Will greed win over quality medical interpreting in the middle of a pandemic?

September 9, 2021 § 4 Comments

Dear colleagues:

On May 15, 2021 the Certification Commission for Healthcare Interpreters (CCHI) released a study suggesting that an English-to-English exam might solve the shortage of healthcare interpreters in what they call “languages of lesser diffusion,” meaning languages other than Spanish, Arabic or Mandarin. The reason for this “sui-generis” affirmation is very simple: developing actual interpretation exams to test candidates on simultaneous and consecutive interpreting, and sight translation in both: source and target languages would be too expensive and therefore not profitable. Interesting solution: examine candidates’ English language skills (reading comprehension, medical concepts, fill-in the blanks, and what they consider can show the candidate’s “potential correlation with overall interpreting ability”: “listening comprehension.”) An English only exam will catapult an individual into an E.R. to perform as an interpreter without ever testing on interpretation!

What about native English speakers, who in the study scored an average of 87.9% compared to non-native speakers, who scored an average of 76.6%? No problem, says CCHI; passing score is 60% and Spanish language interpreters will continue to take the interpretation exam already in existence. I suppose the expectation might be that people who speak other “languages of lesser diffusion” in the United States have a higher academic background and their English proficiency is higher. Another point that makes this “solution” attractive is that most interpreter encounters in hospitals, offices and emergency rooms involve Spanish speakers, which brings the possibility of lawsuits for interpreter malpractice to a low, manageable incidence. I would add that many people needing interpreting services will not even consider a lawsuit because of ignorance, fear or immigration status. The good news: CCHI concluded that although this English-to-English exam option “is a promising measure…(it)…requires additional revision and piloting prior to use for high-stakes testing.” (https://slator.com/can-a-monolingual-oral-exam-level-the-playing-field-for-certifying-us-interpreters/)

Reading of this report and the article on Slator got me thinking about the current status of healthcare interpreting in the Covid-19 pandemic. How long will the American healthcare system ignore that the country is everyday more diverse and in need of professional, well-prepared healthcare interpreters in all languages? The answer is difficult and easy at the same time.

A difficult answer.

It is difficult because we live in a reality where every day, American patients face a system with very few capable healthcare interpreters, most in a handful of language combinations, and practically all of them in large and middle-sized cities. The two healthcare certification programs have poor exams. One of them does not even test simultaneous interpreting, and the other tests a candidates’ simultaneous skills with two 2-minute-long vignettes (one in English and the other in the second language). Consecutive skills are also tested at a very basic level with four vignettes of twenty-four 35 or fewer-words “utterances” each. It is impossible to assess somebody interpreting skills with such an exam after just 40 hours of interpreter training. (https://cchicertification.org/uploads/CHI_Exam_Structure-Interface-2020.pdf).

Except for those interpreters with an academic background or prepared on their own because they care about the service they provide, the current system provides a warm body, or a face on a screen, not a healthcare interpreter. Because the motivation is a robust profit, it is conceived and designed to protect the interests of insurance companies, hospital shareholders, and language services agencies. It has been structured to project the false impression these entities are complying with the spirit of the law; It is not designed to protect the physician or the patient.  

In 1974 the United States Supreme Court ruled that failing to provide language support for someone with limited English proficiency is a form of discrimination on the basis of national origin (https://www.federalregister.gov/documents/2000/08/30/00-22140/title-vi-of-the-civil-rights-act-of-1964-policy-guidance-on-the-prohibition-against-national-origin).  The ruling was later broadened and implemented by the Americans with Disabilities Act (ADA) (https://www.ada.gov/effective-comm.htm) and the Affordable Care Act (ACA) commonly known as “Obamacare.” (https://www.hhs.gov/sites/default/files/1557-fs-lep-508.pdf) This legislation specify that healthcare organizations must offer qualified medical interpreters for patients of limited English proficiency and those who are deaf or hard of hearing.

An easy answer.

Despite the reality we face, the answer to the question above is easily attainable because the healthcare industry has immense financial resources and a system that lets them capture money at a scale no other industry can.

The healthcare sector deals with the lives and quality of living of all individuals present in the United States. Their reason to exist is to save lives, not to produce ever-growing dividends to its shareholders every year. This is an industry that spends unimaginable amounts of money in medical equipment, state-of-the-art technology, physicians, surgeons, nurses, therapists, researchers, attorneys, and managerial staff salaries. New expensive hospitals, medical office buildings, clinics, laboratories, and rehab centers are built all the time. This industry can spend top money in those sectors because it is good for business. It is an investment that produces a profit. I am not even scratching the surface of these expenses, but even if we ignore the money spent in food, gear, vehicles (land and air), utilities, clerical staff, janitorial staff, and medical aide positions, we can safely conclude this is an industry that knows how to spend money when an expense is viewed as an investment that will produce a financial benefit.

