More on the Identity of Medical Interpreters – When the Professional Identity is New

In my previous employment, my duties included training bilingual individuals who wanted to be used by our company as interpreters. This responsibility was particularly important for individuals whose native tongues are referred to, in the United States, as languages of lesser diffusion.  In the case of these languages, there were no formal education opportunities for professional interpretation in our neck of the woods.  When the language services company I worked for received a request for a Jarai or Lingala interpreter, for example, our only options were to prepare either individuals who had resided in the United States for several years, or adult offspring of first generation immigrants of that particular ethnicity.  [The linguistic challenges of individuals who were heritage speakers and not native speakers like their parents will be discussed in later blogs.]  Whether it was new residents of the United States or offspring of first generation immigrants, they were always very eager to serve and learn, making it a pleasure to train them.  They had, however, never received formal training on the role of a professional interpreter, or the code of ethics that they would be expected to follow. 

Orientations were often initiated by asking each individual attendee why he or she had chosen to learn how to be an interpreter.  The answer, in almost 100% of the cases, was “in order to help my people.”  These were individuals who had either personally experienced the typical difficulties of those catapulted by life’s circumstances into an alien culture , or had witnessed their parents’ and grandparents’ struggles as they attempted to adapt to life in the United States.  Despite feeling deep admiration for those who choose a profession motivated by a desire to serve others, years of experience had taught me this was not enough; a lack of professional training and a misunderstanding of the role of interpreters could generate potentially detrimental situations in interpreted encounters, even when the interpreter has the best of intentions.  Therefore, in each orientation, after the first brave attendee identified his motive as a desire to
“help his people,” the next question habitually was: “your desire is to help your people in what way?”  Answers were rarely forthcoming; usually the individual had not had any reason to probe deeper into his motive for wanting to interpret.  Attendees were then guided to determine if this profession would be for them: “If you want to make sure your people are adequately represented in the court of law, you should obtain a law degree and you would be one of the few bilingual attorneys of your language pair.  If you want to make sure your people have access to all the social services and community resources they are entitled to or are available to them, you should become a bilingual social worker.  If, on the other hand, you want to make sure that “your people” are able to communicate with their healthcare providers, social workers, and employees of government agencies providing social services, you are in the correct orientation session.” 

Why was it important to make distinctions such as the ones used as examples above? 

The language services company I was employed by, regularly scheduled observations of interpreters as a way to ensure the highest quality of interpretation for our customers, as well as a means to assist interpreters improve and grow professionally.  When we first began observing newly oriented interpreters at their first assignments, we noticed that the interpreter would answer for the individual of limited English proficiency.  The newly oriented interpreters would also inadvertently slide into giving advice or making personal comments.  This might be in the form of pressuring the non-English speaker to comply with a healthcare provider’s recommended treatment plan or, on the contrary, to trivialize the recommendations of a provider because it came from a “Western” medicine provider. At times the interpreter would divulge information obtained from previous encounters with the same patient or because he/she knew the patient outside of his/her work.   These acts of professional indiscretion were committed without the slightest ill-will or awareness of how they affected the relationship between the patient and the provider.  Certainly, in most cases, there was no realization of the damage being done.  Interestingly, while observing interpreters we found that even experienced interpreters succumb to the temptation of inserting their personal opinions or advice while on assignment.  I can say without hesitation, that not a single day goes by in my current role as staff interpreter when the resolve not to comment, editorialize, or give advice does not get tested.  The only difference (hopefully) is that extensive training and years of experience can provide an interpreter with tools to help combat that natural, human tendency and avoid succumbing to the temptation. Thus, it was deemed extremely important to help the bilingual individuals who were being groomed for professional interpretation to think about what their role and function was, and for our training sessions to begin providing them with necessary tools as well.  

Identity Crisis of Spoken Language Interpreters Cont'd

[This is a continuation of  the October 18th blog  "Identity Crisis of Spoken Language Interpreters]

So, let’s “muse” together.  What was the big deal?   Was there any harm done?

At the very least, it was not taking advantage of a wonderful opportunity to educate the consumers of interpretation services about our identity, our role, how to best utilize our skills and expertise, and compliance to federal laws.  Without having to subject the uncooperative and uninterested receptionist to a lengthy lecture quoting ethical precepts, codes, and best practices of the profession, she would have subtly conveyed the entire message merely by being a professional interpreter.   No “sermon” on the Title VI Statute of the Civil Rights Act of 1962 was necessary.  No verbal promenade through the boulevard of culturally and linguistically appropriate services in healthcare (CLAS standards) was needed.   Without even realizing what had occurred, the receptionist would have provided the same service to the “Spanish folks,” as she provides to “English folks,” and by doing so would have served as a glowing example of compliance to Title VI.  The hospital which employs the receptionist would have been in full compliance to federal law, not for a second risking withdrawal of federal funds. 

