THE

PROFESSION
MEDICAL
 THE PROFESSIONAL MEDICAL
INTERPRETER: A
COMPREHENSIVE 40-HOUR
MEDICAL INTERPRETING COURSE
Acknowledgements

We want to thank our families, friends and colleagues who are not mentioned for their great
support and advice during the writing of this course.

This course was a labor of love for the founders and staff of Liberty Language Services. Plans for
developing this course began in 2012. Our aspiration has been brought to life in a course developed
based on accreditation standards and that gathered our experience and wisdom from being both an
interpreting agency and interpreter training company. The largest effort to bring this course to
completion spanned from late-2019 and throughout 2020 - during the first year of the worldwide
COVID-19 pandemic.

In addition to the writers, contributors, reviewers and staff mentioned below, we would also like to
thank and acknowledge the healthcare providers, hospital language services managers and their
staff who were kind enough to provide valuable feedback, and share their knowledge and
experience that helped us in designing our medical interpreter course and accompanying textbook.
Special thanks to Vanessa Nifio from MedStar Health for her mentorship and advice over the years.

We would like to acknowledge and express our gratitude to the following individuals who
contributed to this course including the textbook, presentation materials, and implementation into
a learning management system (LMS), so the course can be accessed online.

Sameh Abdelkader, Co-Founder and Director of Education for Liberty Language Services and
Recipient of the 2015 IMIA Distinction in Education Award

For the direction, vision and contribution of his ten years’ experience teaching adult learners the
complex skills involved in becoming a professional medical interpreter. Specifically, Mr. Abdelkader
utilized our experiences in the Washington, D.C. metropolitan area, where the hospital systems
expect the very best in terms of quality interpretation services. That combined with his wisdom and
heart has allowed us to achieve success in training thousands of students both in-person, remotely
by video conference, and through online training.

Timothy Worster, Founder of Liberty Language Services

For the vision of developing and providing a world-class training that is affordable and accessible to
all, with the ultimate goal of serving the communities where we live and work. Whether they be
language access services staff within hospitals or individuals who meet the qualifications to be
trained to give the gift of their language, culture, and voice to the limited-English-proficient (LEP)
communities in the United States and beyond.

Drew Bahr, Esq., Spanish/English Legal and Medical Interpreter

Drew Bahr is a licensed immigration attorney, a medical and legal English/Spanish interpreter, and
an interpreter trainer. Mr. Bahr was involved with the creation of the course content including
presentation material.
Cynthia E. Roat, MPH

Cindy Roat is an international consultant on language access in health care and patient navigation.
A recognized subject matter expert on medical interpreting, she contributed the chapter and
exercises on the topic of message conversion: the mechanics of converting a spoken message from
one language into another.

Dr. Izabel de Souza, Ph.D.

Dr. de Souza is an international expert and leader for medical interpreting. She served as reviewer and
contributed to the book as a recognized subject matter expert in medical interpretation and
intercultural mediation. Her contribution to the section on The Roles of Interpreters emphasizes the
undeniable cultural broker role and how medical interpreters mediate intercultural communication
between patients and healthcare providers.

Dr. Jacqueline Messing, Ph.D.

Dr. Messing is a linguistic anthropologist and served as reviewer and copy editor for the course
textbook and presentation materials. Her research interests focus on issues of language, identity,
ideology, race and racism in Mexico and the United States, on indigenous communities,
multilingualism, and attempts to revitalize native languages through education. Dr. Messing’s
review was done in the context of the tumultuous year that was 2020 and she sought to also review
for inclusivity, equality, and diversity.

Maria Teresa Buendia Schlenker, Certified Healthcare Interpreter for English/Spanish and Medical
Interpreter Trainer

With a degree in microbiology and as an experienced healthcare interpreter, Ms. Schlenker is an in-
house subject matter expert and provided her review of the course and contributed medical
terminology content and exercises.

Additional Liberty Language Services staff that contributed to the review, refinement, and editing
include Lia Cunanan and Devin Stewart. Ms. Cunanan also coordinated beta testing of the online
course.

Special recognition goes to Salar Raoufi who brought the course to life in its digital format, as well
as providing project management. Mr. Raoufi contributed graphic content, interactivity to the
online course, final touches, and LMS implementation to bring the course online and available to
the world.

We would also like to acknowledge medical interpreters worldwide for their dedication to the field.
Their commitment to working to serve their communities is admirable and serves as inspiration for
the creation of all our trainings and especially this one. And a special acknowledgment to those
interpreters who chose to continue to work in-person during the COVID-19 pandemic.
Copyright © 2021 by Liberty Language Services LLC

All rights reserved.

No part of this publication may be reproduced, distributed, or transmitted in any form or by any means,
including photocopying, recording, or other electronic or mechanical methods, without the prior written
permission of the publisher, except in the case of brief quotations embodied in critical reviews and
certain other noncommercial uses permitted by copyright law.

For permission requests, contact the publisher at the address below.

Liberty Language Services

1600 Spring Hill Road, Suite 210
Vienna, VA 22102

1-888-746-9108
www.libertylanguageservices.com
Table of Contents
WVGICGI(1G eamrreepnentenee aera ek arm cen sate oer On Mee ays: AR o8. cctancae reat etats osetia cient Camere eoncaeners 2)
BOOULLIDELLY Cane UAZe OCI VICES eri tame: a ecetie: fete nacrie rth Rhee On rer tpnae ee tee ge ee teres eae 10
GOUFSE EXDeCcLations (CONLINUEKG. LFOMSVlaDUS)saterrcnarrerevesteet
cece naenee ye eierct gee meee nareee 10

STHCENMTEXDECCALIONS.csacrssesee cenees se ttsans dean aun eccaceeneec esa arene di temic tin«ae Resear re RMA Tne ay ase Ree 11

SETI) Net ILO DLOtliie veces sccrtsteests tunes cues ceURi vac eausseveis ee nes es hermesee cee cc en mentee te nea wen ee 12

WHE INCERDreting@ IS NOV sscecect: ot ackenucce spas asetes merit steerer oe Cera Gne oe eres taint aoe eee een oe 13
SECTION 2: The Difference Between Translation and Interpretation............cc:ccccccessssceccessceeseesssseeeseaes 15
SECTION Sespeciallzations and Flelds of Interpreting <....,2,ace.. crc tese eer eee ones aerate ee eee 17

SECHON 4s iviodality of INtErpreting ices sercsses fev uesemcobsece iecticoenttseccctartree ereaee eee a ene rte eate meena 20
SECTION.o: Types of Interpreter EMpPlOyMentacssuc: cusccteces ates stesscneeenuseea neceen nae tatters eee cee eee 22

SECTION OF. 1 He ROS OF INTELDPEtErsS..csescescissecastcace sacs cee vecsactetoe itunes vleltenath tier Saancce reat neuen eee 26
An Interpreter is a Type of Mediator, but What is a Mediator?..............ccccccssseeeseescesceeeeeeseeseeeeuuenerss 30

Whatisimeant. Dy, COMMUNICATION MECIAtiON(? 2:.ciscuccscvsaseecceeccrsecace

tesermear ietehence eeeeeet ene eee 30
WING FOUR ROLES tere, tvetatn stoke anaaces ous ice rote Game Hea Te eoues rpecn toeacr eee eet cne tte ates Cec ene ene 31
RANGE ROIES serasces sock ssc vusbotelscensston tren cee ian kecs ovum wo ntiseneces cUnsi Wee dami ena Picec aac cee nO MeanT ees ee aN nen eee ae aii
PEVI@ RONELOL CON GUILE ers, hesnse tec ssteeant os.sxe cased ord sucec tt staeoe cae enceac see etie ae ease tee MeME Ce cectcan eee tenete ee ee 32
HVS ROVE. OF CLALINGM xz baves see sneevie aucune ce uwac setae ntocas cause tient xc au tacec otiscees Aer ee ns oe ee eae ee ne 32
COMMUNICATION: Da GhiersSac aster eciytece toast pertiayateeuvensncvoreuraasatumtvesonnent
erantan hae ester ter tenee eee eee 35
TNE RONG Oli alleHtAUVOCACsr. ncs.ct cc cacntet nates aynon ater gece atiaamnyace’ ccneee aarear taut eoces ic error eeeene 35
What do the IMIA and NCIHC have to say about patient advVoCacy?...............ccsescseeceeeceeeeeeeeeeeeeeesenes 36
PEE SUITHITIGLY sac cadhcattses study osaiiciusanane dapusnutonsianstny ses etsadvewameanauneets desicansncaay re imette tea ed cnayabaseaetensneer tacmeeee 37

BEC IIOOIN 7 ACOMVEN SION acai ra butter spears ae tieudens uesaixvah se vapannauietacouds ss atvnaranteatsue ntea secs te uRMrnn cer ereey teeta eeeeaaeeee 39
he Heart or interpreting, OV CINGV: ROatnasaricsceeccunccieacccde
veceeucranenasere enertenet teeere eneneem eee 40
SECTION S344 NG.FOUR MiOGeS Of INTETDretinm ccs nites sutscaccchatianeesuatieeecuei
cpstceuent qaseneeeetn ercatamaran eeaeeneene 50

CONSECULIVES ITILEMDIE
LIN sacsrreteccedivrasuntantcucass
sensessonswiec caraussaaniean Facnow uncste igh Sant eueee see wevecuay aao-an eee 51

SIMULA NEOUS IOLA OLecitie seeeateteucres treet das cucacransocce.sscracssicat opankwacttekcxies sce cecvady See Conese aeae nee eee 52
SIC OLUESS LOM metne ce etn tochane en eere tonecaver ners manent nm inacahene carina acee mnetnrcuncraaat nc rtwa corte creemmmete 53
SIT
ETc Laeae Ie een ete toe ee cacy earner es oa an erin act co sau nntacatredeacastetterssuseeressl
ceciner concerns 53
SEGION Osihe Coder Ethics for interpreters In Health Gare: ss.csssesassscassssessssesustuetacsscrscncenenerecetneens 55

EtICSAe TIOU VIOLAS eanttecin eestciraarepaetwcunicccorcarasnctbasdsuscss

Consoastvod tceanncnteevectvnnstuas faateumnsen eeuonmeaee ata 57
Erriesrare: Vala
LOL Vater neat etrein ees soci es cvs vivacescoseacvinceasnexsencs svayendns sara crsscaupasies oneghe pat ome ater 57
 The NATIONAL STANDARDS OF PRACTICE for Interpreters in Health Care..........:scccseesesseeteeeereetees 59
seesaeenen crmaur
STANDARDS OF PRACTICES. ccisscsscvovscencatecereevesstinuusgetocnentescreccaiuspuesi cenese teased 59
stsatrnrdeias

ACCURACY co aere. nc siceecnccede conicntoahswcvtsuneyadtacisacs ¥edeeaneceasuntrd pene ty ie psseeyGrtnncam sug smssaerccnlis ersiiee rae cane ocemay 59

Confidentlalityarice, secession svscvussstas ces vsetbowstetvensoic eaacterne

sec einer e 60
nica neveig acne eas
costeseat anetemaes tanedsece

UDA Ctlality, ccccorcsc..ccctrserserac stusrere

seateretnctauclssavacteetvoernerlsns en serenesexesnew erte
ntres caMmiba saaneeiaeesiete Siaanede 61

RES DOCU arate tes evadecsoucceccts neuer aratesciatiartevayensnn sues lesididneseswuncs solges sues usemaethe Oval anas ts (anaes hh aelats races cee can ae 61

Cultual AWarene@SSi ccc, ccccaccossecco cetavgu

swartestescusuandaupee cnsceut
rnneyy pagteeamesanenOs estat
eesvanetear acece sata 62
dsbacectaed saverditecteroatva
ROIS BOUNGATIES rer cccyssvsucsusscsauncvadanrc dectcatea nes 63
cnispeitanet ir esata
ateeilcna tisha caslintsaxa
PFOTESSIONAISIT eres ceviss soe. denconsti scten cate canis vawedcnameasak es cueeemelentrecton vans mee reo Aico Rae eee eto este tates er 64
Professional DEVEIOPMENt cas. aseiiis sinus cavescdvaccaseoatedespsuedetranaseeeeleaees arcectergior
ecancessrde aupeeterans sactaaemnns 65
PAVOCACY etree casera start iceves ea eh econo seh bee cosontav testy ualsnc lcccrtecnad Sauteed oss vette sin tae fete e Ne eae ee 66
UMD AILIGICV sy ercccsonctanccrcss utes deeetsih duperedce eau thone veeasiwes dunce lravumpantsm casey cate ree ee ni: ae ace ieee teens ante eere eee a 66

What.does:impartiality [OOK NIKE? i. cccsssccnsasscet

opeeeteane raetete qcateone een maunecnnence)
cccsatec aaneense asta eee 66
What does parlialitVIOOKIKE tiacsrrecssccccs sccverd fr vsctaace seueasentatentecctbacrset es crencany ete tekae tees Metaa ae eee 67
PEOLESSIONAUISIN cree ate ete en nreccseydiacanf-tptisarevane sionsreavert uss tatetye pada tanccuNtcamenenes ads mee aamea et ae eee 68
ROSDECh emrrer circ tecerr ssnese cian aeu uate ae sachin ecitg ap vasman ePaaeinanensonuubaat auc amie eae ko taces Catea. ce seen eee 68

Accuracy.(and Completeness) Sayiccsccses. ncteerechnceieenstecsur ce mvacewenuemaaguatenesctete eeeaeeec

cencercete eens 69

CONTIGONTIAITY caren. ttecaccesesecentanesarsccecie teu nceeeee sa ueeaness auheauiaien tenes tua eactccQk oa tee Issa meee en eee en 69

IOVOCACV creases sess ah tandgudentensrset coun canta cavsies rae esvehs tiered rime pies nawe eMac gt AI TTe He Uae rae en eee 70

Cultural COMPETENCE yk. ccacnccsscs: cccvatyiiaspcsnaecaasuah soe rsccst avenvancuctcmerse tentie ran Tua Getta te ita aes 70
SECON 20. tne MIA and NCRIHC Codes of Ethicssua. cms. terest careers te estee tee eater a 71
International Medical Interpreters Association IMIA Code of Ethics...............ccccsssessssccccceeeeceeeceeeeeees 72

IMIA-MEDIGACINTERPRETING STANDARDS OF PRACIICEe..:c: ccceecu

saetecerenerse ers
geese eee 72
Evaluation: Methods iiiciiien auevescccceneta cazscanet stuntman mtedece Paceline steee tee area: een ee naan nan igs
PIKGLEiSCalede er .aeccacsrteen canteannsyatirt to mrtaraeits cadsisnscsantesevnsncareue cen tec tameee a teecnte see Cine MRS ete as
SECTION g LINCELVE NEON degeneeus tot taansharcanasspat vasas canasaisnceciaeame nr maareteeeae ere Ceeee ence nee 80
TLEANSDARCTICY mrstrcrasscrastufeavesiagic tase steassuieicrsseret ies comieacinaterteeneee csc tcementicad, haaeitaite eee 80
Examples of situations Needing Intervention «..<1.s101s.;.cn ssssscrr
secan canner eeeaesh 81
CHANEORES OT IICCEVENTION se catvscne favtceteealemrme avis iosueeteravkabvacarez
NU MRMenacecetomeuan
nenel eee anaea 82
The Five Finger Intervention Technique (FFIT).....1..:.-:s:sccecsescacersensproaseesecvaercavecesecersccesvceccececeocccscct 83

The Importance Of Transparency ves.ccsecccyascu ncescost

sce camer cass<ave
tee: ereerre ec ranean acse
enna ee 84
Additional Recommendations 24. ..:.c,cecesscultsvians eerie yersee gee eee treme ig tee ance ene 85
 More: Exalnpies of interventions CCnniques snctia conv ot scans ee eee eee een 86

SECTION 2 aNcremental interventlonarwtcs reise cute vsecr.s. cette atscn ccc teeee ie Pre cet antac 87
More Exatnples of incremental:nterpretingaseaaaie tact cree en eee 88

SECTIONS sProplem Solvinig true scsearcctn vets meres toes Gina se cer geste cc Seen re Rea ent ORR Deze 90
Tne vRelationships inthe Interpreting Session ees:.cs.ccce retest ce este eee eee eee ee 92
section 4 "Ensuring Understanding rycctcc-tesanestucete cot vevscceavency ses tatitatde eeGace en Peete Arcee Sse 94

SECTIONSLS) RESISTED. SA vivacsc scare emcee Vamuneua Eans RPO reece Ee ea 96

SECTION? 67 Managing the Flow:Of- the Sesslon sreesnctesevaresen

cnet ae events coerce oer cemeeeeae ct99

The First Person and Why We Should Use the First Person...........:ccccssssscccsescscssescecesnsessnssnenensnence 100
Positioning in Medical’ interpreting 7.tncAictievesccesccusu.cescuusccceteceus
tuceazeVeeeencensteese: Chrtemes tneenameee oun 101

How’ to Position'Oneself .2A tia nanertines atic wate ates Me ie teen ee ee 102
Some Common Types of Interactions Interpreters ENCOUNTER .............cceeececcceeccsececeeeeeeececeeeceeeseeeee 103

speaking with the Parties Outside the Session sen..c:.ccscteescscvateuestrdeconvaeheteateniles

ceecvaees aaneeeR tren onimene 104

PR ESCSSION Gee aceecetwcnccsus ceca tnsstWsneuee sibeaiete ics wsk’atabire cht dhs Sab uauraens Sasaea 0a vas Steme oe ae eo eae ae Me erie ae a ne 105
AVOId Side Conversations, i xtiusc.tecrcoce ceed tecenew 8st ai es etn 106
SECTION 17: Active Listening & Memory Development. cscivesictercccesscessssvecavee
cheeecetataaeee me mere 108

Difference Between Hearlng:and Listenlng.tcitsns.ticccecteeesae

cesveceusatucesducceseedt sechaetamueoieeier onesie 109

Lhe: Three:types of Memory ii i.sc0i0.. cas reewutiers eevee ipa ceed Aaa eee ee 111
Short-term Memory Enhancement Techniques 2x vcccvvcsscctetecvieusncncescameeueunsteeee
tees eect eceeemetes 112
Long-Term Memory Enhancement Techniques tissicccicccescties cxnvs cvs cusscreeavcvenvsceentecere
eeteeeeneee reraeneee 114

SECTION: 18: Basie Note-Taking Tor INter Dreters ic::.ticcccccscceccuccercescersrerescteties

seeerees avasaateeenote aemeenneaeos 15

How to Practice-Taking Notes 2 aciartien issn cane eh ynaeeeracistvs en aneurin 115

HOW to Properly Take Notes cascevectou tiv ausnumavceteis stave vaca ernie ecaincns eet ine Veit ve clearer eesee eee eee 116
Whatto Avoid when Beginning Note-Taking iii. icc. casas sccavcteveonesuat cay euesruunveuresres nectaeeeteateatneeer 117
SECTIONGS: Expanded Note-Taking Skillsiise. FSi asi ticcseetovss acsnvaceck ceanmeneteesereuteec rs sat erncek rm: seeean Geremeeeee 118
AlWays Write Decontextualized Informatlon vyii.c.tic cossccses ccnvents ectananwsatenaancereemee
reer erence amen 118
How-to Use: Diagonal'SVO.Note=Ta king sci ctitesvesusacistewsetieeteee
uc voveetevees vatecccnecro ute aaeem ee 119
PHOW'UO USO: LUT MOTOS Bec cacecues acs ces cose aise saat buebettn tuewhetsaeeoae teeth etnenk even eoub ane aeae nanegeee ees mene toes 120
KEGEL IU Cte eV IOUS ae carere veeser ota ti eimiisdiriaity stuwuny nvoaqctreaebak is ud Cia devas soerveeteoueath neste ae th ochre ate 120
SEG MON 20FUSING SYMDOIS WHEN NOTE= AKING Sevsctresdasivasshtwersteveieiecesetenesttu
cacticstodeudescbccdeocntueetretes 12d.
Wi Freri tOmSesSVIM DONS catuasnr verre snexeriaveesrumtieatnnntouvss SiesunsdanteduvssanuvhiunscesSeraushuereuaertarvavtentcemerenenmt tal122

HOW-LO DESIR SVMIDONS mikeercateck as te ine tncrsnpe racer eaulieh Seat cau AULantelecevea Rebeag ra manemtenensasenternees ers 122

vi
 enennneshdesap
siensmennpameranita
How Symbols are Modifiable ......::sso:sesenccneesnenssatessuncorasnainavasncsandsn n i238
“mnneteamec

Symbols are Language Neutral..............c:ssccssseccessccccsssnssesrsesssnseesvenesenececsssesevsneaserseseececsonnccecees 123

Letters and Common Medical Abbreviations...........ccc:cccccsccseesssssseeeeseeeeeeetseenssssesseeeeeseeseerreneneenene 124

SECTION 21: Basic Skills in Sight Translation............:::sccccssssccesscsscsssssssesseesceseeseeesssssssassssssuacaaaaananserss 127

Comparing Sight Translation and CONSECUTIVE MOE...........:ccecseceeetteeeseteertneeereeseeetreraeeeeeneaeeetrnes 128

ESteps to SIGNt Translation ...ccssscurcccnsecnacsseccesceseateuecncvsvandvstrousapasnenteujoduinelenvearerszs=srncmatlaanetteaatan 129
eushawece-pegates tiracsans
The Importance of Taking YOUP TMG isicas-ccccttessecrescceonscnersnorsesereeavssapieonmers =nneategeae 130

Note-Taking Ton sieht [iranSlatloncs. ts ssccsssasencenrsrurcoesunuererss Uesiogunaed ice aap oeaaadete occ dadericanemeeaer 131
SECTION 22: Special Problems with Sight Translation.............:cccsssssssccssssseesssssteceesecesneecssserennenssess 132
Addressing Sight Translation in Pre-sessions or Pre-COnferences...........cccccceeeeesssseeeesentneeeeeeeennnneees 133
WHEmNOT LO SIBNE ranSlatecccccsnigssssasurssncdoresen etuenenens assets snstcape
tenants cir? cuayesadseyor.¢ meet acer 133
The.Five:Steps to Refuse Sight Translatlons jcccccive. cove ulacssach cesatrsdangyoseeses. 025. Oeeaanads ciueOeN seas reeMReaes 134

Sights ransiate the. ENTIRE: DOCUMENL.......<:scs-sso ssenegec

tbe setts teckeque
ons><sseeeadaeateeeea seeme135
ceenaas eee aeieeen

=<ata ntetiiy
TraNSPAreNcy. WHEN SIRE LPaNSlatlg. ssconescesdccncanctncmspesccnecdanssancterseeraceesussssde~e er 135
SEGTION 2S NCUILULC eee sacsczcsyssaspsvonss sonnei iabnccnsnbenvicasibedseweannse sre yooxantewsaspasannae tana nash aaNet y ae een a7
REVIEW. OF COILUIC s. causckssvcssavvcnasdtscesste uns tacaesPaeebhes sunt ek oneenn onan eee dane ater a aa eee 138
Cross-Cultural Competence and Interpreting :.......1:..-ccs
senacanet-enetere see eenaeetyae nented
nccssdea nopencntaanryaeaee 138

uetgte tate ouetnaenes

How-to. Overcome, Cultural Bilnd Spots cco... scnccccrcaceaseseszsccxceesceusanesc Renee eens 139
pe. Culture-of, BlOMedICING <sarccdciyccnsneceseccnte sone s Mama owed: ous dtaeeecueeinnc canines: aca tee ei Shae cen eee 140
Biomedical Cultures. scrtisusccse sevast
acu: nanoiceee esdoct eecipe
ceteeh aaah dheSeneca
asetegnaneeeral see een ee eeug
eee 140
cantesan
SECTION (24; Body Language and Culture j2c:141.2s00soaceke Ceeasene anes hh
commeet 0eeePanaeeneneen ean 142
Genders. sacct neti, siete: tbe, ciaeh cases nceee cadabeoya see bnecushestating des ine Oy teu oe ee ee aah teen Cee keen a 143
BiOlORICaliSOX vote ceca craeste ec ceca tera cee eee ease vansti on cdee cat anne cite alee ne afec teen ante eee eee 144
FORM AACOLCSS oem cig 2th tabayaccaaiv nsvans
ipanuncagah etGoonoteaete aie Maem esexncap
iuerat anh
eee ae en nee 144
SECTION 25: Swear-Words, Obscenities, Body Parts, and Modesty.............ccccccescceseeeeeseeececsecseceeeeeeess 146
SWea la W ONS sete saees soca souaitpsnedesnaai
ubdialehet eck aetna iinniga
viemeeayOesso duahnrs
'nsnsas ern 147
Obscenities; Body Parts; and MOG@StY siciccsssnca ee onan Aone veiss
sane cereseteaesReen snsece ne 148
IMEGFOLETMG IUITIO Ross eese etree cess e ny it ca tata c ca avs douirpay wmuinoo easeaian Geka eee cee nance an ae 149
SEGLIONIZG US HealinCare SVSTOM sfecau cca seas duvcutionnaatics ncaa pean bose caccecere va coe eee ee ae 153
Equal: Access to. Careutetcre tacnra ty a een 2 x.y item peat yeas, eee cn ie era 154
The: Roles of:Doctors; Nurses; and OtherStaff....::,.0c0sac peanut eeecceca
tetascecceceass 155
Patient Privacy HIPAA .3-..,ccerasn snsesspsesansmcasey aa sosenass gstosarenenle sure sane aeac tate e eee aan 156

Vii
 PUVatGi Gall iCal cai enmne wet rn ne wee ee ne ak We RA Sele tie eel ee hey ee Se ae isy/

An important observation about interpreting medical terminology: ...........:cccccccesseeessesesseeseeeeeseees hey

SELON SUM MariZatiOn te tacn: erent nt, dette eee Ue Ma teeat ork tins, of Apes a ee ei aan 158

SiLUatighs naLsUstilv. che; sUMinializa

LOU VOC Graeme tces sents eect: eeneenn ce ge rer era 159

ie ROlOnRatlenUAUVOCItG satca terre Cre nerie cnt co ie crc tcadec tiie meri te ee emeee me ac nee 160
Appropriate Situations for the Role of Patient AdVocate............ccccccccccccssssssssscsecssessssseessessesseseeses 160

OVEFCOMING SYSTEMIC Ballers s.,.acc.ccasssssantasi cones ronnesateetecdehsotuscs truce: Cheenti Te mann Eran ence nore ee tne 161

HOW tO Advocate Tomtne Patlential weve nccsscscstessenclecsisteyttectiar

crust teitoanie eeeete teen meee rae 162
SECTION 28:.How.and When to,Use Self-Care. . cai. .atscencasethceudee. cteceuns-neanacnct guaeee amen acme nee 164
Dealing with: Stress-and: ISi@mensase sien sccasccssneecate ie cecvacstaaate tat eas oeeeenan ome aca eee eee 165
Acgitionalsragers fOr INtELOreters.cescecscv.cssuvenevs ceaqsinsh tne tacrersce de tune uwacenetnnse ys geee ee taneteny atte te semne nee166
How to Retake Control When Feeling Overwhelmed............c::::cccccccssssssssscseeeesessessessscescesseeeseneasecs 166
SECTION 29: Identifying Secondary Trauma (VicarioUs Trauma) ...........::ccccccccceesssssecteseeeesssseeneceseeseess 168
Whatis Micanoussl rallimar<:suecst-2 ot ferrx. cz dyee utes sunt ceeeneeeu canes vece ota tant anemeremtes hate eee a eateraa tee Pee 169
Secondary Lauma:( Vicanlouss Lira a) scat sancucter.can dastuareneede rene Toneeteny eceasae iene cence eee eae ee 170

REMOVING tne Suga Ol SeCONGALy EAUIMa.. ante cacuccessetest cae caccanecnceetcataens ase cates acter eee atten 171
What Will: You Do if You Feel Secondary [aura fics......<.:.ccaxseracaceesesensasescuaececeseee
caer neee eeetreeeteeeet“WyAll

LIDS TOR. Dealing With Se@CONndary: [faUMAs i.ccc.sccseesessesuce vane scanecuctes cus cucderaetertana caged eeee enna mee nee 7
Positioning when Interpreting for Vulnerable Groups...............ccccceceseeseccceesesesseesssessnsetecsessrsnnaaeess Tie
VeELUNR PrOvIGers ESLAOIISI RADDOMitriter utente, sacrtoctcaccnemeccucttes
teanineren eeetaees tne ae eee 175

SECTION 31: Resources and Associations for Professional Development ..............cccsccccceceeeesssseeeeeeeees 176
SECTIONS 2arnenamportance of Becoming Certified yi cceccc--. canter ceeds cce conven cessceneoeee ee eee en 181
Wiha ls CeMmifCaton samcnascscecet ie ateutestceesserccta scsi vials ays te ccnmnnamt nstater on einen ccna eeeeeer cae eee eee 182
What is definition of the healthcare medical interpreting certification? ............ccccccccccceesessssseeeeeees 182
Making Certiticatlon. YOur GOalancacnatcwssase nan: cee neepenenne rune aotecchs Seeks ck ecb aera oe arse ee ee tee 183
Differences between the CCHI and NBCMI Certification Programs ............ccccscscccceseseeceestseeeeeeeeeeees 183
SOME AUVaNLaReS OME ITICALOM arenes ater anniascianstanser tact Aesesstoueacien ae aeten once ata cee nar ements 184
ACOA DSePLeDare TOL ENUniCatlOMsme.aee.sersccceraneatererscensettesate
ssn caterer ten teeetanmen etenaethere 185
SE GariyNes SMC la OLILVAISUILANCeueiiear tr cite connector metatnaraie ade cnces cian dn oc sa mane Menace tear. peer aearencee oat 186
SECTION S4 ce lie Vionitoring dd Selt-ASSESSIMGN tiscn creas oscceerceconsaxsvsncansrasxbuavent necksduceusasurbrescsuosanneh 187
Ret erences CILOC meet nnn cosre uaa eee wt vactnMfrencscaceanctcunssnnte oa danchaexaundtdenecatenrcequurcdenes
srtaneaesneneeuaren 190

viii
Welcome

Welcome to Liberty Language Services. We are pleased to present this training to you as the next

exciting step in your medical interpreting career. This course is for fully bilingual individuals who

wish to start working as interpreters. This course is also catered to dedicated interpreters who

may (1) not have previously been trained, (2) wish to refresh their knowledge and skills, and/or (3)

want to build on their foundation of proper interpreting techniques and abilities, in a fun,

collaborative setting.

