The Ministry for Health and Welfare in Korea is now training professional medical interpreters and planning to implement an official licensing examination for medical interpreters.
If this interpreter testing process is formally established, it’ll be Korea’s second interpreter license exam run by a government entity. As of today, the only government-issued interpreter license in Korea is for a tour guide/interpreter who is required to pass written/oral language exams as well as a basic Korean history exam.
Since the State of California indefinitely suspended its medical interpreter program, this certainly is a hopeful change for Koreans who are interested in medical interpreting.
For more updated info on medical interprets in Korea, please visit the following Website.
Lost translation – In Alaska, neglecting to provide interpreters for non-English speaking Medicaid patients means some doctors are breaking the law.
By Joshua Lang
Published on Thursday, September 9, 2010
Imagine: You’re going into an operation with a significant chance of not returning to the waking world. You hardly understand the idea of cancer, let alone how doctors fix it. All you know is that it hurts. The medical staff tells you that to save your life you have to go in to surgery, but the details are fuzzy. They are going to cut what? Slice where? Take what out? Before long you’re on the gurney headed to the operating room. You are still confused. “Where am I going?” you ask. No one answers. They strap you down like a mental patient. You struggle, and to calm you down, they play foreign music, smile, and do a jig as your consciousness fades to black.
This scenario is not fiction. Nor is it legal. It happened here, in Anchorage.
“I asked them, ‘What are you doing?’ And they did not respond. They put me on the surgery bed. They tied me down,” Rebecca says. “I asked them, ‘What is going on? Why are you tying me down?’ I couldn’t understand. They just started dancing and singing, playing music. I was strapped to the bed. I was scared. I guess they were trying to entertain me…”
Photo of Rebecca by Joshua Lang
It’s a disturbing scenario—for most people, intolerable. But it’s happened twice to Rebecca, a 36-year-old refugee and single mother originally from Sudan.
Many Alaska physicians are breaking the law—specifically, “Title VI of the 1964 Civil Rights Act, which requires that any health care provider who receives federal funds, including funding from Medicaid, Children’s Health Insurance Program or Medicare, to take reasonable steps to ensure meaningful access to its health services,” says Doreena Wong, a health policy expert and lawyer at the National Health Law Program, a public interest law firm based in Washington, D.C.
“It is horrifying to watch a human being treated this way. If you look at it from the doctor’s office, they don’t want to get known for this,” says Karen Ferguson, the director of the Refugee Assistance & Immigration Services (RAIS) program in Anchorage. She has a packet of information and a stocked reserve of horrific stories—cases of doctors’ seemingly malicious abuse of refugees in ill health. Her most poignant example is Rebecca.
Although Rebecca is from Sudan and now lives in Anchorage, the majority of her life was spent in Ethiopia. When she was 13 her family fled the religious persecution of a fundamentalist Islamic government. She trekked nearly 500 miles from her home in the south to a camp near the capital of Ethiopia, Addis Ababa.
“We walked for days and days in the bush. Nothing to cook, nothing to eat—only water. Bullets flying, people taking clothes, a lot of people dying, people being killed. They were shooting at us! I wanted to go back home because it was too far. I was tired. They said, ‘We are close; Ethiopia is close.’ So I kept going. After we arrived, they took us to the camp.”
For 22 years, Rebecca lived in that camp. She found a job as an assistant to the pharmacist. She married. She had children. But shortly after her last child was born, her husband died from an infection. Survival became a daily dilemma, and with dwindling options, she applied for asylum in the United States. Numerous interviews, security checks and examinations later, her application was accepted.
On October 6, 2008, she left for America. There were a number of firsts: her first escalator, her first airplane ride, her first time in New York, and her first steps in Alaska, her new home. Rebecca describes the transition in simple terms, “Life here in America is not the same as Ethiopia. Here there are laws.” Her case manager at Catholic Social Services is Rhoda Essary, a British transplant without the accent. She described Rebecca’s transition as stoic, “at least until she began coughing up blood.”
Rebecca had been in Anchorage for a month. “The side of my body was numb. If you pinched me, I didn’t feel it,” says Rebecca. Unfortunately, the doctors never heard this. They did not find out about the numbness until it was nearly too late.
Rhoda accompanied Rebecca to a clinic at the corner of Boniface and Northern Lights. It has a sign in red plastic that reads, “Medical Clinic,” and a neon orange sign below it, “Urgent Care Walk-In.” There was one serious problem: Rebecca had possibly less than a dozen words in her English vocabulary. There are phone lines that doctors can call at any moment for an interpreter, but the clinic refused any suggestion that an interpreter was needed. If she wanted someone, they said, find a family member or a friend. But Rebecca had no friends yet, and her children were equally linguistically confused.
The clinic sent her home, diagnosed with a “touch of pneumonia,” according to Rhoda. No one from the clinic would comment on the details of the case.
