DATE CHANGE for Foundations of Medical Interpreting

The dates for the Fall 2014 Foundations of Medical Interpreting course have been changed to Saturday, December 6 – Sunday, December 7. The class is still 8:30am – 5:00pm.

Completion of this course earns the attendee 1.5 RID CEUs / 15 Michigan BEI units.

Please contact course instructor Christa Moran with any questions or concerns.

FoMI Flyer - Dec 2014

A Positive Change – An American Sign Language/English Interpreter’s Perspective on the Benefits of Becoming a Certified Interpreter

Tucked behind my University of Michigan Health and Hospital System ID badge lays my interpreter certification card. Most people won’t ever see it, but for me it’s my greatest professional possession. Now, more than ten years into my career, I can look back and say with certainty that as a young, untested interpreter I took for granted everything that this plastic and seemingly ordinary card represented.

So, why IS certification important? Some spoken language interpreters have debated:

  • Faithfully rendering the content of a message doesn’t depend on whether or not I have such a card in my pocket.
  • Keeping information confidential is not a skill that depends on a certification test.
  • I can easily keep studying and further my skills without needing to pay yearly dues to various organizations such as the Certification Commission for Healthcare Interpreters (CCHI), the National Board of Certification of Medical Interpreters (NBCMI), the International Medical Interpreters Association (IMIA), or Registry of Interpreters for the Deaf, Inc. (RID).
  • Testing is too expensive and my state doesn’t require me to be certified to work, so I’ll save my money.
  • Certification creates a barrier between me and the community I interpret for. They see me now as an outsider.

The above sentiments are problematic due to the lack of measured accountability and professional responsibility both aspects being vital to the advancement of individual interpreters as well as our chosen profession as a whole.  The field of language communication will stay viable and be able to thrive as long as we keep ourselves accountable and professionally responsible.

Globalization and technological innovations have forced interpreting into the 21st century. Our field is now one of the fastest growing professions of all occupations:

  • The US Census Bureau reports that between 1980 and 2010 the US non-English speaking population grew 140%.
  • The US department of Labor projects a 46% increase in employment growth between 2012 and 2022.

Contemporary interpreters may not be the pioneers of language facilitation but as our field flourishes during this remarkable growth spurt we can lead the way for positive change by becoming certified.

As an American Sign Language/English interpreter working in Michigan I am required, by both federal and state law, to be certified.  Conditions of certification requirement varies by state – for example: Michigan requires interpreters to hold state or national certification and recently implemented rules and regulations to deliver a higher quality of interpreting service, while neighboring Ohio currently grants no rights for ASL users to be provided with certified interpreters – according to the Disability Rights Ohio website.  Spoken language interpreters may not have a law that outlines the specifics of their professional responsibilities however, as hospitals and other institutions strive to comply with national accreditation standards, such as the Joint Commission, the need to ensure your credibility and skills as an interpreter is of paramount importance.

In the most superficial terms, certification allows for freelance interpreters to work for a larger client base and perhaps charge more money for work.  This benefits our livelihood, but it is critical to consider the following and strive for bigger and better outcomes for our entire interpreting community:

Certification proves you have a certain level of skill and knowledge.

If anyone questions your abilities as an interpreter you have concrete proof that shows you have been tested and satisfy the criteria to do your job effectively. If a patient has a positive experience with an interpreter who is certified they will begin to expect certified interpreters at future appointments. If you’re not certified and walk into an assignment with a client who expects a certified interpreter it affects the trust within your relationship. If you don’t have a certification card that shows you are a competent interpreter can the patient fully trust your skills to interpret appropriately?

Certification protects all stakeholders including you, the institutions who employ you, as well as those directly affected by your work.

Perhaps your state or region may not require you to be certified but take a glance at other professionals you work alongside. If doctors need to be certified and nurses need to pass exams for competency, why shouldn’t an interpreter be held to the same sanctions? If an interpreter is not certified any complaint filed against them could bring disastrous consequences. Instances of interpreters being sued, penalized financially, and experiencing damage to their reputation are not uncommon. Hospitals support licensed personnel. If a patient complains about an interpreter the liability falls with the hospital who hired them – not with the interpreter. This does not mean the interpreter will not be held accountable, it simply means that the hospital is held responsible since they hired an appropriately certified person.

Certification helps professionalize interpreter services.