Designing good medical interpreter exams in many languages is expensive, paying professional-level fees to healthcare interpreters will cost money, managing a continuing education program will not be cheap, but the healthcare sector cannot cry poverty. They have the funds to do it. It is incomprehensible how a business that bankrupts its patients after one surgery or a chronic disease can argue with a straight face, they can only pay 30 to 50 dollars an hour to a medical interpreter. This is an industry that charges you fifty dollars for a plastic pitcher of water or twenty dollars for a box of tissue they replace every day.

Quality interpreting, and living up to the spirit of the law, cannot happen when an organization spends money to look for shortcuts such as testing English-to-English in an interpreting program. Only the promise of a professional income will attract the best minds to healthcare interpreting. Current conditions, including low pay, an agency-run system, and searching for shortcuts to go around the law will never produce quality interpreters.

If those deciding understand good professional healthcare interpreters are an investment as valuable as good physicians, surgeons and nurses, the solution can begin immediately. Designing and administering a quality interpretation exam will take time, getting colleges and universities to start interpreting programs that include medical interpreting will not be easy, but there are steps that can improve the level of interpreting services right away.   

A higher pay, comparable to that of conference interpreters will immediately attract top interpreters in all languages, at least temporarily or part-time to the field. Many top interpreters see the need for quality services during the pandemic, and they feel a need to help, but they have to make a living and healthcare interpreter fees do not meet the mark.

Instead of thinking of English-to-English exams to create an illusion they are forming interpreters, stakeholders should recruit native speakers of languages where interpreters are hard to find, but they must stop looking for “ad-hoc” interpreters in restaurant kitchens and hotel cleaning crews, and start talking to college students and professors, to scientists and physicians from those countries who now practice in the United States. With current technology, hospitals should look for their interpreters among the interpreter community in the country where a language is spoken and retain their services to interpret remotely, instead of opening massive call centers in developing countries, using the technology to generate a higher profit instead of better quality.  

Hospital Boards must find the money and allocate it to interpreting services. In these cases, such as Medicaid and others, the cost of interpreter services should be considered an operating expense. Insurers do not reimburse for nursing and ancillary staff. Hospitals and practices pay their salaries.

Payers may also benefit by covering interpreter services. Although data are limited according to the Journal of the American Medical Association Forum, studies suggest that when physicians struggle to communicate with patients, they are more likely to order unnecessary tests and treatments. This not only puts patients at increased risk, but also directly increases payer spending. Limited English proficiency patients may need care more frequently or seek treatment in more expensive settings, such as the emergency room, when they cannot communicate with primary care providers. Similar to insurers in fee-for-service arrangements, risk-bearing provider groups in alternative payment models face a similar incentive to curtail unnecessary or wasteful utilization. Poor interpreting services will also result in malpractice lawsuits against hospitals, language service providers, insurance companies and medical staff. In the long run, by far, this makes investing in quality interpreter services and interpreting education/certification programs a smaller expense. “Paying for interpreter services, from cost-based reimbursement, to their inclusion in prospective payment models, to insurer-led contracting of remote interpreters, would not only address the disparities exposed by the pandemic, but also help support practices facing financial peril due to the pandemic.” (https://jamanetwork.com/journals/jama-health-forum/fullarticle/2771859) It is time to grow up and stand up to the stakeholders in the healthcare sector; it is time to unmask the real intentions of language service providers who take advantage of often-poorly prepared interpreters to get a profit. It is time to have a serious healthcare interpreter certification exam that really tests the candidate’s interpreting skills. We need university and college programs, and a different recruitment system led by hospitals and insurance companies not multinational interpreting agencies, or ill-prepared small local players. Interpreters cannot be made in 40 hours and we can’t have newly trained interpreters learning at the cost of real patients’ safety. The pandemic showed us the importance of healthcare interpreting, let’s seize the opportunity to professionalize it.

The other danger interpreters face during the COVID-19 pandemic.

March 23, 2020 § 7 Comments

Dear Colleagues:

At the beginning of the year it looked like we were on our way to a great professional future. The booming economy, new technologies and new clients coming into the interpreter services market gave us a feeling of security. Then, it all collapsed. Our shiny future disappeared overnight. The rapid propagation of COVID-19 throughout the world brought the economy to an almost complete halt. Conferences were postponed or cancelled, courthouses closed their doors, hospitals regular routines were dramatically transformed by the overwhelming demand for beds and medical staff. The airlines did not fly anymore, and we were told (sometimes ordered) to stay home. To most independent interpreters this meant a total loss of income for the foreseeable future, coupled with uncertainty, anxiety, and fear. Many of us have seen our source of income disappear, our savings go down, and the money we had, and our retirement funds diminish or vanish in less than a week.

This is the world where we live at this time: health risks, no reliable source of income, and a future nobody can yet forecast in the short and mid-terms.