Please note that the information in this welcome and introduction will not be tested. Also, the

numbering of the sections in the textbook will skip some numbers to align with the course

presentation.

Accompanying Medical Terminology Textbook: Medical Terminology for Medical Interpreters, by

Liberty Language Services, is the accompanying textbook to this comprehensive course.

The IMIA and NCIHC

The International Medical Interpreters Association (IMIA) and the National Council on Interpreting

in Health Care (NCIHC) are the most important organizations for medical and healthcare

interpreting in the U.S. Both organizations have developed standards of practice and code of ethics

that are necessary parts of medical interpreters’ training and practice. They are mentioned

throughout this book and our medical interpreter training course is aligned with these
organizations.
About Liberty Language Services

Liberty Language Services www.libertylanguageservices.com is a language services agency

providing total language solutions and language access services to hospital systems, medical

offices, legal firms, courts, public schools, state and local government agencies, universities,

private companies and more.

Liberty Language Services’ core capabilities include on-site, face-to-face interpreting services, over

the phone interpreting (OPI), and video remote interpreting (VRI). Our company also offers other

language services such as written translation, and American Sign Language (ASL) services.

Liberty Language Services serves a multitude of clients in Virginia, Maryland, and the District of

Columbia with qualified medical, legal, and community interpreters who can arrive on-site to

deliver interpretation services through in-person; as well as interpret over-the-phone, or through

video-remote interpreting. Liberty's over-the-phone and video-remote interpreting services serve

customers throughout the United States and abroad.

Course Expectations (Continued from Syllabus)

This is an intensive course; if you have other time-consuming commitments you will need to take

care of on the same days as this course, you should consider re-scheduling your other

commitments or withdrawing from the course.

Note: If taking online version, disregard statement above, as this course is also taught in person.

The online version is self-paced.

At the end of this course, you should be able to successfully perform all the objectives listed in the

Course Syllabus. These skills cannot be learned passively, so you will need to play an active role in

the exercises, role play practice sessions, and complete your homework before each day of class.

10
Student Expectations

Students may dress comfortably during the course, but Liberty reserves the right to modify dress

standards as needed. Cellphones are permitted in the classroom, but trainers have authority to

ban all cellphone use in the classroom if cellohones become a distraction. Please be responsible

with cellphones and courteous to your trainer and classmates at all times.

This training is a safe space for students. A safe space (also known as a “brave space”) is a place

where students can express themselves without fear of rejection or judgment based on any part

of their identity. Racist, homophobic, bigoted, or otherwise disparaging remarks will result in

immediate removal from the classroom and, if necessary, enrollment withdrawal from the course.

During this course, students will give and receive constructive criticism through the critique

analysis process. Many sections of the course will invite students to analyze and critique one

another, or to the entire class, about other students’ performance. Students should feel

comfortable pointing out perceived mistakes and areas of improvement, so long as they also

mention the positive aspects of the performance and focus on the performance, not the student.

11
 SECTION 1: Interpreting
Learning Goal

After successful completion of the Interpreting Section, participants will be able to do the
following:

Define the concept of interpreting and identify the main goal of the interpreter.

Learning Objectives:

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand the concept of interpretation.

e Know the main responsibility of the medical interpreter.
e identify the difference between the source and target language.

Important Terms and

Words

Interpreting

Message

Preserve the meaning

Social work

Profession

Autonomy

Perception of favoritism

Ethics

Professional distance

Neutral

Source language

Target language

Speech

Conscious

tc
io

The word “interpret” may mean many different things in the English language depending on the

context. For example, many museumgoers “interpret” art, and some dancers
ale
“interpret
Wy
MUSIC.
t

However, in the context of this course, which is for spoken languages only, the concept to interpret

What Interpreting is NOT

Sometimes when talking about interpreting, it can be useful to understand what interpreting is

NOT. For example, tintenpretifig

is)NOT social'Workr Many interpreters enter the profession out of
a desire to help others, and interpreters do indeed help many people. However, interpreters help

people by interpreting their messages, and respecting their autonomy. Interpreting is not about

recommending or discouraging patients or providers about something not related to interpreting.

(linterpretersvaresNOT patientirepresentatives: Interpreters need to be careful to be as

professional as possible to all parties to avoid the perception of favoritism (this will be covered

more in the ethics section). Patients especially may wish to become closer with their

Ale!

a
interpreters. However, interpreters should always maintain a professional distance and be

neutral to both sides. This can be challenging, but it is the only way that patients and providers

can trust the interpreters to faithfully interpret their messages to one another.

Personal closeness to patients (due to language and possibly culture) can cause unrealistic

expectations from the patient’s side as well as a level of mistrust from the provider’s side (more

on this later). Interpreting between languages can be confusing to discuss, so this textbook will

introduce some common terms interpreters use when talking about interpreting. Source}

The source and target language can vary during an interpreted conversation many times

depending on who is speaking. Sometimes interpreting is unidirectional, such as when a

presentation is interpreted from French into English. Other times, and mostly in healthcare,

interpreting is‘dialogic’, when aconversation, or‘dialogue’ isinterpreted inboth directions) For

example, if Yuanyuan and Arnold are a Mandarin speaker and a German speaker respectively, and

neither person speaks the other’s language, they could use an interpreter to understand one

another. Whenever Yuanyuan is speaking Mandarin and the interpreter is interpreting Yuanyuan’s

messages, the source language is Mandarin, and the target language is German. However,

whenever Arnold is speaking German and the interpreter is interpreting Arnold’s message (which

may be only a couple of seconds later), the source language is German, and the target language is

Mandarin.

These terms are important because interpreters need to be conscious of errors that may occur
when interpreting in either direction. Theinterpreters‘emainygoalsisstorenablesunderstandingnin

communication between people who speak different languages. The interpreter’s goal is not to
simply repeat words, but also to ensure that the messages are understood (IMIA Standards A-8

and A-9).

14
SS

SECTION 2: The Difference Between Translation and Interpretation

Learning Goal

After successful completion of the difference between interpretation and translation section,
participants will be able to do the following:

e Identify the difference between interpretation and translation

Learning Objectives: - Important terms and words

Using the above goals, participants should also be able to ‘Translation
do the following upon successful completion of this
section: Interchangeably

e Differentiate between interpretation and Professionals

Wiesel ,; Rendering written text

e Know the needed skills for both interpretation and
translation. Signed message

Skills

Many people use the two terms translation and interpretation interchangeably, which causes

confusion among the public and the professionals, since there is a very clear difference between

translation and interpretation.

Translation vs. Interpretation

The simplest way to differentiate between translation and interpretation is that ¢raiislationimeans

Translation is written or typed. Interpretation is spoken or signed.

Many interpreters are not trained or qualified as translators, and many translators are not trained

or qualified as interpreters. Interpreters and translators have a different set of skills.

TRANSLATORS vs INTERPRETERS
While both translators and interpreters transfer meaning between languages,
there's a big difference between what they do and the skills they possess.
This simple infographic will help you determine which type you need.

It's simple:
SPEAK
and interpreters speak.
translators write...

DELAYED
Your final translation
REAL-TIME
The final product
product will take is delivered instantly
days or longer

TARGET
LANGUAGE BOTH LANGUAGES
It's essential that Interpreters are
Translators don't have to be conversationally native or near native in both langauges
fluent in their source language but must be
in the target language

Translators rely on numerous

ON-THE-SPOT
When on the job, interpreters do not have
industry-specific resources consult dictionaries, glossaries, etc.

EXAMPLE: EXAMPLE:
LEGAL CONTRACT
A contract is a common example
BUSINESS MEETING
Conducting a meeting? You will
of a translation product need an interpreter!
 SECTION 3: Specializations and Fields of Interpreting
Learning Goal

After successful completion of the Specialization and Fields of interpreting section, participants
will be able to do the following:

Identify the specialization and fields of interpreting and describe the community interpreting
field.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion ofthis section:

e Understand the differences between all of the Specialization and Fields of interpreting.
e Differentiate between the community interpreting field and other fields of interpreting.

Important terms and words

Specialization and Fields

Communication

Cultures

Trade and diplomacy

Conference interpreters

Educational interpreting

Conflict zone

Diplomatic interpreting,

Liaison interpreting,

Business interpreting,
Community interpreting

Social service,

Law enforcement

Consecutive interpreting

Modes of interpreting

17.
Professionals in many fields need interpreters because language and communication across

cultures is essential in many fields. In some fields such as trade and diplomacy, interpreting has

been around for hundreds or thousands of years old. In others, such as manufacturing,

interpreting is fairly new because the need in that sector is more recent.

Today in the United States, medical, legal, and conference interpreters are the most well-known
interpretingmtields (specializations). However, there are many others emerging, such as

educational interpreting and conflict zone interpreting. In this section, we explore diplomatic

interpreting, liaison interpreting, business interpreting, and community interpreting (social

service, law enforcement, and educational interpreting).

First, diplomatic interpreting occurs at large, prestigious bodies such as the United Nations and at.

panty:tolstop speaking before interpreting) isicommonin'thisisector. Diplomatic interpreting often

needs to focus on and accurately convey nuances in meaning, including evasive answers and

delicately crafted statements. Unlike in some interpreting specializations, where interpreters work

18
for two parties, diplomats sometimes have an interpreter for each party, for political or security

reasons.

Similarto diplomatic interpreting, liaison interpreting requires great flexibility. Maisominterpreters

In
‘need to be able and willing to move from location to location through tours, visits,‘ and travel
liaison interpreting, interpreters often use different modes of interpreting. Accomplished

interpreters may use mobile interpreting equipment.

thatincludesmanysis.a.wi
field. preting
Third, OUSinessiinter usiness interpreters
ub=specialtiessB de
may be on calls between engineers discussing car specifications, a supplier and manufacturer, a

wholesaler and a retailer, or different departments of a multi-national company. BUSiness

properly hear, control the flow of the conversation when necessary, and ensure conditions for
Optimaleinterpreting. One particular challenge for business interpreters is maintaining
transparency in meetings or conference calls with many speakers.

Lastly, community interpreting is a catch-all term that includes different areas such as social

servicemhealthcaren|awsenforcementpandsedueationalsintenpretingy
Community interpreting is
often a relatively comfortable place for some interpreters; however, it requires a lot of practice.

Just as there is a wide range of settings in community interpreting, there is also a wide range of
ethical pitfalls into which unwary interpreters may fall.

19
 SECTION 4: Modality of Interpreting
Learning Goal

After successful completion of the Modality of interpreting section, participants will be able to
do the following: '

Identify the three different Modalities of interpreting and describe the differences between in-
person, telephonically, and via video modalities.

Learning Objectives:

Using the above goals, participants should also be able to do the following upon successful
completion of this section: ?

e Understand the differences between in-person, telephonic, and video remote interpreting
modalities.
e Distinguish between all of the three different modalities.
e Easily differentiate between spoken and signed communication.
e identify the best-known modality of interpretation (On-Site Interpretation).
e Understand the impact of COVID-19 on interpreting and the increase need for remote
interpretation (OPI and VRI).
e identify the differences between the OPI and VRI.
Important terms and words
Modality of Interpreting
On-Site Interpretation
face-to-face interpretation
OPI
VRI
American Sign Language (ASL)
Physical presence
Telemedicine appointments
LEP Limited English Proficient
Patient
Auditory interpretation
COVID-19 Pandemic

20
lnterpretingycanshappensin-personpitelephonicallyslorwwiawvideow
but it must involve spoken or
States»the.most.commononmsofisignedicommunication.is
signed communication. |n.theUnited

There are also remote modalities of interpretation that do not require the physical presence of

either one or all parties, such as VideoRemoteinterpretation(VRI)} OverthePhonedinterpretation _

(OP!) and interpreting for Telemedicine appointments when the three parties (LEP, provider and

interpreter) are in different locations. VRI is a method in which an interpreter works from a

computer with a camera and interprets through the screen. OPI is similar, except the interpreter

will only provide auditory interpretation rather than being seen or seeing the person who needs

interpretation services.

In 2020, due to the COVID-19 pandemic, there was a rise in the need and demand for remote

interpreting modalities.
 SECTION 5: Types of Interpreter Employment
Learning Goal

After successful completion of the Types of Interpreter Employment Section, participants will be
able to do the following:

Identify all types of interpreter employment and describe the nature job of medical, legal,
business interpreters, and other types of interpreters.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

Understand the differences between all types of interpreter

employment. Important terms and words
Distinguish between freelance interpreters, part-time Subject matter
interpreters, and full-time interpreters. Public facet
Easily differentiate between spoken and signed Diverse backgrounds
communication. Deaf or hard of hearing people
Identify the job of dual-role interpreters. Legally entitled
Understand all of the differences between trained
Part-time staff
interpreters, Pro Bono interpreters, and ad-hoc
Employee benefits
interpreters.
Understand the danger of using ad-hoc and non-trained Freelance interpreters
interpreters for the safety of the patients and healthcare Independent contractors
system. On-demand
Decline assignments
Paying clients
Dual-role interpreters
Bilingual
Practicum interpreters
Internship interpreters
Volunteer interpreters
Pro Bono interpreters
Tax deductions
Ad-hoc interpreter
Interpreting competencies
Ambiguity
Federal courts
High stakes settings

22
fausionetanterarcrnnenss
Bea ; eae ase ptestechindividual,\who is

any professional or public

competent to work in the subject matter at hand: It can be required in
facet of life that you can think of.

Interpretation is a huge part of living in a society with diverse backgrounds and cultures. Medical

interpretation is needed at hospitals to interpret between providers and patients. Lawyers need

legal interpreters to enable accurate communication with their clients, and potentially later in

court. Businesses sometimes have foreign investors or customers who need interpretation

services in order to communicate with them. Schools require interpreters for students who don’t

speak English as well as parents who have limited English proficiency. Deaf or hard of hearing

people are legally entitled to an interpreter in any setting.

Employed.
work.as-full-time.ormpant=timerstat,
interpreters. They may be specialized in court/legal,
diplomatic, government, or other type of interpreting. These interpreters have employee benefits,

23
but they are not able to set their hours, nor can they accept or reject projects. They are usually

paid by the hour or receive a weekly or monthly salary.

Freelance interpreters (also known as independent contractors) work on demand, Their work
times, locations, and rates may vary. Freelance interpreters sell their work or services by the hour,

day, job, etc., rather than working on a regular salary basis for one employer. They have the

freedom to accept or decline assignments being offered to them, and usually work for many paying

clients.

Dual-role interpreters are hired or employed professionals who are bilingual and have been
trained and tested to be able to interpret professionally during their normal working hours. For
example, a dual-role interpreter can be working as a nurse and be called to interpret as needed.

Practicum interpreters (also known as internship interpreters) are those that are working towards.
a practice requirement for testing (certification) or the completion of a training: Practice
professions typically have an internship component. In the business world, these are usually called

internships, whereas in the medical sector these are called practicums.

Volunteer interpreters are those that respond to requests for volunteers who can perform,
interpreting’servicés, usually due to their concern for the individuals needing an interpreter (i.e.

refugees, immigrants). These volunteers are commonly nonprofessional bilingual individuals who

do not have any formal interpreter training. While many non-profits make requests to professional

interpreters to volunteer their interpretation services for their conferences or meetings, the

interpreting associations frown upon this type of interpreting as it undervalues and undercuts the

professionalization of interpreting. Some organizations have set up their interpreting systems to

rely solely on volunteer interpreters, often using a lack of funds as justification. However, these

are the same organizations that have no hesitation in paying for other professional services, such

as photography, videography, graphic design, and catering. So clearly, the issue is not a lack of

funds but a lack of understanding that interpreting is a profession that people must train for and

develop their skill in. Typically, these organizations do not verify the qualifications of their

‘volunteers’, which is a big concern given that they run many risks by relying on individuals of

varied skill levels with no form of monitoring the quality of the interpretation or reporting

24
complaints. These organizations also do not realize the potential risks they face should a wrong

interpretation cause an unwanted outcome.

re_professional i an

This arrangement is different

OreanizationitowWolunteerforyjustiastawyersrandeteachersumayedos
as the organization is not requesting the service. It is the interpreter who is offering to provide an

added service for his or her own benefit, such as tax deductions, community service requirements,

or their own self-development efforts.

Nlinn-prote ON nteronretinge nteronretingo neing nerrocmec-b VC WA ere n@ ALOE d

Ofeatestedmifyetheinterpretation=specializationetheymarespracticingsina The CLAS Standards

admonishes the inadequate and dangerous use of bilingual children or untrained individuals to aid

in the communication of their parents or family members due to the risk to the parties involved.

These individuals are often called ‘interpreters’, but they are not interpreting, as they have not

been formally trained to interpret. They are simply relaying partial information back and forth to

the best of their ability. Accurate interpretation is a learned skill.

_— 8 we aa | ee
interpretingwcompetency. However, since the term utilizes the word “interpreter” it confuses
people into thinking the service is being provided by a qualified interpreter.

The use of ad-hoc interpreters in medical and healthcare settings can be dangerous for both
patient safety and in terms of liability for the healthcare providers and the organizations and
systems in which they work. Due to their lack of training and testing, ad-hoc interpreters can cause
misunderstanding and miscommunication. Professional medical interpreters are more accurate.

Additionally, “asking people who have not received healthcare interpreter training to perform this
task compromises some fundamental ethical aspects of healthcare between providers and
patients.” (California Standards for Healthcare Interpreters, 2002).

The use of ad-hoc interpreters can cause serious impediments to communication with patients
and their families and patient safety and satisfaction will suffer.

25
 SECTION 6: The Roles of Interpreters
Learning Goal

After successful completion of The Roles of Interpreter’s Section, participants will be able to do
the following:

Identify all types of barriers to the communication between LEP (Limited-English Person)
patients and the providers and be able to describe the different roles of medical interpreters in a
medical encounter.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e identify the responsibilities of the interpreters and needed soft skills (Active Listening).
e Understand the mediation role of the interpreters and the meaning of the communication
mediation.
e Understand the differences between the four roles of the medical interpreters (Conduit,
Clarifier, Cultural Broker, and Patient Advocate roles).
e Differentiate between the different barriers to communication in the medical setting.
e Understand when interpreters can play the four different roles and which barrier requires
the interpreters to have to switch from one role to another.
e Understand the role of the patient advocate and what the IMIA and NCIHC say about this
role.
Important terms and words
Functions
Tendency
Conduit
Linguistic conversion
Non-thinking technicians
Active listening skills
Misconception
Mediation role
Monitor and arbiter
Clarifier
Intercultural mediator
Patient Advocate
Cultural representative
Co-diagnostician

26
Biomedical interpreter
Intermediary
Conciliator
Cultural consultant
Self-explanatory
Role theories
Maintaining flow
Intervening
Patient’s history
Pre-session
problem solving
resolve conflict
intercultural communication
empathetic listening
Register Barrier
level of formality
specialized or technical
language
facilitating communication
too colloquial (informal)
A barrier of register
Bipolar disorder
Communication Barriers
Environmental Barriers
inter-linguistic issues
Intercultural Barriers
systemic discrimination
barriers
racism,
discrimination
humiliation
ethnicity
race or sexual preference
an ethical perspective
well-being
dignity
the cultural proximity

27
 offense
an adversarial situation
practitioners

Now, we will cover the roles of the interpreters, or the functions that interpreters play in

healthcare. Function can be further defined as the activity or purpose of a person.

There is a tendency among healthcare professionals to see the interpreter solely as a conduit, or

a channel for linguistic conversion. This is verbalized by some people as speaking ‘through’ an

interpreter. When a provider says, “please repeat what | say,” or “tell her this,” the provider may

be under the impression that interpreters, like robots, or non-thinking technicians, merely repeat

the same words or terms in another language (Hsieh, 2008). They do not realize that thes

‘interpreter, through active listening skills, must first gain complete understanding of the message.,
Then, interpreters must reformulate the meaning of the message to successfully construct a new
statement that conveys the exact intent and message ofthe original speaker. If the meaning of
the original message uttered or signed is unclear, the interpreter will not be able to repeat it

because repetition of words is not what he or she is doing in the first place. Since interpreters do

not interpret words, but rather concepts and meaning between two cultures and languages, it

may be more accurate to state that sypninrarytunctioniis:tomediateyianguagerand

thesinterpreten
culturenforimutlal understanding This is very different from repeating or telling someone
something you heard in another language. Basically, stating that interpreters ‘interpret’ or

‘convert’ words from one language into another, enables this misconception to exist. The concept

of interpreters having a mediation role is rarely on the provider's mind (Souza, 2016). We will

discuss what is mediation is in a minute. But first, what specific roles have researchers described

observing medical interpreters in?

Well, research on medical interpreters’ role(s) has shown that aamidewarietyotrolesexistincludings

 i ' i | nisuttant'(Ravate2005)s

(Souza, 2016). There is still a need to further explore issues surrounding

ancuintereultUralimediator

the role and responsibilities of medical interpreters within the contextualized framework of

therapeutic communication goals. Although, now researchers are moving away from describing

the profession as roles, and instead aim to describe the tasks and responsibilities of the interpreter

to explain what interpreters do, versus who they are or act as.

These roles are mostly self-explanatory and clearly showcase the numerous kinds of functions that

are fulfilled, or expected to be fulfilled, by a medical interpreter. When explaining the difference

between Haitian Creole and French, the interpreter becomes a ‘linguistic educator’. When

explaining how to work with interpreters, he or she could be called a ‘client educator’. However,

the reality is that the,.only..purpose=.of.folestheorieswand=explanationss#is*towenhance=the

understanding oftheinterpreter’s workand'strategies! They are not necessarily something that
needs to be adhered to as a set of rules. Interpreters are interpreters and do not change roles, but

simply take on different actions, which are sometimes described as roles.

Certain studies have showed that there can be conflict between some roles, or functions, such as

‘maintaining flow’ and ‘intervening’, which seem to be at odds with one another. This requires

interpreters to eonstanthywanalyzesnext’steps™whilesinterpreting (Shlesinger, 2002). Another

common role conflict occurs when the patient wants the interpreter to take on the role of ‘friend’

and ‘representative’ or ‘personal advocate’, or when the provider wants the interpreter to be their

‘clinical helper’ by asking the interpreter to take the patient’s history (instead of/for the provider).

As you learn more about roles, you will see that these particular requests are not roles within the

work of mediation. You will also learn that an interpreter can perform many roles or functions at

the same time.

Interpreters should not think they are only working as interpreters when they are actively
interpreting. Their job as an interpreter. adjusts and switches between various roles and. tasks.
during the entire process. From the arrival of an assignment to pre-session introductions,

29
communication flow management, problem solving, intervening, and closure activities, the

interpreter will be working and constantly utilizing different skills. The time an interpreter is

interpreting is but a small portion of an interpreter’s entire work, so the interpreting role cannot

be limited to the interpretation time alone.

An Interpreter is a Type of Mediator, but What is a Mediator?

There are many types of mediators. Most are familiar with conflict mediators, intermediaries hired

agreement. However, interpreters are not conflict mediators. laterpreters,.especiallyedialogue

me@diatorsi™he difference is that they are not interpreting an adversarial relationship. Most
medical interpreting sessions are collaborative, where the provider and the patient have the same

goal in mind, which is the wellbeing of the patient.

What is meant by ‘communication’ mediation?

Interpreters mediate intercultural communication between people. Communication requires

understanding. If one communicates a message but the listener did not understand, there was no

communication, there was just the transfer of information. Therefore, language alone does not do

the trick. Interpreters are not ‘language’ mediators because they are not mediating languages.

They are mediating communication, which uses language to communicate. lmmeintercultural.

| | | | Rati «am: |

intercultural. Therefore, from this perspective, one may conclude that (nterpretersmare

communication"professionals. In addition to being communication professionals, intenpnetersare

also language professionals, since they need to know at least two languages at a professional level
of proficiency and know the art of linguistic interpretation in all modes. Of course, ¢heysanevals@
interpreting professionals. However, remember that being an interpreter is not just about the role

you perform when interpreting what other individuals state or sign. Thestole.Of.jinterpreting

Communication mediators need to pay close

durins"the"communicativessession’
interpretation

30
attention to all facets of communication, such as their own communication, ensure understanding

(IMIA, A-8), handle the dynamics of the students, such as managing the dynamics of the triad (IMIA
A-11), intervene when necessary (IMIA, B-2), and much more.

