By Julieta González

A doctoral dissertation written in the 1970s by Roseann Dueñas González had as its focus the use of language in federal and state courtrooms. The results of her research helped launch the prestigious National Center for Interpretation, Testing, Research and Policy (NCITRP) at the University of Arizona. The Center is a research, educational and public service unit dedicated to exploring ways of improving the delivery of language and interpreting services.

The mission of NCITRP is “to diminish the language barrier in societal institutions and increase accessibility for populations excluded on the basis of linguistic and cultural differences.” The center, under González’s leadership, expanded her research into the need for competency levels and training of court interpreters. As the primary consultant to the Administrative Office of the United States Courts, González led a team of experts in the development of the Federal Court Interpreter Certification Project in 1979.

The team then established the testing model which created the national and international criterion-referenced model for testing and linguistic and interpreting skills of interpreters in all languages. González, a professor of English at the UA, headed the program from 1985 until 2000.

To improve the level of competency among courtroom interpreters and to help them prepare for the certification exam, the Center established the Summer Institute for Court Interpretation in 1983. Today called the Agnese Haury Institute, named after its benefactress, the Summer Institute is an intensive, three-week seminar for interpreters. Presently in its 21st year, it is the longest-running intensive Spanish/English interpreter training program in the country. Several years ago, building on the success of the court interpretation program, the Agnese Haury Institute added a medical component.

There has always been a segment of the training and testing that includes medical terminology. “Medical witness testimony, either from pathologists, coroners, physicians and forensic experts as well as law enforcement officers, includes medical terminology,” says González. “Medical interpretation had lagged behind in terms of the way it’s valued and perceived by both the interpreting and the larger community as a whole.”

Paul Gatto, program coordinator for the Center, says that this perception has changed drastically within the past five years. “The changing demographics in the United States as illustrated by the 2000 census has opened up a lot of people’s eyes to the overwhelming need to overcome the language barrier to non-English speaking populations of all kinds in the United States,” says Gatto. He says that now includes one out of every five persons in the United States. In some states, such as California, that number is estimated at 25 percent.

Another factor that impacted medical interpretation was Executive Order 13166 signed by former President Bill Clinton in late 2000. That order mandated quality language services for the recipients of services provided by hospitals and other agencies that receive federal funds.

“Our phones were ringing off the hook with health care providers asking ‘How do we do this?’ Private health-care agencies and the business sector have also come to realize that quality language service is an important need,” says González. Recently, the Center undertook a collaborative research effort in the Phoenix area with funding from the St. Luke Health Initiatives. Together with the Maricopa County Medical Interpreter Project and sponsored by the UA College of Medicine, Phoenix Campus, the center examined the state of medical interpretation and language services in order to make health care more accessible to limited and non-English speakers.

Prior to the Maricopa project, the center has been involved in exploring the ethical and competency problems presented by community interpreting and medical interpretation in Minnesota and in the city of San Francisco. In the San Francisco project a certification test for Cantonese and Spanish-speaking bilingual firefighters who delivered first care was developed. González presently serves on an expert panel to review the standards of testing and training for the State of California Administrative Hearing and Medical Interpreters Testing Program.

In the recent Arizona study González and her staff at the Center set out to address training issues and fully understand some of the language issues specifically related to medical interpretation. “We needed to really understand the discourse and linguistic characteristics of care-giver language as well as the medical linguistic repertoire that’s being used by doctors and nurses in hospital and clinical settings. We examined their complexity and the strata of competency,” says González.

As part of the study, the Center assembled an expert panel of practicing interpreters and instructors. Part of the task was to evaluate the present training offered in the Phoenix area for interpreters. The researchers also observed the range of care-giver and patient interactions from the hospital admitting process, emergency room procedures to doctor visits, outpatient services and care conferences that involved patient education and possible custodial issues stemming from noncompliance.

At one point during the study, González and Armando Valles, senior research specialist at the Center, shadowed two staff interpreters to discern from the interpreting performed the general quality of work, looking both at the strengths and shortcomings. Among the problems observed were those of the use of interpreters by care-givers. They found that doctors, nurses, social workers and clerks did not speak directly to the patient but addressed the interpreter instead and referred to clients in the third person.

