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Cartoon by April Girouard

A Language Array Keeps the Doctor Away

Mediating between doctors and patients, a healthcare interpreter plays the roles of language specialist, culture guru, and even patient advocate. A debate simmers over the right mix of formal certification and cultural sensitivity for the job.

By April Girouard
LALA Reporter

"Sometimes I don't really understand what the doctor says, but I have to try really hard. I pray in my heart that maybe it won't cause any harm to my sister," a 13-year-old boy told healthcare interpreter Elizabeth Nguyen. Before his family was made aware of Nguyen's availability to help, the Vietnamese immigrant family had been pulling their son out of school to interpret at his little sister's oncology appointments. "I'm so afraid to tell my parents that I don't understand, because everyone counts on me," the boy told her secretly.

Awareness of the need for healthcare interpreters is on the rise. In recent years, government committees and private organizations alike have been scrambling to widen and define the hospital interpreting services provided by professionals like Nguyen, so that children and other untrained bilinguals aren't forced into the role. The California Healthcare Interpreting Association's (CHIA) Annual Education Conference this March drew the largest number of people in its seven years of existence. On May 1, 2007, CHIA, representatives from the National Council on Interpreting Health Care (NCIHC), and other public and private entities held the first meeting of the National Medical Interpreter Certification Task Force in Boston in hopes of coordinating efforts to create an official certification standard for healthcare interpreting—one that has been difficult to formulate because of the complexity of the profession and the number of interests involved.

In any given month, Nguyen encounters close to 40 languages in her position as Language and Cultural Services manager at the Children's Hospital Los Angeles. The interpreters she dispatches are expected not only to provide linguistic clarification but to break down cultural barriers, as in the case of the Vietnamese family.

Stepping in can be difficult for even the most culturally attuned interpreter. Patients sometimes prefer to rely on a trusted family member rather than a well-intentioned stranger. "They say, 'what do you mean, I don't need to bring my child?' They are always afraid they will be slapped with a bill," Nguyen observes. "In many cultures there is a sense of duty about how an individual has to serve the family."

Nguyen fears that an across-the-board certification exam would scare away interpreters who have more cultural understanding than classroom training. An interpreter who grew up in Vietnam, for example, may be more culturally sensitive but less linguistically qualified on paper than someone with a master's degree in the language. She suggests that interpreters would be better served by an exam that designates separate classes of certification based on proficiency level.

"The majority of currently functioning interpreters, I promise you, are not the ones with hundreds of hours of school," Nguyen says. "I just jumped in because I wanted to help people. It was only later that I put myself through training and I [helped develop] curricula based on my own learning experience."

The Whole Package

Training, more than certification, has been the focus of local efforts to improve care for patients with limited proficiency in English. Neither private health organizations nor the county have any illusions about the fact that professional interpreters with master's degrees in language aren't the only ones who are called upon to assist patients with a limited knowledge of English. Both the county and the public LA-Care Health Plan provide 40-hour training classes for nurses, radiologists, and other multilingual healthcare workers.

María Elena Gaitán, Cultural and Linguistic Specialist for the Los Angeles County Department of Health Services and trainer of healthcare interpreters, believes that an interpreter's skills must extend beyond cultural sensitivity. The county provides services to patients in 98 L.A.-area languages, including three sign languages, and Gaitán is confident that national certification is not only imminent but necessary to supplement existing training courses.

"Circumstances will obligate us to do that. It's not going to go away. It's not only the right thing to do, it's also the law," she says. "Speaking two languages does not make you an interpreter. We are actually at a very exciting point in our field in which training is beginning to be standardized and implemented, and we need to do that. It will reduce medical errors. All of these interpreters, when they are trained and part of the medical team, can really make a difference in access."

Beverly Treumann, an instructor and interpretation specialist at LA-Care Health Plan, agrees that training programs can greatly improve access for patients with limited English. "We teach people that number one, this has to do with patients' rights, and when people understand that, they are more likely to take it seriously. Equal access means the quality has to be as good as the quality of communication for an English-speaking patient," she explains.

Treumann adds that training can acquaint medical workers with the many roles an interpreter must be able to fill. "My feeling is that some of them learn and some find out they shouldn't be interpreting. And maybe someone who takes the class will help find a qualified interpreter."

Nguyen recalls the difference her training made to the family of the 13-year old boy. "Doctors can talk for a whole paragraph, and the child has only been able to capture a few words here and there," she says. "They realized it was best to have a professional interpreter because now they have a more lengthy version of the diagnosis. They were very helpful and grateful for that."

Whether or not they agree upon the merits of government certification, Nguyen and her colleagues are confident that conditions are improving. For progress to take hold, she says, attitudes will also have to change. "Doctors don't realize that when they come to the janitor, it's even scarier than [interpreting for] the United Nations because it's life and death."

Corrected: An earlier version of this article contained misspellings of a source's name and title and understated the number of languages covered by the Los Angeles County Department of Health Services (98, not 93). Other minor corrections were made after publication. We regret the errors.

Date Posted: 5/22/2007