I discovered this “Wikispace” for us to reference online!
It has some good resources and articles that we can use
during the course:
Go to:
www.interpreter.wikispaces.com
Assignment:
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INTRODUCTION
Becoming and Being an Interpreter
One of the most common misconceptions about interpreting is that anyone
who speaks two languages with relative fluency is automatically equipped
with the skills they need to convert rapidly a message with both accuracy
and appropriateness in such a way that the response of the listener is
identical to what it would have been were there no language
interference/barrier.
This misconception, coupled with ever-increasing demand for interpretation
in the medical setting has unfortunately led to a great variance in the quality
and degree of professionalism encountered in clinical settings where nonEnglish speaking patients meet with healthcare professionals in the presence
of an interpreter.
There are several reasons for the often undetected or overlooked weaknesses
of an untrained native speaker when s/he is thrust into a situation in which
interpretation is needed. The primary cause for concern is unfamiliarity with
the specialized vocabulary encountered in the field of medicine. Often the
speaker uses a term that presents particular difficulty because of the lack of a
term that corresponds exactly with that term in the other language, or simply
the understandable lack of knowledge of that term. The untrained interpreter
then senses the inadequacy of her/his vocabulary or background in
healthcare and feels pressured to invent terminology that may or may not
accurately express the exact impact/meaning of the words spoken by either
party.
Simply stated, the interpreters own experience and education may be
severely or partially lacking if they were speakers of a language that was
primarily spoken at home but were not educated in schools and/or countries
where that language is predominant. These so-called “heritage speakers” are
able to communicate easily in the language during basic social encounters
(e.g. “Go there” “Sign here” “Do this” “Bring this”), but they are not
generally prepared for the more complex linguistic skills required to
“manage the flow of communication” in the more formal speech of medical
care (e.g. “We need to assess your son’s prothrombin time in order to
determine if he needs further evaluations and perhaps additional
anticoagulants”).
©2009 Atlanta Academy of Languages, Atlanta GA
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A second reason for concern is the lack of familiarity with Standards of
Practice which serve to guide the interpreter through situations that s/he may
experience in the encounter. Indeed, Standards of Practice for Medical
Interpreters are now currently available in the field. These standards
function as a practical guide to those with little previous experience in faceto-face interpreting and as a reminder of the ethical behaviors required of all
professional interpreters who have completed a formal course of study in the
field of interpretation.
Additionally, in order to be most effective, interpreters must have a least a
rudimentary knowledge of linguistics, taking into consideration register,
context, content, connotative versus denotative meaning, implicit and
explicit message, common idioms, etc. This understanding of the
complexity of human language (i.e., that often the words being spoken have
much deeper cultural, figurative, derogative, or other emotional
connotations) draws the attention of the experienced interpreter and animates
her/him to find “just the right” words to use in each and every situation.
And this must be accomplished almost instantaneously!
In summary, the tasks of the medical interpreter are demanding and
amazingly complex! A great deal of information is transmitted in a small
amount of time, without sufficient corrective reflection available. It is
indeed a professional challenge! – e s king
©2009 Atlanta Academy of Languages, Atlanta GA
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Working in groups, please discuss the following questions, being sure to assign someone
to take notes in order to report back to the class about your group’s answers and
observations. Be candid and frank!
Discussion Questions:
(1) What are other misconceptions? Do you agree with them? How did/do
they develop?
(2) Can responses really be expected to be identical?
(3) What are the causes of variances among us? Is this necessarily a
problem? What are the strengths and weaknesses we perceive?
(4) What is the concept of “heritage speaker” all about? How do you feel
about being labeled in that way? Can one overcome it? Does one need to
do so?
(5) What Standards would you create? How will they be organized? What
are the most important to least important aspects of Standards of any
kind? Are they intended to be rules or guidelines, or laws?
(6) How does familiarity with linguistics help? Is it necessary? Define words
you don’t know. Give your own examples. Tell us how people use words.
(7) What are the implications of oral (interpretation) versus written
(translation) projects?
(8) How is our job complex/complicated? What areas are beyond our
control? How do we develop professionally?
©2009 Atlanta Academy of Languages, Atlanta GA
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Slide 1
Medical Interpreting
It’s an meaningful art!
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Slide 2
Beginning the
Conversation!
Para empezar…
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Slide 3
What does it mean to be a
PROFESSIONAL ?
•
•
•
•
•
•
•
•
•
Skills / Training ?
Experience(s) ?
Credentials ?
Work Ethic ?
“Craftmanship” ?
Uniqueness ?
Dependability / Consistency ?
Self-realization / Self-proclaimed ?
Recognition ?
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Slide 4
WELL THEN, …
What is “amateur” ?
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Slide 5
Complete this
sentence:
An interpreter …
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Slide 6
What does an interpreter really
do?
• Are you a
noun or a verb ?
– Is understanding the difference important to
you ?
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Slide 7
What are some of the things that
an interpreter should
BE ?
What are some of the things that
an interpreter should
DO ?
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Slide 8
So, what are some of the things
that an interpreter should
NOT BE ?
And, what are some of the things
that an interpreter should
NOT DO ?
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Slide 9
In small groups:
 Create three (3) RULES
 Create three (3) GUIDELINES
 Create three (3) SUGGESTIONS
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©2009 Atlanta Academy of Languages, Atlanta GA
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Slide 10
What skill areas will we need to
examine in this course?
• Cultural Issues and Sensitivity when
working with Hispanic/Latino patients
• Linguistic Expertise
(fluidity/grammar/syntax)
• Medical Terminology (fluency/vocabulary)
• Anatomy
• Standards of Practice (MMIA)
• Resources for Continuing Education and
Professional Development
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Slide 11
What are YOUR
EXPECTATIONS ?
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Slide 12
WHAT
CHALLENGES WILL
YOU FACE?
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Slide 13
The Challenge
• You need to be able to provide a complete
and convincing argument for the use of
professional interpreters in the medical
field as opposed to non-trained speakers
of SPANISH!
–
–
–
–
HERITAGE
BILINGUAL (ACTFL – SUPERIOR)
NATIVE - N/L ED (1-9+)
NATIVE - H ED (9-12+)
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Slide 14
Group Work
• Work within you group to answer the
following question:
• (1) What defines a professional
interpreter?
• (2) What reasons would you give to
someone to try to convince them to use a
professional interpreter in the medical field
as opposed to a non-trained speaker of a
language?
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Slide 15
Skills List Assumptions
• Cultural Expertise / Knowledge / Awareness / Sensitivity
• Linguistic Expertise in two languages such that a
message delivered in one language ilicits exactly the
response it would have ilicited had it been delivered in
the other language.
• Medical Terminology – being increasingly familiar with
medical terms, conditions, and treatments will facilitate
effective medical interpreting
• Standards of Practice – knowledge, familiarity, and
compliance with Standards are a sign of a true
professional in any field.
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Slide 16
What is involved in interpreting for
the patient and the healthcare
professional?
• A keen and real recognition that yours is
also a profession, not just a skill!
• A calm attitude that responds to stress in
helpful ways, using practiced, learned
skills.
• A good sense of each situation…i.e.,
“sizing up the situation”
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Slide 17
Skills-Based
• Becoming an Effective
Interpreter in the Medical Field
is a learned, lifelong, skillsbased process.
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Slide 18
Skill Areas Required to be a
Professional Medical Interpreter:
• Linguistic Expertise
– Spanish and English and “Spanglish”
– Grammar and Common Usage
– Colloquialisms/Slang/Some Jargon
– Ever-Increasing Knowledge of Regional
Differences
– Circumlocution
– Awareness of Contextual Clues
– Awareness of Some Limitations
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Slide 19
Colloquialisms
•
•
•
•
A colloquialism is an expression not used in formal speech or writing. Colloquialisms
can include words (such as "gonna" or “fixin’ to"), phrases (such as "ain't nothin'" and
"dead as a doornail"), or sometimes even an entire aphorism ("There's more than one
way to skin a cat"). Dictionaries often display colloquial words and phrases with the
abbreviation colloq. Colloquialisms are often used primarily within a limited
geographical area.
In some areas, overuse of colloquialisms by native speakers is regarded as a sign of
substandard ability with the language. However, in the mouth of a non-native
speaker, they are sometimes taken as signaling unusual facility with the language as
they may be more difficult for non-native speakers to understand.
A colloquialism can sometimes make its way into otherwise formal speech, as a sign
that the speaker is comfortable with his or her audience, in contrast to slang, which if
used in formal speech is more likely done so consciously for humorous effect.
Words that have a formal meaning may also have a colloquial meaning that, while
technically incorrect, is recognizable due to common usage.
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Slide 20
Slang
•
•
•
•
•
•
Slang is the non-standard or non-dialectal use of words in a language of a particular social
group, and sometimes the creation of new words or importation of words from another
language. It is a type of neologism. Slang can be described as way of deviating from
standard language use, and is very popular with teenagers. Slang functions in two ways;
the creation of new language and new usage by a process of creative informal use and
adaptation, and the creation of a secret language understood only by those within a group
intended to understand it. As such, slang is a type of sociolect aimed at excluding certain
people from the conversation. Slang initially functions as encryption, so that the non-initiate
cannot understand the conversation, or as a further way to communicate with those who
understand it. Slang functions as a way to recognize members of the same group, and to
differentiate that group from the society at large. Slang terms are often particular to a
certain subculture, such as musicians, skateboarders, and drug users. Slang generally
implies playful, informal speech. Slang is distinguished from jargon, the technical
vocabulary of a particular profession, as jargon is (in theory) not used to exclude non-group
members from the conversation, but rather deals with technical peculiarities of a given field
which require a specialized vocabulary.
