Monday, October 13, 2008

Lost in translation?


Imagine falling ill in a foreign country and trying to explain how you feel to a doctor who can’t understand a single word you say.
Hand gestures might have to substitute for spoken word. The diagnosis could become sketchy, the doctor’s instructions lost in translation. Fear pervades an already distressing situation.
It’s a reality dozens face every day in Santa Barbara — when a Spanish-speaking mother starts getting blinding headaches, a field worker suffers heatstroke or a foreign tourist doubles over at dinner with a searing pain in his abdomen.
But a handful of people are working to eliminate that fear, to provide equal treatment and service to everyone who needs medical treatment, regardless of the language they speak.

“There’s a lot of satisfaction in it,” said Cinthya Torres, a medical interpreter and cultural advocate who works at Santa Barbara Cottage Hospital. “You see the relief in people when they understand what they’re being told, especially when they are in critical situations.”
Torres is one cog in the blossoming discipline of healthcare interpretation, a field being spurred on by equal access legislation.
She came to the profession almost by chance, having stumbled across an advertisement seeking volunteer interpreters while looking into nursing. After a year of volunteer work, she was hired on as a part-time staff worker at the hospital approximately five years ago and has found her calling.
“This is where I want to be,” she said.
The mere existence of her job can be traced back, at least in part, to a mandate from the Clinton administration that essentially required all acute care hospitals to provide language services for patients with limited English proficiency.
A bill approved by the governor of California in 2003 also required all managed healthcare plans to provide language assistance. As a result, the need for qualified interpreters is on the rise, particularly in communities with large foreign-speaking populations.
Nonetheless, it’s still far from prominence.
“It’s something I don’t think people realize is a profession,” said Denise Filotas, a freelance interpreter who teaches a series of healthcare interpretation courses at Santa Barbara City College. “People have been asked to do it as a part of their job.”
Just a few years ago, she would still see bilingual nurses or office assistants being pulled into a hospital room as impromptu interpreters. But it’s a trend that is slowly shifting away from volunteer positions to part-time and full-time staff.
That’s a step in the right direction, Filotas said, because of the need for trained interpreters who can nail down each word with the utmost precision rather than roughly paraphrasing their way through a conversation.
“If a doctor would say, well, this could be ‘life-threatening’ — they chose not to say it could be ‘fatal,’” she said. “…It’s part of the training and it’s part of the finessing. Nuance of language is what makes a really exceptional interpreter.”
Filotas is focused on bringing that nuanced approach to the profession through the five-course series she teaches with help from Mary Zeldes, a registered nurse. From memory development to dealing with difficult situations, the series runs the gamut of interpretation-related topics.
In addition to breaking down the fundamental skills necessary for medical interpreting, a section of the course also focuses on medical terminology, a critical component of the profession.
Understanding anatomy, physiology and specialized fields such as diet-related illnesses — or even how to explain a tracheostomy to a Spanish-speaking patient — is a necessary skill when interpreting in a hospital setting.
So it’s no surprise that not everyone makes the grade after completing the program. Surprisingly, the seemingly obvious requirement of fluency in both languages is a pitfall for some.
“They have to have fluency in healthcare English and Spanish,” said Dr. Patty Borgman, supervisor of interpreter services at Cottage Hospital, as she described her standards for hiring an interpreter. “Anything shorter than that and it’s just not a good fit.”
Another issue that frequently comes up is when people sign up for the course and, despite their zeal and enthusiasm for the profession, can’t write in both English and Spanish very well.
Giving discharge instructions for a patient after gallbladder surgery is a common scenario at the hospital, Dr. Borgman said. In addition to spelling out what the doctor says verbally, an interpreter must also be able to translate the written instructions for medications or post-discharge care.
“That separates the women from the girls and the men from the boys,” she said. “It’s the kiss of death for a lot of folks.”
On top of that, the ability to handle tragedy and trauma is often an important quality as a medical interpreter.
Torres grew up in Santa Barbara and will occasionally have to break bad news to someone she’s known for years. Or she might have to tell a mother than her child has a fatal disease.
“You never know what you’re going to get when you come into work,” she said. “…You have to have the people skills, you have to have the compassion.”
Dealing with those difficult situations is just a part of the job, Dr. Borgman said. Try as she might to avoid it, she has inevitably become involved on a personal level.
As the mother of several young girls, it’s often the cases involving a child whose life is threatened by an illness that get her.
“You can be just sucked into it in a way that you never would have imagined,” she said. “You bring it home.”
Due to privacy laws, the ability to share that pain is somewhat hampered. Those who work on a team of interpreters, such as those employed by Cottage Hospital, can go to grief counselors or their supervisor for support.
Those who freelance, such as Filotas, face bigger hurdles.
“You are essentially isolated,” she said. “There is nobody to talk to. … It’s an issue that isn’t resolved.”
When she faces taxing situations, Filotas will occasionally call a friend who works in a similar capacity to talk in general terms about work-related stress. It’s a less-than-perfect solution, but it helps her get through the tougher moments.
But it’s not all traumatic experiences; there is a balance to the job, Dr. Borgman said. Her glee comes when she is able to completely remove the barriers of communication between patient and doctor.
“What I notice is when the patient or family members of the patient will just get a sparkle, a gleam in their eye,” she said. “…They’re just so relieved. We share that sense of relief and accomplishment.”
She just doesn’t know when she goes into work each day whether she’ll be getting that sense of accomplishment or facing a family with bad news about their child.
“One thing we never are is bored,” Dr. Borgman said.
Torres also revels in seeing that expression of relief on the faces of her clients. Taking away the burden of hampered communication is incredibly rewarding, she said, particularly when that burden might have been placed on children in the family who speak some English.
“Growing up, I saw it firsthand when my grandparents would go to the doctor and they wouldn’t understand what was being told to them,” the 26-year-old said. “I’ve been put in a situation where I had to translate as a kid and it just isn’t fair.”
With the course at City College gaining visibility and the realization that Cottage Hospital offers interpretation services slowly spreading through the community, Torres has seen an increased demand for Spanish interpreters in Santa Barbara.
“We have a big need,” she said. “People are learning that they can ask for Spanish-speaking interpreters.”
But it’s important to note that interpreting is not solely a Spanish-oriented profession, even locally. Hospital officials often face the problem of finding an interpreter who speaks Mixtec, a separate language that originated in the southern regions of Mexico.
Large community of Mixtec speakers exist in Santa Maria and Ventura County, Dr. Borgman said, and it’s often difficult to find a qualified interpreter to handle those cases.
“That language is posing a much bigger challenge than Spanish,” she said. “Spanish is kid’s play compared to trying to find a trained, ad-hoc Mixtec interpreter.”
On other occasions, she might find herself dealing with a Mandarin Chinese speaker who refuses to use a telephone interpretation service — the go-to solution when hospital officials are facing a less-common language.
“There are so many needs in Cottage every day that my head is swirling by lunchtime,” Dr. Borgman said. “It’s like being on a buckin’ bronco sometimes.”
Still, those in the field have great optimism for the future. The California Healthcare Interpreting Association, a nonprofit focused on improving language services in the delivery of healthcare, is bringing legitimacy to the profession, as are discussions of forming a national certification process for interpreters.
And it’s safe to say there will always be a need for people like Torres, whose only desire is to make life a little easier for those in tough situations.
“If I can take away a little bit of the pain, I’m happy,” she said. “…I don’t need any more reward than that.”

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