Caring for the Health of Latino Patients

According the U.S. Census Bureau, Latinos are the fastest growing minority population in the U. S. Already approaching 17%, it is projected that by the year 2050, the figure will be 24% with Latinos comprising the largest minority group in 20 of the 50 states. Another interesting statistic is that this population is young in comparison to the general U.S. population, which means more child-bearing age groups. The rising population numbers are indicative of increasing health issues across the board. This means that the health care industry should be prepared to address a population with unique cultural factors and various degrees of biculturalism.

Some illnesses are more prevalent in the Latino population. For example, there are higher rates of diabetes, tuberculosis, hypertension, HIV/AIDS, alcoholism and cirrhosis. For a variety of reasons, many Hispanic patients may delay medical care until their condition worsens and necessitates immediate attention. Some factors that delay or prevent health care include poverty, lack of health insurance and limited access to health care. Along with serious illness, crisis and emotional stress, the complexity of navigating the medical system becomes even more complicated.

The language barrier is another cultural factor that prevents Latino patients from experiencing effective communication with their health care provider. Medical terminology is not always easily understood by mainstream and even less so for Spanish-speakers. Health care professionals who speak Spanish are few in number even though a total of 35 million speak Spanish at home. Cultural factors may also be correlated to delay or lack of doctor visits such as a belief system that some health issues are natural and therefore, do not necessitate medical attention. For example, folk medicine and traditional healers are common practices in some Latino sub-cultures. The culture is broad and unique posing many challenges. Health care providers need to be careful not to allow any characterizations of values, customs or beliefs dominate the way they deliver health care services to such a diverse group. It is noteworthy for health care professionals to keep in mind that each person is unique.

Maria Ugarte-Ramos

Dear Technology: A Letter

Dear Technology… you precocious little Minsk.

What are we going to do with you?

You replicate, expand and improve faster than we can keep up. In a few days time, 4G will be so yesterday. We use you for our own advancement and entertainment with the always underlying thought that someday you very well may trump us all a la some crazy real world version of Terminator.

In the world of medicine you have become quite useful and adept. You provide physicians and patients with valuable information about diseases and the means to treat them. Pharmaceutical companies can now globally reach millions of consumers in the language of their choice.

In parts of the world where the number of patients far exceeds the number of doctors available to treat them, a physician’s time is precious and limited. Again, technology, you come to our rescue, allowing for CME and new product information exchanges to happen quickly and electronically. No appointment necessary.

Patients benefit as well with the ability to access disease awareness and education sites across the globe. Armed with more information than many may actually need, they march into their doctor’s office with many, many questions. Oh so many questions!

Ah, but again you are wily and not easily bound to regulations and conventions of protocol. DTC is illegal in most countries. You know it and we know it, yet you refuse to adhere.

When a patient demands to see your internet content on Lipitor, you are uncontrollable. You always give up the goods. You provide branded programs and information without discrimination. Not once do you ask, where do you live and who regulates your access to this information?

Someone in India can Google a pharma brand name and pull up sites not controlled in India. These online brand discussions can in fact be undercover DTC. You are a naughty little devil.

Ah, technology, you are slippery as an eel. Your benefits in the field of medicine abound, yet you are uncontrollable.

What are we going to do with you?

Sincerely,
aiaTranslations

(Sherry Dineen)

The Translator as a Bi-Cultural Being

Putting a human face on your language services provider

Translators tend to be at home in more than one culture—be it by birth, circumstance, or the conscious choice of immersing themselves in different cultures. But what sets them apart is that, while assimilating to the culture they live in, they also cultivate their membership to other cultural circles. This gives them a unique perspective, not unlike the vantage point of the artist, who needs to step outside his or her paradigm to get a clearer grasp of what shapes its realities.

