MEDICAL INTERPRETER METHODS AND ETHICS Section 1 The

MEDICAL INTERPRETER METHODS AND ETHICS Section 1: The Roles of the Interpreter

OUR PURPOSE AS INTERPRETERS To facilitate understanding in communication: The actions we perform as interpreters should solely be recognized as facilitating communication.

THE FOUR ROLES OF THE INTERPRETER Message Converter Message Clarifier Cultural Clarifier Patient Advocate

MESSAGE CONVERTER Most recognized role of the interpreter. Converting the dialogue from the language of origin to target language. Because medical interpreters are not licensed medical professionals, they are expected to interpret all dialogue without omitting or adding to, or changing the message. This includes not censoring the message. Message Conversión Conversion Mensaje

MESSAGE CLARIFIER Because of the language of origin and target language come from different cultures, societies, and even countries, some things interpreted literally will not make sense. The Interpreter then interprets the message in such a way that the listener can understand while maintaining the meaning of the message. An example is explaining Section 8 housing to a limited-English proficient patient not native to the US: While the words Section 8 housing can be interpreted, the meaning is lost without further explanation because a Section 8 housing program does not exist in the country where the patient originates. Sn. Lu. Potoaisís San Luis Potosí

CULTURAL CLARIFIER Similar to the message clarifier role, an interpreter who clarifies culture will assist in patient provider understanding when a difference of culture is the cause for confusion. An example of this in Catholicism (which is dominant in Latin American culture) is that contraceptives are not to be used. Meanwhile in Gynecology contraceptives not only prevent pregnancy but help regulate menstrual issues. A Catholic patient with menstrual issues who does not know the other benefits of “the pill” will not only be confused but possibly offended by the suggestion to take a contraceptive. The interpreter recognizes the possible confusion and invites the provider to explain why the contraceptive is prescribed.

PATIENT ADVOCATE Because medical interpreters typically work with clients who are not native to the United States, patients may not know their health care rights or the resources available to them. When this information is omitted and becomes a potential hindrance to that patient’s health, the interpreter has an obligation to: Assess what the issue is (Ensure that the issue does not require a medical professional’s knowledge). Deduct whethere is a solution or not. Decide who can provide that solution. Verify that the patient wants the interpreter to advocate. Commence advocating.

REVIEW: ROLES OF THE INTERPRETER Interpreter’s purpose is to facilitate communication only. The interpreter’s purpose is fulfilled through the “Four Roles of the Interpreter” Message Converter: Interpret the message as is. Message Clarifier: Clarify confusing terms or concepts. Cultural Clarifier: Clarify confusing terms or concepts specific to culture such as superstitions, traditions, or health practices. Patient Advocate: When the patient is unaware of healthcare rights or resources, the interpreter steps in to help

MEDICAL INTERPRETER METHODS AND ETHICS Section 2: Pre-session, Encounter Management, Post-session

SECTION 1 REVIEW: ROLES OF THE INTERPRETER Message Converter The common role: does not add to, omit from, or change the meaning of the message. Message Clarifier When a concept does not translate adequately or exist in other language, interpreter interprets the message so that the listener can understand the concepts involved. Example: Section 8 Housing Cultural Clarifier When a cultural aspect is not understood by both parties. Examples: health practices, superstitions, traditions, etc. Patient Advocate When the patient is unaware of healthcare rights or resources, the interpreter steps in to help.

SECTION 2: PRE-SESSION, ENCOUNTER MANAGEMENT, AND POST-SESSION To ensure that the interpreting encounter goes as smooth as it can, and that everyone is helped and satisfied, the interpreter should understand how to do the following: Perform a pre-session with both patient and provider. Manage the encounter, performing interventions as needed to “facilitate communication. ” Perform a post-session to ensure all needs are met by both parties.

