Health Care InterpretingAnna Kenny, Professional Development Coordinator

Session Outline

About Health Care Interpreter Service

NSW Health Policy on Interpreter Use

Health Care Interpreter Qualifications

Role of Health Care Interpreter

Health Care Interpreting Assignments

About HCIS

SWAHS HCIS provides language services to health care providers & clients in public health facilities & some non-government organisations

Services available 24 hours a day seven days a week

Available in over 120 languages, including AUSLAN

On-site interpreting

Telephone interpreting

Interpreting via videoconference

Translation of health related documents

Services Available

NSW Health PolicyTo use professional health care interpreters

Not relatives, friends or unaccredited bilingual staff

http://www.health.nsw.gov.au/policies/pd/2006/PD2006_053.html

Why Not Use Relatives, Friends or Unaccredited Bilingual StaffEmotional involvementUncertainty about community language qualityNon-professional interpretingNot bound by Code of Ethics- Confidentiality

Professional Health Care Interpreters areNAATI accredited in languages in which testing is availableHighly trainedSpecialised in medical terminologyBound by the AUSIT Code of Ethics

Role of Health Care InterpreterProvide professional & confidential interpreting services which facilitate communicationResponsible for clear communication

Close to Interpreter as Manager of Communication Model

Role of Health Care InterpretersAccuracyInterpret everything- including unpleasant remarks & swearwordsAsk for clarificationExplain metaphors, concepts that dont exist in the target languageClarify misunderstandingsMaintain register

Maintain confidentiality (exception: suspected child abuse)Maintain impartiality (*small communities)Sight translationsProvide cultural information relevant to clinical & social needs of the client Overcome barriers to communication embedded in cultural, class, religious & other social differencesRole of Health Care Interpreters

How to Provide Cultural InformationPreferably before or after the interviewIf it is necessary to interrupt the session, ask the patients permission to provide cultural informationAll parties must be informed about what is being saidDo not stereotypeEncourage the health provider to explore the cultural issue with the patient

Interpreting Within Culture A Guatemalan Mayan exampleWhen a Guatemalan Mayan woman explains that she is listening to her ancestors who are giving her advice on how to solve her problems, the provider suggests that she is hearing voices. The interpreter must be knowledgeable about the culture of Guatemalan Mayans to explain to the provider that she may have to explore this more closely before concluding that the Guatemalan woman is hearing voices. In Guatemalan Mayan culture, it is common practice to ask wise ancestors for advice; it is not necessarily a sign of psychosisBuwalda, 2004./ Greg Turner, TMHC, Queensland Health

Role BoundariesHealth providers and patients are responsible for the ultimate resolution of the encounterPatients often have unrealistic expectations regarding the services interpreters provideSome health professionals are unaware of the role of the interpreter

Health Care Interpreters Do NotAssume the role of other health professionalsGive advice or opinionAdvocate on behalf of the patientInterpret for own relatives or friendsFill out forms on behalf of a clientRepeat information that a client disclosed in the waiting area to a service provider upon clients request

Types of AssignmentsHospital inpatient & outpatient appointmentsCommunity Health & Early Childhood CentresPaediatric settingSurvivors of torture & traumaFamily conferencesHome visits

Specialist SettingsMental Health

Neuropsychological Assessment

Speech Pathology

How Do We OperateScheduled appointments

Traveling time

Waiting time

The Interpreting AssignmentIntroduce yourself

Avoid waiting with the patient if possible

Briefing with heath care provider

Debriefing after the assignment

Interpreting Skills and TechniquesSeating arrangement

Use 1st person

Eye contact

Communication pace management

Simultaneous vs. consecutive interpreting

Interpreting in Mental Health

Interpreters must understand the purposes of psychiatric interviewing & therapy sessions, & the role communication plays in them

Psychiatric interviews are often characterised with distortions to normal communication patterns, which are vital for diagnosis and treatment

Interpreting in Mental Health

Interpreting for patients who are confusedSometimes there is no messageDiscourse may be incoherent, fragmented, jumping from issue to issueDisconnected discourse is difficult to remember clearly and reproduce

Mental Health Speech Sample

Patient: Yoga (Pause) Falling everything falling no stopping (Pause) Being held Yoga teacher holding me (Pause) In pieces They wrote to me The Yoga class (Pause) Six months since hadnt been since Im falling again I cant stop the falling. (Casement, 1985: 149)

Mental Health- Role of Interpreter

Give exact renditions of vocal effects & contentInterpret simultaneously if appropriateDescribe communicative features of terms & aspects of speech that cannot be rendered into EnglishDo not make interpretations of what the patient means

Neuropsychological Assessment

Standardised assessment- compare skills with general populationStrict instructions for administering and scoringAssessment to investigate changes in thinking & memory that identifies strengths & difficulties

Neuropsychological Assessment - Role of Interpreter

Awareness of format & purpose of assessment toolsInterpret everything the client saysAvoid giving any helpful clues to the clientProvide information about aspects of clients speech that cannot be rendered into the target language

Interpreting in Speech Pathology

Speech therapy deals with deviations from natural language use: stuttering, slurring, unorthodox pronunciation patterns and confusion in syntaxDiagnosis is based upon a range of verbal, vocal and paralinguistic behaviours that extends far beyond any normal understanding of a message to be passed from one party to anotherLiaison Interpreting, Gentile, Ozolins, Vasilikakos, (1996, p125)

Interpreting in Speech Pathology

Most interpreting is done to convey what the person/speaker means- what they are sayingSpeech pathologists need to know how things are being said- the focus of the task has shifted

