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Healthcare Interpreting in Small Bites

50 Nourishing Selections from the "Pacific Interpreters Newsletter," 2002-2010By Cynthia E. Roat

Trafford Publishing

Copyright © 2010 Pacific Interpreters, Inc.
All right reserved.
ISBN: 978-1-4269-3122-2

Contents

Foreword......................................................................................................................1Introduction..................................................................................................................31. There is No Egg in Eggplant Coping with the English Language.............................................................112. The Pre-session The Interpreter's Magic Tool for Avoiding Frustration....................................................153. The Art of Being Polite...................................................................................................174. Transparency Means Clarity Using Intervention Skills to Keep Communication on Track......................................215. In the Language of Interpreters, How do You Say "Helpful?" Understanding the Role of the Interpreter.....................256. Confidentiality across Cultures...........................................................................................307. When there is No Word for That Compensation Strategies for Interpreters..................................................358. Some Notes on Note-taking for Telephone Interpreters......................................................................399. Memory Techniques for Health Care Interpreters............................................................................4310. Interpreter as Advocate - Yes or No?......................................................................................4711. Sight Translation: What, When and How.....................................................................................5412. Two Big Interpreting Challenges Controlling Pacing and Handling Confrontation............................................5913. Are You as Accurate as You Think You Are?.................................................................................6314. Interpreting in Pediatrics -Not Child's Play..............................................................................7115. Interpreting in the Asthma Clinic.........................................................................................7516. A Prescription for Accuracy Interpreting in the Pharmacy.................................................................8117. The Language of Consent Sight Translating the Consent Form...............................................................8718. The ABCs of DNA Interpreting for Genetic Counseling......................................................................9319. Behavioral Health Interpreting-Part I.....................................................................................9920. Behavioral Health Interpreting-Part II....................................................................................10321. Behavioral Health Interpreting-Part III...................................................................................10722. Interpreting at the End of Life-Part I....................................................................................11123. Interpreting at the End of Life-Part II...................................................................................11524. Interpreting Prayer.......................................................................................................11925. My Daughter Speaks English-Why are YOU Here?..............................................................................12526. Target Practice is Fun (unless you're the target), Or How to Handle Angry Clients........................................12927. Training the Whole Team...................................................................................................13328. The Docs that Drive You Crazy.............................................................................................13729. Why Don' t They Just Learn English?.......................................................................................14130. Staying Healthy While Serving the Sick....................................................................................14731. Taking Care of Business Tips for the Independent Contractor..............................................................15132. Interpreting in Small Communities: Keeping Both your Job and your Friends................................................15733. For the Public Good: Volunteering Your Services...........................................................................16134. Attend a Convention, Get Energized!.......................................................................................16535. A Healthcare Interpreter's Guide to Testing-Part I........................................................................16936. A Healthcare Interpreter's Guide to Testing-Part II.......................................................................17537. Interpreting with a Broken Heart..........................................................................................18138. A Christmas Poem for Interpreters.........................................................................................18739. The Vocabulary of Obstetrics..............................................................................................19340. The Vocabulary of Housing Services........................................................................................19941. The Vocabulary of Domestic Abuse..........................................................................................20542. The Vocabulary of Dentistry...............................................................................................21143. The Vocabulary of the Business Office.....................................................................................21744. Idioms, Acronyms & Abbreviations..........................................................................................22345. Slang Vocabulary & Expressions............................................................................................22946. Signs & Symptoms Crossword................................................................................................23547. The Vocabulary of Cardiology Crossword....................................................................................23948. The Musculoskeletal System Crossword......................................................................................24349. Home Health & Safety Terms Crossword......................................................................................24750. The Vocabulary of Nutrition Crossword.....................................................................................251Answers to Exercises and Puzzles..............................................................................................255

Chapter One

There is No Egg in Eggplant Coping with the English Language

Most interpreters have at least one thing in common with the people for whom we interpret: there was a time when we too spoke only one language. We, however, have learned at least one other. And for most healthcare interpreters in this country, one of those "others' was English.

