Next Please

Patient/provider relations via medical interpreter

While meant to facilitate communication in hospitals and doctor’s offices, the fact that a third party is involved in very personal matters can often lead to awkwardness and even misunderstandings. Healthcare providers are well advised to educate themselves and their patients so both can reap the full benefits of having a professional interpreter assist during appointments and procedures.

 

The elephant in the room

As with the proverbial elephant, it is helpful to start by acknowledging the presence and clarifying the role of the interpreter at the very beginning of each meeting. Everybody will be more at ease if introductions are made and it is established what kind of interpreting services are required. For patients with little to no knowledge of English, the interpreter will translate consecutively what is said. This means that he/she speaks after the respective source-language speaker has finished, rendering the message in the target language.

 

Turning invisible

In this process, the consecutive interpreter will actually take him/herself out of the conversation as much as possible by translating in the first person. While such a linguistic device is not a cloak of complete invisibility, it does make the dealings between healthcare provider and patient as direct as possible. The interpreter relies on memory, so the segments need to be short enough to memorize. If the answer to a physician’s question is more complex—for instance if asking about a patient’s medical history—or the doctor or nurse is explaining a diagnosis or procedure, it works best if the speaker pauses after every other sentence to allow for translation.

 

Keeping it familiar

The interpreter can also serve as a comfort factor, especially if the patient is visiting from another country or seeking treatment abroad. The anxiety often associated with a doctor visit tends to be heightened in unfamiliar territory. In such a situation, the presence of someone who speaks your native language and knows the local customs and conventions will have a calming influence. Cultural differences and barriers can be more easily addressed and overcome, with the interpreter acting as intermediary. Even if the patient speaks basic or conversational English, having an “ally” who shares his or her native background will create a feeling of safety.

 

One-way might be the way

A patient in this kind of scenario may opt for having the interpreter translate only what the healthcare provider says and express him/herself in English. The interpreter will then stand by and assist if anything is unclear. This also works the other way around: Some patients may feel confident that they understand what is said but are insecure about their own language skills. However, if the care provider prefers that everything be translated, the linguist will proceed with the consecutive interpretation. The same applies if the patient requests that the interpreter only be present during the consultation and not during the exam or procedure. While the physician will in most cases grant the patient’s request to make him or her as comfortable as possible, it is ultimately the physician’s choice since the services of the interpreter are usually a requirement on the part of the hospital or practice to ensure effective communication.

 

Party of four

That’s one of the reasons why some patients are actually surprised and—in most cases—relieved to find an interpreter when arriving at their appointment. Since they are not notified in advance, some bring a friend or caregiver to help with the translation. Pursuant to hospital guidelines, however, family members or friends of the patient should not act as interpreters, since the risk of mistranslation is too great. Errors can have serious consequences on diagnosis and treatment—and the healthcare provider must be able to rely on the language skills of the interpreting individual, which is only possible if the service is provided by a certified professional. But the cooperation between interpreter and caregiver can be valuable, since the person accompanying the patient is usually familiar with his or her medical history, allergies and prior doctor’s visits leading up to the appointment. The situation may sometimes be complicated by the fact that more than two languages are involved or the patient’s difficulty to focus on the interpreter, especially if the patient is elderly or a young child. Different scenarios may require different solutions. The interpreter will be glad to offer his or her professional opinion and always defer to what the healthcare provider deems best.

 

Red tape

A patient’s Odyssey at a clinic or practice often continues beyond the end of his visit or procedure. The assistance of an interpreter may be needed even more urgently when the patient is dealing with office matters such as payment, scheduling, and insurance. Especially the latter can be quite complex and involve foreign language documents that need ad hoc translation. Medical interpreters are trained accordingly and will stay with the patient at the hospital or practice until all bureaucratic issues are solved as well.

 

Jack of all trades, master of none?

In the daily life of a healthcare interpreter, he or she may spent one morning assisting in an MRI procedure, then move on to an OB/GYN appointment and finish the day interpreting in a neurological consultation. The terminological challenge is tremendous. Patient and medical staff must be aware that they cannot expect the interpreter to know every term in the book. Based on their experience and training, interpreters will have certain fields of expertise but are required to serve across the board, including questions of insurance and billing as mentioned above. All professional interpreters in the healthcare industry, however, are trained in general medical terminology, ethics as well cultural traditions and idiosyncrasies. They continue their education on an ongoing basis by attending classes and seminars and master the art of interpreting, which requires a high level of skill and concentration.

 

So when everyone is on the same page and knows what to expect, an office visit aided by a professional interpreter will be just what the doctor ordered.

