[Joseph Matthews]

Thank you, Lesly for pointing out a clear example of how this federal legislation has filtered down into a corresponding state regulation as, in your case, that of the Rhode Island. As I am not in the U.S. – your example shows how both federal and state levels operate in sync with each other while avoiding potential areas of conflict as we see in the section on State Law – specifically statutory preemptions and exceptions on page 19 of chapter 3.

[Joseph Matthews]

I find Cristina’s point to be quite on-the-mark about the insufficient access to qualified interpreters in general. I feel this is due to the ever-increasing mobility of the world’s population on one hand and the number of LEPs in the U.S. vis-a-vs even what it was just 10-15 years ago on the other. Imagine a health care provider in Casper, Wyoming that has three LEPs being attending to, one who speaks Farsi, one being the Portuguese dialect spoken in Gao, India and the other is Vietnamese? This is what I meant in my writre-up that the requirements the legislation puts on the health provider as pertains to LEPs to be no small task. Resources are finite in any organization, public or private and a balance has to found.

[Joseph Matthews]

In my opinion, Executive Order 13166 and the current HIPAA, Federal and State regulations, although quite thorough, are not enough as this social need and the statutory tools (i.e., rules and regulations) governing same are always changing in an environment that is dynamic and constantly evolving. This does not mean that I see these statutory guidelines as being weak with structural shortfalls. Having been exposed to many years with commercial contracts (such as oil & gas and banking) – which have to be in continuous compliance with federal guidelines – I have found the HIPAA Privacy Rule (PR) and Executive Order 13166 to amply cover the main points – even to the degree of fine minutia. The content of these regulations and legislation in general can get very technical and even a bit confusing as, for instance, in the case on page 18 of chapter 3 which addresses Group Health Plan disclosures to Plan Sponsors (see the middle paragraph, with focus on the second and third bullet points).

On the other hand – I see the big challenge that these large amount of requirements place on the health care providers, especially when it comes to LEPs, which can number into the hundred as pertains to languages, dialects and cultures. In sum, I do understand that if one wants to achieve minimum results – one has to aim high – which this legislation clearly does. As I have been living overseas since the 1970s, I cannot opine on any specific state law as pertains to the above.

[Joseph Matthews]

The four chief roles of the medical interpreter are as follows: (1) Message Conveyor or Conduit, (2) Message Clarifier, (3) Cultural Broker / Clarifier and (4) Patient Advocate. These four roles provide a complete 360º view of the varying interlinking activities that define this profession. Herewith is a brief description of each role along with a corresponding application to provide additional context.
1. Message Conveyor or Conduit
Role: The medical interpreter is a conduit, i.e., a vehicle to transport / transmit a message from the provider to the patient and vice-versa. The medical interpreter has to ensure that the message is delivered to the recipient with no deletions, no additions, no enhancements, no leaks and always making sure that the content of the message is delivered exactly as it was received from the other party.
A Contextual Application: The provider informs the patient that he / she has to refrain from any strenuous physical activity for the next 10 days. It is the medical interpreter’s professional duty to convey exactly that – nothing more, nothing less.

2. Message Clarifier
Role: In some cases, the medical interpreter will come across certain word(s) or terminology that can cause a misunderstanding of the message being transmitted. When this occurs, it is the medical interpreter’s role to tactfully pause the exchange, either verbally or via a gesture to alert one (or both) parties that the term in question is conveying an unfamiliar concept to the recipient and request that the speaker rephase this in a simpler more understandable way.
A Contextual Application: The provider, for example, is demonstrating how the patient should take his / her temperature with a special new thermometer using the sub-lingual method. In certain cultural communities this is a totally unknown method, therefore the interpreter should tactfully intervene and ask the provider to describe an alternative method with which the patient is familiar – such as placing the thermometer underneath the armpit.

3. Cultural Broker / Clarifier
Role: Language always reflects the culture in any particular country, region or community. In certain instances, the culture of one area of the world has beliefs / practices in which the is no cultural equivalent in another country – therefore there is no clear term or expression which accurately conveys this. In sum, the role of the cultural-clarifier must go beyond that of word clarification as in the preceding interpreter role above. The interpreter should tactfully interrupt the exchange and alert both parties to the cultural gap which is creating a misunderstanding.
A Contextual Application: The provider recommends a mode of treatment that is frowned upon in the patient’s native culture as it is unknown. The interpreter should tactfully pause the exchange, alert the provider of this impasse and assist in conveying / educating the patient, in more understandable words, the biomedical concept of the treatment to, hopefully, bridge this gap.