Four now widely accepted characteristics of slang were identified in the paper "Is Slang a
Word for Linguists," 53 American Speech 5, 14-15 (1978), by Bethany K. Dumas and
Jonathan Lighter. Slang usually shares at least two of the following traits.
First, it is markedly lower in dignity than Standard English.
Second, it tends to first appear in the language of groups with low status, meaning they
may have little power or little responsibility.
Third, it is often taboo and would be unlikely to be used by people of high status.
Fourth, it tends to displace a conventional term, either as a shorthand or as a defense
against perceptions associated with the conventional term.
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Slide 21
•
•
•
Jargon
Jargon is terminology, much like slang, that relates to a specific activity, profession,
or group. It develops as a kind of shorthand, to express ideas that are frequently
discussed between members of a group, and can also have the effect of
distinguishing those belonging to a group from those who are not. Newcomers or
those unfamiliar with a subject can often be characterized by their incorrect use of
jargon, which can lead to amusing malapropisms. The use of jargon by outsiders is
considered by insiders to be socially inappropriate, since it constitutes a claim to be a
member of the insider group.
Jargon can be distinguished from terminology in that it is informal and essentially part
of the oral culture of a profession, with only limited expression in the profession's
publications. Many jargon terms have non-jargon equivalents which would be used in
print or when addressing non-specialists; other jargon terms, particularly those which
are used to characterize or even ridicule non-specialists, have no such equivalents.
The everyday use of the word jargon to describe any technical terminology
incomprehensible to the lay person ignores this distinction between jargon and
terminology.
Oftentimes, people will use jargon derisively, meant to indicate disapproval with the
use of words whose meaning is esoteric, and thus exclusionary of people who do not
understand their meaning and background, for example in The Jargon of Authenticity
by Theodore Wiesengrund Adorno. To describe an idea as jargon accomplishes in
Bourdieu's terms several tasks. It maintains the speaker's "distinction" and social role
as critic and judge, while at time excusing the speaker from listening or reading with
attention, and it also expresses a safe, egalitarian attitude.
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Slide 22
Idioms
•
•
•
An idiom is an expression (i.e. term or phrase) whose meaning cannot be
deduced from the literal definitions and the arrangement of its parts, but
refers instead to a figurative meaning that is known only through
conventional use. In linguistics, idioms are figures of speech that contradict
the principle of compositionality.
Take the English expression to kick the bucket. A listener knowing only the
meaning of kick and bucket would be unable to deduce the expression's
actual meaning, to die. Although kick the bucket can refer literally to the act
of striking a bucket with a foot, native speakers rarely use it that way.
Idioms hence tend to confuse those not already familiar with them; students
of a new language must learn its idiomatic expressions the way they learn
its other vocabulary. In fact many natural language words have idiomatic
origins, but have been sufficiently assimilated so that their figurative senses
have been lost.
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Slide 23
Skill Areas Required to be a
Professional Medical Interpreter:
• Cultural Competency
• many cultures within a broader linguistic culture
• diverse “mini” cultures within one culture
• attitudes toward healthcare issues may vary from
attitudes the interpreter is exposed to in other
areas of life
• etiological and epidemiological facts
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Slide 24
Skill Areas Required to be a
Professional Medical Interpreter:
• Medical Terminology
• Root Words; Prefixes; Suffixes
•
•
•
•
•
•
•
•
The Body and The Diseases
The Systems and Their Function
The Symptoms and The Assessments
The Typical Actions in Examination Process
The Procedures
The Treatments
The Follow-up
The Medications
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Slide 25
Skill Areas Required to Be a
Professional Medical Interpreter:
• Awareness and Knowledge of Standards
of Practice for Medical Interpreting
• Demonstration of Compliance with the
Standards of Practice for Medical
Interpreting
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Slide 26
You’re a Professional!
• It is with this knowledge base that you will
not only improve your personal career
options, but also that of all medical
interpreters!
• “Make" them want us!
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Slide 1
Transcultural Competency in the
Treatment of Hispanic / Latino
Patients
E. Scott King, MA
Spanish for Professionals Division of
Atlanta Academy of Language Learning Inc.
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Slide 2
“Hispanic” versus “Latino”
• Hispanic is defined as Spanish-speaking
– Definitely NOT a racial term!
• Latino is defined as being related to or
from the Spanish-speaking countries of
North America, or from Central, Latin, or
South America
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Slide 3
“Transcultural”
• The relatively new word “transcultural” implies
reaching across cultural boundaries with one
“foot” planted in the familiar ground of one’s own
life experiences…reaching across the sometimes
explicit but often implicit space between ourselves
and another human being. It validates both a
deeper awareness of and a growing appreciation
for one’s own culture, as well as a willingness to
learn about another’s culture in the process of
seeking true communication!
- E. Scott King
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Slide 4
What is Culture?
• The word culture implies an integrated pattern of
human thoughts, communications, actions, customs,
beliefs, values and institutions of a racial, ethnic,
religious or socioeconomic group.
• It’s tempting to think of culture only in terms of what
experts refer to as “Culture with a Capital C” – in other
words, art, music, & literature!
• But culture with a “little c” includes the daily routines and expectations
in a society, and might include how to order food from a drivethrough, use an ATM machine, order a meal, appear to an interview,
drive a car, or act in a hospital! These things are often the more
implicit behaviors of a group of individuals, and therefore are
frequently viewed as the most mysterious barriers between us!
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Slide 5
What is “transcultural competence”
in dealing with Hispanic/Latino
healthcare issues?
• Transcultural competency implies effective
communication !
• Not just Spanish words !
• Cultural knowledge/awareness is crucial !
• These knowledge-based skills can be learned !
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Slide 6
Barriers to Transcultural
Competency
• Barriers may be expected to exist,
therefore, in all three areas of
communication:
• Language Barriers – “A different language is a
different view of the world!” –Federico Fellini
• Shades of meaning in words even when we have
learned the language of the patient
• Body Posture and Gestures may mean one thing
in one culture and something entirely different in
another (or nothing at all!)
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Slide 7
Suggestions
• Ask about words (whether in English or
Spanish) whose meaning or implications are
not quite clear to you…
• What exactly do you mean by “--------” ? is a great question
to ask the patient
• Observe consciously and carefully the body
language (eye contact and gestures, as well as
personal space allowed) that the patient
exhibits…these are clues to their thoughts!
• Distance may indicate either distrust or respect in other
cultures!
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Slide 8
Cultural Sensitivity
Cultural sensitivity is knowing that
cultural differences as well as
similarities exist without automatically
assigning values to those differences,
i.e., better /worse, right /wrong.
(National Maternal & Child Health Center on Cultural Competency, 1997)
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Slide 9
Hot versus Cold Climate Cultures
• Sarah Lanier’s theory of Hot and Cold
climate cultures (Lanier, 2002) offers easy to
understand frames of reference when
working or living with others. The
generalizations found in this explanation of
cultural differences can serve as a solid basis
for “first-impression” insights into the
behavior of others.
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Slide 10
My Own Concept of Hot/Cold Climate Cultures
C OLD C LIMATE C ULTURES
HOT C LIMATE C ULTURES
Lanier points out that there are
exceptions found to solely a geographical
interpretation of the Hot/Cold-Climate
Cultures.
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Slide 11
Hot Climate Cultures
• People in and from hot climate cultures tend
to be:
• relationship oriented rather than task oriented
• indirect communicators rather than direct communicators
• group-identity seekers rather than individual-identity
seekers
• inclusive of many others rather than highly regarding of
individual privacy
• high-context members of their society (everything matters)
rather than low-context members of their society (not
much matters; anything goes-within reason)
• not highly oriented to the clock rather than time oriented.
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Slide 12
Cold Climate Cultures
• People in and from cold climate cultures tend
to be:
• task oriented rather than relationship oriented
• direct communicators rather than indirect communicators
• individual-identity seekers rather than group-identity
seekers
• have high regard of individual privacy over the inclusive
of many others in affairs
• low-context members of their society (not much matters;
anything goes-within reason) rather than low-context
members of their society (everything matters)
• time oriented to the clock rather than flexible in their
concept of time
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Slide 13
Our Patients
• Patients from Cold-Climate Cultures seem to
appreciate logic, efficiency, and informationloaded atmospheres. Respect for others is best
expressed by respect for another’s time and
privacy.
• Patients from Hot-Climate Cultures seem to
thrive on being relationship based where a
“feel good” atmosphere is created. People take
priority over efficiency and time, and “small
talk” is an well-developed and highly valued
art!
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Slide 14
Our Patients
• Patients from Cold-Climate Cultures seem to
use short and direct questions and answers,
and a “yes” is usually a “yes”, and a “no” a
“no”. If they say nicely what they really think,
you won’t be expected to take it too personally!
