Blog 2: Medical Interpretation. A look at birth control, professionalism, and interracial tensions

A quick recap—for several days earlier this summer, I had the chance to shadow Mrs. Paulina Carrión, who works as a medical interpreter at a family planning clinic at the Virginia Department of Health (VDH). As I said in my previous post, 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.  There are three good examples I can think of regarding the kinds of things I noticed that involve all or some of those themes:

1) A particular choice of birth control methods can sometimes relate to social/cultural/personal situations. I’ll be honest—learning extensively about all of the various birth control methods that exist was not something I had expected coming into this project, but seeing as I ended up observing at a family planning clinic, I actually gained a surprising amount of knowledge about the variety of methods that are used, and why they might be chosen. I saw a lot of patients come for birth control shots, some come to have their intrauterine devices (IUD’s) checked, and some come to ask about the effective but expensive tubal ligation. The vibe I got was that the clinic is trying to do its best to protect women and prevent unintended births that would take a toll upon the social services required to care for a child born in the United States. When trying to explain the pressures that some women who come to the clinic face, Mrs. Carrión spoke to me about a certain “machismo” culture that some men have grown up with (translated best as “prominently exhibited or excessive masculinity”) that means that some of these men don’t want to use their own birth control. This leaves the woman to protect herself. Although, even that can have additional challenges—sometimes if the man finds out his partner is using birth control, he will accuse her of being promiscuous. So, for instance, methods that cause hormonal changes are more easily detected than other methods. For the same reasons, some of the women who come to the clinic choose not to tell their partners that they are coming there at all. Of course, every patient and family is different, and it is important not to homogenize the entire group of low-income patients that come to the clinic.

2) Professionalism versus effectiveness—what is the right way to interpret? While I primarily shadowed Mrs. Carrión, I had the opportunity to watch a few other women interpret on Women’s Day, when many of the services were free and so more interpreters were needed to supply the demand. Up until that point, Mrs. Carrión had been my standard for interpretation. She would stand between the patient and the doctor, look at the doctor while he or she was speaking to the patient, and then turn to the patient to translate the information as accurately as possible. Generally, the doctor or nurse should be looking at the patient as he or she speaks, and vice versa, so that non-verbal cues like facial expression are most accurately transferred. On the whole, most of the medical staff seemed very welcoming and well-meaning, although there was one nurse in particular who didn’t seem to feel the need to hold this standard, literally saying “I’m not going to talk to her if she doesn’t speak any English” when another interpreter suggested looking at the patient as she spoke. It makes me wonder what kind of training is required for medical personnel that work with non-English speakers.

On the flip side, a third interpreter who had just come out of training was very serious about looking at the wall while she interpreted, even physically turning away from the patient if needed. This, she says, is a fly-on-the-wall method that interpreters are trained to use nowadays that attempts to eliminate a mistranslation of information through, for instance, changing your facial expression. It was hard for me to get used to this, when it seemed unnatural compared to the way we typically communicate using facial expression to supplement spoken word. Mrs. Carrión says it might have been easier to interpret like this at her previous job, but that she deals with patients in so many different areas at the VDH that it doesn’t make sense to suddenly change her body movements at the moments of interpretation. Everyone I talked to seemed to have a different opinion on this topic.

3) Competition for low-cost services can lead to interracial tensions. Lastly, there were a few instances where the mixed social dynamic of the clinic—mainly a mixture of whites, African Americans, and Latinos—caused some tension. Sometimes it was hard to tell whether race played a role or was just a bystander in the process—the disrespectful nurse I mentioned earlier was African American, and I heard comments suggesting that some of the African Americans working in the eligibility office may have been giving patients a harder time of receiving services than some of the other people working in eligibility. But one of the times when race was clearly a factor was when a Hispanic woman waiting in a waiting room overheard comments from African Americans nearby. They were frustrated after waiting a long time for services, and were saying things like “why does that woman have to have an interpreter…why do these Hispanic people come here…” not realizing that the Hispanic woman did understand enough English to know what they were saying, and was becoming upset. The situation escalated to a point where Mrs. Carrión had to try to intervene professionally, trying to understand the situation that both sides were coming from.

Most of what I have written about so far is observation, as opposed to my own opinion. But overall, I think that many of the conflicts and misunderstandings that occur are largely based on a lack of knowledge or understanding about other people and their situations, and a tendency for people to homogenize groups of people into one stereotypical image. Professor Riofrio, who is sponsoring this project and recommended the clinic to me, actually went and gave a talk at the clinic shortly after I made my observations, and so perhaps he will head them in the right direction.

My observations from part 1 of my project were helpful in preparing me for part 2 of my project, when I would get to do some interpreting of my own at Loudoun Free Clinic for the rest of the summer. Check out my next blog for the updates!