Should healthcare interpreters in the U.S. be concerned?

April 9, 2018 § 36 Comments

Dear colleagues:

For several weeks I have been contacted by colleagues who provide their services as interpreters in the health sector of the United States. They have all expressed the same sense of confusion, anguish, anger, and uncertainty many of us have noticed in social media and professional forums on line.

This environment started after the decision by the National Board of Certification for Medical Interpreters (NBCMI) to not renew the accreditation of their Spanish language interpreter certification program by the National Commission for Certifying Agencies (NCCA) effective January 1, 2018, and it ballooned after the video of a speech during the California Healthcare Interpreters Association (CHIA) annual conference in Irvine, California in early March was uploaded to the web and watched by interpreters all over the world. Apparently, most interpreters were upset about four things: (1) The decision to terminate the NCCA accreditation; (2) That many learned of this decision by the NBCMI at this conference; (3) That the NBCMI authorities did not informed those candidates scheduled to take the certification exam that the exam they would be taking in 2018, although the same test taken by interpreters certified in the past, was being offered after the Board had quit their accreditation of their Spanish language interpreter certification program by the NCCA; and (4) That many did not like NBCMI’s decision to change the wording on their website portal to show in a casual way, hidden in the text, or at least not highlighted, that they had not renewed said accreditation, and the unofficial explanations and assurances by apparently some people associated with NBCMI that such change would not impact their certification.

I am a veteran of the profession, but like many of you, even though I have interpreted my share of medical events as a conference interpreter, I have never been a healthcare interpreter. Let me explain the healthcare interpreting scenario in the United States.

Healthcare interpreting is an essential part of the health sector in modern society, but despite this and the need to elevate this service to a professional level, healthcare interpreting had a later start than other community-based fields of interpreting like court interpreting.

The United States was no exception, until finally, a few years ago, two organizations took the lead towards the professionalization of the field. Embracing the basic principles and values of the certification program the National Council on Interpreting in Health Care (NCIHC) had written about, the Certification Commission on Healthcare Interpreters (CCHI) and the National Board of Certification for Medical Interpreters developed and implemented two interpreter certification programs. Both understood the overwhelming need to certify interpreters in the most widely spoken foreign languages in the United States, and they both developed a program for interpreter certification in Spanish (there are other languages now. Please visit their websites to learn about the languages covered by each program).

Unlike court interpreting, which developed certification programs sanctioned by the government at its different levels (federal, state, and initially sometimes local), the healthcare sector had no government authority sanctioning the validity of its certifications; and even though this brought healthcare interpreters a professional freedom enjoyed by other professionals like physicians and lawyers, and denied to court interpreters who have no control over the administration of their certification exams, it also created an uncertainty about the validity of their interpreter certification programs.

Because in a private sector-oriented society like the U.S., the situation healthcare interpreter certification programs were facing is not the exception, but the rule, there is a reputable trustworthy entity that solves this problem: The Institute for Credentialing Excellence (ICE).

The Institute for Credentialing Excellence, or ICE, is a professional membership association that provides education, networking, and other resources for organizations and individuals who work in and serve the credentialing industry. ICE is a leading developer of standards for certification and certificate programs and it is both, a provider of and a clearinghouse for information on trends in certification, test development and delivery, assessment-based certificate programs, and other information relevant to the credentialing community. ICE created the National Commission for Certifying Agencies (NCCA) in 1987.

The NCAA’s Standards for the Accreditation of Certification Programs, which were created in the mid-1970s, were the first standards developed by the credentialing industry for professional certification programs. The NCCA Standards were developed to help ensure the health, welfare, and safety of the public. They highlight the essential elements of a high-quality program.

The NCCA standards follow The Standards for Educational and Psychological Testing (AERA, APA, & NCME, 1999) and are applicable to all professions and industries. Certification organizations that submit their programs for accreditation are evaluated based on the process and products and not the content; therefore, the Standards are applicable to all professions and industries. Program content validity is demonstrated with a comprehensive job analysis conducted and analyzed by experts, with data gathered from stakeholders in the occupation or industry.

NCCA accredited programs certify individuals in a wide range of professions and occupations including nurses, automotive professionals, respiratory therapists, counselors, emergency technicians, crane operators and more. To date, NCCA has accredited approximately 330 programs from over 130 organizations.

