by Karen Malcolm
There are very few specialized programs preparing interpreters to work in healthcare settings, and yet many graduates of interpreter education programs will work in these settings. The following suggestions offer some ways that healthcare interpreting can be incorporated into existing interpreter education programs.
Students with elective courses in their program should be encouraged to consider taking the following courses (exact titles will vary by institution):
Introduction to Biology
Human Anatomy and Physiology
Death and Dying
Ethics and Healthcare
Mental Health Interpreting:
Introduction to Psychology
Alcohol and Drug Addictions
INTEGRATING HEALTHCARE INTERPRETING INTO THE EXISTING CURRICULUM
Ethical Decision-Making in Healthcare Settings
Ethical discussions are an integral part of every interpreter education curriculum. Discussion of ethical dilemmas and/or case studies focused on healthcare dilemmas can be incorporated into classroom discussion. For some sample dilemmas, click here.
Another useful resource is the Treehouse video entitled Interpreting in Mental Health Settings. A number of scenarios are presented where the interpreter faces a dilemma in a mental health setting, followed by a commentary by the narrator. A study manual accompanies the video. To obtain these materials, click here.
Local interpreters who work in healthcare settings, who are willing to be contacted, could be presented with an ethical dilemma by students and engaged in dialogue about their preferred course of action, and why they would select that option. These discussions could be brought back to the classroom to share with the larger group.
Dr. Michael Harvey is a psychologist in private practice in the Boston area, who has worked extensively with Deaf and hard of hearing clients. He continues to research vicarious trauma and interpreters, and the ways that interpreters are affected by their interpreting experiences. His website, www.michaelharvey-phd.com, offers valuable insights into the potential challenges interpreters face and can be used to generate discussion about the ways that healthcare interpreting could lead to vicarious traumatization.
Students working in healthcare settings need to develop their skill in discussing healthcare issues in both ASL and English. One resource for developing English language skills is the website English for Medical Purposes (www.emp-tmu.net), a free resource offered by the Tokyo Medical University. It offers an extensive list of medical interviews conducted in English, which can be used for developing familiarity with medical discourse. For programs teaching the Demand-Control Schema, an EIPI analysis could be conducted on an interview. The participants are Australian so there may be some challenges engaging with a different dialect of English than an American one. While the resource is free, you will need to register and create an account in order to access it.
This website offers some resources that can be used to facilitate language learning both in ASL and English. One of these is the on-line resource, entitled “Body Language.” This on-line program is designed so that interpreters work in cohorts, and involves reading about health conditions, looking at diagrams that describe the condition, and then seeing the condition discussed in ASL. Students are able to tape themselves discussing the same condition, and then share their work with their cohort.
Another resource on this site can be found under “Medical Resources”, then “University of Minnesota, WEBANATOMY (or click here). This site can be used to develop an understanding of anatomy and includes self-tests as well as games that can involve several participants.
Interpreting skills development
There are a number of interpreting skills development resources available on this site under “Professional Development”, “Independent Study”. These cover topics such as the digestive system, cardiovascular health, taking medication, pregnancy, labor, and delivery, and interpreting in the Emergency Department. Several of these are available on line. These include both language development activities and interpreting skills activities. Students can practice interpreting interactions, and also analyze modeled interpretations.
Another useful activity involves role play. Students can practice live interpretations related to healthcare topics. Students can take turns role playing the participants, so that one student plays the Deaf patient or client, one plays the hearing practitioner, and another student interprets. It is helpful for the “Deaf” patient to use earplugs or some other means of blocking out what is said, so s/he is actually responding to the interpretation. Similarly, the “healthcare practitioner” should avert his/her eyes so as to also be responding to the interpretation.
These role plays are more effective with actual Deaf participants and actual healthcare providers. If your institution has any kind of healthcare programs (for example, nursing, psychiatric nursing, counseling, etc.), consider approaching them to involve students in these role plays. It benefits the interpreting students to practice with knowledgeable participants, and also benefits students in the healthcare programs to learn about working with interpreters. It is also useful to have Deaf people participate in these role plays. A small honorarium might be offered, or some other access to services at the institution as compensation for their time.
Prepare role play cards to hand to each participant (Deaf person, healthcare provider, interpreter). (Note: the Deaf person could also be the healthcare provider, but given that this is less common, the majority of the role plays will likely still have the Deaf person as the recipient of service.) Participants look only at their own card, because there may be different goals for each of the participants. They agree who will make the first utterance, and then continue for approximately 10 minutes, being as realistic as possible. There should be several observers who can offer observations and ask questions afterwards.
For some sample role plays, click here.
created by Karen Malcolm
The following are a series of ethical dilemmas that can be used in Interpreter Education Program.
You have interpreted for a 15-year-old Deaf girl in various settings, and she recently confided in you that she was pregnant, and hadn’t told her mother yet because, “my mom will kill me! She doesn’t even know I’ve had sex yet.”
A few weeks later you are at the hospital where the girl is attending with her mother. She has been having back pain and she has been sent for an X-Ray. The technician asks the girl if there is any chance she might be pregnant. She glances up at her mother, then responds, “no, I’m not pregnant.”
You interpret for a Deaf couple. The wife has pancreatic cancer. The doctor tells them that they have exhausted all possibilities, and no other treatment is suggested at this point. He tells them to go home, and enjoy what time remains with their family. The couple leaves looking very happy and smiling. You have a strong sense that they did not understand that this was actually bad news.
You have been interpreting for a Deaf couple who are expecting their third child. They have had tests done that confirm the sex of the child is female. They start talking about this fact with the doctor, and it becomes clear that they want to abort the child because they already have two girls, and really want to have a boy. You find this very disturbing and are opposed to this kind of action.
