Interpreters

According to Yakushko (2010: 449), there are five main models of interpreting. These are;

• Approximate-interpreting model - ad hoc interpretation from anyone available that can speak the language;

• Tele-active-interpreting - using telephones or computerised interpretation devices; • Bilingual worker model - hiring of clinicians that have language skills;

• Volunteer interpreter pool model - hiring interpreters and translators on an as needed basis and

None of the facilities had fulltime interpreters. Interpreting was done on ad hoc basis. Whenever there was a need for interpreting, the healthcare provider would at that minute seek an interpreter. Interpreting was done by another staff member, family member, friend or another patient who would available and willing to interpreting.

Approximate interpreting (ad hoc interpreting from anyone who is available) was used in all the three healthcare facilities (Settlers Hospital and Rhodes University Healthcare Centre in Grahamstown and to a lesser extent Cofimvaba Hospital in Cofimvaba) where language barriers were found.

In one of the scenarios at Settlers Hospital, an English speaking healthcare provider was seeing an IsiXhosa patient who was not proficient in English. The English speaking health care provider requested one of the IsiXhosa speaking doctors to assist with the medical interview, which meant that the doctor had to leave his own patient in the consultancy room and attend to the patient of the English speaking doctor. This patient was left alone for about 30 minutes which in turn delayed the treatment of that patient by 30 minutes. Apart from the delay in patient’s treatment due to interpreting, other administrative activities also suffered as other administrative staff are also asked to interpret when doctors are not available. Administrative staff members who are called upon to interpret thus have to leave their own administrative work unattended. In a healthcare facility which is short staffed, as most of the healthcare facilities visited were, this presents major challenges in the general operations of the facilities. Other challenges cited by healthcare providers were the ad hoc and lack of training of interpreters and the questionable reliability of the information translated or interpreted.

There was however no open hostility or reluctance observed or cited towards offering interpretation services. This was particularly interesting as other studies have shown that nursing staff are reluctant to provide interpretation services because they were employed as nurses and not as interpreters (see Crawford 1999, Flores et. al. 2008, Levin 2011, Soahatse 1997). This development presents an opportunity for the Department of Health to train administrative staff in translation and editing, interpreting and terminology for the provision of language services to increase access to care.

None of the patients interviewed had ever used an interpreter during medical consultation nor were they opposed to the use of interpreters. The common reason cited was that interpreters

help facilitate the provision of their healthcare. None of the patients cited that they would be uncomfortable with an interpreter as being an infringement of their right to privacy. None of my observations took place where a family member or friend was called to interpret. This information is therefore based on responses from participants.

Although the use of interpreters in the healthcare sector helps healthcare providers to be able to provide care to patients who do not share a common language, the use of interpreters has limitations. These challenges, as found by Levin (2006) & Kamwendo (2004), were common where interpreters were used on an ad hoc basis in multilingual healthcare settings.

These limitations as discussed by Hussey (2013:194) are that interpreting staff may be frequently unavailable or may insert their own values and views into the interpretation. In some cases interpreters have been shown to make many errors in translating and this affects patient care. Nurses particularly have been shown to be inaccurate interpreters. Training nurses to be interpreters and equipping them with the skills to translate may be a useful strategy for professionalising language mediation in the South African context - but the issue is complex, as nurses are already overworked and health facilities understaffed (ibid).

The use of family members (often small children), cleaners, administrative staff, other patients or any ad hoc bilingual person is not satisfactory. It affects patients’ confidentiality. These interpreters are unlikely to understand medical terminology, may have difficulty in sharing confidential information to patients and translate and may have conflicting agendas or priorities. Neither are they counsellors and are not accountable legally for any mistakes or breaches of confidentiality (ibid).

The cost of hiring interpreters is an important consideration but the cost of not using interpreters may be even greater. Interpreter services have been shown to lower costs by decreasing the use of diagnostic testing or reducing post-emergency department visits. The short-term cost may increase as primary and preventive medicine increases in use - but over the long term this could see a possible reduction in cost, morbidity and mortality. The cost may also be overestimated. “In their recommendations to a study conducted in 2008, Deumert and Mabandla (2008) estimate that just under 200 interpreters would be sufficient to cover the 34 public hospitals in the Western Cape. This is hardly an excessive number and would make a significant difference to the quality of health care” (Deumert 2010: 59).

Given that the Eastern Cape has higher levels of poverty with a vast rural population, the numbers for the Eastern Cape would much higher than those estimated for the Western Cape. It is therefore evident that in as much as the use of interpreters was the main strategy adopted in overcoming language barriers, it does have limitations for healthcare providers in providing healthcare services.