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Compared to conference and sign language interpreting, community interpreting is still evolving as a profession. Among the most well-established profession of interpreters are Conference Interpreters, who are most commonly employed at international organizations and provide simultaneous interpretation. As a message is being delivered, a conference interpreter will transmit the message in a different language, often through an earpiece. Perhaps because of the prestige associated with conference interpreting, it has some of the most-developed forms of training, with The Monterrey Institute in California offering graduate degrees in Interpreting and Translating. Interpreters are trained to deliver word-for-word transmission of messages with little additional context provided by the interpreter, for it is the role of the diplomat to pay attention to nuance and subtleties. Conference interpreters comprise a recognized profession, and though there are not many positions or associated career openings, individuals trained as conference interpreters do not generally perform services at the community level.
Sign language and sign interpreting gained ground with Title VI and the Americans with Disabilities Act which mandates the provision of language services for individuals with a physical (and not simply linguistic) impairment. The vigor behind ADA compliance, combined with an active advocacy for hearing-impaired individuals, has gained greater attention to the need for sign language interpreters. American Sign language and interpreting has evolved into foreign language status, promoted through accredited training programs in many universities in the country. Like health care interpreters, however, the sign language community is also working to establish a greater degree of licensing and certification requirements among interpreters.
Interpreters are also widely used on court settings. The importance of a fair trail, supported by the Bill of Rights and Fourteenth Amendment, places great obligation on courts to provide interpreters in order to guarantee a defendant’s rights. The goal of interpreting in these encounters is to provide participants in a court hearing with accurate and neutral transmission of a particular statement. Several sets of guidelines for court interpreters exist, provided by the National Association of Judiciary Interpreters and Translators and the National Center for State Courts. This latter organization has developed a consortium of 25 state and local courts and administers written and oral exams for the certification of interpreters. Both organizations emphasize the importance of maintaining neutrality and transmitting spoken messages accurately.
The field has debated for some time the role of the health interpreter with regard to neutrality and detachment. At the center of this debate is the level of participation of the health care interpreter in the encounter and whether they serve as conduits or active representatives of their community. As conduits, the most important function of the interpreter is to transmit messages in as invisible a manner as possible. These transmissions do not have to be word for word, as is desired in conference and court settings; instead, message transmission should be based on equivalent concepts, requiring cultural knowledge and understanding of both the patient and the medical culture.
In contrast with conference interpreters, where the receiver of the message must perform a degree of cultural interpretation, the health care interpreter, frequently a member of the language community he/she serves, is expected, some argue, to serve as a bridge between patient and provider. Health care interpreters are often called upon to assist in “cultural brokering”--the shared exchange of cultural information on the part of the interpreter.5 Of course, bridging cultural gaps can be quite difficult: cultural values are subjective and require a thoughtful examination on the part of the interpreter for any bias in understanding and delivery. An interpreter may also flag cultural barriers to assist a provider in structuring a message for the patient. Moreover, an interpreter can only serve as an effective broker when there is a willingness of all parties to approach one another with understanding.
The brokering role of interpreters suggests that it is important for both providers and interpreters to understand the dynamics of their interaction. The most common form of interpreter usage involves a triadic encounter between patient, provider, and interpreter. In this scenario, the interpreter is a legitimate and potentially active presence in the dialogue, as the addition of a 3rd party shifts the clinical dynamic between patient and provider.5 While the roles of the patient and provider are to exchange their expertise and knowledge of the symptoms and history, the interpreter’s expertise resides in her linguistic skills and an understanding of the interpreter-assisted communication process. The interpreter assists each party in communicating with the other, identifying gaps in understanding between patient and provider and ensuring that these gaps are overcome.
Unlike court and conference settings, the interpreter actively manages the encounter to keep the focus of communication between the patient and provider, ensuring that two separate dialogues are not occurring, each with the interpreter. An interpreter may occasionally interrupt patient and provider when he/she perceives a lack of understanding during the medical encounter, most typically in the case of cultural barriers.5 Thus, an interpreter may be trusted with a great deal of authority and can even dominate an encounter, if all communication is funneled through the interpreter. For this reason, it is often critical to train providers in using interpreters so that they continue to address patients directly and not interpreters. In addition, interpreters must pace the dialogue to meet the understanding of both parties with attention to the urgency of the clinical encounter. These responsibilities show that interpreters do much more than perform word for word translations; they are part of a dynamic encounter.
Thus, health care interpreting requires the acquisition of several skills beyond mastery of two languages, including a well-developed short term memory to interpret accurately meaning, not words, of several sentences without pauses, along with the ability to mirror the speaker’s tone and inflection. Interpreters must produce accurate paraphrases of terms even when an equivalent is not available and are required to know how to use a variety of interpreting techniques such as being present in unobtrusive ways, maintaining transparency in the encounter, and making eye contact with patient and provider only occasionally when interpreting.
Finally, health care interpreting also differs from other forms in its sheer variability. Conferences and court appearances can be planned, and individuals with appropriate expertise brought in for either setting. In contrast, health care encounters may be simple or complex, short or long, and laden with much cultural content or very little. An interpreter may be called upon to deal with all these situations in a single day.
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