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.

Languages in times of crisis. (The Mexican earthquakes)

September 21, 2017 § 3 Comments

Dear Colleagues:

The natural disasters that hit the western hemisphere in the last few weeks, and that I was unfortunate enough to experience one of them first hand, made think of the importance of all languages to achieve effective communication when human lives are at stake.

Natural disasters are not new, they are with us throughout the year during our entire lives, but unless they directly affect us, we ignore them beyond barely learning the superficial facts. This month, Texas, Florida, Puerto Rico, and several Caribbean nations were hit by strong hurricanes. Mexico was struck by two devastating earthquakes. Because these events happened in my backyard, where I have many colleagues, friends, and relatives, I was interested on the details. I wanted to learn about damages, loss of lives, and I wanted to know if the people I care for were safe.

Mexico had two earthquakes: first an 8.2 earth tremor, followed by a devastating 7.1 seismic activity two weeks later (on the anniversary of the earthquake that destroyed Mexico City 32 years earlier). I was working in Mexico City for the first of these tremors, the strongest one in the country’s history, so I got to see first-hand what was done, and what did not happen communication wise.  I was in the United States for the second one. This allowed me to see the language and cultural deficiencies from the perspective of the individual not physically at the scene, who needs to learn as much as possible about the tragedy.

Although I will use Mexico as an example for the things that must enable effective communication during a crisis, I believe that my comments are valid for the terrible hurricanes that hit the United States and many Caribbean countries, and apply to all natural disasters, terrorist acts, and other calamities anywhere in the world.

The first earthquake was on September 7, almost at midnight. It was a terrifying 8.2 on the Richter scale. The earth moved back and forth on a circular motion that lasted for about 90 seconds that seemed like an eternity. I was there. This gave me the perspective of the eyewitness. The second one took place on September 19 shortly after 1 pm. It was a devastating 7.1 on the Richter scale. First, the earth shook up and down followed by an oscillatory movement.  The first earthquake was the strongest (8.2 equals over 20 billion kilograms of dynamite; 7.1 is about 20 billion) but the September 19 tremor caused more damages because unlike the first one, its epicenter was close to Mexico City.

I am sure there are many stories and there will be many official reports on earthquake readiness, construction safety codes, search and rescue operations; the work of the thousands of volunteers who saved so many lives, and government actions in general. No doubt some will be positive and some will be critical of the authorities, but I am not convinced anybody will have the will nor the interest to do an analysis from the language access perspective.

Let me start by sharing my observations as an individual physically present at the scene of the disaster. I acquired this experience during the first of the two earthquakes.  The first thing I noticed was the lack of emergency, evacuation, and similar signs in a language other than Spanish.  There were no signs, in English at least, as lingua franca of this globalized society we live in.  Nothing on Braille either. At the moment of evacuation, based on my conversations with several friends and colleagues staying at different Mexico City hotels, all recorded public announcement messages were in Spanish (I guess this was good news for blind Spanish speakers). Nothing in any foreign or indigenous language.

Once on the street, non-Spanish speakers were given no direction. Nobody approached them to inform them or tell them in their language what they needed to do to be safe.  There were no Sign Language interpreters of any language to communicate this vital information to the deaf and hard of hearing. People were at the mercy of other bilingual tourists who jumped in to brief these foreign visitors on security protocol and the status of the disaster (at least to tell them where to get a blanket. Remember, this was almost midnight in September and many were asleep when the alarm woke them up).  There were no indigenous languages interpreters or bilingual personnel either. Once again, indigenous Mexicans were treated as always: the invisible people no politician dares to talk about.

What needed to happen and must be common practice the next time an earthquake hits Mexico City? Basically, the solution is not cheap, but it is not outrageously expensive either. They must start by translating all signs, and emergency and evacuation instructions into the most popular languages in the world. I would say at least the main Arabic, Asian and African languages, English, Russian, and those of the European Union. They must have translations into all Mexican indigenous languages, and a video with the translation into Mexican Sign Language, American Sign Language, and International Sign Language at a minimum. When a guest checks in, or when a person is hired as an employee, they should get this information in their own language. Once the information is translated, the hotel needs only to print a page, retrieve a Braille version from the filing cabinet, or issue a USB flash drive with the Sign Language translation.  They can ask guests and employees to return the memory sticks when they check out of the hotel or leave the employment.