Further, without realizing the full impact of simply doing her job, the interpreter would have contributed a brick to the pharaonic pyramid( currently in construction) of being recognized as a professional, a professional as recognized as a doctor, a nurse, a teacher, a nutritionist, a translator, an orchestra conductor, an interpreter - recognition the interpreter in our real-life story ironically has often expressed she desperately wants.  

 The profession of medical interpretation lost out on an opportunity to demonstrate in action what it is.  The individual interpreter was harmed in that she will not be taken seriously as a professional.  And rightly so; she is, after all, a “helper-outer” for Spanish folks.  She is the person who can make these troublesome “different” folks (who keep the sheltered receptionist from doing her job by rote) disappear.  And in merely a tiny episode with no real danger of serious repercussions,  the hospital was harmed because it was in non-compliance to federal laws. 

And last but not least, albeit unwittingly, she harmed you, yes you, the professional interpreter who will be the one to respond to the receptionist’s next page and who, after having brought the “pesky” Spanish folks up to the reception desk for the receptionist to assist, will be asked, with an inpatient tone in the receptionist's voice, “Can’t you just take care of this?”.   Yes, you, the interpreter whose refusal to simply "take care of the Spanish folk problem" and insistence on interpreting (imagine that) will make you the recipient of rude remarks.  You will be asked to identify your manager so a formal complaint can be submitted;   Yes, you, the one called into your manager’s office to defend your lack of “teamwork,”; the very you, who will have to sit through the staff meeting in which the “Spanish folk helper-outer” will receive a “spotlight” for excellent patient care, you also have been harmed. 

Identity Crisis of Spoken Language Medical Interpreters--

One of my colleagues who has been interpreting as a staff interpreter at a hospital in North Carolina recently shared an experience with me that confirmed something I have suspected for a few years now.  The hospital she works for has little experience in the proper use of professional medical interpreters and she, herself, is only recently attempting to attain certification.  While finishing up an assignment, she was paged by the receptionist who told her there were some "Spanish folks" that needed assistance.  The receptionist was about to hand over the phone to them, but the interpreter stopped her and explained that for phone calls, the receptionist would need to use a phone interpreter.  She explained the reason for this was so that on-site interpreters could continue to answer pages for face to face encounters.  The receptionist was very put out and hung up on the staff interpreter.  To the interpreter's credit, once she finished the assignment she was currently on, she went to see the receptionist with not only the intention of smoothing things over and changing the perception that she had been unwilling to assist, but to also educate the receptionist about the proper use of the interpreting resources of the hospital (i.e. the difference between using a phone interpreter versus an on-site interpreter, etc.)  When she arrived, the receptionist endured the explanation but, immediately upon its completion, nodded toward the "Spanish folks" that were still there waiting, since the receptionist had decided to ignore them.  The staff interpreter went over, found out what they wanted, and directed them to the proper department.  In other words the interpreter did what the receptionist would have done with a native English speaker, never involving the receptionist.  

When my colleague finished her story, I confess I was flabbergasted at the ending.  It would have never occurred to me to do what she had done once she arrived.  She had gone all the way down to the reception with the intention of "fixing things", only to solidify the misuse of resources and foment erroneous views.  I spontaneously blurted out that I would have invited the family needing assistance to the receptionist desk, encouraged them to express their needs so I could interpret them to the receptionist, and then would have interpreted the receptionist's instructions back to the family.  My colleague's response was, "Oh that would have been perfect.  I wish I would have thought of that."  She wished she had thought of interpreting.

My purpose in sharing this experience, not a unique one at that, is not to make fun of this particular individual who was hired as a professional interpreter, but rather to highlight the identity crisis that some of us have as medical interpreters.  My colleague did not think of interpreting because that is not who or what she thinks she is.  She thinks of herself, just as the receptionist thinks of her, as a person who is around to "help out with Spanish-folks."  So in effect she did go down to the receptionist to fix things, but she did not fix things as an interpreter.  Her role (in this hospital, interpreters are just interpreters; they don't hold dual titles as in other healthcare facilities), was to help overcome any linguistic and cultural barriers for the receptionist to be able to provide the same service to this family as she would have provided to a family that spoke English well.  Her role was to interpret the conversations in such a way so that each individual would have responded the same way as two English speakers having that very same exchange. 

So, why did the staff interpreter not interpret?  Because that is not who she thinks she is.  She thinks she is a "fixer" for Spanish problems or issues and as such, the quickest, most efficient way of fixing that particular problem, was to take matters into her own hands get the job done.

I suspect that many reading this blog will wonder, "What is the big deal?"  It was the quickest most efficient way to answer the family's questions and the interpreter knew the answers without having to consult with the receptionist.  What harm was done?