THE PRE-SESSION Establish with the patient and provider: Name and Affiliation with the facility Jericho has requested we establish our “Volunteer” status Confidentiality, Transparency, and Accuracy Confidentiality: Patient Health Information (PHI) is restricted to a “need to know” basis. Specifically to the patient, the provider needing the information for treatment, and insurance companies (diagnostic codes). Transparency: Ensuring that all communications between the interpreter and one party is understood by the other party. Accuracy: Goal to maintain the message without admission, or changes in meaning. Modality: 1 st person speech, pausing, and direct speech to listener. Patient speaks as if they are speaking directly to provider and vice versa. Unauthorized to give medical advice or suggestions (this is not necessary to express to the provider) Refer to healthcare provider

ENCOUNTER MANAGEMENT Placement Position self to encourage communication between patient and provider. Behind patient if appropriate Beside patient (outside of visual line between patient and clinical staff, if possible) Intervention Moments when it is necessary to speak to only one of the participants: The interpreter doesn’t understand what was said. Believe the patient didn’t understand what was interpreted. Cultural issue. Need the message to be repeated. Need the speaker to pause more. Steps for intervening while maintaining transparency: Interpret as much of what the speaker said as you can. Tell the listener what you need to ask or do. Ask the speaker your question or share the information you need to share.

THE POST-SESSION Verify that Patient and Provider have asked all questions and received all answers. Assist Patient with any follow up steps (scheduling appointments, arrive to another department as needed, etc. ).

REVIEW: PRE-SESSION, ENCOUNTER MANAGEMENT, POST-SESSION Interpreters can magnify the quality of interpreting encounters by properly performing pre- and post- sessions along with proper encounter management. Pre-session: Preparing patients and providers by explaining expectations and methods of interpreting. Encounter Management: Proper (physical) placement and intervention methods to facilitate communication. Post-session: Ensuring that all needs are fulfilled for both parties.

MEDICAL INTERPRETER METHODS AND ETHICS Section 3: Interpreting Methods

SECTION 2 REVIEW: PRE-SESSION, ENCOUNTER MANAGEMENT, POST-SESSION Interpreters can magnify the quality of interpreting encounters by properly performing pre- and post- sessions along with proper encounter management. Pre-session: Preparing patients and providers by explaining expectations and methods of interpreting. Encounter Management: Proper (physical) placement and intervention methods to facilitate communication. Post-session: Ensuring that all needs are fulfilled for both parties.

SECTION 3: INTERPRETING METHODS There exist three types of methods of interpreting: Consecutive Interpretation, turn-based interpreting. Simultaneous Interpretation, rapid interpreting. Sight Translation, verbal iteration into target language of document in original language

INTERPRETATION METHODS Consecutive Interpretation Simultaneous Interpretation Typical interpreting method, each speaker takes turns speaking, one at a time. Interpreter is interpreting while the speaker is speaking. Is not a preferred method of interpreting and is reserved for specific situations: When person 1 speaks to person 2 in the Optimal form of interpreting, with lower risk of error, omission, or aggregation. same language, while interpreter interprets for person 3 who does not speak the same language. Example: Interpreting for parents of teenager in pediatric appointment. In high-stress or emotional encounters, where asking the speaker to stop or slow would not be appropriate. Emotional / physical trauma/abuse Emergency situations

SIGHT TRANSLATION When: How Documents with specific instructions are appropriate, with clinical staff present (to answer possible questions). Visually scan the document, searching for the purpose, key vocabulary, multiple/vague meaning, and acronyms. General background information (patient bill of rights, HIPPA forms) and education materials are not appropriate to sighttranslate (due to length, and low probability that the patient will remember them). Sight translate 1 sentence at a time. Legal documents (consent forms, for example) should be translated. If necessary, they may be read by the interpreter for the patient’s benefit. Clinical staff must be present. Ask for any clarification needed before beginning. Focus on idea by idea, not word for word, as languages are not organized the same grammatically. If long, break sentences down into bits. Read at a normal, steady pace. Try to avoid long pauses. Sight-translate everything. Do not omit anything even if it does not apply to the patient. The exception being patient forms that do not apply to the patient. Examples being pediatric questions for adult patients, OB/GYN questions for biologically-male patients, etc. Refer all questions to the provider.