The little differences

You might recall the opening dialogue of Quentin Tarantino’s “Pulp Fiction”, when John Travolta’s character shares some surprising discoveries of his stay in Europe—like the re-naming of a burger staple necessitated by the metric system or the unusual way of eating French fries (with mayonnaise). What appears to be completely ordinary to someone who has grown up in a certain culture can be quite astonishing to anyone not accustomed to it. The life of a translator is full of such epiphanies, because no matter how well you know your working languages and cultures, you continue to discover things that would escape you if you did not see them in association with what they are outside of their habitual setting.

Going the distance

By association alone, as a matter of fact, can one small word that may not even be any different in two languages result in an entirely different meaning. After Germany’s liberation from Nazi rule and to clearly distinguish the Allies’ sectors from the Soviet sector, newly or re-founded institutions in Berlin were labeled as “free”: the radio station Sender Freies Berlin for instance, and, as it is still known today, the “Freie Universität Berlin”. 65 years later, it would never occur to Americans that a “Free University” in Europe has anything to do with the “Free world”—free of Nazis, free from communism—instead, they are very likely to mistake it for meaning “free of charge”. Historical and geographical distance creates a new context that can easily be misread, but serves as the road the translator travels when carrying messages across and discovering worlds in between.

Inside out

Immersion is everything, or so we are told, when learning another language and adapting to another culture. And while it is only by way of immersion that we delve deep enough to understand a culture’s treasures and truths, the translator’s work is accomplished by being there and somewhere else at the same time, which tends to characterize how he defines himself otherwise as well. The “other” is never far, because you are trained to keep it present and your identity resides within this continuous duality: You are forever creating the subtitles to your own film. Ironically, this heightened self-consciousness enlightens yet another conceptual and even psychological difference between the English and German languages: While someone who is conscious of his or her self is understood as having (self-) confidence in German (Selbstbewusstsein), self-conscious doubles as insecure in English.

Serving two masters

With the consciousness of complexities, however, comes the mandate of clarity. As Confucius puts it: “If language is not correct, then what is said is not what is meant; if what is said is not what is meant, then what must be done remains undone; if this remains undone, morals and art will deteriorate; if justice goes astray, the people will stand about in helpless confusion. Hence there must be no arbitrariness in what is said. This matters above everything.” The need to be loyal to what is said is trumped only by the necessity to be clear when rendering it in a different language. Striving to do justice to source and target is the daily bread of the translator, and the answer is different every single time. Decisions are called for consistently, and the knowledge that two things can never be the same runs deep.

A band apart

In a world and time where you are defined by what you do rather than by who you are, we easily become what we do. Over the course of a career, the cultural and linguistic as well as social and intellectual sensitivities required to successfully translate from one language into another will thus rather deepen than disappear, making the translator all the more aware of his status caught in perpetuity between the lines. Living in two worlds is living rich, but it also means living apart. Yet, as in art, expression is the key. Continuing to discover, to learn, and to communicate creates a well of knowledge for everybody—or in Ella Fitzgerald’s words: The only thing better than singing is more singing.

Nanette Gobel

Words Within Borders

Using Creative Design Tools to Assist with the Authoring of Multilingual Documents

If you ever happened to be on the receiving end of a French letter or had to even write one yourself, you might have wondered about the longwinded line in the end reading something like this: “Dans l'attente de vous lire, je vous prie d'agréer, Mesdames et Messieurs, l'expression de mes sentiments distingués.” What does it mean? It’s simply the French way of saying “Best regards”: Two words in English, two lines in French.

Not really a problem, unless you are dealing with the layout of a document—maybe a brochure, datasheet, packaging, or similar—intended for publication in a variety of languages, and your spacing needs to allow for both (and more) versions. The translators of course can be directed to try to keep the word count of the target text as close to the original as possible, but that’s not always feasible. In fact, foreign languages take up on average 30% more space than English text, as it is one of the particularities of the English language that it lends itself to brevity (lauded by some as the highest virtue in language and lamented by others as sheer loss of syntax).

