The role that interpreters play in healthcare is complex, difficult, and largely unrecognized. We can’t do our job without them.
The first patient arrived, distraught and with a strong wound. She is a refugee six months after arriving in Australia. The initial glow of finally being here begins to fade, the winter gets colder, and her children have to ride three buses to school. Her employment service providers are increasingly asking her to consider completing her English classes and looking for a job. The humanitarian situation in the country she left continues to deteriorate, and the messages from the families she leaves behind are becoming less frequent and more dire. She’s ostensibly here to follow up on the excellent blood test results from the newly arrived refugees’ medical exams, but it’s clear from the start that there’s still a lot to manage here.
As with almost all of our consultations, this booking is possible through Translation and Interpretation Services (TIS National). We dialed in, gave our details, and almost miraculously within minutes we were connected to someone who spoke the language of the patient in front of us, as well as English.
Communication between patients and doctors may be the basis of medical care. international translation day This day falls on September 30th and was officially established by the United Nations in 2017 to recognize the work of all language professionals and their role in world peace and security. The date was chosen in honor of St. Jerome, a priest from northern Italy who is primarily known for translating the Bible from Greek and Hebrew into Latin and is considered the patron saint of translators. . We would like to celebrate the daily contributions of translation and interpretation services, a little-known workforce in the clinical field (TIS Nationwide).
Due to the nature of the refugee health service in which we work, we primarily utilize on-call telephone interpreters rather than pre-booked or face-to-face services. Interpreters are registered to take calls, but sometimes spend their days washing dishes, dogs barking, and crosswalks in the background, but once connected to an operator, interpreters are in their own world. You step out of it and into the world right away. The intimacy of the counseling room.
The complexities of medical interpretation, even relatively specific ones, are very complex. Difficult to explain why and how to undergo eradication treatment Helicobacter pylori Infection in one language, let alone two (“3 different tablets, 4 total, twice a day for 7 days”). Especially when you can’t see the clunky diagram we drew to demonstrate this. It’s a big responsibility. Misunderstandings can lead to treatment failure or worse.
But more commonly, it begins with a consultation about medications and blood tests, and can even turn into a consultation about the most complex traumas imaginable. Many of the clinical questions we need to ask pose painful revelations. Ask about the cause of the scar, childbirth history, and past medical procedures. Seemingly innocuous questions can be much more important than we think. When we ask how long the headaches have been going on, we often find out that they started after the assault, or that the surgery was not performed because the hospital was bombed. Interpreters hear these stories in their native language. They come from the same communities as our patients and may have suffered similar traumas. After giving voice to tremendous pain, they are limited to repeating our often inappropriate responses.
We draw heavily on the experience of the interpreters we trust. It must be frustrating to listen to those of us who are in great pain trying to find the right words and provide the right support. I’m honored to have the opportunity to try it something – Different medications, stronger language referrals, counseling appointments, etc., but the interpreter is restricted to speaking only about our suggestions. There is also no opportunity for follow-up or termination. Traumatic consultations and stories remain with each of us. But as GPs, we often have the advantage of knowing how things are going. In some cases, symptoms may improve, and some people may be eligible for disability pension or family reunification. The telephone interpreter will not hear any further information. They participate in the consultation one day and then move on to the next incoherent part of someone else’s story on the next call. We are in awe of their professionalism and patience.
Of course, there are limitations and barriers to interpreting, especially consultations conducted via telephone interpreting. If everything takes at least twice as long and it’s clear that the message is somehow getting lost along the way, it can cause frustration on all sides. These can sometimes result in moments of shared humor and humanity when it turns out you’re examining a similarly named toe rather than a pesky toe.
Let’s go back to the first patient. She has a slightly elevated thyroid stimulating hormone that will take a long time to figure out. She recounts previous thyroid tests performed in a now destroyed health care system. Plans are made for follow-up tests, but it becomes increasingly clear that concerns about children riding buses to school in an unfamiliar country are getting in the way of real discussions about thyroid symptoms to look out for. It has become. The interpreter weaves between us, from talking on pathology forms (invisible to the translator), to writing priority housing support letters, to agreeing on the date and time of the next appointment that fits the jobseeker’s obligations. Proceed. After 45 minutes, the patient’s situation does not fundamentally change. Our consulting is subject to resource, time and capacity constraints. Nevertheless, the patient did little better than on arrival. [please check if my change is what the author meant]We have too little to offer, but TIS National is the linchpin of this effort. Like medicine, interpreting is an alchemy of art, science, and profession. We are fortunate to have our colleagues at TIS National join us and help us and our patients navigate the liminal space.
Dr Rosemary Wyver is a Companion House General Practitioner and Research Fellow at the Australian National University.
Dr Steph Davis is a Companion House Public Health Physician and General Practitioner. She holds general practice and policy roles at ACT.
The statements and opinions expressed in this article reflect the views of the author and do not necessarily represent the official policy of the AMA. M.J.A. or Insight+ Unless otherwise stated.
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