Blog 1: Medical Interpretation. The biggest challenge? Every face has a story.

For several days earlier in the summer, I had the opportunity to shadow and interview Mrs. Paulina Carrión, who is a medical interpreter at the Virginia Department of Health (VDH). The VDH is primarily a family planning clinic that caters to people of a low-income status, many of whom don’t speak English. Mrs. Carrión is originally from Ecuador, but has lived in various parts of the United States for the past ten years. In this first half of my project, I expected to learn about what a medical interpreter does, examine the overall social dynamic of the clinic, and gain an understanding of how Hispanic identity plays a role in the system.

While I did observe and learn about all of those things, I also saw the emotional toll that can come with having the responsibility of an interpreter, and I think it is worthy to dedicate a blog to this subject because it is a critical and often controversial part of interpreting. A medical interpreter, in the simplest sense, is someone who translates medical information between the doctor and the patient, helping to empower others with knowledge and resources. But when someone is working with real, live people who have sometimes suffered hardships that are quite foreign to one’s own understanding, the job becomes more complicated. As Mrs. Carrión explained in her own words,

“First there is the emotional challenge, to realize how much they have to go through. They are going to a free clinic because they are dealing with money issues, but also they are dealing with the language barrier. And also most of them are dealing with their migratory status. There are a lot of things that they deal with. So they see the interpreter as the savior. They think that because you speak the language, and that because you are from a country that they have heard of before, even though they have never been there or met someone from that country, you are someone who is going to be able to understand them, not only the language, but what they are going through. And on the other side the challenge is feeling that oh my god, I don’t know if I can do more than what I am doing, just interpreting, and just telling you that I’m sorry, we cannot see you because this is a clinic only for family planning, for example. So, them thinking that you can do more than you really can do is a challenge.”

It wasn’t like this everywhere she worked, Mrs. Carrión tells me. At her first interpreting job, in Madison, Wisconsin, there was barely any type of personal relationship with her patients. Here, she has a much more integrated role in terms of scheduling appointments for patients and responding to their phone calls, in addition to being more involved in the process that helps determine the eligibility of the patients to receive services from the VDH. When a patient comes into the clinic, Mrs. Carrión has to ask who they are, where they came from, their schooling, how many people are in their family, how many babies they have, what kinds of births they had, any problems with the births…the questions go on. And before you know it, she is in a position where she knows a good deal about these people’s lives.

The day before I first shadowed Mrs. Carrión, she had had a very emotional encounter with one of her patients. Although I don’t have space to repeat the whole story to you here (it was pretty intense—the full retelling took up fifteen minutes of interview time), the patient had told Mrs. Carrión that she was sad, because on that very day exactly five years ago she had left her son in her home country, El Salvador. Her son, at the time only three years old, had noticed that his mother wasn’t wearing her usual work uniform that morning, and asked her where she was going.  Of course, she couldn’t tell him where she was really going—to the United States, because, as she put it, “there was nothing for us in El Salvador. I wanted to provide the best I could for my son.” So after many tears from her and her child, who she could not afford to take with her at the time but hoped to bring to the United States as soon as possible, she had to leave on a van run by coyotes bringing people across the border. After telling the astonishing story of how she finally made it to the United States, she explained the horror of her current predicament. A guerrilla group is now checking on her eight-year-old son’s school, where they know there will be vulnerable kids with only aging grandparents to guide them as authority figures. She was terrified, because she had received a letter from the guerrilla demanding a monthly payment to ensure that they leave her child alone. She is now dealing with the mess of figuring out how to go back to her home country and not get stuck there–especially problematic, because she has another child here in the United States.

That is certainly a lot of emotional trauma to deal with, and although sometimes the clinic just seems like an endless stream of names and faces, there is probably a story behind each one of them that is often missed, particularly in a medical interpreter’s efforts to be professionally removed from personal issues. I think everyone that I spoke to agreed that a line should be drawn somewhere in medical interpretation. Although figuring out on the spot how and when and where that line should be drawn can be more challenging than it seems.

Comments

  1. Libby Hennemuth says:

    Thanks, Vivian, for sharing this aspect of your research. As important as it is to draw that line between professional and personal, this patient’s story reminds us of the importance of caring for the whole person, to the extent that is possible. Providing appropriate medical care sometimes means that extra steps must be taken to ensure that the patient is comfortable. In this case the interpreter provided emotional, as well as linguistic, support just by lending a listening ear.

    With my own project, studying the implementation of the right of immigrants to Spanish health care, these issues surfaced in a slightly different light. Many immigrants to Spain cannot successfully access health care services due to lack of fluency in the Spanish language. Though translated written resources exist and the government has introduced more interpretation services, for a variety of reasons the disparity between immigrant and authocthonous access to care remains great. Setting aside a one-size-fits-all mentality has been one of the principal challenges in implementing these services in Spain. Reading your post reminded me that the challenge of providing individualized medical care without losing sight of underlying professional goals is truly universal.