Community Ambassador Program Culture and Language Training

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Community Ambassador Program Culture and
Language Training

• Maria Servin, MSW
• Service Director
• Marketing/Diversity

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The Role of the Interpreter
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Learning Objectives

• Learn from the field of interpreting to learn how
  to effectively use language skills to assist
  community members
• Increase understanding of the role of an
  interpreter
• Become familiar with tips and techniques when
  acting as an interpreter

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The Right to be understood

• A community interpreter has a very different
  role and responsibility from a commercial or
  conference interpreter. She/he is responsible
  for enabling professional and client, with very
  different backgrounds and perceptions and in an
  unequal relationship of power and knowledge, to
  communicate to their mutual satisfaction.
• Shackman, Jan. The Right to Be Understood, A
  handbook on working with, empoying and training
  community interpreters. Cambridge, UK National
  Extension College.

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Building Bridges

• Interpreters build a bridge over the language gap
  that allows people who do not speak the same
  language to communicate with each other.
• The interpreter therefore must be prepared to
  adjust his/her role depending on the need of the
  patient and provider.

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Purpose of the Interpreter

• The basic purpose of the interpreter is to
  facilitate understanding in communication between
  people who are speaking different languages.
• Communication is the interpreters main function,
  and anything an interpreter does should relate to
  that.

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Barriers to Communication

• Four types of communication barriers
• LINGUISTIC BARRIERS
• BARRIERS OF REGISTER AND EXPERIENCE WITH U.S.
  CONCEPTS AND PROCEDURES
• CULTURAL BARRIERS
• SYSTEMIC BARRIERS

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Roles of an Interpreter

• To overcome these barriers an interpreter
  develops skills and takes on four principle
  roles
• Conduit
• Clarifier
• Cultural Broker
• Advocate

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Which role to choose? Interpreters flow from
role to role

• Advocate
• Cultural Broker
• Clarifier
• Conduit

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Three relationships are established

• Provider - Client
• Interpreter - Client
• Provider Community Ambassador
• Which is more important?
• The only reason the interpreter is involved is to
  support the provider - client relationship.

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Interpreter vs Translator????Whats the
difference?

• An interpreter is one who hears information from
  one language and converts it orally into another
  language.
• A translator is one who takes written information
  from one language (source language) and writes it
  into another language (target language).
• We will be dealing with the modes for an
  INTERPRETER not a translator.

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The Interpreter Code of Ethics
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Interpreter Code of Ethics

• What are Codes of Ethics?
• Why do we need them?
• How do we use them?

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Code of Ethics

• The skills of a community ambassador requires
  cultural competence, respect, mastery of
  colloquial terminology which makes it possible
  for the trust and accurate communication to take
  place.
• A Code of Ethics sets trained and untrained
  interpreters apart.
• Provide guidelines and rules for interpreters to
  abide by.

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Modes of Interpreting
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Modes of Interpreting

• Interpreters use different modes of interpreting
  under different circumstances. The four modes
  used include
• CONSECUTIVE INTERPRETING
• SIMULTANEOUS INTERPRETING
• SUMMARIZATION
• SIGHT TRANSLATION

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SIMULTANEOUS INTERPRETING

• The interpreter interprets at the same time that
  the speaker is speaking, just a few words behind.
  
• This technique is useful when an interpreter is
  interpreting for a single person in a large
  group.
• It is also useful when patients launch into an
  emotional speech that cannot be interrupted or in
  times of emergency.

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CONSECUTIVE INTERPRETING

• This is the most common mode used by
  interpreters.
• It involves a relay, in which one speaker says a
  few sentences, the interpreter interprets, the
  other speaker responds, the interpreter
  interprets, etc.
• It closely resembles the way people talk to each
  other.

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SIGHT TRANSLATION

• This involves taking a document written in one
  language and reading it aloud in another
  language.
• This is also common when interpreting consent
  forms, patient education materials, instructions
  or anything that is written.

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SUMMARIZATION

• When one person speaks at length and the
  interpreter summarizes the important points at
  the end.
• Summarization is not recommended in medical
  settings because of the potential for errors and
  omissions.
• If the interpreter is going to summarize, he/she
  should take careful notes while the person is
  speaking.

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Being a Conduit
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Being a Conduit

• The most basic role of the interpreter is that of
  the Conduit, whose rule is to
• Interpret everything that is said, exactly as it
  is said add nothing, omit nothing, change
  nothing.

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CONDUIT

• The least evasive role. Being a conduit involves
  rendering in one language exactly what has been
  said in another language.
• Interpret everything that is said, exactly as it
  is said add nothing, omit nothing, change
  nothing.

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How to be a good Conduit?

• Use the first person. If the patient says My
  stomach hurts. The interpreter says My stomach
  hurts.
• Interpreting in the first person reinforces the
  primary relationships.
• Interpreting in the first person helps the
  interpreter focus on repeating exactly what is
  said.
• Interpreting in the first person shortens the
  communication and avoids confusion as to who is
  speaking.

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How to be a good Conduit? (continued)

• Interpret pauses, ums, sighs, everything or
  anything that adds meaning to the communication.
• Interpreter gives an accurate interpretation not
  a literal interpretation.
• Interpreter also reflects tone, inflection and
  volume. Include all the information that carries
  meaning in the message.

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Being a Clarifier
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CLARIFIER

• The interpreter takes this role when he or she
  believes it necessary to facilitate
  understanding. In this role the interpreter
  adjusts register, makes word pictures of terms
  that have no linguistic equivalent and checks for
  understanding.

