Abstracts and Biographies

How to Translate for the Healthcare Consumer:
A Hands-on Workshop

Maria A. Cornelio

This workshop will address issues of importance in translating for the largest segment of the U.S. medical translation market: the consumer of healthcare information. It will consist of discussions and practical exercises to familiarize translators with the unique challenges presented by medical documents written for the patient. Some of the topics to be covered include: using the appropriate register; protecting patients' rights; following government regulations; and making sure that a translation reflects the purpose of the document. A major focus will be the criteria used by major hospitals and medical research institutions in reviewing translations intended for their patient populations.

Maria A. Cornelio is the Director of the Hispanic Research and Recruitment Center at Columbia-Presbyterian Medical Center in New York City, where she oversees recruitment and language support programs for Spanish-speaking participants in clinical studies. She also provides training sessions for clinical researchers whose studies include non-English-speaking patients. She serves as Spanish-language consultant to the New York State Psychiatric Institute and teaches English>Spanish "Translation in Healthcare," a course at New York University's Center for Foreign Languages and Translation.

She has lectured extensively about medical translation and culturally-appropriate research. Before joining Columbia-Presbyterian, she held various positions with non-governmental organizations carrying out public health and health-education programs in Africa and Latin America. She has a master's degree in international studies from the University of Denver and a Diplôme d'Études Françaises from the University of Poitiers, France. She studied at the University of Seville, Spain, and has a B.A. in Spanish and French from Hunter College of the City University of New York.

AIDS and HIV for Medical Translators
Dr. Steven Weinreb

Infection by HIV has now spread to almost every country in the world, with an estimated 30 million infected persons. Although significant advances in the treatment of HIV infection have been made in the past two decades, medical science still seeks a solution to the worldwide epidemic of HIV/AIDS. The use of combination antiretroviral therapy has allowed for an extension of life for many patients, while intensive efforts are in progress to develop a vaccine. Given the fact that HIV/AIDS infection involves a growing proportion of the limited English-speaking population, it is inevitable that medical translators will encounter this disease in various aspects of their professional work. The objective of this workshop is to provide knowledge required for the translation of medical documents related to HIV/AIDS. Participants will learn the specialized terminology for diagnostic tests, laboratory reports, clinical staging, and patient-related educational and counseling materials. Important Internet resources for further study will be provided to all participants.

Dr. Steven Weinreb is Board-certified in Internal Medicine and Nephrology and is currently an Adjunct Professor in the Translation and Interpretation Department of Modern Languages at Florida International University in Miami, Florida.

Beyond Conduit:
Finding Your Cultural Center as a Medical Interpreter

Zarita Araújo-Lane and Vonessa Phillips

A conduit is defined as "a channel through which something is conveyed" or "a means of transmitting or distributing information." Interpreters are primarily conduits of information and some have even concluded that the interpreter-conduit must adhere solely to spoken content, acting as a mere carrier of an unopened message.

The fact that there is more to interpreting than simply relaying the spoken word is clearly seen in the Massachusetts Medical Interpreters Association's Standards of Practice, which has set forth a framework for evaluating an interpreter's competency beyond the role of conduit. In addition to addressing ethics and interpreting skills, these standards turn our attention to cultural interface. Cultural interface refers to an interpreter's methods of recognizing and communicating the ways in which culturally based beliefs may affect the course and outcome of the triadic encounter. When initiating cultural interface, the interpreter assumes the role of culture broker.

Though encouraged to be transparent in the medical encounter, the very nature of cultural interface and culture brokering dictates that the interpreter make a conscious decision to impose upon the flow of a session. An interpreter never challenges a medical diagnosis or shares a personal opinion about treatment but, if a cultural misunderstanding arises, should the interpreter interrupt to clear it up? How much does a provider need to know or even want to know about a patient's customs, language, and beliefs? Is it appropriate for an interpreter to give cultural coaching when it is unsolicited?

This session will shed light on the thin line between transparency and impartiality in the triadic encounter and will introduce time-tested cultural competency tools for medical interpreters, such as the Immigration Stages Model, the Four Character Values, and the Three Cultural Patterns.

Goals for the session include:
-Finding the cultural competency model that fits you
-Sharpening transparency skills
-Learning when to be a culture broker

Zarita Araújo-Lane, LICSW is the president of Cross Cultural Communication Systems, Inc. and has over 20 years of experience working with cross cultural populations in medical and mental health organizations. She has organized a team to write and design a CCCS, Inc. training manual for medical interpreters called the Art of Medical Interpretation. She was the director of a mental health cross cultural team for over 10 years at Health and Education Services in the North Shore area and has published articles dealing with cross cultural management including a chapter written in 1996 on Portuguese families for the book Ethnicity and Family Therapy by Monica McGoldrick.