DTP to the Rescue

Be that as it may, desktop publishing has come a long way since its introduction in 1985, and while multilingual DTP addresses the issue outlined above, there is more to learn and always room to improve. And we haven’t even mentioned yet the challenges of different writing systems, different hyphenation rules, right-to-left text, special characters and other typical problems. To this date based on the wonderfully simple principle and complex system of WYSIWYG (What You See Is What You Get), multilingual desktop publishing only works if the eyes that see the page know what they are looking at.

DTP and Translation

Most translation agencies work with desktop publishing experts specializing in the integration of target texts into the source document created by you in your authoring application of choice, such as Adobe InDesign or QuarkXPress. Rather than having your document translated as word file and then importing it in-house into your DTP software, using the agency’s specialists offers you the advantage of working with a team that knows the tricks and pitfalls of the different language layouts inside out. They also cooperate closely with the individual translators and make sure that the latter’s “seeing eyes” review the results before the finals go to the client. If the translation is excellent but doesn’t look good on the page, its effect is greatly diminished.

Apart from the basic checkpoints—is everything on the page and in the right place—there are a number of additional items that need to be verified with regard to the foreign language versions. We already brought up hyphenation: the vocabulary of languages like German or Hungarian is full of compound and similarly long words which may need to be hyphenated, and this has to be done correctly and in a way that does not interfere with the flow and look of the text. Ideally, hyphens should be avoided as much as possible and methods like kerning (adjusting the space between characters) used to keep the text in place.

Long words in headers can be a real headache, and capitalization is another can of worms in the same department. While English language DTP experts like to get creative with UPPERCASE, tOGGLE cASE, Sentence case, and lower case for headlines or taglines, different rules apply in different languages and what looks like fun and attention catching in one language will appear simply wrong in another.

Fonts are a tricky matter altogether. Some may not show the special characters in the foreign language or replace them with something else (Über looks like Uber and ingrédients like ingre&dients). Most of the simpler fonts will be able to handle the characters of the other languages; fancy fonts featuring in the original might have to be replaced. There is no room for error: A word without a specific accent in Spanish will be plain wrong, regardless how attractive the font.

Optimizing your DTP files

One way to optimize multilingual desktop publishing projects from the start thus lies in choosing a relatively basic font as well as a simple yet flexible layout that will accommodate different sets of characters and can easily be adjusted to read from right to left (e.g. for Farsi, Arabic, or Hebrew).

An extremely useful DTP feature is the style sheet, since it creates consistency and makes applying and updating even complicated formatting fast and easy. The principle behind the style sheet is the separation of presentation and text data, which facilitates the creation of different language versions following the same format. Equally helpful is the use of different layers, which will need to be aptly named and made available as source files to the translation agency’s translation and desktop publishing team. All graphs and charts must be editable.

How the text and other elements are connected also has an impact on their rendition in other languages. If inline components (text boxes, graphics) are to remain in a certain position in relation to each other, they need to be grouped using the Group command or Ctrl-G, which will create a dotted outline around the elements. When placing a graphic between paragraphs, it is preferable to place it within the text frame—as an additional paragraph—rather than creating text boxes above and below the graphic, which will have to be reformatted if the text expands in the foreign version.

Last but not least, it is crucial to leave plenty of white space in your document to allow for the expansion of text in the target languages, as well as space between the lines paired with a font that is not too small, since it may have to be reduced further. This way, your translated versions will not only sound but also look just as elegant as the French closing of a letter. Je vous donc prie d’accepter, chers lecteurs, l'assurance de ma considération distinguée.

Nanette Gobel, MA

GLOBAL MESSAGE ACROSS THE GAP

Making sure your marketing strategy safely crosses linguistic and cultural barriers by adequately adapting advertising content to local speak and customs.

No two types of material are the same when it comes to translation, and different approaches need to be taken to ensure that content, tone, and style are accurately rendered. This is especially true when it comes to marketing and advertising—while there may be a certain 1:1 equivalency in technical terminology (cholesterol will stay Cholesterin in German and cholésterol in French), all bets are off as soon as language gets creative. So if you have packaging to translate for worldwide distribution, chances are the list of ingredients is pretty straightforward, but the text portion describing and advertising your product could turn into Pandora’s box.