Most mediators consider empathetic listening as one of their core skills, and this is especially
relevant in therapeutic communication. In addition, the advanced skillofireframing is necessary. in

communicationmediation. This involves reframing target messages, so they have the same effect
as if stated in the source language. Whereas the mediation role is the overarching role of the

interpreter, there are four roles that are the most popular when explaining medical interpreting,

and these will be explained for this training’s purposes.

The Four Roles

The four historic interpreter roles usually used in interpreter training will be described in this

section. Conduit,.2).Clari
Thelfounmoles.are.1) fiera3)dnterculturaliMiediatonorCulturalkBroker,and..
AyPpatientiAdvocate, Other interpreting courses may use different names for these roles, but the
meaning is similar and the problems these roles address are the same.

| Interpreter
Roles

Changing Roles
As stated before, interpreting what others state or sign is but one of the interpreter’s tasks. The

interpreter must be able to flow from role to role during the interpreted session as potential

31
misunderstandings arise and are resolved. Thesmost-appropr
role forthesinterpreteris.
iate always.»
the role that will ensure effective and accurate communication between the main parties
ies in
i volved.

The Role of Conduit

cuueennnsnient eta .
: 7 } nee | Paes
sourcelanguage? In the Conduit role, the interpreter always interprets meaning for meaning.

The Conduit role is the role in interpreting which only interpreters can perform and is the role

which is viewed as thesactiofiinterpreting? Amongst the four roles, it is the:Omlyerole-thatsisonOt»

‘meant for problem solving.

The interpreter plays the conduit role when there is a linguistic barrier. For example, a patient may

only speak the Arabic language while the provider may only speak the English language. The

provider will ask some questions in English and the patient will answer in Arabic. However, because

of the language barrier, the two of them cannot communicate with each other. This is when the

interpreter steps in as a conduit to enable understanding between the patient and the provider

by interpreting everything that is said faithfully and accurately.

The Role of Clarifier

Now that we have discussed the role of conduit, we will be talking about the other three roles,

which all involve problem solving in some way. Problem solving may or may not require

intervention (as you will see later). The.rolesofmclarifiersisaused=tonmanagemthenflow..of

communicationbetween
two orimore’parties: Interpreters need to intervene in their own voice

to direct the flow of communication. For example, if two people are speaking at once, the

interpreter needs to state that he or she cannot interpret for more than one person at a time so

that the two parties can be mindful of not speaking over each other. In this example, the

interpreter is problem solving during a situation when something is making it too difficult for them

to properly do their interpretation. Uslally the interpreter playsithe rolevof the:clarifierwhen:there,

meaning
of aimessageThere could be a problem with hearing what was said, a problem with the

32
message or length of sentences used, a problem with a difficult term, etc. These problems or

challenges are sometimes called barriers and they must be removed and cleared to allow for

accurate interpretation.

Communication Barriers
meniaiontianieoue! ue fig dl ff eee re

term
complexity.oflanguage.used.between.the.communicating-partieswA “register” is a linguistic
(further discussed in Section 15) referring to formal and informal, specialized or technical

language choices speakers regularly make in conversation.

Medical interpreting is about facilitating communication and ensuring equal access to medical

services. Therefore, register barriers are a key concern to interpreters. They occur when someone

is using terms that are too complex or too colloquial (informal) for the other person to understand

completely.

A barrier of register usually prompts the interpreter to play the role of clarifier to explain a

complicated medical term or a term that does not have similarity in the target language.

(interpreters.need.to:be-aware
when the term being-interpreted into the target language wil
2. A : ee 7
languagesintotthestangetilangliage} for example, the medical term Bipolar disorder does not make
sense when translated literally into the Arabic language. The interpreter must explain what this

term means, using the clarifier role, rather than just acting as a conduit.

‘HeiNgisunesofethelmeaningiof
thelmessage just UtteredlOnsigHed. Additionally, a communication
barrier can result from the difficulty of expressing a concept to be interpreted. For example, if the

interpreter cannot think of an equivalent term to use for a concept stated in the source language,

the interpreter may ask that party to rephrase or explain to make it easier to interpret. In doing

this, the interpreter is intervening to identify and remove the communication barrier between the

provider and the patient.

33
Spacestherinterpreterisinterpreting
in has no Walls and is very noisy, thisnorse*barriermayneed

As a Clarifier, the interpreter helps ensure the removal of all these types of communication barriers

so that complete and accurate interpretation can be provided. Whereas keeping the flow of

communication may seem to be the goal, managing.the.flow,of, cOMMUNICAtiONeiS»Ofsuitmost,

importamee, as accuracy and completeness of interpretation is the most important service the

interpreter can provide. There is no benefit in glossing over possible misunderstandings or

mistakes in interpretation in the name of keeping the illusion of a seamless flow of communication.

The Role of Intercultural Mediator or Cultural

Broker

Since language is a component of culture, ,inter-linguistic

Barriers The role of intercultural mediator or cultural

broker is the same as that of clarifier, except in this case,

it involves identifying and seeking interventions to

remove intercultural barriers.

ombehaviors. These differences may cause misunderstandings. Therefore, interpreters need to be

able to identify, inquire, and work to help the parties resolve these intercultural

misunderstandings.

34
Take for example, the fact that some cultures use a workweek of Sunday through Thursday instead

of Monday through Friday. This could cause confusion when someone is not familiar with this

cultural difference. If a patient says, “the first day of the week”, he or she may assume everyone

knows they are referring to Sunday. However, if the interpreter simply interprets “the first day of

the week” literally, the provider may think they are speaking about Monday. In this case, the

interpreter should clarify if the patient is referring to a Sunday or Monday. The ‘assumption’ that
the first day of the week is Monday is a cultural assumption, based on tradition and practices that

could be thousands of years old.

dnterpreters need to pay close attention to properly identify an issue as a cultural issues Whereas
the interpreter may think that the issue is cultural, it could simply be a case of missing information,

or an issue of a patient’s personal opinion. Therefore, the interpreter should pescarefulnot'to

) basket : Firm tl , isindeed

the.result
a.culturalmisuaderstanding,
of For example, a female patient might refuse a certain
male provider and the interpreter might assume that the patient refused the male provider

because of gender, and because the patient comes from a very conservative culture. When in fact,

the patient does not like this provider because she thinks that the provider is not good, and he will

not be able to help her as she wishes. In this example, the interpreter should not assume anything.

The interpreter must first confirm what he thinks with the patient, before the interpreter

reinforces a gender stereotype and makes a wrong assumption.

The Role of Patient Advocate

Lastly, interpreters sometimes need to adopt a role called patient advocate.

a | ie — ) if lial
her . / a chiSCHteB
ENTER OSES RRR ma

Some language services and providers have strict rules about the patient advocate role and advise

their interpreters not to play this role. Although interpreters should remember that NOT acting
and playing the role of a patient advocate when seeing systemic discrimination occur may be

35
putting the interpreter at risk of being accused of participating in such an act of discrimination.

Therefore, sometimes the interpreters must do something to help from an ethical perspective.

However, this does not necessarily need to occur during the communicative event. It all depends

on the situation as will be explained in the next section.

What do the IMIA and NCIHC have to say about patient advocacy?
K "ata
wid INTERNATIONAL MEDICAL National Council on
INTERPRETERS ASSOCIATION @ Interpreting in Health Care
Leading the advancement of professional interpreters
NCIHC

Neither the IMIA nor the NCIHC explicitly use the term patient advocacy. Instead, they meferto'the

While the IMIA does not use the term advocacy in

its standards, it does state that “the cultural proximity of the patient with the interpreter may

cause the patient to want the interpreter to act as his or her advocate”. Regarding the patient

advocacy role, it states the following in the ethical section of its standards:

Interpreters deal with discrimination (IMIA: C-7). It further states that, “On occasions

where the interpreter feels strongly that either party’s behavior is affecting access to

or quality of service, or compromising either party's dignity, [the interpreter] uses

effective strategies to address the situation. If the problem persists, [the interpreter]

knows and uses institutional policies and procedures relevant to discrimination’.

Related IMIA Ethical Principle: Interpreters will engage in patient advocacy only when

appropriate and necessary for communication purposes, using professional judgment.

NCIHC states the following in its Standards of Practice:

Advocacy..-ro-prevent:harm-to,partiessthatthetinterpretemsenves,
The interpreter may
speak out to protect an individual from serious harm. For example, an interpreter may

intervene on behalf ofa patient with a life-threatening allergy, if the condition has been

36
 overlooked. The interpreter may advocate on*behalf of a party or group to correct
or abuse. For example, an interpreter may alert his or her supervisor to
mistreatment
patterns of disrespect towards patients. Related.ethical principle: Whenethespatient's

‘advocate.»

Note that both standards apply the advocacy role as a response to either party's behavior, not just

the provider’s behavior towards the patient. Even in cases of discrimination, we cannot assume

that the discrimination will be against the patient. There are cases where patients discriminate

against providers.

Lastly, (aida en inet ing’someoneiofi f.diseriminati :

dnd
thelinterpreter.
te It is important that the interpreter be certain and not use the discrimination

card when it is perhaps simply a situation of a difficult interpersonal relationship between the

provider and the patient. The interpreter needs to Knowstheprotocols in place where they work,

and their first line of action may be to discuss the issue with a supervisor after the communicative

event, and not during it. Only very skilled interpreters with high levels of diplomatic skills should

consider advocacy during the interpretation, as it can become an adversarial situation to the

detriment of all the parties involved. Interpreter training usually includes techniques to address

mild forms of discrimination.

In Summary

The role of the interpreter encompasses a much broader scope than the actual act of interpreting

or the four roles described in this section. Researchers ultimately consider medical interpreters as

practitioners (Dean & Pollard, 2005), engaged in a practice profession, like medicine, law, teaching,

counseling, or law enforcement, where careful consideration and judgment regarding situational

and human interaction factors are central to doing effective work. One can contrast the practice

professions with the technical professions, such as engineering and accounting, where knowledge

37
and skills pertaining to the technical elements of a job are largely sufficient to allow the

professional to produce a competent work product. lnterpretersefumetionsmoreslikespractice

professionalsithanstechnicians due to the significance of situational and human interaction factors

on their ultimate work product; that is, factors beyond the technical elements of the source and

target language (Dean & Pollard, 2001; Gish, 1987; Humphrey & Alcorn, 1995; Metzger, 1999; Roy,

2000a; Wadensjo, 1998). Interpreters cannot deliver effective professional service armed only

with their technical knowledge of the source and target languages, culture, and a code of ethics.

Like all practice professionals, they must supplement their technical knowledge and skills with

input, exchange, and judgment regarding the providers and patients they are serving in a specific

environment and in a specific communicative situation.

38
 SECTION 7: Conversion

Learning Goal

After successful completion of the Conversion section, participants will be able to do the following:

Analyze and explain how to convert from English to the target language and vice versa.

Learning Objectives: - Important terms and words

Communicative autonomy
Using the above goals, participants should also be able to do Fundamental
the following upon successful completion of this section: Blunt
Offensive
Faithful rendition
e Understand the fundamental work of any interpreter:
Operating table
expressing what someone says in one language in Critical
Conjugation
another language.
Mammals
e Identify and explain the term: communicative Ritual phrases
Emergency Department
autonomy.
Idioms
e Interpret the message accurately and completely by The tip of the iceberg
Undress
applying the conversion concept.
Ache
e Identify the common motto of accuracy (“Add nothing,

omit nothing, change nothing”).

e Analyze the units of meaning to be accurate and complete.

e Understand when they can change the words and how they can do that.

of)
The Heart of Interpreting, by Cindy Roat

Hello there. My name is Cindy Roat. I’m a consultant and trainer of interpreters for healthcare

settings. Today |’d like to introduce you to what is thesfundamentaleworksofeanysinterpreter:

: | a Thisiiscalled“ nee

In the course of doing this, Welwantto'support

something we'call communicative’autonomy — hey,
that’s a fancy phrase! What does it mean?

To answer that question, let me ask another:

Who gets to decide WHAT is said in an interpreted conversation?

Does the speaker decide?

Does the interpreter decide?

If you said the speaker, you're right. Thesspeakenschooses»whatyhesorsheawantsstorsaygulihen

tAutonomymeansiindependence,
orfreedomyof action’ So as interpreters, we support speakers’
freedom to communicate whatever and however they want to. We make it possible for the

speaker to be understood on their own terms.

40
 age,g
weare the bridge.over
You might say that Jangu who don't:
two peoplelps
the apithatihe
kt | - § lid

So, what if we do not like the message. Can we change it?

Nope.

But what if the speaker is too blunt?

Nope.

But what if the speaker is offensive?

Nope.

But what if we know that the speaker is actually lying?!

Well, that is the speaker’s right. An English speaker could do all these things, and we support the

right of the non-English speaker to do the same. We are there to make sure their message can

be understood by the listener, just as the speaker said it. It is the speaker’s right to be blunt,

offensive, confusing — or even to lie.

The bottom line is that as interpreters, we follow these three simple rules:

This is the heart of accuracy. And accuracy is the heart of interpreting. If we are not accurate,

nobody will trust that what we say is a faithful rendition of what the speaker said. So, we have to
be absolutely accurate in our interpreting.

So, if the provider says, “We did everything we could, but we couldn’t save your husband. He

died on the operating table. I’m sorry.”, that’s what we interpret.

If the patient says, “You are a terrible doctor! I’m going to sue you!” that’s what we interpret.

41
Add nothing, omit nothing, change nothing.

This sounds easy. Let’s take a closer look.

If the provider says, “What brings you in today?”, how will you interpret that?

If you can’t add, omit or change anything, do you just convert the words into your non-English
language?

What

brings

you

in

today?

What do you think? Try interpreting this word-for-word into your non-English language. Does it

make sense?

Most likely not! Language doesn’t work that way. Part of the beauty of languages is that they are

all organized in different ways.

They put words in different orders, for example. In some languages, like English, the order of the

words is critical. Sentences almost always go Subject, Verb, Object. So, the dog saw the tree is

not the same as the tree saw the dog. But in Japanese, for example, a particle is added to the

end of every word to show what role it plays in the sentence. So “dog tree saw” is the same as

“tree dog saw.” And the verb comes at the end.

In some languages, certain words are understood without being said. In Spanish, for example,

the subject of a sentence is indicated by the conjugation of the verb. “| am” can be “Yo soy”, but

since “soy” is only used as the first-person present tense of the verb “to be”, the “Yo” is

understood and often dropped.

42
Another example of linguistic difference is how time is indicated. In English, the verb is

conjugated to indicate time: | go, | will go, |went. In Mandarin Chinese, on the other hand, the

verb in these three sentences would be the same. Time is indicated using specific time words,

like “today,” “now,” “tomorrow”.

Wed

“Wait a minute!”, | hear you cry!

What happened to, “Add nothing, omit nothing, change nothing? You’re breaking your own
rules
122

Well, yes, |would be — if we were interpreting words.

But — and this is very important — interpreters do not interpret words. We interpret MEANING.

So, let’s look at our doctor’s utterance again.

“What brings you in today?”

What is the provider really asking? Whether the patient took the bus?

43
No, we understand that the provider is asking what the patient wants to talk to the doctor about.
Why is the patient there?

So, an accurate interpretation might be “What problem did you want to talk to me about

today” or “Why did you come in today?”

There’s nothing about “bringing” at all. We have changed the words in order to be faithful to the

meaning.

50, the Gelaiulesobinternneting:acgy

smal

‘Omit
no meaning.

Here’s another example. What if the nurse says,

“Did you have any trouble getting in today? It’s raining cats and dogs out there!”

Or what if the doctor says,

“We've stabilized his condition, but he’s not out of the woods yet.”

Is the nurse saying that small mammals are falling from the sky? Is the doctor saying that the

patient is somewhere lost in the woods? No, of course not. The nurse is saying that it’s raining

really hard, and she’s just using a colorful expression to say it. A good interpretation would be,

“It’s raining really hard.” Not a dog or cat mentioned.

And the doctor is saying that the patient is still at risk. One possible rendering would be,

“He’s still in some danger.” No woods.

Did we change something? Yes, we changed the words, in order to conserve the meaning.

Let’s look at this more carefully.

44
Some of what we interpret are ritual phrases. We say, “good morning.” Is it really a good
morning? It doesn’t matter. The MEANING in this is that this is a polite greeting. What would be

a polite greeting in your non-English language? The word for “morning” doesn’t have to appear,

just the greeting.

Here’s another: “Thank goodness.” It’s an expression of relief. The most accurate conversion into

your non-English language might not use the words “thank” or “goodness.” Because we’re not

interpreting words, we’re interpreting...

(If you didn’t say “meaning”, go back to the beginning of Section 7 and start over!)

A final ritual phrase we use a lot in English: “Have a nice day.” It’s a polite way to end a

conversation and to say good-bye. What would be the equivalent in your non-English language?

Consider this statement by a nurse in the Emergency Department: “We’re going to move her

onto the floor.” In the context of the ED, we know that this means that the patient will be

admitted to the hospital when she is stable. If the context were, say, an EMT talking about a

patient who has collapsed over a chair, the statement might have a different meaning.

Or this one, often heard in health care: “The tests were negative.” In context, we know that this

means that the tests did not find what they were looking for. In a different context — in a school ,

for example — this statement might have a different meaning.

Then there are idioms, like “raining cats and dogs.”

“Runs in the family” indicates a characteristic shared by lots of family members; it has nothing to

do with running.

“A piece of cake” means something’s easy; it includes no pastries at all.

“The tip of the iceberg” is a small part of something much bigger, but involves no ice.

And how would you render “cutie-pie”

?!!!

45
In all these cases, we interpret meaning, not words, so:

“People in the same family often get this same illness.”

“Taking blood will be easy.”

“We're afraid that this is just a small part of something much bigger.”

“You are adorable/cute/lovely/endearing/charming...”

Consider this question: “When you left on your trip, did you take your pills?”

Now, did the speaker mean to ask whether the patient took the pills with him in his suitcase

when he went on his trip, or whether he swallowed his pills before he left?

We can’t tell which of the two meanings was intended, neither from the statement nor the

something whose meaning we don’t understand.

So, what do we do? ihiGasicihe speaker forciarilication, More on that later.

Here’s another example: The patient says, in Spanish, “Tengo cinco hermanos. Hermanos” can
ned

mean brothers, but it can also mean siblings — that is, brothers and sisters. Which did the patient

mean? We don’t know, so we need to ask for clarification.

lf we are going to focus on meaning, not words, it makes sense to practice identifying what we

call “units of meaning.” For example, the question, “What is your name?” really has only one unit

of meaning: “your name?”

The next question, though:

“! need your name, address, and home number” has 3 units of meaning: name, address, phone

number. If we leave one out, we’re omitting. If we mention social security number, we’re adding.

lf we ask for the name, address, and shoe size, we’ve changed the meaning.

46
How about this one:

“Please undress and put on this gown. The doctor will be in shortly.’
Wy)

There are four units of meaning here:

Undress.

Put on the gown.

The doctor is coming.

ee
abe
gee The doctor will be here soon.

As long as we include these four units of meaning, we are being accurate. If we leave one out, if

we add something else, or if we change one of the four, our interpretation is inaccurate.

Let’s look at some examples of what a poor rendition might look like. Suppose a patient says this:

“It isn’t so much a pain as a discomfort in my chest. A pressure, after | eat. Well, maybe it is a

pain.”

What are the units of meaning?

It isn’t pain.

It’s discomfort.

It’s in my chest.

It’s a pressure.

It’s after | eat.

Maybe it is a pain.

So, here’s one accurate rendition: “It isn’t really pain. It’s more like discomfort, like a pressure in

my chest after | eat. Well, | guess it really is pain.”

All the units of meaning, nothing added, nothing left out, nothing changed.

What would a rendition with an addition look like?

47
“It isn’t really pain. It’s more like discomfort, like a pressure in my chest after | eat. Sort of like
indigestion. Well, | guess it really is pain.”

Oops. That’s not accurate. The patient never mentioned indigestion.

Now, how about if there were an omission?

“It isn’t really pain. It’s more like discomfort, like a pressure after | eat. Well, | guess it really is

pain.”

Hey, what happened to the reference to the chest? That could be important. This rendition is

also inaccurate.

Here’s a change in meaning.

“It isn’t really pain. It’s more like discomfort, like an ache in my chest then going down my arm.

Well, | guess it really is pain.”

lf we used this rendition, the doctor might think that this patient’s digestive problem is a heart

attack. Accuracy
isso important!)
And by the way, Wageassebolperabe.vavct
inagguraicngshahou
inletpiglets
e.cay
aNdduamieing’
)
| oat ) ti | | |
GR

“Is not real pain. ls uncomfort, when | eat is like a pushing here.”

These errors are usually signs that we need to improve our language skills in the language into

which we are interpreting.

‘adi tl ition tt | _— |

Sound easy?
It’s easy to do poorly, which is why lots of people think that anyone who is bilingual can

interpret. But it’s actually hard to be completely accurate. Even experienced professional

interpreters are always honing their skills to become more accurate.

So next, we’re going to do a series of exercises to get us thinking like interpreters.

49
 SECTION 8: The Four Modes of Interpreting

Learning Goal

After successful completion of The Four Modes of Interpreting Section, participants will be able

to do the following:

Define the four different modes of interpreting and explain the differences between all of them.

Learning Objectives:

Using the above goals, participants should also be able to do the following upon successful

completion of this section:

e Understand and explain the difference between Important terms and words

modes of interpreting and roles of interpreters.

Modes of interpreting
e Fully understand the differences between all four Mathode
modes of interpreting; consecutive,
controversial topic
simultaneous, sight translation and
circumstances
summarization.
functions
e identify the default mode of interpreting in the
the IMIA Standard
healthcare setting; consecutive.
legitimate need
e Explain when they have to use the simultaneous 6

mode of interpreting. decalage

e Understand when they have to summarize the trauma

messages. verbalizing
 Simultaneous Summarization
Interpreting

Now that we have briefly talked about some terms used in interpreting, it is time to describe the

ways in which interpreting is performed. Which are methods and which are modes of interpreting,
is a controversial topic in the field of interpreting. For the purposes of this training, Liberty

describes the four types of interpreting performance as modes.

deliverraniinterpretationjintovastarget
languagey Interpreters use different modes of interpreting

under different circumstances. Thefounsmodesyof,interpretingvaresconsecutivensimultaneous)

Interpreters should be careful not to confuse modes (e.g. consecutive and simultaneous) with

roles. Interpreters can remember that modes are the methods of interpretation, while roles are

Consecutive Interpreting

Consecutive interpreting is when the interpreter interprets after the speaker stops speaking: The
speaker usually says a few words, a phrase, or a few sentences, and then waits for the interpreter

to interpret before continuing. Consecutive interpreting is sometimes known as “pause”

a
ansimoumatermocerninmonniating for most interpreters.

51
According to the IMIA Standard, the iftérpreter Uses the mode that best enhances comprehension *
andileastiinterrupts
the speaker's train of thoueht given the demands of the situation, and that
that best preserves accuracy (IMIA, A-5, A&B)

When in an interpreting session, it can be tempting to switch to another mode of interpreting;

however, interpreters should stay in consecutive in most situations unless there is a legitimate
Weed tS Switch (described in detail in the next section).

Simultaneous Interpreting

in simultaneous interpreting, the interpreter interprets while the speaker is speaking, witha |
Thismode is most commonly used inlegal orconference settings.
slight delay, called decalage.
This mode is used'wheniit isinappropriate or impossible to have a speaker pause.
This may happen in the following circumstances:

e There is not enough time

e The provider is giving a presentation or explanation to several parties

e Group therapy sessions

e Pediatric interpreting (interpreting the patient-provider conversation simultaneously to

the parent)

e Inpatient resident visits (interpreting resident-doctor conversation simultaneously for the

patient)

patient is describing a traumatic event he or she experienced. ~

Many times, describing that trauma is itself a traumatic experience for the patient.

If interpreters find that the patient cannot pause at brief intervals after several requests, the

interpreter should consider switching to simultaneous mode for the important messages not to

be lost.
Sight Translation

daiguage)sThe interpreter does not provide a written translation of the document in question.

Ideally, parties would always translate important documents in advance of the interpreting

session; however, this is often not the case. liiterpretersshould

be carefultoensuresthattheyonly
sightytranslate"documents)thatvareshortinslengthy
This is because any document that is longer
than two pages should be translated for the patient. Interpreters should feel comfortable declining

to sight translate a document that requires further preparation or terminology research (discussed

in detail in the Sight Translation sections of this training).

Summarization
ea ase | :
anothenlanguageySummarization is a difficult task as it requires the interpreter to analyze which

53
units of meaning are most important. For example, usually adjectives and adverbs may be omitted

if they are not central to the message. Usually/summarizationjisirequestedyby

the provider. It is
important to note that anything that is to be sight translated needs to be done completely, without

omissions. Ifithe:provider asks thejinterpreter to summarize the consent ordischarge instructions;

Interpreters sometimes Mjsiai@uiaailinienaummagiza ionmubenthevratenutble conmbeamnetst nen

entire messages that a speaker stated, This may be because the speaker spoke for too long, there

was a distraction, the interpreter did not fully understand the speaker, or for some other reason.

Once again, if an interpreter uses summarization as a performance method, /tlissimportantethaty

Pei obiccetict SsAe as
ieniensiseeneehenice se | melee
‘modess Interpreters should not summarize sight translations for patient for safety reasons.

However, sometimes providers request a summarization sight translation of a patient’s medical

records. Always disclose or document summarization to all parties for transparency.

54
 SECTION 9: The Code of Ethics for Interpreters in Health Care
Learning Goal

After successful completion of The Code of Ethics for Interpreters in Health Care Section,
participants will be able to do the following:

Define and apply the code of ethics for interpreters in the healthcare setting.

Important terms and words

codes of ethics

potential pitfalls

Morals

individual beliefs

preferences

Mandatory

Definitive

Dilemmas

Credentials

Breaches

mediate communication

NATIONAL STANDARDS OF
PRACTICE

ethical principle

Spirit of the message

cultural context

substituting

redundant

irrelevant

oh)
Learning Objectives: relevant requirements

Using the above goals, participants should also be able to do maintains confidentiality
the following upon successful completion of this section:
disclose information °
Understand and explain the necessity of the code of patient's consent
ethics for interpreters.
interpreter bias
Know that the code of ethics are not morals.
Fully understand that the ethics exist to help inherent dignity
interpreters make decisions when faced with a difficult encounter
ethical situation.
Cultural Awareness
Understand that there are two well-known code of
ethics for medical interpreters; NCIHC Code of Ethics biomedical culture
and IMIA Code of Ethics. potential conflict
Understand and be able to explain the NCIHC Code of
surgery consent form
Ethics.
Realize what partiality looks like. discredit

novice interpreters

life-threatening allergy

emotionally detached

impartial stance

therapeutic rapport

Professionalism

Impartiality

demeanor

Faithfulness and fidelity

literal interpretation

debrief

56
 Interpreting is a complex task with many potential pitfalls (areas where mistakes are easy and

common). THENBESt Way itOlaVvoid interpreting pitfalls"is"to° know “about them and "Vearnlthe™
OlUtions!Some of those pitfalls and solutions are covered within our discussion of ethics here.

difficult situations. They represent a set of guidelines that help interpreters perform their work in

the most effective way possible.