Accreditation for professional or personnel certification programs provides impartial, third-party validation that your program has met recognized national and international credentialing industry standards for development, implementation, and maintenance of certification programs. This solved the problem for both programs and two certification programs were born:

The Certified Healthcare Interpreter credential (CHI) developed by the Certification Commission on Healthcare Interpreters (CCHI) that offers a certification exam in Spanish, Arabic and Mandarin in 2 steps: First, a core exam consisting of 100 multiple-choice questions, to be answered in English, on medical terminology, healthcare scenarios and ethics; and to those who pass the core exam, an interpreting exam that tests the candidate’s skill on sight and written translation, and simultaneous and consecutive interpreting.

The Medical Interpreter credential (CMI) developed by the National Board of Certification for Medical Interpreters (NBCMI) that offers a certification exam in Spanish, Russian, Mandarin, Cantonese, Korean, and Vietnamese to those who pass (with a score of 70 percent, 80 percent in Mandarin) an interpreting exam that tests skills on sight translation and consecutive interpreting (no simultaneous interpreting or written translation).

Besides competing for interpreter candidates in the same market, both programs needed to convince healthcare providers, insurance companies, patients, and attorneys, that their credentials were reliable, trustworthy, and standard. They started an intensive and successful education campaign that used the NCCA accreditation as one of its most valuable resources.

Even today, CCHI’s website proclaims the validity of its program and skill of its certified healthcare interpreters:

“…Just as healthcare interpreters work hard to get credentialed as “certified healthcare interpreters,” certification programs can also “get certified!” The process is called “accreditation” and, today, it is administered by the National Commission for Certifying Agencies (NCCA), the accreditation arm of the Institute for Credentialing Excellence (ICE). Accreditation is the process by which a credentialing or educational program is evaluated against defined standards by a third party and is awarded recognition when found in compliance with these standards. It’s more than just a voluntary membership in an association. Accreditation (and renewal of accreditation) involves a rigorous process that ensures the quality of examinations and certification offered by organizations like CCHI. In fact, NCCA accredited programs certify individuals in a wide range of professions and occupations, including nurses, pharmacists, counselors, EMTs, HR professionals, defense security specialists, and more. CCHI is proud to represent the healthcare interpreter profession as equal among other allied health professions…today, CCHI is proud to offer the only nationally accredited certifications in the interpreting industry. NCCA’s accreditation validates all aspects of CCHI’s certification programs and CCHI as a certifying body…”

To this day NCCA accreditation continues to be a crucial element of the CCHI program.

Apparently, the National Board of Certification for Medical Interpreters (NBCMI) disagrees with this principle, and even though their website lacks detailed explanations or reasons for the decision not to renew accreditation; some colleagues claim they have unofficially argued that continuing NCCA accreditation is unnecessary because their program is now well-established, the accreditation only covered the Spanish certification program, and their exams have not changed from the ones offered during the accreditation era. Several interpreters have indicated that NBCMI claims that a renewal was too expensive; that they had spent fifty thousand dollars on the initial accreditation, and that their Board had directed those financial resources to the development and administration of certification exams in other languages; activity that would be more profitable.

On its official website, NBCMI addresses its decision to end NCCA accreditation:

“…Prior to 2018, the Spanish CMI certificate was subjected to an additional level of NCCA accreditation, but while the National Board remains a member of the Institute of Credentialing Excellence (ICE), each of the National Board programs have been standardized to ensure the CMI certification in each offered language best meets or exceeds nationally accepted standards, including transparency, inclusion, and access…”

It mentions they continue to be members of the Institute for Credentialing Excellence (ICE), the parent entity of NCCA, and adds a self-serving statement where they praise their own CMI certification. They emphasize their continued ICE membership adding this statement to their official website:

“…As a proud member of ICE, we stay informed on best practices in developing and administering quality certification [certificate] programs so that we may better serve you…” 

This could be a simple statement of facts, but unfortunately, it could also be misunderstood by some who may think that continued ICE membership affects their CMI program after January 1, 2018.

