintains contact with his parents and family.

While he always wanted to pursue a career in healthcare, his limited education (Amish schools typically stop after eighth grade) proved to be a barrier. Beiler received a General Equivalency Diploma (GED) in 2007 and, with the encouragement of his wife, began taking prerequisite courses for nursing at local community college. Two years later, he transferred to the nursing program at the Pennsylvania College of Health Sciences and was hired by LG Health upon graduation.

Beiler’s value as a medical interpreter goes beyond his skills as a translator. His innate cultural competence enables him to provide a higher level of comfort to Amish patients – especially children. Beiler recalls recently helping a young boy from the Amish community whose injuries required him to be transferred to a pediatric hospital. While riding with three medical personnel, the boy remained quiet – that is, until Beiler started speaking to him in Pennsylvania Dutch.

“From that moment on, he became animated and talked for the entire ride, telling me about his school and his family,” Beiler said. “For a small child – especially one who is brought back to the trauma bay, with a group of strangers looming above – just knowing there is someone with you who understands your first language can be very reassuring.”

To meet the needs of its diverse, global patient population, Penn Medicine offers free medical interpretation services in over 150 languages.

“There is nothing of greater importance than for us to be able to easily communicate with our non-English speaking patients in a manner that is understandable,” said Mona Matson, director of Patient and Guest Relations and Reception at Penn Medicine. “We have also taken steps to ensure that patients in our deaf community feel safe as they communicate with our care providers.”

At Penn Medicine Lancaster General Health, the Language Services Department, led by Evelin La Paz, provides medical interpretation and translation of vital documents to patients who have language barriers, such as limited English proficiency, deafness, or hearing impairment. In addition to employing a team of bilingual interpreters who speak Spanish, La Paz and her team recruit and train employees from all departments to participate as volunteer medical interpreters with LEAP (Linguistic Employee Advancement Program). The team includes interpreters who speak Vietnamese, Cantonese, Russian, Nepali, Swahili, Bosnian, Spanish, and Pennsylvania Dutch.

Employees who self-identify as bilingual must pass a national fluency test before being accepted into the program. Training is held annually and involves 40-plus hours of education in medical terminology, standards of practice, the role of interpreters, cultural competency, ethics, anti-discrimination regulations and more.

“After classroom training, we shadow the employees and practice role-playing, so that when they are out there interpreting, we know that they are communicating in a way that is safe for patients,” La Paz said. “The role of an interpreter like Crist is not to explain things on his own, but to repeat whatever the provider is saying, and to tell the provider whatever the patient or family member is saying. If he senses that there is any detail being lost in translation, he can clarify what is being said, and that can make a huge difference.”

Beiler completed LEAP training in January and already helped intervene in a special case. A pediatric patient at LGH experienced a serious breathing issue. After pursuing several care approaches, the medical team started to investigate transferring the patient to a dedicated pediatric facility for more advanced care. The lead physician on the case asked the patient’s family for approval to transfer the child, but the family refused. Then, Beiler asked if he could step in.

“The father spoke English, but he didn’t fully understand the situation,” Beiler said. “I spoke with him in Pennsylvania Dutch, and quickly realized that he did not want his son to be intubated, because he thought this was how his son would have to live the rest of his life. Within minutes he understood that intubation was a temporary but necessary step, and he agreed to the transfer.”

This type of situation is not uncommon. “A patient may speak English, but that doesn’t mean they are fluent enough to discuss their medical care in English,” La Paz said. “At the end of the day, illness does not ask you if you can speak English. Illness does not wait until you can speak the language; it can strike at any moment. So for people who come to LG Health who have language barriers, we are merely leveling the field so that they have the same access and quality of care the rest of us already enjoy.”