Ethics are not Morals

It is easy to confuse the things an interpreter should do professionally with the things that an

interpreter might think are inherently “right” or “wrong;” however, @professional

ethics aré not

A person’s understanding of what is appropriate and inappropriate may guide that person in

making the right personal decisions. However, professional ethical rules areytosbesfollowed
by “alle

professionals.

~whateissinappropriateswhenmintérpreting
these ethics are shared by the whole interpreting
profession, and they are independent from an individual interpreter’s beliefs.

Instead of relying on individual beliefs and preferences of what is acceptable (a varying standard

based on personal opinion), aycodelofiethics provides a list of standardsithat interpretersishould

use to hold themselves and each other accountable.’

(Adapted from the 2014 Bridging the Gap: Medical Interpreter Training presentation by Cross

Cultural Health Care Program).

Ethics are Mandatory

Ethics exist to help interpreters make decisions when faced with a difficult ethical situation. A code

of ethics is not a definitive “how to” solve all the difficult dilemmas faced by an interpreter, but

yf)
rather a setofrules tofollow and use asaguideline toavoid behaving inaway that could harm |

to maintain trust for the interpreting profession and to help both providers and patients. Certified
medical or healthcare interpreters, for instance, may lose their national certification credentials

due to breaches in the code of ethics.

Always remember: The basic purpose ofthe interpreter is tomediate communication between +

Interpreters interpret messages, not words! Interpreters should not add messages, omit

messages, or change messages conveyed, even though this may mean omitting words, adding

terms, or changing terminology in order to communicate the same message into another

language.Interpreters
should also problem solve and intervene when necessary.

The most well-known code of ethics for medical interpreters are:

1. NCIHC Code of Ethics (see: https://www.ncihc.org/assets/documents/NCIHC

National Code of Ethics.pdf and

2. IMIA Code of Ethics (see: https://www.imiaweb.org/code &

https://www.imiaweb.org/uploads/pages/376 2.pdf)

Each organization has the code and explanatory text. Here are the code tenets of both

organizations:

1. ANATIONAL CODE OF ETHICS FOR INTERPRETERS IN HEALTH CARE

https://www.ncihc.org/assets/documents/publications/NCIHC National Code

of%20Ethics.pdf)

2. IMIA Code of Ethics & IMIA Guide on Medical Interpreter Ethical Conduct

https://www.imiaweb.org/code & https://www.imiaweb.org/u loads/pages/376 2.pdf

58
. The codes of ethics don’t give definitive answers for every single situation; instead, they use.
\generalized rules to represent the shared goals, values, and expectations for the members of 4
profession. »

The NAFIONAL STANDARDS OF PRACTICE for Interpreters in Health Care

We will cover the NATIONAL STANDARDS OF PRACTICE for Interpreters in Health Care in our

course because it is the national standards of practice for medical interpreters. However, we will

_ also include other codes of ethics and standards of practice that have been created by other

_ professional organizations or state professional organizations.

The NATIONAL STANDARDS OF PRACTICE for Interpreters in Health Care was generously funded

by The Commonwealth Fund and The California Endowment.

STANDARDS OF PRACTICE

Accuracy

eA
7

Objective: To enable other parties to know precisely what each speaker has aid.

Related ethical principle: \nterpretersistrivestoirenderithelmessagelaccuiratelyyiconveying:themy

Content and spirit of the original message, taking into consideration the cultural context

59
 e The interpreter renders all messages accurately and completely, without ading, omitting,

CieSDStituitingeFor example, an interpreter repeats all that is said, even if it seems

redundant, irrelevant, or rude.

e Theihterpretenreplicatesithe
register) istyle'anditenelofithe speaker. For example, unless
there is no equivalent in the patient's language, an interpreter does not substitute simpler

explanations for medical terms a provider uses, but may ask the speaker to re-express

themselves in language (words) more easily understood by the other party.

e Thegintenpreteradvisesspartiessthatveverythingssaidiwillkbevinterpreteds For example, an

interpreter may explain the interpreting process to a provider by saying "everything you

say will be repeated to the patient."

e §6The intérpretenmanagesitheiflowioficommunications
For example, an interpreter may ask
a speaker to pause or slow down.

© ©The (nienpnetermconrectssenorsnimeintenpretationg
For example, an interpreter who has
omitted an important word corrects the mistake as soon as possible.

e The interpretersmaintainsetransparencys For example, when asking for clarification, an

interpreter says to all parties, "|, the interpreter, did not understand, so | am going to ask

for an explanation."

Confidentiality
Objective: To honor the private and personal nature of the health care interaction and maintain
trust among all parties. ~

asiconfidential) Within the treating team, all®

Related ethical principle: \Witerpretersitreat

60
 an interpreter does not discuss a patient’s case with family or community members

without the patient’s consent.

M For

example, an interpreter does not leave notes on an interpreting session in public view.

Impartiality

Objective:

and. refrain. from

Related ethical principle: interpretersestrivestommaintainsimpartiality

e The ‘interpreter does not allow personal judgments or cultural values*to influence
objectivity.»
o For example, an interpreter does not reveal personal feelings through words,

tone of voice, or body language.

e The interpreter discloses potential conflicts of interest, withdrawing from assignments

wifenecessary. For example, an interpreter avoids interpreting for a family member or

close friend.

Respect

Objective: To acknowledge the inherent dignity of all parties inthe interpreted encounter:
m4 Sn eneeneeeeemeneeeee ee

61
Related ethical principle: dnterpreters:treatalhypar
withresties
pectyy
ease Fessionaly,cul | For

example, in greetings, an interpreter uses appropriate titles for both patient and

provider.

For example, an interpreter may tell the patient and provider to address each other,

rather than the interpreter.

e Thesinterpreterpromoteswpatienteautonomys For example, an interpreter directs a

patient who asks him or her for a ride home to appropriate resources within the

institution.

Cultural Awareness

Objective: To
comm
facilitate unic
across
atio
cultural differencesy)
n

Related ethical principle: strivetodevelop,awareness

interpreters oftheculturesiencountereds
‘jn
performance
the of interpreting duties.

e Thelinterpreter strives to understand the cultures associated with the languages he or

Sheuinterprets»including:biomedicalculturemFor example, an interpreter learns
about

the traditional remedies some patients may use.

62
 A pe 1 es tes | ling that arise:

For example, if a provider asks a patient who is fasting for religious reasons to take an
oral medication, an interpreter may call attention to the potential conflict.

Role Boundaries

Objective: To clarify the scope and limits of the interpreting role, in order to avoid conflicts of
wnterest.m™

Related ethical principle: thesinterpretermaintains

the*boundaries of the"professionalirole,

(refraining from personal involvement. ©

eo oThee ee binyol ; |

assignment For example, an interpreter does not share or elicit overly personal

information in conversations with a patient.

e The interpreter limits his or her professional activity to interpreting within an

wencounter™For example, an interpreter never advises a patient on health care

questions, but redirects the patient to ask the provider.

e Th einterpreter with an additional role adheres to all interpreting standards of practie’

wihilesinterpreting. For example, an interpreter who is also a nurse does not confer with

another provider in the patient's presence, without reporting what is said.

63
Professionalism

Sip

Objective: To uphold the public’s trust inthe interpreting profession. !

Related ethical principle: interpretersiat alltimes 'act ina professional and ethical manner. &

e The iitersretemisthonestlland™ethical
in all business" practices” For example, an
interpreter accurately represents his or her credentials.

e The ihterpreteris preparediforall'assignmentsiFor example, an interpreter asks about

the nature of the assignment and reviews relevant terminology.

¢ The finterpreter discloses skill limitations with respect to particular assignments. For
example, an interpreter who is unfamiliar with a highly technical medical term asks for

an explanation before continuing to interpret.

e The interpreter avoids sight translation, especially ofcomplex orcritical document® if

Hieson'shellacks'Sight 'translation’skillS@For example, when asked to sight translate a
surgery consent form, an interpreter instead asks the provider to explain its content

and then interprets the explanation.

e The (fiterpretermistwaccountablefor™iprofessionalmperformancel For example, an

interpreter does not blame others for his or her interpreting errors.

64
 4 Theinterpreter advocates for working.cond jitions that support quality interpreting. For

example, an interpreter on a lengthy assignment indicates when fatigue might

compromise interpreting accuracy.

° Thesinterpreter shows respect for professionals with whom he or she works. For
example, an interpreter does not spread rumors that would discredit another

interpreter.

e Theinterpreter acts in a manner befitting the dignity of the profession and appropriate!
tomthensettingaA
For example, an interpreter dresses appropriately and arrives on time

for appointments.

Professional Development

Objective: Toattain the highest possible level of competence and service. 9

Related ethical principle:

e Forexample, an interpreter stays up to date on changes in medical terminology or regional

slang.

The interpreter seeks feedback to improve his or her performance. —

e For example, an interpreter consults with colleagues about a challenging assignment.

The ifterpreter supports the professional development of fellow interpreters.

e For example, an experienced interpreter mentors novice interpreters.

The interpreterparticipates inorganizations and activities that contribute to the development’of

the
profession...

e For example, an interpreter attends professional workshops and conferences.

65
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
. ed |

The interpreter may speak out to protect an individual from serious harm.)

e For example, an interpreter may intervene on behalf of a patient with a life-threatening

allergy, if the condition has been overlooked.

e For example, an interpreter may alert his or her supervisor to patterns of disrespect

towards patients.

You can read the entire code of ethics and standards of practice by following the link below:

National Standards of Practice for Interpreters in Health Care

https://www.ncihc.org/assets/documents/publications/NCIHC National Standards of Practice.odf

Impartiality
A very important basic ethical principle for interpreters is impartiality. Interpreters often work

with two parties, and mediate between these parties. Amedicalinterpreter

does not work only +

forthe patient or only for the provider; but for both equally. Itis important for the interpreter to

remember this. Both the provider and the patient need our service. We cannot be focused on

only helping one or the other.

Therefore, impartiality means that throughout all communications, thesinterpreter,

works to not,

What does impartiality look like?

Impartial interpreters are professionals who must always do the following:

66
 © Refrainefromeaccepting»tosinterpret-for-family-orpersonalerelationships, as it is almost
impossible to be impartial to those we care for;

¢ Remain.emotionally.detached from.the.content.of.the.message, as the messages are not

ours, even when one of the parties is not the most friendly. dhesonlymexceptionsisnit

balancesyvoursintementionseandsexplanationsetombothspanties. Transparency is key to

maintain a more impartial stance.

e Remember to always use inclusive language, such astl am here to interpret for you and
thespatient!, versus “| am here to interpret in Spanish for the patient.”

Interpreters must always strive to maintain impartiality. The latest research has ascertained that

Ofithepatientonrthe provider? It is important for you to always check your behavior and language
to minimize this perception. Keep in mind that Qeingdmpartiahdoes nob-meam Deine nGanes, It

simply means that you are a mediator who works for two individuals, and in order to do that job

well interpreters need to remove themselves from any disagreement or difference of opinion.

Working for, both parties equally will help enhance the therapeutic rapport! The fact that everyone
in healthcare is working for the benefit of the patient may make some interpreters partial to the

patient, but just remember that the provider is working for the benefit of the patient too, and any

action or behavior should support the provider's effort to do so, versus helping the patient.

Impartiality also helps ensure the autonomy of each party.

What does partiality look like?

has on the interpreter, including their expectation that the interpreter will interpret everything

without adding, omitting, or changing meaning to help one party over the other. A partial

67
interpreter is seen by others as one who is forthe,p
working rovider.and.distancing-himself
from
the patient, orone who identifies Very Closely with thepatient, andtherefore, isworking primarily
for the patient's interests. ©

Professionalism
Interpreters must always act in a professional manner when on an assignment. This includes the

following:

@ heb de =, )} nae GI WII, Uostiif VULAGAVUICI VY LU

¢ (Monitoringione’s\own"performancevandibehavionstoyensure that the interpreter’s actions

will not interfere with the flow of communication

e Nottaking
on.other.roles.while.yvoudnterpnetgeven if you fulfill other roles in other settings
e Recognizing and stating your limitations in all interactions ©

e AVOIdINEPotential'conflicts'orinteresttand personal involvement

Lady ah es es

An interpreters conduct, behavior, and attitude need to be professional, in order for medical
interpreters to be respected by other healthcare professionals. This includes gedressingwasmas

Mal {OF WealINg PFrOTe IOTYa! dlr SUCT? ds SCITUDS WheEFe diOWeQd) dl

control.
over-one’ssemotionsm!rue professionals should consider their appearance, demeanor,

reliability, competence, phone and email etiquette, and their professional written correspondence.

What one medical interpreter does affects the image of all the other professionals in the field.

Affiliation to a professional association, certification, and continuing education are also common

expectations of every professional.

Respect

Interpreters must respect the autonomy and expertise of all parties in the encounter. if»

should:consult with the provider orwith their'agency/Respect does not mean obedience or

68
agreement with something you do not agree with. Respect includes certain qualities, such as

yone’cannothelp, and more. It is important that interpreters respect providers and patients
equally, regardless of the educational level or other characteristic of either party.

Accuracy (and Completeness)

First,

ae ) questdhomelanification (gramm
sema
at nticic
, or al
other),,and

* correct any other mistakes that made the interpretation less accurate.

Completeness means not adding any message or omitting any message when interpreting oral or

signed language from the source language into the target language. This concept goes hand in

hand with accuracy. Completeness is a difficult principle to master because it iAVOlVes=

) a Li ae Bo Seai mi |

language
tothe target language.
Faithfulness and fidelity are terms used to describe how close or how faithful the target language

is to the source language. Do not confuse fidelity with literal interpretation. AsefaithfulS
, ee soa ne , :
pss

Confidentiality

hile sharing issues about certain

patients or providers may be tempting, it is highly unethical.

69
Sometimes, interpreters may describe a case using a limited set of facts and information that does

not identify the patient, in order to seek advice from other interpreters or debrief over a difficult

case. However, this is for a limited purpose and is one of the only exceptions to the complete

confidentiality of the interpreting session.

In addition, interpreters should observe the following requirements of confidentiality:

HHe'BeEINAING of interpreting sessions.

Advocacy

Interpreters should
ind protocols of their employer or the org they are working for.

Cultural Competence

Interpreters should continually develop awareness ofhis orher own culture and:other cultures
that he or she encounters while interpreting.

70
 SECTION 10: The IMIA and NCHIHC Codes of Ethics
Learning Goal

After successful completion of the IMIA and NCIHC Codes of Ethics Section, participants will be
able to do the following:

Define and apply the IMIA code of ethics and standards of practice for interpreters in the
healthcare setting.

Learning Objectives:

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand and explain the IMIA code of ethics and standards of practice for interpreters
in the healthcare setting.
e Analyze the difference between the IMIA and NCIHC Codes of Ethics.
e Master the IMIA standards of practice and apply them when facing difficult situations or
an ethical dilemma.
Important terms and words
maintain confidentiality

language fluency

interject personal opinions

professional judgment

unobtrusive interventions

triadic medical setting

gain favors

implications

clinical parameters

homicidal intent

child abuse

domestic violence

moral fortitude

conflicts of interest

scope of employment

functions or services

effective strategies

fal
 International Medical Interpreters Association (IMIA) Code of Ethics

Interpreters will maintain confidentiality of all assignment-related information.

Interpreters will select the language and mode of interpretation that most accurately

conveys the content and spirit of the messages of their clients.

Interpreters will refrain from accepting assignments beyond their professional skills,

language fluency, or level of training.

Interpreters will refrain from accepting an assignment when family or close personal

relationships affect impartiality.

Interpreters will not interject personal opinions or counsel patients.

Interpreters will not engage in interpretations that relate to issues outside the provision of

health care services unless qualified to do so.

Interpreters will engage in patient advocacy and in the intercultural mediation role of

explaining cultural differences/practices to health care providers and patients only when

appropriate and necessary for communication purposes, using professional judgment.

Interpreters will use skillful unobtrusive interventions so as not to interfere with the flow

of communication in a triadic medical setting.

Interpreters will keep abreast of their evolving languages and medical terminology.

LO: Interpreters will participate in continuing education programs as available.

se Interpreters will seek to maintain ties with relevant professional organizations in order to

be up-to-date with the latest professional standards and protocols.

iW Interpreters will refrain from using their position to gain favors from clients.

IMIA MEDICAL INTERPRETING STANDARDS OF PRACTICE

We would now like to share the section on Ethical Behavior from the Medical Interpreting

Standards of Practice that was developed by the International Medical Interpreters Association

IMIA & Education Development Center, Inc. The IMIA Healthcare interpreter standards of

72
practice were created to serve as guidelines and very important tools for the interpreters during
their interpretation and for their intellectual and professional growth.

Evaluation Method:

The Likert Scale is the rating scale used to evaluate medical interpreting services, with values
from 1-5 for which a person will select the number considered to reflect the perceived quality.

Likert Scale

5 —Fulfills the expectation completely and consistently, with ease and fluidity

4 —Fulfills the expectation in a mechanical way

3 — Performs the expectation but with hesitation or lack of confidence

2 — Performs inconsistently; lapses into behaviors demonstrating lack of mastery

1—Is unable to perform the task; exhibits behavior consistent with lack of mastery

Duty C: Ethical Behavior

C-1 Maintain confidentiality

ae Indicators of Mastery iti Indicators of Lack of Mastery

Can explain the boundaries Cannot explain the boundaries
and the meaning of and the meaning of
confidentiality, and its OO AEs 0) 2.0.1 confidentiality, nor its
implications and implications and consequences
consequences

13
 Knows and maintains the Intentionally or unintentionally
clinical reveals confidential information
parameters of information outside the clinical parameters
sharing,
in keeping with the policies
and
procedures of the
institution and/or
team, for example:
e Supervision
e Patient conference /
continuity of care meetings
e Professional meetings,
workshops, conferences,
[taking responsibility for
maintaining the anonymity QO) O41 ©3 OF Oil
of the parties by ensuring
that any information
shared at professional
meetings does not contain
identifying characteristics
(e.g. hospital names, date
of encounter, etc.) that can
be attached to a specific
individual]

Knows how to respond to Does not know how to deflect

questions dealing with inappropriate requests for
confidential matters that information and violates
eis) OA) Cs OA @ il
may be brought up in the confidentiality
community or health care
setting
If privy to information Fails to act on the obligation to
regarding suicidal/ transmit information to relevant
homicidal intent, child parties
abuse, or domestic violence,
CBE OATO sO 25001
acts on the obligation to
transmit such information in
keeping with institutional
policies, interpreting

74
 code of ethics, and the law

C-2 Interpret accurately and completely

~ Indicators of Mastery Indicators of Lack of Mastery

Can explain the concepts seam

of accuracy and Cannot explain the concept of
O50 450380200. accuracy and completeness, nor
completeness, and
their implications and their implications and
consequences consequences
Is committed to Is not committed to
transmitting accurately transmitting accurately and
and completely the completely the content and
content and spirit of the PES ng Otol spirit of the original message
original message into the
other language without
omitting, modifying,
: condensing, or adding
Is committed to Does not monitor her or his
monitoring her or O50 4!0 210 2tod own interpreting performance
his own interpreting
performance
Has the moral fortitude to Does not have the moral
admit and correct own fortitude to admit and correct
mistakes @5 ©4033 ©2 Oil own mistakes,
instead permitting mistakes to
stand uncorrected

C-3 Maintain impartiality

aie Indicators of Mastery Indicators of Lack of Mastery

ls aware of and able to
ls unaware of and unable to
identify personal biases
identify personal biases and
and beliefs that may
interfere with the ability to beliefs that may interfere with
OQ) OAL OBa
OF Oil the ability to be impartial, and
be impartial, and has the
moral fortitude to does not have
withdraw if unable to the moral fortitude to withdraw
be impartial if unable to be impartial

VAs)
Withdraws or refrains from Accepts assignments where
accepting any assignment close personal or professional
where ties or strong personal beliefs
close personal or may affect
professional ties or impartiality, even when other
strong personal beliefs alternatives are available
may affect impartiality O50 ASOS "O2-Or1
(including conflicts of
interest), unless an
emergency renders the
service necessary

Focuses on the Interjects personal issues,

communication beliefs, opinions, or biases into
between provider and the interview
patient and refrains from
@5 @O41 © 3 OF Oil
interjecting personal
issues, beliefs, opinions, or
biases
into the interview
Refrains from counseling Counsels and advises
or advising O510 4803702 01

Indicators of Mastery Indicators of Lack of Mastery

Respects patient’s physical A. Does not respect patient’s
privacy, and maintains physical privacy nor maintain
spatial/visual privacy of O5,04°03°02°01 spatial/visual privacy of patient
patient, as necessary

Respects patient’s personal Does not respect patient’s

/ emotional privacy: personal/emotional privacy
e Refrains from asking e Asks personal, probing
personal probing questions
questions on own initiative
outside the scope of
e Uses the role of interpreter to
interpreting tasks 05 04.03 02-01
¢ Does not use the role of influence a social relationship
interpreter to influence a with the patient, outside the
social relationship with the interpreting encounter
patient outside the e Becomes personally involved
interpreting encounter

76
 e Refrains from becoming
personally involved in the
patient’s life**

** In small, close-knit communities, it is often not possible for an interpreter to remain personally and
socially uninvolved with patients. However, interpreters should always strive to maintain the ethical and
professional standards of confidentiality and impartiality while in their role.

C-5 Maintain professional distance

Indicators of Lack of Mastery

Can explain the meaning of A. Cannot explain the meaning of
professional distance, and professional distance, and its
its implications and implications and consequences
05°04103°02,01
consequences

Is able to balance empathy Is not able to balance empathy

with the with the boundaries of the
as @O4) @3
boundaries of the interpreter role
interpreter role
e Shows care and concern Ignores patient needs or tries to
for patient needs by resolve everything for the
65) O44 ©3 OR Oil i
facilitating the use of patient
appropriate resources
Refrains from becoming Becomes personally involved to
personally involved the extent of sabotaging or
compromising the provider-
patient therapeutic
@O5 O44 Os OY ©)il relationship, thereby
misleading the patient as to
who the provider is and
effectively disempowering the
provider
Does not create lB. Creates expectations in either
expectations in either party that the interpreter role
. @)s) @Z4) C8} ©)
party that the interpreter SHO cannot
role cannot fulfill fulfill
Promotes patient self- F, Encourages and/or creates
sufficiency, taking into OO ArO seo eto patient dependency on the
account the social interpreter

77
 context of the patient

Monitors own personal Is unaware of transference and

agenda and needs and is counter transference issues
aware of transference and Qs O44 Os © Oil
counter transference
issues

C-6 Maintain professional integrity

Indicators of Mastery Ee Indicators of Lack of Mastery

Refrains from contact with A. | Initiates contact with the
the patient outside the patient outside the scope of
scope of employment, employment for personal
avoiding personal benefit OD fae Ghee eh Tous benefit

Refrains from fulfilling any Takes on functions or provides

functions or services that services that are not part of the
o5 04°03'0 27011 F
are not part of the interpreter role
interpreter role
Knows competency limits Is not aware of competency
and refrains from limits; becomes involved in
interpreting beyond her or situations that are beyond her
his training, level of or his level of training, skill,
experience, and skills, and/or experience; and on
0 5-0:4-0 310:.2.0')
unless these limitations are occasions where no other
fully understood by source of interpreting is
the patient and provider available, does not inform
and no other source of patient or provider of these
interpreting is available limitations

Refrains from interpreting Persists in functioning as an

in situations where there interpreter in situations where
O55 0'4.0 3 072,01 .
may be a there may be a conflict of
conflict of interest interest
Engages in ongoing Ey Does not engage in ongoing
professional development 0 5:04,0370270)1 professional development

C-7 Deal with discrimination

ay Indicators of Mastery Rating =| Indicators of Lack of Mastery

78
 On occasions where the Does nothing or addresses the
interpreter feels strongly situation in an ineffective,
that either party’s behavior disruptive manner
is affecting access to or
quality of service, or @s ©4) G2) ©OF @ il
compromising
either party’s dignity, uses
effective strategies to
address the situation
If the problem persists, Neither knows nor uses
knows and uses institutional policies and
institutional policies and O50 410850. s0e) procedures relevant to
procedures relevant to discrimination
discrimination :

To download and read the whole document from the IMIA, please visit:

https://imiaweb.org/uploads/pages/102.pdf

For further reading, here are some other important codes of ethics for professional interpreters to apply

during their performance:

1. IMIA Guide on Medical Interpreter Ethical Conduct;

https://www.imiaweb.org/uploads/pages/380 4.pdf

2. Medical Interpreting Standards of Practice; https://imiaweb.org/uploads/pages/102.pdf

3. California Standards for Healthcare Interpreters Ethical Principles, Protocols, and Guidance on

Roles & Intervention;

http://www.chiaonline.org/Resources/Documents/CHIA%20Standards/standards chia.pdf

4. A NATIONAL CODE OF ETHICS FOR INTERPRETERS IN HEALTH CARE;

https://www.ncihc.org/assets/documents/publications/NCIHC%20National%20Code%200f%20E
thics. pdf

5. ASTM Standards (Note: Payment may be required to download files);

http://www.astm.org/Standards/F2089.htm

6. American Translators Association; https://www.atanet.org/aboutus/index.php

7. Registry for Interpreters for the Deaf; http://www.rid.org/ethics

12
 SECTION 11: Intervention

Learning Goal

After successful completion of the Intervention Section, participants will be able to do the
following:

Define and apply the ‘The Five Finger Intervention Technique (FFIT)’.

Learning Objectives:

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand and know the situations that require intervention.

e Identify the challenges of intervention to be able to follow the Five Finger Intervention
Technique effectively.
e Fully understand the importance of transparency during the medical setting.

Important terms and words

Intervention

Clarification

a linguistic term

non-verbal cues

pre-determined phrases

glossing over terminology

omitting concepts

concise

Transparency

Transparent communication

articulate the message

invasive

80
 patient-provider
therapeutic rapport

deflate interpersonal issues

As we mentioned before, the interpreter’s goal is to ensure understanding between the patient

and the provider. What should the interpreter do if there are other barriers to communication?

The interpreter may have to take some action or interject with a comment or a question or request

for clarification. This is often called intervention, or linguistic or cultural mediation.

In this course, we will refer to the interruptions of the conversation between the provider and the

patient to remove barriers as intervention.

Examples of Situations Needing Intervention

As stated earlier, the interpreter may need to intervene during an interpreting session for many

reasons, for example:

a. When the interpreter needs a repetition of what was said,

b. When the interpreter needs to ask the speaker to use shorter phrases,

c. Orwhen the speaker is not pausing enough to allow for interpretation,

d. When the speaker is looking and talking to the interpreter,

e. When there is a linguistic term that may cause misunderstanding,

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 f. Or when there is a cultural concern that may cause misunderstanding, lack of trust,

comfort or compliance.

The interpreter will also have to intervene by taking additional steps to clarify the communication.

Intervention including clarification may be required when any of the following situations are

present:

e The provider or the patient uses complicated or unfamiliar language that the interpreter

does not understand;

e The interpreter believes, due to non-verbal cues, that the patient or provider does not

understand what is being said;

e A cultural difference presents a barrier to communication between the patient and the

provider, etc.