Rebecca continued to cough up blood. Her symptoms worsened. Finally, she was persuaded to visit the emergency room. “They told me that I had an hour to live,” says Rebecca. Rhoda explained that she had used her cell phone this time to call an interpreter, facilitating a proper diagnosis. There was a mass in her heart—no pneumonia. Her situation too urgent to even give her a chance to call her children, Rebecca was rushed into open-heart surgery.
The urgent care clinic broke the law while treating Rebecca. Doreena Wong from the National Health Law Program explains that, “this case illustrates the serious consequences when a health care provider does not have the necessary language assistance… The suffering of the patient could have easily been avoided if an interpreter had been used, and the clinic was fortunate that the doctors caught their mistake in time to save the patient’s life. We have other cases where the patients were not so lucky.”
Dr. Jim Billman from the urgent care clinic Rebecca first visited said he had no idea that the provision of an interpreter was required: “If we are breaking the law, I am sure the owner would like to know about it.” Interestingly, the nurse at the front desk explained she knew it was required. The owner was unavailable for comment.
Dr. Thomas Hunt from Providence Hospital describes Rebecca’s care at the clinic as “significantly substandard.” He comments that the diagnosis was flat “wrong.”
These are not isolated incidents. Rhoda Essary and Karen Ferguson have an unsettling number of stories similar to Rebecca’s—refugees that experienced a misdiagnosis or unacceptable care because of miscommunication. They have a list of 20 different “problem” providers, including small clinics and wealthy private practices. There are dentists, ophthalmologists, urologists, internists, surgeons and others.
This list gives an impression of malfeasance. However, meeting with the doctors themselves gives an entirely different impression.
Dr. William Bergeron, for example, is one of these “problem providers.” He specializes in oral and maxillofacial (jaws and face) care at Oral Surgery Associates of Alaska on the border of Fairview and South Addition. He is, in fact, the only oral surgeon in Anchorage that accepts Medicaid patients. He does not have to; he does it because, without him, there would be no one else.
“Refugees are great. Very pleasant and very appreciative,” maintains Dr. Bergeron. The problem is, of course, funding. “The fees for interpreters are expensive and you don’t even know what you get.” Dr. Bergeron agrees that interpreters increase the quality of care. He just doesn’t know how to make it work in his business.
Medicaid in Alaska reimburses physicians for medical services but not for interpreters. It’s simple. An interpreter can cost between $40 to $120 per hour. If you are being paid $150 for a visit, it doesn’t make sense to pay $100 for an interpreter.
Curiously, the Anchorage Neighborhood Health Center in Fairview provides interpreters for any and every client who needs it. According to Joan Fisher, its director, they accommodate “over 21 different languages.” How? It turns out that with the special designation as a Federally Qualified Health Center (FQHC), Fisher can bill the federal government for interpretation services. It’s no secret formula. Find the money and find interpreters. Alaska physicians are not malicious; they’re practical.
Thus one encounters the common “friends and family” solution—the free solution—a pernicious panacea, where the responsibility for finding an interpreter is passed on to the patient, who is recommended to enlist the help of a multilingual friend or family member. Of the nine providers interviewed for this article, eight said that they depend on friends and family for their patients with limited English.
Think about this: If you are a mother, and you have a son who is moderately bilingual, would you want him to interpret for you at your next appointment at the OB/GYN? If you are a father, and you have a daughter who is bilingual, would you want your daughter to interpret at your next prostate exam? Would you want your friend or family member to be the first to know that you have cancer?
In the Americans with Disabilities Act (ADA), the Department of Justice writes, “It is inappropriate to ask family members or other companions to interpret for a person who is deaf or hard of hearing. Family members may be unable to interpret accurately in the emotional situation that often exists in a medical emergency.” Are the Sudanese refugee and the deaf individual different in this respect?
If something goes wrong and the physician used a family member deemed inappropriate (such as a minor) as an interpreter, the provider is liable. The Health Law Program studied a cohort of malpractice cases and found that nearly three percent of all cases arose from such problems, costing doctors millions. There are other opportunity costs also. Dr. Bergeron admits, “Not having an interpreter costs me time in trying to properly explain procedures.”
Doreena Wong from the Health Law Program comments that “larger providers save money with interpreters.” For this reason, hospitals generally have systematic methods for interpretation needs. The problem is with small to medium private practices.
“The solution is simple,” says Barbara Richards, the regional director of the U.S. Department of Health & Human Services. If Alaska requests it, the federal government will provide the majority of the funding necessary to reimburse Alaska physicians for interpreters. Thirteen states have already implemented similar programs, including Washington, Hawaii, Iowa, Idaho, Kansas, Maine and Utah.
Would he offer interpretation service to his patients if he was reimbursed for it? Dr. Bergeron replies without hesitation, “I certainly would.” All of the 20 “problem” doctors interviewed for this article agreed that if they were reimbursed they would at least try out the interpretation service.
According to Karen Ferguson at RAIS, there are about 1,000 Southern Sudanese refugees, between 5,000 and 6,000 Hmong refugees, about 100-plus Somali refugees, maybe 50 Iraqi refugees, 100 Bhutanese refugees and about 500 former Soviet Union refugees. There are also various asylees from Gambia and South America, entrants from Cuba and refugees from African countries such as Togo and Congo.
