For members of the Island's Brazilian population, one of the most frightening prospects is a visit to the hospital. Rather than a lack of health insurance, what keeps many away is the fear of not being understood.
"Most often, the Brazilians don't speak English, and most of them don't go to the hospital," said Maria Mouzinho, a community outreach worker for Vineyard Health Care Access Program. "They don't have enough [English] to go all by themselves to get treatment. They don't know how to explain."
For eight months this past year, Martha's Vineyard Hospital tried doing something to address those fears, hiring a full-time Portuguese interpreter last September. But the hospital eliminated the position at the end of April.
"It wasn't meeting the needs," said Tim Walsh, the hospital's acting chief executive officer. "We run the emergency room 24-7, and with [interpreter] Teresa Rodrigues, she was here just 35 hours a week.
"You have to communicate with the patient," he said. "We're just trying to find the best way to do it."
There is no hard census data to verify how many Brazilians live on the Vineyard, but conservative estimates from health care workers and those whose businesses cater to the population put the year-round number at about 2,000.
Mr. Walsh said he is planning to implement a program that would bring interpreters to the hospital on an as-needed basis. Meanwhile, the hospital is coping with the language barrier by using a service offered by AT&T that allows medical and nursing staff to call for an interpreter, and then share a phone line with the patient to communicate about symptoms and medical history.
"The longest you have to wait is five to 10 minutes, and off you go," said Dr. Alan Hirshberg, director of emergency services at the hospital. He admits that using the telephone is a compromise, but said it's commonplace in hospitals across the country.
But others at the hospital and in the community are saying that the loss of a Portuguese interpreter on staff not only undercuts the quality of the health care that Brazilians are receiving, but also makes the hospital less welcoming to them.
"It's very simple - when Teresa was there, it was excellent," said Dr. Deurward Hughes, a staff obstetrician and gynecologist. "Now we have to go to the telephone interpreter. It's not really the same.
"Without question, having an interpreter in there with us was superb," he said.
"A lot of studies say that you get better and more accurate information when you use a live interpreter," said Cathy Chase, a nurse midwife at the hospital. "Teresa was incredibly helpful. She made it so much easier and she was so much more personal and warm."
Ms. Rodrigues, a native of Portugal who teaches Portuguese part-time at the regional high school, said her workload varied day to day. "There were some days I would interpret for 11 people. Another day there would be just two people," she said.
But according to health care providers and teachers who work closely with the Brazilian community, there's still a lot of work to do to convince Brazilians to go to the hospital for medical treatment.
"They're so intimidated to go to the hospital. We have to beg them to go," said Jeanne Burke, who heads up the Martha's Vineyard Adult Learning Partnership, which operates the English as a Second Language classes. "We had Teresa come in and give a presentation about what she was doing at the hospital."
Sarah Kuh, director of the Vineyard Health Care Access Program, said that Brazilian residents often come to her office asking if someone will go along with them to the doctor, the dentist or the emergency room.
"It's scary for them to walk into a medical facility and not know if they're speaking to someone who knows their language," said Ms. Kuh.
The statistics provided by Mr. Walsh may bear this out. While Brazilians almost certainly make up more than 10 per cent of the Island population, they account for just under two per cent of the patients seen in the emergency room.
While some might argue that immigrants who come here should learn to speak English, the fact is that Brazilians are trying. English classes held in the evening at the high school are bursting, and so is the number of classes filled with people who have no training in English.
After filling four beginner classes last fall, there was still a waiting list of 50 people, according to Ms. Burke. It's unknown what portion of the Brazilian population on-Island cannot speak English.
But Ms. Burke's assessment is that many of her students - 175 in the last year - would have a difficult time utilizing their budding English skills in a high-stress situation.
"They couldn't possibly function in a setting like the hospital," she said. "They'd be completely overwhelmed."
In the past, the hospital has also relied on nonmedical staff to help interpret for Brazilian patients. But Mr. Walsh said he has discouraged the practice because, for example, a member of the housekeeping staff wouldn't have the medical training necessary to translate.
Ms. Chase also said that while she knows some Portuguese herself and can communicate with patients, it's not the ideal situation. "There are big gaps at times," she said. "I can stumble along and use my dictionary."
Mr. Walsh could not say when the hospital would be able to move on its plan to hire on-call interpreters.
"It will cost about the same dollars but it will be more comprehensive," he said. "We don't have enough money to have an interpreter on 24-7."
Mr. Walsh said the scenario with Ms. Rodrigues provided spotty coverage. "If you happened to be one of the patients in the time that the 35-hour person was there, then you were lucky," he said.
Ms. Chase pointed out that since most of the people who need an interpreter are either uninsured or minimally insured, the hospital gets very low reimbursements for the services it provides. "That affects the ability to fund a position," she said. "But it's a typical situation in a small hospital."
Ms. Kuh is hoping to see more efforts made at the hospital to work with the sizeable Brazilian community here.
"We're in our infancy on this Island in how we integrate with the new immigrant community, and they with us," she said. "The health and human service providers need to meet this community halfway as far as making essential services available to them so when they're in a crisis they get the help they need."