Hitting the Mark With A Hispanic Audience

What is the best way to build trust and improve medical adherence with your Hispanic audience?  Considering the Hispanic population’s varied background and different levels of acculturation and socio-economic status, it may seem like there could be no singular way.  Or is there?

According to the February 2012 Patient Journey Study conducted by Univision Communications, there is a strong correlation between medical adherence and in-culture communications. 

“We found that targeted communications have a strong influence during the adherence phase.  If marketers connect with Hispanics in their language and culture, they tend to feel more comfortable about taking the medication” said Eric Talbot, Univision Vice President of Brand Solutions/Healthcare.

When creating communications for a Hispanic audience, you have choices.  Using a neutral-dialect, “Universal Spanish” that speaks to everyone is fine for communicating the news or recording phone system messages but is not a wise choice when trying to reach a target audience through their emotions and feelings.

To gain compliance from your audience you need to connect with them specifically.  You need to create a mental image or emotional connection with the action or role you need them to take.  When you take the time and energy to recognize cultural nuances through accents and word selections, and become sensitive to their belief systems, differing cultures and frames of reference, you connect on a deeper level with your target audience.

This means tailoring your message according to the cultural characteristics of your identified market.  It means making more effort on your part to create multiple ad campaigns instead of just one.  This effort shows your audience you are committed to them and they are worth the added budget it took to reach them in their language and culture.

There are many ways to target a Hispanic audience.  If you wish to gain medical compliance from them, you need to make them feel valued.  The best way to connect with them is in a culturally targeted and honest way.

The Wild Life of Words

Not to personify here, but did you know words are born, die and have mid-life crises?

According to a team of statistical physicists, words emerge into a language and are either sustained or driven to extinction.  In a March 2012 paper entitled “Statistical Laws Governing Fluctuations in Word Use from Word Birth to Word Death,” the authors, using Google’s Ngram viewer estimate there are one million words in the English language.  Google’s Ngram Viewer is a searchable corpus of digitized texts (4% of all the books ever printed) allowing for quantitative study of cultural trends and human behavior through computational lexicology known as “culturomics.”

These scientists see language existing in a competitive evolutionary environment, just like Darwin’s Theory of Natural Selection.  During statistical studies of word patterns in English, Spanish and Hebrew they discovered strikingly similar trajectories for the rates of birth and death for words.

English grows at an estimated rate of 8,500 new words per year, a “birth rate” that is slowing.  They hypothesize this slowing is due to an already existing rich environment of words.  Current objects are well described and new words are quickly born but limited because they describe something singular and new like “iPad” or “YouTube.”

The death of a word, unlike human mortality, refers to an extreme rarity of its use.  Historically, there is a notable increase in word deaths after the 1950s.  Modern day publishing with strict editing procedures and spell check technology created a homogenization effect on our language contributing to a faster natural selection of words.  Despite the arrival of texting, the birth rate of misspelled word variations has dropped dramatically.  Synonyms choke out words too, for instance “loanmoneys” died around 1950 when it was replaced by “loans.”

Words cycle through a mid-life crisis too: a universal “tipping point” identified by the study.  The authors claim 30 to 50 years after being born, words either become part of the long-term lexicon or die from disuse.  Theories for why this exists include a generational acceptance or rejection of (their parent’s) terms or the point where dictionary publishers decide to include a term or not.

Words live, die and compete for survival just like the dodo bird.  Their continued existence depends on historical context (international crises create common media attention increasing lexical diffusion), trends in global communication and means for standardizing communication (technology).  Just like the animals on Darwin’s Galapagos Islands, some will make it and others will not.  

Welcome to the wild life of words.

 

Sherry Dineen

Translating Idioms: Not Quite a Dime a Dozen

While they can be dismissed as unimportant parts of speech, idioms add spice and life to a language.  They are born from their culture of origin and they differ radically from one language to another.

There are different strategies for translating idioms and the care with which your translator uses these strategies can make or break your translation.  Inexperienced translators who only consider plugging one expression in for another may fail to transfer the true meaning of the source text.

Minimizing the effect of idioms to preserve the lexical form of the source language will also ruin your translation.  In both cases, the intended effect on your target reader will be lost and deprive them of the illustrative color idioms provide.

One of the more common solutions for translating idioms is translation by paraphrase.  For instance, in translating “it’s a piece of cake,” a translator would create a phrase in the target language equivalent to “it’s easy” or “no problem.”

In rare instances, the strategy might be to simply leave it out.  When single words have no match in the target language, cannot be easily paraphrased or perhaps the style does not match, sometimes its gotta go.

When two cultures have idiomatic expressions with similar meanings, the easiest strategy is to substitute one for another.  This substitution should be based on inherent meaning, not similar linguistic elements or similar images created by the idiom.  A phrase is needed to serve the same purpose in the translated language as that from the source language.