They also must have evacuation recordings for their P.A. system in at least Spanish, English, and other commonly used languages in their business (if applicable) and train their staff so they can provide basic orientation in many of these foreign, sign, and indigenous languages to the people during evacuation, at least to the point of steering them towards a rescue camp or to a video or telephonic interpreting emergency service where they can talk to real interpreters providing their services remotely.  I am not suggesting that all staff learn how to assist all non-Spanish speakers. Staffers will be assigned one or two languages to memorize these basic instructions. After what I saw in Mexico City, this would be a major improvement, and it can easily be applied to hospitals, airports, train stations, etcetera.

Finally, I think that too many of my interpreter and translator friends and colleagues wasted valuable time addressing concerns of well-intentioned, caring people from abroad who were constantly contacting them to see if they knew if this and that individual were safe.  Most people they were asked about lived in Mexico, but not in the disaster area.  I believe that it is legitimate and humane to care for others and to want to know, but I also think it would be much better if people abroad were to check on a map where the earthquake happened and where their friends live. Understanding that Mexico is a very big country, they would immediately see that people living somewhere else in Mexico would be as susceptible to the earthquake as a Spaniard from Madrid would be had the earth tremor happened in Warsaw. Simple research would save so much time and energy. We can all contribute during a crisis, even from abroad.

My perspective during the second earthquake was very different. This time I learned about the tremor while working in Chicago. I have many relatives, friends, colleagues and clients in Mexico City and I wanted to know what happened: if they were safe, and if there was anything I could do to help.  With a Mexican population in the United States in the tens of millions, this put me in a category shared by a significant segment of the American population right away.

My first reaction was to check on line. I went to Twitter and the internet news organizations to see what they were saying, next, I opened Facebook and WhatsApp to see if there were any concrete updates on the people I care for. Mexicans use Facebook as Americans use Twitter, so this was a good choice. I also remembered how many people communicated by WhatsApp when the telephone lines were down during the first earthquake two weeks earlier.

While I was doing this, I headed to a T.V. set to see what they were showing. I had only access to American TV in English and in Spanish.  Over the air U.S. English TV carried nothing. The cable news networks were showing some images of the devastation, and stayed with the coverage for about thirty minutes before they went back to their usual Trump bashing by the left-wing networks and Trump worshipping by the right-wing networks. Nothing relevant, nothing new, just the same stuff they repeat ad-nausea day in and day out. I was surprised they covered “that much”. That is usually not the case, but with so many Mexicans in the United States I guess they decided this was a sound business decision.

It was time to watch American TV in Spanish. CNN en español, Telemundo, and Univision. All three networks were carrying live coverage. Unfortunately, their coverage was flawed. Let me explain: First, their anchors and most of their on-site reporters were not Mexicans nor knew enough about Mexico to cover such an event. They were saying things that made no sense, not because they are bad journalists, but because they do not know the subject, in this case, Mexico and Mexico City. Mexicans wanted to know the extent of the damage, the neighborhoods affected, and the buildings that collapsed. Unfortunately, because of lack of knowledge, this crucial information was left out or reported wrongly. A CNN anchor woman repeated a thousand times that “children were trapped inside the Enrique Rebsamen School”. This may sound irrelevant to a non-Mexican or to somebody not familiar with the city, but all Mexicans, particularly those from Mexico City know who Enrique Rébsamen (did you notice the accent?) was and have always pronounced the name correctly. This diminishes the credibility of the reporter and creates a lack of trust by the viewer. If you add to this lack of knowledge the accent from Spanish-speaking countries other than Mexico, it becomes very difficult to understand the names of places and individuals. Viewers interested in Mexico who rarely watch American Spanish TV had to deal with unknown regional expressions, an ocean of false cognates, and some very scary Spanglish. Things regular viewers understand because they are used to this deterioration of the language, but incomprehensible for a casual viewer who may forgive the horrendous expression during a soccer match or a telenovela, but not when trying to find out what happened during an earthquake. In just a few hours I heard enough “colapsado” (word that exists in Spanish, rarely used in Mexico, but a favorite of this TV crowd because it is so similar to “collapsed”) to last me a lifetime. I constantly wondered what ever happened to “desplomado” o “derrumbado” more commonly used outside of the United States, but missing in action from the American Spanish language TV networks’ dictionaries. I have nothing against diversity of Spanish accents or good journalists covering a country different from the one they come from, but for a critical situation like this one, Mexicans abroad needed a reporter and an anchor they could understand and could explain where the damages happened, giving the name of the streets, avenues and neighborhoods.