There are many situations where intervention may be required. This requires the interpreter to

have well thought out and clear communication strategies, including pre-determined phrases to

address common problems.

Challenges of Intervention

Some interpreters may feel tempted to spend a long time to intervene to “do it the right way” or

make everything “just perfect.” However, interpreters should only intervene as needed to keep

the miscommunication barriers from interfering with the interpreter’s ability to interpret and the

parties’ ability to communicate or focus on the discussion.

In addition to distracting the speaking parties, intervention can be difficult for several reasons.

Intervention requires interpreters to come out of the background and speak with their own voice.

This change in positioning and interruption to communication can cause the parties to keep

focusing on the interpreter and not each other, even after the barrier to communication has been

removed. It is important for the interpreter to indicate when his or her interventions are finished

and to give the parties instructions to resume, if necessary. Providers are professionals in a

82
position of authority. Intervening requires a good deal of self-confidence and professional

competence from the interpreter.

However, there are also negative consequences to not intervening. A perfect flow of

communication is not a mark of a flawless interpretation. Not requesting a clarification when

needed may ultimately mean the interpreter is glossing over terminology, adding or omitting

concepts inadvertently, due to not addressing the demands of the situation.

Ineffective intervention can cause a breakdown in the relationship between the patient and the

provider as well as undermine the students’ trust in the interpreter. Therefore, an interpreter

needs to be able to intervene effectively and this will be practiced in the medical practice sessions.

The Five Finger Intervention Technique (FFIT)

How does the interpreter intervene?

Interpreters can use the Five Finger Intervention Technique when they need to intervene to

ensure effective communication among all parties.

DEE LIBERTY

#2 Use third \ #4 4 Beve

pe th transparent
erson (the
interpreter)

#5 Go back to conduit

#1 Raise your hand to

intervene

Five Finger Intervention Technique

Here are the steps to follow the Five Finger Intervention Technique (FFIT):

1. The interpreter should raise their hand or change their positioning to signal non-

verbally to the parties that they are going to interrupt the conversation. If this is not

possible (as in OPI or VRI), they will do it verbally, as described below. The interpreter

should already mention and explain the signal of raising their hand when they

introduce themselves to both parties before the session starts.

2. The interpreter should use the third person (e.g. “The interpreter requests...” or “this

is the interpreter speaking”) so that the parties are not confused and they know that

the interpreter is currently speaking on behalf of him or herself.

3. The interpreter should be clear, concise, and brief, and not spend a lot of time when

they intervene. The interpreter should limit the intervention to only one question or

to one or two comments (e.g. “There is a lot of noise in the hallway, the interpreter

would like to close the door”). It can be helpful to have ‘ready-to-use’ phrases prepared

in advance for the most common situations.

4. The interpreter should always be transparent and tell the other party what he/she tells

the first party. This means saying the same message twice, once in each language. This

ensures that trust in the interpreter is maintained. The interpreter must always be

transparent with any side dialogues that occur.

5. The interpreter should alert the parties when to resume, then go back to the conduit

role and start interpreting in the first person again.

The Importance of Transparency

Transparent communication simply means that each party always knows what the interpreter and

the other party have said or signed. For example, if the provider uses a term that has no linguistic

equivalent in the target language, the interpreter should let the provider know that they will need

to explain this term when interpreting to the patient. This way, the provider understands why the

interpreter is asking the patient a question or taking a much longer time to articulate the message

than it took to say in the source language.

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Additional Recommendations

e A good problem-solving intervention should be quick, smooth, and effective in either

resolving a problem or bringing it to the provider's or patient’s attention. Following these

guidelines can help the interpreter to intervene more smoothly and effectively during the

medical interpreting appointment.

e The interpreter should not feel uncomfortable or even emotional when they intervene for

clear communication among all the parties. If patients see that the interpreter is troubled,
they could also become worried or emotional. Therefore, interpreters should always have

self-confidence when intervening.

e Interpreters should not assume that they know what the patient is thinking or feeling. If

interpreters suspect there is a problem (including confusion or a pressing concern), the

interpreter should bring that to the attention of all parties by intervening instead of

assuming that the patient or the provider does not understand or does not care.

e The interpreter should go back to the conduit role after they finish the intervention. The

provider and the patient will be able to resolve the problem.

e Sometimes an interpreter’s intervention may solve the problem directly; for example, by

asking for a clarification of a term. Other times, the intervention shows the party that the

problem may exist, and the provider or the patient must take the next step. For example,

when an interpreter asks a patient if he/she understands, and he/she says “no,” it is best

to simply interpret the response and let the provider decide to handle the situation.

Intervening too often or too aggressively can cause problems. The more invasive a role the
interpreter takes, the greater the risk of getting in the way of the patient-provider relationship.

However, if an interpreter takes a role that is too limited, and doesn’t intervene as necessary,
misunderstandings may also occur that undermine the critical patient-provider therapeutic
rapport or the patient’s health. Intervention is therefore a difficult task that should be approached

incrementally (/.e. in increasing steps).

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More Examples of Intervention Techniques

As we mentioned before, interpreters may need to interject when a message is continuing for too

long or remind a party to slow down during the interpreting session. In face-to-face encounters

when necessary, interpreters should begin problem solving by raising their hand, standing, or even

moving between the provider and the patient if appropriate. In OP! and VRI, verbal indicators are

necessary, and usually started with “Excuse me. The interpreter...”

Then, interpreters should remember to state what was just said to the other party and go back to

resume interpreting.

These interventions take more confidence and care than common problem solving.

There are other intervention techniques that involve intercultural mediation, patient advocacy

and de-escalation techniques, which medical interpreters learn in hospitals, or that involve

helping deflate interpersonal issues that may arise, which we will discuss later.

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 SECTION 12: Incremental Intervention

Learning Goal

After successful completion of the Incremental Intervention Section, participants will be able to
do the following:

Define the concept of Incremental Intervention and apply it effectively when they have to
intervene while in a medical interpreting setting.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand and explain the concept of incremental intervention to be able to intervene

effectively during a medical interpreting setting.
e Give more examples of incremental intervention.
e Explain when the interpreter should shift to simultaneous mode of interpreting.

Important terms and words

incremental intervention

invasive intervention

significant

(This concept was originated by Cynthia E. Roat and is the basis of the CCHCP’s “Bridging the

Gap” interpreter training model.)

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Incremental intervention happens when interpreters start with the least invasive intervention that

might solve the problem and move incrementally towards more invasive, or assertive,

interventions to remove a communication barrier. If that intervention does not produce the

desired effect (i.e. asking a patient to look at the provider), the intervention or request may have

to be repeated. If the second intervention does not work, the interpreter may have other options,

such as change positioning to help the patient look at the provider. If the communicative barrier

is significant and the interpreter cannot play their role effectively, the interpreter has the option

to request to be replaced. The replaced interpreter should intervene as needed to ensure effective

communication, and resume interpreting after finishing the intervention.

More Examples of Incremental Interpreting

First, imagine a situation where a provider insists on speaking for many sentences before pausing

for interpretation, and the interpreter can only remember two to three sentences at a time. In this

situation, the interpreter appropriately raises her hand and speaks as the interpreter to request

that the provider speak in short and simple phrases.

However, the provider soon ignores or forgets the problem-solving request and goes back to

speaking for long periods. The interpreter then steps into the conduit role again, and this time

he/she also requests that the provider remember that the interpreter has a limited memory to be

able to accurately interpret what the provider says.

This second intervention is more assertive than the first, because it includes a reason the

interpreter needs to solve the problem. The reason should always be patient safety focused, so

the provider can relate to and appreciate the medical repercussions of meaningful and accurate

communication in healthcare. However, the provider soon forgets again and continues to speak

in longer and longer segments.

The interpreter should shift to simultaneous mode of interpreting or start taking notes to be able

to remember everything that is said.

88
In a second example, the interpreter is in a session where a social worker is trying to understand

where a child was left alone when an accident occurred. The patient, who speaks Spanish, explains

that the child was in the “solar” at the time. The provider speaks some Spanish, and she assumes

that the word “solar” in Spanish means a sunroom and is inside the house.

Further questions by the provider about where the “solar” is in the house, only confuses the

patient. Sensing a breakdown in communication, the interpreter raises her hand to problem solve.

Here, the interpreter could adopt the role of cultural mediator to explain that in Honduras many

people refer to the area around their home such as a porch or patio as being “in” or “at” their

home. However, the interpreter decides to ask the provider to clarify with the LEP person what

she means by the word “solar.” After the provider asks the patient what a “solar” is, the patient

explains that she is talking about the yard, and the miscommunication is solved.

89
 SECTION 13: Problem Solving

Learning Goal

After successful completion of the Problem-Solving Section, participants will be able to do the
following:

Define and explain how to solve a problem during the medical interpreting setting.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

Understand and explain the concept of solving a problem; and be able to solve the
problems one may face during a medical interpreting setting effectively.
Give more examples of the challenging problems that the interpreters might face during
the medical interpreting encounter, and how they should attempt to solve them effectively.
Realize that some problems do not require intervention (and be able to give examples for
these problems).
Identify the different relationships in an interpreting session.

Important terms and words

problem of ambiguity

good judgment

scope of practice

therapeutic rapport

Problem Solving Quotes

No problem can be solved
from the same level of
consciousness that
created it
Albert Einstein

90
So far, we have discussed intervention and explained when the interpreters should intervene and

how they should follow the Five Finger Intervention Technique to manage linguistic, cultural, and

other types of barriers.

Problem solving is undoubtedly part of the act of interpreting. If you need to ask for clarification,

you are attempting to solve a problem of ambiguity. Some people may seem to think that

interpreting is just the rendering, and that problem solving is separate. However, the truth is that

problem solving is tightly embedded in the act of interpreting, which is why it is now being seen

more as a mediation practice, and not a linguistic practice alone.

In this section, we will discuss different kinds of problems that can be solved by interpreters

without intervening. There is indeed a difference between intervention and problem solving.

Problem solving examples that do not require intervention include:

e asking someone to close the door due to undue noise;

e moving to the other side to hear better;

e explaining a role when there is confusion; and

e doing a debrief to prevent a problem.

The following includes other examples of problems that interpreters may face and how they

should attempt to solve the problem based on the situation:

e The provider asks the interpreter to sight translate a long or complicated document. The

interpreter should refuse politely and mention the reason for his refusal and recommend

any solutions that may be available.

e The provider asks the interpreter to translate a document for a patient, but it is not part of

the interpreter’s job to translate. The interpreter should politely refuse to translate the

document and tell the provider that he/she is an interpreter not a certified translator,

explaining that there is a big difference between translation and interpretation and both

of them require different sets of skills. The interpreter should also remind the provider of

liability in case he/she makes a mistake in translating this document.

Ot
 e The patient might offer a gift to the interpreter. The interpreter should refuse politely

saying that he/she cannot accept any gifts and it is the policy of the employer.

e The patient might ask the interpreter to babysit her kids while the patient is busy doing

something. The interpreter should tell the patient that this is not a part of the scope of the

practice and that he or she cannot do that.

There are many other problems that will require the interpreter to use good judgment and fully

understand the scope of practice for professional interpreters. This means being aware of what

they should or should not do and which activities are parts of their jobs and which are not. In cases

when they cannot solve a problem on their own, interpreters should feel comfortable seeking the

advice of their supervisors or colleagues.

The Relationships in the Interpreting Session

There are at least three relationships in any interpreting session:

1. The relationship between the patient and the provider;

2. The relationship between the patient and the interpreter; and

3. The relationship between the provider and the interpreter.

Out of the three relationships above, the patient and provider relationship is the most important,

and is called the therapeutic rapport. To understand why it is the most important, studies tell us

to imagine that both the provider and the patient speak the same language. In this case, the

92
patient-interpreter and the provider-interpreter relationships would be unnecessary because the

patient and the provider would directly communicate with one another without the interpreter.

However, when there are two different languages being used, an interpreter will have to step in

to enable communication between provider and patient. This makes the interpreter instrumental

for the development of the primary therapeutic relationship, and therefore, must take care to

support and not undermine that relationship. As stated in the IMIA Standards of Practice, the

interpreter “manages the flow of communication to enhance the patient-provider relationship

(IMIA A-11: A).”

23
 Section 14: Ensuring Understanding

Learning Goal

After successful completion of the Ensuring Understanding Section, participants will be able to
ensure understanding of the listener and to check understanding.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand the main responsibility of the interpreter.

e Realize the importance of checking understanding.
e Explain the term ‘teach back’ and when it is necessary to use.

Important terms and words

Teach back

non-verbal cues

puzzled expression

distracted eye contact

The interpreter should be aware of non-verbal cues that indicate a lack of understanding such as

a puzzled expression or distracted eye contact. These are prompts to check for understanding.

According to the IMIA Standards of Practice, it is the interpreter’s responsibility to “ensure that

the listener understands the message” (IMIA A-8). This means ensuring the understanding of all

parties, including the interpreter.

lf interpreters suspect that someone is confused, they should intervene. They might say to the

provider, “the interpreter would like to ensure that the patient has understood.” The provider now

knows that the interpreter wants to check to see if the patient needs clarification, and the provider

can decide what to do next.

An important task for practicing medical interpreters is to invite providers to do what is referred

to as “teach back”. In the past, a check for understanding was normally practiced. A check for

94
understanding happens when a provider asks the patient if he or she understands, and the answer

is usually yes, whether the patient understands or not. Evidently, asking someone if they

understood is not a very useful tactic as many people will be afraid to say they do not. As a result,

Teach Back is now encouraged in healthcare. This is when the provider asks the patient to explain

what he or she understands about what was just explained. This forces the patient to rephrase the

concept as understood as a way

for the provider
to ascertain if the patient adequately understands

the concept.

Sometimes the provider may ask the interpreter to do teach back directly with the patient and

relay the patient’s answer. In other cases, the provider may decide to do nothing at all. In these

instances, interpreters should not insist but should remain professional and neutral unless the

patient’s safety, life, health, or dignity is at risk.

O5
 Section 15: Register

Learning Goal

After successful completion of the Register Section, participants will be able to understand the
term register and its relationship with delivering accurate and complete message.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand the main concept of register and “five-term distinction”.

e Give examples of the differences between high-register and low-register speech.
e Explain how and when the interpreter can lower the register.

Important terms and words

register

five-term distinction

linguistic varieties

formality

fundamental idea

amputate

Quirk et. al. (1989, 25) present a “five-term distinction” to categorize linguistic varieties, and they

narrow down the range of registers to:

Very Formal — FORMAL— Neutral — INFORMAL— Very Informal

The very formal variety of language (“extremely distant, rigid or frozen”; Quirk et. al. 1989, 27) is

often found in written instructions. Very informal language, which is also called ‘intimate, casual,

slangy, or hearty’ (ibid.) is used between family members or close friends. Knowing this scale can

be very useful for interpreters when trying to assess the party’s register level.

Source: http: ia. l 6 discourse

96
Register means the level of formality or complexity of the language a person or professional uses.

High register speech is very formal and complex. The professional and skilled interpreter may have
the ability to lower the register of speech which means to take something that was said in a very

formal, complex way and say it in a simpler and easier to understand way based on the literacy

level of the listener.

lf the interpreter decides to lower the register, he or she should consider the following:

1- Duration of the message; when interpreting into the lower register, the interpreter must

maintain a similar duration as the high register message

2- The fundamental idea/meaning should be the same

3- The interpreter should not explain. Lowering the register does not mean explaining —

explaination is the job of the provider.

Register is also a key part of communicative accuracy. Register, in a general sense, means the

language which is used by professionals who share the same profession. For example, teachers,

doctors, interpreters, lawyers and other professionals use a certain register when they speak.

Generally, medical interpreters should not change the register of the speech they interpret for,

based on traditional interpreting practices. However, medical interpreting requires ensuring

understanding. So, if a patient does not understand a provider's speech because of the high

register and the provider does not try to lower the register to help the patient fully understand

Sis,
everything he/she needs to know, the interpreter’s best course of action is to intervene and

directly ask the provider to ensure understanding or lower the register. In medical interpreting, it

is acceptable to lower the provider's register when the interpreter is confident of the meaning and

other incremental interventions have not worked. Interpreters should pay extra attention to high

register when working with survivors of trauma. Interpreters should never increase the register of

a response to make a speaker or speech sound better.

Below are a few examples of the differences between high-register and low-register speech:

o High register: Your pains were acute.

Low register: Your pains were quick to become bad.

o High register: We had to amputate your son’s leg.

o Lowregister: We had to permanently remove your son’s leg surgically.

98
 SECTION 16: Managing the Flow of the Session

Learning Goal

After successful completion of the Managing the Flow of the Session Section, participants will be
able to understand how to manage the session effectively.

Learning Objectives:

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Manage the flow of the session professionally and effectively.

e Understand the first-person and how to use the first-person.
e Explain the differences between the usage of first-person and third-person.
e Realize when to switch from the first person to the third person.
e Know to position yourself in the medical setting and why positioning is important.
e Explain the importance of pre-session and know to deliver an effective pre-session with
the patient and the provider.
e Avoid side conversation.

Important terms and words

transparent exchange

facilitation

first person

reported speech

culturally inappropriate

physical position

positioning

billing conversations

scheduling appointments

a phrase-by-phrase

Subject Matter

3x5 rule

Side Conversations

99
By now, you should understand the basic steps of intervention and the complexity of the

interpreter’s roles. Next, we will address managing the flow of the session and performing the role

of cultural mediator.

Interpreters are in charge of making sure that there is a transparent exchange of meaning between

the parties during the interpreting session because interpreters are often the only professionals

in the room that understand both sides of the conversation equally well. In other words,

interpreters are in charge of making sure that the parties speak in a way that can be accurately

and completely interpreted. This requires some facilitation skills. In communication, the term

facilitation or facilitator refers to enabling a group to communicate effectively. (IMIA, A-10).

The First Person and Why We Should Use the First Person

_ Interpreters usually work in the “first person” when they interpret. First

person speech means that interpreters interpret for the individual without

changing any pronouns, speaking as the individual.

For example, if a social worker says, “may | come in?” the interpreter should

interpret “may | come in?” and not “she asks if she can come in” or even

“may we come in.”

This form of speaking, referred to as first person speech, is more efficient and clearer once the

parties understand the interpreter’s role. When interpreters do not use first person to interpret

what others are saying (e.g. she says...), interpreters refer to the interpretation as reported speech.

In addition to being shorter and clearer, the use of first person is better than the use of reported

speech because it:

e Helps to strengthen the primary relationship between the provider and patient;

e Helps the patient and provider speak directly to each other;

e Helps the interpreter to stay in the background, and not be the focus of attention; and

100
 e Helps the interpreter to focus on interpreting exactly what was said.

(adapted from the 2014 Bridging the Gap: Medical Interpreter Training presentation by Cross

Cultural Health Care Program)

Many new interpreters and sometimes end users of the service find first person speech

uncomfortable at first, but with practice it becomes more natural.

There is an exception to this rule. The IMIA Standard recognizes that sometimes the third person

is needed, as it states that the interpreter “Uses the first person (“I”) form as the standard, but

can switch to the third person, when the first-person form or direct speech causes confusion or is

culturally inappropriate (IMIA Standards A-7). This may include a situation with a young child ora

mental health patient who may be confused as to who is speaking, for example.

Positioning in Medical Interpreting

The interpreter’s physical position within a room can have a large influence on how the patient

and the provider relate to one another. It also affects the interpreter’s ability to listen to all

speakers. In interpreting, we refer to positioning as the physical location of the provider, the

patient, and the interpreter.

Interpreters should strive to position themselves in a way that facilitates and encourages

communication between the patient and the provider. The interpreter should be unobtrusive (i.e.

not in the way), and direct eye contact between the patient and the provider should be

encouraged through the interpreter’s positioning and gaze (i.e. who the interpreter looks at).

Ideally, interpreters will select a position next to or slightly behind the patient or provider. This

depends on many variables, and will be further discussed in the practice sessions. It may not

always be possible for the interpreter to be in his or her ideal position, but interpreters should try

to consider several factors:

e The ability to hear all parties to be interpreted

e Encouragement of direct patient-provider eye gaze

e Position that doesn’t require too much neck turning back and forth

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 e Position that ensures interpreter safety in certain cases.

Sometimes, it is uncomfortable for a patient to have the interpreter behind them because they

have less experience with the interpreter.

Sometimes, standing next to the provider gives the patient more autonomy as well.

Last, even though the triangle scenario is not encouraged typically, it can work in some instances.
For in-patient scenarios, the interpreter sometimes needs to be on the other side of the bed or in

between the provider and patient in order to hear the bedridden patient.

How to Position Oneself

There are many situations where the ideal position for the interpreter may not be clear. For

instance, there may be many patient family members present (sitting to the side of the family

members may be an option), or the parties may be moving from place to place as the interpreter

interprets (staying close enough to hear is the most important factor here). There also may not be

any room to sit or stand beside the provider or patient. In this case, it may be necessary to explain

that one needs to change positioning.

102
(Sc

Remember, we can’t ask to do our job, we need to do it. Interpreters are not technicians, they are

practice professionals.

Because each situation is different, interpreters need to actively decide where it is most

appropriate to sit or stand to best ensure that the parties communicate directly with one another

and do not address the interpreter. Direct communication is more efficient and contributes to a
more equal power balance between the patient and the provider.

Some Common Types of Interactions Interpreters Encounter

Interpreting can take place during a dialogue (i.e. a back-and-forth conversation), a question-and-

answer session, or a speech, among other formats. There are often only two speakers, in addition

to the interpreter, but there may be more participants to the communicative event, such as a

spouse, family members, or other relatives.

The consecutive mode of interpreting is used in most medical interpreting encounters because it

is the easiest for parties to understand and the simplest for interpreters to use, as it requires no

equipment. These include patient interviews, billing conversations, scheduling appointments,

patient examinations, and many other encounters. Interpreters will switch out of consecutive

mode if there is a need to do so, such as when a patient needs emergency care and will not pause

for the interpreter.

Each of the above situations has specific characteristics and needs for which interpreters must be

thoroughly prepared. These settings may be interpreted in person or over the telephone. Medical

interpreting is most often performed on a phrase-by-phrase basis, with rapid alternation between

the speaker and interpreter. Occasionally, however, longer questions or answers may require that

the interpreter take notes and retain long passages of messages to avoid disrupting the flow of

communication.

Telephonic interpreting poses a challenge to the interpreter because of the lack of visual cues,

such as gestures and facial expressions, which provide vital information that the interpreter can

use to Clarify meaning or intent. To make up for the lack of visual input, the interpreter may need

103
to intervene more frequently to interpret short phrases or to request repetitions or clarifications.

In some cases, facilities are equipped with video connections that can make up for this

shortcoming, but that is not always possible.

Even with a video connection, remote interpreting still presents a different set of challenges

compared to in-person interpreting, due to lack of complete visual cues and possible variable noise

distractions. Background noise that would not be as much of a distraction in an in-person setting

can be extremely disturbing to an interpreter working with a telephone or video connection. That

is why in all remote interpreting cases, it is important to ensure a good audio connection with

limited auditory interference.

Subject Matter Too Complex for the Interpreter

Some interpreting assignments are more complex than others. For example, medical studies may

require very specialized and even rare condition discussions and require assignment preparation.

Whenever a specialty is unfamiliar to the interpreter, the interpreter should consider whether to

refuse or withdraw from the assignment. If an interpreter believes she may be able to accept the

assignment but is not sure, the interpreter can use the 3x5 rule, meaning that if the interpreter

needs to look up more than three unfamiliar terms or ask for explanation more than three times

in the first five minutes, and the medical terminology is beyond the interpreter’s linguistic skills,

the interpreter should consider withdrawal from the assignment (explained in more detail in the

coming sections). All of us have our limits and you must know your abilities and your limits to

decide the best action to take in certain situations. Disclosing a lack of familiarity with certain

highly technical terminology is a sign of professionalism and not of incompetency.

Speaking with the Parties Outside the Session

Many patients and providers have limited experience with working with interpreters. It is

important to educate both the patient and the provider how to work successfully with an

interpreter through the pre-session.

104
Communications with providers outside of the interpreting session are often simple emails or

phone calls to arrange the time, date, and place of interpretation, but they may also involve a
quick discussion of the interpreter’s role, introductions, and the subject of interpretation.

Whenever these preliminary conversations occur before an interpreting assignment and involve

more than just a simple arrangement of the interpreting session, interpreters refer to this

conversation as the pre-session.

Pre-session

Pre-session can help the interpreters to solve several potential problems and challenges that might

cause a lot of headaches for both the interpreter and the parties. Pre-sessions commonly occur

before the interpreting session begins, but they can occur at any time prior to the session, with

the provider and/or patient.

A pre-session is the best opportunity to avoid problems before they arise. Interpreters can use this

time to explain the purpose of their role and strategies that interpreters use, and to ask any
questions before the interpreting begins.

A pre-session not only helps build a professional rapport and trust between interpreters and
providers or patients, but also provides interpreters with an opportunity to explain how the

interpretation will work.

105
Some examples of what to do in a pre-session with the provider, include the following:

Greeting (good morning, hello...);

The interpreter’s full name and company;

Mention the language / dialect that you speak;

Describe the interpreter’s role. For example: “I will ensure accurate and complete

communication between x and y, by interpreting everything that is said in confidence”;

Request that the provider speak directly to the patient, not to the interpreter;

Explain that the interpreter will interpret everything that is said during the interpreting

session, not just what the provider wants the interpreter to say;

Explain that the interpreter may need clarification to do so;

Explain that interpreters sometimes take notes and that the notes will be destroyed;

Explain that the interpreting session will be kept confidential;

Explain that the interpreter will need to position himself/herself for effective

interpretation;

Ask if the provider will need any document to be sight translated;

Explain the use of first person instead of indirect speech;

Ask the provider to speak in very short sentences as much as possible for accurate

interpretation;

Answer any appropriate questions from the provider;

Ask the provider if there is anything special about this session that you should know before

you start. When possible, hold a pre-conference to find out the provider’s goals for the

encounter and other relevant background information. (Adapted from: A-1 IMIA Standards

of practice).

Avoid Side Conversations

When interpreters exchange a conversation with the patient, family member, or providers but do

not interpret it during an interpreting session, this is called a side conversation. Side conversations

cannot always be avoided, but they make the interpreter responsible for relaying the information

106
later, which one may forget to do. This is why interpreters should always be careful to make sure

everything they discuss separately with one party is also interpreted afterward to the other party.

Never have a side conversation with a patient without being transparent and interpreting what

was said to the provider.

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107
 SECTION 17: Active Listening & Memory Development

Learning Goal

After successful completion of the Active Listening and Memory Development Section,
participants will be able to listen actively and understand the concept of memory development.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

Fully understand the concept of active listening.

Know the difference between hearing and listening.
Explain the different strategies to improve active listening skills.
Know and illustrate the three types of memory.
Know the short-term and long-term memory enhancement techniques and how to apply
them to enhance their memory.

Important terms and words

Active listening

Memory development

Crucial

SOLER

Parroting

Fundamental idea

Take Notes

Visualization

word association

In this section, we will talk about one of the most important soft skills that professional

interpreters must develop and practice - active listening. Additionally, we will discuss memory

development and some techniques for how interpreters can better retain information.