Of course it you don’t truly understand the meaning behind the idiomatic expression and the cultural triggers that create it, how can you choose a similarly functioning idiom in the target language?  What if there is no equivalent in the target language? 

Sometimes languages do not overtly express meaning and idiomatic expressions are linked to social behavior or cultural convention that may not translate (for example, “say when” is a very English expression).  This doesn’t mean the expression is untranslatable, just a little more difficult to handle.  This is also where an experienced translator pays off.

Idiomatic expressions make a communication interesting and vivid.  Cats with tongues and bats from hell produce memorable images in your reader’s minds.  Failing to translate them well can create lackluster target text.  Don’t throw caution to the wind.  Make sure the idioms in your source text receive the attention they deserve.

Sherry Dineen

Going with the Flow

Understanding the workflow of translation projects

When I was in 7^th grade, my small town in Germany celebrated its 750^th anniversary, and for this special occasion, our school performed a massive play illustrating the different eras that had come and gone since the town was first founded. To represent the industrial revolution, about 40 of us lined up on stage executing a series of strictly coordinated, repetitive movements in flashing strobe lights (yes, it was the 80s). To this day, that’s the image my mind conjures up when I think of production and workflow.

While translations might not be made on the assembly line, there is nonetheless a specific process involved that needs to be followed in order to create high quality products. In addition thereto, we have the individual workflow of each translator, typically handling multiple projects for different end clients at once.

Phoning it in

Clients will usually contact their language services provider of choice via phone or email and submit their electronic file(s) for a quote, or contact several providers for a bid. What happens behind the scenes—and for this article, we ask that you do pay attention to the man usually hidden by the curtain—is not so much wizardry but a rather technical process of assessing volume, industry, exact language pair (Spanish, yes, but is it Castilian or Latin American?) and type of the document to be translated. If the source file is in English, the project manager will be able to handle most aspects, but if the project is to be translated from another language into English, he or she may contact one of the agency’s linguists specializing in the respective language pair to assist. Any translation cost estimate will be based on these factors, since the prices are contingent upon word count, language, and area of expertise plus turnaround (rush or regular).           

Onto the conveyor belt

Once the quote has been presented to the client and the project is green-lighted, the bands get rolling. The raw material, so to speak, goes to the linguist(s) in the corresponding language pair(s) selected by the project manager based on their project-relevant expertise and experience. This first group of translators performs the actual translation into the target languages. But that is by far not the end of the line. The next step, usually referred to as editing, involves a second group of linguists with an excellent command and a keen sense of style in the target language. Since the original translation process requires a constant back and forth between two languages, it is crucial to have another pair of eyes solely concentrating on the target document to ensure fluency and readability. And the belt keeps going after that—to yet another set of linguists who now will go back to the original document and compare it to the translation, checking for missing lines, confirming all figures, and generally making sure that all the pieces fit. It’s quality control—in the world of language also referred to as proofreading.      

Door-to-door service

Any questions that come up in the process of translation as outlined above will always go back to the original translator, since he or she has the fullest grasp of the source text. The client, however, gets turnkey service—placing the order and submitting the material, then receiving the final top of the line product in all requested languages on the agreed delivery date. Only if there are company-specific terminology issues or document errors (missing pages, illegible text), the client may be contacted for clarification during the process, but in most cases, such issues are clarified beforehand. Translators accepting assignments from their agency clients need to carefully manage their time to ensure they are not only able to perform the translation in a timely fashion but also available to promptly respond to inquiries from editors and proofreaders. If they are serving in one of the latter functions on a different project within a similar timeframe, they have to tend to each of these assembly lines so that nothing gets backed up.          

 

Modern times

Just like in Chaplin’s classic, the whole elaborate scheme can fall apart if only one little wheel fails to turn or unexpected elements are introduced, or if the entire machinery becomes too large or too fast for its own good. One of the precautions the client can take is to ensure that the project is complete before placing the translation order or, if he or she knows that changes to the source document might still be made but needs to get started on the process, alert the project manager to the fact. All reference materials should be submitted together with the source file(s), such as glossaries, illustrations, etc. Turnaround times should be established reasonably—in case of an extreme rush, there is always the option of splitting a project up among several translators, but the workload for editors and proofreaders will be greater in such a scenario, since they will have to create continuity in terms of style and vocabulary throughout the document(s).

 

We didn’t have a Little Tramp in our anniversary show (might have been a little too dark for the famously neon-lit decade), but something to take away from the film and maybe from above description of the translation process is that no matter how automated we make our processes, the major part of the work is still done by humans, for humans. And for me personally as a translator, it’s always a labor of love.

Nannette Gobel, MA