L.Clark & L.Hand, Critical Link Conference, 2007

Speech Pathology- Speech Sample

Non-fluent AphasiaOh, is itterrible, terribleis itI cant imagine is it terribleis it my tongue and is brainis itis itterrible because is, ah, is it hospital and is nonothingto you cup of tea and no good and is, er, is breakfastI dont know what is it breakfastand I cant is terriblefraidfraid meis terribleis, erI cant phoneand communicate , eris, er, is, er, family, is, er, bobblingis it, is itreading islots of actionbut for me it bang (snaps fingers) and is terrible and is family, is erterribleterrible.From Lenore Scali, Speech Pathologist

Interpreting in Speech Pathology

Awareness of format & purpose of assessment tools Render into the target language what can be rendered (Gentile, 1996, p.126)Simultaneous interpreting when appropriateDescribe error patterns in speech and language to the speech pathologist (L.Clark & L.Hand, 2007)

For more information on SWAHS HCIS,visit us on Internet: www.wsahs.nsw.gov.au/services/hcis/index.htmPhone 9840 3456Fax 9840 3789Email: hcis@wsahs.nsw.gov.au Additional Information

Broad topic. Have to summarise it in 1.5 hoursSWAHS HCIS= 1 in 5 HCISs in NSW. Established in 1978= 30 years, more established than health care interpreting in the USAbout 40 staff interpreters, a panel of over 300 contract interpreters covering high demand as well as rare languages.Rare languages include: eg from Sudan: Dinka, Acholi, Fullah, Anuak, Nuer (over 250 languages), from Sierra Leone: Kissi, Kono, Krio, Mandingo, Mende, Sierra Leone Pidgin, Gola, VaiRecommended that health care interpreters also have translating qualificationsWhy?Medical examples of relatives interpreting:Gynaecology: middle aged lady who had had a large number of abortions with daughter interpreting- confidentialityAntenatal- mother in law interpreting who abused the patient emotionally- impartialityCardiology- old lady with a heart condition and daughter interpreting- lack of medical terminologyNAATI testing available in 58 languagesProfessional development courses available: Basic Orientation, Advanced Skills & Simultaneous Interpreting, Specialist Health Care Areas, Mental Health, Ethics, Peer SupportInterpreter as a machine Interpreter as an advocate______________x_______________________________

Jan Cambridge, Chartered Institute of Linguists and University of Warwick,UK:The interpreters responsibility is to the messageTake responsibility for the accurate relay, not the content of the messagesInterpreters will:3.1 Interpret truly and faithfully without anything being added, omitted or changed.3.3 Not enter into the discussion, give advice or express opinions or reactions to any of the parties; 3.4 Intervene only to ask for clarification to point out that a party may not have understood something to alert the parties to a possible missed cultural inference to ask for accommodation for the interpreting process and to inform all parties present of the reason for the intervention Extracted from The National Register of Public Service Interpreters code of conduct , UK, www.nrpsi.org.uk

ConfidentialityHCI often follow the same patient for years and know more about them than some health professionals do but cannot reveal what happened in another session, cannot make comments, comparisons or other judgementsDinka staff interpreter:Interpreters from small communities must make an extra effort to maintain a professional distance from patients, eg not to sit and talk to them prior to appointments, when meeting client in the community not to discuss meeting in the medical setting/interpreting situationThe interpreter may provide information of cultural nature to the clients provided that: It is done appropriately, eg during briefing or debriefing.During the session if communication breaks down. All parties must be kept informed.The interpreter is not put in a position of making decisions or judgements that belong to the other professional.While providing cultural information interpreters must:Provide information in an objective mannerNOT stereotypeRemember that people are individualsEncourage health professionals to explore cultural issues with the client by asking direct questionsInterpreters are frequently faced with dilemmas in the course of assignments due to clients unrealistic expectations. They need to know their code of ethics, the role boundaries and to be assertive. Examples:Psychiatrist- who allows interpreters to run the session and let him know what is going on from time to timeClient on a home visit inviting interpreter in for a cuppa before the professional arrives and not believing that it is against the rules.Client saying to interpreter: So you are an interpreter now meaning unfriendly, keeping a distance.Interpreters must pay attention to their own role limitations.

Advice and opinion examples:Pregnant client considering an amniocentesis asking interpreter for advicePsychiatrist asking: How does the client compare today to ago?Examples of dilemmas arising from waiting with patients:Psychiatric- patient sharing suicidal thoughts with interpreter and not mentioning them to the psychiatristDiabetes- patient telling interpreter they have days off insulin but dont tell the doctorWhat would you do?

Briefing:To find out about the caseTo explore cultural differences and/or interpretation issues eg in assessmentDebriefing:To vent feelings that may have come up in the interview, eg torture and trauma victims, patients with terminal illnessTo discuss linguistic/cultural issues, eg in standardised assessmentKeep the focus of communication between HP and patient.Pace communication to meet own level of language comprehension, eg family conferences, magistrate hearings when a few people talk at the same time forgetting the interpreter.Most HC interpreting in consecutive mode. In some situations simultaneous interpreting is necessaryQuestion: How would you interpret this speech sample? What technique would you use? Why would it be important for the psychiatrist to hear exactly what the patient is saying? What is the danger of trying to make sense out of it?Importance of briefing and debriefing in specialised health care areasStandardised assessment:Series of tasks patient performsCompare skills with general populationContain normative information from populationStrict instructions for administration and scoring

Awareness of format & purpose of assessment tools:Do not change wording as it may give more/less clues than intendedDifference in languages may mean that skill level changes, eg fixed word order versus free word languagesLow/high frequency words, eg aquatic versus wodny= pertaining to water Assessment tools: copyright and exposure issuesTests for phonological similarities (eg frog and Friday- what do they have in common?)Homophones and homonymsUse of rhymeProverbsSometimes you just wont understand what the patient is saying