Unfortunately, there is no time for lamentations; we must keep our minds on these basic goals: Stay healthy; help to stop the spread of this virus by following the rules, spend our money wisely, and protect our profession. Yes, dear friends and colleagues, at some point we will go back to our professional practice, and it is what we do now, during this pandemic, that will determine how we will work once this is all behind us.

Unfortunately, some unscrupulous entities have emerged to prey on our more naïve colleagues and on those who have been affected the most. A despicable multinational translation agency offers work at reduced fees because of the crisis; there is another one telling interpreters to offer remote interpreting services to their direct clients, set the “per-minute fees”, and “just” pay the agency 25 percent of the fee for the use of their platform. Other agencies from less developed countries are taking advantage of this crisis to enter developed economies and offer remote simultaneous interpreting from abroad, using interpreters being paid ridiculously low fees for their services.

Yes, dear friends, they are suggesting you charge “per-minute”, and a platform for 25 percent of your fee. Not even professional athletes’ or movie star’ agents make this money. They get 15 percent, and they represent and protect the interests of their clients. More for your money than just providing a platform.  And there are vendors all over the internet bragging in a celebratory manner they have been saying for a long time that remote interpreting was the future, the solution to all multilingual communication problems. Sadly, some colleagues are taking the bait.

Under current circumstances, regardless of the work you do, it could be tempting for healthcare, court, community, or conference interpreters to accept an assignment from one predator. A “per-minute” payment, a solo assignment, or a reduced daily fee may look good when you have nothing better on your schedule. Please do not do it. Taking these offers will sentence you to a life term of mediocre pay, to a career of second-class assignments, and to a terrible reputation among your peers. In other words: Nobody will ever recommend you for an assignment or willingly work with you again.

There are other ways to procure income without permanently damaging your career: The first thing you need to do is contact all your direct clients, in a tactful way, let them know you are here to help them through these terrible times, and ask them for a time to talk on the phone or chat online about possible solutions.

Then, contact other entities and individuals you have worked with. If you work with a business five years ago through an agency, contact them and offer your direct services for a real professional fee.

Finally, be creative, look around and see who in your immediate universe could benefit from the services of a professional interpreter.

Even if you are working remotely, you must charge your regular professional daily (not per-minute or hourly) fee, plus expenses (depending on the service). If you have to do in-person or on-site interpreting, therefore leaving your house and be exposed to the virus, charge an extra high-risk fee. Do not feel bad about it. This is what professionals working in high risk areas (war zones, high-crime countries, etc.) have always been paid. Look at today’s news and you will see how all big companies are paying an added bonus to their employees who have to work outside their home. The client may cry first, but after a good explanation they will comply. If not, do not work for that client. Obviously, they do not care about you, so why should you care about them?

Currently, in our world, there is a difference between this anomaly’s “reality”, and true reality. During these exceptional times we must satisfy our clients’ needs, make a living and keep our client base.

At this time, we should contact our clients to tell them there is an option, and explain to them that remote simultaneous interpreting is better than noting: it will keep everybody safer, and it will solve urgent and immediate issues. We have to warn them about the voices preaching remote simultaneous interpreting as the salvation of globalization. We must be polite when talking to our clients at this time, always remembering they have problems bigger than remote vs. in-person interpreting. They are trying to save their businesses.

We need to be clear, but we should not lie. We can explain that remote simultaneous interpreting is a viable option for certain business meetings and negotiations, but not for them all. When confidentiality due to the information exchanged, or face-to-face negotiations are necessary to close a deal, in-person interpreting must continue.  We have to let them know of the many risks they would face when using remote simultaneous interpreting for a big or important event. Technology, geography, weather, physics (speed of sound) and lack of visual clues for the interpreters will be risks they need to consider. Tell them of the events that have failed. Platform vendors and interpreting agencies will not address these situations. A good example everyone can understand is the bad experience the Biden campaign went through several days ago when attempting to do a virtual event. (https://www.cnn.com/2020/03/13/politics/joe-biden-virtual-town-hall-technical-trouble/index.html)

Also explain the risks involved in remote simultaneous interpreting when the interpreters are working from a developing country (Please see my post: https://rpstranslations.wordpress.com/2019/10/17/the-very-real-dangers-of-remote-simultaneous-interpreting-from-our-home/)

You have to make sure your clients understand remote interpreting is appropriate during the crisis, but it cannot be adopted as the preferred option once things go back to normal. We must underline that even when remote interpreting may be a solution, it should not be done from a person’s home, and never by a single individual.

These steps should be taken by all interpreters:

Non-negotiable rule: Absolutely no chuchotage!

Keep your distance at all times. There will be little escort interpreting at this time, but all whispered interpreting, escort, during a press conference, or elsewhere is out of the question. Portable interpreting equipment like the one used by tour guides and court interpreters should be used. Make sure the client’s headphones have disposable protective guards, and dispose of them after every event or when you switch users. For health reasons, I suggest you ask the client to rent the equipment, but if you have to use your own, please charge extra for the equipment, disposable protective ear guards and microphone guards, and disinfectants.

