Child as Translator

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.

Zadar Square, Croatia