Alfred Okongo speaks fluent English. Even so, the Kenya native found navigating the U.S. health care system difficult.
“My barriers were not linguistic,” said Okongo, who moved to the area in 2002 as a doctoral student in linguistics at the University at Albany. “They were more cultural. I’m conditioned to speaking first. But here the doctors speak first, so they don’t get to understand you.”
Over the years, Okongo has helped translate for his fellow immigrants, accompanying them to medical appointments and helping them understand what the doctors and nurses are saying. Now he plans to undergo formal training to become a medical interpreter.
The training is sponsored by MAMI Interpreters, a Utica-based nonprofit organization that recently opened an office at the Social Justice Center in Albany. The group plans to train a pool of people to serve as on-site medical interpreters for people who speak little or no English — a service that hasn’t been readily available in the Capital Region.
MAMI has identified approximately 30 priority languages for the Capital Region, including Arabic, Bosnian, Burmese, Cambodian, Farsi, French, Guyanese, Japanese, Korean, Mandarin Chinese, Pashto, Russian, Spanish, Swahili, Urdu and Vietnamese.
The group’s move to the Capital Region represents a collaboration with Catholic Charities AIDS Services, an office of the Roman Catholic Diocese of Albany.
Angela Keller, executive director of Catholic Charities AIDS Services, said many of her organization’s clients speak little English and are uncomfortable using the phone-based interpreters provided by local hospitals and clinics. “For some people, the phone works great,” she said. “But there’s a gap, and we felt that having someone who could interpret for patients in person would help.”
MAMI was founded in 1998 by Utica residents who had been translating informally for friends and relatives.
One of those residents was Cornelia Brown, a linguist who often translated for her Russian in-laws and other immigrants and who now serves as MAMI’s executive director. She and her fellow translators decided to organize, with the goal of creating a better system for providing medical interpretation for immigrants and refugees.
“We realized that what we needed were trained interpreters,” Brown said. “We were seeing kids under 10 being asked to interpret for their siblings. I got a letter from a mom who said she felt like an animal when her baby was born because something was wrong and she didn’t understand what it was. It turned out the baby had an allergy and that he was going to be OK.”
MORE THAN LANGUAGE
Being bilingual, Brown said, does not necessarily make someone a competent medical interpreter.
Interpreters, she said, are trained in ethics, medical terms, cultural brokering — how to serve as a go-between for people from different cultures — and advocacy; people who haven’t received such training can make ethical missteps and run the risk of providing patients with poor information.
Untrained translators are more likely to violate patients’ confidentiality and make decisions for the patient, robbing the patient of the ability to give informed consent, Brown said.
In the training “we talk about ethical conflicts and how to resolve them,” Brown said. “We do role plays. Let’s say you’re doing a pre-natal visit with a Somali Bantu woman who doesn’t want to do a blood test. She might believe that taking blood will delay the birth, or that the blood will be sold on the black market. The interpreter isn’t a medical person, so they shouldn’t be the source of medical information. But they can be the source of a hypothesis about the information. They can mention these issues to the doctor, and the doctor can explain why the blood test is needed. The interpreter is strictly a conduit for the information.”
Mary Stronach, MAMI’s community coordinator, translated for her Italian parents for years without formal training.
She said she questioned the need for trained interpreters until she got involved with MAMI. When she underwent formal training, she said she realized her approach to translation violated ethical standards.
“I was known for summarizing,” Stronach said. “But now I know that if a patient gives an explanation, you should give that explanation to the doctor as accurately and completely as you can. You shouldn’t summarize. … If you summarize what the doctor says for the patient, the patient might not understand all of the issues that are in play.” Sometimes, she said, she went so far as to make medical decisions for her parents. “I would simply say, ‘You’re going to have the surgery,’ ” she said. “I did not understand the importance of being the invisible person in the room as opposed to taking control for the patient.”
INFORMATION CRITICAL
Brown said that without an interpreter, people are more likely to make poor medical decisions.
For instance, Brown’s mother-in-law once visited the doctor because she had a “bad eye.” When she returned home, she reported that the doctor was proposing surgery, and that she didn’t want it. Brown accompanied her mother-in-law to her next appointment and learned that her mother-in-law had glaucoma — a crucial fact that her mother-in-law had missed. The surgery was essential, and Brown was able to convey this information to her mother, who agreed to the procedure.
“I explained that she would be blind if she didn’t do the operation,” Brown said.
MAMI will sponsor its first Capital Region-based medical interpreter training at the end of the month. The 80-hour course will begin on April 30, and run for the next five weekends. Interpreters must be fluent in English and a second language.
Eventually, MAMI plans to provide interpreting services in schools, social services and legal settings.
The 1964 Civil Rights Act and New York law require that federally funded facilities provide qualified oral interpreting and written translations to non-English speakers. Patients are not charged for MAMI’s services, though the interpreters are paid.
In the Capital Region, many health care providers rely on telephonic interpreters — off-site interpreters who can be accessed over the phone.
One of MAMI’s first projects will be to reach out to health care providers, and see whether they are willing to allow interpreters from an outside organization to come in and translate. Brown said it usually takes a little while for health care providers to get used to the idea.
“It’s a cultural shift,” Stronach said. “For the most part, providers are happy with telephonic interpreter services. We need to show them that there are times when a trained on-site interpreter might be better.” Three areas where on-site interpreters might be preferable are mental health, pediatrics and end-of-life care, according to MAMI.
Okongo speaks English, Swahili and other African languages.
He said on-site interpretation is better than interpretation provided over the phone.
“You need to have someone in person,” said Okongo, who is in his early 40s. “The phone makes it difficult because you don’t have that face-to-face contact. A telephone is useful, but it has its limitations. I am convinced of the need for interpreters in the Capital Region.” For some people, “it’s a matter of life and death.”
Categories: Schenectady County
