Informal Interpreters in Medical Settings (2012)

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Informal Interpreters in Medical

SettingsBarbara Schoutena, Jonathan Rossb, Rena Zendedelc&

Ludwien Meeuwesenc

aUniversity of Amsterdam, Netherlands

bBoazii University Turkey

cUtrecht University, Netherlands

Published online: 21 Feb 2014.

To cite this article:Barbara Schouten, Jonathan Ross, Rena Zendedel & LudwienMeeuwesen (2012) Informal Interpreters in Medical Settings, The Translator, 18:2,311-338, DOI: 10.1080/13556509.2012.10799513

To link to this article: http://dx.doi.org/10.1080/13556509.2012.10799513

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ISSN 1355-6509 St Jerome Publishing Manchester

The Translator. Volume 18, Number 2 (2012), 311-38 ISBN 978-1-1905763-35-1

Informal

Interpreters in Medical SettingsA Comparative Socio-cultural Study of the Netherlands

and Turkey

BARBARA SCHOUTEN

University of Amsterdam, Netherlands

JONATHAN ROSS

Boazii University, Turkey

RENA ZENDEDEL

Utrecht University, Netherlands

LUDWIEN MEEUWESEN

Utrecht University, Netherlands

Abstract.Between 2008 and 2010, academics in five Europeancountries collaborated on an EU-funded project, Training Inter-

cultural and Bilingual Competences in Health and Social Care

(TRICC). Among TRICCs aims was to deepen understanding of

informal interpreting through eliciting the perspectives of inter-

preters themselves. To identify commonalities and differences in

the experiences, attitudes and practices of informal interpreters

in distinct settings, the Dutch and Turkish partners interviewed 15

young migrant adults in the Netherlands and 15 Kurdish speakers

in Istanbul respectively, asking them about emotional and techni-cal aspects of interpreting, and about their expectations and roles,

communicative challenges and actions. Thematic analysis of the 30

interviews corroborated the findings of previous research namely,

that informal interpreters are highly visible, use diverse commu-

nicative strategies, adopt various roles, and occasionally speak as

primary interlocutors. Noticeable differences between the two sets

of interpreters included their attitudes towards interpreting and

their preferences for informal versus professional interpreting,

both of which can be better understood in the light of the cultural

backgrounds of the interpreters and the institutional and political

frameworks within which they interpret. This comparative study

appears to support Angelellis (2004a) claim that interpreted events

are heavily influenced by socio-political and cultural contexts.

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Informal Interpreters in Medical Settings312

Keywords. Informal interpreting, Healthcare, The Netherlands, Turkey,

Kurds, Policy.

Many medical interactions that take place throughout the world involvehealthcare providers and patients of different cultural, linguistic and ethnic

backgrounds. In some cases, the patient is a migrant, refugee, tourist or tem-

porary visitor, in other cases, the member of an indigenous or long-established

minority. When a healthcare provider has to deal with a patient with no or

limited knowledge of the dominant language, the lack of a shared language

can seriously threaten the interaction. Several studies have shown that the in-

ability of patients to speak and understand their doctors language leads to a

number of negative consequences for both parties, such as an increased chance

of non-compliance, feelings of fear and despair, and problems in achievingrapport, all resulting in a lower quality of care as compared to the healthcare

received by patients who share their doctors cultural, linguistic and ethnic

background (Bhopal 2007, Ramirez 2003, Stronks et al.2001).

In many countries, the number of patients from diverse backgrounds is

significant. For instance, in the Netherlands around 20% of the population

(about 3 million citizens) consists of first or second-generation migrants (Cen-

tral Bureau of Statistics 2012), half of whom are from Western and half from

non-Western countries, mostly Turkey, Morocco, Surinam and the Antilles.

Research on the latter population has suggested that around half of this grouphave limited proficiency in Dutch. A study conducted in Rotterdam, a city

where almost half of the citizens are of non-Western background, showed that,

irrespective of whether or not interpreting is provided, one in three medical

consultations between general practitioners and non-Western migrant patients

is characterized by poor communication and misunderstanding, which ulti-

mately results in low patient satisfaction (Harmsen et al. 2008:11). Although

there are currently no official figures concerning the use of interpreters in

Dutch general practice, preliminary results suggest that the majority of gen-

eral practitioners make use of informal interpreters in communicating with

those non-Western migrant patients who lack sufficient proficiency in Dutch

(Meeuwesen and Twilt 2011:15).

In Turkey, on the other hand, it is the existence of a sizable indigenous

minority, the Kurds, which poses the biggest challenge for medical commu-

nication involving multiple languages. Statistics for the Kurdish population

vary enormously, partly due to the lack of reliable official demographic data,

partly because of the highly politicized nature of the Kurdish question, which

has encouraged people, including scholars, to downplay or exaggerate thenumbers. Back in 1996, for instance, the Kurds were estimated to make up

between 5 and 25% of a population of around 60 million (Mutlu 1996:517),

and the debate on figures continues (Gzel 2009). According to one recent

study, 46% of Kurdish mother-tongue speakers in Turkey have not completed

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B. Schouten, J. Ross, R. Zendedel and L. Meeuwesen 313

their primary education, and 33% of this group have limited or no competence

in Turkish, with women making up 90% of the total (Grsel et al. 2009:3, 6).

