Late last year, officials at the New York State Department of Health knew they had to act fast to stem the tide of a growing measles outbreak in ultra-Orthodox Jewish communities.
Reaching out in the community’s own language, the agency spent tens of thousands of dollars printing and distributing measles information sheets in Yiddish to hang on the doors of more than 45,000 homes in those communities.
But something got lost in translation: The Yiddish was mangled, according to language experts consulted by CNN.
The door hangers delivered to Rockland County homes were so riddled with errors that parts of it were “barely comprehensible” and “practically indecipherable,” said Chaya Nove, a Yiddish scholar.
“The translation is so ridiculous, it’s almost offensive,” she said.
“It’s incredibly sloppy,” added Anita Norich, a professor emerita at the University of Michigan and a Yiddish scholar. “It’s infuriating.”
The experts said the Yiddish was also poor in two ads highlighting the dangers of measles that the health department placed in publications in the ultra-Orthodox Jewish community late last year.
Some say the bungled language is part of a larger problem: The state has had trouble communicating effectively with its ultra-Orthodox Jewish community, contributing to the largest and longest measles outbreak in the United States since at least 1993.
Not only did the state health department make the Yiddish mistakes, the agency failed to quickly utilize – or in some cases utilize at all – some well-known methods of communicating with ultra-Orthodox Jews, a community that can be closed off to the outside world.
For example, it took the department three months to distribute a booklet that was instrumental in increasing vaccination rates in one ultra-Orthodox community two years ago. Plus, agency officials say they only recently started to work on using two other communication platforms – a news phone line and a texting app – that are particularly popular with ultra-Orthodox Jews.
“In order to be credible, you have to get the message out via the methodologies that a community commonly uses,” said Dr. Irwin Redlener, professor of health policy and management at the Mailman School of Public Health at Columbia University. “And since measles spreads quickly, there are cascading consequences to delay.”
There’s a lot at stake in stopping this outbreak.
Since October, more than 600 New Yorkers have contracted measles, with more than 30 new cases reported in the state during the last week by New York state and city health departments. In New York City and Rockland County, the two epicenters of the outbreak, about 55 patients have been hospitalized, and 14 have been admitted to the intensive care unit. Measles has spread from New York to several other states, including Connecticut, New Jersey and Michigan.
The outbreak has taken a financial toll, with each case costing $32,000, according to the US Centers for Disease Control and Prevention.
A spokesman for the New York State Department of Health said the ads and door hangers were just a small part of a larger campaign.
“The Department remains committed to working with our community partners to share information on the dangers of measles and the safety and effectiveness of vaccines,” Gary Holmes wrote in an email to CNN. “Supporting information material, distributed more than six months ago and later augmented with community feedback, is a small part of a large collaborative effort aimed at ending this outbreak once and for all.”
Holmes said that effort as a whole – which has included meetings with dozens of rabbis, community leaders, parents and health care professionals as well as establishing a measles hotline and supporting vaccine clinics – has worked, citing rising vaccine rates in areas where there have been measles cases.
In Rockland County, for example, there have been more than 20,000 measles vaccinations administered since October – about four times more than during the same period in each of the preceding two years. Other counties where measles cases have been reported have also seen increases in vaccinations this year compared to previous years.
“What we’re doing is working,” Holmes said. “Right from the start, we’ve understood that strong support and trust in the community is critical,” he said.
But several community leaders said the errors gave the impression that the state didn’t care enough to get it right, and even worse, they worry that the mistakes might make parents who are hesitant about vaccines doubt health department officials when they say vaccines are safe.
“It comes through to the person you’re supposed to be convincing as, ‘you can’t even put together an ad right, and you want me to believe your science?’ ” said Alexander Rapaport, a community activist in Brooklyn who tweeted about the errors in November.
“You think, ‘if this is wrong, what else did they get wrong?’” said Dr. Aaron Glatt, an infectious-disease specialist and an Orthodox rabbi who called the state’s outreach in Yiddish “a good idea but a suboptimal execution.”
‘Talk to your health worries nourisher’
CNN asked three Yiddish scholars to analyze the health department’s Yiddish materials: Nick Block, an assistant professor in the German Studies Department at Boston College; Isaac Bleaman, who will start this fall as an assistant professor of linguistics at the University of California, Berkeley; and Chaya Nove, a Ph.D. candidate in theoretical linguistics at the Graduate Center, City University of New York, who like Block and Bleaman has published articles on Yiddish in scholarly journals.
