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Medical Interpreting andCross-cultural Communication

Claudia V. AngelelliSan Diego State University

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p u b l is h e d b y t h e p r e s s s y n d i c a te o f t h e u n i v e r s i t y o f c a m b ri d g e

The Pitt Building, Trumpington Street, Cambridge, United Kingdom

c a m b r i d g e u n i v e r s i t y p r e s s

The Edinburgh Building, Cambridge CB2 2RU, UK40 West 20th Street, New York, NY 100114211, USA477 Williamstown Road, Port Melbourne, VIC 3207, AustraliaRuiz de Alarcon 13, 28014 Madrid, SpainDock House, The Waterfront, Cape Town 8001, South Africahttp://www.cambridge.org

C Claudia Angelelli 2004

This book is in copyright. Subject to statutory exceptionand to the provisions of relevant collective licensing agreements,no reproduction of any part may take place withoutthe written permission of Cambridge University Press.

First published 2004

Printed in the United Kingdom at the University Press, Cambridge

Typefaces Times 10/12 pt. System LATEX 2 [tb ]

A catalogue record for this book is available from the British Library

Library of Congress Cataloguing in Publication dataAngelelli, Claudia (Claudia V.)Medical interpreting and cross-cultural communication / Claudia Angelelli.

p. cm.Includes bibliographical references and index.

ISBN 0 521 83026 51. Medicine Translating. 2. Intercultural communication. 3. Translating services California Case studies. 4. Hispanic Americans Services for California Case studies.5. Hispanic Americans Hospital care California Case studies. I. Title.R119.5.A53 2004610 .1 4 dc22 2004045688

ISBN 0 521 83026 5 hardback

The publisher has used its best endeavours to ensure that the URLs for external websites arecorrect and active at the time of going to press. However, the publisher has no responsibility forthe websites and can make no guarantee that a site will remain live or that the content is or willremain appropriate.

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To my mother, Angela Rizzo, whose dedication toscience and public health served as an inspiration

To my husband, Christian Degueldre, whose longtime

interest and work in this topic and incredible supporthelped make this work a reality

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Contents

List of gures page ix List of tables x Acknowledgments xi List of abbreviations xiii

Prologue 1

1 Questioning invisibility 7Previous studies on interpreting in a medical setting 12

2 Communication in the medical encounter 15The essence of the doctorpatient relationship 15Communication issues in a bilingual medical encounter 18Navigating across languages and cultures: the need for

interpreters 21

3 A different set of lenses 26Looking at the interpreters role through different lenses 26

The lens of society and the institution 27The lens of the interaction 29The lens of discourse 33

Monolingual and interpreted communicative events:differences and similarities 34

4 California Hope: a public hospital in changing times 44Finding a study site 44

The pilot study 44Obtaining consent 45The in-depth study 46

The town 46The hospital 46The study site 48The staff 48The workplace 52Working hours and interpreters responsibilities 53A typical day at Interpreting Services 55

vii

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Figures

1 The invisible interpreter page 82 The interpreter as co-constructor 83 The visible interpreter 104 Multiple lenses to look at the interpreter in an ICE 275 Interpreting service oor plan 546 Examples of an index entry of an ICE 667 Example of visibility in an index entry 708 The visibility continuum at California Hope 78

ix

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Tables

1 Fundamental notions of monolingual and interpretedcommunicative events page 35

2 California Hope interpreters demographic data 503 Artifacts 604 Field notes 605 Interpreter interpersonal role inventory (IPRI) 626 Interviews 627 Audio recordings of interpreted communicative events (ICEs) 658 Inventory of ICEs 68

x

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Acknowledgments

This book would not have been possible without the help and kindness of theCalifornia Hope community. Over a period of twenty-two months, patients andtheir family members, healthcareproviders, interpreters, and other employees atCalifornia Hope allowed me to intrude in their lives and work, even at personaland delicate moments. To them goes my greatest acknowledgment of gratitude.They cannot be mentioned by name, but they all know who they are, and theywill recognize their contributions to this book.

This book evolves from thoughts and perspectives which I rst presented inmy PhD thesis on an interdisciplinary approach to the role of interpreters acrosssettings (Angelelli 2001). A special acknowledgment goes to Dr. GuadalupeVald es who has been a source of inspiration through both her scholarly work and her commitment to social justice, especially for the Latino population. Sheprovided condence and guidance throughout my work at California Hope. I amalso grateful to Dr. Shirley Brice-Heath for introducing me to the scholarly studyof ethnography of communication, which I applied to medical interpreting. Shehas been a model for me as a scholar, researcher, and writer. I am indebted toDr. Ray McDermott for the extended discussions on analysis of social interac-tion which showed me how to step beyond the boundaries. I also try to followhis steps as a scholar and analyst. I am grateful to Dr. Edward Haertel whocrossed disciplinary boundaries to offer critical support as well as insight intothe research product and process. Although I am ultimately responsible for thenal product, these individuals have had a positive impact on the developmentof this work, and I am forever indebted to them.

Janice Kezirian, MD, is behind this book more than any other single individ-ual. Her scientic knowledge and integrity are evident throughout. Her theo-retical approach to the study of doctorpatient communication, coupled withher experiences as a physician in Mexico and her commitment on a personallevel to making communication and language relevant to medical practice, haveinuenced nearly every interpretation of this book. Her enthusiasm, support,and patience for my work have been very important. Her sense of humor andfriendship are gifts I treasure.

xi

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xii Acknowledgments

Special recognition goes to my husband, Christian Degueldre, an outstandinginterpreter, translator and interpreting professor, and loving human being. Hisprofessional recognition in theeld of interpretingpaved my way into CaliforniaHope. During the data collection period, he was extremely patient with therepeated tales about each day I spent at the site. He has encouraged me in thecompletion of this book, and he has been most helpful in verifying data andreferences, as well as in offering insightful comments on multiple readings of the draft.

I am also grateful to Dr. Cynthia Roy for invaluable comments on sectionsof this book. Her insights and challenges have strengthened my arguments.Additionally I would like to thank Dr. Katherina Brett, Helen Barton, KayMcKechnie, and Dr. Alison Powell of Cambridge University Press for theirguidance in the preparation of this book for publication. My hope is that thiswork and the ndings reported here will be of benet to those concerned withissues of healthcare, and that it will help them promote fair and culturallysensitive communicative environments for speakers of minority languages.

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Abbreviations

ASL American Sign LanguageCH California HopeD doctorEMT emergency medical technicianHCP healthcare providerHI hospital interpreterICE interpreted communicative eventIPRI Interpreter interpersonal role inventoryIS interpreting servicesMAC medical admitting clerk MCE monolingual communicative eventN nurseP patientSES socio-economic status

xiii

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