Since many healthcare providers, including those of Kurdish origin, do not

speak Kurdish, patients limited proficiency in Turkish frequently results inthe need for interpretation. In a survey conducted in 2008 and 2009 among

253 doctors in the region of Diyarbakr, the most populous city in the East ofTurkey,1just under half of the doctors questioned reported having to seek the

help of a member of staff or companion of the patient in order to communicate

with the patient (Diyarbakr Tabip Odas 2009).To deal with the above-mentioned communication problems, governments

and NGOs have sought to expand the provision of professional interpreting

and advocacy services. In the Netherlands, medical interpreting and translation

services have been organized by the government since 1976 and provided forfree since 1983. As the Dutch healthcare inspectorate regards the use of profes-

sional interpreters as the golden standard, and the Law on Medical Treatment

(1995) places the onus on healthcare providers to communicate in a language

the patient can understand, ethnic minority patients in the Netherlands with poor

language proficiency in Dutch have the right to a professional interpreter free

of charge. The expenses are covered by the Ministry of Health, Social Welfare

and Sport, and the interpreting is provided by the Dutch Interpreter and Transla-

tor Service, which supplies professionally-trained interpreters working in over

130 languages. In daily practice, however, Dutch healthcare providers do notfrequently deploy these professional interpreters, mainly because they are not

familiar with the service. Instead, they tend to make use of family members and

acquaintances the patients bring along to help them communicate with the doc-

tor (Meeuwesen and Twilt 2011:15). Furthermore, in the coming years, the use

of these informal interpreters is likely to increase, because the free provision of

professional interpreting services will soon be scrapped. In a letter dated 25 May

2011, the Dutch Minister and Secretary of State responsible for health informed

the Lower House that all funding for interpretation and translation services in

healthcare would be withdrawn from the beginning of 2012. The main argu-ment used to justify these cuts is that patients/clients (or their representatives)

are responsible for their own command of the Dutch language (Schippers and

Veldhuijzen van Zanten-Hyllner 2011:4).

Whereas in the Netherlands official policy had aimed (at least on paper)

to cater to the needs of inhabitants with limited proficiency in Dutch, up until

the 1990s the Turkish state tried to solve the problem of inadequate com-

munication between Turkish speakers and speakers of other mother tongues

simply by insisting that the latter learn and use Turkish. This policy reflected

the civic nationalist ideology of the Republic, which was encapsulated in the

slogan One state, one nation, one flag, one language. The policy of stringent

1The East of Turkey will subsequently be used to encapsulate the geographical regions

of Eastern and Southeastern Anatolia.

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monolingualism climaxed in 1983 with the passing of Law 2932, nominally

concerned with the prohibition of publications in languages other than Turkish

but also declaring Turkish to be the mother tongue of all Turkish citizens and

attempting to effectively ban people from speaking Kurdish (Kubilay 2004:72).However, since 1991 (when Law 2932 was repealed, although some limitations

remained) a more flexible approach to minority languages and the Kurdish

issue has prevailed, impacting also on the medical sector. On the one hand,

there has been a marked increase in the number of Kurdish-speaking health

professionals working in the East of Turkey, who now freely communicate with

their patients using one of the two main Kurdish dialects in Turkey, Kurmanji

and Zazaki;2on the other hand, Article 18 of the Regulation on Patients Rights

(Hasta Haklar Ynetmelii, 1998) at least shows some acknowledgement of

the possible need for interpretation, stipulating that [i]nformation should besupplied to the patient in a comprehensible manner, using an interpreter if

necessary (our translation and emphasis). So far, however, next to nothing

has been done to train, accredit or pay professional interpreters, and doctors,

patients and their interpreter-companions (including all those interviewed

in this study) seem largely ignorant of this vague legal obligation.3Thus, in

Turkey as in the Netherlands, the use of informal interpreters be they family

members, friends, untrained hospital staff or even fellow-patients persists

as common practice.

1. Research background and objectives

Faced with this reality, between November 2008 and November 2010 scholars

from universities and representatives of non-governmental organizations in

Germany, Holland, Italy, Turkey and the UK collaborated on an EU-funded

multilateral project, Training Intercultural and Bilingual Competences in

2Although there is no statistical evidence available to support this claim, many Kurdishcitizens and doctors working in the region have mentioned this development to us. In ad-

dition, in the last three years, several meetings aimed at promoting the use of Kurdish in

the medical sector have been organized by non-governmental organizations, events that

would have been unthinkable just five years ago. These include the Mesopotamia Health

Days conferences held in Diyarbakr in 2009, 2010 and 2012 and in Dohuk (NorthernIraq) in 2011, and the symposium on Mother Tongue and Health, jointly organized by

the Turkish Medical Association and the Union of Health and Social Services Workers in

Ankara on 27 March 2010.3In their pioneering study on community interpreting in Turkey, Ebru Diriker and ehnaz

Tahir-Gralar likewise acknowledge that while numerous laws do mention, and containmeasures relating to, interpreting in different public settings, [t]here are a number ofloopholes and limitations that need to be overcome (2004:85); in particular, the authors

point to the relatively arbitrary way in which interpreters are recruited and the failure of

the Turkish authorities to demand appropriate academic and professional qualifications

from would-be interpreters .

