September 9, 2021 § 4 Comments
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.
February 7, 2017 § 1 Comment
This past weekend the United States held the Super Bowl, an ever-growing part of American culture and lifestyle. It is the most watched TV event in the country, and for all practical purposes, the day when the game is played is an unofficial holiday that happens to be more popular than most holidays on the official calendar. We have previously discussed how this American football game is not the same football game played in the rest of the world. This incredibly popular sport in the United States is known abroad as “American football,” and even this designation seems troublesome to many who have watched a little American football and do not understand it very well. Although it is mainly played holding a ball, the sport is known in the United States as football for two reasons: (1) Because this American-born sport comes from “rugby football” (now rugby) that in many ways came from soccer (football outside the United States) and (2) Because it is football, but it is not British organized football, which at the time of the invention of American football was called “association football” and was later known by the second syllable of the word “association”: “socc” which mutated into “soccer.” You now understand where the name came from, but is it really football? For Americans it is. Keep in mind that all other popular team sports in the United States are played with your hands or a stick (baseball, basketball and ice hockey). The only sport in the United States where points can be scored by kicking the ball is (American) football. So you see, even though most of the time the ball is carried by hand or caught with your hands, there are times when a team scores or defends field position by kicking or punting the football. Now, why is all this relevant to us as interpreters? Because if you interpret from American English you are likely to run into speakers who will talk about the Super Bowl, football in general, or will use examples taken from this very popular sport in the U.S.
Ten days ago, most Americans gathered in front of the TV set to watch the National Football Conference champion battle the American Football Conference champion for the Vince Lombardi Trophy (official name of the trophy given to the team that wins the Super Bowl) which incidentally is a trophy in the shape of a football, not a bowl. It is because the game was not named after a trophy, it was named after a tradition. There are two football levels in the United States: college football played by amateur students, and professional football. College football is older than pro-football and for many decades the different college champions were determined by playing invitational football games at the end of the college football season on New Year’s Day. These games were called (and still are) “Bowls.” You may have heard of the Rose Bowl, Cotton Bowl, Orange Bowl, Sugar Bowl, and many others. When a professional football game was created to determine the over-all champion between the champions of the American and National Conferences, it was just natural (and profitable) to call it the “Super Bowl.”
On this occasion, the fifty-first edition of the championship game was played in Houston, Texas, and the outcome of the game will likely be a topic many American speakers will include in their speeches for years to come. For this reason, it is important that we, as interpreters, be aware of the result: The New England Patriots, a team that plays in the vicinity of Boston, Massachusetts, defeated the Atlanta Falcons by coming from behind, overcoming a huge point difference, to win the Super Bowl in overtime after the was tied at the end of regulation. The leader of this unprecedented come back was the Patriots’ quarterback Tom Brady. Remember these two circumstances: The Patriots came from behind to win the Super Bowl, and Tom Brady led them to victory. It will surely help you in the booth during several speeches by American speakers in the future.
As I do every year on these dates, I have included a basic glossary of English<>Spanish football terms that may be useful to you, particularly those of you who do escort, diplomatic, and conference interpreting from American English to Mexican Spanish. “American” football is very popular in Mexico (where they have college football) Eventually, many of you will face situations where two people will discuss the Super Bowl; as you are interpreting somebody will tell a football story during a presentation; or you may end up at a TV or radio studio doing the simultaneous interpretation of a football game for your own or another foreign market.
The following glossary does not cover every term in football; it includes terms that are very common, and in cases where there were several translations of a football term, I selected the term used in Mexico by the Mexican media that covers the sport.
|National Football League||Liga Nacional de Fútbol Americano|
|American Football Conference||Conferencia Americana|
|National Football Conference||Conferencia Nacional|
|Regular season||Temporada regular|
|Standings||Tabla de posiciones|
|Field||Terreno de juego|
|End zone||Zona de anotación/ diagonales|
|Super Bowl||Súper Tazón|
|Pro Bowl||Tazón Profesional/ Juego de estrellas|
|Uniform & Equipment||Uniforme y Equipo|
|Special teams||Equipos especiales|
|Fair catch||Recepción libre|
|Possession||Posesión del balón|
|First and ten||Primero y diez|
|First and goal||Primero y gol|
|Line of scrimmage||Línea de golpeo|
|Neutral zone||Zona neutral|
|Long snap||Centro largo/ centro al pateador|
|Turnover||Pérdida de balón|
|Pass rush||Presión al mariscal de campo|
|“I” Formation||Formación “I”|
|Shotgun Formation||Formación escopeta|
|“T” Formation||Formación “T”|
|Wishbone Formation||Formación wishbone|
|Sidelines||Líneas laterales/ banca|
|Out-of-bounds||Fuera del terreno|
|Head Coach||Entrenador en jefe|
|Offensive Tackle||Tacleador ofensivo|
|Offensive line||Línea ofensiva|
|Wide Receiver||Receptor abierto|
|Tight end||Ala cerrada|
|Fullback||Corredor de poder|
|Quarterback||Mariscal de campo|
|Defensive end||Ala defensiva|
|Defensive tackle||Tacleador defensivo|
|Nose guard||Guardia nariz|
|Free safety||Profundo libre|
|Strong safety||Profundo fuerte|
|Punter||Pateador de despeje|
Even if you are not a football fan, I hope you find this glossary useful in the future. Now I invite you to comment on football, sports interpreting in general, or maybe you would like to share a “sports interpreting anecdote” with all of us.