Monday, September 30, 2013

Medical Interpreters in Honduras

Medical Interpreter
What's it like to work as a doctor with a non-Expert Interpreter, with an Expert one, and finally with an Expert one but by telephone? The following first-hand description by a doctor working in up-country Honduras is both instructive and amusing.
I finally got the simple phrase “Por que estas aqui hoy?” down pat, but the answers sometimes surprised me.

“I wake up every morning and think about blowing my head off.”

That is what my first patient of the day told me through a translator. He was 79 years old, a weather- beaten, wrinkled old caballero with a rusted six-shooter tucked into his waistband.

“How long have you felt this way?”

“For many years.”

Uh-oh. As far as I knew there were no psychiatrists available in the mountain villages of Honduras, and we had not thought to stock anti-depressant medicines in our traveling pharmacy. Hundreds more patients were lined up waiting to be seen. I had to solve this ominous problem somehow. My translator was a University of Virginia student who grew up speaking Spanish at home (her parents were Peruvian) and she was quite fluent. I had her translate the complaint several times and each time it was the same. His very first thought every morning was blowing his head off. And yet something didn’t quite fit. The patient did not appear depressed and in fact was grinning and seemed delighted with the close attention he was getting from the gringo medico. I was missing something. I needed more than a translator. I needed an interpreter.

I called Pedro over. Pedro was a native of Honduras and our local fixer. If anyone could help, it was Pedro. He seemed to know everyone in Honduras and could talk to anyone. I asked Pedro to ask my ancient cowboy why he had come.

“He has a headache,” Pedro told me.

“Does he want to blow his head off?”

Pedro and the patient chuckled.

“No. He is saying his head feels like it’s going to explode. You know, blow up.”

“He has had headaches for many years. He has high blood pressure but can’t get any medicines for it because there is no doctor in his town. He wants you to prescribe him blood pressure medicine. That is why he is here.”

My translator was beet red. Yet it wasn’t her fault. Peruvian idiom is different than Honduran idiom and her translation was accurate but misleading...

Verbal translating and interpreting are closely related but sometimes critically different skills. Translating is generally word-for-word verbatim relaying from one (source) language into another (target) language. Interpreting is more likely to be paraphrasing what each speaker is saying. When done well, interpreting is more accurate than translating, but it requires a deeper fluency in both languages compared to translating, which requires less fluency in the source language, in this case Spanish. When trying to understand complex medical and social issues, especially in the time-pressured ER [emergency room], interpreters are more helpful than translators, who are more widely available.

Early in my career, non-English speakers were not common [as patients] in the ER and interpreting services in the hospital were not available. We improvised when language barriers arose. Spanish speakers could usually be found among the ancillary staff. Once when faced with a patient who spoke only Chinese, our triage nurse called the local Chinese restaurant and used the waiter to translate. Of course this is not HIPAA [US Health Insurance Portability and Accountability Act] compliant, but the patient got the care he needed and we got General Tso’s chicken for lunch.

Times have changed. Now we have instant access to certified medical interpreters in over 200 languages via a subscription service on our ER telephones"
The good doctor has his own non-standard terminology for translator vs. interpreter, but he makes it clear what he means. As for the term fixer, enter it in the Search box on the right to see other instances. I didn't expect to see it turn up in Honduras.

The end of the doctor's story shows the way things are moving in medical interpreting. When no Expert Interpreter is available, you use who you can. But the advent of telephone interpreting, despite its limitations, is bringing Expert Interpreters to remote places. "Telephone Interpreting is the fastest growing modality of community interpreting," claims the website of the International Medical Interpreters Association. Give it another 20 years to become quasi-universal.

References
Dr. Robert C. Reiser. Annals of medicine: lost in translation. The Crozet Gazette (Crozet, Virginia), 7 September 2013. For the full article, click here.
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Source: Interpreter Training Solutions, LLC

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