ICE clearly tells us what membership means:

“…An organization may join ICE at any time whether or not it has any programs accredited by the National Commission for Certifying Agencies (NCCA).  Membership in ICE does not mean that an organization or any of its credentialing programs have been accredited, approved, or otherwise endorsed by ICE…”

Membership in ICE does not mean that an organization or any of its credentialing programs have been accredited, approved, or otherwise endorsed by ICE. We can see this means more than no more accreditation. According to ICE itself, membership means no approval or any other endorsements.

As I write this post, my only goal is for NBCMI to published a written detailed explanation of the reasons they abandoned the NCCA accreditation, the potential consequences this decision can bring to certified medical interpreters, and why candidates scheduled to take the exam in 2018 were not informed of this important change so they could decide to either pursue the CMI certification or perhaps take the CHI exam instead. Spanish language CMI interpreters have a right to know why a certification exam after the NCCA accreditation ended has the same cost as the one offered when the accreditation was in place. How does a business decision to add more languages to the certification program benefit the Spanish language CMIs whose credentialing program lost NCCA accreditation? So far, NBCMI has limited its answer to a statement posted on their newsletter that repeats what they previously said about the validity of the exam and CMI certification, but the explanation of the reasons to discontinue the accreditation have not been disclosed. Dismissing social media as myths and misinformation does not answer the questions so many interpreters want answered.

Some changes have already been impacting those who hold a CMI certification: Some institutions stopped reimbursing the certification exam fee to certification candidates taking the exam in 2018. It has been reported that some clients are now preferring those interpreters holding a CHI certification over a CMI credential; and, a good possibility is that in the future, CMI credentials will be questioned and tested by attorneys who will cross-examine NBCMI certified medical interpreters in the presence of a jury during a medical malpractice trial.

NBCMI needs to explain why NCCA accreditation went from being something they were proud of a few years ago to something no longer needed:

“…The National Board of Certification for Medical Interpreters (NBCMI) is pleased to announce that its Certified Medical Interpreter (CMI) program has been accredited by the National Commission for Certifying Agencies (NCCA), thus joining an elite group of certifying bodies dedicated to public protection and excellence in certification… NCCA accreditation was one of the objectives the National Board set for itself at the very outset…” (NBCMI press release dated January 18, 2013 at Miami Beach Convention Center)

These are valid questions we hope NBCMI will officially address, and they are all legitimate reasons in a free market economy like the United States’ for any interpreter working on the healthcare sector to think very carefully about which one of the two certifications she or he should hold. Let’s hope that at the end of all the confusion and uncertainty the answer is either one of the certifications, but as of today, we do not know if that will be the case, even if both certifications were equally recognized, because one continues to have an accredited certification program and the other one does not. Many of our colleagues would like to know the reason for the changes that both, NBCMI and its parent organization IMIA experienced just now: a new president for NBCMI (we wish her well) and the resignation of IMIA’s president-elect before he officially took office. Interpreters want to know if these changes at this confusing times are related to the decision to end accreditation, or it is just a coincidence.

I now invite you to share your thoughts on this issue, and please, do not write personal attacks, and unless you are officially commenting on behalf of NBCMI, please abstain from sending surrogate comments defending the Board.

When client and agency do not listen to the interpreter.

April 3, 2017 § 5 Comments

Dear Colleagues:

After years of working as a professional interpreter you get to see and live many things. It is called experience. Learning from our mistakes, observing the way other colleagues solve a problem, and years of practice and study make us better interpreters, and gives us the confidence to tackle tough assignments.

Once, years ago, I was retained to interpret during a very important event with the participation of some of the highest government officials from many of the most powerful countries in the world. The event was held in one largest city in the world. It involved several interpreter booths, and interpreters of different language pairs.

The assignment, we were told, was to take place at three venues and it would include all of the guests: A big ballroom for a round table discussion by the dignitaries during the morning session; a press conference in a separate room but at the same facility right before lunch; and where they would eat, there would be several speeches by some of the distinguished visitors right after lunch.  In my particular case, the Spanish booth would have several dignitaries needing interpreting services.

The city hosting the event is a world-class city that holds many top-tier events throughout the year, but it is not the capital of a country.  The local government officials in charge of the activities had great experience with logistics of summits like the one about to take place, and the local interpreting agency is arguably the best one in the region. Unfortunately, they were overconfident and did not prepare for an event involving so many celebrities and such a myriad of languages.

