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All interpreting is not created equal

All interpreting is not created equal. A potential client said something along these lines to us recently and we thought, “Wow. This person really gets it.” This might be a hard concept for many to grasp, especially without a background in language learning or bilingualism, however it’s something we find that more and more clients realize and it’s what sets them apart from their own competition. One might ask, “Well, if you have speakers of two languages and an interpreter present, why is not all interpreting considered equal?” Take the incident that occurred at the funeral for the late Nelson Mandela. Onlookers were appalled that the sign language interpreter was signing phrases that made little to no sense and that clearly were not an accurate rendition of what was spoken during the ceremony. South African officials were ashamed and social media blew up over the incident.

Think about whether or not your brand could afford such an incident in the public eye. Vetting and hiring professionals is key in making sure that the individuals who speak on behalf of your brand will deliver. Contracting professional interpreters (or translators) is no different. Imagine this scenario.

You have a business meeting in two days and you’ve hired an interpreter to assist for a two-hour meeting with a potential client who could boost your company’s sales and visibility. You’ve sent all of the materials to be covered in the meeting to the interpreter ahead of time so that he/she can come prepared. On the day of the meeting, the interpreter shows up late and is stumbling through the assignment, obviously ill prepared. You find out later that the client understood very little of the interpreter’s rendition of the content and that there are still many unanswered questions. What could this mean for your company’s potential contract with this new client? Did you just lose the opportunity to do business with them? Do you bring them back for another meeting with a new interpreter? What does this say to your client about your brand?

Most certainly in life mistakes happen, and you might have hired the wrong interpreter for the meeting. However, if mistakes can be avoided, why not take the steps beforehand to ensure accurate interpreting of the meeting and possibly win a contract that could grow your business?

It seems that more and more people are catching on to the concept that our potential client mentioned: “All interpreting (or translation) is not created equal.” Branding is not only about the content your team creates, but rather, in all of your interactions with others. Hiring professionals who are trained and well versed in a specific content area is key for your business. It’s also crucial for interpreting and translation.

Have you ever been in a situation in which an interpreter was present and misinterpreted the content of a conversation or speech? What did the poor interpreting say about the company or organization for which he/she was interpreting?

3 Things You Should Never Ask of a Health Care Interpreter

Medical interpreting, whether in a hospital, clinic, at the scene of an accident or in a family physician's office, is a professional service provided by professional individuals and language agencies. However, it can often be challenging for the interpreter, both mentally and emotionally, depending on the patient's condition, the situation in which the interpreter is needed and other factors that arise as part of the job. Health care professionals are faced with challenges in their own daily work as well. Nevertheless, it's important to remember that one's own professional challenges in a given situation may not be the same as those of another and vice versa. Doctors, nurses and administrators in medical settings each have their own capacity in performing their work, as do health care interpreters. Here are three things to avoid requesting of a health care interpreter.

"Could you please read/fill this out for the patient?" This question might seem innocent and one that is meant to help a process move along a little faster or more smoothly, but it's a common question asked of health care interpreters in health care facilities daily. Some patients cannot read well, write well or may even be illiterate, however it is important to remember that the interpreter is not responsible for filling out a patient's medical information and should never be asked to do so.

Consider this scenario. A patient arrives for an appointment and speaks little to no English. The interpreter introduces him/herself to the patient and the health care staff upon checking in. While the administrator behind the desk prepares the paperwork the patient needs to fill out, s/he asks the interpreter to explain the forms to the patient and help him/her fill them out. Ethically, the interpreter should know better and kindly inform the administrator of his/her role as an interpreter. The administration should provide someone from its staff to go over the forms with the patient, while the interpreter interprets the content. This way, if the patient has any questions or concerns, the staff can answer these, leaving the interpreter to do his/her job and avoid giving any medical advice, which is clearly not his/her role. This also deflects liability from the interpreter for doling out incorrect information or making a mistake on the patient's documentation.

