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Pharmacies fill language gap

Independent stores ensure people who don't speak English understand their prescriptions, a service often lacking at chain pharmacies.

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By Krista J. Kapralos / Herald Writer
  • Pharmacist Hatam Shafeean (right), owner of Shiraz Specialty Pharmacy in Everett, counsels Sylvia Velazques in Spanish about her tooth pain as Pablo V...

    Dan Bates / The Herald

    Pharmacist Hatam Shafeean (right), owner of Shiraz Specialty Pharmacy in Everett, counsels Sylvia Velazques in Spanish about her tooth pain as Pablo Velazques (left) listens. Shafeean is fluent in Spanish, Farsi and English. He said he left a high-paying position in a large pharmaceutical company to open his small shop because he likes helping people such as Sylvia Velazques.

EVERETT - Viktor Stakhnyuk, a heavyset Ukrainian who can silence his 10 children with an icy glare, is humbled by the most ordinary of neighborhood fixtures: the pharmacy.
For him, a visit to the drugstore is like stepping into murky water.
Stakhnyuk, 54, isn't sure what's written on that little slip of paper.
He doesn't know what the pharmacist behind the counter is saying.
And it's not clear what the pills in the small white bottle are for.
Yet Stakhnyuk pops the cap, rattles out a pill, tosses it into his mouth, and swallows.
That was how Stakhnyuk dealt with prescription medication for years, until a pharmacy for Russian speakers opened in south Everett.
It's one of a handful of independent storefronts in Snohomish County that have opened in response to what experts say is a serious failure on the part of chain pharmacies.
A rash of lawsuits within the past six years changed the way many hospitals do business. But pharmacies, which are obligated just like hospitals to provide an interpreter to anyone who needs one, often fail customers who don't speak English.
"(Chain pharmacists) say, 'We hope they bring a family member who might speak some of the language,'" said Cindy Roat, a Shoreline-based language access expert.
It may take a major lawsuit for pharmacies to change their ways, she said.
Until then, many people who don't speak English are taking their business elsewhere.
At Shiraz Specialty Pharmacy on Casino Road in Everett, a stack of Farsi-language newspapers threaten to slide off a low coffee table in the waiting area. A section of the strip-mall building is empty, awaiting boxes of groceries and curios from around the world.
Hatam Shafeean, an Iranian who sought political asylum in the United States 24 years ago, greets his customers by name, and in their own language.
He speaks Farsi, English and Spanish. He has employees who speak Russian and Arabic.
More than half of Shafeean's customers don't speak English. Many have been turned away from other pharmacies when the pharmacy clerks can't understand their questions.
"They have no idea what other pharmacies have given them," Shafeean said. "They say the other pharmacies just don't talk to them."
Shafeean, who worked as a journalist in Iran, graduated from the University of Washington's pharmacy school in 1999. He opened Shiraz Specialty Pharmacy, named after his home region in Iran, in July 2005.
"The minorities in this area, they're increasing monthly," he said. "They've moved here from other states, and even from this state, from Bellevue and Eastern Washington."
Now, he said, his staff handles about 1,000 prescriptions each week.
Still, too many non-English speakers are taking chances, said Sergey Vorobyev, a former refugee who's built a business translating legal documents for Russian speakers.
"Here's the dilemma," he said. "The parents are older, maybe 60s or 70s. They don't speak English, and they will never learn English. It's just that way. They go to the pharmacy, get the wrong stuff, eat it and maybe even die. Who knows?"
Vorobyev admits that's the worst-case scenario, but he's seen non-English speakers walk away from pharmacies clutching a stapled bag after only a series of hand gestures with the pharmacy clerk. Young children interpret for their parents on sensitive - and sometimes embarrassing - medical issues that would make a grown man blush. Some, too frustrated by the language barrier, never get the medicine they need.
Vorobyev's elderly parents have him translate the labels on their medication bottles, but he refuses to help people outside his family with the task.
"Really, you need a certified interpreter," he said. "I can tell them what is written, but I have no idea if it's what they need."
When new customers walk into Bethel Pharmacy in Lynnwood, pharmacist Chris Yun, a Korean immigrant, often helps them understand their prescriptions.
One woman, who previously went to a chain pharmacy, thought she was taking medication for high blood pressure, but in reality it was for diabetes.
"That's a really common problem," Yun said.
When Yun opened his pharmacy three years ago, he made sure that every sign and medicine label was written in both English and Korean. More than 90 percent of his customers are Korean immigrants, he said.
"They used to go to Rite Aid or Walgreens," Yun said.
According to the 2000 Census, 18 percent of all people living in the United States speak a language other than English at home. Eight percent speak English "less than very well."
"People who don't understand their medication are at a high risk of taking the wrong dose," said Mara Youdelman, director of a language access project at the National Health Law Program in Washington, D.C.
Youdelman cited one study that found that among a group of non-English speakers who were not provided with interpreters, only two percent understood how to take their medication.
"Some people say, 'Why should I care?' If somebody takes their medication wrong and ends up in the ER, when you break your leg, you're going to have to wait until the other person is cared for first," Roat said.
A spokeswoman for the Office of Civil Rights in Washington, D.C., the federal arm that handles complaints stemming from the Civil Rights Act, said there have been no lawsuits against pharmacies on the issue of language access.
A spokeswoman from Rite Aid's corporate headquarters in Pennsylvania said store pharmacists have access to a telephone language bank and can print instruction sheets in 11 languages.
Multiple calls requesting information about the language access policy at Walgreens were not returned.
Rebecca Siegmund, an assistant vice president of marketing for Bartell Drug, said she was not aware of the federal law requiring pharmacies to provide interpreters. In a later e-mail, she said bilingual employees of Bartell stores interpret for customers as needed.
Even when pharmacies have policies designed to comply with federal law, in reality, many pharmacy clerks don't follow them, Roat said.
Roat and other interpreters and experts said they frequently hear complaints from non-English speakers who were turned away from large chain pharmacies.
Until all pharmacies consistently comply with federal law, many refugees and immigrants in Snohomish County will rely on businesses owned and operated by people who speak their language.
Edik Saroyan opened Sevan Pharmacy on Everett Mall Way in 2004.
The Armenian refugee tapes Russian-language signs in the windows of his storefront. The pharmacy clerks look up in surprise if they hear English.
That's where Stakhnyuk, the Ukrainian man, gets his prescriptions filled now.
"Sevan is so much better," he said as his son, Timofey, interpreted. "I understand how to use my medication."
Reporter Krista J. Kapralos: 425-339-3422 or

Legal rights of non-English speakers
Title VI of the 1964 Civil Rights Act prohibits organizations that use or are affected by federal funds from discriminating based on race, color or nationality. Hospitals and pharmacies are obligated to comply with the law because they receive Medicaid and Medicare dollars.

In 2000, President Clinton reaffirmed the law with an executive order that requires those organizations to ensure that they provide avenues for people who are not fluent in English to have "meaningful access" to their services.

The order sparked lawsuits in hospitals around the country. Now, many hospitals comply with Title VI, but experts say pharmacies continue to fail customers who don't speak English.

For more information, contact the National Health Law Program online at

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