108
Difference Between Hearing and Listening

According to Merriam-Webster Dictionary, the definition of hearing is the process, function, or

power of perceiving sound. Meanwhile, the definition of listening is to hear something with

thoughtful attention: give consideration.

Hearing is passive because it happens involuntarily. You can hear what other people around you

are saying but it is your choice to focus on what is being said or not. On the other hand, listening

is an active process whereby we consciously make the effort to pay attention and fully

understand the speaker’s speech.

Active Listening

The National Council on Interpreting in Health Care defines the term active listening as the

following: “A skill or method of listening that focuses on what is being said for content and

purpose in order to achieve full understanding.”

Since interpreters must convey the exact message and intent of the original speaker, genuine

active listening is crucial to the effectiveness of an interpreter. Active listening is one of the best

skills that medical interpreters can benefit from since it will allow them to better understand all

parties and deliver more accurate and complete interpretation. To develop your active listening

skill, you must consciously listen to everything is said. You must pay attention and not be

distracted by anything around you or lose focus or concentration on the speaker’s message.

A great technique that teaches interpreters how to actively listen is SOLER. Gerard Egan (1986)

in his book “The Skilled Helper” created this acronym SOLER which stands for:

S: Sit SQUARELY,

O: Maintain an OPEN posture,

109
L: LEAN slightly in towards the client,

E: Maintain EYE CONTACT with the client without staring, and

R: RELAX.

Strategies to Improve Active Listening Skills

Below is a list of strategies to practice and follow regularly to improve your active listening skills:

Concentrate and Pay Full Attention

e Look at the speaker and have eye contact if it is appropriate.

e Do not get distracted by anything around you such as another conversation nearby,

background activity and noise, or your thoughts, feelings, or biases. Remind yourself to

focus and pay attention again when your mind drifts.

e Pay attention to your body language and show respect to the speaker regardless of what

he/she is saying.

e Listen without Judgement

e Listen and fully understand the speaker’s message regardless of what you think about the

speaker (if they are honest or dishonest, good or bad).

e Beneutral and do not criticize, judge, or make assumptions about the speaker.

Parroting

e Also called oral repetition, parroting is repeating verbatim (word for word) what the

speaker says, in the same language. This exercise can help you practice active listening, but

be careful that you still remember the meaning of the message rather than just the words

used.

110
Main (Fundamental) Idea

e When listening, identify the main idea and the meaning of what is said instead of focusing

on memorizing every word.

e Remember that a verbatim rendition is not accurate because every language has its own

syntax and grammatical structure.

Ask for Clarification

e Don’t be afraid to play your role as a clarifier if you need to clear any misunderstanding or

if there is a barrier to understanding the message.

Take Notes

e Take effective notes to remember what is said if the speaker goes on and on and he/she

does not want to stop. (Note-taking will be discussed in the next section).

Mastering the active listening skill will require consistent practice. Keep training your mind to

concentrate on what the speaker is saying and avoid getting distracted by other thoughts or your

surroundings. By being an active listener, you can become more successful in your medical

interpreting assignments and provide better communication between the provider and patient.

The Three Types of Memory

Memories are all created in the brain, but your brain remembers some things

longer or better than others because of how well the information is stored.

Generally speaking, there are three types of memory storage that the brain uses:

Sensory Memory, Short-Term Memory, and Long-Term Memory.

Sensory Memory is the brain’s ability to remember most things you saw or heard

within the last five to seven seconds, even if you were not paying close attention. For example, if

someone calls your name and you realize that they asked you a question, you may be able to recall

the question exactly even if you were not actively listening.

ila]

a
Sensory Memory is useful for interpreting short exchanges. Usually, these rapid-fire exchanges do

not require notes because your brain is able to retain this information through Sensory Memory.

Second, Short-Term Memory is used for things you saw, heard, or experienced in any span of time

longer than about seven seconds but no longer than a day or two ago. Memory enhancement

techniques for interpreters mostly focus on this type of memory storage because longer

consecutive interpreting can overwhelm the brain’s Short-Term Memory storage abilities.

Lastly, Long-Term Memory storage is used for retaining information beyond a day or two. This is

the most permanent of memory storage types. However, much of what we experience does not

become Short-Term Memory, and much of our Short-Term Memory does not become Long-Term

Memory. An example of Long-Term Memory for interpreters is the ability to remember symbols

and abbreviations that you create to aid you in your note-taking.

Short-Term Memory Enhancement Techniques

There are several techniques you can use to improve your short-term memory when interpreting;

however, these techniques will not give you superpowers. Always keep in mind that your short-

term memory worsens as you get tired or distracted by physical discomfort, thirst, hunger, noises,

or the need to use the restroom.

15125551212

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112
First, chunking means organizing information into groups that are easier to remember. For

example, instead of remembering the number 574,833 you could remember 57-48-33. Mentally

sorting the information into smaller, organized “chunks” will assist you, and you can organize and

label these chunks of information in any way that you will remember them. With chunking, any

association that you can make to simplify the information works!

Second, visualization is when the interpreter imagines a picture or scenario. Many interpreters

imagine that they are experiencing what an LEP person describes when they are relating their

medical history or condition. Visualization is a great technique because it encourages active

listening and can help interpreters remember even detailed descriptions and directions.

Interpreters can visualize a message even when the content is not obviously visual. Some

interpreters report imagining labels on objects with descriptions or using concept maps to visualize

a process. Visualization is an individual process, and anything descriptive or even silly that you

devise will be a helpful memory aid.

Lastly, word association can help you increase your short-term memory by linking a word with a

concept you are already familiar with. Word association can help with remembering long lists by

associating the sound, spelling, or personal associations the interpreter already has with a word.

For example, an interpreter could remember the names of several family members by associating

each family member with a piece of fruit that starts with the same letter: A family with five

members (Anne, Josh, Gary, Mary, and Terry) could become five fruits (apple, jalapeno, guava,

mango, and tomatoes) and their ages could be written on the fruit.

In general, experienced interpreters have their limits both regarding the length of a message they
can remember and how long they can interpret. While an interpreter’s message length limit varies

greatly from interpreter to interpreter, a good rule to follow for how long to interpret is the “rule

of two and twenty” - don’t interpret for more than two hours at a time in consecutive or twenty

minutes at a time in simultaneous.

113
Long-Term Memory Enhancement Techniques

Just as cramming for a test is not the most effective way to remember something long-term, trying

to learn many new symbols in a single, long practice session is not the most effective technique.

To increase your long-term memory retention of symbols and abbreviations, try practicing at

different times of day, in different places, and over many occasions.

114
 SECTION 18: Basic Note-Taking for Interpreters

Learning Goal

After successful completion of the Basic Note-Taking for Interpreters Section, participants will be
able to know the basics of taking notes during the interpreting encounter.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Fully understand the basics of taking notes during their medical interpreting encounter.
e Explain how to practice taking notes.
e Know what they should avoid while taking notes.

Important terms and words

distractor

symbols and abbreviations

Interpreters often use notes to help them remember what has been said. Unfortunately, note-

taking can be a distractor to interpreters who have not practiced note-taking or do not take notes

properly.

In this section, we will address the basics of how to practice taking notes and how to take notes

properly.

How to Practice Taking Notes

The worst time to start practicing note-taking in a different way is during a live interpreting session.

When interpreters are just starting out or changing their note-taking system, they will spend much

of their attention on how to take notes instead of on the speaker’s message.

Interpreters (like all professionals) have a limited amount of attention and memory, so every bit

of attention or memory spent on how to take notes inevitably distracts from understanding and

remembering the speaker’s message.

AAS)
Therefore, some of the best ways to practice taking notes includes while listening to recordings

and when practicing with other interpreters. Both of these methods allow the interpreter to pause,

review, and repeat their practice without affecting medical outcomes.

How to Properly Take Notes

Before anything else, the interpreter should ask for permission from the patient and provider to

take notes during the session. The interpreter should explain that he/she will be taking notes to

help remember everything that is said so that he/she can provide a complete and accurate

interpretation. The interpreter should also reassure the patient that the notes will be destroyed

after the end of the session (usually interpreters can give the notes to the provider afterward to

be shredded).

When taking notes, interpreters should only try to capture the main ideas of a message. Note-

taking is not a replacement for an interpreter’s memory. Instead, interpreters use notes to help

them remember more information at a time and to make it easier to remember so they do not

tire as quickly.

When you start taking notes, try to only write down three or four words per sentence. You should

not worry at first about symbols and abbreviations. Just practice what to write instead of how to

write it, so you will still be able to focus on the speaker's message.

116
Once you feel comfortable identifying the most important words or symbols to write down, you

can start slowly developing your own personalized abbreviations and symbols for common terms

and actions that you interpret.

What to Avoid when Beginning Note-Taking

Here are a few things to avoid when note-taking:

1. Before note-taking, do not forget to inform to all parties that you will be taking notes and

that the notes will be discarded after the session.

2. Donot worry about making your notes look neat. Only you will decode your notes.

3. Do not worry about using too much paper. Use the space on the page to help you

remember relationships, the order of events, and parts of speech.

4. If you do not know how to write down an idea, just focus on people, places, things, ideas,

and actions. These are the central parts of almost any message.

5. Do not use shorthand unless you know it well.

6. Do not forget to discard your notes. They have no value after the assignment and

misplacement could violate HIPAA.

a7,
 SECTION 19: Expanded Note-Taking Skills

Learning Goal

After successful completion of the Expanded Note-Taking Skills Section, participants will be able
to be skilled at taking notes.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand and explain the needed skills for Important terms and words
taking notes. /
f Decontextualized Information
e Always write decontextualized information.
: Di |SVO
e Learn how to use Diagonal SVO Note-Taking. pelsold
Linking Words
e Learn how to use linking words.

pote 4

We have touched on how to take notes (writing down only the key ideas in each sentence) and

how to avoid some common pitfalls. In this section, we will discuss decontextualized information,

how to use diagonal SVO (subject-verb-object) note-taking, and linking words.

Always Write Decontextualized Information

Contextualization means analyzing a word or event in terms of the words or concepts surrounding

it. Contextualization aids memory and helps an interpreter understand a message.

Unfortunately, not all information can be placed in context. Some information such as names,

addresses, and telephone numbers must be interpreted, but they are not connected to other parts

of a story or message the same way that a description is.

118
Always write down decontextualized information in your notes. Decontextualized information is

generally the hardest information to remember. Ask for confirmation, as in confirming a telephone

number, or proper spelling of a name, if you need to, in order to interpret it correctly, or if you
foresee having to interpret that name more than once.

How to Use Diagonal SVO Note-Taking

Interpreters with good note-taking habits tend to use a lot of space when taking notes. This is

because space itself can have meaning. Interpreters generally start a sentence in the top left hand

of a page and then note ideas in diagonal patterns. This arrangement makes it easier for

interpreters to remember the parts of speech of the things they write.

$$
Subject snare

Verb were

Object developments

Subject We

Verb took stock of

Object relations
| + situation
“ ee 5

In a common system of note-taking called SVO note-taking, interpreters place the subject of the

sentence on the top left of the page, the verb in the middle of the page, and the object in the

bottom right of the page. Using this system, interpreters can build on this system to describe

subjects and objects by placing words in the right parts of the page or list actions or things without

worrying about mixing them up with other parts of the sentence.

Because this system uses a lot of paper, many interpreters prefer to use notebooks that have a

spiral on top such as a steno notebook because it is easierto quickly flip between pages with these

notebooks.

119
How to Use Linking Words

Although there appear to be many linking words in English, many of them have similar meanings.

Interpreters are much more concerned with meaning than with words themselves, so most

interpreters combine similar terms when taking notes. One good example of this is the word

“although.” In English, some synonyms of “although” include “albeit,” “despite,”

“notwithstanding,” “supposing,” and “whereas.” All of these ideas can be represented by the same
Wd

symbol.

In fact, according to Andrew Gillies’ well-regarded book Note-Taking

for Consecutive Interpreting,

all linking words can be reduced to the following list: “but,” WY tt

“although,” “hence,” IPP
“in order to,”
fe)

“if/then,” “for example,” and “in addition.” By making a symbol for each of these terms and being

aware of related linking words, interpreters can quickly link ideas in complex as well as simple

sentences.

Keep Out the Obvious

Some words are not worth the trouble of writing down. For example, you can often skip verbs like

“to be” and “there is/there are” entirely because the rest of the sentence will help you remember

these verbs.

Likewise, if you are interpreting a story, don’t worry too much about tenses. The context of the

message will help you remember. Most of the events will be in an easily remembered past tense,

and opinions will be contextualized in the past or present tense.

Additionally, sometimes you can reduce the number of notes you take when speakers mention

related concepts. Often, speakers talk about opposites or synonyms when trying to explain

something, but you generally only need to write one down in order to remember both since these

ideas are already linked.

120
 SECTION 20: Using Symbols when Note-Taking

Learning Goal

After successful completion of the Using Symbols when Note-Taking Section, participants will be
able to be skilled at using symbols when taking notes.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand and explain how to use symbols Important

terms and words
effectively when taking notes. Symbols
e Learn when to use symbols
Language Neutral
e Learn how to design symbols.
Modifiable
e Understand how symbols are modifiable.
Biopsy
e identify symbols as language neutral.
permanent recording
e Learn how to use letters or common medical
abbreviations to aid their note-taking.

Symbols are ideas represented by a simple picture, shape, or marking. A symbol does not have to
be a literal drawing of the thing it represents. Interpreters often use symbols when taking notes

because, unlike abbreviations or words, symbols are modifiable and language neutral.

21
When to Use Symbols

Consider using symbols for many different things: actions, job titles, places, ideas, relationships,

and more. Once you start creating and using symbols in note-taking, the most difficult thing can

be to pace yourself and adopt symbols slowly.

So, what things should you create symbols for first? Some of the best candidates for symbols are

things that come up over and over again or terms that you have difficulty remembering. For

example, if you often work in a dermatologist’s office, you might consider making a symbol for

“biopsy.”

However, some words are not good candidates for symbols because they are generally not

important enough to write down. Some examples include “a,” “an,” “the,” and filler words such as
Well
fi

“wel umm,” and “so”.

We” a
J

How to Design Symbols

No two interpreters use all the same symbols. The best way to make new symbols is by creating

or choosing something that has meaning to you. When you create your own symbols, you put

thought into the process that helps your brain to remember the symbol later. Even if you borrow

another interpreter’s symbol, you should consciously decide why you like that symbol so that your

brain remembers the symbol later when you need it.

One word of caution: symbols are a memory tool, not a permanent recording. Do not waste time

making your symbols elaborate, neat, or fully explanatory. You only need symbols to assist your

short-term memory, not to be read by archaeologists in the farfuture.

Likewise, do not forget to practice drawing your symbols so that your hand will be familiar with

the motion and be able to complete the symbol faster. Many beginning interpreters make the

mistake of taking longer to draw symbols than it would take them to write out the word. Avoid

falling into this trap by drawing the symbol several times and actively thinking about how to further

simplify it when you are interpreting.

122
How Symbols are Modifiable

One other advantage of symbols is that they are modifiable. Consider that in English a single

concept can have many different variations according to number, tense, and parts of speech. For

example, the word “build” can also be “building(s) (noun and participle),” built,” “built up,” and

“over built.”

Instead of making a separate symbol for each of these words, you can simply add to or modify

(change) your symbol to reflect the specific meaning. In this case, you might use the symbol of a

hammer (which you can simplify with a sideways triangle and line beneath) for “build” and add an

exclamation point for “building,” an arrow for “built up,” or a line over the hammer
for “over built.”

Symbols are Language Neutral

Using acommon medical interpreting example, the word “surgery” can be represented by an angle

symbol (representing a knife) and a square (representing a body). This symbol is /Janguage neutral

because it is not specific to the English representation of this concept. The knife and body would

be an equally recognizable symbol in Spanish, for example.

123
Letters and Common Medical Abbreviations

In addition to symbols, interpreters can use letters or common medical abbreviations to aid their

note-taking. Here are some examples of commonly used short-hands in medical interpreting:

Treatment Rx Without S

History Hx With C

Diagnosis Ox If needed sos

Every q Before meals Neeeace |

Everyday qd After meals PC =

Every other day qod Twice a day BID

Every hour qh Trice a day TEED

Every morning Fourtimesaday | Qid

Every 4 hours Q4H Once a day OD

As needed PRN Twice a week TW

ehtbedtime Before Breakfast | BBF

By mouth; orally Before dinner BD ze

pe
124
milligram << Ounce ON

kilogram = ne}7)

Gram

Teaspoon ts Tablespoon tbs

degrees Fahrenheit milliliter

degrees nn
(@)
G) Liter

centigrade/Celsius
|
Number # OR no. Page pg

Year ~< t @

Month S= Following ff

as)iv)4 Maximum max

Less than Minimum min

More than Mostimportantly | *

Question Answer A

Problem prob Equals =

225
Before b/4 Word wd

Percent % Because b/c

Versus /against With w/

Department Dept Without w/o

Within w/i Reference ref

126
 SECTION 21: Basic Skills in Sight Translation

Learning Goal

After successful completion of the Basic Skills in Sight Translation Section, participants will be
able to learn how sight translate documents during their medical interpreting encounter.

Learning Objectives: -
“

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

Understand and explain the needed basic skills in Important terms and words
sight translation. long pauses
Compare sight translation and consecutive mode.
potential pitfalls
Learn the needed 5 steps to sight translation.
language patterns
Know the importance of taking your time when sight
continuous pace
translating.
segments
Learn how and what to take notes for when sight
macro-unit
translating.
diagonal SVO

127
Sight translation is the third mode of interpreting after consecutive and simultaneous interpreting.

Sight translation occurs when an interpreter verbally reads a text in a language different than the

one the message is written in. In sight translation, no written translation is provided (this is the

work of translators, not interpreters).

Interpreters should perform sight translation only for short documents. |n general, you should not

sight translate a document you do not understand well or that is more than two pages long.

Comparing Sight Translation and Consecutive Mode

Whereas consecutive mode commonly uses short messages with pauses, allows for note-taking

while listening, and does not contain long pauses, sight translation is the opposite.

128
With sight translation, interpreters speak for a long period at a time with pauses in between

units of interpreting.

Sight translation is also quite different from written translation. Whereas written translation

allows for significant delays to find the exact right term or phrase, sight translation must be

prepared quickly.

5 Steps to Sight Translation

Almost every interpreter will have to refuse a sight translation at some point either because the

document to be sight translated is too long or too complex. If it is too long, the interpreter must

request that it be translated for the patient. However, when you are able to sight translate, follow

these five steps:

Silently read the document all the way through;

Identify unfamiliar concepts and potential pitfalls;

Analyze the register and language patterns;

Ask for clarification if needed; and

ee
eeeRead at a steady, moderate, continuous pace.

129
The Importance of Taking Your Time

It can feel awkward to take several minutes to silently read a document in the middle of an

interpreting session, but you should take the time you need to prepare so that you will not have

to pause again to read ahead in the middle of the document. Providers and LEP persons may

show signs of impatience if you take longer than they expect, but you should explain if necessary

that you are taking time to preview the document so that you will be able to sight translate the

whole document at once. Sometimes asking to leave the room to study the document takes

away the pressure of having two people over one’s shoulder waiting for you to read the text. Ask

for a pencil or pen to mark the document with your notes if that helps so that when you are sight

translating you can do it with greater ease.

Insummary, it is very important to read the entire document first. Ifyou do not read the document

before beginning sight translation, you will not be familiar with its contents, and will need to pause

130
or correct yourself more. Pauses and corrections are confusing to the listener during sight

translation because they cannot see the structure of the document, so it sounds like parts of

information are coming in bits and pieces. Unlike in spoken language, the organization of written

titles, headings, and paragraphs signals to readers how each sentence relates to each other.

Therefore, if you pause while reading the document, the listener is more likely not to understand.

Generally, it is better to do a longer pause before each sentence, read it, and then interpret it into

segments. If you just interpret segments, the entire text reads like a series of continuous segments.

The longer pause aids the listener to understand that a sentence, or macro-unit of message, is

finished and another one will start soon. It is also good to explain or interpret what you see as you

sight translate. For example, an interpreter may state, “This is a new section entitled: How to

Prepare for Your Surgery”.

Note-Taking for Sight Translation

When taking notes for sight-translation, do not use regular diagonal SVO (subject-verb-object)

notes. Instead, write down words or phrases that you need to pay special attention to and, if

necessary, write the target language term(s) or expression(s) you will use.

If appropriate, ask the provider whether you can mark the document. Marking the document,

especially by circling, or underlining words and phrases, will greatly soeed up your ability to create

a mini-glossary on the spot.

If you are unsure about the meaning of a sentence or term, ask the provider. Write down any

answers the provider gives about a term to help you remember when sight translating.

dai
 SECTION 22: Special Problems with Sight Translation

Learning Goal

After successful completion of the Special Problems with Sight Translation Section, participants
will be able to learn how to manage sight translation and deal with all the special problems with
sight translation.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

Understand the special problems related to sight translation.

Know how to address sight translation in pre-sessions or pre-conferences.
Realize when to refuse to sight translate.

Explain the five steps to refuse sight translations.

Understand the importance of transparency when sight translating.

Important terms and words

mini-glossary

effective. Advocating

justifiable reason

intake form

132
In an ideal world, providers would always have written translations ready of any documents they

needed to give to patients. However, that is often not the case.

In this section, we will cover some concerns that come up with sight translation that are unlikely

to occur with other modes of interpreting.

Addressing Sight Translation in Pre-sessions or Pre-Conferences

One great way to anticipate sight translations is to ask about them in a pre-conference. If you have

an opportunity to have a pre-conference with the provider, you should also try to educate him or

her about alternatives to sight translation such as verbal explanations or written translations so as

to reduce the amount of sight translations you may need to do in the future.

In a pre-session or pre-conference, you may also be able to take additional time to “pre-read”

documents you will have to sight translate. If you have this opportunity, use your time to create a

mini-glossary and think about the organization and language the document uses.

As a reminder, a/ways refuse sight translation requests that are too long or too complex. Cite the

reasons for doing so in a polite and professional manner. Usually providing explanations related

to the patient’s need to understand the document fully are very effective. Advocating for the

document to be translated for the patient’s safety and ability to reread if necessary is also a

justifiable reason.

When NOT to Sight Translate

Do not sight translate documents that are too long, too complex, full of unfamiliar terminology, or

otherwise beyond the ability of the interpreter to competently sight translate.

Also, be careful with documents that are used to write down a client’s information such as an

intake form. These documents should be read aloud to the patients and the patient will fill out this

intake form.

133
The Five Steps to Refuse Sight Translations

One of the most important problem-solving skills in sight translation is to know how to refuse

inappropriate requests, for example, when a document is more than two pages in length, has

complex language, or is a legal document such as a consent to surgery.

When refusing a sight translation, follow these five easy steps:

First, do not say “no”. However, you can say” | would love to do that” or “Thank you very much for

trusting me”. Remember that most providers do not like to hear the word “NO”. They might think

that you are challenging them, especially if they have asked other interpreters to do that and the

interpreters accepted and for some reason did not refuse the task.

Second, say “but “ The word “but” negates or cancels what you already said earlier. So, you say

that you cannot do that. Remember, although declining a request and saying “no” takes courage,

it is an important professional skill.

Third, explain yourself and say why you cannot do what you are asked to do. You should mention

some convincing reasons for your refusal based on your experience in this profession. Most of the

time, the explanation will have to do with the document’s length or content. For example, “This

document contains a lot of complicated terms that are beyond my linguistic abilities”. Or, “This

document is full of complex medical terminology that requires terminological research and

preparation, and the patient is unlikely to understand the sight translation, since | cannot pause

when sight translating” or “unfortunately, this document is simply too long for a professional

interpreter to sight translate; it needs to be translated for the patient.” Even simple reasons like

“this document is too complex” work fine.

Fourth, reassure the provider that you would like to work as one team because you are part of the

medical team. You can politely let the provider know that you are willing to do whatever you can

to help them. For example, “| am ready to do whatever it takes to help you, but..”

Fifth, offer alternatives or solutions so that the provider knows what he or she can do instead of

pushing you to sight translate. Examples of some alternatives include:

134
 e Asking the provider to mark a portion of the document that he or she wants sight

translated and showing the patient the portion that is being sight translated;

e Asking the provider to explain the document or have a nurse explain it;

e Suggesting that the provider obtain a written translation, where appropriate; or

e Requesting that the provider simplify the document so that it can be accurately sight-

translated.

(taken in part from the Language ofJustice: Interpreting for Legal Services course by Cross

Cultural Communications)

Doctors are highly educated professionals, and they often do not realize when documents are

written in a high register. Nevertheless, high-register language will often confuse patients because

written language often uses longer sentences than spoken communication.

Sight Translate the ENTIRE Document

When sight translating, do not lower the register. Authors often choose their wording for a reason.

Remember to translate the ENTIRE document, including document titles, headings, address lines,

and letterhead, and even signatures. You may feel silly sight translating these portions, but if you

omit anything without telling both parties, you are not being transparent nor are you interpreting

completely.

As mentioned previously, interpreters can ask providers in a pre-session to mark portions of a

document to read and then explain to the patient that only part of the document is being sight

translated.

Transparency when Sight Translating

If you skip any part of a document (e.g. at a provider's request), you must let both parties know. If

one party interrupts to make a comment or ask a question, you will need to pause to interpret and

let the provider know where you stopped sight translating.

ES)
Both parties must understand when you are sight translating the document and when you are

interpreting a question or comment.

136
 SECTION 23: Culture

Learning Goal

After successful completion of the Culture Section, participants will be able to learn a lot about
culture and how to manage culture challenges during the medical interpreting encounter.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand and explain cross-cultural competence and interpreting.

e Learn how to overcome cultural blind spots.

e Understand and illustrate the culture of biomedicine.

Important terms and words

Culture of Biomedicine

Cultural Blind Spots

Cross-Cultural Competence

cultural sensitivity

Context

linguistic groups

ethnicity

Caesarian Section (C-section)

surgical procedure

protocols

137
Review of Culture

aWaresOfeAlthough different groups share culture (linguistic groups, countries, clubs, gender

groups, and professional groups), quitunesisvultimatelyindividual'toeach"person! In other words,

even though many people in a group may share similar cultures, mostwoupersons)cultureisiexactly:,

Cross-Cultural Competence and Interpreting

As a medical interpreter or aspiring medical interpreter, you are sure to encounter persons and

providers from many cultures who do not share their language or culture. Usually the interpreter

has some knowledge of cultural nuances by the simple virtue of knowing the language. However,

sometimes, you may be unfamiliar with one or more of these cultures, as culture is an individual

phenomenon.

Whenever interpreters encounter persons or providers from cultures with which they are

unfamiliar, iftterpreters should, beaware ofthecultural assumptions they make byusing askill

138
In general, interpreters who are cross-culturally competent recognize and value diversity among

people. They try to understand other people’s point of view, and they do not assume that there is

only one right way to view themselves and others, nor that there is one right way to live.

beliefs and be
This requires that interpreters Besopenstoudifferenti ideasia nd
able'to’agree tow

Unfortunately, even interpreters with high levels of cross-cultural competence have some €ultural’

These are aspects of another culture of which an interpreter is unaware or that he or she ignores.