• Patients from Hot-Climate Cultures seem to
value being friendly above being honest, and
even avoid taking any chance of offending or
embarrassing others. Their “yes” or “no” may
simply be an indication that they will consider
further the situation, not that they will
comply, act upon, or are answering honestly
your request or question.
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Slide 15
Our Patients
• Patients from Cold-Climate Cultures seem to
cherish their own right to an opinion and to
independence, and take initiative within a
group, making decisions on their own. Their
“own space” is important.
• Patients from Hot-Climate Cultures seem to
seek their identity within a group, avoid
appearing “pushy” by taking too much
initiative, seek the support and protection of
many others, and expect clear direction from
the provider. One’s possessions should be
shared, and one rarely desires solitude.
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Slide 16
Our Patients
• Patients from Cold-Climate Cultures seem to
appreciate planning and advanced notice.
Spontaneity must be brought under control.
Hospitality is a special event and a serious
matter.
• Patients from Hot-Climate Cultures seem to
believe that hospitality is a spontaneous gift,
and is the context for all relationships. Gifts
are usually expected. Food and drink play a
major role in kindness and appreciation.
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Slide 17
• In a Cold-Climate culture, who you
know matters, but not nearly so much as
what you know. Cold-Climate cultures
usually do not expect Hot-Climate
Cultures to know their rules of behavior,
nor are they that interested in knowing
the rules of the other culture.
• In a Hot-Climate culture, honor and
respect often outweigh freedom and
casualness. Manners are of the utmost
importance for success!
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Slide 18
Identity / Nationalism
• Of extreme importance and significance to
almost every Spanish-speaker is the country
from which they or their family have
immigrated !
• Both country and region are important because the culture
and expectations of each may differ significantly from one
area to another.
» Example : MEXICO has three (3) distinct regions and 31
states! Northern, Central (City), and Southern states vary
in history, ethnic background, and culture.
• There are many cultures represented in the
broad terms “Hispanic” and “Latino” !!!
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Slide 19
How well do we really
communicate with each other?
• Communication is more than simply
words. In fact, words do “often get in the
way”!
• Communication is often non-verbal!
• What are some examples of Latin nonverbal communication that might convey
unspoken messages of discomfort or fear?
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Slide 20
Gestures and Body Language
• Hand signs – these differ so be careful
» “OK” gesture
» “Come here” gesture
• Personal Space – extremely different!
» Latin versus Anglo “personal space”
• Other Body Language Signals
» The so called “Latin nod” – don’t make presumptions!
» Eye contact
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Slide 21
Potential Areas of
Misunderstanding
•
•
•
•
•
•
•
•
Epidemiological and Etiological Understanding
Directive versus Options-oriented healthcare
Family Involvement
Perception of symptoms and expression of pain
Standards of modesty and Personal Space
Linguistic challenges and barriers
Diets and food issues
Folkloric Medicines
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Slide 22
Did you know?
Mexican Americans have a
higher incidence of
diabetes, heart disease,
hypertension, pernicious
anemia and tuberculosis
exposure.
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Slide 23
Did you also know?
• ‘Small talk’ before serious discussion may
ease tension and increase comfort level
with Spanish-speakers.
• Courtesy is valued; arguments are
considered rude. One does not openly
question authority without fear of
offending. Question: What implications
are there for the physician?
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Slide 24
What do you know about
Latins/Hispanics and…
•
•
•
•
•
Directive care versus “options”?
Attitudes towards Physicians?
Attitudes toward diseases?
Gender expectations?
The implications of the gender of the
interpreters?
• Their formal educational level ?
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Slide 25
…about Latinos/Hispanics
and…
• Their true knowledge of English?
• The cultural “baggage” they bring with them
that might affect healthcare?
• The folklore medicine and home remedies
that they have seen used or have
experienced themselves?
• Their general tastes in clothing, styles,
foods, and cosmetics/appearance?
• Their “polychronic” versus our
“monochronic” view of events and time?
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Slide 26
• As a “polychronic” culture, many Latins
expect for many people to be involved in
an activity all at one time! They won’t
mind interrupting simply to announce their
presence. Lines are not generally
automatically formed (of course there are
many exceptions among ‘high society”).
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Slide 27
And What’s More…
• Many Spanish-speakers consider it either rude
or humiliating to indicate that they do not
completely understand you (in both Spanish and
in English). Be sure to always clarify and get a
positive response from a Spanish-speaker
before you assume that they understood you
completely!
• This will accomplish the very effective but blunt,
non-Latino style discourse among Americans
expressed aptly by the word “Huh???”!
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Slide 28
Illness and Disease
• Good health may be seen as good luck, a reward from God or a
universal equilibrium with balanced forces of hot/cold, wet/dry,
etc.
• When family member is ill, may practice religious rituals, i.e.,
lighting candles, praying.
• When in pain, many are stoic and exhibit great self-control;
perceived as having high pain tolerance.
• Prefer company of others, especially family, when in pain.
• Folk medicine is practiced by some. “Curanderos”, and home
remedies are frequently used (ear-wicking, copper bracelets,
garlic, teas, rituals to cure “el susto” (post-traumatic stress), etc.
• Illnesses /Death / grief are considered “God’s will;” saying the
rosary with family is common for several evenings after a death.
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Slide 29
It’s all in learning about the details!
• Touch is very important, especially in caring for
children.
• Have narrowed ‘personal space’ & may see
one’s distancing as aloof and unfriendly.
• Smiling & handshakes are important, trustestablishing interactions.
• Modesty is valued.
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Slide 30
• Many Latins would perceive a nurse or
doctor giving them treatment options as a
sign that they are not well-trained! They
prefer directive healthcare!
• Many Latins want others in the examining
area, fearing being alone.
• Many Latins won’t give you clear signs
that they do not completely understand
you.
• Many Latins respond well to just a small
amount of Spanish to relax them!
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Slide 31
Family life
• Mexican and Latin American culture is mainly a
nuclear family culture. 73% of families are
married-couple families.
• Matriarchal /matriafocal society with oldest
female responsible for family cohesiveness,
most health matters and family names.
• Father, however, is often the decision-maker. ut
Mother most approve or there will be little
enforcement of decisions.
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Slide 32
….more about the family
• The elderly are highly respected and live
with their children.
• Extended family also plays visible role in
health and illness situations.
• People of this culture may be hesitant to
seek help / support outside of the family.
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Slide 33
Other issues…
• Working with Interpreters
•
•
•
•
•
•
Family member versus professional
Seasoned professional versus “convenience”
Issues of accuracy
Issues of sharing and discussing
Unauthorized recommendations/guidance
Standards do exist!!!
» Refer to the Massachusetts Medical Interpreter
Association (MMIA)
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Slide 34
Now let’s practice what we’ve
learned or need to learn!
Situation 1:
You’re interviewing a patient and reminding
them of how important it is to “stick with”
the diet you prescribed for them during
their last visit. The patient will most likely
think that………………………
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Slide 35
More fun!
• Situation 2
You struggle to communicate that a patient
needs to be sure to advise you
immediately should their symptoms return
or worsen. The patient smiles and nods
their head
indicating……………………………………
……..
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Slide 36
Even more!
• Situation 3
Your interpreter, Pablo, is assisting you
with Mrs. Rodríguez, who is in her third
trimester of pregnancy and experiencing
some bleeding and pain.
Pablo will
…………………………………………
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Slide 37
More situations…
• Situation 4:
You notice that a child patient has what
appear to be ashes in his/her ears. Most
likely…………………………..
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Slide 38
Another…
• Situation 5:
You are visiting a Hispanic/Latino patient
for Home Healthcare. S/he offers you
something to drink. You do not want
anything because you just had a large
drink before arriving. You should explain
that……………………………
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Slide 39
More situations
• Your patient walks into the lobby and/or
waiting/reception area. You are busy taking
information or explaining how to complete forms
to another patient. The Hispanic/Latino
will/may……………………………………………
• Your nurses notice that all the Latino children
seem to be running “wild” in the waiting
room/reception area. The best way to correct
this is
by……………………………………………………..
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Slide 40
• Linguistic Expertise
– Spanish and English and “Spanglish”
– Grammar and Common Usage
– Colloquialisms/Slang/Some Jargon
• “Did you throw your back out?”
– Ever-Increasing Knowledge of Regional
Differences
– Circumlocution
– Awareness of Contextual Clues
– Awareness of Some Limitations
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Originally published in the Western Journal of Medicine. Reprinted by permission.
West J Med
1992;157:255-259
Copyright © wjm.
Translation Is Not Enough
Interpreting in a Medical Setting
Linda Haffner, Community and Patient Relations, Stanford University Medical
Center, Stanford, California
Correspondence to: Ms Haffner, 343 Lunada Ct, Los Altos, CA 94022
This article is based on speeches given in January and September 1991 at conferences
sponsored by the Mid-Coastal California Perinatal Outreach Program.
Unique obstacles must be overcome when providing medical care to patients who have
an incomplete command of the English language. Serious barriers to effective
communication may arise at the exact point where our health care system must succeed
or fail. Miscommunication, differences in attitudes about health care, and various other
misunderstandings interfere with or frustrate good health care for these patients and their
families. Such difficulties are best overcome by the use of a professional interpreter who
can ensure good communication between patients and health care professionals. My daily
experiences as a professional medical interpreter and translator in Spanish provide
insights into the complexities of bilingual and bicultural communication in the hospital
setting. Although the examples given relate to Hispanic patients, the lessons learned can
be extended to other foreign language patients as well.
