When an interpreter wonders what is holding them back from making progress, it can be useful to analyze the language proficiency skills in detail. Gaucha Translations proctors tests for spoken languages on the ACTFL scale by Language Testing International so interpreters and translators can analyze their strengths and weaknesses and determine how to make progress in an objective way.
How did I start interpreting?
Years ago, I was on a ship. I was thoroughly bilingual in all four skills: reading, writing, listening and speaking. I had gone to med school for a couple of years, gone to secretarial school for a year, graduated from college in Argentina as an elementary school teacher, and I had taken the British Proficiency class when I was 15. After that, I had been a member of an Anglo-Argentine drama group: the Suburban Players.
These are facts. I had the linguistic proficiency. Then I joined a missionary ship, the MV Logos. I was there in Tierra del Fuego, when it shipwrecked. But I spent 15 months going around Latin America interpreting for the ship community, a group of 140 people from 40 countries from all continents. They needed “translators”. That really meant both things: translators and interpreters. So I joined. I worked 40 hours a week in the purser’s office, helping with customs and immigration paperwork in every country in Latin America. In my free time, I interpreted at public events on a daily basis. Pretty soon, I was one of the “preferred interpreters” and was busy seven evenings a week besides doing my day job.
As the interpreting market diversifies, I get questions from people every day.
First of all, you can screen clients before making a commitment. For example, the ATA doesn’t accredit companies. It certifies translators, not interpreters. Advertising claims using the ATA name inaccurately are meant to mislead people. Be careful. Check www.paymentpractices.net, and check the Blue Board on www.proz.com to see what people say about their experience working with a company.
You should also ask questions before the appointment. I use the following worksheets for interpreting and translation projects. They are based on the ASTM Standards for Interpreting and Translation. I developed them to avoid a lot of the problems listed below, and others I am not listing.
I have been asked to do some remarkably unusual things at interpreting assignments. Here are some examples of decisions I have actually had to make. We usually don’t know about them until they happen.
Problem: Interpret for someone in a waiting room, before going in to the doctor’s office, so the patient could sign a HIPAA consent form for another person to be present at his appointments. Should I do this? Continue reading
In our January 2015 class in Woodburn, Oregon, one of the students had an unusual background. This is the story of a professional Mexican nurse who came to the United States to take care of the health of her child in 1989. We had questions.
What training do Mexican nurses receive?
How did she navigate the situation at a hospital in the United States when her child was a patient here?
How did she adjust to life in the United States?
Working with professional interpreters saves time… and money!
How much time do patients spend in the Emergency Room? The following chart compares how much time they spend there with different types of language assistance.
- Telephonic interpreters: 141 minutes
- Bilingual provider: 153 minutes
- In-person interpreter: 116 minutes.
The in-person interpreter is the clear winner. Having interpreted in the Emergency Department, I know the anxiety of the patients in that environment, and the pace the medical providers have to maintain. I remember getting a phone call.
“Helen, the ambulance is on the way to Lahey Clinic. Can you be there in 15 minutes?”
“Let me take a few minutes to shut down what I’m doing. What’s up?”
“There were five Hispanics in a car crash. They need you now.”
“I’m on my way.”
These tools give you a way to self-evaluate your language proficiency.
This link, from the ACTFL Proficiency Guidelines, has the option to click on different languages on the left, and on the different skills (speaking, writing, listening and reading) on the top. As you see the samples matched with the description for each level, you will be able to picture where you are in the grand scheme of things. This is intended to help you see where you are and give you an idea of how to develop tools to grow.
The National Board of Certification for Medical Interpreters requires a level of Advanced Mid to take the certification exam, and the National Council of Healthcare Interpreting recommends a level of Advanced High for healthcare interpreting.
On this page, there are links for self assessment for the ILR scale of language proficiency at the bottom of the page. The skill level descriptions are above, and on the right hand of the page there are links to resources for language study and for teachers of foreign languages. Please evaluate yourself with the speaking self assessment in order to provide an estimate of your language proficiency. Keep in mind that the Federal Government considers an ILR 3 appropriate for professional work. That means you can complete all the tasks in level 3. However, many organizations accept a level 2 with a significant amount of elements of 3 for some kinds of work. That would be a level 2+ in ILR terms.