Try to regularly be aware of cultural blind spots and identify new ones as you gain experience in

the interpreting field.

How to Overcome Cultural Blind Spots

The first rule for overcoming cultural blind spots is togsesattentivesto"other

people’s reactions!
whensinterpreting, Interpreters should look at a person’s nonverbal messages in their posture,

facial expressions, tone of voice, and body language. Nonverbal messages "areas importantyas,

verbalmessages,Itis also important to be attentive to the verbal messages, hesitations, emphasis,

and other paralinguistic (beyond language) features, to judge how that person might feel or how

he or she is reacting to what is happening.

Next, 6éyadaptivey While interpreters will not intervene in the interpreted conversation unless

necessary, an interpreter can use his or her positioning, tone of voice, and hand signals to make

the parties feel more comfortable.

139

ss hhh
When the need to intervene is identified, interpreters must rely on their cross-cultural

competence to identify and resolve cultural barriers.

The Culture of Biomedicine

) fis i Wot >a ol

diseases Using drugs) radiationy orsurgery~y Medical doctors in different parts of the world have
many things in common. For example, doctors in Jordan, India, and the United States all may use

an X-ray machine to find out if a child with a hurt leg has broken a bone. However, doctors in other

parts of the world can also be very different from the US and other countries. For example, in

Brazil over half of babies are born by Caesarian Section (C-section), a surgical procedure to remove

a baby from the uterus. In the United States, doctors perform this procedure much less often.

While some of the differences in medical practice between countries have to do with the

education and resources available to doctors in each country, much of the difference can be

explained by the medical cultures of each country. Below we look into some habits, beliefs,

protocols, and rules that doctors and other medical staff follow in the United States.

Biomedical Culture

Biomedical culture is one of the biggest reasons why doctors in

different areas often diagnose and treat patients differently.

In the United States, most doctors foclis on diseases, symptoms)

lisabiliti | balailitad eset ser |

biomedical
model of medicine; It is also called allopathic medicine, biomedicine,

conventional medicine, mainstream medicine, and orthodox medicine.

140
In the United States, doctors who use this model will diagnose the problem and then negotiate

with the patient the best treatment to pursue. Each person in the interpreted communicative

event has their sphere of expertise. The doctor is the expert and in charge of inquiring, locating

and understanding the problem and identifying the possible solutions, if any. The patient is the

ultimate expert in their own body and is in charge of explaining his or her symptoms to the best

of their ability in order to receive treatment. The patient also has the responsibility to participate

in their healing by complying with the agreed treatment plan. The interpreter is the ultimate

expert in interpreting language/culture and in the process of intercultural communication. Tes

One major difference between the biomedical model of medicine and other models (such as

Alternative Medicine, to be discussed later) is that doctors rarely consider the effects of

psychological, environmental, and social influences on the patient. Instead, based on the doctor’s

training and the practicalities of practicing medicine in a capitalistic society, the focus of the doctor

is to treat the disease in the most efficient manner. Ghemprovider-patient interaction andr
Te NTeC (YFVIEOCTIVE AN NIITNOSEe ()rienr) 20 G C aT ON The

purpose for the patient is to tell the doctor what the complaint is, and for the doctor the purpose

is to find the problem and treat it. However, doctors cannot do everything in a treatment. If a

doctor prescribes medication, it will only work if the patient takes the medication exactly as

prescribed. Therefore, jitiisirecognizediin the United States thatthe patienthasvamimportant.role

141
 SECTION 24: Body Language and Culture

Learning Goal

After successful completion of the Body Language and Culture Section, participants will be able
to learn how to manage interpreting the body language of any party when facilitating
understanding in the communication between the patient and the provider.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand and explain how to manage interpreting body language that is related to the

culture of the speaker.

e Learn how to deal with the gender and biological sex issues when interpreting.

e Learn the best way to address all parties during the medical encounter.

Important terms and words

Gender and biological sex

Body language

Formal address

facial expression,

hand gesture

transgender

risking offense

female characteristics

modesty,

chaperones

cohabitation

patient’s autonomy

142
A —
Even in cases where the meaning of a facial expression, hand gesture or body movement may

seem clear, the interpreter should not assume they know the meaning, and instead, let the parties;
tryto.navigate the:communicationson:theinowns This way, the provider and patient can establish

better trust by learning to communicate and deal with their issues directly with each other.

If necessary, interpreters can ask one party to confirm the meaning of acertain body language.
The interpreter will never ask a patient to explain why they look worried or why they seem

nervous. That would be an odd request. It is easier and more practical and realistic to intervene

and tell the provider the interpreter needs to ask the patient or simply ask the patient if they are

nervous as the interpreter is reading body language that seems to say so.

Gender

anothergenden For a majority of people, their gender is the same as their biological sex. However,
for some individuals, gender and biological sex are different.

When interpreting, be sure to not disrespect a transgender person by using the wrong linguistic

gender
to referto him or her. Instead, always use a person’s preferred gender if that person states

their gender.

143
Sometimes, interpreters may not be certain which gender to use when referring to a patient or

medical provider. In such a case, tfiterpreters)shouldyaskywhatygenderpronounyshoulds|;usestoy

Remember: when in doubt, ask politely and always use a person’s preferred gender.

Biological Sex

In contrast from gender, a person’s\biological’sexirefers

to"male’or female characteristics thatla

Cultures vary widely in their attitudes towards biological sex, including attitudes about jobs, public

and private space, modesty, chaperones, dating, friendships, conversation, cohabitation, and

professional relationships between people of another sex.

Not all cultures have just male and female sexes, and not all people are easily identified as only

male or female. In medicine, a person with internal genitalia that do not match that person’s}
hen interpreting for intersex persons, be aware of the

need to respect that person’s preferred pronouns as explained in the “Gender” subsection above.

Formal Address

Interpreters should almost always use a professional, formal address in interpreting unless there

is a strong reason not to do so. Some common exceptions include speaking to children or persons

with disabilities who may be confused by the use of a formal address.

Some interpreters may feel that using a formal address is inappropriate in the cultural context in

which they work. However, please note that a more formal address avoids the appearance of a

patient being or feeling like an interpreter’s personal friend. Using a formal form of address with

patients is a good way of ensuring that patients understand the professional relationship or

144
distance that needs to be there between patient and interpreter for objectivity and neutrality.

However, there are cases where a formal form of address may make the patient uncomfortable.

In these cases,

decisionsy Remember the patient’s autonomy which means that the patient is the only one who
decides for themselves and the interpreters should not decide for them or suggest any solutions

for them.

When in doubt, use formal, respectful language for all parties.

145
 SECTION 25: Swear-Words, Obscenities, Body Parts, and Modesty

Learning Goal

After successful completion of the Swear-Words, Obscenities, Body Parts, and Modesty Section,
participants will be able to learn a lot about the providers and LEP patients’ culture of swear-
words, obscenities, body parts and modesty. And how they can manage interpreting all of them.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Learn how to interpret vulgarities.

e Learn how to effectively manage overcoming the embarrassment of terminology

references to sex acts or bodily functions that can be cultural taboos.

e Learn how to interpret humor during the medical encounter.

e |llustrate how to play their role as a cultural broker effectively.

Important terms and words

Swear-Words,

Obscenities

Vulgarities

a judgmental statement

linguistic equivalent

interpretation rendition

references to sex acts

cultural taboo

communicative autonomy

an interpreting distortion

Humor

linguistic differences

146
 cultural concept

circular vs. linear

reserved vs. expressive

consensus-driven,

intuitive

Orientation

flexible vs. rigid

Childrearing or childbearing

intercultural humility

diversity of opinions

Swear-Words

Interpreters often struggle with expressing vulgarities they may feel are embarrassing or morally

wrong. However, an interpreter’s job is to communicate the speaker’s message as completely and

accurately as possible, (fitetpretersthaverayprofessionals(afidlethical) responsibility:tovinterpret

147
anendnings Uievmsy personally think are wrong. Interpreters need to remember that these are
not their messages. Personal objections have no place in a professional setting. When the

interpreter is acting as a professional, he has to forget about his personal or cultural opinions or

beliefs and act as a neutral and impartial agent of communication. Remember the tip to learn to

agree to disagree? It is not up to the interpreter to censor either party.

Aside from personal objections, swear=words:cansbe.dithey

fficult
may,not-have
because
.directons,

which would be a judgmental statement.

Instead, use problem-solving to clarify the meaning just as you would with any other term.

In cases where there simply is not a linguistic equivalent for the swear-word, the best action to

take is to ask the speaker what the word means and then interpret the speaker's explanation, even
if the interpreter already knows the meaning. This way, the interpreter avoids inserting his or her

opinion into the interpretation rendition.

Obscenities, Body Parts, and Modesty

For many interpreters, references to sex acts or bodily functions can also be cultural taboo.

However, interpreters need to be professional at all times and overcome embarrassment with

terminology. hate

competent tolinterpret) Interpreting is a profession that requires one to interpret everything that
is said, without objection. Remember that you are not speaking with your own voice. If you

absolutely cannot interpret the words that are used, you must withdraw from the assignment.

However, be advised that you may not be called often to interpret.

C 4 UCVETIU , WV means tnat abe he eI her EV A No CokUP ae PIC] TTS tC ne

the targetylanguage; This would encompass an interpreting

word-choicesstyle;vandsregister)»in
distortion.

148
Interpreting Humor

Humoriis’alsoweryclosely:tied:toveulture. Some jokes can be replaced with an equivalent, which

requires quick thinking on the part of the interpreter, but simply do not have a linguistic

equivalent.

If the joke will make sense in the target language, the interpreter should simply interpret it as

normal. However, when.the,joke willbe confusing or strange to the other party, the interpreter
will
problem-solve.
have to

For example, there are times when an interpreter must simply .ceportethatethe=speaker*said=
bingsthats eat | nae bPhecH tse
TIGUTSHe
OF HA ,)

When interpreting humor, keep in mind the speaker’s style, tone, and use of offensive language,

if any.

There are several challenges to cultural mediation or being a cultural broker:

First, when interpreters perform intercultural mediation,

lati there is a possibility that the party will

“difficulttounderstandforanother. This means that the interpreter needs to know what types of
cultural issues typically arise. The most common imterculttiral Gifferenees involve:

Communication style (circular vs. linear)

Decision-making (individual, linear vs. consensus-driven, intuitive)

Expression (reserved vs. expressive)

Orientation (group vs. individual)

Level of commitment to relationships (high vs. low)

Sense of time (flexible vs. rigid)

Relationships (many, looser, short-term vs. fewer, tighter, long-term)

Childrearing or childbearing beliefs

ee Role of the elderly in society

ee
ae
AoC
sO
he
O88
|
SS.

149
 The IMIA

Standard of Practice (IMIA: A-12), states that the interpreter needs to be able to “manage conflict

between the provider and the patient”. However, thissdoes»not»mean'the

interpreter needs’ to™

tesolverthe conflicts The IMIA provides the following stepstoaddress

aconflict:

A. Remain calm in stressful situations or when there is a conflict.

B. Acknowledge when there is conflict or tension between provider and patient.

C. Assist the provider and patient in making conflicts or tensions explicit (known), so that they

can work them out between themselves.

D. Let the parties speak for themselves and do not take sides in the conflict.

A Word About Cultural Intervention

Intervention to remove a cultural barrier is often much more complicated

than intervention to remove a linguistic barrier, so interpreters should be

extra cautious. A person’s culture is often highly individualized, and

An example of good cultural mediation (cultural broker role) might be to

address the fact that people in some cultures put their hands to their

hearts or simply bow instead of shaking hands. If a provider is confused, the interpreter could

quickly intervene and transparently let the parties know what is happening (e.g. “[patient] is

putting his/her hand to his/her heart to return your handshake”). Thevinterpreter

should always ”

150
 specificre
"groups culturesbefo
Of course, interpreters first meedetosbemverysfamiliar=withwan
performing cultural mediation (problem solving)! Interpreters who do not know enough about the
multiple cultures of their interpreting languages should ,constantly«worketosexpandetheir

barriersewhenever'they"appear. There needs to be cultural humility, since even if one is very

familiar with a specific group culture, one cannot assume to know the cultural background of that

specific patient or provider, since each individual has a unique cultural makeup that is only partially

influenced by their country or regional culture. Otherfactors

influence one’s cultural*makeup,

vand
several
other factors.

Additionally, it is important to note that the intercultural mediation role is not always about

explaining a cultural issue about the patient’s culture to the provider or addressing a cultural issue

that may affect understanding. Jntercultural.mediation.is-also,aboutexplaining:something:about

biomedical,
American,culture.to.the
culture or patient. For example, often patients are surprised
to be asked if they consume alcohol, or if they do drugs. When the interpreter notices a non-verbal

message of discomfort with these questions, the interpreter may decide to alert the patient that

in the US all providers have to ask these questions to all patients by law. This helps the patient not

feel that he or she is being singled out, by giving context to the message. Or, interpreters may

need to explain to the family about HIPAA and why the provider cannot speak to them until he or

she obtains expressed permission from the patient. Otherwise, the family may lose trust in the

provider. Interpreters should be mindful to balance their intercultural mediation in both directions

for the benefit of the therapeutic rapport and to increase impartiality. If an interpreter is only

working one way, it leaves the other party uninformed as to what they also need to know to be

more culturally knowledgeable. Keep in mind, mediation is an impartial activity and is different

from being someone’s educator. It has to go both ways in order for the interpreter to be valued

as a cultural agent in the system, and not just as a patient’s cultural representative.

inoy
Last, self-knowledge isvery key inintercultural humility and awareness. One needs to understand
their own cultural values well, how they relate or compare with other opposing cultural values,

and learn to respect and appreciate diversity of opinions and traditions.

152
 SECTION 26: US Healthcare System
Learning Goal

After successful completion of the US Healthcare System Section, participants will be able to
have a full understanding of the US Healthcare system and the laws related to healthcare system
and LEP patients.

Learning Objectives:

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Understand and explain the US healthcare system and its laws.

e Learn the Equal Access to Care laws.

e Learn the Roles of Doctors, Nurses, and Other Staff.

e Fully understand and explain the Patient Privacy HIPAA.

e Know important interpreting medical terminology to help participants during medical

interpreting encounters.

Important terms and words

Equal Access to Care

Title VI of the 1964 Civil Rights Act

ground of race, color, or national

origin

denied the benefits

discrimination

Federal financial assistance

ADA (Americans with Disabilities

Act),

Culturally and Linguistically

Appropriate Services (CLAS).

Pharmacists

Nurse Practitioners

153
 direct supervision

Patient Privacy HIPAA

Health Insurance Portability and

Accountability Act

Consent

Medicaid

PT physical therapist

Although medical doctors practice all over the world have a lot of similarity but there are a lot of

differences in medical practice between countries that have to do with the education and

resources available to doctors in each country,

Medical'cultures
of each couhtry. Below we look into some habits, beliefs, and rules that doctors
and other medical staff follow in the United States.

Equal Access to Care

Most healthcare providers have an obligation in the United States to provide interpreters for LEP

persons because of mandatesequaliaccess'to"healthiservices,

severallaws that The best-known of

154
these laws is known as Title VI of the Civil Rights Act of 1964. dihemthitlemMiesofecthem

‘subjected to discrimination under any program or activity receiving Federal financial assistance.”

Virtually all healthcare facilities in the United States receive federal financial assistance, so in your

professional work it is safe to assume that Title VI applies unless a provider or agency shows you

otherwise. Most important to interpreters regarding Title VI of the 1964 Civil Rights Act is that it

prohibits discrimination in healthcare settings on the basis of national origin, which includes a

patient’s language.

The ADA (Americans with Disabilities Act) and Civil Rights Act are far from the only laws that

influence interpreting in healthcare, but they are the best starting point for interpreters to be

familiar with. Interpreters seeking to expand their knowledge of the legal framework surrounding

interpreting in healthcare settings may also consult the Department of Health and Human Services

Standards for Culturally and Linguistically Appropriate Services (CLAS).

The Roles of Doctors, Nurses, and Other Staff

In the United States, healthcare providers are usually certified and licensed to practice. In most

states, no one is allowed to practice medicine without a license.

Medical doctors (also called physicians, or MDs) are the only professionals who can treat patients.
They can refer patients to specialists and write prescriptions.
(NOTE: They are not the same as a specialized nurse nor are they the same as physician assistants.)

Sometimes, patients get confused about what type of professional they have spoken with and

what that person’s role was. When interpreting, make sure that the patient knows who you are

and what your role is. According to The Joint Commission (an organization that accredits hospitals

based on patient safety measures),

Patient Privacy HIPAA

In many countries, but especially in the US, where privacy is a strong cultural value, patient”

..The main law that controls patient confidentiality (privacy) is called

. The Health and

Human Services Department has very useful information and videos about HIPAA for all healthcare

workers (see: https://www.hhs.gov/hipaa/index.html).

Patients have always had the right to access their own medical information, but HIPAA protects

that information from others, due to concerns it will be used against the patient. For example,

healthcare providers may not give any health information about a patient to family members

unless the patient gives expressed consent (gives expressed permission). Many family members,

therefore, feel confused when a family member’s doctor or interpreter will not talk to them about

their patient. In these cases, it is up to the interpreter to explain to them that in the United States

there are privacy laws that do not allow the doctor to speak to them unless the patient requests

156
so. It is possible that the doctor will not realize that the patient may have a different experience

or laws in their home country.

Private Healthcare

backgrounds (Medicaid) and:for elderly people over the ageof'6S (Medicare). Private healthcare
is healthcare that is paid by the patient, by the healthcare insurance company, or by both. In

private healthcare, doctors are not supposed to turn patients away from emergency services

based on inability to pay. Some patients may be worried about their ability to pay for healthcare

in case of emergency, or they may be confused about what their health insurance will pay for.

On the other hand, doctors will turn away patients if they cannot pay their portion of fees for

routine care. This applies to both children and adults. Patients with insurance may,be required to,

particularly ifhe orshe isnot from the United States. The interpreter should be able to clarify that
to the patient and educate them about the healthcare insurance laws and regulations through the

help of the providers.

In summary, when interpreting in healthcare, always be aware of the possibility of misguided

patient expectations regarding payment, privacy, or the roles of different healthcare workers.

An important observation about interpreting medical terminology:

Doctors use many acronyms, or abbreviations. PT is physical therapist, but when a physical

therapist states to a patient that he or she is a PT, jt.is.imp

the
ortant:fo
interpreter to interpret
r
(the meaning, and not the words: Therefore, the interpreter will interpret PT as ‘physical therapist’

and not the letters, ‘PT’, which does not mean physical therapist in most languages. Please keep

this in mind when you are interpreting. Our role plays will include these abbreviations. Remember

to interpret their meaning and not simply repeat letters such as, ‘PT’; that will not mean anything

to the patient. Therefore, me

ih
 SECTION 27: Summarization

Learning Goal

After successful completion of the Summarization Section, participants will be able to know
when they are allowed to summarize and how they can advocate effectively.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

Understand and explain when they can summarize.

Know the role of patient advocate.

Realize the appropriate situations for the role of Patient Advocate.

Understand how they can overcome the systemic barriers.

Learn how to advocate for the patient.

Important terms and words

Triggers

Omissions

Irrelevant

intercultural issues

systemic barrier

sexual orientation

gender identity

race

judgment

eligibility criteria

phraseology

intimidated

sexism

158
 retaliation

exaggerated perception

derogatory remarks

derogatory side-conversations

De-escalation strategies

Earlier this course briefly discussed summarization as a mode of interpretation. Summarization Is

to be avoided since it departs from the interpreter’s activity of accurately and completely

conveying a message from source language to target language.

Nevertheless, sometimes summarization is appropriate. Below are some situations in which you

might need to use the summarization mode.

Situations that Justify the Summarization Mode

Some typical triggers for using summarization mode are when one party speaks at length and the

interpreter cannot interpret simultaneously, for whatever reason, or when two or more people

speak at the same time. When this happens, the interpreter should interpret the communication

as completely as possible but may need to shorten or omit some ideas (i.e. summarize). Or

depending on the situation, the interpreter can ask each party to repeat what they just stated so

that it can be interpreted accurately and completely.

Summarization is generally not recommended because of the great potential for errors and

omissions. Summarization should never be used as a technique for editing material that the

interpreter feels is irrelevant or inappropriate. If a provider is speaking too fast, ask the provider

to speak slower, instead of using summarization. If the situation requires simultaneous

interpretation, perhaps another interpreter should be called.

Another situation that may be appropriate for summarization is when there is a terminologically

complex third-party discussion (such as between two therapists) in front of a patient, but no one
is speaking to the patient. The interpreter will then interpret simultaneously for the patient.

USK)

ee t—CssiCi‘CS™COS
However, if the density of the content is such that it is difficult for the interpreter to contain all

the information, summarization will be in order. They may not be able to speak slowly to each
other for the benefit of the patient.

The Role of Patient Advocate

The term ‘advocacy’ is misunderstood. In many languages it means

representation, but in English it has two meanings. One is representation, but

the other is promotion. For example, if one is an advocate for communication,

one will take actions to ensure that communication takes place. If one is an

advocate for language access, one will alert the provider of the need for

language access, such as by suggesting that a document needs to be translated for the patient

instead of sight translated due to its length. If one is an advocate for client education, one will use

every opportunity to educate clients (providers, patients, agencies) on the work of medical

interpreters. If one is an intercultural advocate, one will work hard to alert all on the intercultural

issues that actually may affect the quality of care.

However, when we speak of patient advocacy (or the patient advocate role), we are speaking of

representing the best interests of the patient, usually against someone or a situation. Unlike the

roles of conduit, clarifier, and cultural mediator, the role of patient advocate within an interpreting

session is not a neutral role. Therefore, this role is the most invasive of all, since it means the

interpreter must take the side of one of the parties, which is contrary to the ethical goal of

impartiality that every mediator needs to have.

Appropriate Situations for the Role of Patient Advocate

First of all, in order to establish impartiality, the interpreter is supposed to avoid taking sides.

However, patient advocacy is a ro/e that requires taking the side of the patient. Remember from

the first day of the course that modes are the method of interpretation, while roles are functions

played in order to problem solve.

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In all medical interpreting standards, patient advocacy is an appropriate role only where a patient's

life, health, or dignity is at risk. This role can be tempting for interpreters as many enter the
profession with the idea to help patients. However, interpreters work for patients and providers

equally. This role has been construed as the interpreter’s attempts to put the patient at the same

level as the provider. The mere presence of the interpreter acts as a balancing effect relative to

the power differential between the patient and the interpreter. The interpreter does not need to

take any further action to ensure that the patient is well represented as that may be seen as

assuming the provider doesn’t have the patient’s best interest in mind. This may put the provider

in a defensive position. It is not needed when the patient faces a one-time inconvenience. All

patients face inconveniences every day. Representing the patient is not the role of the interpreter.

Representing both parties equally is.

In this course, a patient’s dignity includes not only physical dignity (e.g. privacy when changing

clothes) but also dignity in the face of systemic barrier as we mentioned earlier in the code of

ethics and standards of practice section.

Overcoming Systemic Barriers

When a provider or important service rejects or otherwise discriminates against a patient because

of his or her race, national origin, religion, sexual orientation, gender identity, or other similar

characteristic, the interpreter has the duty of advocating for the patient. However, this does not

mean that the interpreter has to take any action in front of the provider and the patient.

Interpreters should use careful judgment when evaluating whether a problem was caused by a

systemic barrier. Remember that patient advocacy is needed only in certain situations.

Systemic barriers are policies, practices or procedures that result in some people receiving
unequal access or being excluded. Example: eligibility criteria that effectively exclude people based

on a disability.

es-of-barriers.html

162
How to Advocate for the Patient

During interpreting sessions, interpreters should always intervene incrementally whenever there

is not a medical emergency. If an interpreter can resolve a systemic barrier without taking sides,

the interpreter will enable the parties to resolve the issue themselves and will most likely be able

to continue to interpret between the patient and the provider after the problem is resolved. This

will take high-level soft skills and phraseology that avoids blaming sides. “The situation is (such and

such)” is better than “| see you said... and she said...”. This will be seen as blaming or judging and

can quickly lead to unwanted interpersonal dynamics or even reprimand from the provider or

patient.

Sometimes patient advocacy is the only way to solve a systemic barrier against the patient, such

as discrimination. However, in these cases, interpreters should consider when to intervene.

Interpreters can intervene before, during, or after an interpreting session. Since this is difficult to

predict, it is almost never addressed before an encounter. However, it can happen. For example,

an interpreter may warn the provider that the patient is known to be difficult or belligerent, or

that the patient seems upset, in order to prepare the provider. If the interpreter is uncomfortable

with the language or attitude of a provider towards the patient, or notices that the patient is

uncomfortable or intimidated by the provider’s behavior, the interpreter has several options. If

the issue is becoming unbearable, one option is for the interpreter to ask the provider to step

outside for a quick conversation that may help the session. Then once outside, the interpreter

would begin by describing the perceived discomfort of the patient in the politest way (for example,

stating “the patient’s nonverbal language is signaling that the patient feels intimidated”) and

establishing that this may negatively affect the therapeutic rapport. The interpreter should also

avoid discussing (judging) the provider’s behavior, but instead should describe the perceived

discomfort. The interpreter should never act as patient advocate in front of the patient, as that

puts the provider in a very uncomfortable position and can negatively affect the provider-

interpreter relationship. In addition, it would risk the provider later retaliating against the

interpreter. If the interpreter and/or the patient are ignored, and the session continues with a

discriminatory attitude against the patient, the interpreter may then decide to continue

162
interpreting and choose to wait until after the session and solve the problem by reporting the

behavior NOT to the provider, but to a supervisor or public official. Depending on the provider,

the interpreter may request that the complaint be kept confidential. If the discrimination is subtle

but is observed in many encounters (such as sexism towards several patients), the interpreter

should report it to their supervisor or through the incident reporting mechanism of the

organization, so that remedial action may take place for other patients not to suffer.

Interpreters should realize it is a huge responsibility to act as a patient advocate. Much care has

to be taken to avoid retaliation and to ensure that the discrimination is not just an exaggerated

perception. On the other hand, NOT advocating for the patient when necessary (if discrimination

or dignity is at risk), would in fact equate to tacitly participating in the discrimination. As mentioned

earlier, confronting the provider directly may cause more problems than not, but there are

professionally polite ways to handle some issues, such as a_ provider attempt at a side-

conversation with the interpret or that includes derogatory remarks against the patient. For

example, if the provider says, “These patients should learn English’, the interpreter may say

‘Doctor, are you sure you want me to interpret this?’. This may be a polite manner to alert the

doctor that you will not participate in derogatory side-conversations.

It is important to note that the patients are not the only ones who are discriminated against. On

occasion a patient will discriminate against a provider or an interpreter. In this case, whoever is

being discriminated against needs to use polite and professional language to handle these

situations, which are similar to the skills necessary when working with difficult people. De-

escalation strategies also can be very helpful. When the provider discriminates against the

interpreter, it is very important for the interpreter to report this to their supervisor, with the exact

language and behavior that was considered discriminatory so that the supervisor can keep track

of whether this is a one-time occurrence or whether other interpreters come along with the same

complaint. In the case of the latter, the supervisor will take the appropriate action.

In summary, before acting as a patient advocate, always familiarize yourself with your agency’s

policies and protocols related to patient advocacy.