4. Patient Advocate
Role: This role is the most delicate of the four and has many moving parts. In sum, the patient’s health and well-being is the key objective. For many Limited- English speakers, they face major cultural and linguistic barriers in efficiently navigating the host country’s health care system. This can range from not knowing the basics all the way to outright discrimination concerning access to health care. As this is a very delicate as well as a statutorily complex issue – the role of the interpreter as Patient Advocate must be optional to protect both the patient and the interpreter.
A Contextual Application: A patient is given an atypical medication for a rare disease which may have serious side effects. The interpreter should make sure that this message is clearly understood by the patient in view of the high risk(s) involved.

[Joseph Matthews]

Leonisa – you cite a most valid point about when the provider is not aware of certain cultural idiosyncrasies / sensitivities that could confuse and possibly even offend the patient. The “trust factor” suffers here along with the many pitfalls it entails. Therefore, it is key that the interpreter identifies and conveys this beforehand, in the pre-session with the provider, to help avoid any such occurrence.

[Joseph Matthews]

Good point you make Milleny about when a pre-seesion with the provider is not necessary – in fact not possible – as in the case of an emergency treatment. This points out the reality that a medical interpreter does not always have the luxury of the “time factor” to plan out everything ahead and that he / she must be able to stay focused and on point in a rapidly evolving situation.

[Joseph Matthews]

There are solid benefits of conducting a pre-session among patient, provider and the interpreter. Being adequately prepared, before the formal session begins, is a good step towards a successful outcome for all involved.
It is key that the interpreter should first perform a quick inventory of his/her key deliverables in the session such as scope, specific body parts to be addressed, which overall vocabulary will be most applicable and how to interact with the provider before the session begins.
As pertains to the patient you want to make sure he/she has a clear understanding of what your role as interpreter is, which should include such things as your name, the organization you represent and that the patient can speak directly and candidly with the provider. There are a cadre of potential surprises that can be avoided by the interpreter first doing a quick environment scan of the patient, his / her cultural origin and the specific medical issue to be addressed.
The above will also help lessen the risk of miscommunications about expectations (such as medical advice for example) that may jeopardize the outcome and / or create potential issues concerning ethics.
A brief pre-session with the provider is helpful, when possible, especially in the case when the provider has not had prior experience with interpreters present.
It has been my personal experience that anticipating the key events of an upcoming commitment is always much more preferable than reacting to same as this is an earmark of what it means to be a professional. With the interpreter carrying out key preparations beforehand – this will aid in paving the way for a successful medical encounter between patient and provider.

[Joseph Matthews]

Yona – you describe very well the sometimes [delicate} but functionally important instance(s) when during the provider’s choice of words / terms in explaining a certain point to the patient is not being fully understood by the latter. The medical interpreter has to “how to” tactfully / professionally interrupt the provider to request other terms that will resolve this disconnect. Your use of the term “professionally” demonstrates to the reader the keen need for the medical interpreter to be constantly focused on both the patient and the provider in a fluid environment such as this.

[Joseph Matthews]

Hello Lesly. I found your presentation in explaining the four roles of the Medical Interpreter to be very effective. Aside for the content therein – you post each in its respective title, role explanation followed by an example – much as one would do at a high-level business presentation where much is conveyed with astute use of the language employed as well and keeping the number of words within a target range. This tells your audience you are well versed in the subject and keeps the reader attent.

[Joseph Matthews]

Leonisa – as in the case of our colleagues cited above, you also highlight important challenges an interpreter faces in properly navigating through the various cultural contexts of idiomatic expressions as well as the goal of maintaining sound mental retention to ensure nothing is left by the wayside while interpreting. I especially like the emphasis you gave to the fact the interpreter can suddenly be faced with “stressful and emotional situations” which can be very unsettling. The interpreter has to stay calm and focused throughout such instances because, as Lesly well states – “the stakes are high”.