A Deaf man with hepatitis has been told not to drink because it will worsen his condition. You see him at a community event, drinking quite a few beers. He approaches you and says, hey, remember the doctor told me to stop drinking, so I stopped drinking scotch and now I just have beer.
by Karen Malcolm
The following scenarios are presented for assistance in incorporating healthcare interpreting into interpreter education programs. For more context on how to use these scenarios, please click here.
Acid Reflux – Doctor
A patient comes to see you complaining of heartburn and acid indigestion. You ask what they do to deal with the problem. Find out how often this happens….if it is consistently more than 2X a week, it could be GERD (Gastroephageal Reflux Disease). This is a problem in the esophagus where it doesn’t close properly and stomach acids come back up. Can lead to bleeding and ulcers, can make swallowing difficult, and can lead to esphogeal cancer. Treatment:
• Use antacids
• Stop smoking
• Lose weight
• Eat small frequent meals
• Don’t lie down until 3 hours after meals
If the condition continues, will refer to a specialist to consider surgery as an option
Acid Reflux – Patient
You go to see your doctor because you have been having terrible heartburn after eating. You used to get it every once in awhile, especially if you ate spicy foods, but in the last month it is happening at least 3 times a week. You have been using Tums but now they don’t seem to be helping. You are frustrated that you can’t enjoy eating and worried about what is wrong with you.
Acid Reflux – Interpreter
A Deaf patient is going to their doctor to talk about problems with heartburn, which is happening more and more often.
Asthma – Doctor
You are seeing a regular patient of yours who is in her/his late 40s. S/he has very bad asthma, which is triggered by dust, smog, smoke and pollen, as well as by any exertion. S/he uses two different puffers, a green one s/he can use up to four times a day, and an orange one that is only for serious breathing difficulties and should only be used once per day as needed.
You do monthly checks on her/him to make sure s/he doesn’t need to change medication.
Has anything changed since the last visit
How often does s/he use her green puffer, and how often the orange
Suggest s/he refrain from housework, because both the dust and exertion are bad for her/him
Asthma – Patient
You are in your late 40s and have had asthma for most of your adult life. You see your doctor monthly to check on how you are doing. Your asthma is triggered by dust, smoke, pollen, and smog, as well as by exertion. You use two different puffers, a green one you can use up to four times a day, and an orange one that is only for serious breathing difficulties and should only be used once per day as needed.
In last month have been having a hard time—there is a lot of pollen, and also there has been more smog
When you clean your apartment, you get very out of breath, have to use the orange puffer, sometimes two or three times a day
Very important to you to keep you apt. clean and you live alone so who else can do i
Asthma – Interpreter
A Deaf patient in his/her late 40s is going to the doctor for a monthly check up. S/he has asthma and uses two different puffers to manage the condition.
Car Accident – Doctor
You are seeing a patient of yours who was in a car accident. S/he is complaining about bruises on her/his torso and her/his neck hurting. S/he was struck by an oncoming car when s/he was turning left and her/his airbag deployed
- When did the accident happen
- What did s/he do (eg, get treatment at hospital)
- What is the pain like on a scale of 1 to 10
If s/he complains of sore throat and bad taste in mouth, it is probably because of chemicals and dust in the air bag and will go away
Will need to take pictures of bruises for the insurance company
Will refer her/him to physical therapist but for now need to rest, put ice on neck
Will give her/him pain killers
Car Accident Patient
You are seeing your doctor because you were in a car accident two days ago. You were turning left when an oncoming car struck you and your airbag deployed. You were taken to the hospital and examined, and released that night.
You have a sore neck and sore ribs and abdomen, with bruising. Also you have a sore throat and bad taste in your mouth and you wonder what that is from. You are worried that maybe you injured something and that has affected your taste buds.
Car Accident – Interpreter
The Deaf patient was in a car accident two days ago…s/he was broadsided while turning left and the airbag deployed. S/he has sore ribs and bruising, and a bad taste in her/his mouth.
Jaw pain – Doctor
You are seeing a new patient who is coming in complaining of chronic jaw pain. You want to determine:
- Where the pain is
- When did it first start
- How long does the pain last when it begins
- What time of day is it worse
- Is there anything that makes it worse or better
- Was there anything that seemed to start the pain
- What has the patient tried to make the pain less (e.g., medication, hot and cold treatments, etc.)
You may decide to refer the patient to a dental specialist to investigate the possibility of TMJ.
Jaw pain – Patient
You are going to the doctor to seek help with chronic jaw pain. It is something you have had all your adult life, on and off, but in the last six weeks it has gotten worse and is a throbbing pain. You find it hard to eat at times.
You have tried taking Tylenol and that helps the pain lessen but you would like to find out if there is anything you could do that would get rid of the pain.
Jaw pain – Interpreter
The Deaf patient has had jaw pain on and off for year, but recently it has gotten much worse.
Rapid heart beat – Doctor
A patient has come to see you who is complaining of rapid heart beat. You want to find out how often this happens, and what the patient is doing when it occurs. The patient will need to wear a Holter monitor, which is a portable ECG (electrocardiogram) that will record their heart beat over a 24 hour period. They will need to keep a chart of what activities they are doing at every point of the day (e.g., walking up a hill, sleeping, showering) so the results of the test can be co-related with activity. After that, it can be determined how serious the problem is, and medication may be prescribed such as beta blockers or digoxin.
Rapid Heart Beat – Patient
In the last six months, you have sometimes felt like your heart is beating really fast. You are very worried about it. It seems to happen for no reason. When it happens, you lie down and rest and wait for it to stop. Usually it goes away after 5 minutes but in the last 2 weeks it has happened twice when it lasted for up to 15 minutes.
You are very nervous about what might be wrong.
Rapid heart beat – Interpreter
The Deaf patient has been experiencing times of rapid heartbeat and is very worried about it.