The following encounter is a very
common one. I call Juana Sanchez* into my room to begin her eye exam. Juana
smiles and nods, shyly says ‘hi’, and is followed closely behind by Maria, her
daughter, who I estimate can’t be more than 8 or 9 years of age. After the
initial greeting, Juana hasn’t shown me any indication that she does not
understand me when I speak, so I continue to converse in English during the
beginning of the exam. I ask her to sit down, directing her toward the exam
chair, and usher her daughter to the chairs on the side.
Me: “ I understand you’re here today
for a complete eye exam. My technician was mentioning you lost your reading
glasses and would like another prescription.”
Juana (tensing up and turning quickly
to Maria): “Díle a ella que no hablo íngles.”
Before the child turns to me, I say
to her,
“No, está bien. Hablo español.
Podemos hacer el examen en español.”
Juana smiles and Maria goes back to
her chair, appearing relieved. And I’m happy to know that, at least during the
time that they spend in my office, I can relieve Maria of her translator duties.
Parents using children as
translators has become more of a commonplace issue in the United States- and it’s not something only found in the doctor’s
office. These children will help their parents with banking, legal documents,
and licensing exams. They negotiate rent with the landlord. They fill out
mortgage applications. They interpret job applications. From
1980 to 2000, the country’s “limited-English” proficiency population doubled
from 6 to 12 percent. (1) A 2013 census report found the number of people
speaking a language other than English in the household rose 153% over the last
two decades. As a result, it is projected by 2022, employment of translators
and interpreters is projected to grow 46 percent. (2)
In Cara Nissan’s article regarding
the use of children as interpreters, “Innocence lost in Translation”, she asks
the question, are these children, “..learning valuable life skills, or
shouldering too much family responsibility?”. Many children of immigrant
parents, when asked if they mind translating for mom and dad, say they don’t
mind. (1) However, one has to ask if exposing a child to highly personal information,
such as that found during a medical exam, is potentially harming the child.
I have mentioned previously in my
blog that I grew up a third generation Italian/Polish American. By the third
generation, all foreign language was lost and only English was spoken in my
household growing up. My husband, on the other hand, is a first generation
Croatian American. His parents moved here in the 1970s and while they were
learning the English language, my husband- of elementary school age at the
time- had to interpret and translate for them in Croatian. This included, among
other things, translating the household bills and negotiating with their
renters. I remember when he first told me about this, I was shocked that as a
child he shouldered this kind of responsibility and pressure. But to my
husband, it was all matter-of-fact, nothing unusual. Still, just because
something can be done doesn’t mean it should be. I feel children should be
allowed to be simply that-- children.
Sabriya Rice makes an interesting
point in her article for Modernhealthcare.com, “Hospitals often ignore policies
on using qualified medical interpreters”, that even hospitals with an
interpreter services program in place still have problems making those services
available to those who need it. Many times, the busy setting and sheer volume
of patients in an emergency room make taking the time to access an interpreter
unpalatable to the hurried physician/nursing staff. In this scenario, they
often will use their own limited language abilities or a family member to do
the translating. (2)
I remember well my own experiences
during my residency days at NYU. I worked at Bellevue Hospital and commonly
encountered Farsi, Russian, Hindi, Cantonese, Mandarin, Spanish and Creole on a
daily basis. I felt a giddy sense of relief when my patients were
Spanish-speaking, because my own language skills allowed me to avoid using the
hospital’s Languagelines services. I could get my eye exams with them done
faster, more efficiently, and frankly, more personably. For any other language, Languagelines was an
excellent service, but it took time. I’d call in, get an operator and then I
was told to wait while an interpreter was found. Depending on how remote the
language was, this waiting could last anywhere from 3 to 10 minutes or more. I remember one patient of mine who spoke a
remote Chinese dialect called Fuzhou. I had to go through a Mandarin and
Cantonese interpreter to discover that she spoke neither, and then had to wait
longer until a Fuzhou interpreter was found. All in all this took 15-20
minutes, and this did not yet include exam time which would be another 10-15
min of back and forth talking between doctor – translator – patient. Twenty
minutes may not seem like a lot of time, but when you are seeing 40-50 patients
within a span of 4 hours, these minutes do add up. This is why I can empathize
and understand with the health care professional who desires to create an ideal
interpreter situation with her patient, but in the end chooses the faster route
of having a family member, be it a child, step in for that role.
I am not a polyglot and will never
be one. I know Spanish well and fortunately, I work in a community of patients
where my language encounters are either in English or Spanish. I’m not advising
that every doctor should attain fluency in every language of every one of his
patients. That would be impossible and unreasonable. But I do feel that a
doctor should look at the community she serves and the language(s) spoken, and
work on becoming professionally fluent in them. Language
translation/interpretation services are wonderful, but they are costly and they
do take time. They also make an exam encounter less personal by introducing a
third party communicator. When this is the only option you have, by all means
it should be employed. Patients need to understand their health status to make
informed decisions about it. But if you take the time to know the language and
can speak it yourself, you save time, you save money and by far, foster a bond
with that patient beyond what can be obtained over a phone or through a video.
It’s not easy. It takes work. For me, it is taking a lifetime of learning. But
for me in the end, the rewards far outweigh the trials and efforts to get
there.
Returning to the conversation I had
with Juana and Maria at the beginning of this entry:
Me: OK. Usted tiene ojos sanos, pero
para contestar su pregunta, ‘¿Por qué no puedo leer sin lentes?’, es porque tiene una cosa
muy común después de la edad de más o menos 40 años, “presbicia”. Significa
que, el cristalino dentro del ojo no tiene la abilidad a cambiar en
configuración a permitir una persona leer como facilmente que en el pasado. Es
normal, una parte de vida, y ahora, para ver todas cosas cercanas claramente,
va a necesitar lentes. Escribo la receta ahora para Usted.
Juana: Gracias. ¿Dondé los
compro?
Me: Traiga la receta a un óptico-
tenemos un óptico en nuestra otra oficina.
Juana: Está bien. Gracias- muy
amable.
Me: Un placer conocerle, pase un
buen día.
Maria: Wow. You speak Spanish well.
Me: Thank you – it can always use
improvement, but thank you. Have a good day-
Maria & Juana: ‘Bye.
*patients' names changed to respect privacy
References
(1) Nissman, Cara. “Innocence lost
in translation”. http://www.salon.com/2004/08/04/interpreters/ Aug. 4, 2004.
(2) Rice, Sabriya. “Hospitals often
ignore policies on using qualified medical interpreters”. http://www.modernhealthcare.com/article/20140830/MAGAZINE/308309945 Aug. 30, 2014.
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| Zadar Square, Croatia |