For interpreters, improving our memory is important! We have to remember what we hear so we can interpret it.
This blog post mentions quite a few important topics:
- A good night’s sleep
- Spending time with friends
- Having fun
- Not stressing out too much
- Eating the right things (wine, but not too much!)
- Brain workouts
- Mnemonic devices – or ways to break down what we hear so we can remember it.
- And be sure to check the “5 simple tricks to sharpen thinking and memory skills”! You don’t want to miss them!
Enjoy, and remember! You can’t interpret what you don’t remember! So, always ask the person you are interpreting for to stop when you are about 80% of the way through your memory capacity. Don’t go past it, or you will always be missing the last bit of what they said. After two or three times, you will get used to each other’s rhythm, and you will be fine.
On April 16 three OSTI interpreters interpreted for Dr. Rigoberta Menchu at Portland Public Schools.
What was so cool about this?
I had been in Guatemala, Nicaragua and El Salvador back in 1987, one year after the Civil War officially ended in Guatemala. I remembered the trucks running around with military weapons in “democratic” El Salvador. I was on the missionary ship MV Logos. It was a tough time for those countries. I had the opportunity to visit towns where the Panamerican Highway (a dirt road, actually) ended in the Darien, in Panama, and stay in homes made of bamboo walls. I got to be in homes in the border of El Salvador and Guatemala. And we visited Nicaragua by invitation of the Government. It was an amazing time. So hearing Dr. Menchú talk about the progress that has been made was beautiful. I remembered how hopeful people were when they met us. Their question was: “Wow. You are all so different, and you can get along. How can we do it too?”
On the Logos, our community came from 40 countries, from all continents. And nobody was in dominance. But Guatemala was special. Their people were incredibly welcoming. It stood out in all our minds and hearts, and when I was asked if I could interpret for Dr. Menchú, I just jumped for it. It was an honor.
I took two possible outfits (both Argentine) a jacket or a chal. They chose the chal (you’ll see me next to Dr. Menchú). My colleagues, Jazmin and Heidi, were awesome. We had some limitations based on her requirements, and we worked within them. We practiced, prepared, and worked as a team. We practiced on an empty stage the day before. and when the time came, we knew we could trust each other. It was awesome! More media interpreting might be fun to do!
As interpreters, we learned how to work together, how to build a team. We didn’t just show up. We read ahead of time. I picked the team members because I knew I could count on them. I knew they would take it seriously. We prepared, we had a Dr. Menchú party. We traded emails with YouTube links. We checked the schedule and decided who would do best interpreting for who, and staged it. We practiced together on the stage the day before. We said things like, “I like potato chips!” on the stage, with conviction, to an empty hall, to check the sound and how our diction worked in the room with no amplification.
And we had a group hug in the parking lot the day before, right before leaving. Kind of a Three Musketeers thing: “All for one, and one for all.” That is actually the motto of Switzerland! We were a team, and we were there for each other.
And at the event, it showed. At the reception after the event, that is what I was told. I was told my colleagues were great! That we were a good team.
Interpreting is teamwork. Peace is part of being part of a good team.
As Dr. Menchú said, peace is not just something you acquire through weapons. It is wholesomeness, wholeness. Teamwork, being at peace with your team, is a good place to start.
The Interpreter is prepared for all assignments
The interpreter discloses skill limitations with respect to particular assignments
What information do interpreters need? How is it possible disclose skill limitations to decline an appointment, for example, without knowing the nature of an assignment ahead of time?
The following chart details some logistical and subject matter issues the interpreter needs to know before arriving at the appointment.
As interpreters, we are constantly learning. We learn from every encounter we have every day. However, it is so easy to get carried away and discuss things in a subjective way! As interpreters, we interpret messages delivered from one person to another, and the interpersonal issues sometimes…
Our ASL (American Sign Language) colleagues have developed a system called Demand-Control Schema, and they have meetings called “Supervision” to discuss cases. In these “Supervisions” they discuss encounters looking at the Demands (the challenges of the situation) and the controls (the things the interpreter could have done) in non-judgmental ways.