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Health and Social Care (TRICC).4The objective of TRICC was to develop,

run and evaluate training programmes and materials for people who had served

or were likely to serve as informal interpreters, as well as for the healthcare

workers and patients with whom they interact. At the same time, TRICC aimedto draw attention to the perceived inappropriateness of informal interpreting

by minors in particular. Early on in the project, the Dutch partner carried out

a set of structured interviews with informal interpreters. Meanwhile, the Turk-

ish partner was conducting preliminary library and fieldwork on the hitherto

unresearched area of informal interpreting in Turkey, consulting health pro-

fessionals, patients and interpreters in the East of Turkey. When the Turkish

team shared their findings with their Dutch and other partners in TRICC, they

noted some interesting similarities and differences. To explore them more

thoroughly and systematically, the Turkish group decided to adapt and applythe questionnaire their Dutch partners had used, in order to gather data that

would enable a more structured comparison of the experiences, practices and

attitudes of informal interpreters in these two countries.

The present paper reports on these data, documenting and discussing both

the parallels and dissimilarities between informal interpreters in these ter-

ritories at opposite ends of Europe. Our rationale for comparing the two sets

of interpreters, who perform their tasks in such different settings, is to trace

the impact of the socio-political and cultural context on informalinterpreters

and on the doctor-patient consultations interpreted by them. Since the 1990s,a strong tendency has emerged in the literature on interpreting, especially on

community interpreting, to consider the role of interpreters in relation to the

social contexts in which they operate (Angelelli 2004a, Berk-Seligson 1990,

Davidson 2000, Hsieh 2006, Roy 2000, Wadensj 1992). Such research has

been very effective in demonstrating the social and political situatedness of

what Claudia Angelelli terms Interpreted Communicative Events (2004a:8),

but the interpreters whose actions are analyzed tend to be professional in-

terpreters, not informal ones. Moreover, these studies invariably focus on a

single territory and rarely attempt to compare the experiences of interpretersin different geographical and cultural settings. Even AngelellisRevisiting the

Interpreters Role: A Study of Conference, Court and Medical Interpreters in

Canada, Mexico, and the United States(2004b) reveals surprisingly little about

the relationship between the role definitions of the 293 interpreters surveyed

and the conditions in the country in which they live and work, despite the

fact that these three countries have quite different demographics and distinct

political traditions, histories, institutions and norms with respect to interpret-

ing. Our study aims to address this gap in interpreting research.

Previous research on informal interpreting in medical settings haslargely involved critical analysis of the (recorded) performances of informal

interpreters or discussion of the experiences of health workers and patients who

4See http://www.tricc-eu.net/(last accessed 13 March 2012).

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rely on these interpreters. The first line of research invariably documents the

negative effects of informal interpreting on communication and on practical

and clinical outcomes. For instance, it has been noted that interpreting errors

are common (Flores et al. 2003), crucial information is lost (Bhrig andMeyer 2004, Cambridge 1999), important linguistic and discursive features

of the communication are altered by interpreters (Aranguri et al.2006), and

quality of clinical care is compromised (Karlineret al.2007). Results of the

second line of research partly reflect these negative effects by commonly

documenting negative experiences from the perspective of healthcare providers

(Hornbergeret al. 1997, Pchhacker 2000, Rosenberget al. 2007), in particular

when children are used as informal interpreters (Cohenet al. 1999). Patients

themselves report more varied experiences, ranging from having more trust

in informal interpreters as compared to formal ones (Edwardset al. 2005)to preferring professional interpreters because they offer a higher quality of

service (MacFarlane et al.2009, Ngo-Metzger et al.2003).

Although these two lines of research have provided valuable insights into the

practice of informal interpreting in healthcare settings, some crucial elements

have so far been neglected. For one thing, we know remarkably little about this

area from the perspective of the interpreters themselves. With the exception of

a few isolated studies (Green et al. 2005, Rosenberget al. 2008, Valds 2003),

little has been published on how informal interpreters working in medical set-

tings perceive their own roles and performances. In the present article, therefore,we focus on the interpreters themselves. However, as mentioned earlier, rather

than offering a decontextualized and deterritorialized analysis of interpreters

responses, we aim to examine the situatedness of interactions between healthcare

providers, patients and interpreters in distinct socio-political contexts. In addi-

tion, since it is widely recognized that the diverging cultural backgrounds of the

parties involved can have considerable influence on the medical communication

process (Schouten and Meeuwesen 2006:21), we will scrutinize how the cultural

backgrounds of informalinterpreters impact on the interpreting situation. At the

same time, we are interested in seeing whether there may nevertheless exist moreuniversal patterns of behaviour and discourse that stem from the particularities

of the situation where an untrained volunteer interprets in a medical setting for

a patient often the interpreters relative and a health professional.