Anchorage is home to an increasingly diverse population. Over 94 languages are spoken in the Anchorage School District. The demand for interpreters is significant, but still manageable. If Washington and Hawaii can do it, so can Alaska.
Dr. Thomas Hunt from Providence Hospital points out the common sense behind the law: “It is a basic diagnostic tool.” Would you deny refugees the access to X-rays? Being able to communicate with your physician to explain what is wrong is fundamental, a basic tool of physicians.
Communication is the difference between a physician and a veterinarian.
Rebecca lived through the encounter with the heart tumor but the pain never went away. Five months later she was diagnosed with ovarian cancer. In her second surgery the physicians removed her ovaries and danced to western music to assuage her confusion.
Ever since that first episode she has been attending English class three times a week and church twice weekly. She can understand basic greetings; she can even fill out government forms when needed. Her progress is impressive but limited. The pain has still not gone away, but you wouldn’t know from her honest smile and the way in which she describes her experience in the United States.
She says, “I am alive, so thank God. I thank God for coming to the United States. I love my new home.” The pain does not deter her from Bible study, nor does it prevent her from taking care of her children.
Like many refugees, she demonstrates all of the best qualities of Alaskans. She is a survivalist, fiercely independent, honest, hard working and hospitable. She survived the Sudanese bush. She has raised a beautiful family by herself, and still makes time for schooling and church. When you enter Rebecca’s home, she immediately places a cold Pepsi on a cork coaster in front of your seat.
The process to solve situations like Rebecca’s is easy. Either the Alaska Legislature or the state director of Health & Human Services would need to recommend that interpretation services be included in the state Medicaid budget. Because law requires it, the federal government would immediately approve the expense. The state would cover a minority of the cost. Doctors would then be able to bill for interpreters.
Doctors want access to interpreters. Refugees need it. The law requires it. All the state needs to do is suggest it. In one of the most culturally diverse states in the nation, it only makes sense.
How large is the interpretation industry?
By Adam Wooten, Elanex General Manager (US)
Originally posted on Adam’s blog, T&I Business in February 2006.
The entire translation and interpretation industry has heard of Common Sense Advisory‘s list of the Top 20 Translation Companies, which is also the most timely resource for projections and estimates of translation and localization industry size ($9.46 billion in 2006). Unfortunately, it is much more difficult to find such information on the interpretation industry. Does such information exist? If so, where is it available?
Due to the nature of translation and interpretation, information on the interpretation industry is difficult to extract from most language industry research. This is particularly evident in Common Sense Advisory’s “Top 20″ list of companies ranging from $377.1 million to $17.2 million in revenues. The report ranks Lionbridge and Titan (soon to be part of L-3 Communications) as the top two translation companies, both of which generate unspecified millions in revenues from interpretation services; however, the same report excludes the telephone interpretation giant Language Line, Inc., which generated $145.0 million in 2004 and therefore could be ranked 4th.
When questioned by T&I Business about Language Line’s absence from the rankings, Renato Beninatto, COO of Common Sense Advisory, noted that “in the case of all the Top 20 companies, interpretation represents less than 30% of their business, the formula being the inverse in the case of OPI [Over-the-phone Interpretation] companies.” Beninatto also noted that Language Line and NetworkOmni, the 2nd largest OPI firm, are often viewed differently by both buyers and other language companies Clearly, there are valid reasons both for and against distinguishing the interpretation industry from the translation industry in market reports, but that leaves us with very little information on the interpretation market and its key players.
Within the interpretation industry, the OPI market has seen an enormous amount of growth in recent years, so more information is available on this segment. Language Line’s 2004 SEC filings are a wonderful source of information on the OPI market. In one filing, Language Line pegs the potential OPI market at greater than $1 billion and the served OPI market at less than $200 million (based on the fact that it claims to hold 75% market share), which differs from the $300 million to $400 million estimate made by George Ulmer, owner of NetworkOmni, in the April 2004 issue of Los Angeles Magazine.
Language Line lists its most significant U.S. competitors as NetworkOmni, Tele-Interpreters, Bowne (now Lionbridge), and Pacific Interpreters, none of which were estimated to have generated more than $15 million in revenues in 2003. Language Line also estimated that Language Line, Ltd. (which Language Line, Inc. has since acquired), of the UK, generated $8 million and CanTalk, of Canada, generated $2 million in 2003. Language Line also provides internal information that may be very representative of the industry (considering Language Line’s self-declared 75% market share) and useful for competing in the market. This representative information includes language usage by billed minutes, customer distribution by industry, and an average annual increase in billed minutes of 21% from 1998 to 2003. All this information is vital to executives at small OPI firms who wish to identify competitors, languages to staff, industries to target, and growth expectations.
