This year the 7th MiTiN Annual Regional Conference on Interpreting and Translation took place October 1st at the Crowne Plaza Hotel in Novi. The conference was attended by about 120 people, being Interpreter Services represented by Angelica Snyder (speaker), Megumi Segawa and David Porta (exhibitors), and Christine Kim (attendee). The conference itself was introduced by a keynote presentation followed by several talks organized into three different tracks devoted to translation, interpreting, and business.
Angelica Snyder presented her talk on the certification process for medical interpreters to a packed room of over 35 highly interested individuals eager to widen their knowledge, some of them certified court interpreters while others were healthcare interpreters not yet certified or people new to the field. One of the major interests of attendees it appeared to be learning about the cost and process of certification. Hence, CCHI (Certification Commission for Healthcare Interpreters) and NBCMI (The National Board of Certification for Medical Interpreters) options for certification were specifically discussed, and written and oral exams were exemplified.
This year’s key note address was delivered by Mr. James Nolan, who has served as deputy director of the Interpretation, Meetings and Publishing Division of the United Nations, head of linguistic and conference services at the International Tribunal for the Law of the Sea, chief of the UN Verbatim Reporting Service, UN senior interpreter, and linguist/legal writer with the Garden City Group.
Mr. Nolan’s talk focused on diplomatic interpreting, but I believe that most of his insights into interpretation can also be of help to healthcare interpreters. Among his universal tips on how to improve interpretation, something we should always keep in the back of our minds, were included:
- MESSAGE – be after the message, not the words.
- Silence is golden – wait for a full unit of meaning before interpreting.
- Don’t embroider – do not elaborate.
- Do not improve – if what is said is good enough, leave it as it is.
- Do not expect perfection.
- Be as accurate as possible.
- Do not panic – maintain steady delivery.
- Use all your available tools.
- The tortoise and the hare: be the tortoise – do not fall ahead of the speaker.
- Keep it simple.
- There is more than one way: be after the sentence, so do not miss the next.
- Do not correct yourself unnecessarily.
- Apologies – only if you misled the audience.
- Bring mistakes to the attention of who needs to know them.
Mr. Nolan also stressed the need for daily interpretation practice and self-expose to the current status of language by reading and listening in internet, to record oneself for self-evaluation and improve our own voice, for each interpreter to work on what is more difficult for oneself, and to not spend too much time theorizing.
In one of the conference interpreting track sessions Ms. Judy Ravin, co-founder of Accents International and author of a software-based learning systems for rapid language acquisition, lead an interactive session on ”Accents and Pitches”. It was a workshop on accent reduction that was divided in two parts: one devoted to articulation techniques for pronouncing the sounds in English and another one focused on listening comprehension.
An accent is a particular type of pronunciation, and everybody has an accent or speech pattern. The goal of accent acquisition/reduction is not that we all sound alike, but that everybody can understand us easily.
One way to acquire and reduce accents is to focus on:
- Sounds in English not present in other languages (main language of speaker)
- Listening to difficult accents (difficult for the interpreter)
To that, it is important to learn how it looks like to make a sound, how does it feel like. In short, we have to turn our ear to patterns and bear in mind that while talking the most important task is to pronounce well the STRESSED SYLLABLE, not mattering much the pronunciation of the others (weak syllables).
In another session within the interpreting track Cassandra Kiger (a case manager for unaccompanied refugee youth in Grand Rapids, MI) and Sara Proano (coordinator of professional development and director of language services at the Hispanic Center of Western Michigan presented “Social Work Interpreting: I thought this was a medical appointment?”, where they elaborated on the sometimes much needed, according to their own experience, dual role of interpreters as social workers.
Initially, when I read the presentation’s abstract:
“Medical interpreters are frequently called upon to interpret for professionals and appointments that are not strictly medical. A child coming to the emergency room results in a CPS (Children’s Protective Services) investigation, a routine yearly physical requires follow-up with the Children’s Assessment Center, or a CT scan ends with a doctor giving a terminal diagnosis. (…) This process is not only difficult professionally, but it can be difficult personally; (…) This session (…) will provide medical interpreters with a base understanding of social work experiences and how to interpret them effectively.”
I thought that due to its likely controversial issues this talk could lead in itself to a very interesting debate. However, although the presentation was interesting and highly informative, the roles of interpreter and social worker were not there clearly defined; at instances they were overlapping or merged together as pointed out by a puzzled audience. It appeared that the speakers’ vision was in clear conflict with the code of ethics, being the impression that they were encouraging interpreters to step into the social worker’s shoes. There was confusion between the occasional interpreters’ role as patient advocate and the customary broader role of the social worker. More specifically, the session included information on trauma-informed care, vicarious trauma, child-specific interviewing, cultural competency, and forensic interviewing.