Healthcare interpreters.

If you are a healthcare interpreter, right now you should be working from home using a computer, a tablet, or a telephone. Most reputable hospitals are already following this practice, but even if they have not instituted it, you must set it as one of your working conditions. These are extraordinary times. If it has been good for remote town in Alaska during all these years, it has to be good for New York City or Chicago today. If your physical presence is absolutely necessary, wear safety gear furnished by the hospital (no gear = no interpreter. Sorry) try to work from a different room in the hospital, and if you must be in the same room as others, keep your distance and use portable interpreting equipment provided by the hospital. If someone needs to get closer to the patient because it is hard to hear what they say, let medical staff do it. In the worst possible scenario, they can put a cellular phone by the patient’s mouth so you can hear on another phone at a safe distance. Please remember to charge for your services as described above. Please see AIIC best practices for remote simultaneous interpreting during the COVID-19 crisis below under “Conference Interpreting”.

Community Interpreters.

There is no reason for community interpreters to be providing in-person services. All work can be rendered by phone or video. Schools are out almost everywhere in the world, and government agencies that provide social services and benefits can call you at home for you to interpret for an applicant or benefit recipient. Here again, please charge. Please see AIIC best practices for remote simultaneous interpreting during the COVID-19 crisis below under “Conference Interpreting”.

Court Interpreters.

Most courthouses have continued hearings and trials worldwide, but there are some court appearances that must take place even during toe COVID-19 pandemic. For these services, interpreters must demand remote work, even if it has to be via telephone and rendered consecutively. Most hearings will be short as they will likely be constitutional hearings (arraignments, bond redeterminations, conditions of release, protective orders, probation violations, etc.) if an interpreter is asked to appear in person, all work must be performed using the court’s interpreting equipment (portable or fixed depending on the venue) and under no circumstance interpreters should agree to close contact with victims, defendants, petitioners, plaintiffs, respondents, or witnesses.

Jails, prisons, detention centers, and immigration courts carry additional risks and interpreters should refuse work, unless it is remote, at these locations. Like all others, court interpreters should charge their professional fees as mentioned above in this same post. Please see AIIC best practices for remote simultaneous interpreting during the COVID-19 crisis below under “Conference Interpreting”.

Conference interpreters.

Always remembering everything discussed above about remote simultaneous interpreting, conference interpreters must be very clear when talking to their clients.

First, they should try to convince the client to postpone the event until it is possible to do in-person interpreting, only doing what is necessary to keep the business running and protect the company, its customers, and its employees. It is very important we emphasize that the service we are about to provide is an anomaly. We have to explain to the client that the conditions will not be the best, that even with the best platforms, the interpreters will be working from home, not a soundproof booth, and they will not have on-site technical support. The client needs to know there may be interruptions to the electric power, interference by other internet users, background noise coming from next door, or because your children and dogs are at home, even if they are in a separate room. Explain that you can use one of the free platforms, a paid platform you already use for other things, or that you could download and install another one they may prefer as long as they pay for it. Something as simple as Skype can save the day under these circumstances. Remember that it is unacceptable to do a remote interpretation lasting over 30 minutes without a booth partner (at least a virtual booth partner somewhere else in the world).

Before you provide the service the client must sign a written contract where you will detail your daily fee, the total hours you and your teammate will work per day, overtime fees, and a cancellation clause which must include postponements or cancellations for force majeure (sometimes half of the total fee, sometimes the full fee depending on the time you are notified of the postponement or cancellation. Under these conditions cancellations will be on short notice, so the fee must be a full amount). Your contract must include a release of liability where the client and all others participating in the event, directly or indirectly, release all interpreters of any liability due to any events or circumstances related to the remote service. Also, include that only the law and courts of your country will have jurisdiction over the contract and event. That way you eliminate the need for foreign or international law attorneys and overseas litigation if this happened. Finally, inform your client of all best practices for remote simultaneous interpreting by AIIC (even if you are not a member), and do your best to adhere to them all. (https://aiic.net/page/8956/aiic-best-practices-for-interpreters-during-the-covid-19-crisis/lang/1)

You have to keep in mind that there is a difference between RSI platform providers and interpreting agencies. Always go for the platform providers with your direct clients. Here you are in charge. It is less desirable, and even discouraged, to do RSI through an agency. They will call the shots, communicate with the client, and negotiate your pay with their client, always looking after their own margins. I will soon deal with this issue on a separate post.

Please turn down low paying jobs. They insult our profession. Before selling your soul to an agency, try the strategies I suggest above. Be polite, professional and show empathy when you talk to your clients. Whenever possible, try to help a colleague by referring them to an assignment you cannot or will not take. More important, be patient, stay home, and stay healthy.

I now invite you to share your thoughts about this “other” very real danger we face as interpreters at this time.