(Haffner L: Translation is not enough: Interpreting in a medical setting. West J Med 1992;157:255-259)
Health care professionals often experience communication difficulties with Spanishspeaking patients; some also have various misconceptions about these patients. As a
professional Spanish-language interpreter and translator* at Stanford (California)
University Medical Center and being from Nicaragua, I know the problems these patients
have in the clinics and the hospital wards. In this article I invite readers to accompany me
on a typical day and to share some of these experiences. Some of them are sad, some are
amusing, and all are interesting. If they counter a misconception or provide some small
insight, I will have been successful.
*Although these terms are often used interchangeably, technically interpretation involves oral
communication and translation involves written communication.
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Before I describe a typical day in my profession, I must point out that not all Spanishspeaking patients are the same. They come from different cultural backgrounds, cultural
influences, and educational levels.1 Highly educated and affluent Latinos have attitudes
and beliefs about health care reasonably comparable to those of similarly educated and
wealthy Americans. The challenge, and the subject of this article, are the Hispanic
patients who are poor, come from rural areas, have little or no schooling, and have little
or marginal fluency in English. These patients frequently but not necessarily are migrants
or recent immigrants.
In this article the terms "Hispanic" and "Latino" are used interchangeably to refer to persons who are
Spanish speakers and whose principal cultural identity is Latin American.
CULTURAL ISSUES
My day begins at 8:30 AM. When I arrive at the hospital, three messages are already
waiting for me on my beeper. The first is from an anesthesiologist in the Delivery Room
who needs me to translate his explanation of the epidural procedure. An 18-year-old
Mexican patient is having regular contractions, but she is only 4 cm dilated. The patient
is becoming tense and exhausted from the pain, which is interfering with the childbirth
process. The nurse has suggested some pain relief medication or an epidural block, but
the patient refuses.
As I clarify the nurse's offer to the patient, I learn the patient's real concern. She thought
that she was being offered a raquea. Raquea or raquidea, a term frequently encountered
in patients from rural Mexico, refers to the anesthesia procedure commonly known in the
United States as a spinal block. Mexican patients associate raquea with a high incidence
of serious complications. This patient is afraid that she would have chronic back
problems or be paralyzed for life if given the raquea, problems she believes are caused
by that procedure. To make it worse, at this moment her husband reminds her that if she
does not have pain, she will not be a real mother, a common belief among Mexican
patients. We explain to the patient that the epidural block is not like the raquea, that she
would be awake and able to push and actively participate in her baby's birth. Finally, the
husband and the patient agree to the epidural, and the baby is born without complications.
The problem here is the patient's expectation that medical practices in the United States
are the same as in Mexico and her fear (justified or not) about those medical practices, all
complicated by basic cultural differences and beliefs. By creating in the patient a better
understanding of the epidural procedure, we are able to bridge the language, cultural, and
knowledge gaps.
By around 9 AM the Obstetrical Diabetic Clinic is active. Each patient is seen by a
physician, the hospital's dietitian, a social worker, and the nurse in charge of drawing
blood. An interpreter is needed for almost every interaction. One patient, Ramona, is
being seen for the first time in this clinic. She is 34 years old, Central American, and
poor. She is a first-generation immigrant and, as is typical, believes herself to be a
transient by choice. She has the idea that she will return to her country someday and has
not committed herself to becoming part of the Anglo culture. "I would learn English if I
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planned to stay," is a common comment. Her command of English is exhausted after a
few simple words and smiles.
As I go into the room, I recognize her from another clinic in the hospital, and we greet
each other by name. As part of her medical history, she is asked how many pregnancies
she has had. She responds, "two." I continue to interpret for the physician as he asks all
the different questions connected with her history. Ramona and I talk a little in Spanish
while the physician makes some notes. Latino women, once they get to know you, tend to
be talkative. She tells me how worried she is about her diabetes, which she believes she
probably caused herself by "doing something wrong."
She tells me about a third pregnancy that miscarried due, in her mind, to susto. Susto
means "a terrible fright," and she holds the common belief that a terrible fright during
pregnancy is bad for both mother and baby and can even kill an unborn child. She
explains that, while pregnant, she was taking care of a 15-year-old niece. Suddenly the
young girl felt sick to her stomach, went to bed, and died on the spot. Our patient had
been terrified and had felt responsible. To make matters worse, the girl's family blamed
our patient for the girl's death. The patient was about four months' pregnant at the time
and miscarried four days after the incident.
On hearing her story, I realize that she actually has had three pregnancies, not the two she
had stated in response to the physician's question. For many Hispanic women, having a
miscarriage or a stillborn child does not equate with a pregnancy; only the successful
pregnancies count. In this example, the patient answered the physician correctly in the
context of her cultural views, but, through no fault of his own, the medical history he
obtained from this patient was incomplete. Her different cultural attitudes and beliefs are
discovered and better understood through our conversation, and a more accurate and
complete history results after those beliefs and attitudes are taken into account.
At 9:25 AM there is a knock at the door as I finish up with Ramona, this time from the
dietitian. The dietitian explains that a patient needs to be put on a special diet for diabetic
pregnant mothers, to see if her diabetes could be controlled without insulin. This is a
major task of persuasion. There is a saying in Spanish, "Dame gordura y te daré
hermosura" ("Give me plumpness and I'll give you beauty"). This idea applies to babies,
too. The belief is that a pregnant mother has to eat for two, that a thin baby is undesirable
because a thin baby is unhealthy.
In addition, many of these patients come from poor rural areas where most of their food
is scarce and expensive, where meat is a luxury, and where anything American-made is
beyond reach. When these patients come to this country, where food is abundant and
comparatively cheap, they naturally tend to indulge. They have difficulty understanding
that they should voluntarily go on a diet of restricted foods in the land of plenty. This
patient believes in having a big baby, and she enjoys being able to eat anything she
wants. We finally convince her that she cannot do this any longer and that, for the sake of
her health, she has to diet to have a smaller baby.
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Often there is another complication if the family has little money to buy food. The diet
we recommend, lots of vegetables and less tortillas and beans, typically is more
expensive than what these patients otherwise would eat. It is also less popular because it
omits the foods they like the best. The surprising result is that there are fewer compliance
problems than would be expected, even with all these frustrations. Having a baby is
important to Hispanic women, so most of them overcome their reluctance and comply
with the recommended diet or at least try their best with their limited resources. In the
Latino culture, women are supposed to sacrifice for the family, even to the point of eating
a lot of vegetables.1,2
My next summons is from the Internal Medicine Clinic. The patient, a 50-year-old female
peasant from Mexico, is accompanied by her 35-year-old son. Although the patient has
been coming to the clinic for some time, she is new to me. Her son usually interprets, as
he is reasonably fluent in both languages. This time I am called because the son has to
leave to go to work.
Before going into the room, the physician expresses to me his concern about whether the
health problems claimed by this woman are real or imagined. She has been in the clinic
three times before, each time with different vague and diffuse complaints, none of which
make medical sense. As we learn, the poor woman has a fistula in her rectum. In her
previous visits, she could not bring herself to reveal her symptoms in the presence of, and
therefore to, her son as he interprets for her. She tells me that she has been so
embarrassed about her condition that she has invented other symptoms to justify her
visits to the physician. She confesses that she has been eager to have a hospital staff
interpreter from the first visit, but her hope had not materialized until now.
This story illustrates two things: first, the modesty of many Latino women can be a
serious problem; second, Latino women are often reluctant to reveal personal or private
problems if their children are used to interpret. I have seen many Hispanic women who
are reluctant to tell their physicians about vaginal problems or to have a Papanicolaou
smear done because they are afraid of a pelvic examination.1 Their fear is partly caused
by their expectation of discomfort, but to a large degree it is the result of a higher cultural
standard of modesty. In addition, traditional Hispanic women often have an amazingly
limited knowledge of female sexual anatomy. These attitudes may puzzle Anglo
professionals but must be dealt with for medical care to be effective.
USING CHILDREN AS INTERPRETERS
My day is becoming hectic, and I am needed in several places at once. A common and
unfortunate practice when an interpreter is temporarily unavailable is to use family
members to interpret. It is easy to forget that the person in the middle is affected by what
is happening and must assume a normal family role when the interpreting duties are over.
The next page I answer involves this difficult and disturbing problem. The call is to help
with a pregnant woman who may have a stillbirth. As I enter the patient's room, the first
thing I see is a beautiful little girl with haunting big brown eyes--the patient's 7-year-old
daughter. I introduce myself with the proper Spanish salutation. The mother seems upset,
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but the daughter looks very distressed and frightened. The child is shaking and with a
quiet voice says to me, "No podía explicarle a mi mamá todo lo que los doctores me
decían" ("I couldn't explain to my mom everything the doctors were telling me"). I
quickly discover that this little girl was used as the interpreter during the ultrasound
examination and was told to tell her mother that the baby (her little brother-to-be) is dead.
