BICOM Partners
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Ad-hoc interpreting in health care: An introduction

Despite the fact that the European Union recognises only 23 official languages, it is well-known that in most European countries hundreds of different languages are spoken by people of various different ethnic groups. As a result of this diversity, a significant proportion of healthcare consultations concern interactions of health care practitioners with people from ethnic minority communities speaking diverse languages and having diverse cultural backgrounds. Research has clearly indicated that in such intercultural medical consultations the communication process is often less than adequate: miscommunications and misunderstandings are common and patients are often dissatisfied with the care they receive. Ultimately, the poor quality of the communication process might have negative consequences for the health of those whose linguistic and cultural backgrounds differ from that of their doctor. To counter these problems, strategies aimed at improving the communication process between health care providers and patients are desperately needed. One viable strategy is to foster and enhance the linguistic and cultural competencies of healthcare professionals and relatives of the patient, who act as ad-hoc interpreters during healthcare consultations with non-native patients.

During a two-year learning exchange process, healthcare professionals, scientists, public health experts and ad hoc-interpreters have reflected on the theory and practice of ad-hoc interpreting in health care through group discussions, lectures, workshops and so on. Different perspectives on ad-hoc interpreting have been explored and existing practices in a number of European metropolitan areas investigated. The results of this quest are summarized in seven papers, each describing different aspects of the issue of ad-hoc interpreting. In the contribution of Akgul Baylav’s “role of bilingual advocacy in communication”, the conceptual difference between ad-hoc interpreting and bilingual advocacy is highlighted and described. Her main argument is that bilingual health advocates can help bridge the power gap between patients and healthcare providers and that advocacy services are essential in delivering good quality of care to patients who do not speak the same language and have a different cultural background than the healthcare provider. In the second paper, “position of the physician in multilingual communication”, Hans Harmsen outlines the need for physicians to be aware of cultural differences with non-Western migrant patients. Apart from removing linguistic barriers, which requires the help of an interpreter, physicians have an obligation to be culturally aware. In raising their awareness, better mutual understanding with their patients, and as a consequence, better care, can be achieved. Bernd Meyer’s paper on “ad-hoc interpreting in hospitals” starts with a case of a Turkish patient in a German hospital, illustrating the common practice of ad-hoc interpreting in healthcare and the lack of policy when it comes to making use of the linguistic competencies of interpreters. He makes a plea for the development of policies with regard to the linguistic rights of migrant patients and ends his paper with a number of recommendations on how to develop these. In the paper by Ortrun Kliche, “training for ad-hoc interpreters in public health”, proper training for ad-hoc interpreters to improve the quality of interpreted conversations is stressed. She describes several aspects such training could encompass, such as the mutual exchange of experiences, empowering interpreters and Forum Theatre. The paper by Frances Rifkin and John Eversley, “Forum Theatre”, describes this last tool in more detail. The theoretical background and key ideas about Forum Theatre are reviewed and the practice of this “theatre of the oppressed” is briefly summarized. How Forum Theatre can actually be used in practice, is outlined in the paper by Trish Greenhalgh and colleagues, “the science and the art of lay interpreting: using forum theatre to give voice to child interpreters”. This paper describes and reflects on the results of an international workshop in which child interpreters enacted their experiences as ad-hoc interpreters.. Last but not least, Ludwien Meeuwesen’s paper, “which research methodologies are useful for promoting bilingual and cultural competencies in public health?”, gives a clear overview of research methodologies that can be employed in the study of promoting bilingual and cultural competencies in health care. She concludes her paper by stating that in choosing a particular research strategy, the aim of the project and the specific questions to be answered should serve as the main criteria.

All in all, the seven papers presented here highlight various relevant aspects of the theory and practice of ad-hoc interpreting and shed more light on the issues at stake. They also demonstrate that there are no easy answers to this complex issue, and that for every answer, more questions can be raised. Hence, the quest for more knowledge, insight and wisdom continues. Hopefully, the BICOM project will be regarded as a starting point in this respect and will stimulate others to take the lead and proceed on the information gained during the last two years. One thing has become evidently clear though: to improve the quality of care for non-native patients, all parties in the patient-doctor-interpreter triangle have to be taken into account. So, it looks that in this particular case Nietzsche was wrong when he said that it takes two to make a truth. It takes three.

Barbara Schouten, June 2007