Interpreters work like life’s subtitles, serving as a calming influence when a storm of words floats around a room. At St. Jude Children’s Research Hospital, medical interpreters go a step further, gathering unfamiliar words, medical terminology, clichés and colloquialisms and reassembling the dialogue to ensure that nothing is lost in translation.
When a family arrives at St. Jude for the first time, their apprehension can be overwhelming. For patients and families whose native language is not English, the anxiety is intensified by communication challenges. Medical interpreters bridge the language gap between caregivers and families, assisting with communication about admissions, procedures and treatments.
“We’re of critical importance as the connection of communication between providers and patients,” says Marc Friedman, Interpreter Services coordinator. “It’s clinically, medically and emotionally imperative to have clear communication in these types of circumstances, and I feel like we help empower families.”
Medical interpreting has been an emerging vocation for many years but is now considered an established profession, which led to the creation of a national exam and certification process in 2010. Three out of four St. Jude medical interpreters have been nationally certified within the last year. They are also trained and approved in Spanish, Portuguese, French and Catalan.
Training for medical interpreters at St. Jude is a continuous process that consists primarily of mastering the standards of practice and demonstrating competency in a list of about 50 specific encounter types that are essential to St. Jude. The initial training process includes shadowing and observing a mentor, discussing possible situations and role playing. Trainees then interpret in the presence of a mentor before proceeding to the next competency.
“We want to be a role model for other institutions around the nation by providing the best language services possible to patients and providers,” Friedman says.
Medical interpreting is not just about being bilingual. Medical interpreters have to pay attention to what is being said, the style and register of what people say.
“You need to have medical knowledge and, the other key, is that you have to be able to hear a segment of information, convert its exact meaning into another language, and then say it in the other language—which is not typically word for word,” Friedman says. “To me, it’s like running up and down a basketball court at top speed—but it’s all happening inside your head.”
In moments of confusion or misunderstanding, medical interpreters ask for clarification.
“We also have to decode colloquial expressions and metaphors to more literal terms,” Friedman says. “If a clinician says to me, ‘We’ll have to run it up the flag pole,’ I can’t interpret that literally; I have to determine how to say what he really means. I also have to be sensitive to dialects. There are at least five different ways to say ‘bus’ in Spanish, depending on where you come from.”
Aware of not inserting their own opinions into conversations, interpreters must sometimes bite their tongues to maintain transparency. “It’s a challenge sometimes not to jump into the conversation, but we are there to negotiate meaning,” Friedman says.
Part of great medical care is ensuring clear communication, especially for these patients.
“Marc and the other medical interpreters are truly hands-on,” says Alicia Huettel, Family Centered Care coordinator. “Humanness is such a key to this process. It’s a standard of care for the team to make sure each family’s needs are being met.”
Huettel and Friedman collaborate on written translations for patients whose English skills are limited. St. Jude patients and families are encouraged to share their thoughts and views on everything from new hospital signage to universal symbols and verbiage.
“The essence of information sharing is about understanding the information and the ability to act on that information,” Huettel says. “We’re continuously assessing the effectiveness of our patient education efforts in English and other languages so we can effectively promote the multi-directional communication between our families and staff. We include our patients and families in this process to ensure accuracy and understanding. How you ask the question, what symbol you choose, makes a difference.”
When approved on-site interpreting services are unavailable, a contract telephonic interpreting service is available through dual-handset blue phones and most desk phones in patient care areas.
“When we’re not available, or the need is for a language we’re not trained in, we utilize the phones,” Friedman says.
Before becoming a certified medical interpreter at St. Jude in 2006, Guillermo Umbria volunteered at the hospital as a medical interpreter for two years. His days now start early and can be hectic.
“First thing in the morning, we start getting calls from the clinics requesting our services,” Umbria says. “We also get calls from patients wanting to get in touch with the medical staff, Patient Services or schedulers. We not only provide language services in person, but also by phone, so it makes for a busy day.”
Mornings are usually the busiest, with interpreters visiting clinics, Social Work, Patient Services or patient rooms.
“When things slow down, usually in the afternoons and weekends, we focus on translating emails and conducting teleconference interpretations. But we never know when we’re going to get that random call or page,” Friedman says.
For Umbria, being a medical interpreter is a balance of rewards and challenges, including interpreting end-of-life conversations or confirmations from physicians about diagnoses.
“Interpreting ‘Your child is cured; now you can make arrangements to go home’ is rewarding,” Umbria says. “It’s an honor to be a part of a patient’s journey at St. Jude.”
In the last three years, interpreting service time at the hospital rose from about 580 hours to more than 1,480 hours. Of the demand for language translations at St. Jude, 95 percent are for Spanish. The patient population also includes those who speak Arabic, French, Portuguese, Russian, Chinese, Vietnamese and Thai.
“The visible demand for interpreters is only a fraction of the total real demand. The unmet need becomes more visible as more demands are met. And, as we better meet the requests for interpreters, the demand grows,” Friedman says. “There are more than 5,000 languages on the planet, so we accomplish what is possible with the resources we have—and I’m very proud of what we do.”