Reaching medical “understandings” in intercultural and interlinguistic settings

Maribel Tercedor Sánchez 7th Terminology seminar: Health threatening misunderstandings Brussels, April 25th 2014

Context for action

• Global access

– Working under pressure

– Providing user-tailored tools

• Awareness of local identities

• Rethink traditional academic frames

• “[…] sensitivity to changes in language and developments in languages (useful for exercising creativity)” (EMT 2009, p. 5).

• Health is a basic human right

• Language and cultural barriers hinder access

to health

• Awareness in Medical scenarios

-Language Barriers in health care. Journal of Internal Medicine. 2007.

-"language barriers" between technical discourse and ordinarily comprehensible expression (ACOG 2012)

What does patient-centeredness mean?

Terminology, and translation,

and interpreting, and…

must consider

Language adequacy issues

• register

• cultural terms

• languages in contact situations

Cognitive issues

• world knowledge

• situatedness

• embodiment

Multimodality issues

• images

• gestures

Travelers diarrhea Montezuma's revenge refers to diarrhea contracted in Mexico by tourists.

Terms as pointers to larger situational, linguistic, and

cultural contexts

– User-based parameters: geographic, temporal or

social

– Usage-based parameters: field, tenor, and

channel

– Interlinguistic parameters

Terminology tends to be similar in most languages with scientific tradition, on account of their classical (i.e. neo-Latin and classical Greek) origin (Verdaguer et al 2013: 22)

Language adequacy

Intercultural competence A set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community in developing targeted interventions, communications and other support.

Source: Office of Minority and Women’s Health, HRSA, NIH

The strategies

Ingrowing toenail --- Onicocriptosis infectada, es decir, uña del dedo gordo encarnada.

Interlinguistic differences NITRATES - ORAL USES: This medication relaxes blood vessels allowing more blood to flow through. This improves blood flow to the heart. Oral dose forms are used to prevent angina (chest pain). This medication is NOT for treating an attack of chest pain that is already happening. HOW TO USE: This medication is best taken on an empty stomach with a full glass of water. Take exactly as prescribed. To be effective in preventing chest pain, you must continue taking this drug even if you feel well. SIDE EFFECTS: Headache, dizziness, flushing, rapid heartbeat or restlessness may occur as your body adjusts to the medication. If they persist or become bothersome, inform your doctor. Notify your doctor if you experience: blurred vision, dry mouth, skin rash, nausea. Headache is often a sign the medication is working. If the headaches continue or become severe, notify your doctor. In the unlikely event you have an allergic reaction to this drug, seek medical attention immediately. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Use caution engaging in activities that require alertness or in operating machinery if this medication makes you dizzy or drowsy. Alcoholic beverages may increase the risk of fainting or of experiencing dizziness. This medication should be used during pregnancy only if clearly needed. Discuss the risks and benefits with your doctor. It is not known if this drug is excreted into breast milk. Consult your doctor before breast-feeding. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include nausea, vomiting, dizziness, fainting, unconsciousness, slow or rapid heartbeat, confusion, fever, or persistent throbbing headache.

• Cognitive theories of Terminology: Sociocognitive Terminology (Temmerman 2000); Termontography (Temmerman and Kerrremans 2003); Frame-based Terminology (Faber 2012).

• embodiment can be interpreted according to (i) parts of the body, (ii) people’s actions and other body-related traits (e.g. posture), (iii) mental representations with bodily contents, and (iv) mental representations with other aspects (Goldman and De Vignemont, in press)

Cognitive issues

Understanding pain

Localization Consequently, if you are experiencing back pain you owe it to yourself to look into the

if there is difficulty breathing, chest pain, cough with high fever, or if symptoms illnesses such as rheumatoid arthritis. Muscle pain is known as myalgia. </p><p> Arthritis : </p>

Etiology on by nerve malfunction or damage, while nociceptive pain is brought on by something apart from the

visceral spasm. It helps neuropathic and nociceptive pain. Mobility can improve with or without analgesia root ganglia (DRG) may contribute to neuropathic pain, and may arise under the influence of nerve

Intensity a massage therapist experiences extreme pain simply because he stands on his feet over blood pressure, fatigue, mild to severe pain and urinary tract infections. </p><p> Renal