This revelation stuns me. I sit and hold the little girl on my lap, trying to comfort her as
she hugs me tightly. I softly talk to her about what has happened, and she starts to weep
with big, slow tears. To me, one of the saddest moments is when she says to me, in a
pleading voice, "Maybe my little brother's heart will work when he comes out of my
mother's stomach."
I am reminded of the time when I was required for a family conference for a patient about
to be discharged. When I arrive at the conference, present are a physician, a nurse, a
physical therapist, a social worker, and several family members. The patient, the father, is
absent. Everyone is sitting around a table except one. Standing by the physician is the
patient's 9-year-old son, who is acting as the interpreter. The child looks frightened. The
physician rather abruptly says to me, "We don't need you, the boy is doing fine." The
boy, however, pleads with me to stay and take over, saying, "Please, Señora, can you
help me? I don't know if I am doing it right."
Having to rely on interpreters certainly can be frustrating at times. The communication is
inevitably slower, more awkward, and less precise, even if the interpreter is excellent.
Another source of frustration is that the health care professional has less control when
having to use an interpreter (professional or otherwise), and some, understandably, have a
hard time with this fact. There is a simple explanation: The physician and the patient
cannot speak to each other directly. Also, there may be a wait before the interpreter
arrives. Because of budgetary constraints, there never are enough interpreters on staff for
there to be on-call interpretation available for every need. Medical interpretation often
involves unexpected matters of life and death. Being an interpreter is a heavy burden for
a child, whose English is frequently marginal and certainly is not sophisticated. Disregard
for these factors is hurtful to both the child and the family and threatens the effectiveness
of the communication. The trauma to the unfortunate little girl (whose mother has a
stillborn) is easily seen. I doubt anyone would consider using a child in this way if there
were no language barrier. The situation in which the boy was used as an interpreter is
similarly difficult, but the difficulty is perhaps a little more subtle.
In rural Hispanic culture, the hierarchy is strict, with authority running from older to
younger and from male to female. These relationships are for life, with parents in control
of adult children and older adults in control of their younger adult siblings. Traditionally
in Latino culture, the head of the family is expected to make the decisions regarding any
family member. The whole family looks to this person for support and advice.3 By using
a young family member as an interpreter, the physician puts the child in control, with a
much higher status than the child would otherwise have. This disrupts the family's social
order.
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In both of these cases, there was no emergency and no reason not to wait a few minutes
for a professional interpreter to arrive. When foreign language gets in the way, however,
otherwise sensitive and caring people occasionally become oblivious, and unintended
harm can result.
INFORMED CONSENT
I am getting tired; it is nearly lunchtime, and the pages are relentless. This time I am
called to the Well-Baby Nursery, where a woman needs to be asked about some routine
matters: the family constellation, safety in the home, safety in the car, breast or bottle
feeding, and follow-up care for her baby. Interpreting for the physician, I ask her whether
she wants her baby boy circumcised. She nods, but then pauses and very seriously adds,
"But my friend had a baby circumcised here, and they did it too much. I don't like how he
looks. Can they just cut off a little bit?" To me, the woman clearly wants to decline the
procedure but is having difficulty refusing what she considers an instruction from the
physician. In general, Latinos feel they should agree with physicians out of politeness and
respect, even when they really disagree or do not understand the issues involved. They
expect physicians to make the decisions for them and do not understand why they are
asked to make choices. They are used to, and seem to prefer, deferring to experts. These
patients do not understand the American medical system and its notion of informed
consent. Only when more acculturated do they start taking the level of responsibility for
their own health that Americans routinely assume. Language and cultural issues once
again are intermixed.
The next interpreting request, which comes from the Gynecology Ward, involves a
different issue of informed consent. The patient, a seriously ill 71-year-old Nicaraguan
woman, has been in this country only a few years. Her children have been with her day
and night, never leaving her side. When I arrive, the patient's family is distraught. They
request a conference with the physician out of the patient's presence. The physician tells
the family that the mother is dying and needs radical surgery, but he emphasizes that the
surgery would prolong her life only a little. The physician wants to tell the patient and to
ask for her consent to the operation. The daughters are very upset and against saying
anything to their mother. They beg me to explain that their mother has the right to have
hopes, that she should not be told that she is going to die, and that a painful and difficult
operation that may buy her only a little more time is cruel. The result is an impasse that
looks to go on for several days. The daughters vigilantly watch their mother, guarding her
from physicians, and hiding the truth from her. Eventually a compromise is reached, with
the patient receiving an accurate but moderated version of the bad news. Here the
problem is partly language barriers, but mostly it is conflicting cultural attitudes about
how (or whether) bad news should be conveyed to patients.
I am convinced that the daughters would have lied to their mother about her condition
(and tell the physician they did the opposite) if they were relied on to interpret. Hispanic
families often try to hide the seriousness of the situation from ill relatives, especially if
the patient may be dying. Instead, the patient is always given encouragement by the
family with words like, "It is going to be OK," "You'll be out of here soon," and "The
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doctor said that you'll be fine and on your feet again." These desires and cultural practices
are directly opposed to the Western notion of informed consent and our practice of
describing medical situations in frank, sometimes brutal, detail.
Next I am called to the Maternity Ward. A woman had previously signed a consent for an
elective tubal ligation after her delivery and is scheduled to have the procedure in half an
hour. The nurses noted that she seemed uncertain about the operation and wisely chose to
call in an interpreter. It is quickly obvious that the patient has not fully understood that
the sterilization is essentially permanent. A tubal ligation has been described to her as
having her tubes "tied." She has consented, but with the idea that she can later change her
mind-thinking the procedure is easily reversible. If her tubes can be "tied," she reasons,
they can be "untied." She began to worry after asking a few questions to confirm her
belief. She does not fully understand the answers in English but was having doubts. After
I interpret the answers to her questions, she declines the procedure.
Many Latinos believe that the main purpose in life is to reproduce, to people the land.
This idea is strong and deeply rooted in their religious beliefs, which must be
acknowledged, respected, and understood if we want to comprehend their attitudes
toward family planning. Another family planning complication in Latinos is that men can
feel threatened by the sterilization of the women. They often believe that a woman who is
sterilized or uses birth control is going to be unfaithful. Besides, in their eyes, maleness is
proved by paternity, and their attitude is that a wife is no longer a complete woman if she
cannot bear children.
LANGUAGE BARRIERS
A patient in another room, a 30-year-old spunky but illiterate poor woman from Mexico,
is hard working and proud. She is seven months' pregnant and has diabetes. Her diabetes
is under control, and she is generally in good health, but she has complained of swelling
and pain in her hands on previous visits. Sitz baths were prescribed so that the patient
could have immersion therapy for her hands and arms. Because the physician knew some
Spanish and the patient knew a little English, no interpreters were used on previous visits.
On this visit, the physician and the dietitian are concerned about the patient's unexpected
weight loss during the previous week, and they decide to call for an interpreter to help
find the cause. As we try to figure out what is going on, the patient asks me to tell the
physician that her hands are still hurting, but she proudly adds that she has been very
good about doing her sitz baths. She says, "They are very tiring, but I have been doing
them for 20 minutes twice a day." I ask her to tell me what she was doing because I
wonder how a bath could be so tiring. Very seriously, she explains she would fill the
bathtub with water and get in and sit down. Then she would stand up, sit down, stand up,
sit down, stand up, sit down-for 20 minutes at a time. No wonder she was tired!
I want to both laugh and cry. The image of this very pregnant woman intently doing
deep-knee bends in the bathtub is comical, but her pride and sincerity are touching. If she
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had fallen, she could have suffered serious injury. Once again I realize how important
good communication is and how risks can be increased by faulty communication.
Next I am called to the Emergency Department. When I arrive, the room is full of
physicians and nurses. Among them is an x-ray technician busily taking an x-ray film of a
man's leg. The patient, a 38-year-old Mexican gardener, had fallen out of a 10-ft high
tree. After I introduce myself, the physicians and I ask the patient routine questions. The
man keeps repeating, "Mi canilla, mi canilla." Somebody else in the room knew a little
Spanish, which explains to me why the technician is taking x-ray films of the man's leg. I
tell them that he means his wrist, which turns out to be broken. In most Spanish-speaking
countries, canilla means shinbone and the use of canilla for the wrist is a little unusualexcept in certain parts of Mexico where the word means wrist. Spanish technically is not
divided into dialects, but the meaning of a word can vary by context or the region of the
speaker.
I sometimes observe physicians and nurses who know a little of the language trying to
converse in Spanish with their Hispanic patients. I always encourage this practice.
Among other benefits, it helps make a patient feel more comfortable and builds rapport.4
It is important when making this effort not to overestimate language abilities and to
remember that a much lower skill level of communication is required for "chatting." It is
also important to remember that even if a question appears to be more or less understood
by the patient, the answer may not be understood by the health care professional well
enough to be the basis for a medical decision.
