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3. Ad hoc-interpreting in hospitals

What is 'ad hoc-interpreting'?
Consider the following case: A patient with a Turkish background comes to the hospital because of heart problems. He has lived in Germany for more than 30 years and is now retired. His German is good enough for his daily affairs, but a hospital visit is, usually, not a daily affair. The hospital visit takes a certain time during which time he gets frequent visits from his family, including his oldest son, who was born in Germany and speaks German and Turkish equally well. Right from the beginning, the hospital staff noticed that the patient doesn’t speak German very well, but they make do – in most cases. This patient is able to communicate his needs and understands more less what the staff members want him to do. However at certain moments, the communication with him is noticeably difficult and that’s where the son comes in: he explains treatment decisions, diagnosis, or risk information to his father. After a short while, the staff members start making appointments with the son when they have to talk about difficult matters to the patient. Thus, the son gradually starts acting as an interpreter for his father. Maybe he doesn’t even think about it, and maybe he is acquainted with this task because he is doing it since childhood. Nevertheless, his role changes: he is not just visiting his father any more, like other family members do with their relatives. Rather, he significantly facilitates the work of the hospital employees, especially that of the medical staff. Without this bilingual person, it would have been much more difficult to proceed with the treatment, otherwise crucial information would not have been delivered to the patient because of the language barrier. Therefore, ad hoc-interpreting is typically the spontaneous, relatively unprepared engagement of people with language skills in communication with non-native patients, be they employees with a migrant background, tourists, or business travellers from abroad. Ad hoc-interpreters don’t get paid for their services. The service is usually perceived as a kind of social or moral duty – by themselves and those around them. Some hospitals provide lists of staff members who are willing to act as interpreters on an ad hoc basis, but often staff members don’t know about the linguistic resources of their colleagues and simply have to find out who is speaking other languages when communication with non-native patients breaks down.

Who can act as an ad hoc-interpreter?
Everybody who is present or within reach and speaks the language of the patient and the physician. That can be a nurse or a relative, or a gardener or a taxi driver waiting outside. Usually, communication problems become obvious in cases of emergency, when time is short and solutions need to be found rapidly. Therefore, people mostly don’t care about the professional, educational, cultural, and linguistic background of the interpreter. This is not wise, but as long as nobody complains, all involved parties believe that it works. The interpreters are usually those who notice the difficulties more clearly than others, because only they know what has been said and what actually has been translated. Is ad hoc-interpreting good or bad practice? It depends. By definition, ad hoc-interpreters are not trained for this job, and they don’t get paid. Therefore, the activity is almost completely non-institutionalized and lacks any feature of professional work. However, as communication problems with migrant patients are not that rare, some staff members may acquire a high level of interpreting competence simply on the job. I remember a Hungarian health worker with Russian as his second language who worked in a German-speaking hospital for twenty years – for some reasons he was the only person who was acting as an interpreter for these languages in this hospital, and he had achieved a certain level of expertise and reflection without any formal instruction. Similarly, many professional interpreters outside hospitals who work with so-called exotic languages never had any formal training and learned how to interpret simply by doing it. Therefore, it is not true that all ad hoc-interpreters necessarily perform badly or are unprofessional. Rather, competence depends largely on the professional and educational background, the type of bilingualism (successive or simultaneous), and the motivation of the interpreter. Furthermore, family members often show greater ability to address the patient adequately, by being not too technical or too direct. However, if one is looking for a good interpreter, the topic of the talk should also be considered – for some topics it might be good to have someone who is not linked to the family, while in other cases, it might be crucial to have someone who knows the family from inside. If doctors are in doubt, they should ask the patient – and not only then. For patients it is equally important to communicate through someone they can trust in, as it is for doctors. However, children under-age are usually ruled out – for ethical reasons, not because they are necessarily bad interpreters.

What are the main difficulties in ad hoc-interpreting?
One big problem is the lack of preparation and regulation for ad hoc-interpreting as such. It starts with the detection of language problems – usually nobody systematically checks whether migrant patients have sufficient linguistic skills for medical communication. From the moment they are admitted at the hospital they are treated just like other patients. Thus, the problem is usually detected by chance, and then the search for an interpreter is not organized and regulated. Doctors are not trained to handle this situation, just as they are not trained to communicate via an interpreter. Similarly, ad hoc-interpreters are often not consciously taking the role of an interpreter by organising the interaction and steering the flow of talk. They don’t know how to stop the doctor if the talk is getting lengthy, and they don’t slow down the patient if he is looking for more support than the interpreter is willing or able to give. However, typical problems of ad hoc-interpreting in hospitals entail medical topics and technical terms on one hand, and the purposes of medical talk on the other. It’s not just knowing that inscrutable medical language, but also knowing why doctors talk about certain things in certain ways: “one can take a sample then” is not equal to “they will take a very small sample”, and “we would like to do an ultrasound” Is not equal to “they will do an ultrasound”. Thus, communication sometimes depends on inconspicuous linguistic forms which ad hoc-interpreters tend to disregard.

Should ad hoc-interpreting be abolished?
No. Although some alternative models exist (telephone interpreting, patient advocates), ad hoc-interpreting will continue to play an important role in providing medical care to migrants – despite all problems. However, it would be a great step ahead if hospitals would develop policies regarding the linguistic rights of migrant patients. This includes:

  • The duty for all hospital employees to address the language issue whenever they feel that it could be a serious problem.
  • Training for bilingual hospital employees who are willing to act as ad hoc-interpreters, Chapter 4
  • Training for medical staff in working successfully with interpreters, Chapter 2 and Chapter 4
  • Acknowledgement and remuneration for bilingual hospital employees who are willing to act as ad hoc-interpreters.
  • Development of internal accredited interpreting services for hospitals which have a high percentage of migrant patients.

Bührig, K. & Meyer, B. 2004. Ad hoc interpreting and achievement of communicative purposes in briefings for informed consent. In: J. House & J. Rehbein (eds.) Multilingual communication. Amsterdam: Benjamins, 43-62.
Interpreting – International Journal of Research and Practice in Interpreting, Vol.7, No.2, 2005. Special Issue on Healthcare Interpreting: Discourse and Interaction.