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Review of  Healthcare Interpreting

Reviewer: Laura Michele Callahan
Book Title: Healthcare Interpreting
Book Author: Franz Pöchhacker Miriam N. Shlesinger
Publisher: John Benjamins
Linguistic Field(s): Discourse Analysis
Issue Number: 19.115

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EDITORS: Pöchhacker, Franz and Shlesinger, Miriam
TITLE: Healthcare Interpreting
SUBTITLE: Discourse and Interaction
SERIES: Benjamins Current Topics 9
PUBLISHER: John Benjamins
YEAR: 2007

Laura Callahan, The City College of the City University of New York

This volume was first published as a special issue of the journal _Interpreting:
International Journal of Research and Practice in Interpreting_ (7:2, 2005),
prior to which the papers had been presented at the Fourth Critical Link
Conference (Stockholm, 2004). It contains an introduction, five articles, and
five book reviews. The articles cover various ''settings and specialties, from
general medicine to pediatrics, psychiatry and speech therapy'' (p. 6). Language
pairs include ''Arabic, Dari, Farsi, Italian and Spanish in combination with
Danish, Dutch, English and French'' (p. 6). As the editors inform us, the two
common focal points are discourse-based analysis of interpreter-mediated
interaction, which in turn forms part of the larger field of cross-cultural
communication in healthcare settings (p. 2).

Franz Pöchhacker and Miriam Shlesinger. Introduction: Discourse-based research
on healthcare interpreting.
Pöchhacker and Shlesinger describe the trajectory of healthcare interpreting, as
both practice and object of research, within the larger field of community
interpreting as well as in other disciplines. As recognition of its importance
has grown since the mid 1990s, various theoretical approaches have been used to
study this type of interaction. The editors highlight the influence of Cecilia
Wadensjo (cf. Wadensjo 1992, 1998), whose approach centers on dialogic discourse
in triadic interaction. Pöchhacker and Shlesinger next offer brief reviews of
other important literature in healthcare interpreting, noting that the first
investigations came from researchers outside the field of interpreting studies.
Having situated this volume's work within its broader historic and
methodological context, the editors conclude the Introduction with a description
of each of the five papers.

1. Yvan Leanza. Roles of community interpreters in pediatrics as seen by
interpreters, physicians and researchers.
Leanza highlights the need for professional interpreters in order to avoid the
linguistic errors and subsequent misdiagnoses that may occur with ad-hoc
interpreters. Noting the presence of cultural differences between the
pediatricians and their patients and patients' parents, the author examines
whether the interpreter exercises linguistic skills only or also cultural
knowledge. Reference is made to Jalbert's (1998) taxonomy, which shows a cline
of involvement and hence, visibility, moving successively from the minimum
presence of the translator up to cultural informant, culture broker or cultural
mediator, advocate, and finally, bilingual professional. Leanza examines
videotaped preventive pediatric consultations in a clinic in Switzerland to
determine which role the interpreter plays. The languages used are French and
Albanian or Tamil. Stimulated recall interviews with the physicians were also

Critical incidents were the unit of analysis in the interpreter-mediated
interactions, defined by the author as a sequence in the consultation in which
the topic under discussion corresponded to the study interest, ''discourses about
educational issues in a multicultural pediatric setting'' (p. 22). In regard to
the interpreter's role and Jalbert's taxonomy, Leanza finds that the healthcare
provider's dominance remains unchallenged, with interpreters having little
chance to advocate for patients, acting instead as agents of assimilation. He
proposes a new role typology as well as some training recommendations, including
recognition of the need for healthcare providers to receive instruction on
working with interpreters. He promotes giving interpreters an official status,
so that they may be ''acknowledged as professionals in their own right,'' and thus
experience less of a temptation to align themselves with the healthcare provider
in order to demonstrate their superiority over fellow immigrants who happen to
be patients (p. 30).

2. Carmen Valero Garces. Doctor–patient consultations in dyadic and triadic
Valero Garces studied consultations with and without ad-hoc interpreters in
Madrid, Spain and with trained interpreters in Minneapolis, U.S.A., using
institutional discourse analysis as her theoretical framework. The languages
involved were Spanish and Bulgarian or Arabic, and English and Spanish. Although
in general the power imbalance inherent to the institutional context is
maintained, manifested by the doctor's dominance in dyads with the patient,
there are some unexpected changes. These revolve around changes in the
interaction order, contribution types, and lexical choice.

