The right choices in medical translation

When engaging interpreters, legal imperatives aside, consider the idea that there is no such thing as a routine conversation. The interpreter who is doing the job well is handling medical and vernacular language; idiomatic expressions and jargon; culturally laden references and non-verbal aspects of communication all in the same few seconds.

A complex issue
Untrained interpreters sound cheap; but when something sounds too good to be true, it is.
There is a growing body of research that supports the use of nationally certified ITALS practitioners.
   
Language is a very complex system and interpreting requires professionally relevant education and skills training along with in-depth knowledge of the subject area. It is dangerous to think that someone whose English is hard to understand has understood you, unless you know what they are saying in the other language. As with doctors, nurses and social workers, interpreters should be able to show they are accredited and registered by a professional body. Risk, endemic in medical consultations, is also present in interpreted ones.
    
Standards
Professional structures exist for Public Service Interpreters/Interpreting (PSIs). An interpreter’s commitment to professionalism is evidenced by membership of them.
Doctors and nurses base patient protection, their own and the institution’s reputations upon information obtained via bilinguals, many of unknown provenance and competence unless clinicians themselves check their bona fides, say by checking the National Register of Public Service Interpreters (NRPSI) online. Fluency is not a guide unless you speak both the languages.
   
Fluent may only mean being able to describe the route from here to the lavatory without pausing for breath. Nationally benchmarked and accredited exams for interpreters and translators do exist as do national occupational standards.

Real life example
So let us consider María Jesús Fulano Mengano, a recent immigrant who arrived in the UK so terrified that for several days she didn’t know which country she was in.
   
María Jesús worked as a senior hospital sister in the capital city. There was a coup d’état. The army took over. At that time she had coincidentally called a meeting of the staff on her unit to discuss government funding cuts. For many weeks she received threatening phone calls in the night; obscene graffiti were painted on her house. She was beaten and raped. She has fled to protect her family and does not know where or how they are. She is not feeling well (not unnaturally). She has never been able to tell any care professional what happened to her because there has been no interpreter who could deal with the language, situations or emotions involved. She is at A&E complaining of weight loss and insomnia. This is her first interpreter-assisted conversation with anyone in authority after five months in the country. This is a synthesis of various true stories:

Extract of interview with María Jesús Fulano Mengano:

1.Doctor: Did you say you were eating alright? [You’re eating well?]

2.Mediator: ¿Estas comiendo bien, dices? [you say you’re eating well?]

3.Patient: Sí, también [Yes, I am as well]

4.Mediator: ¿Estás comiendo bien, cosas que te gustan o cosas que no te gustan? [Are you eating well, things you like or things you don’t like?]

5. Patient: Hombre, lo que no me guste no me lo como. Pero, suelo comer bastante o sea que lo que suelo hacerme. No sé, lo que encuentre que me guste yo puedo comer ¿no? [Oh, if I don’t like it I won’t eat it. But, I usually eat enough I mean I usually make myself... I don’t know, when I find something I like I can eat, you know?]

6. Mediator: ¿Buenas cantidades? [Good quantities?]

7. Patient: Si, pero es eso lo que me extraña porque si fuera que no comiera o que comía solamente algo, pero es que lo que como, lo como en bastante cantidad porque tengo hambre. [Yes, but that’s what’s strange because if I weren’t eating or if I only ate a little, but what I eat I eat in fairly big quantities because I’m hungry.]

8. Mediator: That is what she’s surprised about. She eats really well, no what she doesn’t like but when she finds something she likes she eats in big quantities.

9. Doctor: Right, so maybe some changes in what you eat, from [the home country] is that right? Some big changes?
10. Mediator: ¿Quizá el cambio de alimentación puede afectar? Aquí se come otras cosas distintas, tú estas acostumbrada a vegetales, frutas, ..carne. [Perhaps the change of food could be affecting you? The food is different here, you’re used to vegetables, fruit...meat]

11. Patient: En parte me imagino, no sé, digo yo que pueda ser algo de eso, o sea…, la comida es bastante diferente, ¿no? [Partly I suppose, I don’t know, I think it could be something to do with that, I mean.. .the food is pretty different, isn’t it?]