Your carefully conceived and developed marketing content should never come out of this proverbial box distorted, clumsy, or plain wrong. Every word in the original text was chosen carefully, the syntax built subtly but solid. What you need now are linguists who can do the same in each target language, who do magic with words while staying loyal to yours, and who know how to navigate all potential cultural pitfalls.

Geography

It may seem obvious, but geography should actually be your first concern when assigning the right team of translators. It is crucial to discuss with your language services company of choice what the exact target markets are—a translation “into Spanish”, for instance, will greatly differ if performed for the Latin American market or for Spain. Not only are there linguistic differences, especially in the colloquial language often used for marketing purposes, but cultural sensitivities vary as well. Sometimes two or more translations into Spanish are necessary to reach your target audience, depending on which countries you are distributing your product or services in, and they must be performed by experienced, native linguists.

Philosophy

As noted above, there is a different approach and philosophy to working on creative materials vs. technical texts. Translators who specialize in this kind of material are strong writers, unafraid of letting go of structures and metaphors contained in the original that need to be recreated or replaced in order to accurately convey what is being said, and how. Not every translator masters this paradox. Those who do must know target and source languages inside out and be tuned into subtleties of style and tone. The act of translation becomes an act of reinvention, at the end of which stands a text that mirrors the original in rhythm, imagery, and content but reads as if created from scratch for the intended audience.

Fluency

Readability is crucial for the appeal of any marketing and advertising piece. If a text doesn’t flow right, we will easily abandon it or even be turned off by it. This of course will affect our perception of the product or services it relates to. Be it a tagline, slogan, ad, packaging or other promotional material, its purpose is to lure the audience into wanting to know more. If the line or text is no longer catchy or witty in translation, its entire effect is lost. Stylistic tools are of highest order, although the linguist must sometimes carefully weigh if it may not be better to replace a rhyme with an alliteration or the other way around—again, the paradox lies in remaining true to the original while making the adaptation fit into its own linguistic and cultural context. Every language has its own musicality and every audience is tuned into different melodies.

Vocabulary

Whatever the melody or music of a text may be, it is still made up of words, and choosing the right words is crucial not only to sound and fluency but also to content and tone. The way you address your audience, the industry-specific terminology, the common ground you strike or new ground you break with the target customers must ring true in every single translation. And this of course will vary from market to market, and it is the responsibility of the respective linguist to know and research the adequate wording. The challenge is to “package” it in a way that makes it attractive and follows the idea of the original as closely as possible in consideration of the different idiosyncrasies of each culture.

Accuracy

The translations can only be as accurate as they are befitting for their respective market. This means that we cannot simply look at individual words or phrases and determine if they are “right” or “wrong”. You may say translating ‘sugar’ with ‘salt’ will always be wrong—but even that does not necessarily apply, for instance if it involves a metaphor or saying. One of the greatest mistakes that can be made in the adaptation of creative texts is the literal translation of an idiom or figure of speech, which can easily be an oversight. The English “thorn in someone’s side” is a “thorn in someone’s eye” in German, and if a German speaker told an English speaker something is “for the cat”, he or she would not necessarily know that it’s simply a waste of time. If your marketing or advertising piece is rich in imagery and colloquialisms, be prepared that it will need to be adapted to suit the conventions and sensitivities of the target audiences. The notion of accuracy must always take into account the bigger picture.

Sensitivity

Cultural and linguistic sensitivity is ultimately the key to successful adaptations of any kind of promotional materials. In order to bring your global message across to every single target market, the linguists must be familiar with what’s deemed appropriate and what isn’t, what’s funny and what isn’t, what sounds good and what doesn’t and so on. Their in-depth knowledge of target and source culture combined with their skill and expertise of recognizing and choosing the right words, stylistic tools and expressions to render your text in the most adequate and appealing way will ensure nothing gets lost in translation, and gaps will be masterfully bridged.

Nanette Gobel