Joseph R. Paraguas entered the operating room. The patient lay on the operating table, her body covered with drapes except for the face and right lower leg, which ostensibly was the infected area. Mr. Paraguas nervously glanced over at the instrument table. He identified the scalpel, forceps, sterilization tray, and syringe. There were a few other instruments he did not recognize, but he felt confident he would get it all after a little practice. He could tell from a cursory examination of the leg, and based on his autodidactic surgical studies, that this was going to be a question of either removing the infection or amputating the entire lower leg. It was his first day on the job and his supervisor had given him no guidance as to the particulars of the procedure. The department was understaffed and his new boss himself had five other operations he had to attend to that morning. Although Mr. Paraguas was unsure how to proceed, he knew that, having passed the medical doctor certification exam shortly after graduating from high school, he was the most highly skilled individual in the operating room. Without raising his glance, he commanded the person he assumed to be his assistant: “Scalpel.”
Before I go into the significance of the hypothetical scenario above, I note the following. This essay sets forth my observations of some of the problems that impede the ability of translators and interpreters to serve their clients and some possible solutions. I discuss both translation and interpreting in this article because, although they are two distinct and different professions, they coincide in the broader sense of converting one language into another, and share many of the same challenges. I also practice both, so I am intimately familiar with them and they are close to my heart. For the sake of clarity, I suggest a series of five steps to perfect our rendering of service: 1) identify that there is a problem; 2) envision a solution to the problem; 3) develop the momentum for change; 4) implement the solution; 5) evaluate outcome to adjust strategy and commence the five-step plan again. I finally propose a working group structure to continue to review and address these challenges.
Readers should have little trouble extrapolating the imaginary situation sketched above to translation or interpreting. Indeed, it could apply to the inadequacies of medical, legal, or diplomatic interpreting or translation, and to a lesser extent of commercial interpreting or translation, such as market research. In the latter case, any damage would more likely be financial and not a matter of life, liberty, and death, but who is to say what the outcome of inadequate translation will be? Errors and mishaps are, by definition, unpredictable and any faulty or lacking translation is a risk. Skills of a very high level are required for translating or interpreting: superior command of a native language, superior command of another language, experience and training in the process of translation, and subject-matter expertise. Translation requires excellent writing skill in the target language; interpreting skills include simultaneous and consecutive interpreting and sight translation. There are also many subsets of skills, and the process to achieve this demanding level of competencies is almost inevitably long and arduous.
Despite the inadequacies, our profession has come a long way, and its gradual evolution was probably inevitable. One should not forget that a couple of centuries ago, barbers were the ones performing surgery, along with haircuts. We can assume that this fact derived from a lack of development of the medical field and not from some type of moral depravity. One hundred years from now, people will probably look back on our age with disdain for the primitive medical treatments we now use.
- Identify that there is a problem
I believe readers recognize that our industry faces serious challenges, but for good measure, I cite Eric Candle of the International Medical Interpreters Association (IMIA), who has studied what happens when interpreting is deficient or lacking. He states that patients’ limited proficiency in English results in “longer length of hospital stays and greater risk of complications…greater risk of surgical delays and readmission due to greater difficulty understanding instructions, including preparing for procedures, managing conditions, taking medications, as well as identifying symptoms for immediate return to care and follow up.” Fifty-five million people in the United States speak a language other than English at home. Yet it is worth noting that in the medical sphere, miscommunication is the number-one cause of patient harm whether a foreign language is involved or not.[1] Every year 96,000 patients die in the US due to miscommunication with their healthcare providers. Fifty percent of all patients are unable to communicate adequately with their healthcare providers.[2] Even though poor communication is already a major issue even if a foreign language is not involved, the potential for miscommunication is greater for individuals with limited English proficiency. This implies an enormous responsibility for translators and interpreters. Since translation and interpreting are used beyond the medical sector and presumably in every sphere of human interaction, the potential benefit of competent translation is formidable.
