1. Project funded by the Canadian Institutes of Health Research Through interpreters’ eyes: roles in the clinical encounter Ellen Rosenberg, MD Yvan Leanza, PhD Robbyn Seller, PhD

2. Rationale

3. Research question What perceptions do professional and lay interpreters hold with respect to their roles?

4. Data Collection Methods - 1 Focus Group 4 professional interpreters

5. 1. Videotape consultation 2. Translate patient discourse 3. Identification of indicators 4a. Video Revision Interview with Physician 4b. Video Revision Interview with Patient 4c. Video Revision Interview with Interpreter Data Collection Methods - 2

6. 16 Interpreters - 6 Professionals, (5 women) - 9 Family members, 1 acquaintance 20 Family Physicians -16 staff physicians, 4 residents -25-60 yrs, 15 women -“trained” to work with interpreters 24 Patients -Adults Sample

7. Languages Professional Bank Punjabi Spanish Bengali Tamil Chinese Turkish Khmer Urdu Vietnamese Arabic Study Sample ProN-Pro Punjabi102 Bengali2 Chinese1 Vietnamese1 Tamil2 Farsi11 Greek1 Tchiluba1

9. Professional Interpreters Ensure information transfer Create ‘space’ to work Create a safe environment for patient Act as cultural mediator Avoid overstepping role Professional Interpreters

10. Ensure information transfer Linguistic agent Interpreter Patient Physician

11. Create ‘space’ to work Failure of turn-taking It’s very difficult to say to the patient not to interrupt us, to let us finish, because it doesn’t serve the purpose, because the patient is very anxious, they are worried, they want to say again and again, “Yes this is happening, this is happening”. Create space to work

12. Create safe space for patient Confidentiality Sometimes the doctors don’t know the patient does not have confidence in the interpreter. But I can feel it. He feels: “ If I say something I want to say, maybe the interpreter will say to someone else ”. I will say to the doctor : “ Let me say something to the patient. I would like to explain the work of the interpreter ”.

13. Create safe space for patient Confidentiality I say: ‘You are not the first patient that I’m seeing. You can feel very comfortable to express what you want to say. We will always respect you. We are not allowed to say to anyone else. If I say to someone else, about your story, I can lose my work tomorrow. Then, they have more trust in their heart to talk to the interpreter. Before, they are not sure because we meet in our community.

14. Create safe space for patient Respect For us, an older person must be shown a lot of respect and there are certain things that we may not feel we can say because we are young, we are women. And certain things may be more difficult but if the pt is comfortable with us, we can also feel comfortable.

15. Interpreter Communication and Interpreter’s Roles Physician Patient Community agent Health agent Linguistic agent

16. Interpreter Physician Patient Community agent Health agent Linguistic agent Pakistani women find it hard to accept a male physician. I told him (MD) he was not to feel bad because it is the culture. The doctor insisted on giving her son good nutritious food instead of juice. This time she brought a muffin. So I’m saying to her ‘You didn’t bring the juice bottle’. Interpreter

17. We are just waiting in the waiting room. The patients are in front of us – they are from our culture, from our community and we feel like we are trapped – we can’t do anything. They think we are there to understand what they are going through – it is like being a half-social worker; they expect us to at least give them advice or to listen to them. We are there to give them support. Avoid overstepping role

19. Caregiver role Ensure diagnosis & treatment Ensure recovery Interact with health care system Extension of family role Lay Interpreters

20. We are always together and when she is in trouble I see myself what she is doing, how she is doing, and we can feel each other more better. Ensure diagnosis and treatment

21. I encourage. He tell to me the instructions and I explain that I’m not only going to explain to her. I’m going to take care of her. Ensure recovery

22. That’s why I keep the papers, to make sure I make the phone call or something to get some information I accompany them as an interpreter and as well as to make sure that the information given by my sister or my wife should be right. Interact with health care system

23. I’m the elder brother. As I don’t have father or mother she now lives with me. There’s no choice. Everything I have to manage it. As a girl if she's even going to the market, she never goes alone. She's going with my sister in general. Extension of family role

24. Professional interpreters must create space in which to work by showing respect, establishing trust and managing conversation flow. Professionals must also define the limits of their expertise and responsibility For family members, interpreting is only one of many care-giving tasks Discussion

25. Thank you ! Ellen.Rosenberg@mcgill.ca Yvan.Leanza@pse.unige.ch Photo of Robbyn