Unfortunately, information comparable to that already mentioned does not appear to be available for the interpretation market as a whole. T&I Business has informally asked many language executives how large they believe the interpretation market to be, and most have “guesstimated” it to be approximately 10% of the translation market – whatever that is. Applying that percentage to Common Sense Advisory’s numbers, that would put the US interpretation market at $397 million and the world interpretation market at $946 million in 2006. Until a market research firm accepts the challenge to tackle the interpreting industry, these are the some of the only estimates available.
Opportunities abound for translators
By Elaine Varelas, boston.com
May 18, 2008
Q. I’ve spent a lot of time on the Net looking for a job as an interpreter in America. I’m an English graduate, I’ve been a journalist for 23 years in radio, TV, and print journalism. Would you please help me?
more stories like this
A. This is a great question about a fast-growing industry. As the global economy shrinks, the demand for language services is exploding. There are opportunities in translation, which is written communication, and interpretation, which is spoken. It is important to note the differences in these two services when you look at your job options. Fortunately, no matter where you are located, you can find work as a linguist.
To better understand the opportunities, I consulted Wendy Pease of Rapport International, a language services firm based in Sudbury that offers translation and interpretation services.
“There are many ways to provide linguistic services in either full-time employment or contract work through agencies, global companies, and providers of community services,” she said.
“Full-time jobs are found via regular job-search avenues like networking and using online job boards. If you’re looking for contract work, it takes effort on the individual’s part to connect with the organizations that hire and market themselves. By sending an e-mail blast or telephoning the targeted agencies, you may have luck. Make sure to explain your language pair (fluent knowledge in your native language) and the specific languages and areas where you have expertise. Rarely will we hire anyone who says that they ‘translate anything.’ ”
Even if you are monolingual, there are a number of other positions available in this industry, such as sales and project management. Detail-oriented project managers with an understanding of translation management software such as SDL Trados are in demand now. As the industry grows, support positions in finance and IT will see an increase in demand, too. To work in this industry, you must be passionate about working with people from a variety of backgrounds.
The language services industry is highly fragmented, and experts expect to see consolidation over the next decade. There are a few large companies and thousands of small agencies just in the United States. Many firms were started by translators or interpreters who started offering services in languages other than the original one that they provided. This is a great time to tap into a budding industry.
The Difference between Translation and Interpretation
Written by Adam Wooten , May 2010
If you are an author, reporter, or journalist of some type, you have probably been referred to this page because someone wants to politely explain to you the difference between translation and interpretation. There is no need to take offense. This is just an effort to educate many people who have previously been unaware. Not everyone outside the language industry knows the difference, but here is a basic principle you need to understand if you want to maintain credibility and appear as if you know what you are talking about.
Translation is Written & Interpretation is Spoken
It is really very simple. Translation is written. Interpretation is spoken. Translators work with written language. Interpreters deal with spoken language. That’s it! There is nothing more to it!
Still, many reporters and journalists get this wrong on a daily basis. I will not cite any examples here because I am not looking to embarrass anyone, but examples can be found easily with a quick Google search.
Authoritative References on the Difference
Trust me. You can take my word for it since I’ve worked as both a translator and an interpreter, and I’ve managed both translators and interpreters. If that is not enough to make you believe me, then check out a few of these authoritative references:
Although interpretation and translation have much in common, the practice of each profession differs in the same way that written language differs from spoken… Interpreters must be good public speakers who are adept at grasping meaning and solving complex linguistic problems quickly, whereas translators must be able to conduct thorough and meticulous research and produce accurate, camera-ready documents while adhering to tight deadlines.
Graduate School of Translation, Interpretation, & Language Education
Monterey Institute of International Studies
Translation refers to the rendering of written materials into a different language…. Interpretation refers to the relaying of spoken words, such as lectures or conversations, into another language….
Center for Language Study
Translators work with the written word…. Interpreters work with the spoken word….
American Translators Association
Interpreters deal with spoken words, translators with written words.
US Bureau of Labor Statistics
Even Wikipedia recognizes that many people attempt to use the word “translation” to refer to both; however, “interpretation and translation are not synonymous.”
Maintain Journalistic Credibility when Reporting on Language Services
I hope by now you get it and you think I’m beating a dead horse. If you find this repetitive and are almost ready to click away from this page, that is a good thing. Unfortunately, after all the evidence above has been presented, there are still some incredibly stubborn people who bury their heads in the sand and insist the two words are interchangeable. Sometimes these people will become very defensive and attack the person correcting them. I once had a reporter tell me he would not pay any attention to my suggestion because I had omitted a serial comma from my email. Please don’t be one of those people. It will only embarrass you.
Imagine how embarrassing it would be for a reporter to confuse “libel” with “slander,” when there is such a clear difference: libel is written, and slander is spoken. Or imagine how silly it would sound if a reporter referred to how a pair of political candidates demonstrated what great writers they were as they spoke impromptu in a recent debate. Clearly speakers speak and writers write, and it is just plain wrong to think that the words for speaking and writing are interchangeable.
