Many countries like The United States of America have a long history of immigrant communities. Although a country’s indispensability of immigrant workers and their skills varies through time, it is inevitable to say that such communities enrich a country’s cultural and economic life, especially the life of the city in which they are mostly concentrated. In America, the biggest cultural diversity is found on the east coast of the country. Having in mind that the first settlers arrived there from Europe, no wonder cites like Boston, Chicago, Washington DC, Philadelphia, New York, Richmond and many more have a continuous tradition of linguistic variety. The sounds of another language besides English is heard every day for decades. Despite the beauty and advantages of such multiplicity, a problem may arise with the first generation of immigrants. A person who has recently arrived to a new country, to The States in this case, usually does not know the language of the country yet while he or she is still attached to the language and the culture the person is coming from.
Furthermore, this trouble can last for years and sometimes even decades if the immigrant is not prone to easily acquiring the language, or is too busy to attend classes due to a daily amount of work, or his job does not require nothing much than some basic knowledge, or all of this.
However, this situation may evolve into a huge problem when healthcare is needed. What problems can a linguistic barrier between a first-generation immigrant and a healthcare services provider cause? In one word, immense. On some occasions, a patient who is an immigrant, may not be able to understand the instructions given by the doctor and therefore fail to follow them, which can put his health and even life in danger. On the other hand, a misunderstanding can arise if a medical professional does not have a clear, accurate idea of their patient’s symptoms and, even though, he conveys the message properly, the problem is in the message itself. On top of that, imagine a combination of poor or inaccurate diagnosis and its misinterpretation.
How is this communication barrier to be surpassed? Is it recommendable for a family member to be an interpreter? What can possibly go wrong if they take a role of being an Ad-hoc interpreter in states of emergency? How can healthcare providers avoid or diminish the risks of miscommunication between their staff and Limited English Proficiency (LEP) patients?
Ad-hoc interpreting or formally called liaison interpreting, represents converting and rendering the speaker’s words into another language. This act must be done at frequent intervals during the speech. Being limited by time and the situation, an Ad-hoc interpreter is usually not able to take notes and thus can only resort to his own oral skills on the spot.
Aside from healthcare services, this method of interpreting is generally used for site visits, business meetings, conference calls, interviews and similar. In any of these situations Ad-hoc interpreter is, more often, a link between two people, although serving as a liaison between even small groups of people who speak different languages is not rare at all.
Being less formal than consecutive interpreting, this technique is more suitable for working groups like companies and other dynamic environment and events. In other words, it provides the opportunity for interaction between the parties.
An extremely high level of skills is required for Ad-hoc or liaison interpreting in order to circumvent possible mistakes. The quality and accuracy of interpreting must not be affected by stress and fatigue which arise as consequence of an intense level of concentration. Therefore, Ad-hoc interpreters must be highly trained, skilled and specialized in certain areas such as: pharmaceutics, engineering, livestock&farming, tourism, intellectual property, finance, oil&gas, IT/electronics, gastronomy, market research, legal documentation, environment, journalism, energy, automotive industry, health&beauty, marketing and more.
Although we have mentioned what Ad-hoc interpreting should be, practice has shown different outcomes. In reality, as much as this kind of interpreting required precision and accuracy, which for skills and training are necessary, Ad-hoc interpreting is interpreting on the spot and the only skill enough at that moment is being a bilingual. However, a bilingual person is not professionally skilled, but asked to interpret in an emergency situation. Having this in mind, you can easily spot the risks and dangers of this service.
In addition, a bilingual person possesses the knowledge of both languages－the language of the patient, in this case, and the language of the healthcare provider and the diagnosis. To put it differently, a bilingual interpreter uses the languages proficiently in everyday life, but he still does not have the high degree of fluency that is required to interpret, nor is he skilled at this field of expertise. Furthermore, this combination of skills lacking professionalism and knowledge of medical settings and terminology can be confusing, stressful and exhausting for someone with no training in medical area.
How do these problems reflect in practice? There was a case of Florida teen Willie Ramirez in 1980, who suffered irreversible brain damage after experiencing an intracerebral hemorrhage. The hemorrhage was mistakenly treated as a drug overdose. After losing consciousness due to the hemorrhage and falling, the boy was taken to the emergency room. Since this situation was urgent and highly-risked and lacking a professional medical interpreter in English and Spanish language pairs, Ramirez’s mother was the only one there to serve the purpose of an Ad-hoc interpreter from English to Spanish and vice versa. During the interpreting she committed a terrible mistake due to the similar sounds of the Spanish word “intoxicado” and the English word “intoxicated”. Many language pairs have them and refer to as false pairs. Something sounds very similar to the other language word, but it is just a false flag and usually a terrible mistake which makes the interpretation or translation frivolous and jazz. Anyway, Willie’s mother, not knowing what caused her son’s condition, told the doctors that he had been intoxicated instead of being ill due to probable food poisoning. That mistranslation resulted in misdiagnosis, so doctors started treating him for alcohol abuse instead of digestion problems. Much later, when the true cause of his state was discovered, Ramirez had already lost his ability to walk, so he sued the hospital, and won. Unfortunately, the case of Willie Ramirez is not a lone example.
Technically speaking, any bilingual person can be an interpreter, but is it enough and recommendable in any given situation? Any imprecisions and mistranslations can bring irrevocable and irreparable consequences to the patient’s health condition. Therefore, legislation all over the world tends to pose very strict rules regarding who can provide language assistance in a medical field of expertise. With more strict regulations, doctors need to make sure that arrangements are made, where possible, to meet patients’ language and communication needs.
Mistakes committed during Ad-hoc interpreting in medical field
A study of medical interpreter errors with potential clinical consequences shows an average of 31 medical interpretation errors per patient visit. In the study, Dr. Glenn Flores and his team tape recorded 13 encounters between pediatricians and Spanish-speaking mothers in a Boston hospital out-patient clinic. Professional hospital interpreters were present for six of the encounters. The rest of the encounters relied on Ad-hoc interpreters’ work, among whom were three nurses, three social workers and an eleven-year-old sibling.
After the tapes were transcribed and analyzed for errors in translation, the categories and the statistics said the following:
In addition, the errors were evaluated and observed in the context of potential medical consequences if they altered the history of the present illness or past medical history, if they misinterpreted diagnostic or therapeutic interventions or if they affected parent understanding of the child’s condition or plans for follow-up visits or referrals.
Since LEP or Limited English Proficiency patients (in US) have the right to a qualified medical interpreter, the demands a professional medical interpreter must meet is profound knowledge of the two languages at hand, and profound knowledge of medical terminology to enable doctors and other healthcare providers precise information about a patient’s condition so they can give the right treatment on their behalf. Therefore, hospitals and other medical centers have legal cooperation with medical interpreting professionals. But, what if there is no such service at hand for any reason? A bilingual family member can adopt and adapt to this role, but he or she must be careful and check any term or phrase they even doubt, especially nowadays when technology tools are available. Or even better, interpreting family members can do the best job if they explain the symptoms and aches the patient has in relatively simple words so the doctor can get a clear idea of what kind of the condition is about.