In consultations with no interpreter or with an interpreter who lacks
proficiency in the doctor's language, the doctor may adjust his or her syntactic
constructions and lexical choices, sometimes resulting in ungrammatical
utterances. The untrained interpreters may struggle to translate even simplified
medical terms. The author notes that there is less direct interaction between
doctor and patient when an ad-hoc interpreter is present. A reduction in direct
interaction between primary speakers in interpreter-mediated encounters has been
cited by many investigators. But, as Valero Garces observes, this effect may be
greater in the case of ad-hoc interpreters, due to the fact that many who assume
this role are relatives of the patient, who may feel more at liberty to add
turns and speak for the patient without prior consultation.

3. Friedel Dubslaff and Bodil Martinsen. Exploring untrained interpreters' use
of direct versus indirect speech.
The authors analyzed four simulated medical interviews, focusing on direct vs.
indirect speech, as measured by pronoun shifts and their interactional
functions. The languages involved are Danish and Arabic. The original purpose of
the interviews, each of which followed the same scripted role-play, had been to
evaluate the skills of four untrained Arabic interpreters who worked for a
Danish interpreting agency. As Dubslaff and Martinsen and other authors in this
volume point out, use of the direct mode (the first person) is widely considered
to be superior and more professional. Among the advantages cited is an
enhancement of accuracy. Nevertheless, the indirect mode (the third person) has
been found to be more common among ''so-called natural interpreters or lay
interpreters'' (p. 54).

In the corpus for this paper two of the interpreters used the direct style more
and two used the indirect style more. The authors posit that direct address is
used to express solidarity with the monolingual participant with whom the
interpreter shares a dominant language, in this case the patient. Regardless of
whether they spoke in the first or third person, all four of the interpreters
personalized the indefinite pronoun ''one'' when interpreting the doctor's words
to the patient. Dubslaff and Martinsen conclude that, contrary to received
wisdom and standards in the profession, indirect speech may be necessary at
times, for example when use of the first person pronoun would result in an
ambiguous construction. They also observed problems caused by deficiencies in
the interpreters' medical knowledge, and for this reason recommend training in
specialized terminology.

4. Hanneke Bot. Dialogue interpreting as a specific case of reported speech.
Bot's data come from psychotherapy sessions in the Netherlands in which
experienced interpreters worked between Dari or Persian and Dutch. She maintains
that indirect speech may not be so problematic as traditionally assumed, and
that, among other things, its use simply acknowledges the reality of the
situation: that of an interpreter-mediated dialogue in which a third party of
necessity has a presence.

The author found that in many cases the interpreters did not actually change the
first person pronoun; they merely prefaced their renditions of the primary
speakers' (the therapist and patient) utterances with ''he says.'' Thus, rather
than ''repeat'' they ''report'' (p. 96). Using perspective and mental space theory
(Fauconnier 1985; Sanders 1994), Bot shows how interpreters make it clear to
listeners that their rendition of another person's utterances are not the
interpreters' own words. They do this by presenting it as reported speech,
especially when there is a chance that the person to whom the message is
directed could be offended by its content.

5. Raffaela Merlini and Roberta Favaron. Examining the ''voice of interpreting''
in speech pathology.
Merlini and Favaron studied English-speaking speech pathologists' sessions with
Italian-speaking immigrants in Australia. This type of encounter represents a
special case in the field of healthcare interpreting, since the interpreter is
responsible for transmission of not only ''what is said [but also] what should
have been said'' by the patient, so that the speech pathologist can ''recognise
the extent and causes of the language impairment and provide appropriate
feedback'' (pp. 102-103). Hence the interpreter uses knowledge of the language in
which the patient is speaking to provide the doctor with a normative model
against which to measure the patient's utterances.

The authors use two analytic categories from Mishler (1984), the ''voice of the
lifeworld'' and the ''voice of medicine,'' and add a third, the ''voice of
interpreting'' (p. 105). The exposition follows a conversation analytic
perspective, focusing on items such as turn-taking and topic control, footing,
divergent renditions, and prosody. Unlike in typical medical interviews, in
which the doctor's voice dominates, in Merlini and Favaron's data the
interpreter is a ''powerful participant'', who self-selects as next speaker and
performs other functions that exceed the boundaries of the professional model
dictating an invisible presence. The authors conclude that ''strict adherence to
a dry, formal, passive and detached interpreting style, though it might be in
line with an idealized notion of professional conduct, is not always the best
way to serve one's clients, especially when their intention is to engage in a
friendly and co-operative dialogue'' (p. 132).