- Writing vs Speaking
- Authors vs Orators
- Translation vs Interpretation
- Translators vs Interpreters
Journalists and reporters can maintain or lose credibility depending on how well they convey their understanding of the differences between the following: U.S. House and Senate; libel and slander; civil court and criminal court; speaking and writing; translation and interpretation; and more…
The Nicole Kidman Example
For one final example, remember Hollywood’s 2005 film starring Nicole Kidman. Hollywood does not always get it right, but it did in this particular case. The film is correctly called The Interpreter, NOT The Translator, because Kidman’s character works as a U.N. interpreter and deals with the spoken word, NOT the written word.
A simple illustration was created by interpreters Johanna Parker and Sam Pinilla while they were pursuing graduate studies in translation and interpretation at the Monterey Institute of International Studies. It was distributed to moviegoers in the Language Capital of the World when the The Interpreter was released in 2005. In a very simplified “see-Jane-run” style with stick figures, the illustration read: “Why isn’t this movie called˜The Translator?’ See Nicole. See Nicole listen. See Nicole interpret. See Lydia. See Lydia read. See Lydia translate. Got it?”
Thank You for Writing about Translation & Interpretation
So, after kicking this dead horse a few more times, I hope you are convinced enough to use the words translation and interpretation correctly in the future. No one was insulting you by directing you to this link. This is merely an effort to educate journalists and reporters. Greater understanding will benefit everyone, and anyone reporting on this topic will be taken much more seriously if he or she uses these terms correctly.
Thank you for taking the time to write about or report on translation or interpretation. And thank you for taking the time to educate yourself about these two professions and their differences.
Industries wherein accurate translation is crucial
Translation is a very complex discipline that demands very high standards of accuracy. Organisations in all manner of industries require accurate translation services if they are to function successfully in languages other than the native tongue of the company in question. In order to demonstrate the importance of high quality translation, it is pertinent to look at some of the industries wherein inaccuracies have the potential to cause severe negative effects.
It calls for incredible skill to translate medical jargon and terminology successfully. This is why translation tools like machine translators are inadequate for medical translation. Poor quality medical translation can lead to the misuse of equipment and medication in an industry where there really is no room for inaccuracy.
Clarity is key to effective legal translation. Poor translation of legal documentation can lead to ambiguities and misunderstandings that can have negative effects ranging from the loss of time and money resolving matters of confusion to errors affecting the actual legal sense of the document. Specialist legal translators are required to translate legal documents, taking into account the nuances of each country’s legal system the records must be treated for, as well as the legal system under which it was originally drawn up.
Interpreting Health: Cultural Barriers at New York City Hospitals
By Sarah Kate Kramer, WNYC News
In order to serve its increasingly multi-lingual population, New York State requires interpretation services in all hospitals. But when caring for immigrants, the language barrier is just one of a myriad of issues health providers grapple with. Even though there is no statewide mandate for cultural sensitivity, many doctors say it’s become a necessary instrument in providing medical care for the city’s immigrant population.
Cover your cough poster in Arabic (Courtesy of the Department of Health)
Maha Attieh is the health program manager at the Arab American Family Support Center, and she has a constant stream of clients at her small office on Court Street in Brooklyn. Attieh’s job is to help new immigrants navigate a daunting and foreign health-care system. But she says she spends a lot of her time educating health providers about what alienates her clients.
“Like in the hospitals, if a Muslim person is dying they’re supposed to be facing east. Does the hospital know these things? If a Jewish [person is] dying when they wear their yarmulke, they should leave it on their head because of the religious issues,” Attieh says.
The city’s public hospital system, which receives the bulk of immigrant patients, established a special department, the Center for Culturally and Linguistically Appropriate Services (CLAS) in 2006. Attieh says she’s glad hospitals in the city are becoming more sensitive to the needs of the Arab-American community. But she says there are still cultural hurdles that make medical care an unpleasant ordeal for her clients.
On Christmas Eve, a 31-year-old woman from Yemen, wearing a traditional black robe decorated with red embroidery, walked into Attieh’s office for help with a Medicaid application. Halima (who did not want to use her real name because she didn’t want her community to know about her struggles), has eight children. The first five were born in her village in Yemen, where it’s traditional for women to give birth in their homes while kneeling on a special mat placed on the ground.
“My father’s father, he cut the umbilical cord and cleaned everything, he took care of everything,” Halima tells Attieh, in Arabic.
But when giving birth to her first American-born child at Kings County Hospital in Brooklyn, Halima found herself lying immobile on her back, hooked up to an IV, feeling helpless and exposed. She wanted to be in her customary position, on her knees. So she asked the nurses, but they refused. “This is our business, not yours,” Halima remembers them telling her.
Not knowing hospital rules or her rights as a patient, Halima found childbirth in Brooklyn frightening and traumatic.
Patients refusing medication, requesting specific foods, and preferring home remedies are issues hospitals in New York face daily. And major life events like birth and death are when cultural issues are likely to arise. Even though hospitals in the city are training their staff in cultural competency, they can’t always accommodate patients completely.
Surrinder Suri, a nurse at Elmhurst hospital in Queens, says when there are tragedies like still births, some of her patients ask to take the placenta home for burial in their back yards. But the hospital can’t allow that because of Department of Health regulations.