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 SECTION 28: How and When to Use Self-Care
Learning Goal

After successful completion of the How and When to Use Self-Care Section, participants will be
able to know how to deal with their daily stresses and apply some self-care strategies
professionally.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Realize and explain how they can deal with daily stress and triggers.

e Learn how to retake control when feeling overwhelmed.

Important terms and words

Stress

personal commitment

linguistic skills

grasp of idioms and nuance

traumatic situations

anxiety,

avoidance,

irritableness

a crime victim

sexual assault

secondary trauma

stress symptoms

rapid heartbeat

Cognitive Behavioral Therapy (CBT)

164
A lot of bilinguals choose to be professional medical interpreters for several reasons. Some of

them come to the interpreting profession because of a personal commitment to better serve

their communities and save the lives of the LEP patients. Some have worked as ad-hoc

interpreters for family members or friends, so they chose this professional career to make

money while using their linguistic skills to help those in great need of them. However, some of

us who have been interpreters a long time feel that new interpreters may not understand that it

is likely that their lives might be changed dramatically by choosing this career.

Normal stress is a part of everyday life. Any time that something unexpected or out of the routine

takes place, adapting to that event can cause someone to feel stress.

Interpreting can often be very stressful, more so than people imagine. Parties expect interpreters

to have great vocabulary, memory, ethics, and grasp of idioms and nuance. In addition, some

interpreting fields may trigger interpreters with a history of trauma when interpreters interpret

traumatic situations similar to ones they have previously experienced.

Dealing with Stress and Triggers

Normal levels of stress are usually tolerable. Sometimes, however, stress is a problem. Too much

stress can cause bad reactions such as nightmares, anxiety, avoidance, irritableness and
depression.

165
For example, if a crime victim lashes out at the interpreter for misinterpreting something, that

situation can be stressful and even traumatic. If the assignment runs over time, or the interpreter

constantly must remind the parties to address one another, or to pause regularly, that can also be

a significant source of stress.

If you interpret for victims of major trauma, even though you must actively listen to their stories,

you will also need to avoid empathizing too much. When feeling overwhelmed, try to distract

yourself by focusing on how each part of your body feels in that moment. Take deep breaths and

ask for a break. If necessary, take several minutes to call someone and discuss something else or

confide in someone and ask for their emotional support.

If an interpreting situation becomes too traumatic, you should not feel ashamed about

withdrawing. It is better to take care of your own emotional health than suffer just for the sake of

completing an assignment.

Additional Triggers for Interpreters

lf an interpreter has a history of experiencing domestic violence, sexual assault, or other violent

crimes, the interpreter is at particular risk for developing secondary trauma.

Interpreters who have been survivors of trauma may need to manage not only their own

emotional reaction of what the patient has experienced, but also the interpreter’s own

experience. Interpreters in these situations can experience sudden stress symptoms while

interpreting, such as sweating, rapid heartbeat, or fear.

How to Retake Control When Feeling Overwhelmed

The first step to managing these reactions is to be aware of them. Then, interpreters can try to

find distractions by focusing on their own bodies, taking deep breaths, and asking for a break when

necessary. You should do your best to separate yourself from the story and take a break if you can.

Another technique you can follow is calling someone you trust and telling them about your

feelings, which can release a lot of your stress. If you have time, you can get fresh air or walk

166
ane

around. Washing your hands and your face is another technique that you can use to reduce some

of your emotional stress.

If you cannot take a break from interpreting, try to “ground” or “center” yourself — take deep

breaths and distract your negative feelings and emotions by focusing on how your toes feel, for

example.

In general, the principles of mindfulness and Cognitive Behavioral Therapy (CBT) are useful starting

points for additional research for interpreters who would like more guidance in these areas.

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 SECTION 29: Identifying Secondary Trauma (Vicarious Trauma)
Learning Goal

After successful completion of the Identifying Secondary Trauma Section, participants will be
able to know how to identify and manage secondary trauma.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Learn how to identify the symptoms of secondary trauma.

e Define vicarious trauma.

e Learn how to remove the stigma of secondary trauma.

e Know what the patient will do if they feel secondary trauma.

e Learn valuable tips on how to deal with secondary trauma.

Important terms and words

Vicarious Trauma

Secondary trauma

Empathy

Disoriented

Neurological

Cognitive

Exposure

Intrusive or distressing thoughts

Insomnia

Stigma

168
Interpreting traumatic content can be even more stressful and traumatic for interpreters than it

is for many therapists, doctors, and police officers because interpreters must listen carefully,

extract the meaning of a message, and deliver the message as if the event happened to them (.e.

in first person). Empathy is a natural emotion in interpreting because interpreters are often the

voice for patients.

When interpreters are feeling especially stressed by the content of the messages they interpret,

it is acceptable to switch to third person interpreting.

Before interpreters reach this point, however, they can identify and manage something called

secondary trauma.

Other exceptions to using first person interpreting include if the patient is disoriented, mentally

ill, or otherwise shows confusion about who is speaking.

What is Vicarious Trauma?

According to the vicarious trauma institute:

Vicarious Trauma is defined as a transformation in the helper’s inner sense of identity and
existence that results from utilizing controlled empathy when listening to clients’ trauma-

169
 content narratives. In other words, Vicarious Trauma is what happens to your neurological

(or cognitive), physical, psychological, emotional and spiritual health when you listen to

traumatic stories day after day or respond to traumatic situations while having to control

your reaction.

Resource:

https://vicarioustrauma.com/whatis.htm|

Secondary Trauma (Vicarious Trauma)

Vicarious trauma is also known as Secondary trauma, a buildup of exposure to the trauma others

experience. Even therapists trained in secondary trauma can experience it. It means that the

interpreter starts to experience some of the trauma symptoms of the people whose stories he or

she hears and repeats during the interpreting session.

One example of secondary trauma in interpreting is when interpreters begin having nightmares

about the experiences they interpret about.

Interpreters can also start to have the following secondary trauma-induced responses related to

their work:

e Intrusive or distressing thoughts;

e Anxiety;

e Depression;

e Insomnia;

e Recurring health problems like infections;

e Fear for one’s own safety (e.g. fear of parking lots); or

e Fear for the safety of loved ones.

If you find yourself having some of these symptoms, it could mean that you are experiencing

secondary trauma.

170
Removing the Stigma of Secondary Trauma
Many people in the United States feel inadequate when they experience the symptoms of trauma.

They may feel that they are “not tough enough” or are “being too emotional.” However, secondary

trauma is normal for people exposed to others’ trauma. It is not a sign of weakness.

Part of overcoming secondary trauma is to remove the stigma associated with it. Interpreters can

do this by no longer associating it with a personal failure and recognizing that it is often a natural

consequence of working with survivors of trauma.

What Will You Do if You Feel Secondary Trauma?

You can follow any of the following when you feel Secondary Trauma:

m (|f you are in an interpreting session, you should ask for a break to move around and focus
on something else.

m_ If you cannot take a break, you may switch to reported speech from first person (using the
third-person {he, she and they} instead of the first-person {I, me, myself, and mine}).

m Realize that withdrawing and feeling secondary trauma are not weaknesses; they are
recognitions of our situation.

Tips for Dealing with Secondary Trauma:

To deal with Secondary Trauma, you should follow these valuable tips to manage your feelings
effectively:

m Remember stress is a part of everyday life

gah
Normal levels of stress are normally ok

Sometimes you can feel too much stress

When you feel overwhelmed, try to distract yourself or pause

Focus on how parts of your body feel (known as “grounding”)

Take deep breaths and ask for a break

Call someone and discuss something else

Tell the provider about how you feel

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 SECTION 30: Working with Trauma Survivors

Learning Goal

After successful completion of the Working with Trauma Survivors Section, participants will be
able to know how to work with trauma survivors during their medical interpreting encounters.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Learn how to work with work with trauma survivors and manage the sessions that include

trauma survivors smoothly.

e Learn what the best position will be when interpreting for vulnerable groups.

e Understand and explain how they can let providers establish rapport.

Important terms and words

Trauma survivors

Dire poverty

Homelessness;

immigration detention

vulnerable group encounters

detached

Rapport

Second guess

Trauma survivors (also referred to as trauma victims) are people who have experienced trauma,

which is the response to a deeply distressing or disturbing event that overwhelms an individual’s

ability to cope. (Trauma Relief | Dr. Kristin Schaefer-Schiumo, Manhasset, NY.

https://www.drkristinschaeferschiumo.com/services/trauma/ )

73
LEP trauma survivors can sometimes appear to make strange decisions. However, patients often

have good reasons for their decisions. For example, an LEP person may be in one of the following

situations that affects his or her decision-making:

Dire poverty;

Homelessness;

Stolen documents or documents confiscated by an abuser;

Threats from an abuser to place a victim in immigration detention;

Threats to take the victim’s children; and

Fear of retaliation from the abuser if the victim leaves the relationship.

Unfortunately, fears of retaliation by abusers are often well-founded.

Although it may be tempting to advocate for traumatized clients with their providers,

interpreters should not do so in the absence of the triggers mentioned in the “last resort”

section above. Instead, the interpreter should let the provider take charge of the situation.

Providers, not interpreters, are trained to help trauma survivors process the trauma they

experience. Providers such as therapists may sometimes seem to act harshly with LEP patients,

but they often do so for good reasons.

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Positioning when Interpreting for Vulnerable Groups
Positioning is also unpredictable and difficult in many vulnerable group encounters because the

LEP person may need additional personal space to feel safe or the LEP person may unexpectedly

reach out to the interpreter when the LEP person feels strong emotions. Interpreters should

conduct a pre-session whenever possible if they know they will be working with trauma survivors

because the therapist or other public service provider may have special requests.

One of the most common requests from providers to interpreters when working with trauma

survivors is to remain calm and detached during the interpreting session. While an interpreter’s

tone may reflect the emotions of the speaker, the interpreter needs to remain calm because LEP

persons will detect an interpreter’s distress and may become more distressed in turn.

Letting Providers Establish Rapport

Rapport is a close relationship in which people understand each other’s feelings or ideas and

communicate well. Providers often try to establish good rapport with patients.

Interpreters may sometimes find that the relationship between the LEP person and the interpreter

(one of at least three relationships in any interpreting session) is getting in the way of the rapport

the provider is trying to establish with the patient. When this happens, interpreters should

immediately signal the provider and look to the provider for cues.

Interpreters must trust the therapists and other providers they work with, even if the professionals

speak in ways that puzzle or upset interpreters. Do not interfere or second-guess the provider. Be

sure to follow the provider’s lead.

u75
 SECTION 31: Resources and Associations for Professional Development
Learning Goal

After successful completion of the Resources and Associations for Professional Development
Section, participants will get very helpful resources and be introduced to some non-profit
associations and organizations that will help them develop their interpreting profession.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Gain plentiful medical interpreting resources that will help them grow professionally.

e Learn about professional interpreting organizations and associations that will help them

develop their interpreting profession.

e Learn how to improve their medical terminology over time.

Important terms and words

Associations

Professional development

glossaries

a study tool

professional networking

professional forums

unabridged monolingual dictionary

SUCCESS
practice
instruction
training
learning

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Improving Terminology over Time

Every interpreter’s path in interpreting is different, but many resources that interpreters use to

develop themselves are the same. For example, most interpreters can improve their terminology.

Acquiring proficiency in terminology can take years, and interpreters must continuously strive to

enhance their vocabulary. This effort requires steady work and practice. It cannot be accomplished

during a single training. Instead, interpreters must prepare carefully for each assignment.

Interpreters can identify new terminology by recording the new words they encounter and then

adding them to a personal glossary (i.e. a short, personal dictionary). Many modern websites,

Twitter or other social media accounts, and services also offer terminology sets, or word-a-day

posts.

Interpreters often create glossaries as a study tool then keep returning to them to add additional

translations for words or to review what they learned from previous assignment types they need

to refresh. When building a glossary, do not try to create one in a single session, week, or even

month. Instead, keep slowly adding word and phrase translations to your glossary until you have

a rich, personalized resource. For many interpreters, electronic documents are best because they

can be edited without the need to erase or mark out old information.

Associations and Additional Resources

Second, most interpreters will benefit from professional networking, in addition to speaking with

and learning from other interpreters. This can be done online through professional forums at
ata.net, proz.com, or the forums at wordreference.com. It can also involve in-person meetings

such as workshops or conferences. Some professional associations that medical interpreters

should consider joining include:

e The American Translators’ Association (Interpreting Division) http://www.ata-

divisions.org/ID/ ;

e The National Council on Interpreting in Healthcare (NCIHC) https://www.ncihc.org/;

e The International Medical Interpreters Association https://www.imiaweb.org/; and

177
 e The National Association of Judiciary Interpreters and Translators https://najit.org/.

Apart from compiling a glossary and professional networking, interpreters can improve by building

a personal library. Some helpful resources include:

e Acomprehensive or unabridged monolingual dictionary for each working language;

e ACEBO materials;

e Interpretapes; and

e Books on interpreting techniques such as Andrew Gillies’ Note-Taking for Consecutive

Interpreting and all of Holly Mickelson’s works.

e The following list of resources are from IMIA Guide on Medical Interpreter Ethical
Conduct. By Eva Hernandez-lverson.
(https://www.imiaweb.org/uploads/pages/376 2.pdf)

List serves

e CLAS TALK Listserv: http://www.diversityrx.org

e |MIA List serve: [email protected]

e NCIHC List serve: www.ncihc.org

Medical Information Sites

e Medline Plus: http://www.medlineplus.gov

e Web MD: http://www.webmd.com

Online Glossaries

e Language Automation, Glossaries by Language: http://www.lai.com/glossaries.htm!

Book Services

e ACEBO: http://www.acebo.com
e InTrans Book Service: http://www.intransbooks.com
e John Benjamins Publishing: http://www.benjamins.com/cgi-bin/welcome.cgi

178
 Recommended Reading

California Standards for Healthcare Interpreters:

http://chiaonline.org/images/Publications/CA standards healthcare _interpreters.pdf
HIPAA: http://hhs.gov/ocr/hipaa
LEP, Language Rights:
‘//www.migrationinformation.or
efing Book.pdf
The Commonwealth Fund: http://cmwf.org/Content/Publications/Fund-
Promising-Practices-for-Patient-Centered-Communication-with-
Vulnerable-Populations-Examples-from-Ei.aspx

National Library of Medicine. National Institutes of Health. Hippocratic Oath. Viewed

March 13, 2009 (http://www.nim.nih.gov/hmd/greek/greek_oath.html)

Arocha, Izabel. 2006. Ethical Considerations. Boston University Center for Professional
Education. Izabel Arocha, M.Ed.
o Office of Minority Health. 2000. National Standards on Culturally and Linguistically
Appropriate Services. U.S. Department of Health and Human Services. Office of
Minority Health.

American Society for Testing and Measure Standards (ASTM). 2001. Standard Guide for
Language Interpretation Services, F 2089. American Society for Testing and Measure
Standards. Viewed November 10, 2009. (http://www.astm.org/Standards/F2089)

International Medical Interpreters Association. March 2009. Ethics Survey.

Sapir, E. 1921. Language. Harcourt, Brace & Co. New York.

International Medical Interpreters Association. 1995. Medical Interpreting Standards of

Practice. International Medical Interpreters Association and Education Development
Center, Inc. Viewed March 19, 2009. (http://www.imiaweb.org/uploads/pages/102.pdf)
U.S. Department of Health and Human Services Office for Civil Rights. Limited English
Proficiency. U.S. Department of Health and Human Services. Viewed March 17, 2009
(http://www.hhs.gov/ocr/civilrights/resources/specialtopics/le

Office of Minority Health. 2000. National Standards on Culturally and Linguistically

Appropriate Services. U.S. Department of Health and Human Services. Office of Minority
Health. Viewed November 10, 2009
//www.omhrc.gov/templates/browse.aspx?lvl=2&lvilID=15 )
California Healthcare Interpreters Association. 2002. California Standards for Healthcare
Interpreters. California Healthcare Interpreters Association. Viewed November 10, 2009.
(http://chiaonline.org/images/Publications/CA standards healthcare interpreters. pdf)

179
Additional Training

Lastly, interpreters should consider taking additional trainings. This is called continuing education

(CE). Almost any training will help enhance an interpreter’s skills, but interpreters can maximize

their learning in trainings by pairing them with shadowing experiences with experienced

interpreters, and by focusing on a particular field of interest in interpreting.

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 SECTION 32: The Importance of Becoming Certified
Learning Goal

After successful completion of The Importance of Becoming Certified Section, participants will
know the importance of becoming a certified medical interpreter instead of a qualified medical
interpreter.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Learn the main differences between certificate and certification, qualified vs certified.

e Know the two organizations (CCHI and NBCMI) that certify medical interpreters who speak

certain languages.

e Know the differences between the two organizations (CCHI| and NBCMI) that certify

medical interpreters.

e Learn important tips on how to be certified.

Important terms and words

CCHI and NBCMI

Certified Medical Interpreter (CMI)

Certified Healthcare Interpreter

(CHI)

Certification

Credentialing Excellence

prestigious credential

Core Certification Healthcare

Interpreter™ (CoreCHI™)
ae eS eee eee ee ee

The Liberty Language Services Medical Interpreting Course is a foundational course that gives

qualifying students either a completion or attendance certificate at the end of the course. This

181
certificate should not be confused with certification, which means passing one of the two major

tests administered for medical interpreters in the United States.

What is Certification?

The Institute for Credentialing Excellence (formerly NOCA), established by Congress to

develop standards for quality certification in the allied health fields, says,

The certification of specialized skill-sets affirms a knowledge and experience base for

practitioners in a particular field, their employers, and the public at large. Certification

represents a declaration of a particular individual’s professional competence.

Source: https: www.ncihc.org/certification

What is definition of the healthcare medical interpreting certification?

According to The National Board of Certification for Medical Interpreters website, the healthcare

medical interpreting certification is the most prestigious credential which is considered an entry-

level certification for medical interpreters who meet industry-standard educational

requirements and pass a written and oral examination. These exams test adequate knowledge

of the medical interpreting profession, including ethics, standards of practice, role boundaries

and medical terminology, among other important competencies; (Program Overview —

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MemberClicks (https://nbcmi.memberclicks.net/overview). The National Board of Certification
for Medical Interpreters website: https://www.certifiedmedicalinterpreters.org/overview.

These tests are offered by the National Board of Certification for Medical Interpreters

(NBCMI) or Certification Commission for Healthcare Interpreters (CCHI) Certified Healthcare

Interpreter (CHI). We will discuss the differences between both of them shortly.

Making Certification Your Goal

Professional certification is an important mark of a profession, as it means there are officially

accepted and recognized mechanisms to certify that an individual is competent to practice a

particular profession. While national certification has been available to medical interpreters since

2009, interpreters are not required by law to be certified to interpret. However, many healthcare

organizations are requiring it or listing certification as a preference. Certification allows

interpreters to prove to agencies and providers that they are competent and knowledgeable in

interpreting. Additionally, certification often allows interpreters to charge higher rates.

All medical interpreters should make certification an important career goal. Working towards

certification and maintaining certification helps interpreters improve.

In the United States, the two major agencies that offer national certification are the Certification

Commission for Healthcare Interpreters (CCHI) http://cchicertification.org/ and the National Board

of Certification for Medical Interpreters (NBCMI) https://www.certifiedmedicalinterpreters.org/.

While interpreters just need to get certified by one organization in order to be called a certified

interpreter, some interpreters have decided to become certified by both organizations to

differentiate themselves from other colleagues and gain a marketing and branding advantage.

Differences between the CCHI and NBCMI Certification Programs

According to its website, CCHI offers two national credentials for medical interpreters: the Core

Certification Healthcare Interpreter™ (CoreCHI™) and Certified Healthcare Interpreter™ (CHI™).

The CCHI written exam evaluates an interpreter’s knowledge about healthcare interpreting. It is

in English and has 100 questions total from the following topics: professional responsibility and

183
interpreter ethics, managing the interpreting encounter, healthcare terminology, US healthcare

systems, and cultural responsiveness. CCHI offers the CoreCHI™ credential to all interpreters who

do not interpret into Arabic, Spanish, and Mandarin. To obtain the CoreCHI credential, the

candidate must pass the CCHI written exam only.

The CHI Credential is offered to those that interpret into Arabic, Spanish, and Mandarin, and

requires candidates to pass the written CCHI exam and also to pass the oral CCHI Exam, which

evaluates an interpreter’s skills in interpreting in healthcare. The oral CCHI exam includes

consecutive, simultaneous, and sight translation modes. In order to receive the CHI™ credential

an interpreter needs to pass both the oral and the written exams. The CCHI credentials last four

(4) years.

According to the NBCMI website, NBCMI offers one credential, the Certified Medical Interpreter

(CMI) credential. The NBCMI written exam tests adequate knowledge of the medical interpreting

profession, including ethics, standards of practice, role boundaries and medical terminology,

among other competencies. It is important to note that 75% of the exam relates to medical

terminology. As of the date of publishing, the oral exam is offered in six languages: Spanish,

Cantonese, Mandarin, Russian, Korean, and Vietnamese. The oral exam includes consecutive and

sight translation modes. In order to receive the CMI credential an interpreter needs to pass both

the oral and the written exams. The NBCMI CMI credential lasts five (5) years.

Both organizations require continuing education units (CEUs). IMIA requires 30 hours of

continuing education in 5 years CCHI requires 32 hours of continuing education in 4 years. Both

require certificates or other proof of completion of CEUs in order to recertify.

Some Advantages of Certification

m More assignments

m Higher pay

m Greater variety of assignments

m Easier way to prove your training

m Preparation helps you improve

184
Additional Tips to Prepare for Certification

m Set long-term goals

Many interpreters start preparing a year or more in advance }

m Buy preparation materials

Many authors have written preparation materials, not only Holly Mikkelson

(https://www.middlebury.edu/institute/people/holly-mikkelson)

m Ask someone to hold you accountable

You are more likely to achieve your goals when you are responsible to someone

m Don’t be afraid to ask for help!

Many of your colleagues are struggling or have struggled with the same problems

185
 SECTION 33: Liability Insurance
Learning Goal

After successful completion of the Liability Insurance Section, participants will know how to get a
liability insurance as professional interpreters.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Learn and explain the interpreters’ liability insurance that can cover them in case of

Omissions or errors.

Important terms and words

liability coverage for errors and atgef

“3s “a ie
omissions
% ws
claims process
\‘

Few interpreters immediately think of being sued when starting their careers (and statistics show

that few interpreters are in fact sued). Nevertheless, many interpreters, agencies, and parties

prefer to have or work with interpreters who have liability coverage for errors and omissions.

When choosing liability insurance coverage, be sure to ask about exclusions, deductibles, and the

claims process. Some insurance companies will take an active role in litigation if you are ever sued;

others will not.

Liability insurance is more broadly a part of how you want to present yourself to agencies,

freelance clients, and other interpreters: does your brand carry a guarantee of accuracy, and can

you back up that guarantee with insurance?

186
 SECTION 34: Self-Monitoring and Self-Assessment
Learning Goal

After successful completion of the Self-Monitoring and Self-Assessment Section, participants will
know how to perform self-monitoring and self-assessment on a daily or weekly basis to help
them grow professionally.

Learning Objectives: -

Using the above goals, participants should also be able to do the following upon successful
completion of this section:

e Learn and explain all the self-monitoring and self-assessment techniques that they can

perform on daily or weekly basis to increase self-esteem and help them grow

professionally.

e Learn how to make their goals SMART.

Important terms and words

self-monitoring and self-assessment

shadowing

Measurable, Attainable, timely y

Acronym

Professional athletes exercise daily, and serious language-learners speak and learn daily because

both groups know that they need to always be improving to reach their goals. Just like a

professional athlete or serious language-learner, you can set goals and improve regularly.

First, a goal that is not written is merely a dream. Take the time to sit down and write out your

interpreting goals. Some of those goals may include learning field-specific vocabulary (e.g. medical

terminology), becoming certified, interpreting for a certain number of hours per week through

187
shadowing other interpreters, practicing note-taking outside of interpreting sessions, or other

means that will help you achieve all your professional goals.

When setting goals, always make your goals SMART:

Specific,

Measurable,

Attainable,

Relevant,

and Timely.

Specific goals are expressed in a way that makes it easy to determine what you are aiming for. “|

want to get better at note-taking” is not a specific goal, but “I will practice note-taking by listening

to recorded speeches” is specific. Next, make sure your goal is measurable. In the previous

example, you might add a time element such as “for 15 minutes per day.” Depending on your goal,

you may instead opt to measure an outcome such as “learn five new medical terms per day.”

Third, attainable goals are those that push you to improve without making you feel overwhelmed.

Be excited about your goals, but do not be too hard on yourself when you fall short. No one meets

100 percent of their goals. Part of self-assessment is accepting yourself for who and where you

are on your professional path and adjusting your goals to be more attainable as you learn.

The last two letters of the “SMART” acronym stand for relevant and timely. Relevant goals focus

on your needs as an interpreter. If you already have great note-taking skills, for example, you will

not need to set goals to learn about note-taking (although it may still be appropriate to practice).

Timely goals, on the other hand, are those with an appropriate deadline. When setting a timely

goal, you might include language such as “for the next three months” or “by June 1.” Lastly, involve

a friend or close colleague in your goals and report to them when appropriate. You are more likely

to follow through on your goals when you are accountable to someone else.

188
Goal setting is a skill that requires practice and patience
l just
l like exercising,
isi languag
age-learning, and

l
interpreting. As you improve your goal-setting skills, your interpreting skills will also benefit.

189
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192
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The Professional Medical Interpreter

This book was created for the aspiring medical interpreter who wants a complete and
comprehensive course based on accreditation standards for medical interpreting education. It
is also for those who are seeking to complete a course that will serve as pre-requisite for CMI
and CHI certification.

Developed by Liberty Language Services, an interpretation agency that also trains

professional medical interpreters, this course was developed for the modern-day interpreter
working in the 21st century. The medical interpreting profession has come a long way over the
past 20 years, and we have created a course that includes the necessary skills and knowledge
to perform as a trained and qualified medical interpreter.

A comprehensive textbook that presents the required knowledge and skills required to
‘become a professional medical interpreter. Readers will learn about the roles of the
interpreter, code of ethics, and how to perform as an interpreter from Nha acta al to
managing the flow of an interpreted session.

Aspiring interpreters can find all they need to know to begin their journey as a professional,
trained and ence medical interpreter.

The field of medical and healthcare interpreter training has been evolving. We have included
an innovative chapter written by Dr. Cynthia Roat on message conversion—the mechanics and
how to of converting a spoken message from one language to another. The role of the medical
interpreter as cultural broker has also been debated and has evolved to include the
undeniable fact that medical interpreters serve as mediators of intercultural communication.
Aspecial emphasis on intercultural mediation, which is the contribution from leading expert in
medical interpreting, Dr. Izabel de Souza.

Being an interpreter requires confidence and the aspiring interpreter can use this book and
accompanying course to that, they will learn all that is needed to perform successfully as an
interpreter. Interpreters mediate intercultural communication between people. Interpreters
do more than transfer information from one language into another. There is a distinct cultural
aspect, which is also taught, for students to gain awareness about this role also known
historically or traditionally as cultural broker. .

LIBERTY INM
| ISBN 9798701223101

| LANGUAGE SERVICES