REVIEW: INTERPRETING METHODS Using a certain method for interpretation can be determined by the situation: Consecutive: Preferred and Primary method. Simultaneous: Reserved for situations in which more than one person speaks the original language or high-stress situations. Sight Translation: Verbal iteration in target language of written information in original language.

MEDICAL INTERPRETER METHODS AND ETHICS Section 4: Information-Retention Techniques

SECTION 3 REVIEW: INTERPRETING METHODS Using a certain method for interpretation can be determined by the situation: Consecutive: Preferred and Primary method. Simultaneous: Reserved for situations in which more than one person speaks the original language or high-stress situations. Sight Translation: Verbal iteration in target language of written information in original language.

SECTION 4: INFORMATION-RETENTION TECHNIQUES The more the speaker can say without pausing, the more genuine they may be. Here are some skills to improve information-retention and lessen interventions: Concentration Visualize the Action Clump meaning, echo key words Finger-Lists Note-taking

CONCENTRATION As simple as it sounds, loss of concentration is one of the most prevalent complications in information retention. Recognize situations that cause loss of concentration and find solutions: Hunger/Thirst Repetitious concepts/ themes Personal life distractions Worries/stressors/excitement Frustrations Difficult patients/providers, difficult concepts, frequent errors/misunderstandings

VISUALIZE THE ACTION Especially useful in moments of storytelling, a mental picture of the event can assist in information retention for retelling. Try practicing with a real-life event.

CLUMP MEANING, KEYWORD ECHOING Interpreters are expected to maintain the meaning of the message to the best of their abilities, however they are not expected to interpret word-for-word. Recognizing key words and applying previous knowledge can improve the accuracy of interpretations: Using context, fill in the blanks with your best guess to complete the sentences: Mrs. Salazar, your baby’s bilirubin level is just _____ enough to be considered jaundice. It is not very high, however, so please do not _____. As you know, ______ is a result of your baby’s underdeveloped liver. Her _____ will mature as time passes. We will just want to _____ her levels each week until it returns to ______. This time, determine the topic of discussion based on these keywords: Left foot, x-ray, two days, results and return

FINGER-LISTS When a short list is made (typically procedure steps), your fingers are perfect placeholders and allow your brain to associate information with muscle movement. Then, muscle memory can help you remember the keywords to information associated with each digit!

NOTE-TAKING While note-taking is helpful, your brain cannot truly multitask. That means, the time you spend writing is time spent not paying attention. The follow helps in creating the best notes: When to take notes Unfamiliar Subject Use of Direct Quotes Names, Numbers, or Lists When you are tired What to write down Keep the idea in mind, the details on paper Symbols are better than words Shred notes post-encounter Notes with Protected Health Information (PHI) must be shred, and making a habit of shredding all notes is the safest habit.

REVIEW: INFORMATION-RETENTION TECHNIQUES Practicing the following information-retention skills can greatly improve interpreting encounters: Concentration Visualizing the Action Clump Meaning, Keyword Echoing Finger-Lists Note-Taking

MEDICAL INTERPRETER METHODS AND ETHICS Section 5: Compensation Strategies

SECTION 4 REVIEW: INFORMATIONRETENTION TECHNIQUES Practicing the following information-retention skills can greatly improve interpreting encounters: Concentration Visualizing the Action Clump Meaning, Keyword Echoing Finger-Lists Note-Taking

COMPENSATION STRATEGIES Words change and evolve. With political and technological advances, new concepts emerge. While interpreters are fluent, they are not all-knowing and there will be times when we do not what to say or how to say it. The following are compensation strategies to help continue the encounter without major pauses: Speaker Definition Word Picture

WHEN TO USE COMPENSATION STRATEGIES The term / concept does not exist in the target language. Examples: Section 8 Housing, DSHS, WIC, culturally-based reference. When an equivalent does not carry the same meaning. Example: Red Flag Bandera Roja would be a reference to: The Communist Organization of Spain Peruvian Communist Party – Red Flag Party, a Venezuelan political group.

