My Night as Medical Interpreter - Conclusion

Continued from October 17. Please read this series in the correct order, starting at October 11.


My reflections on the experience.

1. I did it. Not much of it, but enough to let me feel how it feels. Actually my wife, who has no training as an interpreter, also did some of it at Cullera.

2. We’ve seen two kinds of medical interpreting in this mini-series. There’s a regulated, neutral, keep-your-distance, cut-and-dried kind in which the interpreter is assigned by an organisation, interprets for a limited time and then disengages and moves on to another assignment. That’s the kind reflected in the Australian paper. Then there’s a kind where the interpreter accompanies the patient for as long as necessary, adds information when it can be useful and does more than just translate. In G.’s case, I wasn’t only his language interpreter, I was his mediator with the bureaucracy and ‘interpreter’ (in another sense) to the doctors.

3. Interpreting for patients who are mentally ill is different from doing so for those who are physically impaired. The mental patient’s discourse may be part of the disease. It may be incoherent; or it may, as in G.’s case, mask the problem. The interpreter becomes a collaborator and an explainer.

4. The interpreter is at an advantage if he or she knows the patient’s medical history and current state of health. Interpreters are always at an advantage if they have background knowledge, whatever the mode of interpretation. This is something that laymen don’t understand; they think language proficiency is everything. But as one of my mentors, a seasoned conference interpreter, used to say, “Half the battle is knowing what they’re talking abut.” Court and legal interpreters ought to be provided with a copy of the case summary (called the factum in Canadian law) but they rarely are. Medical interpreters should likewise be briefed with a case summary. In G.’s case, I enjoyed an immense advantage by knowing what was wrong with him and I couldn’t have been so useful otherwise.

5. Lionel Dersot, in his comment on the previous post, rightly says that there’s information which the interpreter mustn't withhold. However, when supplying information, interpreters must make it clear what it is that they know personally and what's only hearsay. G.’s heavy drinking was something I’d witnessed myself; but when I told the doctors about the tests he’d undergone in England and the possible cause of his affliction, I was careful to say that I’d only heard about it from his wife.

6. You can't be squeamish. In my case it went no further than watching the security guards tie G. down to the bed. ("Sometimes we have to do it to old people," one of them said to me.) But there are also accident sites, battlefields, deathbeds, even operating theatres.

7. The doctrine of Protection of Personal Data is sometimes enforced ad absurdum. When I phoned the hospital at Alzira, all I wanted to know was whether G. was still there and whether he was improving.

6. Although Professional Expert Medical Interpreting will spread, aided by video-conferencing, there will always be places and circumstances where medical interpreting has to be done by Native and even Natural Interpreters.

My Night as Medical Interpreter - 3

Continued from October 16. Please read this series in the correct order, starting at October 11.

The ambulance took us to the Hospital de la Ribera at Alzira (see photo).

G. was put into the observation section of the Emergency department and there we waited. From time to time a doctor or a registrar would come to examine him. To each of them I repeated the same information (in Spanish of course):

* G. hadn’t been drinking. He’d been lying on the bedroom floor for 36 hours.
* Physically G. was strong and healthy. His problem was mental. He’d lost part of his long-term memory and his short-term memory was very short. But some things he recalled obsessively.
* He’d been tested in England for Alzheimer’s and the conclusion was that he didn’t have it. An alternative hypothesis was that his brain had been affected by chemicals that were used at a job he’d had and which caused severe physical symptoms at the time. (This was information that B. had given me.) But it was also true that although he wasn’t drunk now, he’d been a heavy drinker in the past.

G.’s dishevelled appearance and stinking clothes were enough to convince anybody that he needed help, but when the medical staff addressed him in Spanish he caused the same confusion as he had with the initial ambulance men (see previous post). So we weren’t getting very far until, around ten in the evening,…

A doctor arrived who wasn’t Spanish but Indian. He spoke perfect English. He was therefore able to converse with G. directly in English for an extended time. At last somebody understood what I was getting at. He ordered an immediate brain scan.