Learning a foreign language to the point of the true bilingualism of a professional
interpreter takes a lot of time and practice, and the subtleties involved-and the potentially
disastrous consequences of an error in interpretation-are even more telling in the medical
context. Proper medical interpretation requires a firm grasp of two different and complex
languages to achieve immediate, highly functional, and accurate translation, often at
times of high stress and in critical circumstances, plus an ability to communicate
effectively in each language at many different educational levels. A modest course of
study in Spanish is not enough to interpret reliably in a medical situation. An
inexperienced Spanish speaker usually does not know the right Spanish word or may
know the right word but not how to pronounce it properly. The results can be confusing,
insulting, or comic. One physician who was trying to be friendly with a female patient,
asked her, "¿Cuántos anos tiene usted?" He intended, "¿Cuántos años tiene usted?"
("How old are you?"), but, by mispronouncing the word años as anos, what he really
asked was, "How many anuses do you have?"
In another case, a 70-year-old Cuban woman was being discharged from the hospital into
the care of her daughter, also a non-English-speaking resident of Cuba. The woman's
granddaughter was doing the interpreting, as she had throughout the hospital stay with
reasonable success. The young girl thought she did a good job of clearly explaining the
discharge instructions, but her aunt, the person for whom she was interpreting, did not
understand that the grandmother's medication was to be tapered off. Instead, after release
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from the hospital, the aunt cut back the dosage suddenly. This error was discovered only
when the patient returned to the hospital very ill with other complications.
The granddaughter, although fully bilingual, was not trained to make certain her aunt
fully understood the instructions. In these instances, "back-interpretation" should be usedask that the interpreted instructions be repeated back so that any miscommunication can
be detected and corrected and questions can be cleared up. I am asked many times, "How
do you say this or that in Spanish?" In most cases several words or expressions need to be
tried until the interpreter is certain that the patient truly understands what the interpreter
is trying to say. Few Spanish-speaking patients or families ask a lot of questions. Most of
the time they just nod and go home, wondering what they were told in the hospital or the
clinic. Using a professional interpreter who is aware of this tendency helps to avoid
misunderstandings.
So goes a typical day in a large university medical center. This account of my daily
experiences shows why it is important to always use professional interpreters in medical
settings. This may not always be possible, of course, because of limited staffing or in
emergencies. It is tempting, when rushed for time, to forge ahead and "make do," relying
on dimly remembered high school Spanish plus the patient's or a family member's broken
English. However tempting it may be, this choice should be avoided. A little Spanish and
broken English typically are inadequate for the level of communication required for good
medical care. Using family members, friends of the patient, or Latino cleaning staff rarely
is sufficient and can have bizarre consequences.5,6 Cleaning staff are untrained and
inexperienced in medical interpretation, among other problems. Family members-and
patients, for that matter-similarly are untrained and inexperienced and may suffer a
dramatic decline in English proficiency when confronted with the stresses inherent in the
context of illness. It has been observed that the "language of our childhood remains the
language used during times of intimacy and stress."1
Professional interpreters are the conduit for effective, efficient, and reliable
communication between a health care professional and a patient or family member not
fluent in English. Health care professionals must recognize that the situation always is
bicultural and not merely bilingual. Successful communication between a health care
professional and a patient, if a non-English speaker is involved, requires more than
mechanical translation between English and the foreign language. The use of a
professional interpreter can help achieve this objective.
REFERENCES
1. Poma PA: Pregnancy in Hispanic women. J Natl Med Assoc 1987;79:929-935
2. Hall TA: Designing culturally relevant educational materials for Mexican
American clients. Diabetes Educat 1987;13:281-285
3. Poma PA: Impact of culture on health care: Hispanos. Illinois Med J
1979;156:451-458
4. Swartz MH: Textbook of Physical Diagnosis. New York, NY, WB
Saunders/Harcourt Brace Jovanovich, 1989
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5. Rader G: Management decisions: Do we really need interpreters? Nurs Manage
1988;19:46-48
6. Carol E: Use of interpreters in medical care. Sonoma Co Physician 1991;42:28-31
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STANDARDS OF PRACTICE FOR MEDICAL
INTERPRETERS
Atlanta Academy of Languages
ACCURACY
OBJECTIVE: To interpret with the highest degree of accuracy
achievable.
Related Ethical Principle:
Interpreters strive to render
the message accurately,
conveying the content and
spirit of the original message,
taking into consideration
the cultural context.
1. The interpreter renders all messages accurately and
completely, without adding, omitting, or substituting.
For example, an interpreter repeats all that is said, even if it seems
redundant or irrelevant. This information may be more important than
the interpreter realizes.
2. The interpreter replicates the register, style, and tone of the
speaker.
For example, unless there is no equivalent in the patient/provider 's
language, an interpreter does not substitute simpler explanations for
medical terms a speaker uses, but may ask the speaker to re-express
themselves in language more easily understood by the other party.
3. The interpreter advises parties that everything said will be
interpreted.
For example, an interpreter may explain the interpreting process to a
provider by saying "everything you say will be repeated to the
patient/provider"
4. The interpreter manages the flow of communication.
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For example, an interpreter may ask a speaker to pause or slow
down.
5. The interpreter corrects errors in interpretation.
For example, an interpreter who has omitted an important word
corrects the mistake as soon as possible.
6. The interpreter maintains transparency.
For example, when asking for clarification, an interpreter says to all
parties, "I, the interpreter, did not understand, so I am going to ask
for an explanation."
CONFIDENTIALITY
OBJECTIVE:
To honor the private and personal nature of the educational
interaction and maintain trust among all parties. To be in
constant compliance with the Health Insurance Portability and
Accountability Act (HIPAA).
Related Ethical
Principle:
Interpreters treat as confidential,
within the direct clinical team, all information learned
in the performance of their
professional duties, while
observing relevant requirements
regarding disclosure.
7. The interpreter maintains confidentiality and does not
disclose information outside the treating team, except if required
by law.
For example, an interpreter does not discuss a patient’s case with
his/her own family or with community members.
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8. The interpreter protects written patient information in his or
her possession.
For example, an interpreter does not leave notes on an interpreting
session in public view.
IMPARTIALITY
OBJECTIVE:
To eliminate the effect of interpreter bias or preference.
Related Ethical
Principle:
Interpreters strive to maintain
impartiality and refrain
from counseling, advising,
or projecting personal biases
or beliefs.
9. The interpreter does not allow his/her own personal
judgments or cultural values to influence objectivity.
For example, an interpreter does not reveal personal feelings through
words, tone of voice, or body language.
10. The interpreter discloses potential conflicts of interest,
withdrawing from assignments where such a conflict of interest
may in reality exist or appear to exist.
For example, an interpreter avoids interpreting for a family member or
close friend, or for neighbors.
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RESPECT
OBJECTIVE:
To acknowledge the inherent dignity of all parties in the
interpreted encounter.
Related Ethical
Principle:
Interpreters treat all parties
with respect.
11. The interpreter uses professional, culturally appropriate
ways of showing respect.
For example, in greetings, an interpreter uses appropriate titles for
both parents and providers. Interpreters use the polite form of
address (in languages where such distinctions are customary)
appropriately.
12. The interpreter promotes direct communication among all
parties in the encounter.
For example, an interpreter may tell the patient and the speaker to
address each other directly, rather than addressing the interpreter.
13. The interpreter promotes patient/provider autonomy.
For example, an interpreter directs a patient who asks him or her for
a ride home to appropriate resources within the institution.
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CULTURAL AWARENESS
OBJECTIVE:
To facilitate communication across cultural differences.
Related Ethical
Principle:
Interpreters strive to develop
awareness of the cultures
encountered in the performance
of interpreting duties.
14. The interpreter strives to understand the cultures associated
with the languages he or she interprets, including the culture(s)
in regard to health care, and represents the non-speaker of that
language in the most culturally-appropriate manner possible.
For example, an interpreter learns about the health care system and
customs, etc. of countries where the patient’s language is spoken.
When interpreting, s/he may also suggest appropriate ways to
approach a variety of topics and create a higher degree of trust
among the parties involved.
15. The interpreter alerts all parties to any significant cultural
misunderstanding that arises.
For example, if a speaker recommends that a patient who is fasting
for religious reasons eat a good breakfast, an interpreter may call
attention to the potential conflict.
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ROLE BOUNDARIES
OBJECTIVE:
To clarify the scope and limits of the interpreting role, in order to
avoid conflicts of interest.
Related Ethical
Principle:
The interpreter maintains
the boundaries of the professional
role, refraining
from personal involvement.
16. The interpreter limits personal involvement with all parties
during the interpreting assignment.
For example, an interpreter does not share or elicit overly personal
information in conversations with a patient.
17. The interpreter limits his or her professional activity to
interpreting within an encounter.
For example, an interpreter never advises a patient in regards to
medical or health care questions or decisions, but redirects the
patient to ask the provider.
18. The interpreter with an additional role adheres to all
interpreting standards of practice while interpreting.
For example, an interpreter who is also a patient
representative/chaplain/nurse does not confer with another provider
in the patient’s presence, without reporting what is said.
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PROFESSIONALISM
OBJECTIVE:
To uphold the public’s trust in the interpreting profession.
Related Ethical
Principle:
Interpreters at all times act
in a professional and ethical
manner.
19. The interpreter is honest and ethical in all business
practices.
For example, an interpreter accurately represents his or her
credentials and therefore does not claim to have expertise in the field
of education other than those reflected by his/her specific experience,
job position, and/or professional degrees.
20. The interpreter is prepared for all assignments.
For example, an interpreter asks about the nature of the assignment
and reviews relevant terminology prior to an assignment.
