The Evolving Role of the Healthcare Interpreter

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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