Summary of IMIA 2014 Conference in Houston

by Chi-Wei Chang

This was my first time going to a national conference for interpreters. My goal was to be there and learn about simultaneous interpreting and how to teach simultaneous interpreting. Unfortunately the speaker for that specific topic was missing in action! What a disappointment!

Nevertheless, this conference was packed with workshops. One of them in particular drew a huge crowd of interpreters: Becoming an expert interpreter. As any medical interpreter can tell you, every interpreting encounter has its own challenges. How can a novice interpreter advance to be an expert?

Mr. Ryan Foley spoke about many tips for interpreters to improve their skills. Among those, three are fundamental and should be remembered:
1. focus on the techniques: the example he gave us was figure skating (which I can relay really well). How a skater improves on making a perfect axel not only requires repetitions but more importantly, using the right techniques. The same principle can be applied to interpreters who want to improve themselves and become better at interpreting.
2. goal oriented: set goals for oneself. Whether they are weekly goals or monthly goals, it is crucial for medical interpreters to learn more about medicine and look up information about illnesses or procedures that one has come across at an appointment.
3. look for constant and immediate feedback. Always seek direct and indirect feedback from patients, providers and peers. Based on clients’ feedback, interpreters can better prepare him/herself by identifying and correcting his/her own mistakes right away as well as gaining new ideas.

The conference’s hospital tours also offered an invaluable experience. I signed up for a tour that took us to MD Anderson, one of the hospitals that is part of the Texas Medical Center. The scale of this medical center is enormous. The interesting aspect about these tours is not just getting first-hand experience about the size or the appearance of the hospitals but how their language assistance program is run. As expected, Spanish is the most requested language. Yet to my surprise, the Vietnamese patient population is more than Mandarin Chinese here in Houston. The manager of the program explained to us that they use two schedulers to schedule all interpreters, temp and staff alike. What intrigued me the most was that their interpreters are sent to appointments when providers are ready to see the patients. And when interpreters are done with one job assignment, they are obligated to call their schedulers so they can be deployed to other available jobs. This way they do not have to keep a huge staff of interpreters. Wow! I would love to learn more about their model and how it can be applied to our own.

One of the best parts of going to a national conference is networking with other interpreters. It offers a great opportunity to learn from one another and to build one’s contact network. I was fortunate to be able to form on day-one a small group of interpreters from Asian countries. We went to most of the workshops together and shared our thoughts and experiences. All of us are now friends on social media and we provide resources and support to each other on a regular basis!

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On Depression, Madness, and Melancholia: One Patient, Two Visions

Depression is a persistent brain disorder, component of various psychoses that interferes with the patient’s everyday life. Its symptoms can include: sadness, loss of interest or pleasure in activities one used to enjoy, change in weight, difficulty sleeping or oversleeping, energy loss, feelings of worthlessness, and thoughts of death or suicide.

There is no single cause for depression, among them genetic, environmental, psychological, and biochemical factors. It is estimated that in the United States alone 20 million people suffer depression with feelings that do not go away, even though antidepressants and talk therapy have been considered effective treatments.

Darkness Visible - William StyronWilliam Styron, an American writer best known for his novels The Confessions of Nat Turner (1967) and Sophie’s Choice (1979) had his worst bout of melancholia in 1985; a bout so severe that provided him with a seven week stay in the psychiatric unit at Yale –New Haven Hospital. Out of his experience with depression he wrote an article that appeared in the magazine ‘Vanity Fair’, which was later expanded and published as a book: Darkness Visible: A Memoir of Madness (Random House, 1990). There, he reflects on his knowledge of the malady acquired as a long-sufferer of this incurable and recurrent illness.

Here are some very interesting issues as expressed by him in regarding the illness and his own experience of it (underlined are mine). I trust that some of his comments about the malady are largely self-explanatory:

  • Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self – to the mediating intellect – as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode (…)
  • My acceptance of the illness followed several months of denial (…)
  • A disruption of the circadian cycle (…); this is why brutal insomnia so often occurs and is most likely why each day’s pattern of distress exhibits fairly predictable alternating periods of intensity and relief.
  • (…) never let it be doubted that depression, in its extreme form, is madness. The madness results from an aberrant biochemical process. (…) such madness is chemically induced amid the neurotransmitters of the brain, probably as a result of systemic stress, which for unknown reasons causes a depletion of the chemicals norepinephrine and serotonin, and the increase of a hormone, cortisol. With all of this upheaval in the brain tissues, the alternate drenching and deprivation, it is no wonder that the mind begins to feel aggrieved, stricken, and an organ in convulsion. Sometimes, though not very often, such disturbed mind will turn to violent thoughts regarding others. But with their minds turned agonizingly inward, people with depression are usually dangerous to themselves. The madness of depression is, generally speaking, the antithesis of violence. It is a storm indeed, but a storm of murk. Soon evident are the slow-down responses, near paralysis, psychic energy throttled back closed to zero. Ultimately, the body is affected and feels sapped, drained.
  • (…) certainly one psychological element has been established beyond reasonable doubt, and that is the concept of loss. Loss in all of its manifestations is the touchstone of depression – in the progress of the disease and, most likely, in its origin.
  • (…) The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come – not in a day, an hour, a month, or a minute. If there is a mild relief, one knows that is only temporary; more pain will follow.
  • A phenomenon that a number of people have noted while in deep depression is the sense of being accompanied by a second self – a wraithlike observer who, not sharing the dementia of his double, is able to watch with dispassionate curiosity as his companion struggles against the oncoming disaster, or decides to embrace it. (…)
  • (…), the hospital was my salvation, (…) – I found the repose, the assuagement of the tempest in my brain, that I was unable to find in my quiet farmhouse. This is partly the result of sequestration, of safety, (…) the hospital also offers the mild, oddly gratifying trauma of sudden stabilization – a transfer out of the too familiar surroundings of home, where all is anxiety and discord, into an orderly and benign detention where one’s only duty is to try to get well. For me the real healers were seclusion and time.
  • Save for the awfulness of certain memories it leaves, acute depression inflicts few permanent wounds. There is a Sisyphean torment in the fact that a great number – as many as half – of those who are devastated once will be struck again; depression has the habit of recurrence.

Reading My Father - Alexandra StyronQuite recently, Alexandra Styron, one of his daughters, has reflected on her personal father-daughter relationship and how this relationship has been, over the years, shaped by her father’s illness; personal impressions and thoughts made public in Reading My Father: A Memoir (Scribner, 2011). Therefore, father and daughter provide the public with a rare case, in which the interested reader can somehow experience firsthand the effects of a given mental illness from two different perspectives: that of the patient himself and that of one his most direct (though not quite sure if close) family members. Some of her impressions follow (underlined are mine):

  • (…) He was also praised, perhaps by an even larger readership, for Darkness Visible, his frank account of battling, in 1985, with major clinical depression. A tale of descent and recovery, the book brought tremendous hope to fellow sufferers and their families. His eloquent prose dissuaded legions of would-be suicides and gave him an unlikely second act as the public face of unipolar depression.
  • (…), he flatly refused the two forms of treatment universally acknowledged as beneficial for the maintenance of a mind inclined to melancholia: talk therapy and antidepressants. (…)
  • (…) Wretched and panic-stricken, Daddy began suddenly clinging to my mother as if she were the last raft on the Titanic. He’s spent more than twenty years pushing her away. Now he wouldn’t let her out of his sight. (…) If she did manage to sneak away one hour, a passing rain shower was enough to convince him she and her car were wrapped around a tree.
  • (…) His voice all but disappeared, his gait slowed to a palsied shamble. The fantasies of suicide he’d harbored through much of the fall turned still more lurid – although, institutionalized as he was, he did grow resigned to the fact that the option was probably out of his hands. (…) His hyperreactive system – hitched to his chronic hypochondriasis (…); every “possible side effect” tried out its routine on him. Electroconvulsive therapy (ECT) was suggested as a possible option, having proved to be a particularly efficacious treatment for unresponsive, older patients.
  • Watching Daddy go insane was tough on all of us but utterly devastating for my mother. His obsessions were endless and exhausting. (…) But sometimes it looked at her and it seemed as if she could not breathe, as if the whole unbearable situation would literally suffocate her. (…)
  • Some days I just looked at my father and thought: Are you really going to die of depression? (…) He knew he was losing the fight, but he drew the line at being forced to feel better. No trying was his toehold on personal dignity, his last stand.

Although depression affects everybody in a different way and degree of intensity, it is noticeable from both Mr. Styron and her daughter’s comments that depression is a difficult to accept long-standing illness that strongly affects both patients and family alike. However, as with many diseases, acknowledging it is the first step to fighting it. And it is important to keep in mind that in making public a battle such that can only help other affected people to cope and fight against it, while hiding it and denying it not merely delays to the point of suppression the patient’s options for recovery but also prevents fellow patients, caretakers, and medical providers alike to benefit from our understandings.

