On the Job: Relay Interpreting in a Medical Appointment

Relay interpretation is a type of consecutive interpretation used when multiple languages are at play at the same time, where the source language is  interpreted into different languages, and at least two interpreters are present. We see this most commonly used in conference interpreting where the source language is rendered into a common target language and then further rendered into specific language groups. This type of interpretation is similar to the game “telephone,” where one message is whispered down a line of people, and the last person in line announces to the group what the message was. If you’ve played this game before, you’d know how easily it is for the original message to become distorted at the end of the line.

With this in mind, we can see the challenges of relay interpretation. Because multiple players are involved, the risk of distorting the message is high, where omission from or addition to the original message can occur; thus, it is important that all interpreters involved are professionals and are  familiar with the code of ethics and the  necessary means they need to take to ensure accurate interpretation of the message.

At a recent  medical appointment, a Mandarin interpreter was requested. I learned early on that while the patient spoke Mandarin, he also spoke a Chinese dialect that I am unfamiliar with. This was not a problem because he understood Mandarin, but his son was present as well, and my work complicated when the two of them communicated in their dialect, leaving both the provider and myself out of the conversation.

During the appointment, the patient and his relative would have side conversations in their dialect. I had to inform the provider that the side conversations were in a different dialect that I didn’t understand, so she knew I wasn’t keeping information from her. After the side conversations ended, I tried to find out what they were talking about, and the son would kindly summarize it for me, allowing me to interpret the summary to the provider.

Much of the appointment went like this: the provider spoke, I interpreted the English into Mandarin Chinese, after hearing my interpretation, the patient and the son would converse in their dialect, and then the son would respond in English or in Chinese–if in Chinese, I would interpret it into English for the provider. What worried me was that while the side conversations lasted for at least 30 seconds at a time, the summaries were only a few words long, such as, “he said okay.”

In this case, relay interpretation took place, from English to Mandarin to the separate dialect back to Chinese then to English again. As I mentioned earlier, to ensure that messages get transmitted without distortion, we need to make sure that the interpreters are professionals; however, since the son was a family member, he felt that as long as he understood the message, it was okay. This is partly why family members are highly discouraged to act as interpreters. As well, when messages are summarized, the interpreter, not the speaker, decides what was most important and less important in the message. Because of this, important information can be lost during the transmission of information.

As an interpreter, I always want to make sure that messages are being understood, so I worried about what the patient was saying to his son and whether they full understood the provider’s instructions. However, it seems like the  in situations like this, it’s hard to repeatedly instruct the family members to interpret everything, or ask that the patient speak for himself rather than through the family member.

Fellow interpreters, what would you have done in this situation?

Phone Interpretation: Could You Repeat that Again?

In the perfect world, an interpreter will relay every single message perfectly without interruption. However, sometimes even when everything is perfect–you have the perfect phone connection, you’re in a quiet environment, you’re following all protocols for phone interpreting–there are times when a new word comes up or when you didn’t get all the information the first time around. The first thing to do when this happens is remain calm. After that, you can take the steps below to remain professional and still complete the task of relaying the correct information.

What if I don’t know how to interpret a word?
If an unfamiliar term comes up and you’re unable to interpret it, the ideal solution should be to quickly look it up. One benefit of interpreting on the phone is that you can have your internet or glossary handy. If that doesn’t work, and you happen to know the meaning of the word, interpret that. However, if you’re unfamiliar with the word and what it means, it’s okay to ask the speaker for clarification or for an alternative word. Of course we all wish we could interpret everything without any mistakes or lapses, but when you’re on the call, it’s important to be on your toes and think fast.

When to ask for Repetition, Verification, and Clarification? 
When information received is unclear, the interpreter can ask for repetition, verification, or clarification of the information. It’s important to ensure accurate information before interpreting so the callers receive the intended information. Of course the ideal would be that the information is jogged down correctly on the first try, but we are human. When asking for such information, make sure to use third person, “This is the interpreter. May you please repeat what you said after ‘London’?” Or, “The interpreter would like to verify the phone number. Is it 543-210-3429?” Or “The interpreter would like you to clarify what you mean by ‘vital signs.'”