The doctor in charge of the brain scan was Spanish. He said to me, “He must keep perfectly still during the scan. Tell him that if he doesn’t keep still we’ll have to sedate him.” I retorted, “Even if I tell him, he won’t remember for more than two minutes. You’d better sedate him.” The doctor replied testily, “Tell him anyway.” Which I did. But it made me realise that I’d broken two rules:

* Translate everything the doctor says.
* Don’t voice your own opinion as to medical procedure.

I was learning on the job.

Some time after midnight the results of the scan arrived. Nothing wrong there. So they started to focus on G.’s liver, taking many blood samples while I passed on instructions and tried to explain to G. what was happening and keep him calm.

Then nursing assistants came to clean G. up. He reacted by kicking one of the nurses in the chest. That set off the alarm. Security were called and they tied G. down to the bed. It was tough treatment, but it was a blessing in disguise because G. dozed off, and I tried to do likewise in an armchair next to his bed. However, each time he woke up I had to respond to him and sometimes call for help.

When the nurses started their morning round at seven o’clock, it seemed to me that I couldn’t do any more. So I walked out into the crisp air – Alzira is a hill town – and took the bus back to Cullera to tell B. what was happening. That done, I caught the train back to Valencia, coughing all the way.

The following morning I called the hospital to find out how G. was. This time they didn’t even ask me if I was a relative. All I got was, “Sorry, we’re not allowed to give any information over the phone. Protection of Personal Data.”

To be concluded.

References
La Ribera: Departamento 11 de Salud. In English. http://www.hospital-ribera.com/english/index.htm.

Photo: Ribera Salud.

My Night as Medical Interpreter - 2

Continued from October 11. Please read this series in the correct order.

I’m not a Medical or Health Care Interpreter, neither Professional nor Expert nor even Native. I'd never done it. I’d heard about it, read about it and watched videos about it; but translating is a practical skill, and learning about it isn’t enough. You have to do it.

Nevertheless, in mid-September, just when symptoms of my incipient flu were becoming manifest, I received an anguished call for help from an elderly English lady who lives with her husband in Cullera. Cullera is a pleasant resort town with a fine beach about 25 km south of where I live near Valencia (see photo). I knew the couple because they previously lived in the same village as me. Let’s call the lady B. and her husband G.

B., like all too many English residents in Spain, though she’s lived here for several years, hasn’t learnt to speak or read a word of Spanish. The Spanish National Health Service has trouble dealing with them. On the other hand, G. does speak some Spanish. He was born in England, but his father was Spanish, a refugee from the Civil War, and when he was a child his father used to send him to spend a few weeks each summer with the family in Spain. So he was an early bilingual and could at times give the impression that he spoke Spanish well. But in reality his Spanish was very limited and uneducated.

Ever since I’d known him, G. had been losing his mind. His English was correct, but his discourse was rambling, highly repetitive and full of fantasies. He continually rehashed memories of Africa and talked about his three houses when he didn't even own one. Now he was getting worse. At moments he was violent. He had knocked B down. and she had broken her hip. She had been operated on successfully at the nearest regional hospital, but they had sent her home with a report and a list of prescriptions that neither of them could read. She couldn’t walk more than a few steps, so she couldn’t go to the doctor’s.

My wife and I drove down to Cullera. Our priority was to get proper medical attention for B. The Spanish National Health Service is well organised and free, but sometimes it's slow and it has its bureaucratic side. To be assigned a doctor, you must be registered at the town hall as a resident of the place where you live (the procedure called empadronamiento). B. and G. were not. We spent the day getting that sorted out, and from the second day onwards B. was well taken care of, and the local Health Centre put her into a rehab programme where the physiotherapist speaks enough English.

The problem of G. was not so easily dealt with.