The interpreters in the booths, and the interpretation equipment technicians, who are often the same all over the world, had worked in these conditions many times and knew what needed to happen.

From my first telephonic conversation with the agency, certain things had not been planned thoroughly and I raised my concerns. The main problem was that, after the first session, the dignitaries would have a press conference somewhere else in the building, but unlike the first ballroom, this time there would only be interpreter booths for certain languages: the ones expected to get most questions from the media, and Spanish was not one.

When I asked what would happen if one visitor was asked a question, I was told to just walk to him, whisper the question in his ear, and interpret the answer consecutively.  Logically, I had the two obvious follow-up questions: How am I going to find my way to the guest quickly when surrounded by so many bodyguards; and second: What about the context? Are these VIPs supposed to divine what was said before the interpreter gets to them? Had they thought that these visitors would have no context and no idea about everything said in the press-conference up to that point?

First I was told that they would look into it. Days later nearly at the event, I was told that things would stay the same despite my objections and concerns.  I suspected something would get ugly the next day but it was too late to back out of the project. I was left with one last recourse: Use my experience as an interpreter to do the best I could under those circumstances.

When I arrived to the ballroom on the morning of the event, I was greeted by a well-known interpreter equipment technician who told me right away: “You know there are no booths for you at the press conference and at the luncheon, right?” Well, I knew about the press conference, but the luncheon situation was news to me.  I was told that only the English, Arabic and French interpreters would have booths at those two events. I just threw my hands up in the air, smiled, and told him: “well, at least it couldn’t get any worse, right?” He looked at me right in the eye, and answered: “at least you are not the Korean interpreter. They don’t have a booth here either.  The will be asked to sit right behind the Korean delegation and whisper the entire thing…”  I just turned around and retrieved to the safety of my “morning-only” Spanish booth.

The morning session went fine. My colleague in the booth and I did our job as usual and the round-table moved along as scheduled. I must say I was impressed by the professionalism of my Korean colleagues. After taking a deep breath when they learned there would be no booth, they went to their delegation, sat behind them, and interpreted magnificently without complains or remarks about the adverse circumstances they encountered.

We moved on to the second event. The Spanish interpreters were lucky at the press conference because there were no questions to any of our clients. I felt bad for them as they sat there without understanding a word of what happened during the session, but at least I was not in the shoes of the Portuguese interpreters who had to do their best Harry Houdini impersonation to squeeze in and reach their delegations from Brazil and Portugal to do a whispered rendition for their clients, without the benefit of any prior context, followed by a consecutive interpretation of a long answer by one of the two delegations.

The luncheon was another disaster with little room for extra chairs for the interpreters and without headphones. I call this interpretation “silverware interpreting” because it is difficult to hear anything a speaker is saying when you must listen over your own voice and the symphony of spoons, forks and knives dangling against the china.  I heard no derogatory remarks, but the delegations were not happy with the interpreting infrastructure offered by the program organizers.

I realized there are no valid excuses for these mistakes. It is understandable that clients and agencies who rarely work these events, especially if they are monolinguals, may not think of all these basic needs of the foreign language audience; what is inexcusable is to ignore the interpreters’ and sound technicians’ comments and observations when they live and breathe these programs. Ignorance or stinginess should never be an obstacle to the correct delivery of a professional service.

I now ask you to share with the rest of us those times when you knew more than the agency or the client but they did not listen.

The scariest movies in all languages.

October 31, 2016 § 7 Comments

Dear Colleagues:

It is Halloween time in the United States and many other places. Whether a native tradition, or an imported commercial scam, the fact is that Halloween is now part of many lives.  In past years, I have used this space to talk about the history of Halloween, we discussed monsters and ghouls, and we told ghost stories from around the world. This time I decided to share with you my fifteen scariest movies of all time.  Contrary to what many think because of the enormous amount of films produced in the United States, my favorite horror movies of all time come from many continents and are in many languages. I think that we as interpreters should look for opportunities to practice our languages and improve our skills, and what a better way to live the Halloween experience than watching some foreign language films. There are plenty more movies, and my list may not include some of your favorites; if that is the case, please contribute to our list by posting a comment at the end, but for now, please let me tell you about the movies, in many languages, that kept me awake at night. I list them in chronological order, but I leave it up to you to decide which one is the scariest. Go ahead, dim the lights, get under the blanket, and prepare yourselves to be spooked:

Nosferatu (1922) Director: F.W. Murnau. Cast: Max Schreck, Gustav von Wangenheim, Greta Schröder, Alexander Granach. A wonderful silent movie about vampire Count Orlok who expresses interest in a new residence and a real estate agent’s wife. A classic based on the story of “Dracula.”

