Souma Kundu, a medical student at the University of California San Diego Health (UCSD), sat down with us to discuss her role in an ongoing Process Improvement Project surrounding Martti and interpretation services. Her drive to improve health equity and her passion for empowering patients shine  through her involvement in passion projects and UCSD’s Prime Health Equity program.

Martti: How did you get into medicine? What interested you?

Souma: I’m a very values-driven person so the concepts of equity and doing something to help people  are really important to me. When I was thinking, “What is a career that would have a lot of flexibility and allow me to keep being curious and continue being a learner?” medicine ticked many of the boxes. Being a teacher and mentor and having those relationships while also taking care of patients and communicating with them were all very exciting to me. It’s also important to me to empower patients – not only by treating their ailment, but making sure that they leave feeling like they participated in their care. They’ll know a little bit more about their body and their condition and it contributes to the notion that they should expect that in healthcare settings

Martti: You mentioned equity and I know UC San Diego has programs that promote Health Equity. How is your department involved in these efforts?

Souma: I am in a program called Prime Health Equity which is UC-medical-schools-wide. In San Diego, our program is focused on training a generation of physicians to be leaders in their field in combating health inequity. My cohort is made up of myself and nine other students in my year, who are pursuing both an MD and a master’s degree that allows them to tackle these larger problems within our field. In 2015 I graduated from UC Berkeley with a master’s in public health. The program allows us to think about health equity in a multidisciplinary way, to see different parts of the problem.

Martti: Is the Prime Health Equity program how you got into the Process Improvement Project that you’re currently working on? Can you tell us about it?

Souma: With the Process Improvement Project we focused on the issue of lack of interpreter use and evaluated if we were providing the same level of communication and information to patients who don’t speak English, as to patients who do. When I was working toward my master’s degree, the program required doing rotations and seeing things in action. That’s when COVID had first struck and patients weren’t allowed to have visitors or family members. It felt like the amount of communication with limited English proficient patients was so much shorter and everything was crammed into one interpreter session. Or the small talk that we typically used to build rapport with patients would be left out with those patients. We had a series of questions we would ask them and then not a lot of communication around how they’re doing, how they’re feeling, or if they had questions.

Everybody knew that this was a problem and the project was easy to get approved because we were providing an opportunity to investigate more closely and come up with some solutions. Dr. Reeves was the main lead on the ground in San Diego while I was in Berkeley, and he and I came up with the Language Improvement Project. If you ask anybody in healthcare, they will say, “We don’t use interpreters as well as we should or as often as we should.” We wanted to really drill down: “How are we currently using interpreters and where are the barriers? What are the problems with usage and which ones can we address?” The project highlighted a couple of key areas where we could make meaningful changes. We realized Martti offered capabilities that people weren’t even aware of, for example, the fact that Martti was on a patient’s bedside tablet in these facilities.  Also, we learned that audio interpretation by phone was available even when video interpretation wasn’t. Our risk department put together a comprehensive educational package which is now being rolled out, which we hope every UCSD health clinical staff member will touch.

Martti: How do you use Martti in your hospital?

Souma: We realized how much we need Martti during the pandemic. It highlighted how important having a video interpreter can be for patients. When none of the providers speak the patient’s language there’s a helplessness that you see on the faces of the patient and the provider. Removing that obstacle from the conversation and being able to have an interpreter is second to none, in terms of improving patient care. Interpreters allow you to do your job well and feel like you’re getting everything that you need from the patient to make an accurate diagnosis and give an accurate treatment plan. Knowing that that interpreter is taking the time to repeat  everything that you said including the encouragement, sympathy, and empathy is huge. Those nuances often get missed in ad hoc interpretation. That is the difference between just getting by and doing a really good job, which is what the patients deserve.

Martti: Tell me a little more about your role at UCSD.