[Joseph Matthews]

Reaching out to you Cristina as well as to Lesly as both of you hit on something key for all of us. I found Cristina’s comment on certain “cultural expressions or sayings that have no translation” very interesting, as well as a similar comment on the part of Lesly that alludes to this very same issue. This makes the job and goal of the interpreter of “conveying the message right” all the more challenging as the language always follows the evolving culture, and not the way around, as some might think. Finally, Cristina focuses on another key challenge of for all interpreters (especially me) which is keeping sound mental retention of all that is said and how best to convey this in its sequential order and content.

[Joseph Matthews]

In my experience, the subject of the differences between interpreters and translators and their respective challenges is material for a dissertation so I will keep to my cardinal “A-B-C” rule which is: “Appropriate”, “Brief” and “Clear”.
As for translators – there are two key categories – the first being those that translate written statutory and legal documents, etc. These people are usually certified and bonded depending on the jurisdiction and their work has to be laser sharp accurate in grammar, syntax and structure, avoiding cultural idiomatic expressions where possible, due to the final decisions / rulings a government, corporate legal entity or judicial court may issue based on said translation. The translator in this case has the benefit of extra time to “get it right” – which is something that the interpreter does not.
The other type of translator, in my case for example, is in the business world where this person translates simultaneously in person or via teleconference for his/her offshore shareholder on one side and with a Union representative, Central Bank specialist or potential joint venture partner, etc. on the other. Here the line often gets blurred between this type of translator and the interpreter because of the similarities of time constraint, need for technical accuracy, etc. The big difference I see between the two is this type of translator is never neutral as he/she represents the interests of the offshore legal entity while the interpreter has to be neutral while always keeping an astute and transparent balance between the patient and the health care provider. Another difference that I have already noted in this training course is the “business translator” develops his own style, code and approach to the task which of course can vary a lot. The interpreter, however, follows a established and standardized set of codes, demeanor, ethics and protocols which levels out the playing field – no matter the forum or task at hand.
It is in the last point above that I find my greatest challenge in this course, as follows. How do I NOT allow my decades of experience of simultaneous translating in the business world to create dangerous “blind spots” or “comfort zones” that may impede my “step up to the ladder” in becoming a proficient interpreter which, in my opinion, brings the “complete package” to the table in this field of correctly, properly and transparently conveying the message at hand from one language to the other.

[Joseph Matthews]

Hi there Lesly and Cristina. Interesting to see that you are both form Colombia and both also reside in R.I. Small world indeed!

[Joseph Matthews]

Hello there Leonisa!
By your being from Cape Verde and now residing in Boston, MA and I having grown up in the state of Virgina but now living in Brazil for many years – you and I can both appreciate Fernando Pessoa’s famous call to all when he wrote: “Navegar é preciso!” Although we have all followed his call and are spread out over the world – we now find ourselves together in this digital forum to learn the skills of medical interpretating. I look to working with you, our fellow classmates, instructors and coaches over the next 10 weeks. Success!

[Joseph Matthews]

Greetings to all – my name is Joseph Matthews. I am an expatriate American citizen and retired business executive who has been living and working in Brazil since 1976 and currently reside near the São Paulo metro area. My target language is Brazilian Portuguese in which i am fluent. I came to Brazil with an academic background in Latin American Studies and International Business seeking an international career with Brazil as my base of operations.
I promptly discovered that in the business world, the key critical success factor is information which, in turn, is driven by sound, concise and effective communications – regardless of the language. Over these years, I have had the privilege of being exposed to and involved in dynamic bi-lingual forums ranging from Agribusiness to Union Contract Negotiations. Upon retiring recently, I often wondered how I might continue using these linguistic skills in a post-retirement venue albeit with a focus on altruism. After all – I was mentored well in my younger years and the only way to repay those mentors – is to help others – as I was helped.
The answer suddenly came to me last year while closely watching my son who works in Rio as a professional interpreter in various fields. I witnessed, in every call he would take, there was always a patient or a customer on the line with a specific and even urgent need that he was able to address through his formal linguistic training. It was right then and there I decided to follow in his footsteps to provide that same degree of help that interpreters around the world perform every day. I know translating is not interpreting – so I will have a steep hill to climb, yes, but what is life, at any age, if there are no challenges to face, right? I look forward to working with you all in this course!

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