Not only was he degenerating, but he had lost (or quite likely hidden) his medical identity card (the Tarjeta Sanitaria or SIP). Again the bureaucracy. To obtain service from the National Health, you must present your SIP, and without it you’re in limbo. In the course of negotiating a temporary SIP for G., I had to phone the National Health Service in England for some information. (British residents in Spain are covered for health services as European Union citizens.) The conversation went like this:

Me: “I need some information about G., who’s mentally ill, so he can’t come to the phone himself.”
Them: “Who are you? Are you a close relative?”
Me: “No, I’m a friend trying to help out.”
Them: “Sorry, I'm not allowed to give you any information. Doesn’t he have a relative there?”
Me: “There’s his wife, but she’s been injured and can’t walk to the phone.”
Them: “Sorry, I can’t give you any information. Protection of Personal Data.”

By that time, G. was sprawled on the bedroom floor and refused to budge from there. I called for an ambulance. When the two ambulance men arrived, their first question to me was the first one that every medical assistant asked me from then on: “Has he been drinking?” I assured them that he hadn’t been and that his trouble was mental. At that point G. sat up and talked to the ambulance men in Spanish. They asked him, “How do you feel? Have you got any pain? Do you want us to take you to the Medical Centre?” He replied that he felt fine, had no pains and didn’t want anything to do with the Medical Centre. The ambulance men said they sympathised with me, but G. was conscious and coherent, and in view of his answers they had no right to force him to go. So they left him there.

I now concentrated on getting G. the temporary SIP, and by the end of the day, even without the information from England, he had it.

The following morning, G. was still on the bedroom floor. Armed with his SIP, I went to the emergency section of the Medical Centre. There I happened upon a very helpful doctor who ordered the ambulance to be sent again and G. to be brought in. This was accomplished. I explained what was wrong with G., but it was really the fact that G. had trouble lifting one arm that convinced him to send G. to hospital for tests and observation. The regional hospital is about 15 km from Cullera, so that meant another ambulance journey.

At that point I had to decide what to do myself. I realised that nobody would understand what was really wrong with G. unless they spoke English well enough to diagnose him from his discourse. There is in fact a voluntary interpreter service for medical care along that coast, the Costa Blanca, run by British residents themselves. But it’s based at Denia, a fair distance further south, and there’d be a long delay obtaining somebody from it. In spite of my worsening flu, I went with G. in the ambulance.

To be continued.

Photo: fotolog.com

My Night As Medical Interpreter – 1

Before I was laid low by the flu, I read a very interesting article about Medical Interpreting – the Professional Expert kind. It’s a paper from The Critical Link 5 conference (see References). The Critical Link is the premier international conference series on Community Interpreting (or as the British call it, Public Service Interpreting). Critical Link 5 was held in 2007 in Sydney. It was an appropriate venue because Australia was a pioneer in the provision of high-quality Community Interpreting. Indeed, when we organised the first Critical Link conference, which took place in Canada in 1995, I was amazed to learn that Australia was way ahead of my own country both in the provision of services and in the setting of standards.

The reason for all this activity is made clear in the article. There are still people who still think of Australia as an outpost of England and of English. But the reality is, as the article says, that

Australia is one of the most culturally and linguistically diverse countries in the world. In the 2006 census it was possible to code up to 282 countries of birth, 364 languages and 115 religious groups.

The change began immediately after WW2, in the late 1940s, with the arrival of large numbers of non-English speaking refugees and other immigrants from Europe. Later waves of newcomers have come from Latin America, Asia, the Middle East and more recently Africa. By 1973, in the face of this ‘new look’, the Australian government adopted a ‘multiculturalism’ policy and there was the political will to implement it by substantial increases in government expenditure on immigrant welfare and assistance.

The first part of the article relates the history of these services in the state of New South Wales (NSW) from 1972 onwards, and makes it very clear with a timeline graphic. In 1973, the government Telephone Interpreting Service was organised – a world first and a decade ahead of North America – to cope with the problem of delivering interpretation in such a vast country.

