A call to stop positioning the interpreter between a rock and a hard place.

“When one considers the enormous task with which the interpreter in the healthcare setting is entrusted, one that involves such a multiplicity of factors and relationships, it becomes much more understandable that the interpreter’s role in these encounters take on a certain fluidity.”

Although the conventional characterization of the community interpreter is that of a language conduit, healthcare settings have had a significant influence in a redefinition of the role, and considerable research has shifted the lens to broader scope of the interpreter role, one that moves beyond that of message transmission. It can be said that all situations in which interpreters work are intercultural situations and that the dynamics of the intercultural space becomes even more heightened in healthcare settings, where cross-cultural concepts of health are permeated by the often emotional and traumatic circumstances of illness and wellness.

The Oldest Profession

Interpreters have been around for a very long time – perhaps as far back as 2500 BCE according to Yvan Leanza – but did not establish a designated title until the 1950’s, when the Association Internationale d’Interprètes de Conferénces (AIIC) successfully championed the conference interpreter title. Changing migration patterns experienced later in the decade shaped a linguistic and cultural diversity now found within many nations, which in turn fostered the development of new brand of interpreting known as community or public service interpreting.

Community interpreting was initially an ad-hoc response to these changing linguistic and cultural demographics and one that was often found service in family or friends of minority-language speakers, or institutional staff that were thought to have adequate language skills. Even if the language skills were present, for which there was no guarantee, bilingual staff pulled from other duties, or family members asked to assist, can hardly be considered professional language resources.

Interpreters in Healthcare

Community interpreters are generalists that work across public services, but research has shown that the largest consumer of interpreting services is the healthcare sector, which also has a major impact. Interpreters are both active and impartial participants in a communication exchange, because they are contextually situated between 2 or more people that do not share a language, do not share a culture and may also not share an understanding of the system in which they are involved. Nonetheless, community interpreters working in healthcare settings have been expected to maintain role boundaries that tell them to not get involved. In 1999, Joseph Kaufert reported in the journal Anthropology & Medicine on his ground-breaking study Cultural mediation in cancer diagnosis and end of life decision‐making: The experience of Aboriginal patients in Canada, in which he conducted an ethnographical study of 10 cancer patients, through interviews with the patients, their families and care givers and Aboriginal language interpreters and found interpreters claiming that maintaining strict boundaries as an interpreter in healthcare forced them to provide “reductionist or decontextualized explanations of diagnosis and treatment options.” What does this mean for the accuracy of the intended message?

Community interpreters act as both language conduits and as intercultural communicators in healthcare settings as they often must become a part of the process in order to ensure that the intended message is understood. As communication facilitators community interpreters serve a vital role in multicultural, multilingual societies, and moreover, as bilingual and bicultural resources they connect service providers with service users while navigating cross-cultural issues, non-verbal communication and intercultural communication. When one considers the enormous task with which the interpreter in the healthcare setting is entrusted, one that involves such a multiplicity of factors and relationships, it becomes much more understandable that the interpreter’s role in these encounters take on a certain fluidity.

The definition of health varies from culture to culture and region to region. Complex factors such as ethnicity, religion, age, gender, acculturation and migration further influence those definitions. It is not surprising that the healthcare domain is exerting influence on the shifting role of the community interpreter, at least within this venue. The interpreter would not be able to meet the most fundamental element of their mandate of conveying the intent of the embedded meaning as offered by the speaker, if they did not provide some cultural context. Culture in this sense is both the culture of the community and the culture of the healthcare syst≤ ı∫So, how do we begin to understand the interpreter in a healthcare setting? We must start first by having a dialogue on what the role is, engaging practitioners, trainers, service providers and policy makers, in addition to our cultural communities, to come to a common understanding and move forward as a healthcare team. And we must stop putting the interpreter between a rock and a hard place, and focus on the goal of effective communication in interpreter-assisted appointments. As Robert W. Putsch (1985) so succinctly stated, “communication in health care is a complex issue. Language and cultural barriers complicate the situation.”