Dracula (1931) Director: Tod Browning. Cast: Bela Lugosi, Helen Chandler, David Manners, Dwight Frye. The legend of vampire Count Dracula begins here with this original 1931 Dracula film from Bela Lugosi. This is the film by Universal Studios that has inspired so many others, even more than Bram Stoker’s own novel. The movie is in English, but Bela Lugosi was Hungarian and had trouble with the English pronunciation, so the director decided that the vampire should speak very slowly and deliberately, giving Dracula, inadvertently, his unmistakable speech style.

Psycho (1960) Director: Alfred Hitchcock. Cast: Anthony Perkins, Vera Miles, John Gavin, Janet Leigh. When larcenous real estate clerk Marion Crane goes on the lam with a wad of cash and hopes of starting a new life, she ends up at the notorious Bates Motel, where manager Norman Bates cares for his housebound mother. The place seems quirky, but fine… until Marion decides to take a shower in this Hitchcock classic American film in English.

Even the Wind is Afraid (1967) Director: Carlos Enrique Taboada. Cast: Marga López, Maricruz Olivier, Alicia Bonet, Norma Lazareno. The film is about a group of students in an exclusive boarding school, where a student decides to investigate a local tower that has figured prominently in disturbing her recurring dreams of a hanged woman. She learns from the staff that the person in the dream is a student who killed herself years before, and that others have seen her ghost. This is a suspenseful Mexican movie in Spanish. (“Hasta el viento tiene miedo”)

Kuroneko (1968) Director: Kaneto Shindo. Cast: KIchiemon Nakamura, Nobuko Otowa, KIwako Taichi. Kuroneko (The Black Cat) is the tale of a band of marauding samurai who rape and kill two women in the countryside. Awoken by the titular feline, the spirit women vow their revenge on the samurai. Things get complicated when one of their intended victims turns out to be the son of one of the women and the husband of the other, long thought lost in battle. This is an engaging black and white movie in Japanese.

Rosemary’s Baby (1968) Director: Roman Polanski. Cast: Mia Farrow, John Cassavetes, Ruth Gordon, Sidney Blackmer. The movie tells us the story of a young couple that moves into an infamous New York apartment building to start a family. Things become frightening as Rosemary begins to suspect her unborn baby isn’t safe around their strange neighbors, and the child’s paternity is questioned. One of the greatest American horror films of all time. It is in English.

Hour of the Wolf (1968) Director: Ingmar Bergman. Cast: Max von Sydow, Liv Ullmann, Gertrud Fridh, Georg Rydeberg, Erland Josephson, Ingrid Thulin. In this, his only horror film, the Swedish master brings us the story of renowned painter Johan Borg who is recuperating on an isolated island with his wife when they are invited to the nearby castle and discover that the lady of the house owns one of Borg’s paintings (which we never see), of Veronika, the woman he loved and lost and whose memory begins to obsess him all over again, despite his wife’s steady, practical devotion. This is a great movie in Swedish, although not an easy one to follow, that is full of surrealism in Bergman’s style. (“Vargtimmen”)

The Exorcist (1973) Director: William Friedkin. Cast: Linda Blair, Max von Sydow, Ellen Burstyn, Jason Miller. This is a well-known American blockbuster about 12-year-old Regan MacNeil who begins to adapt an explicit new personality as strange events befall the local area of Georgetown. Her mother becomes torn between science and superstition in a desperate bid to save her daughter, and ultimately turns to her last hope: Father Damien Karras, a troubled priest who is struggling with his own faith. This film, in English, is a must see for all horror film fans.

Suspiria (1977) Director: Dario Argento. Cast: Jessica Harper, Stefania Casini, Flavio Bucci, Miguel Bosé. A true nightmare from Italian terror genius Dario Argento, Suspiria brings us a menacing tale of witchcraft as a fairy tale gone horribly awry. From the moment she arrives in Germany, to attend a prestigious dace academy, American ballet-dancer Suzy Bannion senses that something horribly evil lurks within the walls of the age-old institution. Besides all of its artistic and clever qualities, this Italian movie has another unique characteristic: Because the cast is multinational, and the actors spoke their lines in their native languages, the movie is dubbed into English, and sometimes the dubbing quality is less than top-notch.