Interpreters: Your clients, and your clients’ clients.

June 4, 2018 § 8 Comments

Dear colleagues:

I get goosebumps every time I hear freelance interpreters talk about their “boss”. I am constantly surprised at the huge number of independent contractor colleagues who refer to the authorities at the agencies, hospitals and courthouses they provide interpreter services for as their bosses.

This is an abomination when used to describe the other party to a professional services contractual relationship, now exacerbated by the very dangerous ruling by the United States National Labor Relations Board (NLRB) in SOSi where it ordered this interpreting agency to reclassify its interpreters working as independent contractors as employees. SOSi is appealing the decision, and we will discuss it in depth on a future post.

Our concern today is the conscious or subconscious lack of understanding of the professional services relationship derived from a contract where an independent interpreter is the service provider.

Freelance interpreters are independent professionals who provide their services for a fee. The terms of such services and fees are agreed upon by the interpreter providing the service and the individual or corporation recipient of the interpreting services in a contract. The parties to this contract are: The professional (who provides the interpretation, in other words, the interpreter) and the recipient of the professional service, called the client.

Yes, dear friends and colleagues, as freelance professional interpreters we provide our services to a counterpart called the client. Our main contractual duty is to render the interpreting services as agreed with the client, and the client’s main obligation is to pay the agreed fee in exchange for those services. The contract is called: Professional services contract.

Freelance interpreters are independent professionals free to choose the clients they want, under the terms they see fit, and for the service they picked. There is no authority figure over the freelance interpreter. All duties, responsibilities and obligations are contained in a voluntary contract (oral or written), a professional code of ethics, and the legislation governing the profession in a particular jurisdiction.  Client and interpreter are equals. There is no boss.

Bosses exist in labor relations where a part: the employee, is in a subordinate position to the other: the employer or boss, who gives directions, orders, and instructions to the subordinate who must comply with these commands during working hours, in exchange for a fixed wage. Employer and employee are not equals in this relationship. An employee cannot choose what she does. If she does not comply she will be sanctioned and even fired.

Webster states that: a client is “… a person who engages the professional advice or services of another…” Oxford tells us that a client is “…a person or organization using the services of a lawyer or other professional person or company…”

Interpreting is a profession. Interpreters perform a professional service. Interpreters, like all professional service providers, have clients.

Here we see then that we must not call a client a boss because it is inaccurate, and it immediately puts the interpreter at a disadvantage. Calling your client “boss” creates a subservient relationship in your mind that will quickly translate into an attitude and lifestyle. It paralyzes the interpreter as she or he will no longer feel capable or worthy of arguing work conditions, professional fees, or assignments.

For those of you who see judges, doctors, court and hospital administrators, and language service agencies: Eliminate that thought. It is wrong. They are your clients, and you can negotiate and refuse assignments when you consider it appropriate.  Your duties and responsibilities to do a professional top-notch job come from the contract, the legislation, and from your professionalism. You do a good job because you are a professional who wants to provide a good service because you want to keep the client, or you just want to do the right thing. You don’t do it because you have somebody breathing on your neck looking over your shoulder micromanaging everything you do. You do not need someone telling you how to dress for an assignment, or reminding you to get there on time. However, as long as you see the client as your boss, they will act as your employer.

Professional interpreters have clients and charge professional fees. They do not charge rates. A commercial product vendor or a non-professional service supplier do not have clients. They have customers. A customer buys goods or non-professional services from a business. Webster defines them as: “…one that purchases a commodity or service…” Oxford gives more details when it tells us that a customer is “…a person who buys goods or services from a shop or business…” Unlike professionals, these merchants get a rate or a price in exchange for the goods or non-professional services purchased.

Physicians and dentists are professional service providers, so they technically have clients, but for historical reasons, and due to the nature of their services, these service recipients are called patients. According to the American Medical Association’s Code of Ethics (AMA), physicians must be “…dedicated to providing competent medical care, with compassion and respect for human dignity and right.” It also considers that people with an illness must wait to see a doctor or to be treated, and that requires patience. Webster indicates that a patient is “…an individual awaiting or under medical care and treatment…”  To Oxford it is “…a person receiving or registered to receive medical treatment…”

I have observed how many freelance interpreters have a hard time separating their client from others who may participate in the process like vendors and providers. The convention center or hotel events center are not the interpreter clients, they are vendors who provided the facility so there can be a conference. Unless the interpreter hired them directly, they have no contractual relation with the interpreter. They are the interpreters’ clients’ problem. The same can be said for the technical support: booths, interpreting equipment, sound system, etc. Unless they were hired directly by the interpreters, these are also suppliers who have a contract with the interpreters’ client, not with the interpreters. They are not your problem either.