2. Research design

For the sample in the Netherlands, we attempted to gather data from 20 young

migrant adults through personal contacts and a snowballing method. The main

criterion for inclusion was that they had experience in informal interpretingas children (at least before the age of 19) and/or currently interpreted on a

regular basis. As we strove to gain a broad picture of the contexts and issues

present in informal interpreting in medical settings, no criteria were set in

terms of their ethnic background; in addition, we approached both men and

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women. Of the 20 interpreters approached, 15 agreed to participate (5 men, 10

women). These 15 interpreters had either migrated to the Netherlands as young

children or were born in the country. Most (11) of them belong to the two larg-

est ethnic minority groups in the Netherlands: Moroccans (8) and Turks (3).5

Other ethnic backgrounds in the Dutch sample were Azeri (2), Iranian (1) and

Italian-Colombian (1). Three of the Moroccan interpreters interpret between

Dutch and Berber, three between Dutch and Arabic, and two between Dutch,

Berber and Arabic. The three Turkish respondents interpret between Turkish

and Dutch, the two Azeris between Russian and Dutch, the Iranian between

Farsi and Dutch, and the Italian-Colombian between Italian and Dutch. The

mean age of the interviewees was 23 (the age range being 19-34), and all had

been educated to at least secondary vocational level, with 10 being students

or graduates of vocational education institutions or universities. The young-est age at which they had started to interpret was 6, the oldest 18. Length of

experience in interpreting ranged from 5 to 16 years, with a mean of just over

10 years. The frequency with which the interviewees currently interpret varies

greatly: some interpret just a few times a year, others interpret several times

a week. All but one of them still interpret, mainly for one or both parents, or

for other relatives. Two also interpret for acquaintances.

In terms of ethnicity, the group of respondents in Turkey was more

homogenous than that in the Netherlands. All 15 interviewees (6 women, 9 men)

were born in Turkey and live in or near Istanbul. They are connected with eitherof the two main groups commonly classified as Kurds: 9 are members of the

Kurmanji-speaking minority, 4 are ethnic Zazas, and 2 are of mixed heritage.6

Eleven interpret between Turkish and Kurmanji, two between Turkish and Zazaki,

and two between Turkish and both Kurdish dialects. At the time of the interviews,

they were mostly in their twenties (ten respondents), three in their 30s, and two

were 40, resulting in an average age of 28 (the age range being 22-40). As with

the sample from the Netherlands, the majority of respondents (ten) were in, or

had completed, tertiary education. However, in order to gain some insight into

the experiences of less-educated Kurdish-speaking informal interpreters, whoare probably more representative of those performing this activity at large, four

people who had left school at or before the age of 14 were also interviewed. The

5 In tIn the Netherlands, people of Moroccan descent are estimated to number around

67,000, while there are around 91,000 individuals of Turkish descent (Central Bureau

of Statistics 2012).6It has long been a controversial, heavily politicized issue in Turkey whether the Zazas

(estimated to number somewhere between 500,000 and 3 million) should be considered part

of the Kurdish minority, alongside the much larger group of Kurmanji-speakers, or whetherthey constitute a community quite distinct from them (van Bruinessen 1994). This debate

parallels, and feeds on, the discussion on whether Zazaki is a Kurdish dialect that is a close

relative of Kurmanji or an entirely different language (Scalbert-Ycel 2006). However, since

many Zazas including our respondents seem to identify themselves subjectivelyas Kurds including our respondents seem to identify themselves subjectively as Kurdsseem to identify themselves subjectively as Kurds

(van Bruinessen 1994:1), we decided to include Zazas among our respondents.

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mean age at which respondents had started interpreting was around 13, with the

range being between 4.5 and 21, although most (9 out of 15) started at some

point between 11 and 16. The interviewees had been interpreting for an average

of more than 15 years. Similarly to the Dutch sample, there was great variationin the frequency with which respondents interpret, with the students generally

only interpreting when they return to their hometowns in the summer, and the

two housewives interpreting in different contexts on an almost daily basis. Seven

of the interviewees said that they had only interpreted for older female relatives,

while eight reported assisting both male and female relatives. Eight respondents

(i.e. around half of the sample) mentioned cases where they had interpreted for

strangers they met at the hospital or even on the way to the hospital.

The data we gathered from the interviews are accounts of the issues our

respondents chose to talk about, guided by a broad topic list (see Table 1 for a sum-mary), to ensure that themes known to be relevant from the literature on informal

interpreting were discussed. Interviews, lasting about 45 minutes, were thus held

in a semi-structured in-depth format, to leave enough room for the respondents to

tell their own stories, although themes were discussed in the same order in every

interview. The questions addressed their background, personal history of interpret-

ing, experiences of and feelings about interpreting (as well as feelings reported

by those they interpreted for), roles, strategies and actions in the triad, and other

emotional and technical aspects of their performances as informal interpreters. The

resulting corpus of 30 interviews was subjected to a thematic content analysis. Themost common or striking themes and issues are outlined below.

Language and family background Which languages do you speak at home, at the doctors office, with

friends, etc.?

How proficient are you in these languages?

How often do you speak these languages?

For which family members have you interpreted?

Do other members of your family interpret?

Interpreting experiences: general From what age have you been interpreting and for whom?

In which situations?

Are there differences between these situations? If so, why?

Technical aspects of interpreting Do you consider yourself a good interpreter?

Are there specific topics that you find harder to interpret than others?

Do you always succeed in interpreting, and if not, when and why does itgo wrong?

And what goes well?

