Tuesday, December 15, 2009

Traduttore Traditore

  1. Reflections on the Certification of Healthcare Interpreters in the United States

The ancient Roman expression: “Traduttore Traditore” (Translator Traitor) calls to the fact that the art of translation can turn into a gross distortion of the original message, and that the act of transmitting a message from one language into another is fraught with the possibility of errors and private agendas, steeped in a history of deceit and betrayal.

It is truly a paradoxical journey that ultimately recognizes interpreting (the oral form of translation) as one of the oldest and most honorable professions “documented in stone since the time of the Pharaohs.” So how did it develop? What shaped it? Where is the frontier between self-interested lies and fastidious accuracy?

Ah, the irony of the human condition, of conflict, language and history.

Historically, translation and interpretation are professions often tied to the making and business of war and peace, of devastating loss and unbridled greed. Consequently, the matter of how these finally became respectable professions is embedded in the history of international conflicts, in questions of justice and peace-making.

Perhaps the most poignant historical example is the extraordinary role played by interpreters at the 1945 Nuremburg trials of Nazi war criminals that “set forth as a principle of international law that crimes of war and crimes against humanity would not go unpunished. The Nuremburg Trial was also the first official international gathering in which simultaneous interpretation was used. However, when 42 volumes of the transcripts containing an estimated six million words were published, not a single word was devoted to the role of interpreters.”

Ergo, a history of unrecognized and heroic labor that marked a future of anonymity and a profound lack of appreciation.

Fast forward. Since the advent of the Civil Rights Act of 1964, healthcare interpreting -a vitally important specialty in the field of interpretation- has been impatiently waiting in the wings for recognition, acceptance and legitimacy. While in the legal field, court interpretation became a certified profession little more than a decade after the Civil Rights Act under the Federal Court Interpreters Act of 1978, healthcare interpreting has lingered in the shadows.

In the meantime, at stake has been the essential need for competent and accurate communication between a patient and her doctor. Anyone who ever traveled abroad and got sick in a country where they didn’t speak that language, understands how frightening and potentially lethal this can be. Yet untold millions of people suffer this fate unnecessarily due to a lack of trained and certified healthcare interpreters.

Millions of messages between patients and those who would heal them, have been silenced, misunderstood and misrepresented. To give an example, until very recently it was perfectly acceptable in healthcare to use child interpreters, family members, other patients and unqualified staff -from the kitchen to the parking lot- to serve as conduits for life or death communication.

Now at last, the legitimate process of certification for healthcare interpreters -the professional benchmark for meticulous accuracy in transmitting communication between languages and between cultures and worlds in medicine- is in the process of being born, conjured and crafted by interpreters themselves and their allies.

Why is this important? Because until now, the voice and knowledge of the healthcare interpreter has been prominently absent throughout a profession too often appropriated and defined by people outside of the profession, people who speak only one language and know very little about the act of interpreting or what the interpreter experiences in the act.

Subsumed in the complex world of a national managed healthcare system in flux, dwindling resources and insurance and billing issues, the voice and contributions of healthcare interpreters have often been treated as a mere inconvenience. This is in part due to the power relations that exist within a healthcare environment where professional certifications are clearly necessary, and where the uncertified interpreter has been invisible at best and a necessary nuisance at worse. We have been strangers in our own land. But all this is about to change.

I arrived in Chicago last week in the throes of a bitter wintry blizzard. Perfect metaphor for the purpose of my trip. For the first time in the history of healthcare interpretation in the United States, there is a valid effort to achieve a healthcare interpreter certification driven by the practitioners and allies of the profession itself, and this is as it should be.

Invited by the new Certification Commission for Healthcare Interpreters, I attended a convening of subject matter experts, all healthcare interpreters. Our function was to make an unpaid contribution to the process of producing a job task analysis and to contribute freely to the body of knowledge in healthcare interpretation.

In other words, for the purpose of informing the creation of a healthcare certification, interpreters with all their vast wealth of unspoken and rich knowledge, are at the helm of defining what it takes to do the job, something that has never been done before in healthcare.

We represent the broadest possible spectrum of healthcare interpreting practitioners: varied cultures, ethnicities and races, women and men, young and elder and in-between. We represent the major languages of our profession as well as dialects and the rarer languages, also known as ‘languages of lesser diffusion’ in linguistic parlance. Some of us work for public health care systems, others work in the private sector including agencies and companies. Our youngest emissaries are in their 20’s and the eldest of our tribe is 79, charming, wise, witty and sharp as a tack. Our collective knowledge represents what only trained and seasoned interpreters can know: How to do the job well and how to represent the profession.

We examined every aspect of what it takes to do this job from the interpreter's point of view. We put our cards on the table of candid discussion and widely varying experiences in one of the most intense professional encounters I have ever had the privilege to be part of. We had honest differences and similarities that had to be mediated by consensus and a brilliant facilitator. No stone was left unturned.

The birth of the Certification Commission for Healthcare Interpreters (CCHI) heralds the most legitimate and interpreter-centered effort to date that intends to open the doors for a profession burdened with neglect, misunderstanding, and political and profit-driven agendas, a profession that is critical to the lives of patients all over the country.

For me, what is most welcome and needed in the CCHI’s certification process is that it is prominently transparent, highly ethical and best of all, it is vendor-neutral. It is a process in which actual healthcare interpreters are at the center of the effort, rather than money or personal gain.

In an age of flagrant profiteering, scams and swindles, the certification of healthcare interpreters is a baby in the cradle of burning necessity and moral obligation. It is an urgent response to the utterances of a terminally-ill patient, a child in unbearable pain, a rape victim in the emergency room, all waiting to be understood in their greatest time of need, since 1964.

©2009 María Elena Gaitán
All Rights Reserved


Anonymous said...

Well said, Maria Elena. I applaud your effort and may we have the certification soon! Gracias mil, Liliana

Mark Halfmoon said...

Very informative and thoughtful. I hope it's OK for me to post on fb.

adarder said...

Strong and eloquent analysis that is long overdue. Years ago, when I worked in the arena of child abuse treatment, an effective court interpreter made all the difference as to whether a child remained in foster care or was reunited with his or her family. As a pediatric nurse, I saw first hand the difficulties non-English speaking patients and parents faced when trying to navigate the health care system, if a knowledgeable interpreter was unavailable. This certification for health care interpreting can make a world of difference, assuring that interpreters are available and well-trained to serve some of the most vulnerable populations. Thank you Maria Elena for your efforts!

Amanda said...

Bravo! Thank you so much for sharing.

Anonymous said...

Thank you so much Maria Elena for braving that blizzard in Chicago, indeed symbolic of your very concrete decades long efforts at the forefront of REAL healthcare with REAL communication. More power to you as you--with others--push to see that certification happen. Que gusto me da!! Te felicito!! Arriba y adelante,

Yolanda Broyles-Gonzalez