21. The interpreter discloses skill limitations with respect to
particular assignments.
For example, an interpreter who is unfamiliar with a medical term or
acronym (such as MI or TIA) asks for an explanation before
continuing to interpret.
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22. The interpreter avoids sight translation (reading a text
silently and then rapidly translating it orally), especially of
complex or critical documents, if he or she lacks sight
translation skills.
For example, when asked to sight translate a consent form,
an interpreter instead asks the speaker to explain its content and then
interprets the explanation.
23. The interpreter is accountable for professional performance.
For example, an interpreter does not blame others for his or her
interpreting errors.
24 The interpreter advocates for working conditions that support
quality interpreting.
For example, an interpreter on a lengthy assignment indicates when
fatigue might compromise interpreting accuracy.
25. The interpreter shows respect for professionals with whom
he or she works.
For example, an interpreter does not spread rumors that would
discredit another interpreter.
26. The interpreter acts in a manner befitting the dignity of the
profession and appropriate to the setting.
For example, an interpreter dresses appropriately and arrives on time
for appointments.
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PROFESSIONAL DEVELOPMENT
OBJECTIVE:
To attain the highest possible level of competence and service.
Related Ethical
Principle:
Interpreters strive to further
their knowledge and skills,
through independent study,
continuing education, and
actual interpreting practice.
27. The interpreter continues to develop language and cultural
knowledge, as well as interpreting skills.
For example, an interpreter stays up to date on changes in medical
terminology, health care trends or practices, current health care
concerns, and/or regional slang.
28. The interpreter seeks feedback to improve his or her
performance.
For example, an interpreter consults with colleagues about a
challenging assignment and on occasion asks that another qualified
interpreter observe an encounter in order to provide honest and
useful feedback.
29. The interpreter supports the professional development of
fellow interpreters.
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For example, an experienced interpreter mentors novice interpreters.
30. The interpreter participates in organizations and activities
that contribute to the development of the profession.
For example, an interpreter attends professional workshops and
conferences.
ADVOCACY
OBJECTIVE:
To prevent harm to parties that the interpreter serves.
Related Ethical
Principle:
When the patient’s health,
well-being or dignity is at
risk, an interpreter may be
justified in acting as an
advocate.
31. The interpreter may speak out to protect an individual from
serious harm.
For example, an interpreter may intervene on behalf of a patient with
a life-threatening allergy or a severe fear/phobia, if the condition has
been overlooked.
32. The interpreter may advocate on behalf of a party or group to
correct discrimination, mistreatment or abuse.
For example, an interpreter may alert his or her supervisor to patterns
of disrespect towards patients.
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The competent interpreter:
1. Introduces self and explains role. Ideally, the interpreter consults first with the provider to learn
the goals of the medical encounter, and with the patient to assess language requirements. Then, if
this is their first meeting, the interpreter explains his role to both the patient and provider. The
interpreter must emphasize the professional obligation to transmit everything that is said in the
encounter to the other party and to maintain confidentiality.
2. Positions self to facilitate communication. The interpreter should be seen and heard by both
parties, but should position herself in the place that is least disruptive to direct communication
between provider and patient, and most respectful of the patient's physical privacy.
3. Accurately and completely relays the message between patient and provider. The interpreter
converts oral messages expressed in one language into their equivalent in the other, so that the
interpreted message can elicit the same response as the original. The interpreter does not alter or edit
statements from either party, or comment on their content. The goal is for the patient and the
provider to feel as if they are communicating directly with one another.
4. Uses the interpretation mode that best enhances comprehension. The interpreter encourages
direct communication between patient and provider using whatever modes are appropriate. Usually
the best mode will be to use "I..." in reference to the speaker rather than "he said that..." or "she said
that..." and to interpreter for the patient and the provider alternately.
5. Reflects the style and vocabulary of the speaker. The interpreter attempts to preserve the register
(special vocabulary and level of formality) as well as the emphasis and degree of emotion expressed
by the speaker.
6. Ensures that the interpreter understands the message to be transmitted. The interpreter asks for
clarification or repetition if the message from either party is unclear.
7. Remains neutral. In situations where there is conflict between patient and provider, the interpreter
remains outwardly calm, continues interpreting completely, lets the parties speak for themselves and
does not take sides.
8. Identifies and separates personal beliefs from those of other parties. The interpreter does not
project his own values into the discussion.
9. Identifies and corrects own mistakes. The interpreter checks the accuracy of her own
interpretation.
10. Addresses culturally based miscommunication when necessary. The interpreter identifies
instances in which cultural differences between provider and patient have the potential to seriously
impair their communication. In those instances, the interpreter shares cultural information with both
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parties that may be relevant, or assists the speaker in developing an explanation that can be
understood by the listener.
Professional Standards: Ethics
Professional ethics are rules that help you maintain a professional relationship with the people you work
with and for. A medical interpreter must maintain a professional relationship with both the patient and
the provider in a health care encounter. The Working Group recommends the following set of
professional ethics standards.
An ethical interpreter:
1. Maintains confidentiality. Information exchanged in any interpreter exchange--for example,
between a patient and a health care provider--is private. The interpreter does not intentionally reveal
confidential information.
2. Interprets accurately and completely. The interpreter is committed to transmitting the content and
spirit of the original message into the other language without omitting, modifying, condensing or
adding.
3. Maintains impartiality. The interpreter withdraws from assignments where personal ties or beliefs
may affect impartiality and refrains from interjecting personal opinions or biases into the interview.
4. Maintains professional distance. The interpreter understands the boundaries of the professional
role and monitors her own personal agenda, refraining from becoming personally involved in a
patient's life.
5. Knows own limits. The interpreter refrains from interpreting beyond his training, level of
experience and skills. In addition, he avoids situations that may represent a conflict of interest or
may lead to personal or professional gain.
6. Demonstrates professionalism. The interpreter clearly understands her role and refrains from
delivering services that are not part of that role. The interpreter conducts herself in dress, posture and
speech in a manner appropriate to the situation, and is respectful, courteous and honest.
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OTHER SUGGESTIONS:
BODY POSTURING:
 HANDS
 FEET
 SHOULDERS
 LOCATION
Remember:
The goal of all body positioning and body language should be
enhancing effective and direct communication between the
healthcare provider and the patient.
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APUNTES SOBRE TERMINOLOGÍA MÉDICA (A PROPÓSITO DEL TALLER EN
LAS TUNAS)
1- ACENTUACIÓN DE LETRAS MAYÚSCULAS
Recordar que todas las letras mayúsculas deben llevar tilde al igual que las minúsculas
cuando así lo recomienden las normas ortográficas.
2- USO EXCESIVO DE LETRAS MAYÚSCULAS EN TEXTOS
Las letras mayúsculas en los textos deben limitarse en lo posible a nombres propios,
de países, de ciudades, de instituciones y como primera letra de cualquier párrafo o de
ciertas abreviaturas.
3- USO DEL GERUNDIO EN MEDICINA
Tratar de evitar el uso del gerundio (terminaciones en –ando, -iendo) cuando no
expresen acciones simultáneas con el verbo principal.
4- USO DE ABREVIATURAS
Siempre que se utilice una abreviatura en un texto por primera vez debe escribirse al
lado entre paréntesis su significado.
5- EXPRESIONES INADECUADAS
a) PALABRAS TOMADAS DIRECTAMENTE DE OTRO IDIOMA
INCORRECTAS
CORRECTAS
shock
choque
stress
estrés
tractus, tracto
vía, tubo
ductus
conducto
déficit
deficiencia, insuficiencia
shunt
derivación, cortocircuito
testis, testes
testículo
canal
conducto
diabetes mellitus
diabetes sacarina
septum, septo
tabique
b) PALABRAS PARECIDAS A LAS DEL INGLÉS
INCORRECTAS
canalículo
transplante
imagenología
reasumir
malrotación
droga
ostomía
sonda de Levine
©2009 Atlanta Academy of Languages, Atlanta GA
CORRECTAS
conductillo
trasplante
imaginología
reiniciar
rotación anómala
fármaco, medicamento
estoma
sonda de tipo Levin
94
amoxicillina
ampicillina
salvataje
remover
consentimiento informado
INCORRECTAS
patología
severo
scintigrafía
manejo
amoxicilina
ampicilina
preservación
extirpar, extraer
autorización
verbal o escrita
CORRECTAS
enfermedad, afección
grave, intenso, extenso
ganmagrafía
conocimiento (enfermedades)
tratamiento (enfermos)
exstrofia
asistencia (en determinado contexto)
proquinéticos
citoquinas
desorden
fallo cardiaco
división de un órgano
precoz
proceder (como sustantivo)
usualmente
extrofia
ayuda
procinéticos
citocinas
enfermedad, alteración
insuficiencia cardiaca
sección o incisión
temprano, preclínico
procedimiento
con frecuencia, frecuentemente,
generalmente
efusión
derrame
ultrasonido (examen complementario) ecografía
invasivo
cruento
no invasivo
incruento
resucitación
reanimación o
reposición de volumen sanguíneo
desorden
enfermedad, alteración
infante
niño
pacientes en edad pediátrica
niño, niñez
5- ERRORES DE GÉNERO O DE ACENTUACIÓN
INCORRECTAS
CORRECTAS
el éxtasis
la estasis
la hipospadia
el hipospadias
la epispadia
el epispadias
-scopía
-scopia
epístaxis
epistaxis
anastómosis
anastomosis
quémosis
quemosis
equímosis
equimosis
©2009 Atlanta Academy of Languages, Atlanta GA
95
6- PALABRAS QUE NO EXISTEN EN LOS DICCIONARIOS
INCORRECTA
CORRECTA
sangramiento
sangrado, hemorragia
lisar
seccionar, separar
íctero
ictericia
endopleural
pleural
minitoracotomía
toracotomía pequeña
transabdominal
intra(a)bdominal
transoperatorio
intraoperatorio, perioperatorio
protocolizar
siclemia
siclémico
hacer un protocolo,
incluir en un protocolo
drepanocitemia, anemia drepanocítica
paciente con
drepanocitemia
7- INCORRECCIONES EN LA GRAFÍA DE PALABRAS Y ACRÓNIMOS
INCORRECTAS
CORRECTAS
la TAC
el tac
SIDA
sida
delección
deleción
meningococcemia
meningococemia
desición
decisión
autoingerto
autoinjerto
debridar
desbridar
decamación
descamación
8- EXPRESIONES INADECUADAS
INCORRECTA
CORRECTA
de acuerdo a
de acuerdo con
asociado a
asociado con
relacionado a
relacionado con
respecto con
respecto a
mortalidad (con respecto a una enferm.) letalidad
cirugía (como procedimiento)
operación, intervención quirúrgica
sepsis (limitada)
infección
sepsis generalizada
sepsis
©2009 Atlanta Academy of Languages, Atlanta GA
96
hematoma infestado
hematoma infectado
9- UNIDADES DE MEDIDA
Siempre se debe tratar de utilizar las unidades internacionales, y emplear abreviaturas
escritas con minúsculas y sin punto (m, cm, kg, ml, etc.).