Can you describe a situation in which miscommunication occurred? Why

did this happen and how did you solve it?

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Emotional aspects of interpreting What aspects of interpreting do you like?

What aspects of interpreting dont you like?

What are the easier and more difficult emotional aspects of interpreting?

Communication, attitudes and roles During medical conversations, how do you get on with the doctor and

the person you are interpreting for?

How would you describe your role as an interpreter?

Can you describe a situation in which a conflict arose during a medical

conversation you were interpreting?

What causes communication problems between the doctor and the patient

(language, cultural issues, etc.)?

What do the doctor and patient expect from you? In your opinion, what could be improved during medical conversations

with you as an interpreter?

Would you prefer to have formal interpreters interpret for your family?

Do you think your family prefer formal interpreters? Why?

Table 1. Topic list for interviews

3. Interview results

The results of the interviews can be summarized under three headings: tech-

nical and emotional challenges; communication and attitudes; and role(s) of

the interpreter.

3.1 Technical and emotional challenges

Two thirds (10) of the Dutch interpreters considered themselves good interpret-

ers and felt they had sufficient command of both languages to give an adequatetranslation of the conversation. As a whole, the interviewees in Turkey seemed

slightly less satisfied with their performances, with eight claiming that they

interpret successfully and seven evaluating themselves negatively. Technical

challenges of interpreting were mentioned in all the Dutch interviews, though

particularly frequent reference was made to the difficulty of translating medi-

cal terms, such as those relating to medication, body parts or diagnoses. Like

their counterparts in the Netherlands, many (ten) of the interviewees in Turkey

recalled facing difficulties rendering the names of body parts, illnesses and

medical procedures into Kurdish. While eight attributed this to the limitationsof their own vocabulary and to the fact that they had acquired Kurdish only

within the family and community, not receiving any academic or specialist

education in it, two stated that their mother tongue, Zazaki, was itself a vil-

lage language (ky dili) that lacked specialist terminology, since it had not

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had the chance to develop and to be applied in different fields. Dutch-speaking

respondents made a similar point about the Berber language, which they see

as a language for the home that lacks equivalents to Dutch medical terms.

In addition to mentioning these technical challenges, both sets of interview-ees referred to negative affective dimensions of their interpreting work. Among

the interpreters in the Netherlands, the number of such aspects mentioned in the

interviews was three times higher (51 comments) than the number of positive

emotional aspects (17 comments). Two thirds found it particularly challenging

to interpret topics connected with sexuality, as they and/or the patients felt

embarrassed to talk about sex, genitals and diseases related to sexuality:

Well, it is about being embarrassed, isnt it? You feel embarrassed

towards the patient and also towards the doctor, you know. Once,there was this woman ... and she said: A doctor is a doctor, you can

just [translate]. But I was so ashamed! I just could not [do it], but

anyway, I had to tell everything, and she even started to talk about sex,

that when she slept with that man it hurt .... At one point I thought: do

I really have to translate all this? And she started to say where exactly

it hurt, and then I thought: oh, these kinds of things are hard. 7

Likewise, a significant majority (12) of the interviewees in Turkey either

recalled their own awkward experiences of interpreting for a patient with aproblem affecting their genitalia or with some other condition perceived as

embarrassing or shameful, or speculated that such a situation would make them

and the patient feel uncomfortable. One interpreter, for instance, recounted

the difficulties he faced in getting his father to talk openly about a prostate

condition. The grandmother of another interpreter had complained at home

about having a burning sensation when urinating but told the doctor she had

had a headache and mentioned some symptoms related to her ongoing diabetes

and heart problem. According to several respondents in Turkey, patients and

interpreters were especially uneasy about discussing taboo topics when theinterpreter and/or doctor were of the opposite gender to the patient. A total of

eight male interpreters mentioned occasions when they felt awkward about

interpreting for a woman with a gynaecological problem or stated that they had

not had such an experience but knew that they would find it very embarrassing

or even impossible to deal with. Five respondents made the point that there

are many patients who are ashamed of talking about such matters with a doc-

tor of the opposite sex. However, those respondents in Turkey who addressed

this issue gave the impression that what disturbed the relatives for whom they

had interpreted was not so much being examined by a doctor of the oppositesex as talking about gynaecological and similar matters in the presence of a

7Unless noted otherwise, all subsequent translations from the Dutch and Turkish are

our own.

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young relative. Three respondents emphasized, moreover, that this seemed

more disconcerting for female patients who were around the same age as their

interpreter than it did for patients from an older generation.

A noticeable difference between the two groups of interpreters concerns theirattitudes towards having to interpret for family members and acquaintances.

