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4. Training for Ad hoc-Interpreters in Public Health

An interpreted medical setting is no better or worse than a dialogue between physician and patient without interpreter, it is different. This difference is challenging and gives new or other possibilities for communication.

Medical care for non-native patients with limited national language skills causes serious problems in hospitals - for the patients, for work procedures and for giving and receiving correct diagnoses.

Taking Germany as example, it has to be said that hospitals and surgeries only rarely solve their linguistic problems with patients with the help of professional interpreting services for medical purposes. The necessity of bilingual health advocates (as described in Role of Bilingual Advocacy in Communication) is not yet seen at all. The vast majority of health care providers solve their linguistic problems spontaneously, with the help of ad hoc-interpreters, i.e. bilingual staff members (with or without a health care background) or relatives of the patient. These persons solve the problems of communication by spontaneous interpreting and try to mediate between physicians and patients. Thereby, they contribute – off the cuff – an invaluable part in medical care.

Unfortunately, ad hoc-interpreting is not without risk and does not always lead to the wanted results (see Ad hoc-interpreting in hospitals). Misunderstandings and extended dialogues in the triangle of physician - patient - interpreter interfere with the work routine, but above all with satisfying examination results for the patients. The interpreters are often overburdened by the spontaneous situations and the additional work that has to be done and the issues they have to deal with. Despite all the problems ad hoc-interpreting will continue to play an important role in providing medical care to migrants. The question is how can we improve this situation?

Training for ad hoc-interpreters
Without abandoning (and repeating) the main demand – that of a professional, bilingual health advocate for every patient with limited national language skills – at least a certain quality of ad hoc-interpreting should be guaranteed where possible. This is realistic for a group of ad hoc-interpreters who easily can be addressed to: health care staff in hospitals, surgeries or other health care facilities, e.g.: nurses, ancillary staff or administrative personnel.

Training is necessary for bilingual hospital employees, acting as ad hoc-interpreters, as well as for medical staff, who are working with interpreters to improve interpreted conversation, to make use of the advantages a three-part-conversation can have and to raise consciousness about the issue of “multilingualism” in general. Moreover, a well- trained ad hoc-interpreter will appreciate the own language performance and will more be self-confident if it is recognized as additional professional work by colleagues and superiors.

Training for Ad hoc-Interpreters in Public Health includes linguistic and (trans)-cultural knowledge as well as the experience and the practical background of ad hoc-interpreters and medical staff themselves. At the same time, the training is a field of research in itself . It analyses how translated dialogues between patients and physicians function from a practical as well as from a linguistic and communicational perspective. Furthermore, the need for further training for ad-hoc-interpreters and clinic staff will be assessed.

Methodical approach (“Everybody is an expert”) and contents
Fundamental for the training is the experience that every ad hoc-interpreter has gained at work as well as his or her skills, be they informal (E.g. very often linguistic skills, as a mother tongue) or formal (knowledge of health care issues etc.). Mutual exchange of experiences of possible problems and solutions that have worked in practice, are an important part of the training. The role of the trainer is mainly that of a facilitator of knowledge, which the training gives room for.

From concrete successful or unsuccessful interpreting situations, the participants of the training have experienced, analyses are made of what went wrong or well and why, and recommendations for a better performance are developed and discussed. In order to bring in the knowledge and experience of the ad hoc-interpreters and to work out feasible solutions, active and dynamic methods are required. Methods that really involve the participants of a training, are extremely useful, as e.g. role plays but particularly the Forum Theatre (see Forum Theatre).

The analyses focus on the three interlocutors of the communication triangle (physician – patient – interpreter) and explore their different contributions to the progress of conversation. But besides the interlocutors’ roles and actions, language itself (its possibilities but also its limits) is also object of a critical reflection.

I do not want to go deeper into the contents that are part of all training for interpreters, such as interpretation techniques, communication skills and the question of technical terms, but would like to go on to another point that is particularly important in the training for ad hoc-interpreters: empowerment.

Medical settings do not take place in a kind of social vacuum but right in the middle of our society which raises a lot of questions:

What role does multilingualism play in our society? What about language hierarchies? Do ad hoc-interpreters normally experience their bilingualism as a value or do they meet with disapproval because of e.g. an accent? And what does this mean for a health care setting interpreted by an ad hoc-interpreter with a migratory background?

Training for Ad hoc-Interpreters in Public Health has to consider these questions and has to strengthen the ad hoc-interpreter’s role – both as interlocutor in the communication triangle and also as colleague and employee.

In a conversation no interpreter (neither professional nor ad hoc) is a mere tool for comprehension. The training helps fulfil the role as ad hoc-interpreter with more self-confidence. The questions are - how to influence on the conditions of an interpretation setting, how to influence – if necessary – on the ongoing conversation, how to deal with the increasing responsibility, but also how to reject the unsaid obligation to help with ones language competence. These are important issues to reflect upon, and the list is not complete.

Insofar, training for ad hoc-interpreters includes a meta-level that raises consciousness. The question of providing language support in public health is a political issue in several aspects:

Multilingualism is a fact in our societies and consequently public health cannot deny its responsibility to provide language support.
Bilingualism is a competence, regardless of the language that is spoken.
Ad hoc-interpretation is additional work that has to be recognized as such.
Ad hoc-interpreters must somehow be remunerated for their work.
Training is necessary to help bilingual staff members gain interpretation competencies.
To encourage and promote bilingual competencies of staff members helps them to contribute their linguistic knowledge in a professional way.

Training for Ad hoc-Interpreters in Public health provides professional communication skills that are indispensable for good medical care for non-native patients. At the same time it sensitizes for the social value of informal skills, such as bilingualism or cultural skills. It supports ad hoc interpreters, who often have a migrant background, to develop confidence in their own capacities, which is an important aspect of empowerment. In these respects training is part of a political debate about multilingualism in societies with migrant populations.

Dagmar Domenig (ed.): Professionelle Transkulturelle Pflege. Handbuch für Lehre und Praxis in Pflege und Geburtshilfe. Bern, Göttingen, Toronto, Seattle, 2001.
Peter Saladin (ed.): Diversität und Chancengleichheit. Grundlagen für erfolgreiches Handeln im Mikrokosmos der Gesundheitsinstitutionen

Ortrun Kliche, May 2007