Repetition. Asking for repetition means you’re asking the person to repeat what was said.

Verification. Asking for verification  means you will read back what you think you heard and wait for affirmation that you got the correct information.

Clarification is used when you are asking for the definition of a word. An interpreter is sometimes confronted with words for which the equivalent to the target language is not off the tip of his tongue. The first way to deal with this is to figure out from the context what the word is. Once you’ve figured that out, you can verify with the speaker if that is the correct word. However, if you still can’t  interpret or describe the term, ask the speaker for further explanation or a definition so you can interpret their response instead.

One more tip about asking for clarification: always be specific about the information you need again. If you missed the zip code, ask for the zip code.

What if the speaker talks too much and I’m unable to retain the information?
In this case, gently interrupt the speaker and ask them to break the information into smaller segments, so details are not missed. “Ma’am, this is the interpreter, may you please break down the information into smaller segments so I can ensure accuracy of my interpretation? Thank you.” You’d be surprised, but people can be accommodating–they want the same thing you want, which is to pass on necessary information to the person on the other end of the phone.

Hope this is helpful. Happy interpreting!

Note Taking for Phone Interpretation Calls

In “How to Prepare for a Phone Interpretation Session,” I talked about the preparation needed before the call. Today, I’ll talk about the importance of your note-taking skills during an interpretation call.

The main difference between phone interpretation and in-person interpretation is the lack of non-verbal cues such as facial expressions and gestures. When interpreting in person, an interpreter can discern meaning from body language; the speaker can also take cues from the interpreter when he uses a hand gesture to indicate a need for a pause. Without these physical cues to help the speaker and interpreter during a phone call, excellent listening and note taking skills are especially important to ensure the transmission of accurate information between source and target languages.

The three basic skills needed for phone interpreters are good memory, attentive listening, and excellent note-taking skills. These probably sound familiar to seasoned interpreters as they are the same skills needed for in-person interpretation; however, because an interpreter is usually unable  to conduct the interpreters introduction as they would for in-person appointments, speakers aren’t always aware that they should give information in short segments. This can at times result in compact and lengthy segments of information.

While we need to depend on our short-term memory here, jogging down key words, such as nouns and verbs, as well as all numbers and proper nouns, are especially important. In fact, all numbers and proper nouns need to be written down because those are information that tend to escape our short-term memory fastest. One thing to avoid is writing out every single word. Instead, symbols and abbreviations will help make note taking more efficient. For example, if we’re talking about rising temperature, a simple upward arrow with a degree sign would work. Efficient note taking will also ensure that you are not focused more on note taking than listening. When you’re not listening carefully, it’ll become more difficult to recall the information later on when it’s time to render the message.

Fellow interpreters, what kind of information do you jog down when you’re taking notes? I’d love to hear your experiences with this.

Happy interpreting!

How to Prepare for a Phone Interpreting Session

What is Phone Interpretation
Phone interpreting is the oral translation of conversations through the phone.  Some people find it easier because it doesn’t involve direct human contact; others find it more difficult because there isn’t face-to-face contact.

The benefit of phone interpreting is you can focus on the words while taking notes in a place you’re comfortable in–your quiet office, your bedroom, wherever. You can even have your laptop in front of you and quickly look up unfamiliar terminology while on the job. The downside is that you are not physically present and that you are reliant on technology that can sometimes be unpredictable.

Preparing for A Conference Call
The basics are the same as any interpreting session. You need the language capacity and to keep in mind the code of ethics, but you’ll also have to make sure that you put yourself in the best setting when making calls.

Environment. It’s important that you are in a quiet place when placing calls so that you can hear the other line(s) and so you’re clear of distractions during the call. While you can’t control the connection or sound quality on the other end of the phone, you should do what you can to ensure that you are in a quiet environment.

Phone Reception. I prefer landlines over cell phones as I find that the connection is better. Not everyone has a landline nowadays so making sure our phone reception is good is the best we can do to ensure clear transmission of messages. If you’re using Skype or an internet phone service, make sure that the internet connection is stable.