On many occasions I have walked into a job, professionally dressed, and people ask me “Are you their daughter?” or they look at my interpreting bag and question “When will you be graduating?” This is when I turn around my hospital badge so they can see my certification card. It’s not enough to look and behave professionally. Credentials are essential for assuring others that you are a trained and experienced specialist. The more we professionalize, the more we will be seen as a need and not an appendage. This will foster more job opportunities and with those opportunities comes greater awareness of the need for certified interpreters.

Certification prevents harmful effects that commonly happen with untrained interpreters or family members used to interpret.

Speaking two languages does not qualify someone to be an interpreter. This is a popular misconception. Hospitals that use ad hoc interpreters (those without training – most often friends/family) face a myriad of possible problems. Not only is confidentiality an issue, but reliability is as well.  Certified interpreters help improve patient safety and alleviate frustrations and misconceptions between providers and patients.  There is no way to prove untrained interpreters and family members can render the message faithfully and accurately.  Again – fluency in two languages does not necessarily make someone a qualified interpreter.  Interpreter training helps improve our skills.  Certification helps foster trust.  Imagine you need heart surgery and when you arrive the hospital informs you that they can’t provide a thoracic surgeon and instead supply an eye doctor to do your procedure. The hospital argues that both doctors completed medical school. How comfortable would you feel?

Without proper training and certification, interpreters may be in danger of misunderstanding instructions on how the patient is to take their medication, doctors have given incorrect diagnoses having to rely on the ad hoc interpreters error in usage of terms, and even deaths have been caused by ad hoc interpreters. Shouldn’t saving lives compel interpreters to become certified?

An interpreter working without certification is equivalent to walking a tight rope over an abyss without a net. Not only do you put yourself in harm’s way, but you also put the lives of those braving the rope after you in a compromising position – thinking they can cross the dark abyss without the aid of safety measures as well. If you visited another country or became Deaf wouldn’t you want a certified interpreter?

If we, as interpreters strive to lift our own professional standards so, too, will the expectations of persons who require our services. It is important to remember that our clients include not only those persons with Limited English Proficiency (LEP) but also those people who are part of general American/hearing society. We constantly work between two languages – two worlds – equally facilitating communication between those who are LEP and those who speak English – the professors, the doctors, the lawyers, the bosses. Once you show them your certification card you become the greatest tool possible for everyone involved.

Today, many language champions still struggle to promote the idea of interpreting as a profession. For thousands of years, interpreters have been lending their talents for use. It’s only recently that it has begun developing into a structured occupation. From our first interpreting ancestor – trudging a muddy path between villages to perhaps nurture trades and negotiations between tribes OR family members supporting deaf relatives to make sense of our young civilization – our work bolstered self-sufficiency. For a long period of time we have had to rely on ourselves to create positive change, but now we have the opportunity to support each other to foster favorable advancements within our work – by becoming certified.  With my certification card available for all to see, I – for one – am happy to trudge through the mud.

 

Jamie Fidler, BA, NIC
American Sign Language/English Interpreter

University of Michigan Health System, Interpreter Services
Nationally Certified / State of Michigan Registered

Caretakers of patients with Alzheimer and other types of dementia: Who is the real victim?

Keeper - front cover US‘la víctima principal del Alzheimer no es el enfermo sino el propio cuidador’

[The main victim of Alzheimer is not the patient but the keeper]

Pablo A. Barredo

This is one of those sentences that send your body to a sudden stop while your mind races at the speed of light. You attempt to rationalize it, but cannot. What is going on? Does it apply to everybody and every single case? Is this a particular happenstance of our fast-paced productive-driven society?

Alzheimer’s disease (named after Dr. Alois Alzheimer) is considered the most common cause of dementia among older people, with the first symptoms usually appearing after age 60. It is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, with other disturbances of cognitive function and personality change, and, eventually, even the ability to carry out the simplest tasks of daily living. Alzheimer’s is a slow disease that progresses in three stages—an early, preclinical stage with no symptoms, which most of the times goes unnoticed (Stages 1 to 4), a middle stage of mild cognitive impairment (Stage 5), and a final stage of Alzheimer’s dementia (Stages 6 and 7, if reached).