"Can you hold this child's legs while we give her the booster?" This question might even sound humorous to someone reading, but it has happened and continues to happen often. Ask any parent or nurse. Giving a child a vaccination can be a stressful situation. A child is upset, sometimes crying, squirming, etc. But again, the interpreter's role is to interpret, not to assist in performing any medical act or procedure.

Image Source: "Dedicated to All Better: A Blog by Children's Healthcare of Atlanta"

Many times, health care staff see the interpreter as an extension of their own staff. This is wonderful in terms of respect and professionalism, but it's important to know where to draw the line when it comes to overstepping an interpreter's role. This is all in addition to any liability issues that could result from an interpreter helping to restrain a patient. Ask another staff member to assist and leave the interpreter to interpret.

"Tell us your opinion of this patient's mental state." Many of you who are reading may already be shaking your head. How can an interpreter assess a patient's mental state? Yet, this question is often asked of interpreters in situations in which the patient's mental or emotional health is being assessed.

Consider this. Would it make sense to ask an English-speaking individual present for another English-speaking patient's visit what s/he thinks of the patient's mental state? What authority does this person have to assess another's mental condition? The same goes for an interpreter and the ethics we practice in our industry. Interpreters are not health care professionals, nor are they qualified to assess a patient's condition. Yes, they are professionals who are able to communicate in both languages with a high level of medical knowledge and terminology, but this does not make them colleagues in the same sense.

Interpreters' professional code of ethics also prohibits them from stepping out of the roles of the profession. The National Council on Interpreting in Health Care (NCIHC)'s Code of Ethics and Standards of Practice for Interpreters in Health Care clearly states, "The interpreter maintains the boundaries of the professional role, refraining from personal involvement." This allows the interpreter to remain unbiased as much as possible and avoid any involvement that could result in larger problems down the road.

Many health care professionals are unaware of interpreter ethics and standards, which is why it is crucial to take the time to learn about these aspects of the interpreter's role and what to expect of a professional service. For more information on National Standards of Practice or the Code of Ethics for Interpreters in Health Care, please visit the NCIHC webpage.

Medical Translation and Interpreting: Saving Money, Saving Lives

Some professions can be very competitive and those who don't perform the same type of job duties may not understand why. Sometimes I think, "Why are these people being so competitive and cut-throat with their colleagues? It's not like they're saving lives!" However, in the field of medical translation and interpreting, we can say that yes, linguists often might be saving lives. Here are two examples of how medical translators and interpreters can save clients money while their work can save lives: The first example is found in an article posted in January 2009 in American Medical News from the American Medical Association. This case involved a New Jersey rheumatologist who refused to provide a sign language interpreter for a patient being treated for lupus. This patient consistently requested an interpreter, but claims that her requests were always denied. The physician's argument was that Medicare did not reimburse the entire cost of an interpreter for each visit. Instead, he passed written notes back and forth to the patient and her family.

Apparently, this was not enough for the patient to feel as though she understood what was happening at the medical visits and she transferred to another doctor. The patient sued the original physician, claiming violation of the federal Americans with Disabilities Act and the Rehabilitation Act, along with New Jersey's anti-discrimination law. The jury found the rheumatologist had indeed discriminated against the patient when failing to provide a sign language interpreter.

If a medical interpreter had been present at the child's visits with the rheumatologist, she might have felt differently about the care she received and would not have sued the physician, which will likely cost him more than an interpreter would have.

Then there is the story of Lia Lee, a child raised in California of Hmong refugees and the focus of Anne Fadiman's book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Lia was misdiagnosed twice as having had pneumonia, when in reality, she was epileptic from the time she was an infant. Lia's parents did not speak English well enough to communicate with the doctors who treated her, and they often misunderstood how to care for her at home. They did not know how to describe the child's seizures effectively to her physicians, as in their own culture, these episodes seemed to convey that her body was being overtaken by a spirit.

