The Language Barriers to Health Care in Prison

This story was published in partnership with Prison Journalism Project, a national nonprofit organization which trains incarcerated writers in journalism and publishes their work. Sign up for PJP’s boletín, follow them on Instagram or connect with them on LinkedIn.

“¡Neto! ¡Ayúdame a escribir una nota para la enfermería!” shouts Señor José through the wired chuckhole on my cell door that stinks like rust when you stand too close.

He’s asking me to write him a request note to visit the infirmary. Of course, I can, I respond. “Claro que sí puedo”. 

Translation assistance is crucial for incarcerated people who speak English as a second language or not at all. Many Spanish speakers inside my Illinois prison believe that their identities prevent them from receiving adequate medical care.

Something must be done about this. As a bilingual, first-generation Mexican American, I offer language assistance to all Spanish speakers who need support. Health care communication is a big issue. Often, people need help writing medical request slips and describing their symptoms. This is the first step for anyone trying to access health care in prison.

But more systemic solutions are required. Hiring bilingual doctors and nurses is one option; another is using tele-medicine to access a wider pool of bilingual medical providers. In the short term, the prison could rely more on AI translation tools, or organize occasional events when confidential translators come to the prison to support Spanish speakers seeking medical care.

The language barrier between the prison population and staff results in a kind of desensitization. Incarcerated Spanish speakers avoid talking about their pain, which leads to a mistaken belief that there is no pain to discuss. That narrative must change.

Consider Señor José, who migrated from Mexico to the U.S. in his 20s and is now 68 years old. Like much of the aging incarcerated population, he suffers from several ailments and says he does not receive adequate health care for a man his age. Sciatica and chronic heartburn keep him up at night, he says. And years ago, he fell off the top bunk and injured his hip. Like many incarcerated migrants, José speaks only Spanish.

In prison, Señor José requires a slow-walking permit to move between buildings without receiving a ticket. One must apply for this permit, trusting the prison bureaucracy to recognize and respond to the physical challenges articulated in the application. 

The application process, which asks patients to describe their medical condition for largely monolingual doctors and guards, is cumbersome. It requires a level of English competency that migrants like José simply do not possess.

The struggle to relay symptoms and understand diagnoses can be dangerous. It’s also  humiliating, Spanish speakers here say, so it dissuades them from seeking medical attention at all. This is also true for bilingual residents whose lack of access to education has left them unable to adequately communicate their needs on paper. 

And so, many wait, hoping that the cough will ease or the headache will dissipate, because to speak or write is to feel ridiculed or, worse, ignored. 

Of course, rather than improving on its own, the illness often festers, especially for the elderly and immunocompromised. Physical discomfort hinders even simple movements like walking or sitting. Eventually, an even more medically — and linguistically — complex interaction with medical staff is required.

Víctor is a middle-aged Guatemalan who regularly regales me with verbal replays of the Copa América fútbol tournament. He told me recently that the guards failed to open his cell door for his daily dose of insulin, something he says has happened before. Víctor has Type 1 diabetes, a lifelong autoimmune disease that requires a daily dose of insulin to regulate his blood glucose. Though he should not consume food without the insulin dose, he eventually gets so hungry that he has to eat. The physiological effects are immediate.

Víctor believes the guards are aware that he is diabetic, since he says his name appears on the list of doors to unlock for insulin administration.

Although his English is limited and heavily accented, it is intelligible to me. He interprets the guards’ failure to open his door as stemming from his identity and language — all the other diabetic residents in his cell house are fluent in English. Worse, he fears his language barrier prevents him from receiving proper medication. 

Incarcerated people depend on prison bureaucracy to fulfill their basic health care needs. We are expected to advocate for our own health care. But, as with Víctor and his missed insulin dose, those without the language or literacy skills to advocate for themselves may fall through the cracks. 

In the meantime, I will continue to offer my translation services to my Spanish-speaking peers. Fulfilling this role feels like both an act of service and an act of resistance. From what I have observed, the discrimination suffered by elderly, chronically ill, disabled and non-white people outside of prison walls is exacerbated for those inside. Confronted with those barriers, I have a duty to do my part to help bridge the gap between those who provide medical care and the people — mi gente — who need it.