In 1977, the Health Care Interpreter Service (HCIS) of NSW was set up, initially providing a workforce of twenty-seven interpreters to serve seventeen Sydney hospitals. Today, the HCIS has a workforce of over 1,000 full and part-time interpreters… generally free of charge, in more than seventy languages (including Auslan or Australian Sign Language)… In rural and remote regions, HCIS interpreters are able to facilitate consultations using videoconferencing.

In the same year, 1977, the National Authority for the Accreditation of Translators and Interpreters (NAATI) was established to act as a uniform standards-setter. Guidelines were drawn up, then reissued and revised over the years.

The rest of the article is mainly taken up with case studies in the form of accounts of their experiences by some of the interpreters. They dwell more on the problems of cultural differences than of language differences that the interpreters encounter. Here’s an example.

Vietnamese families try to protect old patients with terminal illnesses by not telling them the diagnosis or that their time is nearly up.
Many families often approached me outside the [hospital] cubicle and told me not to break the bad news to the patient. I could only say: ‘I have to interpret what the doctor says but, if you like, I can interpret for you with the doctor. You can make the request and it’s up to the doctor to decide.’

The general conclusion is that “in all the case studies collected… the effectiveness of the interpreter’s intervention was a source of great job satisfaction.”

Yet in spite of the wealth of experiences in these real-life case studies, nothing in them prepared me for my own initiation willy-nilly into medical interpreting. This was because all the accounts treated of patients with physical injuries and illnesses, whereas I found myself up against the perplexities of mental illness, where language – or rather the discourse in the language – itself constitutes a major symptom of the disease.

To be continued.

References
Ilse Blignault (U. of New South Wales), Maria Stephanou and Cassandra Barnett (NSW Transcultural Aged Care Service). Achieving quality in health care interpreting: Insights from interpreters. In The Critical Link 5, ch. 14, pp. 221-234, 2009.

The Critical Link 5: Quality in interpreting – a shared responsibility. Edited by Sandra Hale (U. of Western Sydney), Uldis Ozolins (Royal Melbourne Institute of Technology U.) and Ludmilla Stern (U of New South Wales). Amsterdam: Benjamins, 2009. 255 p.

New South Wales Department of Health. Standard Procedures for Working with Health Care Interpreters. (Doc. No. PD2006_053). Sydney: NSW Health, 2006. http://www.health,nsw.gov.au/policies/pd/2006/PD2006_053.html.

Photo: travelguide2australia.com

Nou d’octubre

The posters warn that flu is dangerous for old people. I no longer take that lightly. Unfortunately the inoculation campaign that the posters advertise didn’t begin until 1st October, and my flu began on or about 19th September. I’m not out of the woods yet; but thanks to in-the-nick-of-time medication, I didn’t collapse into pneumonia and I can write again.

My longtime Followers know that I like to celebrate anniversaries, even if it takes us off topic. Today it’s once again Nou d’octubre (Ninth of October), the National Day of the Valencians. I wrote about it last year (post of October 9, 2009) and about the classic of Valencian mediaeval literature called Tirant lo Blanch (Tirant, the White Knight), but here’s some more.

Today is the day when, in 1238, King James I of Aragon (Jaume Primer in Valencian – there‘s a university that bears that name) entered the city of Valencia after receiving the capitulation of its Muslim regime, which had occupied it for most of the previous 400 years. Soon afterwards, the Cathedral started to rise on the site of the Mezquita. At noon today the Valencian national flag, the Senyera, will be paraded through the downtown streets to the magnificent equestrian statue of James I as Conqueror that dominates Alfons the Magnanimous Square (seen photo). Old national passions die hard.