This presentation is a very basic outline of the DC-S approach, which helps maintain confidentiality as we share information in the interest of learning from each other.
For more information on DC-S, see the Demand Control Schema website!
Those interested in signing up for the 10-week class, receiving articles, or other information, can sign up for their mailing list at this link.
When an interpreter arrives at an appointment and interprets, that is the visible part of the process. However, the work of the interpreter starts before the appointment, and ends after the appointment.
How can a requester of interpreter services work with an interpreter and ensure the best possible result?
CLAS Standard 7: Competence of interpreters – Use of untrained individuals and/or minors as interpreters should be avoided
According to CLAS 7:
Untrained family, friends, minors, and staff often do not possess the necessary skills to provide meaningful language services. Moreover, given their relationship to the patient, the use of friends, family members, and minors may compromise the autonomy and confidentiality of the communication (AMA, 2006; Diamond & Jacobs, 2010).
Why not work with trusted family members who are bilingual?
CLAS Standard 7: Competence of interpreters – Use of untrained individuals and/or minors as interpreters should be avoided
The use of clinical and nonclinical staff who speak a non-English language but who are untrained in medical interpretation can pose potential safety risks (Regenstein et al., in press). Research has shown that when clinicians speak a non-English language, or when untrained bilingual staff is available, an important set of potential barriers can arise and hinder the effective and appropriate use of trained interpreters (Maul, Regenstein, Andres, Wright, & Wynia, 2012).
All those who provide language services should be held to the same standards, regardless of their place of employment.
In other words, based on their needs, organizations should use a combination of bilingual employees, contract interpreters and staff interpreters, but they should all be held to the same standards:
- Have the necessary language skills to understand and speak the languages in question.
- Have the necessary skills to transfer meaning from one language to another accurately.
- Have the necessary training in terminology, protocols, ethics and standards of practice to provide appropriate services in the setting.
As an interpreter, I have seen medical practitioners try to apply their Spanish skills a few times. In some cases, their Spanish was truly not sufficient to communicate effectively. As an interpreter, I established my role promptly and professionally, and provided my services so communication was accurate and effective.
The desire to have direct communication is commendable, and it is appropriate for some levels of communication. As I traveled in foreign countries as an interpreter, I have certainly observed that people who made an effort to introduce themselves in the language of the other person were more effective in making a personal connection. However, when it comes down to the medical interview, when a diagnosis is at risk, a professional interpreter must be allowed to use their professional skills to avoid the risks of misdiagnosis. This risk can happen early on in a conversation!
I recommend that bilingual staff who intend to use their foreign language professionally be tested by LTI for the skills they are expected to use. If they are expected to speak the language, they should take the oral proficiency test. If they are expected to write the language, they should take the writing proficiency test. The industry standard for professional proficiency is Advanced High on the ACTFL scale or ILR 3. Not everyone who graduates with a Bachelors in a foreign language achieves these levels. See this post for more information.
This is a sampler of some resources from around the country on how to work with a medical interpreter.
Highline Public Schools has also put together a free, online, ~30 minute tutorial on how to work together with spoken language interpreters.
The Washington State Health Care Authority Interpreter Services Program has developed this checklist for working with an interpreter.
Some items on the checklist:
- Look and speak directly to the patient, not the interpreter.
- Please wait for the interpreter you requested before starting the appointment.
- Always speak in first person, just as you would in a normal conversation.
- Some terminology may not have an equivalent in the target language. Be prepared to explain some things in more detail, or for the interpreter to ask for clarification.
- Avoid asking the interpreter for his opinion.
- Expect the interpreter to leave the room when a provider is not present.
These are recommendations from the Minnesota Refugee Health Provider Guide 2013 for Medical Interpreters.
And from the Massachusetts General Hospital Medical Interpreter Services…
Keeping in mind some health literacy issues published by the American Medical Association about English-speaking patients might be helpful. Watch this video from the AMA: Health Literacy and Patient Safety
There are certainly more resources available, but as of January 19, 2015, these links are helpful and may be useful.
CLAS Standard 7: Competence of interpreters – Ability to communicate in all registers and at varying levels of formality
What is a “register”?