- Envision a solution to the problem
To a great extent, we can continue doing what we have been doing, but more can be done. We have to educate the public, government, and employers so they understand that translation and interpreting are professions that require specific skills and training. We have to raise their awareness about what is at stake when the job is not performed or is performed inadequately. We should probably advocate for government investment in translator and interpreter training and certification programs. There should obviously be some regulatory threshold beyond which pay and quality shift upward. Some jobs should be legally reserved for linguists with specific certification. Possibly, unionization as a medium for professionals to advocate for their profession would play a role, as it already does in certain sectors of our industry, for example, in some courts. The IMIA has recommended mentoring programs for medical interpreters once they begin their duties after certification. The ATA is sponsoring mentoring efforts as well. This is advisable and helpful in any branch of our industry, since many challenges cannot be anticipated during previous training. For this reason, the initial days, weeks, and months on the job also tend to be particularly stressful.
- Develop the momentum for change
The fact that good translation saves lives and money is a compelling argument in favor of investing more resources in it. But actually raising this awareness among the public and decision makers is more challenging. The tragic case of Deisy Garcia here in New York City is a harrowing example of why translation should not be an afterthought. She, along with her two daughters, was murdered by her husband after a domestic incident report that she filed with the police was never translated from her native Spanish into English. In that report, she specifically stated that she feared her husband would kill her and her two daughters.[3] Besides cogently demonstrating that proper translation can be a matter of life and death, this case shows that translation that is inadequate or absent altogether incurs civil liability and, hence, loss of tax-payer dollars. Politicians lose face and are therefore not reelected, but costly lawsuits against government agencies are another likely consequence. Case studies of the effects of absent or deficient translation or interpreting abound, but further studies would surely be useful, since the use of language services has grown and proliferated throughout society. Which case studies one would cite depends on who needs to be convinced.
- Implement the solution
Implementation will involve any stakeholders who want to play a role. It will be a lot of work and always hark back to the previous steps based on the insights gained from step 5. Once again, much has already been achieved. Various certification credentials exist, including the ATA translation certification for several language pairs, state- and Federal-court certification for Spanish and some other languages, and numerous medical-interpreter certification programs. Court certification and the right to an interpreter in court were codified by the Court Interpreters Act of 1978.[4] The progress in court interpreting has resulted in a colossal enhancement to the administration of justice in this country. The work of the IMIA to promote and standardize medical-interpreter certification has also been pivotal. But it would be a mistake to think no further work needs to be done. It is only sensible to build on the achievements of organizations and individuals that have already pioneered the advancement of our industry.
- Evaluate outcome to adjust strategy and then commence the step plan again
Inevitably, trial and error will play a role. No grand solution will anticipate every eventuality. But what are some of the lessons we have learned already? How easy or difficult are the problems to fix?
Translators or interpreters must be intimately familiar with the specific subject matter of a given project. In the legal field, for example, terminology is so vast that the challenge of mastering it is herculean: what law? Texas law? New York law? New York criminal law? I am constantly talking to lawyers about terminology, and they often cannot answer my queries since they concentrate on a relatively circumscribed yet broad area of law. Once we start talking about the different types of legal documents and jurisdictions in our country, let alone in others, discourse becomes byzantine. My point here is that, although translators and interpreters have to be highly trained, getting to where they need to be is not necessarily straightforward. Demands go beyond linguistic knowledge and specific translation and interpreting skills that also require years of preparation. While perfect translation—and particularly perfect interpretation—are rare, translators and interpreters must be highly educated and continually seek further education.
Even though the aspiring linguist can look to a local training program for guidance and preparation, one should not assume that such programs are the magic bullet for success in the field. After all, they have to prepare their graduates for virtually everything under the sun that can be talked or written about. The trick seems to be to anticipate vocabulary, concepts, phenomena, situations, and pitfalls as much as possible in the training. Teaching reliable methods of acquiring new knowledge prepares students for the unexpected. No one can predict everything that will happen, and experience will have to teach its lessons accompanied by the risk (as minimal as possible) of learning on the job.