Duration much in the way people with chronic pain require constant medication to function

ipulation is indicated for management of acute pain and to improve function, and should be Introspection

ingesting cherry juice may assist alleviate pain attributable to uric-acid crystal formation recognize and accept that some injuries and pain are inevitable with any physical activity

Subjective/emotional perception convenient as can be. We know that while back pain is very debilitating , it is also quite

patient will not experience excruciating pain due to anesthesia, but probably just a

Cognitive issues

Sensorial dimension

back abdominal

joint chest neck

knee stomach pelvic arthritis

sciatic muscle nerve

shoulder neuropathic mild

extreme intense sharp severe

minimal chronic acute

constant persistent

Cognitive dimension

manageable inevitable

unavoidable attributable imaginable

Affective dimension

emotional excruciating extreme

un/bearable in/tolerable indescribable debilitating

subjective

Alternative Names in Medline

Quartan malaria

Falciparum malaria

Biduoterian fever

Blackwater fever

Tertian malaria

Plasmodium

Malaria

Multidimensionality

Graphical information for terminology

• Information in terminographic definitions

meshes with the visual information in images

• Selection of images based on concept

features and user needs

• Graphical profile in consonance with concept

type

Ostensive definitions may use any form of multimedia that allows one to exhibit non-lexical representations of the concept ISO 704 (2009: 46).

Multimodality

Images are difficult for certain subjective concepts

Or can help clarify concepts, such as those lexicalized through metaphorical terms

Source: VariMed project. http://varimed.ugr.es

Before we take images: •Can we understand medical concepts better with the support of images?

•Are images always a good learning tool?

•Are they sometimes better than definitions?

•Are they good representatives of a concept feature?

•Is a specialist knowledge needed to understand the image?

•Not all images are good for all users.

Images have proved to be useful in identifying and understanding objects

(Kosslyn, 2005 and Pylyshyn, 2002)

Internationalization vs. Localization

Materials do not appeal local communities

because their cultural identities are not

reflected

No materials in own language

Presented in a way that causes distrust

towards Western/mainstream medicine

Representing values and world views: body language

.

First draft Final version

I must respect the elderly

K’a’abet in tsikik nojoch máako’ob

Debo respetar a los mayores

Interdisciplinarity

Cultural awareness

Research challenges

Corpus data

Non spontaneous production

Objective frequencies

Subjective frequencies familiarity

Spontaneous data

Experimental data

Objective frequencies and familiarity only coincide in high frequency words (Guzmán y Jiménez 2001)

• Cultural and language awareness

• Importance of multimodal presentation of identities to achieve communication goals

Are we invisible?

Clear communication is essential for safe, quality healthcare services

(Partida 2007)

A Navajo interpreter explained this perspective when she said: We have to think of ourselves as being part of the community. We have to think

about the people that we are talking to (and our relationship to them). There is a clan system. There are certain things I cannot interpret if it is for my husband’s

clan . . . or for my father’s clan, especially if it is about certain sensitive things, like the male

parts of the body. There are certain things that I, as an interpreter, cannot interpret if the person I am interpreting for is older than me. I cannot say certain

things to a male that I can say to a female. There are certain things a young female interpreter cannot say to a young man. There are certain things a male interpreter

cannot say to a man.

And, then there is spirituality. There are certain things I cannot interpret to anybody because of the spiritual part of it. In our culture, there are some things

you do not say. So, I have two worlds that I have to take the patient through. Western medicine that is separate from our lives and the Indian way of life where we’re at all the time. By knowing both sides, I bring those two forces

together. I show the patient - this is what is over there. I show the provider - that is what is over there. So, it’s a lot more than just saying what the doctor and patient

say.

http://web.clark.edu/bellis/Guidelines_for_Multicultural_Practice.htm

If only every doctor would “see” each patient

as a vibrant human, that might help

(Schattner 2014)

We, translators, interpreters,

terminologists…

• Cooperate in access to health and basic

(communicative) human rights

• Contribute to interculturality through intercultural and

interlinguistic awareness and competence

• Support the development of local communities

through our work.

THANK YOU

Maribel Tercedor Sánchez

maribeltercedor@gmail.com