Additional References:

Medline plus (NIH: National Institute of Mental Health);

UMHS Depression Center

Summary of IMIA Conference 2014 in Houston, TX

What prompted me to attend the International Medical Interpreter Association (IMIA) conference this year? The opportunity to attend a BTG Trainers meeting at a national gathering of IMIA conference attendees and meet with other trainers from other states. We reviewed a few CCHCP short-term plans and learned about a new 64-hour BTG Training pilot program. All licensed agencies have the choice of continuing with the 40-hour BTG Training or participating in the 64-hour pilot training. This new version will include an 8-hour Code of Ethics course. Hopefully, the COE booklet will be ready by April 2014.

Jane - IMIA 2014 aLast year, I was selected as IMIA State Chapter Chair of for Michigan for a 4-year term. I took this annual conference opportunity to meet with other state chapter chairs in person and learn what other states have been doing to promote medical interpreting professions and encouraging interpreters to take National Certification exams and become certified healthcare interpreters. If you have not taken the national exam yet, here are the websites for The National Board of Certification for Medical Interpreters and The Certification Commission for Healthcare Interpreters.

One of the Sunday workshops that interested me was “Is Your Training Program IMIA Accredited?” I now have a better understanding of the IMIA Accreditation components, including Admission, Administration, Notices, Instructors, Curriculum, Methodology, and Evaluation. Our department is considering combining a few of our training programs and apply for IMIA Accredited Program.

Jane - IMIA 2014 bUMHS Interpreter Services Director Michelle Harris encouraged me to present at the national level. So I decided to give a presentation on “Tips and Techniques for Public Speaking in Your Non-Native Language” at the IMIA Conference this year. I noticed at earlier interpreter conferences, we often had the same speakers year after year and non-native-English speakers were seldom willing to get up and share their knowledge and experience with their colleagues from different states and countries. I wanted to start by setting an example and let people who came to my presentation know that I immigrated to the U.S. at age 30, and that I’m aware that I have some degree of foreign accent when I speak English. However, I also let the audience know that I thoroughly enjoy giving presentations and teaching Bridging the Gap Medical Interpreter Training. At this presentation, I shared my 20 tips for Public Speaking in Your Non-Native Language and Things to Avoid for Public Speaking. At the end of session, one of the participants came up to me and said it was the best workshop the whole weekend. I was flattered by her compliment and was glad that I picked an interesting and practical topic to share with colleagues. One of the Spanish interpreters from Ecuador said she would consider giving a presentation at the next conference following my suggestions. Receiving positive feedback and kind words from participants was inspiring to me.

The IMIA Conference brought hundreds of medical interpreters together from all over the world. We shared experiences and increased our interpreting knowledge. We have a common goal - to provide excellence in healthcare interpreting.

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“How are you?” “Fine”

A colleague recently sent me an opinion piece from The New York Times. I really enjoyed reading this article and, in my opinion, it is very accurate. Now, do not get me wrong, I bet a lot of people (especially the younger generation) probably will disagree, but for me, and majority of my patients, this is very true. Though I must say that some Americans told me things I felt I did not want to know at all and some Russians guard their personal life and feelings as a top-secret.

I really do not think that Russians are unable to “fake fineness” due to some “opposition” to enthusiasm, proclamations of joy and optimism of the Soviet government.

I know that I can “fake fineness” almost perfectly after living in the US for almost 20 years. Most of the time, I do not feel like faking at all.

I actually think that traditionally Russian people are more open and direct and may be even more sincere and genuine than some Americans. Russians love to talk and some (but just some) of them are great at listening. And after all if there is a question mark at the end of the sentence that implies an answer (and not just a one word answer). If you ask old school Russians “How are you?” – you most likely will hear everything what happened to them, their family members, friends, neighbors, etc. for the last month (if not the last year or decade). There is a story I’ve told many times about having stiff facial muscles at the end of the day because of the constant smiling at strangers all day long. This is something I would never do in Russia, because people would think that I’m not well if I just smile without any specific reason for it.

And I suddenly realized, after reading this article, that I’m probably more depressed now, because I must smile and be fine all day long, while my patients are complaining non-stop and quite often angry and gloomy, but I do not get a chance air my own grievances!

Then, a couple of days after reading this article, I went to get some gas early in the morning. There was a wind chill warning that day (the wind chills to – 30F) there were just a few cars at the gas station. As soon as I got out of the car, I was frozen and almost blown away by an awful wind. An employee appeared in front of me. A shapeless, ageless female in her winter uniform and neon orange vest over that, and her face covered by a balaclava hat so I could see only her eyes behind the eyeglasses.