10- TAXONOMÍA DE LOS GÉRMENES: Deben escribirse en palabras procedentes del
latín con letras cursivas, o en español, pero utilizando la grafía correcta.
INCORRECTO
CORRECTO
Streptococus Pyogenes
Streptococcus pyogenes,
estreptococo piógeno
Prescription Terms & Abbreviations
Prescription
abbreviation
a
ac
ad lib
AM
ASAP
BID
c
d
h
hs
mo
p
pc
PM
PRN
q
qAM
QD
q4h
QID
QOD
qPM
rep
Prescription term
before
before meals
as desired
morning
as soon as possible
twice a day
with
day
hour
bedtime (hour of sleep)
month
after
after meals
evening
as needed
every
every morning
every day
every four hours
four times a day
every other day
every evening
repeat
©2009 Atlanta Academy of Languages, Atlanta GA
97
STAT
TID
UD
wk
i
ii
iii
iv
v
vi
vii
viii
ix
x
xii
xv
xvi
xx
xxx
L
C
D
M
ss
cc
g, G, GM
gal
gr
L
lb
mEq
mcg
mg
mL
no.
oz
pt
qt
tsp
tbsp
BP
NOW-immediately
three times a day
as directed
week
1
2
3
4
5
6
7
8
9
10
12
15
16
20
30
50
100
500
1000
1/2
cubic centimeter
gram
gallon
grain
liter
pound
milliEquivalent
microgram
milligram
milliliter
number
ounce
pint
quart
teaspoon
one tablespoon
blood pressure
©2009 Atlanta Academy of Languages, Atlanta GA
98
c
D/C
Disp
HA
non rep
N/V
qs, qsad
Rx
s
Sig
sx
T, temp
<
>
with
discontinue
dispense
headache
no refill
nausea and vomiting
fill up to
prescription; take
without
signatura; directions for the patient
symptoms
temperature
less than
more than
©2009 Atlanta Academy of Languages, Atlanta GA
99
Medical Terminology Quiz
Matching exercise
acro
???
chir-, chiro-
???
pod-, poda-
???
thorac-, thoraco-
???
broch-, broncho-
???
pneu-, pneumo-
???
pulmo-, pulmono-
???
angi-, angio-
???
vas-, vaso-, vasculo-
???
cardi-, cardio-
???
phleb-, phlebo-
???
vene-, veno-
???
throm-, thrombo-
???
viscero-
???
col-, colo-
???
cyst-, cysto-
???
enter-, entero-
???
mast-, masto-
???
metra-, metro-
???
gastr-, gastro-
???
Top of Form
©2009 Atlanta Academy of Languages, Atlanta GA
100
ANSWER KEY TO PREVIOUS PAGE QUIZ
acrochir-, chiropod-, podathorac-, thoracobroch-, bronchopneu-, pneumopulmo-, pulmonoangi-, angiovas-, vaso-, vasculocardi-, cardiophleb-, phlebovene-, venothrom-, thromboviscerocol-, colocyst-, cystoenter-, enteromast-, mastometra-, metrogastr-, gastro-
usually refers to extremities
relationship to the hand
relationship to the foot
relationship to the chest
relationship to the bronchi
relationship to the lungs
relationship to the lungs
relationship to the blood vessels
relationship to the blood vessels
relationship to the heart
relationship to the veins
relationship to the veins
relationship to a clot
relationship to the body organs
relationship to the large intestine
association with the urinary bladder
association with the intestine
association with the breast
uterus
association with the stomach
©2009 Atlanta Academy of Languages, Atlanta GA
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
:-)
101
PRACTICE QUIZ
1. -emia means:
Blood Condition.
NEPHRO =
HEPATO =
Deficiency.
Excess of.
MYEL =
Death of
2. -pnea means :
LITHO =
Break.
Breathing.
GLOSS0 =
Swallowing.
Circulation.
OTO =
3. -stenosis means:
Hardening.
RHINO =
Constriction.
Expanding.
ENCEPHO =
Malignancy.
4. -ostomy means:
OSTEO =
Cut into or incision.
Ablation.
STOMATO =
Enlargement.
Create an artificial opening.
©2009 Atlanta Academy of Languages, Atlanta GA
GASTRO =
102
5. -otomy means:
Cut into or incision.
ENTERO =
Ablation.
Enlargement.
Create an artificial opening.
ORCHIDO =
POD =
6. -megaly means:
-ALGIA
Multiply.
Ablation.
- HISTERO
Enlargement.
Diseased.
- ARTRO
7. -plasia means:
Formation, development or growth.
MASTO
Repairing of, suturing.
Metastisizing of a tumor.
Condition.
8. -cele means:
Cell.
Chest.
Cavity.
Swelling, protrusion.
©2009 Atlanta Academy of Languages, Atlanta GA
103
9. -itis means:
Itching.
Burning.
Scaly.
Inflammation.
10. The Suffix "pepsia" refers to:
Chest muscles
The nervous system
Digestion
Hearing
11. onc/o means:
old
cancer
tumor
deadly
12. iatr/o means:
hirsute
iodine
physician, medicine
cold
13. lip/o:
white
fat
rough
soft
©2009 Atlanta Academy of Languages, Atlanta GA
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14. xantho means:
yellow
brown
anti
reversed
15. eti/o (as in etiology):
system
science of
cause
history
16. dys- means:
two
difficult
easy
forked
17. hypo- means:
below, incomplete
over, outside
through
inside, within
18. chrom/o means:
silver
color
brittle
shiny
©2009 Atlanta Academy of Languages, Atlanta GA
105
19. rhabd/o means:
rod-shaped
science of
rapid
history
20. sarco means:
flesh, connective tissue
solid
opaque
forked
21. Endo means:
Above.
Below.
Within.
Fat.
22. Thromb/o means:
To throb.
To divide.
To clot.
To dry out.
23. Brady- means:
Fast.
Irregular.
Prolonged.
Slow.
©2009 Atlanta Academy of Languages, Atlanta GA
106
24. Salping/o means .
Fallopian tube.
Pus.
Polyp.
Flesh, connective tissue.
25. Onych/o means
Testicle.
The same as Orchi/o.
Single, one.
Nail.
26. Tachy- (as in tachycardia) means:
A slowing down
Irregular
Fast or rapid
Malignant
27. andro means:
above, over
human
through
male
28. viscer/o means:
cut open
internal organs
exoskeleton
relate to
©2009 Atlanta Academy of Languages, Atlanta GA
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29. cyano
blue
white
cyanide
large
30. gno/o means:
small
knowledge
science of
branch
31. cyto means
fat
smooth
blue
cell
32. myo- refers to your:
brain
myoptic nerve
feet
muscle
33. neuro means:
nerve
new
digestive system
endocrine system
©2009 Atlanta Academy of Languages, Atlanta GA
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34. kary / o means
cell
karaoke
nucleus
illness
35. leuk/o means:
white
limpid
black
sickle-shaped
36. erythro/o means:
membrane
heart-shaped
red
brown
37. histo/o means:
film
time
tissue
yellow
38. melano means:
black
diseased
malignant
cancer
©2009 Atlanta Academy of Languages, Atlanta GA
109
39. path/o means:
within
purple
excised
disease
40. somat/o means:
extremity
body
tissue
nerve
©2009 Atlanta Academy of Languages, Atlanta GA
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