A typical scenario played out as follows: The doctor looked at the interpreter and said “Ask mom if she thinks the son has worse troubles when he visits with his father?” Center staff observed and reported that this use of “third party” interpretation is detrimental to the interpreting process because, among other reasons, the initial question is not directed at the patient and eye contact is not made. The Center’s report states that “This body language and non-direction of language to the patient is exclusionary and has the predictable effect of making the patient feel uncomfortable and often removed from their own care. It naturally makes the patient feel that his only lifeline is the interpreter, and all the trust, confidence and warmth that should be building between patient and care-giver is building between interpreter and patient instead.”

Other problems arose when care-givers interrupted the interpreter while the interpreter was trying to convey the entirety of a patient’s answer and instead, the interpreter was asked to summarize. The Center’s report recommends that, “A care-giver must not ask the interpreter to summarize, edit, or otherwise truncate the spoken communication by a patient nor should the interpreter take it upon him/herself to interrupt the patient or doctor during a message to truncate the message in any way.”

González says that these problems point out the need for obligatory in-service education for care-givers to demonstrate the appropriate protocol to use when communicating with patients through an interpreter. “Also,” says González, “interpreters need a clear set of ethical guidelines and protocols to define their roles and duties as interpreters.” The Center’s report indicates that interpreters need to convey with accuracy every linguistic detail of the source language utterance. “In medical interpreting, as in legal interpreting, conserving how something is said as well as what was said has importance to the final outcome. If a patient uses certain colloquialisms to describe a pain, then colloquial language in English should also be expressed with the same level of emotion and in the same style.”

In the report, González suggests that the role of the medical interpreter may be broader than that of a legal interpreter’s. “In a legal setting,” says González, "the context is adversarial. In the medical context, in most cases, the context is collaborative and all are gathered as a team to improve the health outcome of the patient. In this more collaborative setting, the duty of the interpreter is broadened to not only convey messages from one language and world view to another, but to check comprehension and to minimize discomfort during communication.”

The study concluded that curriculum and materials development for medical interpreters, the production of a strong and comprehensive set of ethical guidelines and training programs for care-givers are areas that impact the quality of linguistic services that are offered to limited- and non-English speaking patients.

González states that she and her colleagues at the Center created the professional standards of court interpreting and codified them in her book, “Fundamentals of Court Interpretation: Theory, Policy, and Practice.” Although the medical interpreting field has been dismissed by some medical professionals as not applicable, she believes that both fields require the same precision. “Some care-givers believe that their bilingual staff can handle any interpreting needs. The problem with bilingual staff is that many of them have a very limited register of Spanish. For some, Spanish might be the home language and since the schools for the most part have made most Spanish speakers keep their language underground, they don’t have the proficiency in Spanish that’s required. Also, bilingual staff have their own jobs to do and are not compensated for extra work while performing their normal job duties.”

The benefits to the medical profession and to the health of the community might be a result of improved training of interpreters in the medical arena. “The more a patient understands about his or her own medical care, the more he or she will comply with the doctor’s advice. This can only help because with more compliance on the part of the patient, there might be fewer visits required because the patient actually understands what they’re supposed to be doing,” says González.

Because of the obvious need to develop greater expertise in legal and medical interpretation and translation, the Center has begun to realize a long-awaited goal of training undergraduates in the subject. Currently, with a grant from the Fund for Post-Secondary Education of the Department of Education, the Center is developing a curriculum and set of materials to offer the first undergraduate degree program in interpreting and translation in the state of Arizona. González says that “not only will this program meet a local, regional and national need, but the goal of the project is also to develop an exemplary model that can be used by university systems nationally.”

The undergraduate degree is an interdisciplinary effort by the College of Humanities and the College of Social and Behavioral Sciences to bring this much-needed area of study into fruition. The Center is working with the UA’s Mexican American Studies and Research Center to develop the program and the academic home of the major will be in Mexican American Studies. It is González’s hope that improving language services can only come through education and the establishment of a core of professionals who can carry on this important work.