“We tell them we can give you a piece of the cord and you can put it in a test tube and you can bury it. So you find an alternative to help them carry their practices,” Suri says. To improve relations with the community, Suri says Elmhurst has been training its nurses in cultural sensitivity. They’re now open to Muslim women who insist on female doctors, and Chinese and Korean patients who hang numbers in their rooms as signs of good luck. But the line is drawn at what the hospital considers patient safety issues. Touching a newborn’s lips with honey is a traditional practice in many parts of the world–but in American hospitals it’s forbidden, for fear of botulism. It’s times like these when arguments between patients and providers occur.
Dr. David Rubinstein, director of cardiology at Elmhurst, finds that taking the time to find a middle ground with patients is crucial. “You have to be very sensitive to their family and community needs,” Dr. Rubinstein says. “The idea that you can just give a pill and think that a person is either going to take it or continue to take it is not correct.”
Dr. Rubinstein is trying to forge a relationship with the South Asian community living around Elmhurst hospital, which has a disproportionately high rate of heart disease. But he says it’s difficult to communicate — and not just because of language barriers. Last summer for example, he brought a group of college students to a Sikh temple to give a presentation about heart disease. But one of the students who helped organize the outreach project was upset when he found the older community members, mostly senior men, didn’t take him seriously because he was so young. He asked Dr. Rubenstein why they weren’t listening to him. Dr. Rubenstein replied, “Because people have to be approached in a certain way if we’re going to get the message across.”
Cultural differences in how to define illness and treatment also compound the communication problem — and can have fatal consequences.
Last year, Evens Jean, a language interpreter at Bellevue Hospital, was working with a Haitian patient and her doctor. In the patient’s previous appointment, many months earlier, she had been diagnosed with breast cancer.
“So by the time the patient came back to see the doctor it was already too late because the cancer had metastasized. The patient was asking the doctor, ‘Is there any way you can give me some pills or some ointment I can apply over that area because I don’t feel any pain.’ The doctor was trying to talk to her, saying ‘no,’” Jean says.
Jean, who was born in Haiti, understood the cultural barrier, and decided to step out of his role as an impartial interpreter and explain to the doctor why communication had failed. “I jumped in and told the provider that this is how it is in our culture. If we don’t feel the pain, if we don’t have an open wound, basically, we’re fine.”
That’s exactly the kind of situation Maha Attieh is trying to avoid at the Arab American Family Support Center. She desperately wants the women in her community to get screened for breast cancer before it’s too late. But she says it’s been a struggle to even get women to the hospital, and many don’t know they can request a female doctor.
“Our women, they don’t like to show the whole body in front of the doctor when they do their mammogram. They think it’s painful for them to do it, but we assure them that a woman will be doing the mammogram for them,” Attieh says.
A few years ago, Dr. Francesca Gany, director of the N.Y.U. Center on Immigrant Health, noticed the same thing. She saw data showing there were almost no Arab-American women getting screened for breast cancer in New York City. In an effort to counter this health disparity, she started an outreach program. It wasn’t simple. Many of the women had had negative experiences with the health-care system, and they were reluctant to return. They told her they received high bills they didn’t owe, and encountered providers who weren’t “sensitive to their needs or who could be racist about having immigrants come in for care.” After those experiences with the health-care system, Dr. Gany says “chances are they’ll never come back unless it’s dire.”
Back at the Arab American Family Support Center, Halima tells Maha she not only had a traumatic childbirth experience in the U.S., but she also struggles with the American health-insurance system. Halima’s henna-stained hands are clutching a plastic bag that holds eight passports, Social Security cards, birth certificates, old health-insurance cards, and pay stubs. Halima only knows a few words of English, and can’t read or write Arabic. Maha Attieh, who is filling out the Medicaid application for her children, asks Halima for a new document every few minutes, and she shuffles through the documents.
Because she didn’t understand the Medicaid re-enrollment form that was sent to her home, Halima missed the renewal deadline, and her eight children lost their insurance. Attieh says most of her clients get lost in the American health-insurance system, so they just go without it. Furthermore, she says many avoid public health insurance even if they’re eligible for it, because they think it will affect their citizenship applications. That means they don’t see doctors until they land in the emergency room, which ends up being more costly to their health, not to mention hospital budgets. For all these reasons, the Arab American Family Support Center started a health advocacy program last year. They trained six bilingual community members to be cultural navigators for the health-care system.
“They are our eyes and ears in the community, they let people know it’s okay to get health insurance, it’s okay to access health care because we are there to help them out,” Attieh says.
These navigators accompany immigrants to hospital visits, advocate for culturally sensitive care, and make sure patient and doctor are truly communicating. Necole Brown of Healthy Families Brooklyn helped train the advocates and says they help new immigrants learn the very basics.
“Okay, you have a health insurance plan, now you have to pick a primary care doctor. What does that even mean to somebody?”