The “register” is the variety of the language we use in a particular social setting or for a particular purpose. For example, we speak differently at a doctor’s office, our friends’ living room, or when we want to express approval, anger, respect, or insults.
This may seem obvious, but some of my students have found it a challenge when they learned that some words they use are actually considered unprofessional in some places, or when we have discussed how to interpret insults. They’ve been frustrated, and wondered how to pick up that register they are missing. It seems such an impossible task! So… we give up and say it can’t be done.
Why bother? As interpreters, we must interpret not just the words, but the words in their cultural context: the linguaculture. The register reflects the cultural aspect, the social and cultural aspect of the encounter. When we alter the level of formality, the level of casualness or even refrain from interpreting insulting language, we are changing the interaction.
To do this, we must read many types of material continually. I read the following types of material:
- The Merck Manual for Home Health both in English and in our non-English working language
- Cuban short stories
- Chilean short stories
- The newspapers of the countries our patients come from, online
As we develop this variety of registers, the people we interpret for will become more comfortable in the interpreted setting and will be able to express themselves more confidently, knowing we can express their messages accurately.
According to the Cultural and Linguistic Appropriate Services Standards, published by the Office of Minority Health, US Department of Health and Human Services, in April of 2013, Standard 7 says: Ensure the competence of individuals providing language assistance.
The skills listed are:
- Active listening: Interpreters must listen more intensely than anyone else, in order to faithfully render the message.
- Message conversion: This skill involves analysis of the message and how to find equivalent ways to express it in the target language. High levels of language proficiency in the source and target languages are a prerequisite for this skill!
- Clear and understandable speech delivery: To develop this skill, interpreters may need to work outside of class, listen to each other for clarity, focus on diction, critique each other’s clarity of speech, etc.
- Medical terminology: Anatomy, physiology, diagnosis, prevention, treatment, management of illness and disease. Participants need to develop research skills in their non-English language to see how these topics are discussed in that language, beyond the simple use of a bilingual dictionary. Participants will be able to develop their own terminology database, write their own short articles on medical topics in both languages, and give short presentations on medical topics in both languages on short notice.
- Sociolinguistics: The following areas are very complex and a short class can only introduce these topics.
- Familiarity with regionalisms and slang in both languages
- Ability to communicate at various levels of formality
- Understanding of colloquialisms and idiomatic expressions in all working languages
- Key concepts in health care: confidentiality, informed consent, patients’ rights. Legal concepts are beyond the scope of what a 64-hour class can cover in depth, but this course does provide an introduction to these topics.
In a 64-hour course, we must assume that students come with strong language proficiency. In class, we will be able to teach problem-solving strategies for all these areas, but will not be able to teach all the answers to any of them! A successful class will be one where students leave with the tools to continue learning with partners and colleagues, ready to continue studying in future workshops.
These concepts are introduced through lectures, readings, and occasionally guest speakers, student presentations and videos. They are reinforced with homework, role-plays and class discussions.
Interpreting role-playing is practiced in every session! Students gradually become confident enough to evaluate each other and interpret several sentences at a time, consecutively. Students ask questions by email and in class. Some of the discussions lead to blog posts! Sometimes the students write blog posts.
I was talking with a colleague about Title VI.
Interpreters are supposed to uphold Title VI of the Civil Rights Act, and I was checking what, exactly, that meant.
Title VI prohibits discrimination on the basis of race, color, or national origin in any program or activity that receives Federal funds or other Federal financial assistance. There is information on this topic in the Health and Human Services website and, of course, in the Department of Justice website of the United States.
Discrimination by national origin is understood to include language access issues.
So, my friend, an attorney, told me, “Well, you have to start with ‘Lousy nickels‘”.
“Lousy nickels?” I was puzzled. She insisted, and we left it at that. I wrote it down on a scrap of paper. This conversation was on the phone.
My daughter saw it and asked me what it was about. We looked it up. In the process, I found out that there was actually a court case, Lau v. Nichols. It set strong precedent for language access applications of Title VI.
Sometimes, the interpreter needs clarification… What do bad quality five cent coins have to do with civil rights? Not much. That’s why the interpreter should ask for clarification in this case. Because accurate interpreting is impossible when the meaning of what is understood simply makes no sense!