Six interpreters in the Netherlands reported experiencing feelings of conflict

between their obligation to interpret for their parents and their own, often

hectic, schedules such feelings were not voiced by any of the respondents in

Turkey. Furthermore, two Dutch-speaking interpreters expressed annoyance at

the fact that their parents did not learn Dutch themselves: Sometimes I think:

why dont you have command of the [Dutch] language? I understand that it is

quite a difficult language, but it would really make things easier if my parents

could speak Dutch. In contrast, a clear majority of the interviewees(12)inTurkey made it very clear that what upset them about performing this role was

having to interpret at all for a person whose mother tongue (i.e. Kurdish) was

actually the most widely-used language in that area, whereas the doctor was

speaking Turkish, the mother tongue of a minority in Southeastern Anatolia, but

the sole official language nationwide. Five interviewees commented on how

sorry they felt that their parents and elders were in the humiliating position of

having to rely on them. All 12 of the above-mentioned interpreters noted that

it would be preferable if the patient and doctor conversed in Kurdish, so that

there would be no need for an interpreter.8

As they saw it, getting someone tointerpret between a Kurdish-speaking patient and a Turkish-speaking doctor

effectively meant upholding the exclusive dominance of Turkish in the public

sphere, whereas they wanted to see a higher degree of parity between these

two languages. In the words of one of them, In fact, interpreting means doing

something that is forced on you by the state.

Although interpreting was generally regarded as a burden, in particular

by the Dutch-speaking interviewees, none of our interviewees had ever

thought of refusing a request to interpret. At the very least, they felt they had a

responsibility to help those in their family or community less capable of com-municating with the healthcare providers. Thus, respondents in both countries

had ambivalent feelings about their interpreting work. Eleven interpreters in

the Netherlands mentioned that it was normal to give something back to their

parents or other family members, and that the act of interpreting was part of

8 This position concurs with the policy backed by activists and supporters of the former PeaceThis position concurs with the policy backed by activists and supporters of the former Peace

and Democracy Party (BDP), the most popular party in many areas of the East of Turkey. The

same idea underlies the efforts of the Diyarbakr Chamber of Medicine, who are engaged in

various projects to develop Kurdish as a language of medicine and to improve the Kurdishcompetence of doctors working in the region. In 2009 the Chamber published a book,Krte

Anamnez/Anamneza bi Kurmanc (Anamnesis in Kurdish), which presents Kurmanji andTurkish versions of the questions general practitioners and specialists will need when taking

a patients history (Blbl et al.2009). This was followed in 2010 by the publication of a

manual for obtaining informed consent from Kurmanji-speaking patients.

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their responsibility to take care of them. In the Turkish case too, providing

interpretation was regarded very much as part of everyday family life. Talk-

ing about interpreting as a child, one woman commented, You see it like

any other request, like Take this glass to the kitchen and bring an ashtraysomething usual normal a striking illustration of how interpreting is

lumped together with the various other tasks children in Turkish and Kurdish

societies are expected to perform for their seniors. This concurs with the find-

ing of Rosenberg et al.concerning various family interpreters in Canada, for

whom [i]nterpreting is just one of many family [sic] roles family interpreters

carry out (2007:92).

Moreover, ten of the Dutch-speaking interpreters and seven of those in

Turkey said that they actually derived satisfaction from helping people through

interpreting. One of the latter, who grew up in a small village where very fewpeople spoke Turkish, emphasized that being able to interpret heightened his

status within the family and community and made him feel rather special. Other

positive consequences mentioned were the fact that the interviewees had the

opportunity to improve their own social, communicative and linguistic skills:

It is instructive. . You learn specific words you never use, for instance in

Russian or the other way around: I know the word in Dutch, but I dont

know how to say it in Russian .... It was instructive to [interpret].

3.2 Communication and attitudes

Twenty-two fragments in the Dutch interviews refer directly to the medical

communication process: 11 in positive terms, 11 in negative terms. In general,

the interpreters in the Netherlands commented positively on their experience of

communicating with general practitioners. Most of them were patients of the

same GPs as their parents, so the family had established a relationship of trust

with their doctor. In contrast, the negative fragments refer to communicating

with medical specialists, with whom such a relationship is absent. According

to the Dutch interviewees, specialists are impatient, use too much medical

jargon, and seem to be annoyed by the fact that the interpreted communication

takes up too much time.

The interviewees in Turkey pointed to three kinds of responses from doctors.

Nine interviewees had not personally experienced any uneasiness or aggressive

demeanour on the part of doctors when it became clear that the patient could

not speak Turkish and that the interviewee was there to interpret. However, two

respondents felt that the doctor was reluctant to communicate with them, giving

the impression that he or she was thinking Ive got enough on my plate withouthaving to deal with you lot, as one interviewee put it. The remaining four in-

terviewees mentioned occasions when they had actually ended up arguing with

doctors: in two of these instances, the interpreter believed the doctor was not

giving the patient the attention they deserved, whilst in the other two the doctor

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simply insisted that the patient address him or her in Turkish, even though it

was patently impossible for them to do so. Notwithstanding these quite extreme

examples of conflict, the picture the respondents paint of doctors responses is

probably very different from what one would have witnessed in Turkish hospitalsand clinics twenty years ago, when doctors who communicated with patients in

Kurdish faced persecution (Maviolu 2010:20).Turning to interpreters perceptions of the process of communicating with

the patient, ten Dutch-speaking interpreters reported negative experiences.

