Since my massage practice at the Refugee Clinic involved working with many clients who did not speak English, and since translators weren't always available, I took a course on medical translation, in order to help me better translate from the limited Khmer language I had studied in school into the language of real-life healthcare situations with clients.
All translation is not created equal. One of the things I learned is that, in legal translation, there is no special obligation to ensure that the client understands the translation at the concept level of meaning.
An English-speaking defendant is told certain things, but--except for that defendant's lawyer, or advocate--no one in the court system takes the extra time and effort to ensure that the client actually understands the ideas and meaning of the words. If the defendant hears the words, the obligation to communicate is fulfilled, as far as the court is concerned.
Legal translation operates on a similar principle--the non-English-speaking defendant must be given the same opportunity to hear in their language what the English-speaking defendant would hear in English. There is no time or extra resources in the system to ensure that someone sits down with the defendant, and--acting as a culture broker--ensures that the defendant actually deeply understands what is heard.
That culture-broker role, someone who understands both sides of the translation well, has a foot in both worlds, and actively helps the client bridge those worlds, is much more characteristic of medical translation than it is of legal translation.
There, where the client/patient is the highest priority, and understanding can be, literally, a life-or-death matter, people do invest the effort to bridge that gap and promote true understanding, because the results can make such a difference in the quality and impact of care that the client/patient receives.
Garcia-Castillo D, Fetters MD. Quality in medical translations: a review. J Health Care Poor Underserved. 2007 Feb;18(1):74-84. PMID: 17337799
Despite a growing number of U.S. citizens who do not speak English fluently, little literature attends to issues of accurate translation of medical documents. We conducted a systematic review of the World Wide Web and electronic library resources to identify sources on translating clinical and medical research documents. We identified and carefully examined 44 relevant articles. Each article was coded with 5 to 10 key words that were used as a guide when we searched the articles for issues salient to assuring quality in medical translations. We divided these into two major categories, mechanics/practicalities of translating medical documents and extrinsic factors influencing medical translations. The results of this review confirm that medical translation is a complex process involving far more than mechanically converting one language to another. Attention to translation procedures can improve the quality of care for limited English proficient patients.
Just as good quality of translation can improve access and care for underserved clients, unawareness of cultural issues involved in medical translation and care can lead to serious problems in delivery of healthcare services:
McCabe M, Morgan F, Curley H, Begay R, Gohdes DM. The informed consent process in a cross-cultural setting: is the process achieving the intended result? Ethn Dis. 2005 Spring;15(2):300-4. PMID: 15825977
This report is based on the experiences of Navajo interpreters working in a diabetes clinical trial and describes the problems encountered in translating the standard research consent across cultural and linguistic barriers. The interpreters and a Navajo language consultant developed a translation of the standard consent form, maintaining the sequence of information and exactly translating English words and phrases. After four months of using the translated consent, the interpreters met with the language expert and a diabetes expert to review their experiences in presenting the translation in the initial phases of recruitment. Their experiences suggest that the consent process often leads to embarrassment, confusion, and misperceptions that promoted mistrust. The formal processes that have been mandated to protect human subjects may create barriers to research in cross-cultural settings and may discourage participation unless sufficient attention is given to ensuring that both translations and cross-cultural communications are effective.
These are the kinds of issues we care about, as evolving healthcare providers, but the priorities in the legal system are different. Understanding those different priorities is key to understanding why legal translators make decisions the way they do, and why those decisions are different from the ones medical translators would make in their role as culture brokers.
Still, I was happy to see in my legal translation overview, that the specialty is not totally impervious to what the defendant perceives and understands.
In that class, I was introduced to the concept of avoiding the appearance of impropriety, and to practical applications of what that principle means in real-life practice.
"Impropriety" means behaving inappropriately, and the appearance of impropriety is when it looks as though someone is behaving inappropriately, even though their actual behavior may be totally innocent.
The example given in the legal translation class is that--even if they are in reality good friends outside the courtroom--once they get into the courtroom, the lawyers don't stand around laughing and joking with the judge on breaks.
The reason for this is that, even if the conversation is totally innocuous (like picnic plans for the upcoming weekend), if the prosecutor and the judge are joking around, the client could reasonably interpret that friends support friends, and as a result, the judge is biased in favor of the prosecutor and against the defendant as the trial proceeds.
As a result of situations like this, professional codes of ethics have been developed to offer guidance on how is the appropriate way for professionals to behave.
Avoiding even the appearance of impropriety in the mind of a reasonable person is one basis of those codes. Some of the behaviors they prescribed by may seem nit-picky and unnecessary--recently, a social-worker friend of mine discovered at the grocery checkout line that she had left her wallet at home, and one of her clients, who happened to be behind her in line, offered to lend her the money.
Instead of accepting the money, she thanked the client graciously and then left her groceries at the checkout, and went home to get her wallet.
The reason is that she works with very poor clients, who are underserved by our system. They spend hours waiting in line for things that most of us in the middle-class take for granted--if, indeed, those things are available at all to them.
If she is seen in public accepting money from a client, then other clients who might see that transaction take place, or hear about it from others, could--very reasonably--interpret that to mean that the client was purchasing access to special favors from my friend.
The sticking point is what "in the mind of a reasonable person" means. That standard is open to interpretation; like abductive reasoning to the "best" explanation, we can't define a one-size-fits-all definition for it. Life would be so much easier if we could do that, but people are so complex and diverse that it's not possible.
Last week, I had to reschedule an appointment with an older, frail, client in the early stages of Alzheimer's disease because of car trouble I was having. The expensive car repairs are coming at a most inconvenient time, but that's just the way it is.
My client offered, of his own initiative, to help me finance the purchase of a car to replace the one that's giving me such trouble.
As tempting as the offer was, and as much as it would help me out to have assistance in financing the purchase of a replacement vehicle at this inconvenient time, I think everyone reading this post can see what my answer to my client had to be, and exactly why that is so.