I believe that the rapid growth of translation and interpreting programs that has occurred in the last decade or so is generally a very positive development. Yet this boom could develop into a bubble if such programs do not channel their students into jobs that will justify the expense of the prior training. If the programs are too expensive and/or the salaries too low, they will not be sustainable, and by extension, employers will have difficulty finding qualified interpreters and translators to do the necessary work. This situation harks back to the need to educate companies and government, as well as individual customers. They will not be willing to pay substantial and fair remuneration to translators and interpreters if they do not understand what goes into the results they are seeking. We should take a lesson from the current status quo, which, though a major improvement from a couple of decades ago, leaves much to be desired.
It seems that the cost-effectiveness and moral imperative of investing resources in translation and interpreting are not conventional wisdom. But exactly how to educate is more complicated. In the case of the government, conflicting budgetary priorities will make it challenging to obtain more funds to pay translators and interpreters, especially in times of crisis such as our own. Swaying public opinion to valuing quality translation and interpreting is an endeavor that undoubtedly will extend beyond our lifetimes.
Certification exams seem indispensable even after training, but enthusiasm to enroll in training may wane if the candidate cannot necessarily count on passing the certification exam. Of course, if the exam is too easy, the linguists and society as a whole will be exposed to greater risk. And, while it may be cost-effective for the government to promote programs to train and certify translators and interpreters of Spanish, it may not be for languages of lesser diffusion such as Wolof, Tibetan, or Kaqchikel. Indeed, it would be a delusion to aspire to preparing linguists adequately for every possible language pair. What might be considered an unacceptable rendering for Spanish or Mandarin may have to be tolerated for Vietnamese or Tajik, under certain circumstances. But, once again, the lack of high-quality translation or interpreting in any language pair carries incalculable risks.
Conclusion
I think that permanent dialogue between the providers and users of language services is a crucial element to tackling the challenges our professions and their users face. There are numerous examples of such dialogue, such as the work of the NAJIT Bench and Bar Committee and the ATA PR Committee. As I indicated above, I acknowledge that this essay only scratches the surface of problems and possible solutions. By identifying some of the sore spots and suggesting some possible cures, however, I hope to contribute to this necessary debate. I propose the following structure to improve the rendering of services in our industries:
- Establish a working group to discuss and research problems and recommend solutions, based on the five-step plan I propose, or a similar evaluation scheme.
- Choose a specific area of our industry in which to begin this work, i.e., observation in a specific court or hospital system as well as library and media research.
- Obtain funding to enable this ongoing work.
It bears reiteration that miscommunication (in the medical or legal services sectors, for instance) is a problem that extends beyond the intervention of translators and interpreters. Yet this does not absolve us from making sure that we are a strong link in the chain of communication. The potential for positive change in doing so is enormous.
Originally published in The Gotham Translator.
[1] “The Joint Commission on Accreditation of Healthcare Organizations describes communication error as the cause of 60% to 70% of preventable hospital deaths.” Murphy, Joseph G. and Dunn, William F., “Medical Errors and Poor Communication,” Chest: Official Publication of American Chest Physicians. December 16, 2010. Hyperlink: http://www.pathology.med.umich.edu/intra/AP%20Updates/ErrorsCommunicationEdit_MurphyCHEST2010.pdf. Accessed October 28, 2014.
[2] “Improving LEP Population Health & Health Care through Meaningful Communication,” presentation by Eric Candle to the New York Circle of Translators, May 29, 2014.
[3] Boyette, Chris and Santana, Maria, “A woman’s plea in her native language goes untranslated, three lives are lost,” CNN U.S., February 20, 2014. Hyperlink: http://www.cnn.com/2014/02/19/us/new-york-domestic-killing-warnings/. Accessed on October 28, 2014.
[4] The Court Interpreters Act in turn was the culmination of a series of historical factors, such as Civil Rights Movement, decades of research and advocacy, and landmark case law such as Negron v. New York (1970). Roseann Dueñas González, et al. Fundamentals of Court Interpretation: Theory, Policy and Practice. Durham: Carolina Academic Press, 1991. Pg. 37-69.
Leonard Morin 