Ring (1998) Director: Hideo Nakata. Cast: Nanako Matsushima, Miki Nakatani, Hiroyuki Sanada, Yūko Takeuchi. This original Japanese version of the movie is about a mysterious video that has been linked to a number of deaths, when an inquisitive journalist finds the tape and views it setting in motion a chain of events that puts her own life in danger. Nakata executes the film in an incredibly smart way, and brings the traditional ghost story firmly into the modern day by melding folklore and technology. There have been several imitations in Japan and elsewhere, but the original, in Japanese, is by far the best. (“Ringu”)

A Tale of Two Sisters (2003) Director: Kim Jee-woon. Cast: Im Soo-jung, Moon Geun-young, Yeom Jeong-ah. Based on a famous Korean folk story, the film centers on a pair of sisters who become suspicious of their new stepmother, when one of them starts to have some terrifying visions. From there, things get complicated. This is a true Korean horror movie with Korean actors speaking their language, and it is superior to the American remake released under the name “The Uninvited”. (“Hangul”)

Inside (2007) Directed by: Julien Maury and Alexandre Bustillo. Cast: Aymen Saïdi, Béatrice Dalle, Alysson Paradis, Nathalie Roussel, Nicolas Duvauchelle, François-Régis Marchasson. This French movie is about a grieving woman set to give birth at any minute, who is interrupted by a mysterious intruder who wants the unborn child for herself. The movie is cruel, sadistic and full of violence, including the scene where the pregnant woman accidentally stabs her mother to death, but it keeps you in suspense and very scared. The film is in French. (“Á l’intérieur”)

The Orphanage (2007) Director: Juan Antonio Bayona. Cast: Belén Rueda, Fernando Cayo, Roger Príncep, Mabel Rivera, Montserrat Carulla, Andres Gertrúdix, Edgar Vivar, Geraldine Chaplin. It is the tale of a mother and wife returning to the house where she was raised as an orphan, but she now brings her son who starts to see a little boy in a terrifying sackcloth mask, whom he befriends before mysteriously disappearing. The movie is really creepy, but it is also very sad because it deals with a ghost story in which the ghosts are as real as the grief they leave behind. I personally think that this is Spain’s scariest movie ever. In Spanish. (“El orfanato”)

Annabelle (2014) Director: John R. Leonetti. Cast: Annabelle Wallis, Ward Horton, Alfre Woodard. The movie is a sequel to “The Conjuring”, but in this one, by far scarier than the first on the series (there are more of them now) a couple is expecting their first child, and the husband gives his wife an antique doll she has been trying to find. At night, the wife hears a murder occurring at their neighbors’, and when she calls the police, she is attacked by a woman holding the doll and a male accomplice. The police arrives and kills the man while the woman kills herself by slitting her own throat. A drop of her blood falls on the face of the doll in her arms. Later, a news report shows that the assailants were Annabelle Higgins and her boyfriend who were part of a satanic cult in which they worship a demon with horns. Since Annabelle was holding the doll while dying, the couple tries to get rid of the doll, but this is the moment when all their troubles begin. I personally think this is an extremely scary movie. In English.

A Girl Walks Home Alone At Night (2014) Director: Ana Lily Amirpour. Cast: Sheila Vand, Arash Marandi, Mozhan Marnó, Marshall Manesh, Dominic Rains. This is a Farsi (Persian) language, American horror film about a young hardworking Iranian man who takes care of his drug-addict father who falls in love with a lonesome hijab-wearing vampire. The movie is in black and white, it was filmed in California, but the story takes place in a fictional Iranian city. Although not as scary as the other movies on the list, it is an interesting and different vampire tale. (“Dokhtari dar šab tanhâ be xâne miravad”)

There you have it, dear friends and colleagues. This is my list of scary movies. I hope you find some of them interesting enough to watch on Halloween; and I also invite you to share with the rest of us some of the titles that you think are very scary, and hopefully you will include some interesting films because of their language.

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