James was not only a great warrior, he was also a great administrator. He parcelled out the lands he conquered judiciously to his followers and supporters, including of course the Church. The College of Notaries of Valencia is the oldest in Spain. Last spring, I visited one of the rare public displays of the Llibre del Repartiment (Book of Property Distribution), which is to Valencia what the Domesday Book is to England. It was lent by the still-intact Archives of the Kingdom of Aragon in Barcelona. In a hasty hand, its three small-format volumes, compiled between 1237 and 1252, list all the property holdings granted by James in what became the Kingdom of Valencia. It’s written on paper manufactured at one or other of the several paper factories that James expropriated from the Muslims.

Although James entered Valencia on this day, he’d actually received the capitulation of the city on September 28. Why did he hold back? Well for one thing he may have been waiting for his rearguard to catch up. When he did finally move, he left the rearguard six kilometres outside, near the place where I now live. There’s a mediaeval cross to mark the spot – but only approximately because the coastline has receded and the cross has had to be moved. Another reason may have been the need to finalise documents and translate them. The Muslims spoke and wrote in Arabic, the Christians in some variant of Catalan. It’s hard to pin down the latter, and it’s not certain what dialect James himself spoke because he was brought up in several different regions. What’s clear is that in this situation, translators were needed. Who were they?

Astonishingly, considering how long ago it was, we do know the names and even a little background of some of James’s staff translators, his ‘secretary-interpreters’. (Bear in mind that the sharp distinction between translators and interpreters is modern, and that until the last century ‘interpreters’ were just as likely to translate written texts as spoken ones.) They were Drs. R. David, R. Solomon, and R. Moses Bachiel; David Almadayan, secretary to the infante Don Fernando; Drs. R. Joseph, R. Samson and Abraham ibn Vives. The last was probably the father of the wealthy Joseph ibn Vives who in 1271 held a lease of the salt-works of Valencia, and who was likely the ancestor of the prominent Valencian Renaissance humanist Luis Vives, of whom there is a statue in the courtyard of the University of Valencia.

As you can guess from the names, they were all Jewish.

The Jews formed a neutral group between Christians and Muslims. There were flourishing Jewish communities in all the major Iberian towns and in many of the not so major. When I met the Israeli translation theorist Itamar Even-Zohar last year, he was going around the old nucleus of Tarragona looking for remnants of the Jewish quarter there. The Jews spoke the languages of their milieux (Arabic in the Muslim areas) and wrote Hebrew in Arabic characters. As so often, they were cultivated and connected, and they were extremely useful to their rulers of whatever language or religion.

As a reward for the important services which they had rendered him in the conquest of the strongly fortified city, he presented to some of them houses belonging to the Moors, as well as real estate in the city and its precincts... In 1239 King James assigned the Jews a commodious quarter for residence.

From 1283 onwards, well after James’s reign, this idyllic cohabitation turned sour. But that’s another story.

References
Llibre del Repartiment de Valencia. In Spanish. Wikipedia Español. http://es.wikipedia.org/wiki/Llibre_del_Repartiment_de_Valencia.

Alfons Garcia. Por muchos estudios, nunca conoceremos la lengua de Jaume I. (However many studies are done, we will never know what language James I spoke). In Spanish. Levante-EMV newspaper, May 8, 2009. http://www.levante-emv.com/cultura/2009/05/08/estudios-conoceremos-lengua-jaume-i/587030.html.

Isidore Singer and Meyer Kayserling. Valencia. Jewish Encyclopedia.com.
http://www.jewishencyclopedia.com/view.jsp?artid=5&letter=V.

The promised post on Medical Interpreting will appear in the next few days.

Hiatus Extended...

because I've had a very bad bout of flu and I'm still under the effects of the flu itself and the medicines for it.

But there will be something posted these coming days about Medical Interpreting.

Church Interpreting in Nigeria

In a post on August 9, 2009, I told how I first become acquainted with church interpreting at a service on the campus of the University of Buea in Cameroon, West Africa. Since then, I’ve learned many things about how it’s done in other parts of the world, some of them from you readers (see References). Now an article just published in the latest edition of Babel, the research journal of the International Federation of Translators, brings me back to West Africa, and almost next door to Cameroon in South-West Nigeria.

