Using Interpreters: Perspectives from Service Providers

Most healthcare providers cited that being able to speak the patient’s language is the most desirable option. Using interpretation was however used as a last resort.

The reasons cited were that not using an interpreter removes the likelihood for misinformation due to third party involvement. Another reason cited was that removing interpreters also significantly reduces the time factor involved in seeking an interpreter and significantly reduces the time it takes for a patient to be able to receive treatment. The third reason cited in favour of not using interpreters was the confidentiality factor involved. All healthcare providers cited their discomfort in using interpreter due to the ethical implications on the right to confidentiality of the patient.

Relying on interpreting therefore produces possible room for error, errors that could be minimised if the healthcare provider and patient spoke the same language. Here I cite two examples. At Cofimvaba hospital, one of the healthcare providers cited the difficulties foreign doctors used to encounter while they were working at the Cofimvaba hospital.

We’ve had Nigerian and Ghanaian doctors here at the hospital and they could not speak IsiXhosa. This presented serious challenges for hospital staff because this meant that those doctors had to have permanent interpreters (nurses) with them because most of the patients we see do not speak or understand English. A patient would say I’ve got this condition, and when they explain their condition or symptoms, the doctor would rely on the person who is interpreting of which could sometimes not be correct or the full information the patient gave (HCP 1: 06/05/2013).

The inability of the local population to understand English was attributed to the town being a rural town with a large and illiterate population. The town has high numbers of migrant labours who leave their villages to seek job opportunities in urban areas.

The challenge with interpreting in most cases is summarising. Healthcare providers at the Settlers Hospital in Grahamstown cited that instances where a patient would say, “I have a pain in my back, in these areas of my back and it is this type of pain which takes place in these types of situations” and the nurse would summarise and say “the patient has a backache.” For a doctor to give appropriate diagnoses, they need to examine everything the patient said, and if the doctor only relies on what the interpretation of the nurse, the doctor could be missing something significant in their diagnosis.

Interpreters often summarise and neglect to relay the smaller details when interpreting, smaller details which are important when the healthcare provider takes the history of the patient. One healthcare provided said “it is important for a doctor to know the precipitating factors, when it started, what relieves the pain and all those things. When the doctor knows the language of the patient, the doctor is able to communicate directly and get all the information they need as opposed to relying on sometimes unreliable information from the nurses” (HCP 5: 07/06/2016).

One of the healthcare providers from Cofimvaba hospital who interprets for Sesotho speaking patients at the hospital said he sometimes experiences great difficulty with interpreting because he has no official training in interpreting and only does it because Sesotho is his second language. The difficulty of translating medical terminology was also cited as a challenge. He said,

I am sometimes not able to translate the medical terms the doctors use because although I know Sesotho and grew up speaking the language, there are medical terms I do not know. What I have found in most instances as someone who does regular interpreting here at the hospital for Sesotho speaking patients is that the message does not go through the manner in which the doctor or nurse would have wanted me to communicate it because I don’t have that particular training. These are very few individuals but the challenge still persists (HCP 2: 06/05/2013).

On the question of the type of interpreter healthcare providers preferred to use, there were varying responses as to whether they prefer interpreters with medical insight or not. Some preferred that the interpreter be familiar with the medical profession because this would make the work of the healthcare providers easier in terms of assisting the healthcare provider in identifying a diagnosis. Other healthcare providers however saw this as a potential obstacle.

The reasons cited was that interpreters with medical insight might have differing opinions about the medical action to be taken and this might lead them to translating the wrong information with the intention of influencing the medical action to be taken. This could result in tensions between healthcare providers and interpreters.

Other studies show the use of professionally trained medical interpreters improved communication (e.g. errors and comprehension), utilisation (of health services), clinical outcomes and satisfaction with care. Medically trained interpreters may increase the reception of preventive services and adherence which increases patient’s access to primary care (see Hussey 2013: 192; Jacobs et. al. 2004: 94; Yokushko, 2010: 41).

It therefore appears that although the use of interpreters is not the first choice where communication between the healthcare provider and patient takes place, it does assist in providing that bridge between the doctor’s ability to provide healthcare and the patient’s ability to access the care provided, the most favourable scenario being that where both healthcare provider and patient share a common language (s).

Although most responses cited the knowledge of the patient’s language as the most ideal situation, there were varying responses to the need for healthcare providers to learn the language of the patient. One of the healthcare providers at Settlers Hospital said,

You become a doctor to help people; you cannot help someone if you do not understand each other or are not able to communicate with them. Therefore refusing to learn the language of the patient is refusing to provide treatment to that patient (HCP 2: 06/06/2013).

Another healthcare provider at the same healthcare facility had a slightly differing view, he said.

Most people would say it depends on the doctor that if the doctor cannot speak the patients’ language, then the doctor is at fault. But the same would apply if an IsiXhosa speaking doctor would have to see an Afrikaans patient who could hardly spoke a word of English, and the doctor could not speak Afrikaans. The doctor would expect that patient to speak some level of English. To force doctors to go learn a third or fourth language would be adding onto a doctor’s already very crowded schedule and leave doctors highly frustrated (HCP 1: 06/06/2016).

What emerges from the views of healthcare providers is that learning the patient’s language is not a mechanical thing but rather that there is an interplay of different factors that could either motivate or discourage a healthcare provider to learn the language of the patient. Some healthcare providers preferred to learn the patient’s language and others prefer a situation where interpreter services would be employed on a full time basis as is currently already done in the justice system where full time interpreters are employed on a fulltime basis.

All of the above factors could be mitigated through the implementation of the Language Policy as one of the key aims of the policy is provide language services through interpreting and translation. Thus demonstrates that the implementation of language policy is crucial for the provision and access to healthcare services.