The Minnesota Department of Health gives these recommendations for working with a healthcare interpreter.
As professional interpreters, we often introduce ourselves telling the provider… “and please speak directly to each other. I am simply here to be your voice in the other person’s language, saying exactly what you say.”
Often, doctors inadvertently lapse into this type of conversation…
Dr: Please tell the patient to sit down.
Interpreter: The doctor just asked you to sit down.
[Patient sits down.]
Doctor: Please ask the patient why she came.
Interpreter: The doctor would like to know why you are here.
Patient: Interpreter, what do you think I should tell the doctor? I don’t really know how to explain this…
Now, picture this conversation:
Doctor: Mary, good afternoon.
Interpreter: Good afternoon, Mary.
Mary: Good afternoon, Doctor.
Interpreter: Good afternoon, Doctor.
Doctor: Please sit down, Mary.
Interpreter: Please sit down, Mary.
[Mary sits down.]
Doctor: What brings you here today, Mary?
Interpreter: What brings you here today, Mary?
Mary: Well, Doctor, I was walking down the street, and there was a patch of mud. I slipped, and I think I might have broken something. It hurts a lot. I have had a lot of trouble walking…
Interpreter: Well, Doctor, I was walking down the street, and there was a patch of mud. I slipped, and I think I might have broken something. It hurts a lot. I have had a lot of trouble walking…
What differences do we see in these conversations?
- The interpreter is much more unobtrusive in the second one. The interpreter can stay out of side conversations effortlessly.
- The message conversion is much simpler, and therefore much more accurate!
- The patient is much more respected. The patient is treated just the same way as any other English-speaking patient. This helps the patient participate in his/her own decisions and avoid leaning on the interpreter for decision-making and security.
To encourage this direct communication, interpreters may use a variety of strategies:
- Gestures, to remind the parties to communicate directly with each other
- Visually positioning themselves so they are in the line of sight to encourage direct communication between the parties: people address the person they are looking at, so interpreters position themselves in a way to avoid neck strain on the part of the speakers.
- Maintaining the register and the tone of voice, so the conversation is a true conversation
- Interrupting the conversation as little as possible: using note-taking to allow the parties to express as complete of a thought as possible before interrupting the flow of their thinking.
- Wearing clothing that does not attract attention to the interpreter.
- Stepping out of the room every time the provider steps out of the room: when there is nobody who does not speak a language the patient does not understand, the interpreter is not needed. These may be good moments for the interpreter to clarify issues with the provider, if needed.
As interpreters, our goal is, as the Oregon Court Interpreters say, “to put the non-English speaker on the same footing as an English speaker”.
According to CLAS Standard 5, one of the purposes of language assistance is
To help individuals understand their care and service options and participate in decisions regarding their health and health care
The Oregon Law states that interpreters must follow the Standards of Practice of the National Council for Health Care Interpreters. On page 13, Standard of Practice #12 states:
The Interpreter promotes direct communication among all parties in the encounter.
For example, an interpreter may tell the patient and provider to address each other, rather than the interpreter.
Related ethical principle: Interpreters treat all parties with respect.
CLAS Standard 7: Competence of interpreters – Providing effective and accurate communication between individuals and providers
To be able to accomplish this, memory skills are essential! An interpreter must be able to let the speakers express two or three sentences at a time. Why? Because people need to be able to express a coherent thought without interruption to be able to communicate effectively.
How can we do this?
In consecutive interpreting (turn-taking), taking notes is essential to be able to keep track of the details of the conversation. However, we do not take notes of everything that is said! We take notes of just what we need to keep the picture together. We might write down phone numbers, spell names, draw simple sketches, or use abbreviations. Whatever strategy we use, the goal is the same: to be able to express what the speaker said accurately and completely.
(See this post on the use of notepads)
How about in simultaneous interpreting? Do we still need a good memory to be able to interpret simultaneously?