Misunderstandings continued between Lia's parents and her physicians, as both sides were unable to communicate effectively and understand each other's cultures. A New York Times article reported, "The seizures worsened; by the time Lia was 4 ½, she had made more than 100 outpatient visits to medical facilities and been admitted to the hospital 17 times. When she was not quite 3, in frustration at what he viewed as her parents’ refusal to administer her medication, Dr. Ernst (Lia's physician) had Lia legally removed from the family home." Lia was sent to live in foster care for one year, yet another blow to her parents. Her health worsened and the relationships between her parents and her physicians were strained, as neither side seemed to adequately comprehend the culture and language of the other. Lia died on August 31, 2012.

A medical interpreter at Lia's visits and proper translation of her prescriptions and care instructions could have allowed Lia to receive consistent and proper care for her condition, likely avoiding her placement in foster care. Needless to say, such services would have greatly improved her quality of life.

These are only two of the stories about how medical translation and interpretation can save lives and reduce costs by avoiding unnecessary tests, misdiagnoses, treatment errors and miscommunication. To ensure compliance with federal regulations as a health care provider, be sure to request professional interpreting and translation for patients and their families. It truly can save you money and continue to save lives.

“Obamacare” and LEPs: How does the law upheld by the Supreme Court affect the translation/interpretation industry?

What a week it’s been in politics! Now that the Health Care Law has finally gone before the Supreme Court, which upheld it on a 5 to 4 vote, those of us who work in medical translation and interpretation on a daily basis want to know: What does this mean for us?! For most Americans, the Health Care Law has been confusing from the start. However, imagine how confusing it could be for those millions of Americans who have limited English proficiency (LEP). This can be even more confusing for them. What are their rights? First, we have to look at what the rights have been so far for these individuals when it comes to language access in health care.

Title VI of the 1964 Civil Rights Act

Executive Order 13166, Title VI of the Civil Rights Act of 1964 states, “No person in the United States shall, on the ground of race, color, or national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” (42 U.S.C. Section 2000d). In short, any organization, whether a clinic, hospital or other health care facility that receives federal funding must comply with this executive order by providing language access (free of charge) to LEP individuals. This is also true in areas of law and other fields, but for the sake of this post, we’ll stick to the health care issue at hand.

Unfortunately, many health care facilities will try to get around this law by asking patients to bring a friend or family member who is bilingual, or many times, they’ll have someone on staff come in to “interpret” for LEP patients. For those who work as interpreters and language agency owners or project managers, we know that this is a bigger problem, as those individuals are usually not trained in the medical terminology needed to carry out the appointment, nor are they trained in the fine skill of interpretation. Much of these attempts to weasel one’s way out of providing professional, quality service stems from the fact that these facilities have to foot the bill.

Don’t get us wrong. Many, many hospitals and doctors offices DO comply with Title VI;, however, many, many more do not. According to the National Center on Immigration Policy, LEP individuals accounted for 25.2 million (9%) of the population in 2010, although large concentrations of these demographics were attributed to states like California, Texas, New York, Florida, Hawaii, New Mexico and Massachusetts, among others. More and more states are seeing a rising number in minority populations whose first language is not English. In fact, although the Latino population has had steady growth in the past ten years, just recently, Asian Americans became the fastest-growing minority in the U.S.

So, what does all this have to do with language access in the health care debate?

One of the biggest issues in the political discussion on health care has been cutting costs and allowing all to receive health care and be insured. Although we may not see health care insurance covering the cost of language access for LEP patients anytime soon, we should see money saved by both insurance companies and health care facilities that provide professional language services to patients, as many more individuals will be able to go to the doctor and receive the care they need. Those who do not provide these services, but rather, rely on untrained individuals or (even more sadly) no one at all, will see their costs go up and possibly skyrocket, because miscommunications often lead to more doctor’s visits and adverse events that could have otherwise been avoided by providing proper language access to their LEP patients.

One section of the law discusses the implementation of effective approaches and specifically identifies “the ongoing, accurate, and timely collection and evaluation of data on health care disparities on the basis of race, ethnicity, sex, primary language, and disability status.” This data will be invaluable to many of us and it will be interesting to see if the information on patients’ primary languages affects the way that health care providers are reimbursed for offering professional language access services to patients.