Brown says the Center’s program is successful because the advocates come from the community itself, and they’re natural leaders that people flock to anyway. Not only is this program highly sensitive to the community’s specific cultural needs, it may also be more financially sustainable than hospital led programs.
Back in Queens, Dr. Rubenstein says it’s getting harder for him to raise money for his South Asian outreach program as the hospital’s budget is squeezed. Especially since Elmhurst doesn’t get paid for preventative medicine.
“It’s very difficult to find targets to treat and goals to measure with outreach activities. If you bring 1,000 patients into the hospital to get care and follow up, you’ve probably done a tremendous good to the community, but how do you track that? It’s very difficult,” Dr. Rubenstein says.
That’s why community based health programs run by groups like the Arab American Family Support Center are taking on a bigger role in immigrant health. These insiders are fluent in the cultural language that builds trust with hospitals — and trust is what’s needed to get people in, before there’s a crisis.
This series was conceived and produced as a project for The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School for Communication & Journalism.
Court says interpreter necessary, overturns conviction
Legal rights groups are applauding a Georgia Supreme Court ruling Monday that granted a new trial to a Malaysian woman because she was denied the right to a court interpreter.
Ling’s appeal was supported by the American Civil Liberties Union, the ACLU of Georgia and the Legal Aid Society, which filed a brief saying the denial of interpreters to those who need them violates the U.S. Constitution and civil rights laws. The Asian American Center for Advancing Justice, represented by the Atlanta firm King & Spalding, also filed a brief in support of Ling’s appeal.
“The court acknowledged that we don’t have two systems of justice in this country – one for English-speakers and another for everyone else,” said Azadeh Shahshahani of the ACLU of Georgia. “The constitutional guarantee of due process applies to everyone in this country, not just fluent English-speakers.”
American Sign Language interpreters: the theater world’s unsung heroes
By Maya Kroth SPECIAL TO THE U-T
Sunday, January 2, 2011
Doug Hlavay, with the American Sign Language interpreters, interprets for the deaf patrons at a performance of “Beauty and the Beast” at the San Diego Civic Theater. Photo by Earnie Grafton/The San Diego Union-Tribune.
ASL-interpreted performances are offered regularly at La Jolla Playhouse, Broadway/San Diego and San Diego Junior Theater, and by request at the Old Globe Theatre and other theaters. Liz Mendoza’s Stage Signs of San Diego maintains a calendar of ASL-interpreted performances throughout Southern California via its Yahoo group. Upcoming interpreted performances include:
Billieanne McLellan looks sharp as she stands outside the Casa del Prado Theater in Balboa Park one recent Saturday, wearing a black-velvet blouse, black trousers and black patent-leather shoes. Her long, red hair is pulled back into a low ponytail, and her nails are impeccably manicured: Today they’ve got to look flawless. She cuts through the bustling lobby and dashes toward the front of the theater, where her partner (or “team,” in industry parlance) is waiting near the stage. Also dressed in black, Lynn Ann Garrett has her hair slicked back and her eyelids shaded dramatically in dark shadow, to better show up under the hot lights of the theater. Against the heavy, black-velvet curtain, the two women seem to almost disappear as if into a blue screen, only their hands and faces standing out from the sea of black.
And that is just the way they like it. Because they’re American Sign Language (ASL) interpreters, two of about 10 actively working in San Diego theaters, all of whom would tell you it’s their job to be invisible, as much as possible anyway, so as not to detract attention from the “real” stars performing on stage. That humble attitude, combined with the huge volume of work that goes into doing what they do, makes this one of the most underrated gigs in show business.
Interpreters typically work in teams of two to mount a single ASL-interpreted performance, for which they spend many dozens of hours — some say even hundreds — preparing. Beginning weeks in advance, they get together to pore through scripts line-by-line and divvy up characters, often juggling two dozen or more between them, many of which speak simultaneously.
With their “team,” they will strategize to find the best way to translate a playwright’s words into a wholly different language that has a grammar and syntax all its own, while retaining as much of the script’s subtler features — such as cadence and double entendre — as possible. They will read up on the background of the playwright and research the political history of the epoch in which a play is set. They will Google the definitions of words they don’t know, or allusions they don’t get. Then they will try to figure out how to explain the reference in signs before the actors on stage have moved on to the next line, because otherwise the whole thing derails.
And they will try to make their interpretation appropriate enough to avoid raising the ire of a discerning deaf patron like Tom Humphries, a UCSD professor and frequent theatergoer.
“The really good theater interpreters know when to make the translation literal enough to preserve the original English of a playwright,” Humphries writes in an e-mail. “The best example of this is with Shakespeare or a well-known musical, when I want to see the famous lines, not bad translations of them.”
The Bard is a particular challenge for ASL interpreters.
“It requires almost a double interpretation,” says McLellan. “Once from Shakespearean English to English that I can understand, then from English to ASL.”
While some things (like iambic pentameter) are bound to be lost in translation, certain other literary devices don’t have to be.