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Clarifier

• Well, your thyroid gland is overactive, causing
  a hormonal imbalance in your system that accounts
  for many of your symptoms. We suspect that
  cancer in the thyroid is causing this
  overproduction. This is a hard one to call.
  Well have to do a radioactive uptake exam
  followed by a fine needle aspiration to ascertain
  exactly whether the tumor is benign or malignant.

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Basic Interpreter Skills
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Being a Clarifier

• The clarifier may have to change the form of the
  message significantly in order to be faithful to
  the meaning of the message. This includes
• Lowering the register Register refers to the
  level of formal or complex language a person
  chooses to use. High register speech is very
  formal and complex. Low register is used in
  everyday speech. If the provider uses high
  register the interpreter could
• use high register if he/she thinks the patient
  will understand
• lower the register but not change the meaning,
  the meaning must stay the same
• ask the provider to speak in simpler language
• Create Word pictures Sometimes there are no
  words with the same meaning.
• Symbolic meaning Symbols have meaning in only
  one language.
• Check for comprehension Be aware of clues that
  suggest that either the patient or provider is
  not understanding. The interpreter would like to
  ask if the patient understood. If the patient
  is really confused the interpreter should
  communicate this to the provider so that the
  provider can explain, not the interpreter.

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Clarifier Guideline

• Interpret what is said faithfully but in such a
  way that the listener can understand check for
  understanding.

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Managing the flow of the Interpreted Session

• In an interpreted session, the interpreter is the
  best person to facilitate the flow of the
  communication.
• Interpreters do this by using a number of
  techniques
• Introduction and pre-session (with both provider
  and patient)
• use of first person
• appropriate intervening
• transparent communication
• positioning

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Introduction and Pre-Session

• The pre-session helps to set the ground rules for
  the interpreted session.
• Example Buenas Tardes mi nombre es Maria, voy
  a servir como su interprete. Para asegurar la
  mejor comunicacion le voy a pedir que hable
  directamente con la enfermera, voy a interpretar
  todo lo que usted diga, palabra por palabra, use
  frases chicas, digale lo que usted guste, todo se
  mantenera con confianza.
• Example for Provider Hello this is Maria
  Servin, I will serve as your Spanish interpreter.
  There are a few things to help me do a better
  job of interpreting. First, please speak
  directly to the patient, I will interpret
  everything you say exactly as you say it. If
  there is something you do not want the patient to
  hear please do not say it. Use short sentences
  and pause often so I can interpret accurately.
  If I need you to clarify I will ask you to do so.

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Sight Translation

• Oral rendering of one language of a document
  written in another language.
• Sight Translation is a high level skill for an
  interpreter.

• Interpreters are asked to sight translate any
  number of documents
• scripts and protocols
• consent forms
• registration forms
• financial aid forms
• patient education materials
• instructions, etc.

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CULTURAL BROKER

• In this role, the interpreter provides a
  necessary cultural framework for understanding
  the message being interpreted. The interpreter
  takes this role when cultural differences are
  leading to a misunderstanding on the part of
  either provider or patient.

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Cultural Broker

• People who speak different languages live in
  different worlds, not the same world with
  different labels. Edward Sapir, Noted Linguist
• Culture is a shared set of belief systems,
  values, practices and assumptions which determine
  how we interact with and interpret the world.
• Culturally competent means that we must educate
  ourselves further about other cultures, the role
  culture plays in health care and the differences
  these can generate in the health care setting.
  WE need to learn specific information about a
  community and simultaneously treat each person as
  a unique individual.
• We must understand basic cultural frameworks and
  point out that there are many differences between
  individuals who come from the same community.
• We run the risk of stereotyping if we do not
  maintain this delicate balance.

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How to be a Cultural Broker?

• The first step to intervening is to be aware that
  a culture-based misunderstanding may be
  occurring.
• Interpreter should intervene in a transparent
  way, letting the patient know what he/she is
  going to do, then offer key information to
  provider. The goal is to get back to
  interpreting as fast as possible.
• Use the following steps
• Be alert to potential cultural barriers
• Tell the patient briefly what you intend to tell
  the provider.
• Briefly tell the provider the appropriate
  information. Dont give the impression that this
  is necessarily true for this particular patient,
  above all avoid stereotyping.
• Let the doctor decide what to do with the
  information.
• Go back to interpreting.
• Make sure you are respectful, make no
  assumptions, not creating or reinforcing
  stereotypes, get back to interpreting.

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The Role of Advocate
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The Role of the Advocate Washing ones hands of
the conflict between the powerful and the
powerless means to side with the powerful, not to
remain neutral Paulo Freire

• What is advocacy?
• Advocacy is the most controversial of the
  interpreter roles.
• Guidelines must be established to help
  interpreters know when they are advocating
  appropriately and when they are invading the
  patient/provider prerogative.
• Interpreter must be taught skills necessary to
  advocate well so as to increase trust rather than
  undermine it.

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The Role of Advocate

• There are times when advocacy is not appropriate.
  
• These include
• when the contested decision is based on medical
  expertise, and there does not appear to be a
  misunderstanding or oversight
• when the patient does not want to continue
• when the patient needs a service not provided for
  by anybody else
• when the request is of primary benefit to the
  interpreter and not the patient
• when advocacy would involve breaking
  confidentiality

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ADVOCATE

• Advocacy is any action an interpreter takes on
  behalf of the patient outside the bounds of an
  interpreted interview.
• The advocate is concerned with quality of care in
  addition to quality of communication.
• Interpreters appropriately become advocates when
  the needs of the patient are not being met due to
  a systemic barrier such as the complexity of the
  health care system or racism.
• Advocacy most often takes the form of giving
  information or connecting the patient to other
  clinic staff whose job it is to resolve the
  patients problem.