Avoid trouble by using right interpreter for job
Match for fluency, age, expertise
When a public health jurisdiction with meager resources confronts a difficult cross-cultural situation, things can go wrong in a hurry, says Carey Jackson, MD, the medical director of the International Medical Clinic of Harborview Medical Center in Seattle.
When it comes to civil or criminal detention, the very nature of the doctor-patent relationship is strained, he says. "In a project where we’re working with newly arrived refugees on isoniazid compliance, the patients sometimes ask, Whose agenda are you promoting — mine or that of the greater society?’"
The refugees soon realize the harsh truth, he adds. "If someone is feeling sick from the medication, and he’s complied with the regimen all that he can, it doesn’t really matter," says Jackson. "They figure out that you’re not really their doctor; in a sense, you’re much more concerned with the bug that’s inside them."
Given that public health officials do have the authority to police their patients, it’s all the more important to make sure interpreters are a good match, Jackson adds. Ideally, the match should work on three levels, he says — language fluency and competency, level of sophistication, and sphere of technical expertise.
The man who stole the horse’
Whenever understanding what’s going on is critical, so are language competency and fluency, he says — and that means avoiding the use of interpreters for whom a language is only a second language. "Someone has no business interpreting unless they’ve been certified as absolutely fluent," he says; that’s not just fluent in the language, but fluent in the dialect of the region.
He offers a classic example: "Suppose I’m interpreting for a man who’s speaking Yiddish and who’s accused of stealing a horse; the judge asks him, so, did you steal the horse?" With typical Yiddish inflection, the accused responds: "I stole a horse?"
Someone not sensitive to cultural nuance might mistakenly translate the question as a simple declarative statement — that is, a confession — and convict the innocent man, Jackson says.
In the Fresno County case, he adds, a com petent Lao speaker would not have taken the avowal "I want to die" as a literal suicide threat. "In our medical clinic, we long ago gave up hauling off everyone who said this to the emergency room for a mental health evaluation. It’s just an expression of momentary discouragement. All it means, basically, is This [situation] stinks.’"
For similar reasons, the age of the speaker of a language makes a big difference. "Any of us who grew up speaking a language [only] in our parents’ homes knows that what we speak is basically just an infantile version, not a robust and fully developed one," he says.
Yet in hospitals and other health care settings, children of non-English-speaking parents often are pressed into performing interpretive services.
Don’t use kids as interpreters
"You see that the child speaks English well. The child says he speaks the [target] language, and you naturally assume that means the child can perform this service for you," says Jackson. But one of many difficulties in using children in such a way is that their fluency is limited to their experience. Notions such as "quarantine" or "legal rights" are completely lost on them, he points out.
Finally, the sphere of expertise needs to match as well. That is, only someone trained as a medical interpreter — as opposed to, for example, a social services interpreter or a legal interpreter — can follow along as a physician describes the need for a CT scan, a bone scan, or an MRI.
"The medical interpreter knows these are three different experiences for the patient and can help [the patient] make sense of it," says Jackson.
Granted, most small towns won’t have all, or perhaps any, of those resources. The point, says Jackson, is that when a critical and sensitive situation is at hand, it makes sense to bring someone in from the outside.
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