First Person. Same with in-person interpretation jobs, interpretations should be in first person, and if you need the speaker to repeat or rephrase something, ask in third person, “The interpreter would like you to repeat….”

Consecutive Interpretation. Phone interpretations are often consecutive. At in-person interpretation sessions, I ask the parties involved to use short sentences so I can make sure that I interpret everything that is said. I also raise my hand in a “stop” motion if I need them to pause, so I can interpret. On the phone, it’s a little different because no one can see each other. The way I interrupt is simply to start interpreting after a sentence or two. Don’t be shy to interrupt. Your goal and job is to transmit all information, and you’ve gotta do what you’ve gotta do.

Sensitivity to Tones and Cultures. This one is obvious. To be a good interpreter, one must know the language. Especially in cases where you can’t read the speaker’s facial expressions, hand gestures, and body language, it’s even more important to know the cultural nuances and be able to read/copy the intonations of the speaker.

Familiarity with the Topic. Interpreters are sometimes given the subject to be discussed before the conference call. This would allow you to prepare ahead of time–catch up on the vocabulary, and read up on the topic. This is not always the case, however, so it’s important for interpreters to constantly educate themselves on new subject areas and vocabulary.

Happy interpreting!

Code of Ethics for Medical Interpreters

Interpreting is not just about conveying a message from the source language to the target language, it also involves following codes established by the profession. There are different sets of ethics code provided by different interpreting groups, but they are generally similar. Below is a summary of the National Council on Interpreting in Healthcare’s (NSIHC) code of ethics, which can also be found on their website http://www.ncihc.org.

What are ethics? Ethics is a set of principles or values that govern the conduct of members of a profession. It provides guidelines for making judgments about what is acceptable and recommended behavior.

The code of ethics is based on three core values: beneficence, fidelity, and respect for importance of cultures and cultural difference.

     Beneficence. In healthcare interpreting, the patient’s (and his or her family’s) health and well-being is our goal. This goal is shared by the healthcare team, the patient, as well as the interpreter. We all want the patient to get better.

     Fidelity. It is our obligation as interpreter to stay loyal and faithful to the original message conveyed by the patient and the practitioner. When rendering the messages into the target language, our aim is to interpret everything that is said, without distorting the message by making additions or omissions.

     Respect for importance of cultures and cultural difference. Cultural differences can lead to misunderstandings and miscommunication. It is important that interpreters are knowledgeable about the culture of the source and target language.

The nine code of ethics in NISCH are:

     1. Confidentiality. Interpreters need to treat all information during an encounter confidential within the treating team, which includes all professionals within one treatment facility who provide medical care to the patient.

     2. Accuracy and Completeness within Cultural Frameworks. Interpreters need to deliver the complete package. In other words, they should strive to render the message accurately by conveying not only the meaning of the message, but also the spirit (emotion, tone, and gestures) that came with the message, taking into account the message’s cultural context. Interpreters must not omit from, add to, or distort the speaker’s message; even offensive remarks and gestures, body language, and tone of voice must be interpreted. Interpreting does not mean rendering each word, but rendering the meaning of the message.

     3. Impartiality. Maintaining good customer service to both patient and provider is important for a successful professional relationship. An interpreter is simply a conduit, so interpreters should refrain from counseling, advising, or projecting personal biases or beliefs. They should also avoid judging the content of the message of the parties in the interaction; they should keep their values to themselves. Because one’s tone of voice, inflection, and facial expressions can show bias without one’s knowledge, interpreters should take note of their own voices and make sure they are putting emphasis only on words that were emphasized on in the original message.

An interpreter should avoid potential conflicts of interests is at all possible. Interpreting for family members, for example, is highly discouraged as the interpreter may unintentionally show his or her bias opinions, which can interrupt the medical interview.

     4. Professional Boundaries. Developing professional rapport with a patient is acceptable and encouraged  but interpreters should try to avoid personal involvement with their clients, such as building friendships with clients. Interpreters should also avoid taking on other roles while they are interpreting to avoid potential conflicts of interest. For example, an interpreter who is also a nurse should not provide medical recommendations while with the patient; in a situation like this, an interpreter should only focus on acting as a conduit and not as a medical professional.