Angela Sasso – Director. Interpreter’s Lab

Resources

Kaufert, J.M. (1999). Cultural mediation in cancer diagnosis and end of life decision‐making: The experience of Aboriginal patients in Canada, Anthropology & Medicine, 6:3, 405-421.

Leanza, Y. (2005). Roles of community interpreters in pediatrics as seen by interpreters, physicians and researchers. Interpreting, 7(2), 167-167.

Putsch, R.W. (1985). Cross cultural communication, the special case of interpreters in health care. Journal of the American Medical Association. 254(23), 3344 – 3348.

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Empathy can be a tricky situation for interpreters. How do we show empathy and respect for individuals while maintaining our roles as impartial and unbiased communication facilitators? And how do we keep our own emotions balanced?

Tianyi Zhang presents a few tips and insights in this article on empathy.

A woman sobs inconsolably into the phone. She hurls incoherent accusations between long breaths of drawled out weeping, and on the other end of the phone a healthcare worker bombards me impatiently:”Madame Interpreter, what is she saying? Madame Interpreter, tell her to calm down please. What is she saying, you’ve got to tell her to calm down.” I stare out of my window and adjust my headphones. I interpret the woman’s accusations to the best of my ability, and I ask the health care worker to please hold on while I ask the woman to speak slower in Mandarin. The woman ignores me and continues to cry, the healthcare worker falls into a silence along with me.

I often felt overwhelmed while working as an over-the-phone interpreter for a company that handled phone calls spanning social services, health care, and customer service sectors. As my day stretched on, I was swathed with waves of human emotions. I heard the cries of newborn babies and the bereaved alike, and I was often left struggling in a sea of feelings after a call was disconnected.

The work of a community and health care interpreter is unique in its context: we often have the privilege of seeing people at their most vulnerable. Our ethics training guide us as we seek a right course of action, and we navigate between our roles as conduits, clarifiers, cultural brokers, and advocates. Decisions are made swiftly, and adjustments are made based on moment-to-moment dynamics. An ethical and efficient community and health care interpreter is impartial yet empathetic, which presents an obvious contradiction at face value: being impartial implies distance, whereas empathy denotes a connection — how do you establish a connection without crossing certain boundaries?

Here’s the thing, people are unreasonable when they are confronted with difficult situations. I often have to remind myself of a quote by Victor Frankl:”An abnormal reaction to an abnormal situation is normal behaviour” while working, and realize that people often act the way they do with good reason. Empathy is not walking a mile in someone else’s shoes, empathy is walking a mile in someone else’s shoes as that person. Construing the situation in this manner usually helps me establish an empathetic connection with the limited English speaker, yet this is not the difficult part.

It isn’t hard at all to suffer alongside someone going through great distress: how do you not feel sad when someone is weeping so hard they can barely speak? It’s more difficult to distance oneself from that suffering and act within one’s professional boundary. I had been tempted to share my private contact information on various occasions, despite such action being an outright offense against both company regulations and work ethics. As a professional interpreter, it is crucial to remember where our roles end, and to not overextend beyond boundaries. Yet this is easier said than done, especially when facing someone with a weak support system, and it is obvious they could use a friend, or any local expertise someone could offer in their native tongue. At times like these an interpreter best keep in mind that their value is in their role and not in extending friendship.

Retaining distance is also an important part of an interpreter’s self-care. A stronger-than-necessary attachment has many detrimental psychological consequences. Carrying someone else’s emotional weight home with you after a session has its tolls. If the organization you work with does not provide you with the proper support and counseling needed, you might find yourself speaking to a friend or colleague. Keep in mind the ethical treatment of privileged information: We must caution ourselves against sharing the content of sessions. I have gotten into the habit of writing out my thoughts on a piece of paper, and shredding it immediately. This has proved to be immensely helpful, and may be worth a try if you find your mind engaged in strife with the remnants of your work. As the industry moves forward, perhaps language workers will be provided with access to better solutions. For now, we must use our own discretions and be wary of issues related to the empathetic aspects of our job.