Souma: I’m a medical student in this dual degree program with Prime Health Equity and last year I finished my MPH at Berkeley. I’m currently on a leave of absence doing research, in a continuation of work that came out of that Process Improvement Project.  I’m working with my mentor, Dr. Berndtson, and the trauma surgery department looking at differences in how the limited English proficient patient population compares to English-speaking patients when they’re discharged from the hospital. We are focusing on how well they understood what happened during their hospital stay and if there are any major gaps or differences in the two populations. We also want to know if there’s anything that we can do to improve that understanding. If discharged patients don’t have a great understanding of what happened and what they must do when they get home, or they’re not aware of follow-up appointments, these factors can have a huge impact on both their care outcomes and costs for the system. We also evaluate trauma patients – both how their assessment is initially handled and whether it differs for English-speaking patients versus limited English proficient patients – if there’s something we can address, from a quality and safety standpoint.

Martti: You mentioned an interest in mentorship and teaching. Do you have any aspirations for yourself along those lines?

Souma: Definitely. I think it’s really cool that medicine offers a lot of formal and informal opportunities to mentor and teach.  Even trainees can mentor and encourage others, and get involved where they have experience. One of my fellow trainees, Dr. Jeff Reeves, who worked with me on the Process Improvement Project, has been a teacher and mentor to me. Without Jeff, I wouldn’t have had the platform and ability to do this project on the scale that we are doing it. He is an incredibly well-connected person because of all the work that he’s done, and we were able to leverage his  relationships with C-Suite executives at UCSD Health and is. He opened a lot of doors for me. When I’m in a position like his, I hope I can do the same for someone else.

Martti: How has Martti changed the way your team works?

Souma: I’ve been lucky that Martti has been a part of my entire experience. I don’t know a world without Martti, and I can’t imagine not having it. It’s the ability to not hesitate to talk to a patient. I don’t question myself because I know Martti is there. I’m connected to a qualified interpreter within moments and then able to update a family member who’s been anxious and wants to know how their child is doing, or I can answer a question that the patient has, which might not be medically urgent but is really important to the patient. Every time I pull up a Martti they know that I’m going to communicate with them in their own language, which builds trust.

Martti: What were some challenges from the pandemic in relation to clear communication and how has it changed communication?

Souma: The positive thing that the pandemic brought to light how important it is to use interpreter services by removing all the ad hoc options that providers had before – family members and visitors. On the other hand, when language is another barrier on top of an already short- staffed environment full of high acuity patients and huge patient volumes, it highlights the inequity in the amount of information and education that we’re able to provide patients. When a provider is really busy, education can get dropped because efficiency is so important. Now more than ever, it’s a prime opportunity to consider: “What are these barriers? How can we better educate everybody in our hospital to know when and how to use interpreter services?”

The pandemic also brought attention to how important it is to have a diverse workforce. Having Martti is incredible but it’s also important to have a workforce made up of people who look like and come from the patients’ own communities.

Martti:  When you aren’t combating health inequity, what do you do for fun outside?

Souma: I love cooking and baking. That’s a big act of self-care for me: being able to cook a meal for myself that’s not just the bare minimum in sustenance. I also really enjoy being outside and here in California, where I was born and brought up, we’re so lucky to have wonderful enjoyable weather.  I love getting on trails, going on runs or walking. My partner and I recently got a puppy, who has pretty much taken over our lives for the last couple months. Puppy-raising is a full-time job! He’s a little rescue mutt — we were told he’s some sort of shepherd mix, but maybe we’ll do one of those fun DNA tests . He’s 100% adorable.

Martti: What are your hopes for continued work in equitable care?

Souma: In San Diego we’re grateful to serve a very diverse community of patients, and with that comes a diversity of spoken languages. Serving those communities is absolutely a matter of providing equitable care. Sometimes we can forget how valuable a tool like Martti is. Sometimes providers tend to turn off the computer monitor as soon as they’ve finished getting the patient’s history and physical evaluation done. It’s important to remember to keep using Martti when you’re asking a patient, “Do you have any questions for me?” or when using the teach- back method. We have to harness the full power that having a live interpreter provides. I hope we continue to work on this as we educate and train physicians and staff, and I also hope patients will grow to expect and ask for language access. And for me, the empowerment is the best part — patients advocating for their own care.