     5. Cultural Competence. Culture is a central factor in all communication and the understanding of culture is necessary for accurate interpretations. While interpreters are not expected to possess expertise in all cultural nuances, they should strive to continually develop awareness cultural competence in the target and source language cultures, including biomedical cultures.

     6. Trust and Respect. Treat all parties with respect, using proper greetings and titles applicable to specific cultures. Interpreters should also respect the autonomy and expertise of all parties in an encounter.

     7. Advocacy. Advocacy is understood as action taken on behalf of an individual that goes beyond the facilitation of communication, with the intention of supporting good health outcomes. When a patient’s health, well-being, or dignity is at risk, the interpreter may be justified to act as an advocate. Advocating actions should be undertaken only after careful and thoughtful analysis of the situation, and only when other less intrusive actions have not resolved the problem.

     8. Professional Development. Language acquisition and maintenance is a continual process. Just because an interpreter has a lot of experience doesn’t mean there isn’t more to learn. Interpreters should strive to continually further their knowledge in the field/subject matters, language skills, and interpreting skills. They should also strive to further understand the socio-cultural context of the population they serve. Interpreters should also serve as mentors to help those in the same field and participate in professional activities that contribute to the development of the profession.

     9. Professionalism. A good interpreter acts professionally. This includes but is not limited to:
– disclosing skill limitations
– preparing for all assignments and arriving on time
– monitoring his or her own performance and behavior
– does not in any way exploit the vulnerability of the patient (for example, doesn’t accept gifts from patients)

Other code of ethics for medical interpreters can be found:
IMIA Code of Ethics- imiaweb.org
Certification Commission for Healthcare Interpreters (CCHI) – http://www.healthcareinterpretercertification.org/

Heartland Alliance Cross-Cultural Interpreters training 10/8/2011
NCIHC Code of Ethics http://www.ncihc.org

Defining Terms: Interpretation vs. Translation

Many people interchange the words “interpretation” and “translation,” but they are in fact different. Below is a quick list of terms and definitions to help you understand the big differences between the two.

Translation is the conversion of written material from one language to another. The translator often works alone or with one main contact.

Interpretation is spoken, and is thus the oral conversion of one language to another. Interpreters work with clients in person or sometimes through the phone or video technologies. Interpretation can be done in two ways: simultaneously or consecutively.

Simultaneous interpretation is often used in courts, conferences, and the United Nation. In the medical setting, this is used when a patient is extremely upset, during a medical emergency, or during a mental health interview. While this type of interpretation saves time, it can also involve the most errors, which is why it is not recommended during a medical interview.

Consecutive interpretation is most commonly used in a medical setting to ensure the accuracy of the message. In consecutive interpretation, there are also four different forms:

  • Sight Translation/Interpretation. Used when the interpreter reads a document in another language, basically translating the document orally from what is seen. The reason why we term this sight “translation”  even though the final message is spoken, is because the source is written.
  • Relaying Interpretation, also known as Indirect Interpretation, is when multiple languages (more than two) are at play, and involves at least two interpreters. For example, in a room where there are Korean, Chinese, and Hindi speakers, when Korean is spoken, the interpreter will render the message into English, after which the other interpreters will render the message again to the preferred language pair (Chinese and Hindi). Relaying interpretation often takes more time, and because the message is rendered into two different languages, there is the risk of omission, addition, and message distortion.
  • Summary Interpretation is when one person says several sentences and the interpreter summarizes what was said in a different language. The downside of this is that the interpreter, not the speaker, decides what was most important and less important in the message. Because of this, important information can be lost during the transmission of information.
  • Remote Interpretation happens when the speaker and interpreter are not in the same room together, instead, phone or video technologies are used.

Heartland Alliance Cross-Cultural Interpreters training 10/1/2011
World Interpreting Inc. http://worldinterpreting.com/relayinterpreting.aspx