Another common mistake is to confuse the direct beneficiary of the interpretation with the interpreter’s client. Usually, they are not your client. The five hundred people in the auditorium listening to your rendition are the direct beneficiaries of your professional rendition. Without you they could not attend the event; however, they are not your clients. They are your client’s clients. As professionals we must accommodate all reasonable requests by the audience and the speakers, but they are not the ones paying your fee. They are paying your client because they are your client’s clients. For this reason if a person in the auditorium asks you to speak louder, you may consider the request, and even honor it when reasonable; but if somebody attending the conference asks you to take a recorder to the booth and record the rendition for him, you will decline, and direct him to your client (please read my blog post on what to do in this situation).

Dear friends and colleagues, as professional interpreters who provide our services as freelancers we have many clients we choose. We decide who we want as our client, and who we do not. We have the last word on whether we do an assignment, and when a professional relationship with a client must end. We set and negotiate the terms of our work, our pay, and out booth mates.  Employees do not get to do this because they have a boss: the employer. We do not. We practice in a world where we are equals with our counterparts in a professional contractual relationship. We do a magnificent job, we accommodate all reasonable requests of our clients’ clients, and we cooperate and support other providers and suppliers such as facility workers and technical support staff, but we do it because we are professionals and we have made a business decision to keep the client we want to keep, not because we are told to do so. Please stop referring to your client as your “boss”, and the next time a project manager tells you what to wear to an assignment, to be on time; or the next time a hotel waiter tells you not to have a cup of coffee, please stand up for your dignity and that of the profession. I now invite you to share your thoughts on this issue.

Is it medical interpreter, or healthcare interpreter?

June 26, 2014 § 5 Comments

Dear colleagues:

I have struggled with the issue of how to refer to a growing number of our colleagues whose work mainly takes place in hospitals, clinics, or medical and dental offices. Their primary function is to enable communication between a person who does not speak the language of the land and a healthcare provider: physician, dentist, nurse, psychologist, paramedic, and other support staff. As you all know, this area of interpretation has been around for some time, but it has just become formally regulated in the recent past. Because of globalization and its migration consequences, now many countries experience the need to have somebody to bridge the gap of communication that has developed between native speakers and immigrant communities. These developments have augmented the need for court interpreters, legal translators, school interpreters and many others; the healthcare field has not been an exception; in fact, this is the area where we can appreciate the most dramatic changes to the old “business as usual” format. Unlike other interpreting specialties, like conference, military and court interpreting, which have been around for a long time, these new service providers just organized a few years ago. Great efforts and devotion on the part of some individuals have produced important results like the creation of professional associations, the adoption of ethical and professional responsibility canons, and the development of certification programs and examinations. This is truly admirable.

There are two organizations in the United States that have emerged as standard-bearers of this profession: The International Medical Interpreters Association (IMIA) which endorses the National Board of Certification for Medical Interpreters exam, and the Certification Commission of Healthcare Interpreters (CCHI).

Keeping in mind the services provided by these professionals (based on the organizations’ websites, several hospitals’ information, and conversations with many of my esteemed colleagues) I reviewed all information I could find on the two certification exams that test English, professional conduct and ethics. To a lesser degree they test some medical-related vocabulary that a true bilingual individual should know, without any medical or pharmacological terminology studies, and they include very short paragraphs, or vignettes as one of the test refers to them, where patient and healthcare provider communicate regarding the symptoms that the non-native speaker is experiencing. The dialogue is an everyday conversation at a moderate to low register. Finally, I also noticed that the main part of the score overwhelmingly goes to the consecutive interpretation, leaving simultaneous and sight translation at about 10 to 15 percent each.

I am convinced that the work these colleagues do is essential to the healthcare industry and well-being of those individuals who otherwise would see their chances of receiving appropriate services diminished by reason of the language they speak. Nobody is disputing this. I also applaud the conditions under which they constantly work in hospitals, emergency rooms, and urgent care facilities where people perform under great stress. The writing of this post was simply motivated by my need to find a term I can feel comfortable with when referring to my colleagues, but before I am ready to form an opinion I should also consider what the rest of the world is doing and saying on this issue.

In Europe the services performed by our medical interpreters are part of what is known as public service interpreting or community interpreting in some countries. This public service interpreting also covers legal interpreting but not court interpreting as I will explain in a moment.

Public service interpreting refers to those services provided by an interpreter to help two individuals who speak different languages so they can communicate regarding everyday affairs, personal issues, including important topics, in cases when individuals who speak the same language would usually speak for themselves, but in this particular situation, because of the language difference, and cultural considerations, an interpreter is needed.

My dear friends and colleagues, conference interpreters provide their services to make it possible for individuals who do not speak the same language to communicate, by interpreting almost exclusively on the simultaneous mode, complex information at a high register. Their audience is usually formally educated. Court interpreters provide their services in cases when one or more individuals do not speak the language employed in court, to make it possible for officers of the court, litigants, jurors, and others, to communicate on the simultaneous, consecutive, whispered, and sight translation modes, everyday information, complex legal concepts and terminology, and expert witness testimony, at a variety of register levels.