They felt that patients demanded too much from them, for instance by get-

ting them to repeat the same information over and over, or by asking them to

translate information which was, in the interpreters opinion, irrelevant. They

also sensed that patients were frustrated and distrustful, feelings that stemmed

from them being entirely dependent on the interpreter. As for the interpreters inTurkey, although ten claimed that they had a good rapport with the patient dur-

ing the consultation, four admitted that they often found elderly relatives rather

stubborn, demanding and sceptical. One respondent related the story of when

she had gone to see an eye specialist with her grandmother-in-law, who was

hoping to have an operation to correct her sight. When the respondent relayed

the doctors judgement that such an operation was too risky given the patients

age, the grandmother-in-law accused the interpreter of deliberately adding this

message in order to avoid the costs of such an operation. Another interpreter

similarly recalled being accused by her own grandmother, who lived with her,of making up the doctors advice that she diet in order to save on food expenses.

Such examples reveal the potential for problems when the informal interpreter

has multiple and possibly conflicting interests with respect to the patient a

situation all the more likely when the two are connected by the strong bonds of

an extended family. As is evident from the two examples, things become more

complex still when the patient has little grasp of health issues.

Suggestions made by interpreters in the Netherlands to improve doctor-

interpreter-patient communication ranged from doctors allocating more time to

these triadic conversations and showing more concern for their patients, to organ-

izing formal interpreters in their practices, for instance by having them available

a couple of hours each week. For two-thirds (10) of the interviewees in Turkey,

the optimal solution was that Kurdish-speaking doctors should be employed or

Turkish doctors coming to the area should learn Kurdish.9For the most part,

their prime demand was not that the Turkish state should provide professional

interpreters but that the indigenous population should be able to communicate

with doctors in their own language. As one student put it rather passionately,

9 With regards to areas outside the East with large Kurdish populations, three intervieweesWith regards to areas outside the East with large Kurdish populations, three interviewees

suggested that Kurdish-speaking doctors could be deliberately hired there and Kurdish

speakers would naturally gravitate towards such doctors. For a real-life example of the

latter-mentioned phenomenon, see Maviolu (2010), a portrait of a Kurdish-speakingdoctor working in Istanbul.

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Im not asking for my family to have a formal interpreter. because

its my country Im living in . My family has been living on their

own land for thousands of years. Thats why I want them to have

their own doctors, using their own language. Were not Turks liv-

ing in Germany; were Kurds living in Kurdistan . Were the real

owners of this land . Im not demanding [professional interpreting

services]; in fact I want exactly the opposite.

Aside from such ideological considerations, another reason why informal

interpreters and their families in Turkey have doubts about the viability of

interpreting as a solution to their communication problem is arguably the

damage that negative experiences of informal interpreting have done for the

reputation of interpreting in general. Based on a history of interpreting byinappropriate people10with poor competence in both languages, with little

biomedical knowledge, with no training in effective interpreting methods,

and scant awareness of ethical issues such as confidentiality, transparency

and accuracy, ordinary citizens and health professionals alike tend to tar all

interpreters with the same brush. Thus, in the editors preface to Anamnesis

in Kurdish, we find the comment Patient histories and complaints conveyed

to doctors through an interpreter are unreliable and may give rise to wrong

diagnoses and treatments (Adem Avckran, in Blbl et al.2009:8). This

generalization of course flies in the face of successful interpreting practicesin healthcare settings elsewhere in the world.

While Dutch-speaking interpreters acknowledged the superior (language)

skills of professional interpreters, 13 preferred to interpret themselves, giving

both practical and affective reasons for this. Besides feeling obliged to help

their relatives by interpreting, they also incorrectly assumed that it was too

expensive to hire a professional interpreter, as well as overly complicated. In

contrast, according to one interpreter, informal interpreting is simple: you

ask your son and he goes with you. Or you have to arrange a [professional]

interpreter, and I dont know, it sounds much more complicated than canyou come with me, do you have time?. The misconception that patients

themselves are responsible for solving their language problems, which is also

widespread among healthcare practitioners, might have been leading these

interviewees to resort to doing the interpreting themselves. However, many

of their remarks also reflected a general sense of mistrust towards formal

interpreters; they were, in essence, seen as outsiders. Doubts were expressed

about professional interpreters ability to convey the patients emotions to the

doctor. Respondents mentioned that patients disliked relating intimate details

to formal interpreters and preferred to keep such things within the family:

10For example, a child, or the husband of a woman who has come to see a psychiatrist

about her marital problems.

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In particular when it is through the telephone. Because then, my mother

will think What am I saying here to someone I dont know at all? ...

You often talk about personal things with your doctor, and I dont know,

I am almost 100% sure that my mother will think No, to arrange an

unknown person for things like this goes way too far.

Almost all the interpreters in the Netherlands (13) stated that they would rather

accompany their family members themselves, as they feel they are better able

to do the job than professional interpreters, because they have firsthand knowl-

edge of their relatives medical problems: I know about the whole situation,

while a [professional] interpreter doesnt know my mother at all. He or she

does the job and goes home. But I know my mothers complaints and when

she suffers from them.In marked contrast to their counterparts in the Netherlands, no fewer than

ten of the respondents in Turkey looked positively on the possibility of trained

professionals interpreting for non-Turkish-speakers, although, for the most

part, they saw this as a second-best alternative to monolingual communication

in Kurdish between the doctor and the patient. They thought that interpretation

by a person appointed by the state an option that does not currently exist in

the Turkish health system11 would be more reliable than interpreting done

by family members. Two interpreters acknowledged that their seniors would

be reluctant to divulge intimate and potentially embarrassing information to astranger, but even more interviewees were of the opinion that those for whom

they interpret would have more confidence in officially trained and appointed

interpreters. Five interviewees felt that patients mistrusted their capabilities

and motives, with some recalling specific occasions when an elderly patient

did not believe their junior was fully and accurately recounting in Kurdish

what the doctor had said in Turkish. One explanation proposed for this by

an interpreter is that, for older generations, in rural areas of the Southeast in

particular, being able to speak Turkish seemed like a fantastic achievement,

one that they found difficult to associate with their own children.

