Advice from an Interpreter

Author(s): Ozzie F. Daz-Duque

Source: The American Journal of Nursing, Vol. 82, No. 9 (Sep., 1982), pp. 1380-1382
Published by: Lippincott Williams & Wilkins
Stable URL: http://www.jstor.org/stable/3470215
Accessed: 26-02-2017 22:29 UTC

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American Journal of Nursing

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OVERCOMING THE LANGUAGE BARRIER

Advice from
An Interpreter
who is familiar with interpreting because he doesn't understand. Also,
By Ozzie F. Diaz-Duque
techniques, patients' rights, and the if the interpreter speaks in too
There is a widespread misconcep- way the health care system functions. learned a register, the patient may
tion that being bilingual automati- At the University of Iowa Hos- fear that the interpreter will find his
cally qualifies a person to be an pitals and Clinics we have had an speech amusing or unpolished.
interpreter. This notion leads health interpreter program and staff since Health professionals (and inter-
care professionals to recruit the pa- 1975, and there is general agree- preters) need to be aware of the
tient's family, friends, and even oth- ment that it has proved useful in quick nod, because many of the
er patients to interpret-a practice facilitating understanding betweenquestions they ask require yes or no
that should be relegated to the cate- health care provider and patient. answers. For example, are you in
gory of "last resort." For health professionals to pain? Did you have a BM today?
For one thing, friends and rela- work effectively with interpreters, Are you allergic to any medica-
tives usually do not have a health they need to know the kinds oftions? It may take the staff a long
care background, and therefore problems interpreters have, as well time to realize that even though a
lack, in either language, a knowl- as what to expect from them. Thepatient gives an affirmative nod, he
edge of medical terminology; nor principles upon which good transla- has really not understood much of
are they familiar with hospital poli- tions are based stem from a thor- what was said.
cies, procedures, and routines. In ough knowledge of both the lan- Some patients may have a com-
addition, many patients have com-guage and the culture of the patient, plete absence of register with regard

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plained since barriers to communication can

that their
to certain subjects. If the problemrig
is
dentiality arise from either source.have a gynecologicbeen
one, for instance, the v
relative or friend who served as a conversation often deals wtih highly
translator. Register. All languages have sev- personal matters. Many Hispanic
We therefore strongly urge eral registers, defined generally as women have never given names to
care givers to rely either on a bilin- the social/intellectual level at which such body parts as the vagina or
gual member of the health care the language is placed. The transla- such aspects of sexual response as
team or on a trained interpreter tor must be able to determine the orgasm. The interpreter must there-
patient's register and communicate fore transmit messages as clearly as
with him or her on that level. Other- possible, while maintaining deco-
OZZIE F. DIAZ-DUQUE, PhD, is a medical wise, the interpreter runs the risk of rum and diplomacy. Even under
interpreter at the University of Iowa Hospi- alienating the patient or precipitat- these circumstances though, the pa-
tals and Clinics, Iowa City. He is also an
instructor in the department of Spanish and
ing the "nodding syndrome"-that tient may still provide the wrong
Portuguese, where he teaches Spanish for is, the patient who nods in agree- information, none at all, or simply
health professionals. ment out of fear of embarrassment succumb to embarrassment.

1380 American Journal of Nursing/September 1982

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 In order to overcome such cul- cates that the latter approach is the Anecdotal information. "Flor-
turally based difficulties, it is help- preferred one. Otherwise, the inter- eado," the somewhat flowery,
ful for the interpreter to meet the preter has to continually interrupt discursive style in which many His-
patient before the interview. In to ask for an illustration or simplifi- panics speak, can create communi-
this way, the interpreter can find cation of a point before it can be cation problems, too. The busy pro-
out about the patient's educational translated into the other language. fessional, looking for short, succinct
background, attitudes toward health answers to questions, may be dis-
and health care, and other aspects of Semantics. Often, patients who mayed or irritated by the amount of
his or her social makeup. Then, the have learned the meaning of a word anecdotal information that accom-
interpreter can determine which in one context apply it to all other panies the facts. The answer to a
register is most appropriate for that contexts, giving rise to considerable question like, "Have you had any
particular person in that particular confusion. Thus, one patient who problems with your joints?" for in-
setting. Register is not determined was told he was going "to be dis- stance, may go something like this,
solely by socioeconomic and edu- charged tomorrow," interpreted translated: "Well, I've been having
cational factors, but also by the situ- this to mean he was going to devel- a little pain in the hip for a few days
ation, the parties involved, the op "a discharge from below." Simi- now, since we went to visit my
place, and the nature of the conver- lar problems arise with cognates mother. We were there in the fields
sation. such as constipaci6n and constipa- for about two months, with the
tion. Constipaci6n generally refers tomatoes, there in Illinois. You
Jargon. Language problems are to nasal congestion, not to intestinal know, like that, under the sun,
often related to the health profes- constipation. bending over all day long. My
sional's unfamiliarity with folk mother had some discomfort in the
health practices and associated vo- Polishing. "Tengo una bola en el throat and her eyes. We went to a
cabulary. Even a bicultural inter- tragadero," can be literally trans-
preter can have difficulty in iden- lated as "I have a ball in the swal- doctor,
tions likebut
this...be."handled?
How should situa-
Should
tifying and translating many of the lowing pipe," or it can be pol- the patient be allowed to continue?
terms used in folk healing. One rea- ished-that is, processed into a Should the interpreter summarize
son for this problem is that a visit to higher register-and translated as this information, emphasizing the
the curandero (the folk healer of the "I have a growth in the esophagus." pertinent information?
Hispanic community) involves a We believe that in most instances Many patients tend to add ir-
certain amount of secrecy, ceremo- the translation to the professionalrelevant material, we have found,
ny, and mysticism. The folk healer should remain in the patient's regis-because it lessens their feelings of