Because my hunger for accurate information was not yet satisfied, I made it home where I can access live Mexican TV. This time I watched Milenio, Azteca and Televisa.

Throughout the entire wall to wall coverage (September 19-20) Milenio had the most objective coverage. Azteca started fine, but then they brought in Patty Chapoy who may be very important in the network, but has nothing to do during a tragedy of this proportions, so I had to leave Azteca to never come back again for fear to run into this nefarious “Ventaneando goddess”.

The worst coverage was that of Televisa. On a moment of national tragedy, they brought back one of the most hated and corrupt “journalists” in Mexican history: Joaquín López Dóriga, who made sure that the official agenda was covered to the last detail. Instead of covering the human drama and giving the facts to the viewer, he spent the entire day praising the government of President Peña Nieto and minimizing the damages and the mistakes of the government. Another “jewel” of Televisa: Paola Rojas, harassed an earthquake victim and obstructed the search and rescue operation so she could quench her thirst for fame and glory. Unfortunately, this was not the worst part of Televisa’s or Azteca’s coverage: They ignored the needs of the deaf community by actively discriminating against thousands of Mexican citizens by not including a Sign Language interpreter during their coverage; in Televisa, arguing that having a square on the screen with a Sign Language interpreter would be “too distracting”, and in TV Azteca because there were already “too many squares on the screen”.

Finally, I could find nothing in any indigenous language, not even government or college TV channels. The only highlight: the Intercultural Indigenous Languages Interpreters Organization (OTIGLI) offered interpreting services to the members of the Indigenous community in hospitals and shelters. I believe that in a crisis like this one, those deciding and developing protocols to save lives and assets must understand the importance of communication. If they do, then they will try to provide the best and most accessible information to everybody, regardless of the language they speak or sign. There are very capable interpreters and translators in Mexico; there are also honest people in the government. I know this because I have met many in the last two years and I am convinced of their commitment and dedication to a more accessible, inclusive Mexican society.  The solutions are not outrageously complex nor they require an obscene amount of resources, but they are not cheap either, they need of honest capable people and a generous amount of resources. Remember that there is not such a thing as the “government’s money”, it is the people’s money. It came from the millions of taxpayers. When viewed this way, suddenly, it is not such an irrational request to ask that more lives be saved by making everything accessible to all. If there was ever a justified expenditure of the taxpayers’ money, this is it. A society cannot be safe, and a government cannot be compassionate or civilized unless it takes care of all of its people. Inclusive, accurate, accessible communication is a good start.

I wish the best to all our fellow humans affected by these earthquakes, hurricanes and other disasters anywhere in the world, and I invite you to leave your comments and ideas to improve how a society deals with all languages in a time of crisis.

How to pack for an out-of-town conference.

July 14, 2013 § 3 Comments

Dear colleagues:

Today I want to share with you my formula to work assignments all over the world while only carrying what I really need.  There is nothing more annoying than having to cough up excessive weight fees at the airport counter or arriving sweaty and tired from dragging heavy luggage from terminal to terminal to hotel and back to your home.  I know that many of you travel as much as I do and I am sure you have a system that works for you. My first rule is: When you already have a method that yields a light bag without being deprived of the basics, don’t change anything; but if you struggle every time you pack before a trip, or if you cannot figure out why your stuff doesn’t fit in the bag when you pack at the hotel, even if you were able to put it all in there at the beginning of the trip and you haven’t bought anything else, then this posting may be for you.  Second rule: My system works perfectly for men, but women would have to make some adjustments as you have to pack items that we do not.  While the little shampoo and conditioner bottles at the hotel bathroom may solve a man’s problem, many women will need to carry (or purchase at the point of destination) bigger bottles of shampoo and conditioner. Men can travel for a month with a pair of shoes; women cannot.  But even if you have long hair and need to pack high heels and booths, these tips can help you with the rest of the items you throw in the suitcase and never even use during the trip.

I have been traveling all my life, and when I say traveling, I mean it. Last year I was on the road for 320 days, and rarely stayed home in Chicago for more than a week at a time.  This means that I have learned how to live with less without being deprived of life essentials.