Now I ask you to contrast these job descriptions with the job that public service interpreters such as school interpreters, welfare services interpreters, church interpreters, and community organization interpreters do. These professionals (and sometimes paraprofessionals that may include a family member) provide their services so that individuals who do not share the same language can communicate about important everyday matters such as parent-teacher conferences, services provided by religious organizations, and dealings with government agencies at the customer service window or over the phone. This work is almost exclusively performed on the consecutive mode, unlike court interpreting, and there are no formal rules to keep the interpreter from asking questions and give explanations to facilitate the communication. The main objective is to bridge the language gap without any consideration for rules of evidence or procedure. These interpreters can interrupt the parties and ask them to speak slower or in shorter sentences. While conference and court interpreters work with complicated and sometimes rarely used words as part of their everyday job, public service interpreters work with common vocabulary; not simple words, but words that anyone with a certain level of formal education, regardless of any interpreting training, should know.

This explains why we occasionally see conference interpreters in the courtroom and court interpreters in the booth. It also explains why conference interpreters, and not medical interpreters, interpret medical and pharmaceutical conferences; and why court interpreters, not medical interpreters, interpret the expert testimony of a pathologist or other medical professional during a trial.

I mentioned earlier that there was a difference between court and legal interpreters in many countries, and why the latter are considered public sector interpreters: A court interpreter provides her services in a formal court setting and during out of court events that are related to a current or future court or legal proceeding. A legal interpreter assists an individual who needs help with his dealings with the authority, such as getting a driver’s license, applying for government benefits, or requesting government documents. These interpreters are clearly outside the scope of the very strict canons of ethics and professional responsibility that govern the activity of court interpreters. Just as we may encounter a conference interpreter in court or a court interpreter in the booth, we may find a school interpreter or a medical interpreter in a government agency assisting a foreign language speaker with some excruciating government administrative process. I hope the example clarifies the issue, but I also ask you to look at this very carefully, because there are some who would like to assimilate the services provided by a court interpreter outside a courtroom to those of a public service or community interpreter; they would argue that these services are “legal” and not court services. They are wrong.

They are wrong because the terminology of legal versus court interpreter that was valid in the past does not apply to our globalized world. When most countries had a written legal system there was very little work for a court interpreter. In those days legal translators did most of the court work because everything was done in writing. Legal interpreters were then relegated to in-office interviews and customer service windows. If you consider that migration was less popular than it is now, then you would have a very low demand for court or even legal interpreters. Lack of migration did not impact legal translators who had to translate official documents, contracts, deeds, and many other written statements that originated within the other country. At the time the legal interpreter was really a community or public service interpreter. That reality is so different from ours. Presently, an interpreter who works before an administrative law judge, such as an immigration court, workers’ compensation court, or social security court, is subject to the same ethical and professional rules as the court interpreter who appears before a traditional court. The fact that some jurisdictions allow for non-certified or licensed interpreters to provide their services in administrative law courts does not mean that community interpreters should do the job. These courts still abide by rules of evidence and procedure, the interpreter has to act as if working before the traditional judiciary, the job must be done at a higher register, with specialized complex legal terminology, and on a simultaneous interpreting mode that does not allow to stop the procedure so the interpreter can request the litigants to slow down, or a consecutive rendition where the interpreter cannot ask the parties to speak in shorter sentences. The same can be said for civil depositions, jailhouse visits, and the transcription of wiretaps. On the other hand, those individuals who are appearing before the motor vehicle office are better off employing the services of a community interpreter because this professional knows more about handling situations where the interpreter has the freedom to step outside the box to achieve communication between the parties.

After considering all of these concepts and possible scenarios, and after reviewing the materials I have mentioned before, I understand that there are arguments to be made for the term medical interpreter, but I just do not believe that in my book that would be accurate. I think that the appropriate and accurate way to describe this very important segment of our profession is the one adopted by the Certification Commission of Healthcare Interpreters (CCHI). For this reason, I believe that we should call our colleagues Healthcare Interpreters instead of Medical Interpreters. Please let us all know your comments on this issue that to some may seem irrelevant, but is actually very important.

Some medical interpreters need to feel and act like professionals.

November 5, 2012 § 14 Comments

Dear Colleagues,

For some time I have wanted to write about the medical interpreter profession, it seems like for the last several months I have run across more medical interpreter colleagues, I have talked to more of my friends who work as medical interpreters, and I have read more about medical certifications than any other emergent area of the interpreter profession.  I congratulate all those who have fought so hard for recognition, professional development, and certification. You are on your way to a great future.