While well-versed in literary Yiddish, the three scholars specialize in the language as it’s spoken in ultra-Orthodox Jewish communities today.
They analyzed the door hangers, which were distributed in mid-November, and two ads that were placed in three publications in November and December.
The experts said that despite the errors, the two ads were comprehensible, and their messages were clear. The doorhanger, however, had hardly a single error-free sentence, and parts of it can’t be understood at all.
The cost to disseminate the error-ridden materials was considerable: more than $33,000 to place the two ads and more than $23,000 to print and distribute the door hangers.
Sometimes, the mistakes were downright funny. In the door hanger and one of the ads, “Talk to your health care provider” was translated into Yiddish as “Talk to your health worries nourisher.”
That error was corrected in a pamphlet that the state distributed months later.
Also among the errors: Instead of saying to call the state’s hotline, the door hanger and the first ad say in Yiddish, “Summons 1-888-364-4837,” with “summons” as a noun.
“It’s as in a legal summons, like a subpoena. It doesn’t make any sense,” said Block, who is a professional Yiddish translator.
That mistake was corrected in the second ad.
The door hangers mangled a vital piece of information during an outbreak: the list of symptoms.
The Yiddish experts said they’d never heard of the phrase that was used for “runny nose.” Also, the Yiddish lists “red sad eyes” when it was supposed to say “red watery eyes,” and the word used for “rash” would be unfamiliar to many current-day Yiddish speakers.
“It’s just word salad,” Bleaman said of the jumbled translation. “Not only that, but some of the words in the salad are misspelled.”
Those misspellings are numerous. The word “sneeze” has an extra letter. In the question “Who is most at risk?” the word “risk” is misspelled. Even the word “measles” couldn’t escape: On the door hanger, it’s spelled three ways.
And then there are the grammatical errors. Subjects don’t agree with verbs. Words are correct but in the wrong order. Prepositions pop up where they don’t belong, such as a translation that reads “Questions about measles or from the vaccine?”
“The Yiddish is laughably bad. That’s unfortunate, because an outbreak of measles is a serious matter,” Bleaman said.
He and the other Yiddish experts noted that it looked like someone with an insufficient knowledge of Yiddish used Google translate and then tweaked the translation. Bleaman said that when he put the English version of the material into Google Translate, it re-created some of the errors in the health department’s translation.
Holmes, the department spokesman, emphasized that the two ads were comprehensible.
He said that those ads were “understandable but not optimal” and that officials made changes in Yiddish materials that came later because “just understandable wasn’t enough.”
How did the errors happen?
Holmes said his agency hired a licensed translation service, Language Service Associates, to translate the materials from English to Yiddish. The cost to translate the three documents was more than $900.
In an email, Melisa Eskin, vice president and director of corporate compliance and government relations for Language Service Associates, wrote that the company “fully stands by the translation and the accuracy of the information it conveyed.”
“Please keep in mind that it is common for there to be different viewpoints and preferences in the way a text is translated,” Eskin added. “That is why linguistic experts may create different – but equally valid – translations from the same source document. These differences among professional and scholarly translators happen most often with languages that derive from a wide variety of geographic locations and language sources, such as Yiddish and Spanish.”
But the experts CNN consulted said the errors are errors no matter what, independent of geographic differences or language sources.
“These errors are not dialectal differences in the Yiddish language,” Nove said.
Holmes said that whether it’s Yiddish, Spanish, Haitian Creole or any other language, the health department typically takes a translation from a licensed service and runs it past a native speaker in the community.
But he said that didn’t happen with the door hangers and the first advertisement.
“Sometimes, there are time constraints, and there isn’t always the opportunity” to run it by a community member, Holmes said.
When someone at one of the publications pointed out some of the errors, the health department pulled the ads.
“We have a strong commitment to making sure our materials are not just culturally competent but optimally achieving the objectives we’re trying to achieve,” said Brad Hutton, the agency’s deputy commissioner of public health. “We always take the community’s advice and improve the product.”
The agency then ran a new ad by Rabbi Hersh Horowitz, executive director of the Community Outreach Center in Monsey, New York.
Although that ad is an improvement, it still has errors, according to the Yiddish experts.
Horowitz said in a statement, “The [New York State Department of Health] reached out to me for my thoughts. I was happy to assist and did provide some ideas for revisions on some of their materials, most of which the DOH incorporated into the final product. It is my opinion that the remaining language more than adequately conveys the message, and should not be used as an excuse not to vaccinate nor to undermine the commendable efforts of the Department of Health.”