She has a long history of designing, implementing, supervising, and training interpreter programs in the Cambridge and North Shore areas and has extensive experience presenting to medical providers on cultural competency models. In 1997, she was the coordinator for a two-day conference on multicultural mental health offered by the Multicultural Mental Health Research Center, Inc. She taught a course on cultural competency for medical interpreters at Cambridge College and is currently teaching Portuguese medical interpreting at Bentley College while developing curricula and teaching interpreting courses nationwide.

She is a native of Portugal and speaks Portuguese and French as well as an interpreter and translator for the Portuguese language. Perhaps most importantly, she is a Portuguese immigrant raising an interracial and interfaith family. She has three wonderful daughters.

Vonessa A. Phillips is the director of the Cross Cultural Communication Institute and travels nationwide to present issues related to interpreting and cultural competency. She is a legal and medical interpreter trained at Bentley College in Massachusetts to work in the Portuguese<>English language pairs. She currently coordinates translation services at Cross Cultural Communication Systems, Inc. and is a member of the Massachusetts Medical Interpreters Association and the American Translators Assocation.


Information Sharing: The Medical Interpreter's Dilemma
Zarita Araújo-Lane and Vonessa Phillips

You are interpreting for a patient with a sprained ankle. Throughout the examination, the patient minimizes the pain and seems anxious to leave. You sense that the patient plans to seek the help of a folk doctor or healer. When you know that a patient will seek alternative treatment, should you share that information with the provider?

You arrive at an interpreting assignment only to discover that you have previously interpreted for the same patient in a detox center. During the session, the provider questions the patient about alcohol intake. The patient swears to have never had a drink. When you know that a patient is lying, should you disclose the truth?

You are the primary interpreter for a terminally ill patient with an extended family network. You step out of the session for a bathroom break and the patient's uncle stops you in the hallway. He demands to know his nephew's status. Whose role is it to give bad news, the interpreter's or the provider's?

It is winter, and you are interpreting for a newcomer family from a tropical country. The mother asks if you know where she can get winter clothes for her children. Should a medical interpreter refer patients to social service organizations?

On a daily basis, medical interpreters navigate a minefield of ethical dilemmas surrounding the sharing of information inside and out of the triadic encounter. How do professional standards of practice governing confidentiality and ethics affect real-life interpreting sessions?

This session will also address "secret keeping" in the medical encounter, as well as interpreter-patient referrals, the sharing of information between sessions, and the giving of bad news.

Goals for this session include understanding:
-Whose "side" the interpreter is on
-Who is responsible for information-sharing in the triadic encounter
-How professional interpreter guidelines shape your conduct on a daily basis

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The Language of Clinical Medicine
Dr. Rafael Rivera

Who cares? The U.S. healthcare delivery system has incurred an ever-increasing number of significant changes in all aspects. Physicians have turned into providers and so have other members of the medical team. Patients are now clients or members or users. The time-honored word intern has lost favor with the American Medical Association and it will no longer appear in formal correspondence. A scale of post-graduate years replaces both intern and resident. Fellow, the next step in medical postgraduate training, is a word with several meanings and continues to be a common translation problem. What is the difference between a physician assistant and a nurse practitioner? How many types of nurses fall into the category of an advance practice nurse? What is the difference between a physiatrist in the U.S. and un fisiatra in Spain? What is the difference between being licensed, registered, certified, or accredited? What is the difference between a doctor and a physician? What other kinds of physicians are there? And finally, does anybody really know who is a caregiver?

Where is the care given? In the beginning, there were three places where care would be rendered: the home, the physician's office, or the hospital. This is true today but home care is an entirely different concept and a physician's call at home would provoke an article in the local newspaper. A wide variety of centers of care has filled the medical landscape: hospital centers, specialty hospitals, skilled nursing facilities, rehabilitation centers, nursing homes, assisted living facilities, to name a few. And then there's hospice, the real "lifesaver" for "when the time comes" along with an entirely new specialty in medicine, Palliative Medicine, that looks more closely at end-of-life issues.

Who pays? While all of this increasingly complex array of people and places continues to expand, another layer of financial, social, and political experts tries to figure out the thorniest question of all-how to pay for all this care? Medicare, Medicaid, and the world of managed care are the three main sources of payment. Private medical insurance exists, but it is only affordable by the very well-to-do.

A glossary will be distributed.

Dr. Rafael Rivera is a physician and medical translator associated with the Department of Modern Languages at Florida International University where he teaches medical interpreting. He is Board-certified in Internal Medicine, Psychiatry and Neurology, and Gastroenterology, with additional certifications in Medical Management and Medical Law. He has published medical articles in peer-reviewed medical journals with recent contributions to Panacea, newsletter of the Med Trad medical translators forum, Médico Interamericano (ICPS), Apuntes (SpanSig) Intercambios (Spanish Language Division of the ATA) and the Medical Division [being established] of ATA. He is also Fellow of the American College of Physicians.

Miami-CSI: The Real Thing
To be announced

A physician from the Miami Coroner's Office will discuss the issues confronting their professionals when facing different cultural traditions and language barriers.

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