“How are you?” she asked.

“Cold,” I replied. “How are you?”

“Great!!!” she answered enthusiastically.

“Aren’t you cold???” I asked with disbelief.

“It is not too bad today,” she replied. “During the recent Polar Vortex we got wind chills to – 52F in here, so today is not bad at all.” She actually sounded happy. “And I’m almost done with my shift.”

“I’m happy for you,” I said, thinking that she is probably counting seconds to go home.

Instead, she replied, “I have less than 5 hours to go.” And with that, she moved on to cheer up the other drivers getting out of their cars.

When I got back into my car I could not feel my hands or feet, but I realized that this woman made my day, that I would take this small talk, this optimism, and this smile a hundred times over the angry, grim, murky, and gloomy outlook from my former fellow-countrymen.

Do We Remember What Really Happened?

What’s your earliest memory? How far back can we really remember? And how accurate are the events we recall? In his book ‘Remembering our childhood: how memory betrays us’ (Oxford University Press, 2009) Karl Sabbagh, in an attempt to answer these questions, discusses, and refutes the claims of the ‘recovered memory’ movement, a psychotherapy movement that during the eighties and nineties was in the midst of several controversies. In doing this he lays bare the history of psychotherapy, and its most widespread methodologies while discussing and analyzing some of their outcomes.

According to one of its Oxford English Dictionary (OED)’s definitions, memory is “the faculty by which things are remembered; the capacity for retaining, perpetuating, or reviving the thought of things past”. Therefore, what we call memory is a series of intermingled dynamic processes where information travels in multiple directions. When a stimulus reaches a sensory register it sets up a chain reaction in which information can travel among different ‘compartments’ where it can be stored or else, forgotten.

And as such, memory is not homogeneous, and more than one type of memory can be distinguished. Madeline Eacott a psychologist who works on mechanisms of long-term memory, has been studying the differences between two types of memory – semantic and episodic: (1) episodic memory is what makes up the bulk of people’s early memories – specific places, people, and events; (2) semantic memory concerns memory for words and concepts and general knowledge about the world.

memory process 1

It is accepted that there is an inflexion point in memory development at the age of two. Two hypotheses try to explain why this is so: (1) one is that the brain is still developing and the proper functions of the nervous system for acquiring and retaining memories are not in place; (2) the other is that we are very limited in what we can store and recall until the age at which we develop language: “(…) language would help in some way to ‘fix’ a memory in the brain, so that if you can describe something in words you can remember it better than just storing separate images and sounds, (…)”. Therefore, as mentioned by the psychologist David Pillemer “deliberate attempts to recall an early childhood event years later may fail because the imagistic of childlike memory is incompatible with the adult’s purposeful reconstructive efforts”.

There can be several reasons: medical, legal, criminal… that might bring somebody to attempt to recover memories of past lived events. However, being a dynamic process, memories are continually influenced by a multitude of factors, especially those ones somebody recalls of a particular event; among these factors we find the level of stress to which the individual attempting to remember was subjected at the time of the event’s occurrence:

efficiency of memory

Within this context, it is very interesting the concept of the ‘seductive detail’: a specific happenstance, which although not particularly significant, just by being interesting, might be conducive to recall certain facts but not others. It is for this reason that psychologists point out that, in therapy or while conducting surveys, “communicators should choose their words very carefully, because the minor details that a communicator reports might be as influential as information that has genuine significant value”. Therefore, (…) leading questions could contaminate or distort a witness’s memory, (…), and likewise have the potential for the establishment of false memories that could, or could not, be enhanced by the power of imagination.

False memories “are more than merely incomplete, inaccurate, or imprecise memories. (…) False memories are for things that didn’t happen at all, and may have been created or planted in some way”. The power of imagination refers to the fact that if somebody actually believes has experienced something that person is going to show physiology consistent with that belief; (…) people have all sorts of reasons for believing strongly in events from their past, many of which have nothing to do with whether the events happened or not.

Additionally we have to be aware that people from different cultures are bound to have different perceptions of the world around them, being those particularly apparent in autobiographical accounts. Especially striking, although by no means unexpected, are those ones present among eastern and western populations: Asian cultures place great emphasis on (1) social relations and (2) moral rectitude, while western cultures focus on (1) positioning of individual roles, (2) individual preferences, and (3) individual feelings.

All in all, we can assert that “memory is fallible and the longer ago a memory refers to, the more likely it is that errors will creep in”. At the end, “it seems (…) the ability to remember accurately anything about our personal past can sometimes be no greater than chance”.