As a native speaker of English, I would like to personally apologize to those of you who had to learn this language after childhood. I mean, really, could you invent a more difficult language, even if you tried? Just think about it! As an anonymous and much-quoted linguist has written:

"There is no egg in eggplant or ham in hamburger; neither apple nor pine in pineapple. English muffins weren't invented in England nor French fries in France. Sweetmeats are candies while sweetbreads, which aren't sweet, are meat.

"... quicksand can work slowly, boxing rings are square and a guinea pig is neither from Guinea nor is it a pig. And why is it that writers write but fingers don't frog, grocers don't groce and hammers don't ham? ... Doesn't it seem crazy that you can make amends but not one amend, that you comb through annals of history but not a single annal? If you have a bunch of odds and ends and get rid of all but one of them, what do you call it? If teachers taught, why didn't preachers praught? If a vegetarian eats vegetables, what does a humanitarian eat?

"... In what other language do people recite at a play and play at a recital? Ship by truck and send cargo by ship? Park on driveways and drive on parkways? Have noses that run and feet that smell? How can a slim chance and a fat chance be the same, while a wise man and a wise guy are opposites? You have to marvel at the unique lunacy of a language in which your house can burn up as it burns down, in which you fill in a form by filling it out and in which an alarm goes off by going on."

But no, it's not true that English was developed specifically to torture those who try to learn it as a second language! English started out originally as Indo-European, an ancient language that branched into Romance (based on Latin), Germanic, Indo-Iranian, Slavic, Baltic and Celtic languages. English belongs to the Germanic group. It moved west out of mainland Europe with the Angles, Saxons and Jutes who invaded the British Isles in the fifth and sixth centuries A.D. But in 1066 A.D. William the Conqueror invaded England from Normandy, bringing with him Anglo-Norman, an early version of French. For centuries, then, the rulers of England spoke one language while the populace spoke another. Even today, one can see that many of the words commonly used by the aristocracy (such as "beef", which you eat) have their roots in French while the common man's vocabulary (such as "cow", which you take care of) remained more rooted in the Germanic English.

After England lost Normandy to the French in 1204 and the bubonic plague wiped out a third of the country's population in 1350, English rose in prominence over Anglo-Norman in England. The mixture of the two languages became Middle English, which flourished until the 16th century, when the Renaissance brought more Latinate words into the language. The printing press was introduced into England in 1476, leading to a process of standardization of grammar and spelling which was embodied in the publishing of the first English dictionary in 1604.

From the 1600's, the major changes in English have been in the addition of vocabulary. The industrial revolution initiated the need for a whole host of new words to describe things and processes previously unknown. This process continues today, especially in the world of technology. Secondly, the rise of the British Empire and global trade led to the introduction of English as a language of commerce and power around the world. It led as well to the introduction of words from many of the world's languages into English. In the U.S., in particular, the influence of Native American languages and Spanish has been significant.

So, no wonder English is a mess. The origins of the language in both Germanic and Anglo-Norman lead to a plethora of synonyms; almost everything has one word with a Germanic root and another with a Latinate root. The spelling and grammar were standardized four centuries ago, but pronunciation has continued to change. Then worldwide diffusion has led to enormous regional variations and a hodgepodge of vocabulary stolen from other languages! In fact, 99 % of the words in the Oxford English Dictionary are borrowed from another language. This leads to rules for spelling and pronunciation for which there seem to be more exceptions than rules. Just consider:

1. The bandage was wound around the wound.

2. We produce produce on a farm.

3. A full dump must refuse refuse.

4. There is no time like the present to present a present.

5. Get the lead out and lead!

And that doesn't even count the words that are spelled differently but pronounced the same!

And yet, despite all this, English is a wildly popular language worldwide. Wikipedia, the on-line free encyclopedia, reports that English is the most widely taught and understood language in the world. Between 300 and 400 million people speak it as a first language, and The Times Online reports that about a third of the world's population (that's about a 1.9 billion people) has a basic proficiency in English. Certainly English has become the lingua franca in international trade, science, aviation, and the Internet. English is chosen as a common language even in some international organizations in which no native English speakers participate, such as the European Central Bank.

