Working with interpreters

Why is it important to use an interpreter? What are the benefits and challenges?

Click here to listen to Maratja, a Yolŋu interpreter, talk about these issues.

Click here to listen to Batumbil, a Yolŋu interpreter, explain why it is important for staff to assist the interpreters in making sure the patient and family get a 'clear story'.

Good interpreting in health care encounters requires a high level of expertise - both the interpreter and the health professional need a high level of skill in communicating in complex intercultural interactions.

The cultural distance between most healh staff and their Indigenous clients - and interpreters - is extreme. It is unlikely that the interpreter shares much of the cultural knowledge that underlies communication processes and content in medical encounters.

The pre-interview - a meeting between the health professional and the interpreter before the encounter with the patient - is a very important opportunity for you to:

• explain what you want to achieve with the interpreter and ask about communication strategies which might be effective
• check the interpreter's understanding of the key concepts and issues you will be talking about with the patient / family and find the best way to talk about those concepts and terms that are difficult to translate
• find out if there are any cultural issues you should know about for this interaction

Yolŋu interpreters and health staff have suggested a 'pre-interview' discussion between the patient/family and the interpreter is also important to:

• find out what the patient /family wants to achieve in the encounter
• to inform patients unused to interpreters about the role of the interpreter
  

It is also essential to learn about your own communication practice:

• how much of your communication process and content is culturally specific?
• what are your assumptions about the extent of shared knowledge (e.g. terms and metaphors) and shared communication practices (e.g. waiting time, non-verbal communication, use of question and answer routines)
  

Practice good communication strategies. For example:

• talk to the patient, not the interpreter, and encourage the patient to talk directly to you (arrange seating to facilitate this)
• do not speak too quickly (or too slowly)
• keep your sentences short: one idea or question at a time
• pause frequently and allow sufficient time for translation and/ or questions
• avoid complex grammar but do use standard English (not 'broken English')
• repeat the same information in different ways
• avoid over-simplification of information: detailed explanations are important if the patient / family are to make genuinely informed choices about their health care (with the assistance of an interpreter this can be achieved)
• avoid metaphors which are culturally specific e.g. clock and calendar references to time, quantification in terms of percentages, grams or litres e.t.c
• fully explain terms and processes in plain English
• encourage the interpreter to interrupt when clarification or repetition of information is needed
• provide opportunities for the patient / family to use their preferred communication style e.g. ask them to tell their story rather than using question and answer routines which are can be uncomfortable/ unfamiliar / ineffective
• avoid questions that require a yes/no response
• learn about different linguistic and politeness conventions which could cause confusion e.g. in some cultures it is polite to give the answer you think the person wants to hear: a patient may say 'yes' to a request for consent to a procedure even though this is not what they want, then does not attend for the procedure as this is their culturally appropriate way to communicate refusal.
• WAIT: pause times are very different across cultures; some people might need a few minutes before they are ready to respond to a request or question or to continue a story.. just relax - you'll get used to it..
• check frequently to check the message has been understood - both the patient's understanding of your message and your understanding of the patient's message (asking 'do you understand is not a valid way to assess comprehension - ask the patient to tell you what they think you have said in their own words; summarise what you think the patient has said and check if your understanding is accurate)
  

Click on the links below for more information on working with interpreters:

http://www.ethnomed.org/ethnomed/clin_topics/intrprt.html

http://www.health.qld.gov.au/multicultural/pdf/guideto.pdf