THE STAGES OF ALZHEIMER’S DISEASE

Mostly unrecognized(up to 10 years) Stage 1 No impairment evident
Stage 2 Intermittent memory lapses
Stage 3 Mild cognitive impairment (MCI)
Stage 4 Trouble with trivial activities
Obvious dementia stages Stage 5 Help is needed – Forgetful – Hazy on major autobiographical events
Stage 6 Noticeable personality changes; loss of coherent sense of surrounding  environment
Stage 7 Loss of ability to talk, walk, eat; bed ridden, immobile, and helpless

According to Dr. Barry Reisberg sensu Gilles

Thinking about Barredo’s statement I discovered Andrea Gillies, a writer and journalist who ended becoming keeper of Nancy, her mother in-law. From her experience from the days spent caring for her she writes a memoir (A. Gillies. 2009. Keeper. Short Books, London and Broadway Books, New York). A memoir where, besides describing the physiological whereabouts of the disease and the ways they are experienced by the diseased, she lays bare how this very personal experience affected not just her life, but also those of each one of her family members.

Some of her concerns about the illness itself are expressed here:

The most widespread misconception is that dementia’s good way to go: “They’re in their own little world and pretty happy” (…) If I had to pick one catchall descriptor for Nancy’s life in the last few years it would be misery. Profound misery, unceasing and insoluble. She knows that something is wrong, very wrong, but what is it?

(…) Her mind [Nancy’s], unable to deal with not being able to make sense of things, makes its own sense, delivering explanations up from fragments, inventing new scenarios that make things seem coherent. (…)

There’s no cure for dementia. There’s no partial cure. All that’s available is a slowing down of the symptoms of fire damage. Sufferer’s experience of the drugs available is patchy and inconsistent. They don’t work for everyone. They’re hit and miss, and usually only of short- to medium-term use.

When Nancy is upset, distraction’s the only way out. Everything else, and especially reasoning, only escalates and intensifies the trouble.

Therefore,

People are afraid of this disease. (…) People act as if dementia were contagious, (…), and the social stigma is as strong as ever. (…) When things get difficult for old colleagues and fans, it’s easier for them to turn them away, untroubled by duty.

And then, she poses a poignant question regarding her own unrequested role:

Does anybody who hasn’t been through it understand just how dehumanizing caregiving can be?

This is, of course, a rhetorical question that refers mainly to non-professional caregivers, those thousands of ones that cannot go home by the end of the day because they are already there; those keepers who do not have breaks, weekends, or vacations because they care for a loved one; those who are caregivers 24/7, 365 days a year, and who have to pay an undeserved toll precisely because of that. Gillies continues:

I am not feeling well. This not-feeling-well feeling is persistent and low-key. I am not going to the doctor. I don’t want to have a conversation about stress and embarrass myself. Stress would be the word used at the consultation. It’s an easy word, protectively imprecise, a useful box to tip your feelings into. But a better word would be incompatibility. It’s the shock of daily, ongoing proximity to this “vegetable universe” of my in-laws: their lives pared back to the bone, to the medical, physiological, placed squarely in the raw, reduced to material struggle, an easy decline the most that can be hoped for.

Why is all this of important consideration?

  • Because the risk of Alzheimer’s increases with age;
  • Because beyond age 65 the amount of people with Alzheimer doubles for every 5-year interval;
  • Because it is estimated that there as many as 5 million Americans aged 65 or older who have the disease; and,
  • Because unless we can find a cure or a way to prevent it, with current population trends the number of affected people will significantly increase. And with that the number of caregivers needed to care for all of them: see the following graph.

dementia caregivers graph

Modified from: Alzheimer’s disease Facts and Figures 2014 Report, Alzheimer’s Association, Chicago.

These considerations bring to mind several questions directly related to our role as medical interpreters:

  • How might be this affecting the outcomes of the medical encounters where patients have to be accompanied by their caregivers and are most likely unable to speak out by themselves?
  • Are there any available symptoms or cues that may serve as an indication as to what extent keepers might be psychologically worn out by their own role? And how those distress them and might ultimately affect the medical caregiving to the demented patient they care for if the most trusted information regarding the patient’s condition should be coming from the keeper?
  • Are there any specific cultural cues that interpreters might be able to spot that clinicians would likely miss due to cultural differences?
  • Is an intervention by the interpreter appropriate in cases as such?

I trust that interpreters can be of invaluable help in acquainting medical providers with the nuances of cultural understanding, and socially driven responses, to Alzheimer’s disease and other dementia as well as to get useful insights into the patient’s (family and friends alike) expected management of their illness. September 21st of each year has been established as the World Alzheimer’s Day; a day in which Alzheimer’s organizations around the world concentrate their efforts on raising awareness about Alzheimer’s and dementia. I was wondering how many of you did this year remember this particular date or simply knew about it and its significance.  Be this note of some help towards this goal of awareness to see if we can start answering some questions.