To sum it up:

This work investigates and evaluates the… effectiveness of religious interpretation in Yoruba speaking areas of Nigeria. The study focused on only religious gatherings that make use simultaneously of English and Yoruba languages to communicate the message of God to the worshippers. The objective of the study is to… evaluate the quality of the output through a questionnaire distributed to members of the spiritual congregations. The level of professional competence in the interpreter will also be investigated.

The term professional in the quotation is inappropriate and betrays a prior bias as to norms, because, as the author states,

40 respondents [to the questionnaire] said that most interpreters… are selected from within the congregations where they worship. 43 out of 50 reveal that they are not paid for the job, perhaps because they are potential future preachers and regard the service as a training ground.

And further on,

Interpreters in spiritual gatherings in the Yoruba speaking lands of Nigeria are not trained interpreters. They know nothing about the rules guiding the profession. They are simply bilingual with a deep knowledge of the subject matter.

In other words, these are not Professional Interpreters. They are Native Interpreters who may or may not have reached the competence of Expert Interpreters by work experience. We are told nothing more about their backgrounds, not even their ages, level of education and years of experience.

As at my Cameroon initiation,

The interpretation [is] consecutive interpretation, where the interpreter is present in a room or in a church, close to the pastor ministering the word of God. For easy communication and to avoid confusion, the speaker often stops…, passing the floor to the interpreter for the reproduction… of what the pastor has just said.

In other words, short consecutive mode. We aren’t told whether they employ the interpreter mimicry that I observed in Cameroon, where the interpreter imitates the manner of speaking and even the gestures of the preacher. However, there’s a hint as to manner in one of the questions in the questionnaire: “Is the interpreter free to correct the preacher?”

The research instrument is reproduced in full. It’s an interesting client satisfaction and opinion questionnaire but it doesn’t interrogate the interpreters. Nevertheless, there are some interesting conclusions:

39 respondents [out of 50]… are satisfied with the quality of the interpretation from English to Yoruba… Respondents with a tertiary education carried the highest number of 37 to support that the output of the interpreter was satisfactory. On the other hand, only 24 of the respondents are satisfied with the interpretation from Yoruba to English… the interpretation is better from English to Yoruba for the simple fact that Yoruba is the interpreter’s mother tongue.

There is an additional difficulty because Yoruba is a tonal language and the tones carry nuances that are hard to render in English.

A journal assessor took me to task last year for proposing that divine inspiration is an element that should be recognised in studies of religious translation. So I was interested to read that respondents enjoined both pastors and interpreters to "seek for God's guidance" as well as to "master the subject matter and the languages."

The article begins:

Christianity and Islam… were adopted in Yoruba-speaking areas of Nigeria with the accompanying languages, English and Arabic. Today the two religions are well spread and cannot be disassociated from Yoruba culture.

Yet there is nothing further about Arabic or Islam. Muslims everywhere learn to say their prayers in Arabic, just as all Catholics used to pray in Latin; but there are other parts of religious services that may be in a local language, for instance the sermon, and there's a Yoruba translation of the Qur’an.

Despite how widespread church interpreting is in Africa, this is the first research article I’ve read that’s specifically about it, and the veteran editor of Babel, René Haeseryn, is to be thanked for publishing it even if it has shortcomings. It leaves me hungry for more.

Image: Calvary Roseville United Methodist Church, Ado Ekiti, Nigeria.

References
Adawuni Salawi (University of Ado-Ekiti). Evaluation of interpretation during congregational services and public religious retreats in south-west Nigeria. Babel, 56:2.129-138, 2010.

Qur’an. The Meaning of the Holy Qur’an. Translation in Yoruba. Medina: King Fahd Complex for Printing the Holy Qur’an, 2007. http://www.islamhouse.com/p/30467.

Previous posts on church interpreting: July 29, August 3, August 9, August 11, August 27, October 28, 2009; April 10, 2010