Although up until now health care providers have not reimbursed by Medicare and Medicaid, we may see this change as a result of the passing of the Health Care Law. Provenzano argues, “Ultimately, one of the best arguments for Medicare reimbursement for language services is that the services themselves represent the linguistic equivalent of preventive care. By spending modestly up front to communicate effectively with LEP patients, Medicare—as well as Medicaid and private insurers—can save significantly through the prevention of costly errors.”

For those of us in the interpretation and translation industry, we will see a larger need from our clients who require on-site and telephonic oral interpretation, as well as the translation of vaccination records, consent forms, insurance policies, prescriptions, medical charts, etc. We’ll be on the edge of our seats to see what the next several years hold in store for all of us as Americans, especially LEP patients and we who provide professional language access to them every day.

For more information on LEP rights, please visit http://www.lep.gov/

On-site or remote interpreting: Which is the best fit for you and your organization?

Something we've noticed with a lot of our interpreting clients, especially those here in Columbus and Central Ohio, is that they want to know which route to take when it comes to oral interpreting for their organization. Many who call as first-time language service buyers are not sure which is the best option for them. So, we make sure to ask them some key questions first in order to assess the situation before we can recommend an option or a combination of the two. Here are some options if you are in need of oral interpretation. Remember, you may decide that you need to choose more than one option to fit your interactions with clients, colleagues, patients, etc.

On-Site Interpretation This type of service offering is probably the most commonly sought in our industry. Interpreters are hired to perform this service in person at the time of an arranged appointment or meeting where an LEP (Limited English Proficient) individual or group of people is present and requires an interpreter. Once the interpreter arrives and meets the LEP individual, s/he will explain to all those involved that s/he will interpret everything that is spoken during the meeting.

Remember, a good interpreter will interpret everything that is said, even the side conversations that take place if within earshot. The reason for this is that the LEP person should be on equal footing with the rest of the individuals in the room, i.e. the interpreter's job is not to select what is or is not important for this person to hear.

Telephonic Interpreting Another very effective form of interpreting, telephonic interpreters are hired when an organization may not need an interpreter on-site or when certain languages are required that are rarely spoken in a geographic area, among other reasons. Although there is a disadvantage in that the interpreter cannot see the gestures and movements of those involved in the appointment, there is not always a need for an interpreter to physically be present to interpret, particularly if the interaction is brief or very simple.

One of the most common reasons our clients contract us for telephonic interpreting is for short, simple communications, such as those that take place in the workplace almost daily (think greetings and quick interactions like depositing a paycheck, scheduling a future appointment, etc.). Many clients like to use dual-handset phones, which allow both you and the LEP individual to each hold a receiver while the call takes place. This way, you can both hear the entire interaction with the interpreter and talk directly to one another, avoiding "he said, she said" conversations. Video Remote Interpreting Another type of remote interpreting, video remote interpreting (VRI) is often used for sign language interactions, as telephonic services would not be effective. You will need to have video conferencing equipment, or at the very least, a webcam, speakers and a microphone. The interpreter may be working from a call center or from home, much like a telephonic interpreter. However, you and the LEP individual will be able to see this person, and s/he will listen to you through a headset. If the person who needs the interpreter is not deaf, but rather, speaks another language, the interpreter will speak through his/her microphone in first person (using pronouns like "I", "me" and "you" to reflect the speakers' words accurately).

Sign language interpreters will also interpret in a similar way, but this is often referred to as "in person" interpreting. They will speak through the proper signs directly to the deaf individual as if s/he were the one originally speaking.

Hopefully these explanations will help you to decide what is the best option or set of options for you and your organization. If after reading this you are still unsure, contact a professional company that provides these services and request more information. An important thing to remember is that interpreters should always interpret the entire message and do so in first person. This not only creates a more personable and authentic interaction, but it ensures a more accurate interpretation as well.

What types of interpreting have worked for you? Which would you like to see utilized within your organization if you do not already have one of these services available?