Additional references:

  • Baldwin, C. and Bradford Dementia Group. 2008. Narrative(,) citizenship and dementia: The personal and the political. Journal of Aging Studies 22:222-228.
  • Maurer, K et al. 2006. Has the management of Alzheimer’s disease changed over the past 100 years? The Lancet 368: 1619-1621.
  • Interview: Pablo A. Barredo: “Un enfermo de alzheimer no pierde nunca la memoria emocional” www.lavanguardia.com. [in Spanish]

The Importance of Medical Terminology

Why should you learn Medical Terminology?

Different professions have different “languages”. An example of this is Information Technology (IT): IT professionals use terms such as “server”, “cloud”, “domain resolution” or “operating system” to describe objects or situations they encounter. Comparatively, in the medical field, different terms are used to describe the objects and situations encountered in the field, such as “amniocentesis”, “gastritis” or “cardiomyopathy”. The words – or terms- which make up the language of medicine are referred to as Medical Terminology.

Medical Terminology eases clinical proceedings and enables everyone involved in the process of treatment and care to perform more efficiently for the patient’s benefit. In the medical field, doctors quite often use different medical terms interchangeably, but depending on the situation and context the terms could have very different definitions. For example: abdomen/ stomach/ gut/ belly. But stomach is an organ inside of our body that is a part of Digestive System and it is positioned inside the abdominal cavity or abdomen. And what about the gut?  Is it an abdomen or a bowel – another organ? It depends on the context of what is said during the medical encounter.

Sometimes, familiar words do not have the same definitions in the medical field.  Think about “stool” and “evacuation”. And yes – we are not talking about chairs or emergency/ war situations.

Many people are convinced that “infection” and “inflammation” have the same meaning. Yet the meaning is very different for these 2 medical terms.

Transliteration of “angina” in many languages has definition “sore throat”, but not in English.

In Cardiology pulse, heart rate, and heart rhythm are used interchangeably all the time. But these very similar medical terms have very different meanings in Cardiology encounters.

Very often within the clinical environment medical terminology is composed of abbreviations. But familiar abbreviations could have a different meaning in medical language. AAA is not an insurance company, MI is not a state and TUNA is not a fish.

Once, I checked the short description of an upcoming appointment for one of the Russian-speaking patients in the Hospital database that said: “Russian patient, SOB, presented with symptoms of…” I was confused and shocked. SOB was a familiar abbreviation that I’ve heard multiple times before on the talk-shows, those were a big source of my learning of street/common English. And even though the patient was very unpleasant and often rude, I still could not believe that someone would use this abbreviation in the official Hospital database. So eventually I asked one of the physicians if there is a medical abbreviation “SOB”. And guess what? There is – shortness of breath.

If we would like to work in the health care field or simply become familiar with the basics of medical science – we have to know medical terminology. The importance of fluency in medical terminology cannot be overstated, which applies to all hospital personnel, including allied healthcare professionals and the patients as well. During medical encounters we would like to feel like an equal and knowledgeable medical team members and not uneducated outsiders.

Learning of the Medical Terminology and Body Systems is the one of the most important steps we should take in order to be successful in healthcare field.

 

Why should you take the class?

Many people nowadays have access to the Internet and software applications that are designed to help learn Medical Terminology. But just learning a list and memorizing unpronounceable terms is not sufficient: in order to learn and memorize we must reflect, become self-aware, and monitor our use of medical terminology.  We are adults and adults learn by DOING.

Without guided practice we usually do not master new skills.  Learning terms in context promotes retention.  No true understanding comes without the practice component.  Without structure and entertainment medical terminology becomes a chore.  We are all a mix of different learning styles, so we need a variety of teaching methods to learn well.

Even in pairs students often learn more from each other than an educator or trainer.  They correct and help each other.  They keep each other on task.  They share experiences, offer solutions to real-life problems, and make “dry” terminology interesting.  A variety of games, presentations, and quizzes introduce a little (lot!) fun to (otherwise) tiring theoretical learning.

The majority of terms are derived from Greek and Latin and in medical language systematic methodology goes together with science-based vocabulary.  The best way to learn medical terminology is to become familiar with the structure and the most commonly used word parts and apply your knowledge to different specific medical areas. Then it is possible to decipher the meaning of most any medical term and actively participate in a dynamic patient-provider encounter as a knowledgeable medical team member.

Needless to say, the 40-hour Medical Terminology and Body System class is only an invitation to the never-ending process of self-study, continuing education, research, field experience.

Coming Soon! Deaf Health Talk on Diabetes

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Deaf Health Talks - Oct 2014