Certainly! Interpreting isn’t just taking words from one language and repeating them in another language! Each language has its own word order, its own structure, which may be totally backwards from each other depending on the message being transmitted. We often delay our start significantly to accommodate for this! However, just yesterday I was speaking with a colleague who was asking me how she could explain this to a judge… How often do we, as interpreters, just go ahead and get started, and do a lower quality job, because of the pressure to perform in a way that the English speaker understands? But I digress…
To be able to restructure a sentence in a second language, we have to listen, analyze the content, structure it in a way that sounds smooth in the other language, speak it in the other language, and continue to listen to the material in the source language at the same time. In some ways, it’s like singing a round without knowing the music ahead of time. This is why we work with a partner! Simultaneous interpreting requires taking turns every 20 minutes or so to avoid losing too much quality. This applies to the very best interpreters in the world!
See this article, which is a report on an article by AIIC, the International Association of Conference Interpreters, on the subject.
In this post, I will quote the CLAS Standard 5 in normal font, and will give the Gaucha TI response in italics.
The purposes of offering communication and language assistance are:
- To ensure that individuals with limited English proficiency and/or other communication needs have equitable access to health services
- To help individuals understand their care and service options and participate in decisions regarding their health and health care
- To increase individuals’ satisfaction and adherence to care and services
- To improve patient safety and reduce medical errors related to miscommunication
- To help organizations comply with requirements such as Title VI of the Civil Rights Act of 1964; the Americans with Disabilities Act of 1990; and other relevant federal, state, and local requirements to which they may need to adhere
Several of my students are dual-role employees. They have told me that interpreting sneaks up on them, and we have discussed how to work this out.
I created this spreadsheet to help them with this challenge, per their request. Well, I did offer to do it… Interpreting log for dual-role employees
CLAS Standard 7: “Ensure the competence of individuals providing language assistance”
The Cultural and Linguistic Appropriate Services Standards published by the Office of Minority Health, US Department of Health and Human Services in April of 2013, are closely followed by many hospitals.
These standards have been written to reduce health inequities. Projections show that in 2050 the US demographic will be 29% Hispanic, 9% Asian. Currently, approximately 20% of the US population speak a language other than English at home.
As interpreters, we are part of the solution. Standard 7 focuses on the competence of individuals providing language assistance.
The skills mentioned in Standard 7 are critical. As I teach them to interpreters and I explain them to clients, these are my thoughts.
The National Technology Transfer and Advancement Act (NTTAA) was signed into law March 7, 1996. The Act made a direct impact on the development of new industrial and technology standards by requiring that all Federal agencies and departments shall:
- Use technical standards developed or adopted by voluntary consensus standards bodies if compliance would not be inconsistent with applicable law or otherwise impracticable; and
- Consult with voluntary, private sector, consensus standards bodies and shall, when such participation is in the public interest and is compatible with agency and departmental missions, authorities, priorities, and budget resources, participate in the development of technical standards.
The following worksheets are based on ASTM Standards for Translation and Interpretation.
I have developed a series of cultural conversations to help immigrants and members of the host society understand each other better and interact more effectively. This Proposal for Culture Conversations outlines my experience with Cultural Conversations.
These conversations are open-ended, and developing a growing, enriching relationship between people of different cultures takes time. It can’t be done in one meeting. However, even if small groups meet, I believe these conversations affect the larger community. As people begin to be comfortable reaching out and asking each other questions, the understanding they gain enriches them personally and enables them to approach others more confidently.
I am not aware of other efforts to do this, and would love to hear from others who are doing this type of thing!
The following are three different ways to define cultural competence or competence in intercultural communication. In today’s environment diversity training is very common, and it is important to understand what aspects of this are relevant to interpreting. In this blog post, I will focus on aspects of cultural competence that lead to developing better communication between individuals.
The Interagency Language Round Table (ILR) has developed a scale to evaluate readiness for particular tasks. The ILR is a collaborative effort of Federal, academic and Non Government Organizations (NGO) specialists. They found that competence in intercultural communication was closely linked to language proficiency, since when we communicate a message in a particular language, it is almost always heard by a person who lives in a culture where that language is dominant. Because of this, in May of 2012, the ILR published the skill level descriptions for competence in intercultural communication.
“Competence in intercultural communication is the ability to take part effectively in a given social context by understanding what is being communicated and by employing appropriate language and behavior to convey an intended message.