However, and despite of the immense respect I have for medical interpretation, not everything I see looks so bright in the future of medical interpreters.  Just as I have come across all the good things above, I have also seen how many medical interpreters do not feel or act like professional interpreters yet. Even some who have passed one of the certification examinations continue to act, and react, in a way that will not help the advancement of medical interpretation.  As you know from my blog and workshops, I am a big proponent of diversity in the work that we do as professionals. I am always talking about the benefits of having a wide portfolio of clients that include agencies, conferences, attorneys, courthouses, hospitals, etcetera.  For years I have said that the best way to earn a very good living as an interpreter is to always have a job option, and the only way to always have a job option is to be good at what we do and to study and prepare ourselves in as many fields as we feel comfortable with and capable of performing.  It seems to me that every time I bring up this issue, a medical interpreter stands up and argues that “other” interpreters should stay in their field and leave medical interpretation alone, that “other” interpreters do not know what is needed to work as a medical interpreter, and that just as medical interpreters should not try to do court interpretation, court interpreters and conference interpreters should leave medical interpretation alone.   Obviously this is a very unfortunate mind set because it shows the lack of confidence these interpreters have.  A true interpreter who knows and feels that he or she is a professional would never react this way.  When I talk of a diverse client base I am referring to a capable professional interpreter providing different services.  To even think that this business-based point of view constitutes an invitation to pseudo-interpreters to go into any field only shows a big silent problem in the profession: Many medical interpreters think of a non-professional interpreter as their first reaction. They do not feel and act as professionals yet. A real court interpreter who works as a medical interpreter or as a conference interpreter meets all necessary requirements before going to work: certifications, subject matter expertise, etc.  The same applies to conference interpreters.  In fact, and as an interesting matter, in all the years I have been interpreting conferences, many of them medical, I have never worked with a medical interpreter. I have worked with court interpreters many times, and many of them do a great job as they are professionals.  Court interpreters simultaneously interpret very complex medical procedures and terminology when they interpret expert testimony during trials; conference interpreters simultaneously interpret very complex medical peer-presentations and pharmaceutical studies.  My suggestion to my medical interpreter colleagues who still agonize over this medical interpretation is “my turf” issue, is to stop thinking of pseudo-interpreters who show up to work for a few dollars that the agencies pay them, and to see themselves as professionals, to feel like professionals, to act like professionals, and part of this behavior is to collaborate with other interpreters whose fields are professionally more advanced so that sometime in the future, these newly certified medical interpreters start working as simultaneous interpreters who do medical expert testimony in a court of law, and a medicine Nobel Prize research presentation during a medical conference.  I would like to read your comments on this issue.

An interpreter ethics class that is useful and fun?

October 23, 2012 § 3 Comments

 Dear colleagues:

This Friday I will be presenting during the ATA Annual Conference in San Diego. This is nothing new of course. Many of you have attended my presentations in the past; however, this time I will be covering ethics for interpreters.

That’s right, I will be delivering a presentation on that arid subject that most of us need in order to (at least) keep our licenses, certifications, or registrations current.  The title of the presentation is: “The Client-Attorney Privilege and the Interpreter’s Duty to Maintain Confidentiality.”  As you can see, it is a legal interpretation topic that up until now has been little explored by our colleagues, by the Judiciary and by the Bar.  When I decided to tackle the “ethics presentation” one-ton gorilla in the room, I set some goals: First, the presentation had to be useful. I had to find a topic that interests interpreters, but more importantly, I had to look for something that would help them with their career; something that they could use time and again for the rest of their professional lives. Then, I decided to find a way to do it fun. Of course, we will not have stand-up comedy (Darn. I guess I thought of it too late to incorporate it) but we will have fun by making this session an interactive exchange where we all explore concrete situations that we face in our profession, and try to find a solution that is legal, ethical, and good for our practice (meaning: our business!)  How many of us know when we are legally bound to do or abstain from doing something because of the person we are working for? How do we know when we are covered by the client-attorney privilege and when we are not? How do we stand up to a Judge when we are ordered to do something we are legally barred from doing? These are some of the everyday scenarios legal interpreters face all the time at courthouses, law offices, jails, board meetings, hospitals, and many other settings.  The goal is that by the end of the session we will all understand the client-attorney privilege, when it affects the work of an interpreter, how it influences what we do, and what are the differences between this privilege and our ethical duty to uphold confidentiality.  I believe that the practical cases I have selected will teach us how to correct some behaviors, how to detect a potential problem, and how to look for a solution.   While we do this, I will also try to dissipate some myths about so-called privileges like the medical, religious, and others. My opinion is that this session represents a great way to get those ethics credits that you may still need, and at the same time you will learn something that will benefit your interpretation practice and business.  The session will be presented in English. I invite you to join me this Friday, October 26 in the sapphire H room at 2:00 PM, and then, after the session is over, I invite you to join me and our good friend Freek Lankhof at the InTrans Book Service stand (6 & 7 of the Exhibition Hall) from 3:30-4:00 PM for a book signing of my new court interpreter manual: “The New Professional Court Interpreter.”  I am sure you will like the book.

Please join me for a fun and useful interpreter ethics session in San Diego!

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