By Hadley Rentz, MusicWorx Intern

Any working music therapy professional can tell you how many times a day they have to explain what they do. With only a select few having knowledge of and easy access to music therapy services, many members of populations and communities are omitted from treatment. One of these communities which is abundant in San Diego is the Latinx community (30% as reported by the Census of July 2019). Latinx folks are not often given the same economic or educational opportunities as white Americans, and therefore are more likely to miss out on supplemental therapies and support. The American Academy of Family Physicians drives this point home by saying, “Many Latinos are accustomed to self-treating because most pharmaceuticals are available without prescription in their home countries. Recent immigrants may face additional obstacles to care, including illegal immigration status (fears of deportation), illiteracy, and a radically different set of health beliefs.” The academy also cites that “nearly one-third of Latinos (30.7 percent) lack [healthcare] coverage.” Linguistically and culturally, small changes can be made to our practice as music therapists to create a space in which Latinx people feel more welcome, validated, and appreciated. Below is a list of tools to help make that change.

Code-switching

Code-switching, as defined by the Merriam-Webster dictionary, is “the switching from the linguistic system of one language or dialect to that of another”. Code-switching can occur from word to word, throughout a sentence, or from phrase to phrase. Note too that code-switching can happen as frequently as the speaker wishes. Subconsciously or with purpose, they may choose a specific word or phrase in their native language vs. a second language. This could depend on many factors, including familiarity with either language. For example, many Spanish speakers I know choose to code-switch the word “chips” when speaking in Spanish. One translation for “chips”, among many, is “papas”. Interestingly, most of the Spanish speakers I know not only switch to English for this word, but also continue the sentence in it. In this particular example, I would imagine “chips”, particularly potato chips as I’m referring to here, being more typical in the United States than the rest of Latin America. Knowing this, it might make more sense to switch to English.

Why do people code-switch? You can read more about common reasons for code-switching here.

Possibly the most important reason for code-switching within the medical setting and our music therapy practice is comfort for our clients. Our patients deserve to feel heard and understood always, but especially through the stressors which naturally accompany hospital stays: personal health, missing work, financial stress, family care, and much more. NPR refers to this as the fifth reason mentioned in the article listed above, “conveying a thought”. Imagine your patient has severe stomach pains. You ask them to describe it, but they just hold their side and say the word “hurt” over and over again. Now imagine the patient describes to you a piercing, stabbing pain, like a knife, cutting just below their lower left ribs. You, as a medical practitioner, gather significantly more information to decipher what exactly is happening in your patient’s body. The same idea applies with music therapy. Whether it’s a similar situation to the one above, or describing specific musical preference, such as slow 60s blues on the harmonica, the more equipped our communication can be with our patients, the better we will be able to serve their individual needs. In our daily work as music therapists, we should be cognizant of  code-switching. Work with the tools you have as a learning and growing music therapist, and at the same time, practice self-awareness and know your limitations. Even if you personally are unable to fill a client’s needs, being aware of the ways they prefer to and best express themselves is the first step in navigating offering our highest quality care!

Translation

Along with the notion of code-switching comes its parallel, translation. The American Academy of Family Physicians writes, “Many hospitals and offices lack trained interpreters and rely on ad hoc interpretation by bilingual staff or even the children of patients. Lack of third party reimbursement for professional interpreter services exacerbates this problem. Adding to the language barrier is the pitfall of false fluency, when physicians mistake the meaning of a Spanish word because of unfamiliarity with cultural or linguistic subtleties.” Understanding information regarding personal health, especially revolving around medication instructions and treatment plan, is crucial for the betterment of our patients. A difficult balance lies in translation and interpretation. Many Latinx people appreciate any effort to include them in a conversation in a language other than their native tongue. Simultaneously, it is imperative that the patient understand their current medical situation. Part of our job as music therapists is to recognize when something is causing more harm than good. This applies musically (for example, choosing a style of music for relaxation which causes the patient stress), and in this context, in translation. Interpreting a message incorrectly and relaying false information could be detrimental to the health of a patient. Rather than a word for word, literal translation, monolingual and bilingual dictionaries are often found much more accurate. See the list below for online translation resources:

• Collins
• Oxford
• Cambridge
• Webster’s
• MacMillan
• Dictionary.com
• Larousse
• Diccionarios (Santillana)
• DRAE (Diccionario de la Real Academia Española)
• lexico.com/es

Paper dictionaries include: Collins, Oxford, Cambridge, Larousse, Webster’s, and DRAE, and Diccionario de uso del español (María Moliner).

Note: While the resources provided are tailored specifically toward Latinx people, it should be noted that many of these considerations would greatly benefit any non-English speakers or those with English as a second language. Allowing for opportunities of code-switching, accurate translation, and providing additional resources for these individuals aligns with the music therapy goals of ethical care. For myself, this population holds extra resonance, being that I am Latina, speak Spanish, have family whose primary language is Spanish, live in San Diego, and greatly value Latinx culture. Countless times during my internship I’ve entered a hospital room, older adult home, or online session in which a client expressed great gratitude for hearing Spanish (many of which have not heard it in a long time, especially normalizing extended hospital stays), and granting the ability to fully express themselves in the way they feel most comfortable. While accommodating to these preferences would be ideal for all cultures, the Latinx community to me feels like a good place to start. See below for excerpts from the American Music Therapy Association’s Code of Ethics which parallel these ideas:

“1.8  acquire knowledge and information about the specific cultural group(s) with whom they work, seeking supervision and education as needed.

2.3  be aware and accepting of client’s individual factors and cultural differences in the treatment process.

5.2  strive to be self-aware and to continually improve skills and knowledge by integrating the best available evidence and findings from research to maintain best practices.”

Already a Spanish speaker? ¿Ya eres hispanohablante? Use this encyclopedia for language relating to music therapy in the medical field. This particular collection of terminology gravitates toward older adults with memory care needs, my own area of interest. A summation of definition, synonyms, etymology, examples, and occasional photographs are provided for each word to deepen understanding of the variety of diagnoses, clinical, and music therapy terminology. My challenge to you is to familiarize yourself with this list, apply it within your practice, and further explore terminology specific to your interests in the field!

Additional health resources for Latinx people in San Diego:

• San Diego Latino Health Coalition: https://chicanofederation.org/sdlatinohealth
• Latinx Resource Center of San Diego State University: https://sacd.sdsu.edu/latinx-resource
• Therapy for Latinx – Mental Health Professionals: https://www.therapyforlatinx.com/united-states/california/san-diego

Looking for more information regarding how we, as music therapists, can better support Latinx communities in our practice? Check out these blog posts by former MusicWorx intern, Lindsy Lev:

• “15 Songs in Spanish for Music Therapy”
• “6 Things to Know To Make A Good First Impression with Spanish Speaking Clients”

Buena suerte, Hadley