Interchange and story box loosely based on (Cambridge 1997: 90-91)
   
We can see several things happening here. Firstly the mediator (used here for an interpreter with some experience but no training) makes a perfectly proper intervention to establish meaning at point four. However he has cut off the word ‘también’ meaning ‘also’ or ‘as well’ because he interrupts to clarify the ‘yes’ response. That little ‘as well’ is not relayed to the doctor and is never returned to. The next five turns at talk are a parallel conversation between him and the patient, asking his own questions. He offers a brief summary of it at point eight, on the basis of his own perception of what ‘eating well’ includes. Any interpreting task is complex, involving listening for meaning, while not locking the doctor out and attending to the little words that ‘dangle’.

All of which takes education, training and professionalism.

What about translation?
The following was overheard in a doctor’s surgery: “Mr. XXXX, do you speak English? Can you understand what I’m saying to you? If you can’t understand my instructions we will need to get a translator to help you.” Translator, interpreter, aren’t they the same thing?
   
The short answer is no, despite suggestions to the contrary you might get from any TV or radio broadcaster: “Mr. XXX, talking to us just now from the scene of the accident through his translator.” Translation and interpreting are two sides of the same coin, one –  translation – producing what is hopefully the equivalent effect in written form, and the other – interpreting – relaying information and cultural input using the oral medium.  Both are similar, but each vastly different in approach, technique, methods and skill sets.

An interpreter is the channel through which often culturally loaded oral information is transmitted from one to one or more individuals, frequently in settings of extreme stress. A translator communicates or transfers this information via the written word.  
   
Let’s imagine a not-so-uncommon scenario:  Mr and Mrs J Bloggs are on holiday in Spain. After a bit too much sun exposure, a rich meal and perhaps an over-enthusiastic consumption of the local tinto (red wine), Mr. Bloggs complains of chest pains, discomfort in his legs and a severe headache. He is taken to hospital, where he undergoes various tests and is kept overnight for observation. When he leaves, he is given his hospital discharge summary, the results of his laboratory tests, the ECG report and brain and abdominal CT scan reports – all in Spanish, of course. After returning to the UK, Mr. Bloggs needs to submit the reports to his GP and insurance company – in English, naturally. Mr Bloggs needs a translator, and one specialising in medical translation. He may require further treatment and even a surgical procedure in the UK, but any future treatments and even the outcome of his condition will be dependent on the information provided by an accurate translation of his medical reports.   
   
So, where does someone like Mr. Bloggs turn for help? Hopefully, not to the neighbour, friend or relative who did a gap year, worked as au pair or taught English as a second language in Spain. Not to disparage any of those activities, but to emphasise that translation requires a great deal more than such experiences offer. Both UK professional bodies for translators and interpreters, the Institute of Translation & Interpreting (ITI – www.iti.org.uk) and the Chartered Institute of Linguists (CIoL – www.iol.org.uk), offer directories listing qualified translators in the medical/pharmaceutical and numerous other fields. In addition, the ITI Medical and Pharmaceutical Network (one of several subject, regional and language networks associated with ITI) provides a website where users can search by various language combinations for translators specialising in the medical and pharmaceutical fields (www.itimedical.co.uk). Only qualified ITI Members and Fellows of ITI (MITI, FITI) are listed on the website.  
    
Finding a translator
Finding a qualified translator experienced in medical/pharmaceutical translation is essential for obtaining the potentially crucial information required by the patient’s doctor.  The professional translator will be a member of the respective professional body, such as ITI or the CIoL. Membership of such an organisation indicates at the very least that the freelance translator or translation agency/company has met specific admissions criteria and committed to a Code of Professional Conduct.
   
The ITI’s directory of members is a free online list of primarily UK-based, qualified translators and interpreters working in a combined total of over 150 languages.  
   
Expect to pay more when using the services of a qualified professional translator: years of experience in a specialised field, membership of a professional organisation and all that implies, and taking advantage of training opportunities and continuing professional development offerings all go into the mix of a highly specialised, qualified translator whose rates should be commensurate with that experience.
   
Obviously, in the current climate of belt-tightening and cuts, everyone is concerned about how, when and where to economise, but caveat emptor – trying to save money by contracting the services of an unqualified translator for medical subject matter is risky business, certainly for the patient but also for NHS staff and related bodies. Mistranslated patient notes or instructions can have devastating consequences regarding patient diagnosis, treatment and future care. This sort of false economy gives new meaning to the old adage of being ‘penny wise and pound foolish.’
    
Win-win situation
Commissioning a qualified professional translator or interpreter for the appropriate situation results in a win-win situation for all concerned and is a sound investment for patient and doctor alike in the short and long term.