And though English is not, as some people claim, the official language of the United States (the U.S. has no official language), it is certainly the language of common discourse here. That means that immigrants and refugees who weren't lucky enough to learn English before coming must learn it here if they want to advance economically and participate in the country's civil life. As we have seen, English is not an easy language to learn. Certainly the courtroom and the emergency room, where the potential consequences of misunderstanding can be very serious, are not the places to be practicing.

And that's where you come in. Interpreters bridge the language gap for non-English speakers seeking access to public services. You are the guide to this strange and confusing language until the patient learns enough to get around the vernacular by himself. And, like any good guide, you must know your way through the complexities and seeming illogic of this language.

So to those of you who have already mastered English, congratulations! And for those who are still struggling with the language, no wonder! Don't give up, and if you get discouraged, just read this little ditty and you'll remember what you're up against. And what your patients are up against as well.

We'll begin with a box, and the plural is boxes; But the plural of ox becomes oxen not oxes. One fowl is a goose, but two are called geese, Yet the plural of moose should never be meese. You may find a lone mouse or a nest full of mice; Yet the plural of house is houses, not hice. If the plural of man is always called men, Why shouldn't the plural of pan be called pen? The cow in a plural may be cows or lone, But the plural of vow is vows and not vine. If I speak of my foot and show you my feet, And I give you a boot, would a pair be called beet? If one is a tooth, and whole set are teeth, Why shouldn't the plural of booth be called beeth? Then one may be that, and three would be those, Yet hat in the plural would never be hose, And the plural of cat is cats, not cose. We speak of a brother and also of brethren, But though we say mother, we never say methren. Then the masculine pronouns are he, his and him, But imagine the feminine, she, shis and shim.

- Alice Hess Beveridge (also attributed to Richard Ladere)

August 2006

Chapter Two

The Pre-session

The Interpreter's Magic Tool for Avoiding Frustration

"Patients don't seem to trust interpreters."

"Providers don't seem to trust interpreters."

"The patient and the doctor always talk to me, not to each other."

"Nobody pauses to let me interpret."

"Patients are always telling me things that they don't want interpreted."

Sound familiar? These are some of the most common frustrations that community interpreters run into. And though nothing you do will completely eradicate these problems, you do possess a tool that will minimize them: the pre-session.

What is a pre-session?

A pre-session is a short (sometimes very short) introduction that you do with the patient and provider before beginning the interpretation. The purposes of the pre- session are to introduce yourself, to establish yourself as a professional interpreter, to clarify your role, and to help patient and provider know how best to use your services. Remember, if a patient or provider has not worked previously with a professional interpreter, they won't know what to expect. You need to tell them.

How do I do a pre-session?

Pre-sessions with the patient can usually be done in a fairly relaxed manner, sitting next to the patient, since there is usually ample time. There is often time to do a pre- session with patients before the provider comes in, either while sitting in the waiting room, or while sitting in the exam room after the vital signs have been taken. Here are some things to include in a pre-session with a patient:

1. your name,

2. the organization you represent,

3. that the patient can speak directly to the provider,

4. that you'll interpret everything that is said exactly as it was said,

5. that it would help you be more accurate if he or she would pause after a full thought to let you interpret,

6. that all information will be kept confidential,

7. that you cannot answer questions or give medical advice.

Pre-sessions with the provider must be done more quickly, as they typically take place right after the provider comes in and introduces him- or herself to the patient. You will want to include many of the same things you told the patient:

1. your name,

2. the organization you represent,

3. that you'll interpret everything that is said exactly as it was said,

4. that the provider can speak directly to the patient,

5. that it would help you to be more accurate if he or she would pause after a full thought to let you interpret.

If you have worked before with a particular provider, you don't have to do a pre- session every time. However, if you've never done one before, do at least one with every patient and provider with whom you work!

So why don't interpreters do pre-sessions more often?

