Bridging the Gap: Medical Interpreters in the Washington Area
By Jackie Bong-Wright
Medical interpreting sounds like highly specialized work, but there has never been more need for it here in the Washington metropolitan area. To help meet this need, nineteen service providers from different ethnic backgrounds attended 40 hours of interpreter training, called “Bridging the Gap,” at George Mason University in late October. The goals were to teach participants the roles of the interpreter, discuss professional ethics, and develop basic skills. The training was organized under the auspices of the Northern Virginia Area Health Education Center (AHEC).
Medical interpreting is a young profession, with a curriculum developed only in 1996. This training course aimed at certifying interpreters in the Washington area, and included interpreting for medical professionals in Chinese, French, Amharic, Korean, Spanish, Kurdish, Arabic, Portuguese, Vietnamese, and other languages.
Four Roles of the Interpreter
Unlike interpreters in the legal, diplomatic, and business fields, who tend to translate exactly what was said and no more, the medical interpreter’s basic purpose, according to the training manual used in the AHEC course, is broader: “ to facilitate understanding in communication between people who are speaking different languages.” Misunderstanding a message in health care can be dangerous, even fatal. So it may be necessary that interpreters intervene to make sure that patients with limited English get the care to which they are entitled when faced with the complex health care system in the U.S. At the same time, course participants were told interpreters must never try to take control of a situation in which their job is only to facilitate communication.
The interpreter, according to the AHEC organizers, may take on four possible roles, depending on the particular situation. He or she may serve as a conduit, rendering in one language exactly what has been said in the other without adjusting register, that is, with no emotion or change of voice. There are no additions, no omissions, no editing, no polishing. The interpreter may also serve as clarifier, adjusting register, making word pictures of terms that have no linguistic equivalent, and checking for understanding. The interpreter can also be a cultural broker, providing a framework for understanding the message being interpreted, avoiding misunderstanding between provider and patient. The last task would be that of advocate, concerned with quality of care and quality of communication, giving information or connecting the patient with other clinic staff whose job it is to resolve the patient’s problem.
The medical interpreter, course participants learned, must be able to flow from role to role depending on circumstances, switching, for example, as potential misunderstandings arise and are resolved. Whichever role he or she adopts, the least invasive is always the most appropriate. The interpreter is the bridge that links two people who cannot talk to each other. Without the interpreter, there is no communication, no understanding, no healing.
The four roles described above can also be applied in a collaborative situation, such as a social welfare setting, in which the participants have similar levels of power and preparation, but not in adversarial situations such as court trials or diplomatic exchanges.
Code of Ethics and Confidentiality
The rules of confidentiality that are part of medical ethics also apply to interpreting. They are essential to establishing an atmosphere of trust and respect. The interpreter cannot share the patient’s information with family members or friends without the patient’s consent. The relationship between patient and interpreter is based on respect for people’s life style, ethnicity, and political and religious beliefs.
It is also advisable for an interpreter not to interpret for family members or close friends. In such a case, the interpreter might become involved in medical decisions, which could present a conflict of interest. Interpreters must focus on interpreting accurately, refraining from becoming emotionally involved. That would impair their ability to function professionally. Finally, it is unethical to accept extra cash payment, favors or valuable presents from patients; interpreters are compensated via an agreed fee as independent contractors.
AHEC of Northern Virginia has offered training in cross-cultural and interpreter service since it opened in 1996. Nationwide, Area Health Education Centers have worked for the last 25 years to improve the health of medically underserved communities by addressing the needs of primary health care workforce. The Community Health Connect Education Network has designed customized programs, workshops, and conferences in this important field. AHEC faculty associates are experienced bi-lingual, bi-cultural professionals, who bring to each program an interdisciplinary perspective as well as individual expertise, says Lyn Hainge, AHEC Executive Director. Hundreds of health care professionals and patients benefit from this program each year.
AHEC’s Community Health Interpreter Service (CHIS), said to be the first and only one of its kind here, is a language bank with the metropolitan area’s most commonly spoken languages. Priscilla Coudoux, AHEC Program Director, collaborates with hospitals, clinics, and health departments to train the interpreters who work for them.
The October interpreting course featured a wide range of participants. Sherril Jones, 29, originally from Costa Rica, is a school nurse in Arlington County who has been interpreting for the past three years for Latino students. After taking the AHEC training, she said she was more aware of her role as interpreter and of the need to put limits on what she should and should not say. The course also helped her be more precise, especially with newly-arrived children coming from another culture who need a careful explanation of what is happening to them.
Nemat Sharif, a high-school teacher in his native Kurdistan, Iran, has been an interpreter/translator since he came here in 1976. Now self-employed, he is versed in Kurdish, Arabic, and Persian. He contracts with translation and interpreting agencies, and has worked in the legal, business, educational, and medical areas. As an interpreter for the last 24 years, what did he take away from the course? Mr. Sharif said he now approaches his work in a more organized manner, formally explaining his position to both his clients and their providers in an introductory session. He said the technical terminology provided by AHEC Medical Glossary was very useful for his work.
Suguru Jacques, an electrician from Burundi, is new to interpreting. Since the course, he has interpreted for a French-speaking patient from the Ivory Coast, and said he was glad to be in a position to provide people with this helpful, professional service.
Those interested in more information should call Priscilla Coudoux, AHEC Program Director, at (703) 750-3248, or e-mail her at firstname.lastname@example.org.