“If there’s, say, a rhyming joke in English, we have to make it rhyme in American Sign Language,” says Liz Mendoza, whose company Stage Signs assigns ASL interpreters for productions at San Diego Junior Theater and Broadway/San Diego.
She explains that just as spoken rhymes comprise words that sound alike, signed rhymes are built from hand shapes that look alike. “It might not be the exact same translation, but it’s the exact same experience.”
Shared experience is an ASL interpreter’s ultimate goal, which is why so much preparation goes into each performance. It’s not enough to merely translate a play word for word (though theaters that lack a budget for interpreters may employ captioning services to do just that). Interpreters also try to visually convey the kinds of aural cues — a foreign accent, a tone of voice — that help hearing audiences better understand a character. To do this, interpreters will attend as many dress rehearsals or performances of a given play as possible in order to see what the actors on stage are doing. Mimicking certain physical traits — a hunch, a trademark scowl, a haughtily upturned nose — can add texture to a deaf patron’s understanding of a character, while also clarifying which character is speaking.
“ASL is as much about facial expression and what the entire body is doing as what their hands are doing,” says Stephen McCormick, La Jolla Playhouse’s Director of Education and Outreach who oversees the interpreters. “It’s a beautiful art form.”
While signing songs from musicals, for example, the interpreter’s gestures may become larger, more rhythmic and graceful, to impart a bit of the melody and lyricism a hearing patron takes for granted. Interpreters complain of sore backs and shoulders from having to stand and sign constantly for two hours, breaking only at intermission. And that’s to say nothing of the emotional toll that some plays may take.
“I equate it to when actors play murderers, or people that are a little bit crazy,” says interpreter Suzanne Lightbourn, who observed a change in herself while preparing to interpret the vile lead character of Man in the La Jolla Playhouse’s recent production of Dostoevski’s dark “Notes From Underground.” “My team said she noticed she was snapping at her partner a lot, and I realized, yeah, I’ve been taking my grumpy pills in the morning! It gets in you.”
This raises the inevitable question: To what extent should sign-language interpreters be considered actors? The answer varies depending on whom you ask.
According to Mendoza, who received her training at a weeklong interpretation workshop at Juilliard, the overlap is minimal.
“We mimic what the actors do on stage, in order for the deaf audience to identify who’s speaking,” she says. “We’re not actors per se, because we’re just taking what the actors give us. It’s not originating from us.”
Lightbourn, by contrast, says the two are very close: “Probably about 99 percent. You can’t be inhibited with your body. You have to really put yourself into the actor’s role and give what the actor’s giving.” Many who have some acting or theatrical training in the past say the experience has improved their interpretations.
The line between robotic, detached translation and overacting is a fine one to walk.
“Many interpreters have the false belief that they need to perform or act the lines in a play. I’m sorry, but most interpreters are terrible actors and can’t pull that off,” writes patron Humphries. “I guess the difference between good and bad interpreting is a bit like good and bad acting: You certainly know it when you see it.”
The work, though demanding, is not exactly lucrative. Paid around $500 per performance, an interpreter’s hourly rate, with all things considered, can be as low as a few dollars. And there’s a limited number of outlets in San Diego that even have the budget for their services: Broadway/San Diego, San Diego Junior Theater and the La Jolla Playhouse are the only major houses that offer a regularly scheduled interpreted show, while others, including the Old Globe Theatre and Moonlight Stage Productions, may provide interpreters upon request.
“You can’t make a living off of just interpreting for theater,” Mendoza says flatly, noting that even her peers in New York City are not able to make ends meet without taking day jobs interpreting for public schools, hospitals and courts. Even the most active theater interpreters spend only about 20 percent of their working hours on performances.
“We really do it for the love of it,” says Mendoza.
For Mendoza’s frequent interpretation partner Doug Hlavay, the payoff is more than just economic: “Any time a member of the deaf community has an experience at the theater that evokes some type of emotion — laughter, tears — that makes all the prep worthwhile,” he says.
“They’re having a direct relationship with the content of the play,” echoes Lightbourn. “You’re not in the middle anymore. That’s when it feels like you’re doing a good job.”
Maya Kroth is a San Diego writer.
Medical interpreters are a patient’s right
Federal and state law requires assistance for patients with limited English. New national competency standards begin in 2011.
December 27, 2010 By Francesca Lunzer Kritz, Special to The Los Angeles Times
Even people who speak English fluently often find that conversations with healthcare professionals sound like Greek to them. So imagine if you speak only Greek or Spanish or Farsi and want to have, say, an in-depth conversation with an oncologist about the risks and benefits of an aggressive form of chemotherapy.
Until recently, the most likely interpreter in such an encounter would be a family member, often a poor choice because he or she might be reluctant to share bad news or be unfamiliar with medical terminology. But new developments are helping patients with limited English communicate better with their healthcare providers — including a 2-year-old California law that requires health insurers to provide interpreting (oral) and translating (written) services to patients with limited English proficiency, draft standards on how medical interpreting should be conducted in hospitals, two new certification bodies for medical interpreters and the rapidly increasing use of remote interpretation service by phone or video conference.