It's a mystery to me! As I train interpreters around the country, I find that many are reluctant to do pre-sessions. They tell me they are afraid it will take too much time, that the provider will be impatient, that it seems too formal with the patient. Yet when I train providers to work with interpreters and show them what a professional pre- session looks like, they say: "Wow, that's great! It really clarifies how things should work. I wish my interpreters would do that."

So, avoid the frustration of patients and providers who don't know how to work with you. Do everyone a favor, and do a pre-session.

March, 2002

Chapter Three

The Art of Being Polite

I remember the first business letter I ever received in Spanish. Written by a colleague at the Ministry of Health in Ecuador, it started out something like this:

"A travs de la presente, reciba Ud. un muy cordial saludo de parte de su servidor, junto con la esperanza de que la presente la encuentre gozando de buena salud y rodeada por los suyos."

Or, literally:

"By means of this letter, may you receive a very warm greeting from your servant, together with the hope that this letter finds you enjoying good health and surrounded by your loved ones."

Having grown up in a country where a business letter should get to the point in the first three words, I remember thinking that this was a silly way to begin and wondering why this colleague was writing in such a ridiculously formal fashion. (OK, so I was young and culturally incompetent!) After living in Ecuador for a while, however, I began to appreciate how gracious this fashion was, how respectful - and how widespread. This was not some flowery poetry that this colleague had composed for me; it was a standard, polite way to start a business letter.

Every language has such constructs. There are polite ways to greet someone, to ask for a favor, to interrupt, to apologize. They can't be changed; the words have to be just so. Sometimes we learn these constructs when we learn a second language, but often we don't. As a result, while we may do fine in everyday conversation, we seem rude, uneducated or boorish in certain situations. I can't imagine what my Ecuadorian colleagues thought of my business letters before someone taught me the "formulas!"

So, why am I writing about this in an interpreting bulletin? As interpreters, we spend most of our time in the background, repeating in one language a message that was expressed in another. At times, however, we need to speak for ourselves. We need to intervene, ask for a repeat, point out a potential misunderstanding, ask for clarification. If we have not learned the polite formulas in English, we - and the company for which we work - can look very unprofessional.

So, here are some of the formulas used in English that will mark you as an educated, polite, respectful and professional interpreter. Tape them to your bathroom mirror and practice a few every day. Clients and friends will be suitably impressed!

When introduced:

"Ms. A, this is Mr. B."

"Pleased to meet you." Or "A pleasure."

And the proper response is: "The pleasure is mine."

When intervening to ask for repetition:

"The interpreter asks if you could please repeat your last sentence." or "The interpreter would like to request a repeat."

When intervening to ask for clarification:

"Speaking as the interpreter, could you please explain to me what you meant by ___________?"

When intervening to check for understanding:

"As the interpreter, I am concerned that Ms. X did not understand how she is to take her medication. Would it be acceptable for me to ask?"

When intervening in the role of culture broker (for example):

"I couldn't take this medication, because it's too hot. The interpreter says, the way the patient is using this word "hot" has a special meaning in his culture. Would it be helpful to you if I explained it?"

When bringing up a problem:

"I am concerned...."

When suggesting a solution

"I was wondering if ..."

When forced to interrupt:

"Forgive me for interrupting."

When thanking someone:

"I very much appreciate your help ..." or "You are very kind."

And a polite response when thanked:

"It was my pleasure." or "Think nothing of it." or "Consider me at your disposal."

Here are some other tips that will mark you as a polite and professional interpreter.

Avoid blaming. Professionals focus first on how to solve a problem, not on who caused it.

Disagree, but don't contradict.

Try not to interrupt unless absolutely necessary.

Be slow to judge and quick to apologize.

Start statements or questions with "I" instead of "you". For example, instead of saying "You never said that!" you could say, "I didn't hear you say that."

Always stay calm. In the dominant culture here, professional people do not raise their voices at each other. Get mad when you hang up, but while on the line, don't lose your cool.

February, 2003

Excerpted from Healthcare Interpreting in Small Bitesby Cynthia E. Roat Copyright © 2010 by Pacific Interpreters, Inc.. Excerpted by permission.
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