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may use a special language that the
patient doesn't understand. As a re-
sult, the patient may not be able to
explain what actually took place or
give a history of his ailment or its
folk treatment.
Professional jargon. Similarly,
English-speaking health care pro-
viders tend to speak a jargon of their
own, and this has to be decoded for
the patient. Is this the interpreter's
responsibility? Or should the health
professional use a simpler language
to begin with? Our experience indi-
ter, especially when the professional embarrassment. Often, too, in an-
wants some idea of the patient's per- swering health-related questions,
ception of a problem, state of mind, they are more comfortable if the
educational background, self- attention is not focused on their
medical problem, especially if it is
image, or attitude toward health.
In addition, nuances and of a personal nature. Cultural fac-
tors may also play a role in what
meanings can be misinterpreted or
seems to be the patient's verbal ram-
totally lost if the interpreter polishes
a patient's language. For this reason,bling. Patients who have used folk
summarizing what the patient says healers believe that health is direct-
is also not recommended. In a psy- ly related to such things as the
weather, the environment, and eat-
chiatric setting, for instance, it is
important for the interpreter to re-ing habits. Thus, what may appear
to be irrelevant information is, from
alize that every syllable may be cru-
cial in evaluation and diagnosis. their perspective, highly relevant.

American Journal of Nursing/September 1982 1381

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 On the whole, it is usually bet- talking through an interpreter. It is true that there are prob-
ter for the interpreter to include lems in communicating with the
anecdotal information in the trans- Nonverbal. behavior. Interpret- non-English-speaking patient, even
lation. Health professionals who try ers who provide only a literal trans- with an interpreter, but it is possible
to prevent patients from relaying lation of the patient's words may to break down some of the barriers.
such information run the risk of not be as effective as those who take We would recommend, first, that
alienating them. Since a curandero into consideration such nonverbal efforts be made to educate clients
never isolates the patient's illness aspects of communication as about modern health care practices,
from his or her social environment, nuances, intonation patterns, and in order to demystify medicine and
the patient may lose confidence in a facial expressions. These tell their to bring it closer to the people in
practitioner who does. own story, and it is important for their own language. Second, health
Health professionals should everyone involved in the interview care personnel should learn some-
also realize that Hispanic clients to be able to see, as well as to hear thing about popular beliefs, folk
may expect immediate results, in- each other. Interpreters who "act medicine, and sociocultural barriers
cluding returning home with a out" their message-through inton- that interfere with the delivery of
medication and a rapid cure for ation, facial expression, or ges- health care. Third, health care facil-
their ailments. They expect this be- tures-are likely to be more effec- ities providing services to large non-
cause most folk healers diagnose the tive in getting their message English-speak-
problem and offer an immediate across. They need to be ing
cure or treatment. What they offer similarly expert in inter- "X4!~?:2

may be only a placebo, but some- preting the patient's

thing is done and this gives the gestures and move-
patient satisfaction and may pro- ments.
vide psychological reinforcement Even when
that may indeed speed recovery. every effort is
made to insure
Fear. One factor that can and effective trans-
does interfere with a person's ability lations, neither
to communicate and receive a mes- the health pro-
sage is fear. Thus, the mere fact that fessional nor
a non-English speaker is ill and in a the interpreter ;
hospital can interfere greatly with can be com-

ix

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that person's ability to communi-

pletely sure that ac-
cate. curate communication
We have also noted that pa- has been achieved. Even " populations
tients who otherwise have a basic when two people speak the same s should consider
command of English often request in- language, misunderstandings can establishing interpre-
terpreting services when they come occur. Communication through a tation and translation
to the hospital. This is particularly third party compounds the prob- services.

true in such specialties as gynecolo- lem, and one may discover, a few The need for trained
gy, urology, obstetrics, and psychia- hours later, that the patient hasn'tmedical interpreters will contin-
try, or in relation to such services as really understood. Even when ue, however, and both the health
pa-
abortion, venereal disease screen- tients are asked to repeat what care was providers and patients should
ing, and family planning services. just said, they tend to add to or beedit
made familiar with the role of
Because of the delicate nature of the the material. This is especially likely
the interpreter, an important-and
conversation on these subjects, the to happen when the patient hassometimes
had crucial-member of
patient may feel more comfortable little or no formal education. the health care team. A
1382 American Journal of Nursing/September 1982

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