The department used a different service to translate another measles pamphlet months later. The Yiddish experts say that pamphlet does not contain errors.
The Minnesota Department of Health knows a thing or two about stopping a measles outbreak in its tracks – and it says spelling counts.
A 2017 measles outbreak in that state sickened 75 people, mostly children in the state’s Somali community. It lasted about three months.
“Whenever anything is sent out for translation, we always double-check it,” said Doug Schultz, an information officer with the department. “It always needs to be correct. Always.”
Fatuma Sharif-Mohamed, a community outreach planner at the department who is Somali, added that “when language is wrong and that gets back to the community, it hurts.”
One of the health department’s main partners in dealing with the outbreak was Minnesota Children’s Hospital, which cared for most of the sick children.
After posters in Somali were put up in the hospital, a Somali hospital employee noticed a single misspelling: One letter in one word was wrong.
The hospital took the posters down and ordered new ones.
“It would have looked like we were sloppy or didn’t understand or didn’t care,” said Patricia Stinchfield, a pediatric nurse practitioner and the hospital’s senior director of infection control. “That’s not the image we would want to portray.”
Some members of New York’s ultra-Orthodox Jewish community said the grammar and spelling errors in the two ads there weren’t really a problem.
“I don’t think it matters whether or not there are errors,” said Chanie Sternberg, president and CEO of Refuah Health Center, which serves Rockland and surrounding counties. “I think the idea that they’re raising awareness is abundantly clear, and that’s the crux of the issue as far as I’m concerned.”
Binyomin Mermelstein, an official in an ultra-Orthodox village in Rockland County, said the errors in the ads were “minor” and would go unnoticed by many in his community.
“So they spell something wrong – OK, they spelled something wrong. I don’t see an issue,” said Mermelstein, clerk-treasurer of the village of Kaser. “I try to write things for people in our community, and I don’t know the grammar or the rules you have to use, and people would sometimes laugh at how I write, but that doesn’t make a difference.”
He added, however, that the door hangers were “bad” and never should have been distributed.
A booklet ready and waiting
Posters, ads and door hangers are just one part of communicating a public health message.
Another method may seem antiquated, but it’s a proven winner in the ultra-Orthodox community: a booklet.
Two years ago, Shoshana Bernstein, an ultra-Orthodox Jewish writer in New York, wrote the 52-page booklet to help increase vaccination rates in Kiryas Joel, an ultra-Orthodox village about an hour north of New York City. The booklet, which was mailed to residents’ homes, was tailored to the religious community – and they worked, according to Dr. Adam Polinger, director of pediatrics at the Ezras Choilim, the village’s community health center.
“It definitely had an impact,” Polinger said.
The result: In the current measles outbreak, Ezras Choilim has treated just 12 cases out of a population of more than 20,000 people.
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“We’ve had about one case every two to three weeks. It hasn’t been epidemic proportions,” said Tamy Skaist, the health center’s deputy executive director.
The New York State Department of Health knew about the booklet; in fact, the agency funded its creation in 2017, channeling a grant from the CDC.
But in the current outbreak, the agency didn’t distribute the booklet until January, when the outbreak was three months underway. Holmes, the spokesman, said the process of printing and distributing it took a few months.
Finding the right platform seven months into the outbreak
Thus far in the outbreak, the state health department has failed to use two other media platforms that are extremely popular in the ultra-Orthodox Jewish community: a texting app and a news phone line.
Ultra-Orthodox Jews frequently use WhatsApp to share headlines. Glatt, the infectious disease doctor and rabbi, calls it “kosher Facebook” because it keeps out material that religious Jews might find offensive.
Like the booklet, the other platform might seem antiquated to most Americans: a telephone line on which callers hear presentations on the news and topical subjects.
Such phone lines are also popular in Minnesota’s Somali community, and that state’s health department made extensive use of them during the 2017 outbreak, arranging for Somali doctors and nurses to make presentations on the lines encouraging vaccination.
“You have to use the media, the methods, that fit your audience,” said Schultz, the Minnesota health department spokesman.
Hutton, the New York health department’s deputy commissioner, said last month that his agency started to focus on utilizing WhatsApp and news phone lines.
But that effort came six months after the outbreak started.
Glatt, the doctor and rabbi, hopes New York can learn from the success in Minnesota and in one of its own villages.
“Kudos to the department of health for trying to be culturally appropriate,” he said. “It was a learning episode, and hopefully everyone can learn from their mistakes and do better the next time.”
CNN’s John Bonifield and Debra Goldschmidt contributed to this story.