Book Reviews
Five books of great relevance to the topic of the main volume are reviewed.

1. Carmen Valero Garces and Guzman Mancho Bares, eds.: _Traduccion e
interpretacion en los servicios publicos: Nuevas necesidades para nuevas
realidades / Community Interpreting and Translating: New Needs for New Realities_.
2. Carmen Valero Garces, ed. _Traduccion e interpretacion en los servicios
publicos. Contextualizacion, actualidad y futuro_. Reviewed by Holly Mikkelson

As Mikkelson explains, the first title is a CD of proceedings from the Fifth
International Conference on Translation and the First National Conference on
Translation and Interpretation in Public Services (Alcala de Henares, Spain,
2002). The second title is a book that was compiled to provide an update and
expansion of community interpreting issues covered in the CD.

3. Bernd Meyer: _Dolmetschen im medizinischen Aufklärungsgespräch. Eine
diskursanalytische Untersuchung zur Wissensvermittlung im mehrsprachigen
Krankenhaus_. Reviewed by Christina Schaffner

Meyer investigates doctor-patient communication interpreted by nurses or
relatives of the patient, using data from German hospitals. The patients and
interpreters share Portuguese as their first language, with the former having
acquired it in Portugal and the latter as a heritage language at home in Germany.

4. Claudia V. Angelelli: _Revisiting the interpreter's role. A study of
conference, court, and medical interpreters in Canada, Mexico, and the United
5. Claudia V. Angelelli: _Medical interpreting and cross-cultural
communication_. Reviewed by Helen Slatyer

The first of these volumes reports on a quantitative study carried out in three
countries, and the second is an ethnographic study focusing on interpreters in
one hospital in Northern California. Both examine the construct of the
interpreter's visibility or invisibility. Of special interest in the second
volume are the interpreting services provided by telephone, and the implications
that this has for visibility and other concerns.

This volume offers a very coherent examination of healthcare interpreting in a
wide range of settings, and as such it will be of great use to students and
instructors in courses having to do with this profession. Its editing is
impeccable, and the presentation of data in each article is clear and easy to
follow. The book will also be of interest to scholars and practitioners in other
disciplines, such as translation, discourse analysis, and linguistic minorities.
Each of the papers contains authentic data as well as a wealth of theoretical
models, only a few of which have been cited here. The book reviews that close
the volume constitute another valuable resource for researchers.

The authors of all five papers challenge the idealized myth of neutrality that
dominates the Western medical profession, part and parcel of which is the
assumption that the function of an interpreter in a medical encounter can or
should be confined to direct translation. Another common conclusion is the
importance of providing training for community interpreters, as well as for the
healthcare professionals who will work with them. As can be seen from this
collection, both types of training are still fairly scarce worldwide. Healthcare
Interpreting represents a step in the right direction, since it documents the
need with empirical evidence.

Fauconnier, G. 1985. _Mental spaces: Aspects of meaning construction in natural
language_. Cambridge: Cambridge University Press.

Jalbert, M. 1998. Travailler avec un interprete en consultation psychiatrique.
_P.R.I.S.M.E_. 8(3), 94-111.

Mishler, E. G. 1984. _The discourse of medicine: Dialectics of medical
interviews_. Norwood, NJ: Ablex.

Sanders, J. M. 1994. _Perspective in narrative discourse_. Ph.D. dissertation,
Katholieke Universiteit Brabant, Tilburg.

Wadensjo, C. 1992. _Interpreting as interaction: On dialogue interpreting in
immigration hearings and medical encounters_. Linkoping: Linkoping University Press.

Wadensjo, C. 1998. _Interpreting as interaction_. London/New York: Longman.

Laura Callahan is Assistant Professor of Hispanic Linguistics at the City
College, City University of New York (CUNY), and Research Fellow at the Research
Institute for the Study of Language in Urban Society (RISLUS), at the Graduate
Center, CUNY. Her research interests include intercultural communication,
language and identity, and heritage language maintenance. She worked for several
years as a health educator, medical assistant, and interpreter in a community
clinic in the San Francisco Bay Area, California, and is currently co-principal
investigator of a project entitled Increasing the Effectiveness of
Spanish-Language Healthcare Materials: Documenting the Problem and Finding a