Additional References:

Loftus, E.F. 1980. Memory: surprising new insights into how we remember and why we forget. Addison-Wesley Pub. Co., Reading, Mass., xv, 207pp.

On Sexual Abuse and the Victims’ Power to Heal

On the evening of November 21, 2013 Dare to Dream U of M presented at Kraus Natural Science Auditorium a special screening of the 2010 documentary film “Boys and Men Healing”, directed by Kathy Barbini. The film was followed by a panel discussion amongst male survivors of sexual abuse led by survivors Chris Anderson and Jim Struve. Not aware of many events dealing with this issue I decided to attend in the hope of learning something to improve my skills as a medical interpreter. I believe it did.

The American Psychological Association defines sexual abuse as “unwanted sexual activity, with perpetrators using force, making threats, or taking advantage of victims not able to give consent. Most victims and perpetrators know each other. Immediate reactions to sexual abuse include shock, fear, or disbelief. Long-term symptoms include anxiety, fear, or post-traumatic stress disorder. While efforts to treat sex offenders remain unpromising, psychological interventions for survivors — especially group therapy — appears effective.”

The numbers of abuse victims asking for help show that 70% are women and 30% are male. It has been established that these numbers are not related to the actual numbers of abuse victims but to the social stigma among males concerning disclosing abuse. More than one in the audience seemed stunned that perpetrators of sexual abuse on males were 60% male and 40% female.

The Pennsylvania Coalition Against Rape exposes some Common Behaviors of Survivors of Sexual Abuse:

  • Victim privacy is a basic need. The identity of sexual abuse victims should be protected.
  • It is common for survivors of sexual assault to initially deny they were abused.
  • Delayed reporting of sexual abuse is a common, normal reaction from someone who has experienced traumatic events.
  • Many victims continue to have a relationship with their abuser.
  • A victim’s view of the offender’s actions change over time.
  • It is normal for a victim’s story to evolve throughout the investigative process.
  • Victims may deny the abuse they’ve suffered, or misrepresent parts of their story.
  • It is normal for victims to freeze and be unable to physically fend off their abuser.

To those ones, especially in the case of male victims, it can be added that:

  • All touch becomes seen/ perceived as sexual.
  • There might be post-traumatic stress thought by victim – not connected with abuse.
  • In case of female abusers on males, being abuses regularly related/ involved to hygiene/care (bathtub, babysitting), the victim becomes confused about his role of victim.
  • Sexual abuse on males by males creates a barrier/wall between male victims and other males (distrust); there is a psychological trauma related to predation.

Healing is a process conducive to recovery where for the victim it is important to talk. The victim has to understand that manhood is not diminished by weeping or crying and, more important, that asking for help does not imply weakness; on the contrary, it is an act of kindness for oneself. Breaking the silence induces liberation!

anger - violence graphic

Additionally, any guilt should be definitely saved for the perpetrator, not for the victim; there is a strong need for victim to shed off the guilt. Therefore, to provide victims with the most needed support to heal it must be understood, according to The Pennsylvania Coalition Against Rape, that: “No victim – whether a teenager, adult, male or female – should have their instinctive response to being sexually assaulted called in to question. No victim should be expected to prevent or interrupt their abuse. The fault for abuse lies squarely on the abuser.” A repressive society victimizes victims!

healing graphic

Stress was placed in four points for the victims to internalize to help themselves to heal: (1) victims are not alone; (2) the abuse was not the victim’s fault; (3) it is possible to heal; (4) it is never too late to heal.

And, as stated in Male Survivor, in order to heal any male who has been sexually abused, the survivor has to become free of existing male sexual victimization myths and learn the facts, an essential part of the recovery process:

  • Boys and men can’t be victims.
  • Most sexual abuse of boys is perpetrated by homosexual males.
  • If a boy experiences a sexual arousal or orgasm from abuse, this means he was a willing participant or enjoying it.
  • Boys are less traumatized by the abuse experience than girls.
  • Boys abused by males are or will become homosexual.
  • The “Vampire Syndrome” that is, boys who are sexually abused, like the victims of Count Dracula, go on to “bite” or sexually abuse others.
  • If the perpetrator is female, the boy or adolescent should consider himself fortunate to have been initiated into heterosexual activity.

All in all it was established that healing is a personal process and there is the victim’s choice to ask. However, there is the need to provide a safe environment for the victim to open up. And as medical providers (and here I would like to include medical interpreters) we can never assume the gender of the perpetrators. When dealing with a case of sexual abuse, there is the strong need to make non-gendered questions to be absolutely gender neutral.