By Tatiana González-Cestari, PhD, CHITM, Director of Language Service Advocacy.
Medical interpreters connect the patient to the provider, and sometimes, a spiritual figure or guide.
Presenting the case
Visualize the following scenario:
“Good morning! We are calling from the prepping area in the operating room,” a nurse says to the video remote interpreter on the screen. The interpreter, a professional accustomed to the fast-paced environment of remote interpreting, is already thinking and processing, within the few seconds available, what areas of medical vocabulary to focus on and picturing in her head what kind of complicated procedure she will be interpreting for. The nurse continues, “Our patient is about to have a very important surgery and has requested someone to talk to and receive a blessing from, so here is our chaplain who came to pray with him.”
The interpreter quickly realizes that the vocabulary and context of the interpretation that is going to happen has NOTHING to do with what she had just formulated in her mind. In only milliseconds, the interpreter needs to make a decision (which is a process we always go through, but we don’t think about the fact that WE, the interpreters, are making that decision before we accept every session and in many times during the interpretation).
The interpreter’s options are:
- to adjust to the new scenario and proceed with the interpretation;
- to ask more questions or clarify that this is going to be a challenging experience, but she is still willing to give her best during the encounter;
- to refuse to interpret based on the terminology and scenario.
Option ‘c’ is definitely one I would not recommend and one that would make the interpreter part of a problem and not a solution. So, how could interpreters be prepared to choose ‘a’ or ‘b’? Believe it or not, very little of this scenario is different from other interpreting sessions.
Scenarios like the one described above are common. This has been a controversial topic among interpreters, language service organizations, and providers (both medical and spiritual) for multiple reasons, and the worst part is that only few people talk about it. The debate seems to be limited because human beings have made this subject so taboo or because many would like to be respectful of people’s different beliefs. By not talking about it, we may think we are being more respectful, or that we are in a better place because we don’t have to deal with a potential conflict, or all of the above!
As with many other things, I have come to the realization that NOT talking about it doesn’t really make the problem go away. My personal and professional way of thinking about this topic is that it is OK to have different spiritual beliefs or faiths, and it is also OK to have no spiritual beliefs at all. We must respect that. Bottom line is, as interpreters, we are called to serve our patients and healthcare communities, and spiritual care may be an important part of a patient’s healthcare.
Looking for answers to some questions about this topic, my team performed a survey in which 80 video healthcare interpreters from different U.S. states participated. The main purpose of the survey was to determine how video healthcare interpreters felt about interpreting for spiritual care. In addition, we wanted to make data-derived suggestions to the remote interpreting community on how to enhance training for these types of sessions and obtain preliminary data for potential further research.
More than 63% of the participants agreed with the statement, “I like to interpret for spiritual care,” because of the importance it has to the patient or the patient’s health. About 23% were neutral and 14% did not agree with this statement.
More than 48% of participants feel confident when interpreting spiritual care because they are familiar with the subject; 20% were neutral and 31% did not agree with the statement.
When asked if they liked having fixed vocabulary or more from-the-heart prayers to interpret, we found an almost equal number of respondents liking one type of vocabulary over the other.
It was surprisingly good to observe that only 10% of the interpreters in this pool feel uncomfortable when interpreting a spiritual session if it involves a faith that they don’t follow because it is disrespectful to their own faith. And almost 80% of them did not mind interpreting in a spiritual care session even if it is a faith that they don’t follow.
Elba Nazario, former hospice chaplain and current video remote interpreter, comments about the topic: “I think people interpreting in cases of pastoral care should be genuine and show compassion […]. Body language is very important. People can tell when you are being sincere or when you are just playing a part or doing your job. People that are in distress want to know that other people care. For me, as a chaplain, it was more important to show compassion than to say the right words, but I understand that as an interpreter, both things are important.”
A non-spiritual view
Apart from the spiritual aspect of things, we healthcare interpreters may not believe in many things in life, but we still interpret about them and we do a terrific job at it. Thus, we interpret for many things we may not share, follow or practice, such as:
- Bottle or breastfeeding
- Sex change
- Hormone replacement
- Gastric bypass
- Birth control
- Natural family planning
- Blood transfusions
- Breast augmentation
And there are many others. We have to focus on the fact that the content of the interpretation has nothing to do with us as interpreters; we are there to serve others and convey the message following our professional guidelines.
Responsibility and outcomes
Any interpret who abides by the NCIHC Code of Ethics must practice:
- Impartiality: The interpreter interprets everything without allowing their own thoughts and beliefs to affect the interpretation in any way, even when they conflict with the interpreter’s beliefs.
- Transparency: The interpreter makes all parties aware of any challenges or struggles that the interpreter faces during the encounter.
- Professional Development: The interpreter strives to continually further his/her knowledge and skills and spiritual care is included in this.
- Accuracy: This must be the star in any interpretation. However, I believe it is fair to say that interpreting in spiritual care is an area that is slightly more flexible when it comes to accuracy of the message. Allow me to explain: A prayer, if prayed/interpreted with the heart, even if it is not 100% accurate, will NOT cause harm as other accuracy errors in healthcare terminology may. Of course, it is important to be as accurate as possible but minor edits or omissions may be even “lighter in weight” when it comes to a prayer.
The goal of healthcare providers, including interpreters, must be the well-being of the patient. Refusing to interpret for a spiritual care session can have deleterious effects on the patient. On the contrary, helping to communicate in those circumstances may be what a patient needs to make a recovery, cope or feel peace (the most precious prize a human being can have in life!) (Puchalski, 2001).
In addition, spiritual care is the main reason chaplains and priests call for interpreters. If interpreters refuse to help, these providers get the impression that interpreters never want to serve. No healthcare interpreter acting as an exemplary professional deserves that reputation.
Toolkit and resources
Let’s be ready! Below are some ethical principles and tips to keep in mind to help navigate some scenarios when interpreting for spiritual care sessions—
- As with any other interpretation, the patient’s words are their own and not the interpreter’s. On the other hand, shared beliefs could make the encounter very emotional for the interpreter.
- Debriefing with a trusted colleague after one of these encounters may be needed.
- Let the chaplain/patient know that a specific term or concept is unfamiliar and if clarification is needed.
- Find resources on the topic to ensure that you continue learning and evolving to be able to handle various encounters. Your company may have tools already available for you.
- Have these resources pulled up and ready for a smoother spiritual care interpretation.
- Here are some examples, which focus on Christian rites and prayers for being the most common scenarios to interpret in healthcare:
- Catholic Online
- The Book of Common Prayer according to the Episcopal Church
- Catechism of the Catholic Church
- The tools under Professional Development (above) will help you enhance your accuracy.
- The National Council on Interpreting in Healthcare’s Code of Ethics: https://www.ncihc.org/assets/documents/publications/NCIHC%20National%20Code%20of%20Ethics.pdf
- Puchalski, C. The role of spirituality in healthcare. Proc (Bayl Univ Med Cent), 2001, 14(4): 352-357.
- Martti”s QA Tips on Interpreting for Spiritual Care