Until four years ago, the Bhutanese-Nepali population in Lackawanna County consisted of a handful of families.
That's when Catholic Social Services of the Diocese of Scranton began resettling Bhutanese refugees from camps in Nepal under a contract with the U.S. State Department. As the agency brought refugees to the county, others who initially went elsewhere came as well.
Suddenly, what had been a blip in demographic terms became a thriving community of more 900 individuals, and Nepali is now the second most prevalent non-English language spoken - after Spanish - among people served by Catholic Social Services, said Monsignor Joseph P. Kelly, executive director.
It highlights one of the challenges his agency and others will face as the Affordable Care Act, President Barack Obama's sweeping health care overhaul, moves toward implementation:
How do you explain a complicated health care reform law that befuddles most English-speaking Americans to non-English speakers who can benefit from it?
"It will be a challenge. It will be a challenge all the way around," said Gloria Blandina, director of the Care and Concern Free Clinic in Pittston.
Melting pot
Although language and cultural barriers to the implementation of health care reform are expected to be most acute in states with large and diverse immigrant populations, Northeast Pennsylvania will not be immune.
The U.S. Census Bureau estimates about 8 percent of the residents of both Lackawanna and Luzerne counties spoke a language other than English at home between 2007 and 2011. In Scranton, it was about 12 percent; in Wilkes-Barre, 11 percent; and in Hazleton, 28 percent.
Across Pennsylvania, 1.1 million people, or 9.5 percent of the population, had a first language other than English. Nationwide, the number was 55 million.
Nurse practitioner Andrea Mantione, director of the Edward R. Leahy Jr. Center Clinic for the Uninsured at the University of Scranton, said the majority of the clinic's non-English-speaking clients speak one of a handful of other languages: Spanish, Portuguese, Gujarati, Hindi, Russian, Polish or Nepali.
She does not think language will necessarily present a barrier to understanding the new health care law.
"We are blessed at the university to have second-language students, and we have core teams of students and community volunteers who help us with that," she said.
At the Care and Concern clinic in Pittston, Spanish is the most frequent non-English language spoken, and the facility has Spanish translators whom it can call on a moment's notice when needed, Ms. Blandina said.
Other languages are more challenging, she said,
"Recently we have gotten people of Iranian descent," she said. "That's a problem because we don't have translators. With someone like that, it takes a lot longer for the doctors to figure out what is wrong and treat them."
Like Ms. Mantione, Monsignor Kelly believes the language difficulties can be overcome, provided agencies like Catholic Social Services can be comfortable that the information they are providing to people is accurate.
"We have the ability with the language," Monsignor Kelly said. "The thing we don't have is a clear understanding of what people are eligible for and what they are not eligible for. That is the struggle."
Catholic Social Services has reached out to federal officials for information it can provide to non-English-speaking clients in their native languages, he said.
"We have gotten some documentation back in Spanish," he said. "We have not gotten anything in any other language."
Ms. Mantione said most of the individuals who seek care at the Leahy Clinic are well-informed, whether they speak English or another language. If they receive information about how to access care appropriately, they are able to do that, she said.
"Just because you don't speak English doesn't necessarily mean you don't understand the system," she said.
Contact the writer: dsingleton@timesshamrock.com