Trauma Informed Care
Early childhood trauma (traumatic experiences suffered between 0 and 6 years of age) increases medical and mental health issues along the life of affected people, and also later on their lives (social, emotional, and cognitive problems, an upsurge of behavior of risk, the appearance of disease, and the possibility of an early demise).
Consequently, if we are trauma informed, that is to say informed regarding a prevalent history of trauma:
- We can change the questions: asking “What happened to you?” instead of “What’s wrong with you?” (Although this should mainly be left to the provider’s discretion.)
- Create a trauma sensitive culture: recognize symptoms to survival skills and give patients a different experience.
- Create a compassionate trauma informed environment.
Kiger and Proano strongly encourage healthcare interpreters to always follow the lead of the medical provider, but at the same time advise of the need to know where the medical provider is leading to provide the best possible interpretation; and to always follow the standards of practice and the code of ethics.
With vicarious trauma, a secondary traumatic stress that professionals from different disciplines, healthcare interpreters included, take upon themselves there is the need of safety planning. And for the interpreter to be prepared for, in the hypothetical case of losing it, be able to step out with the provider to have a break. As interpreters we must to get to know ourselves to autocorrect any alleged personal issues and get as soon as possible back on track.
Child Specific Interviewing
There may be multiple reasons for the requirement of children interviewing, each case with its own circumstances and specific issues, but it is undisputed that in situations as such there is a strong need for rapport building. And to that end, to establish rapport with children, is highly recommended to:
- Explain our role friendly
- Use age appropriate terms
- DO NOT influence/provoke answers
Specific words are used (by social workers) for very specific reasons. Therefore, as interpreters, we have to pay extra careful attention to WORDING!!! We must at all costs to avoid changing what the social worker says due to the power to influence outcomes. Nor can we forget to maintain boundaries, follow the clinician’s tone of voice and posture, and preserve privacy while sustaining a poker face (to show empathy without getting emotional).
In summary, the message provided there was that interpretation with social workers should be different than that with medical providers. The interpreter has to entirely mimic the social worker, his gestures, his tone, and his physicality.
Cultural competency/ Cultural broker
In this capacity there are specifically three points that the interpreter should never overlook:
- To check for clues of understanding
- The potential fear of social workers
- The need for clarification of who the patient is talking to, and the role of that person.
The forensic interview is one component of a comprehensive child abuse investigation; it is a legally closed procedure that cannot be messed up. According to Peterson et al. (1997) in many forensic incidents, children’s statements are the primary or even sole evidence, and the challenge for interviewers is that young children often provide much abbreviated responses to open-ended questions; they are also vulnerable to a suggestive nature of certain specific questions. Furthermore, there is considerable variation in terminology making things even more difficult. Because of all that, there has been increasing recognition of the skill and sensitivity required to conduct effective and humane forensic interviews. Poor interviewing can alienate and distress children, which may in turn lead to inaccurate assessments (Jones et al, 2005).
Therefore, as healthcare interpreters facing the difficult and extremely sensitive task to interpret a forensic interview it is highly recommended, if given the opportunity, to ask for the interview information beforehand. And right from the beginning we should be able to:
- Introduce oneself and build rapport
- Establish ground rules
- [Conduct a practice interview]
- Introduce the topic
- Elicit a free narrative
- Keep up with questions and clarity
- [Close the interview]
As healthcare interpreters we are always learning, yet it is obvious that sometimes we are provided with advice that could be cause for concern (or food for thought) due to existing natural boundaries among different services. It might such be the case between interpreters and social workers, especially in relation to forensic interviews, a happenstance that should never be overlooked, and for which we should certainly be prepared.
- Jones LM et al. 2005. Criminal Investigations of Child Abuse: The Research Behind “Best Practices”. Trauma, Violence, & Abuse 6(3):254-268.
- King, Elizabeth. Forensic Interviewer/CAC Coordinator,Randolph-Tucker CAC (http://wvcan.org/forensic-interviewing/)
- MiTIN, Michigan Translators/Interpreters Network; http://www.mitin.org/index.cfm
- Oxford English Dictionary; http://www.oed.com/
- Peterson, C and Biggs, M 1997 Interviewing Children About Trauma: Problems with “Specific” Questions. Journal of Traumatic Stress 10(2):279-290.
- The “H” Word; dedicated to demystifying the “H” word – hospice – and normalizing end-of-life conversations; https://thehword.net/
- Michigan Department of Health & Human Services. Forms and Publications. http://www.michigan.gov/mdhhs/0,5885,7-339-73971_7119_25045—,00.html
- State of Michigan Governor’s Task Force on Children’s Justice and Department of Human Services. Forensic Interviewing Protocol. DHS-PUB-779 (Rev. 4-05)
- The National Child Traumatic Stress Network; http://www.nctsn.org/trauma-types