If you are going to be away for a week or less, you need a suitcase, ideally a garment bag so that your clothes are protected. My favorite is the 46” Zurich wheeled garment bag from Swiss Gear. It is affordable and of good quality, plus you can get it at places like Office Max and Target.  You can always bring a collapsible bag inside the garment bag in case you need more extra room on your way back.  You will also need your favorite briefcase. This will be your carry-on and it is where you will keep your electronics.  If the trip is longer, or if you need to take more shoes, shampoos, or other items, take a second suitcase.  I prefer the 20” Swiss Gear Zurich upright spinner because I like to take it on the plane with me, but if you prefer the 24” one, that is fine, just document it together with the garment bag.  I like these collection because it looks good, it is durable, and the price is right.  I learned many years ago that there is no need to buy expensive luggage if it will last you, at the most, one year (Have you seen how they handle your bags at the airport?)  I suggest you fly an airline where you have a frequent flyer plan. This way in most cases you can take two pieces of luggage in the plane’s underbelly at no extra charge. You will also board before most passengers, even when flying coach, so you will have plenty of overhead compartment room for your carry-on luggage.  Get your electronic boarding pass sent to your iPhone, store it in Passbook (the application is free) go to the airport, document your bags, and relax at the airline club. Domestically I prefer Admiral’s Club over United, Delta and other smaller carriers, but we all have different tastes. The important thing is that you want to find a place where you can charge your gadgets and enjoy a drink before the trip.

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What to pack? Men need to pack three wrinkle-free blazers that match the season at the place of the event. Remember, you may live in the northern hemisphere where it is winter, but if your assignment is down south you will need summer clothes.  Take three of the classics: navy blue, black, grey, dark brown, light brown, etcetera.  Take 6 pants. Same rules apply.  You will need 5 wrinkle-free pants and one set of jeans. Remember that you are wearing your sixth wrinkle-free pants during the flight. These items, plus six wrinkle-free long sleeve dress shirts in assorted colors will give you all the combinations you need for a month-long trip. I would also take 9 ties, a two-way belt (the kind you turn around to go from black to brown) and enough underwear for a week.  Hotels have laundry and dry cleaning services that are often cheaper than the same services in a big urban area.  My laundry and cleaners are always more affordable at a hotel in Virginia than at home in Chicago.   After that, all you need are three polo shirts, one T-shirt, shorts for the gym, a baseball hat, and a pair of snickers. You are already wearing your dress shoes. Take comfortable good moccasin-style shoes. No shoelaces when going through security at the airport; for the ladies: No boots when dealing with TSA.  Remember, you are already wearing the extra jacket or winter coat during the flight.

It is essential to pack your toiletries in the garment bag as well. Less items to show at the airport security point. Always take travel size items like deodorants, shaving gels, hair products, after shaves, toothpaste, and others. Do not forget your toothbrush. Men: Don’t bother with shampoos, conditioners, mouthwash, or body lotion. Hotels provide them. They also furnish other toiletries when you request them at the front desk. My experience has taught me that you should also take a small pair of scissors, nail-clippers, a sewing kit, shoe-shine cloth, and yes: a corkscrew.  The worst thing after a long day in the booth is a bottle of wine in the room and no corkscrew.  Finally, a small collapsible umbrella and your vitamins and prescription medications need to go in the big bag.  Save some for the carry-on if you will need them during the flight, plus an extra set in case of an emergency. The rest can travel with the checked in luggage.

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In your carry-on, ideally the same briefcase you will take to the event, take all your work tools: i-Phone, i-Pod, i-Pad, computer, all necessary chargers and cables, a portable electronic dictionary (in case there is no internet) your headphones (the best ones for music and the best ones for work) a few of your favorite pens, all your hotel, airline, car rental loyalty program cards, plenty of business cards, your passport (if traveling abroad) some cash and foreign currency if applicable, your official identification card, an ATM card, and a couple of good solid credit cards (from a travel plan so you get credit) That’s it. All other documents should be scanned and taken electronically, your reading materials, for work and for fun, should be on the i-Pad.  Finally, lock your home when you leave and put your home keys away for the duration of the trip. Most briefcases have a place where you can hang clip them. Do this so that you can easily find them when you get back after a long trip.

I know we all have different habits and needs, so this posting may not
completely solve your problems; however, I hope it gives you some suggestions
that you can incorporate to your travel routine the next time you are hired to
interpret an event away from home.  Please share your comments and suggestions on this issue that is crucial to so many of our friends and colleagues.

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