COMPENSATION STRATEGY: SPEAKER DEFINITION This simple technique is best used when only a couple of terms (1 -2) need defining. As the interpreter, simply ask for a definition of the term from the speaker, then interpret the given definition to the listener as defined by the speaker.

WORD PICTURE This technique is most effective when a number of terms (2+) need to be defined and you know an accurate yet efficient definition of each term you define. Interpreter explains the term by its definition retaining all key points without being wordy Can use a combination of word pictures and speaker definitions in cases of high term numbers.

SECTION 5 REVIEW: COMPENSATION STRATEGIES While interpreters are fluent, they are not all-knowing and there will be times when we do not what to say or how to say it. The following are compensation strategies to help continue the encounter without major pauses: Speaker Definition: ask for a definition of the term from the speaker. Word Picture: Interpreter explains the term by its definition retaining all key points without being wordy

MEDICAL INTERPRETER METHODS AND ETHICS Section 6: Localization

SECTION 5 REVIEW: COMPENSATION STRATEGIES These are compensation strategies to help continue the encounter without major pauses: Speaker Definition: ask for a definition of the term from the speaker. Word Picture: Interpreter explains the term by its definition retaining all key points without being wordy

SECTION 6: LOCALIZATION Localization is the ability to use a vocabulary common to the client’s nation of origin to create an authentic experience. This can at times also ensure clear communication in cases where terms have different meanings in different areas. Examples: Pana Venesuela: Friend Colombia: Courdery (type of material) Porro Colombia: Happy tune Other places: Joint (marijuana) or stupid La chucha Chile: “a la chucha” something is far away Argentina: slang for the female sex organ Colombia: underarm smell In Uruguay they say “chivo” for this smell Chivo is goat in most places In Costa Rica it is a school dance or concert

MEDICAL INTERPRETER METHODS AND ETHICS Section 7: Cultural Competency

SECTION 6 REVIEW: LOCALIZATION Localization is the ability to use a vocabulary common to the client’s country of origin to create an authentic experience. This can at times also ensure clear communication in cases where terms have different meanings in different areas.

SECTION 7: CULTURAL COMPETENCY Understanding cultural beliefs and practices can greatly benefit both patient and provider in ensuring the best care. It can also be used to maintain safe practices and avoid hazardous ones.

HOME REMEDIES Spanish Name English Name Use(s) Efficacy Safety Ajo Garlic Hypertension, antibiotic, cough + +++ Azarcón/Greta Lead/Mercury oxides Empacho, teething -- --- Eucalipto Eucalyptus (Vicks Vapor Asthma, bronchitis, TB Rub) Respiratory + TB nothing + Manzanilla Chamomile Nausea, flatus, colic, anxiety, eyewash All but eye wash + ++ (if not allergic) Orégano Oregano Expectorant, menstrual All but worms + difficulties, worms +

HOME REMEDIES CONTINUED Spanish Name English Name Use(s) Efficacy Safety Ruda Rue Antispasmodic, abortifacient, empacho, insect repellant ? ? ? - Internal / external Savila Sage Prevent hair loss, coryza, ? ? ? diabetes --- chronic use Tilia Linden flower Sedative, hypertension Sedative + Others ? ? ? -- chronic use Yerba Buena Spearmint Dyspepsia, flatus, colic, susto ++ + Zapila Aloe Vera External – cuts, burns Internal – purgative, immune stimulant external ++++ internal +? ? ? + external - Internal Zapote Blanco Sapodilla Insomnia, hypertension, malaria ? ? ?