3.3 Role(s) of the interpreter

While interviewees did tend to resort to fairly hackneyed metaphors of neutral

and objective transfer to characterize their role, referring to themselves as transfer to characterize their role, referring to themselves astransfer to characterize their role, referring to themselves as

relayers of messages from one language into another, the stories they told

suggest that they were much more active and interventionist while interpreting,

11In July 2011, the Turkish Ministry of Health announced plans to develop medical care,

advice and interpreting services in English, German, Russian and Arabic, starting with

the establishment of pilot projects in four resort areas in Western Turkey (Cantrk 2011).

These measures, however, are targeted not at indigenous minorities but at the 30 million

tourists who visit Turkey every year.

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sometimes filtering out information and orienting the medical consultation in

a manner that no professional code of ethics would recommend.

For instance, an interpreter in Turkey commented that his grandmother,

who lived with his family, had been ill for a long time and had constantly beencomplaining about her symptoms. Up until three days before their visit to the

doctor, he listened to her complaints and arrived at his own diagnosis, but then

stopped paying attention to her grievances. When it came to the appointment

itself, he did not listen very carefully to the responses his grandmother gave

to the doctor and essentially reported only the symptoms he had remembered,

which did not include the most recent ones. The interpreter claimed that his

behaviour, as reprehensible as it may be, was by no means unique. He argued

that those who live with the people for whom they interpret believe they are

familiar (and perhaps even fed up) with the patients complaints and think

they know which ones are genuine and which are invented or irrelevant. The

interpreter, today a medical student, admitted that he translated in a much more

faithful and ethically acceptable way when his client was a stranger in the

hospital where he was doing the rounds together with his professor. All the

same, the case involving his grandmother certainly ties in with the findings

of several researchers that untrained, informal interpreters are particularly

likely to slip into the role of the primary interlocutor and ask questions and

supply information of their own volition, rather than restricting themselves torelating what the other interlocutors have said (Baker et al.1998, Hasselkus

1992, Meyer 1998).

In another example, in order to give a patient more appropriate care, a

Dutch-speaking interpreter advised the healthcare provider about the proper

medication dose for her mother. This interpreter, who has a background in

biomedical science, felt that she was more capable of assessing the right treat-

ment for her mother than the nurse treating her:

The nurse did not consider increasing the dose for my mother, so I asked,Is it possible to increase the dose? She originally wanted to give my

mother another medicine .... Since then my mother has been using that

[increased] dose and it works perfectly for her. I can quite accurately

assess what they need, what they want, and how they want it to be

improved. So I sometimes talk based on my own feelings .... I want the

best medicine, yes, the correct medicine, the optimal solution.

A further example indicating the responsibility the interpreters might feel to

act on behalf of the patient, even when they hardly know him or her, was re-called by a Dutch interpreter who had accompanied an old lady to the general

practitioner to discuss a heart problem. To make sure the patient obtained a

referral to a cardiologist, this interpreter directed the patient to exaggerate

her complaints:

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I once went to the doctor with this old lady and [the doctor] said: I

only give a referral if she suffers because of her heart at night ....

But the old lady said, I dont have any pain at night. Then I said

to her in my own language, You do have pain at night, dont you?.

Then she said, Yes?. I said, You just told me that you have pain at

night. Because she desperately wanted a scan of her heart, but the

doctor did not want to do that, so I was thinking: I feel sorry for her,

lets just do that, maybe there is something wrong. But then the old

lady said, It hardly hurts at night. I said, Just say you are in pain

at night!. Because I knew what the doctor had just said to me, you

know, so I said: Yes, she is in pain at night, but not as much as during

the day. And then he said, Okay, if she is suffering at night, then I

will write a referral.

In the interviews in both countries, we also heard about several cases where

an interpreter claimed to have carried out rather more subtly selective and

manipulative renditions in order to ensure that, within the limited time allowed

by the medical interaction, the uneducated and elderly patient received what

the interpreter believed to be the appropriate information about the illness

and also acted in the way recommended by the doctor. For instance, one of

the Zazaki-speaking interpreters in Turkey tended to use general expressions

to render the doctors comments on the severity and consequences of the

illnesses, partly not to shock the patients and partly because his language sup-

posedly lacked the terms needed to describe a medical condition in detail. He

translated fairly technical diagnoses with sentences like Theres no need to

worry, Its a very simple problem, or This needs to be taken seriously.

Another respondent in Turkey conceded that he had sometimes exaggerated

the warnings or advice given by the doctor, since his father was not taking

sufficient care of his health. For example, when a doctor said Youshouldnt

eat red meat, in Kurmanji this became, The doctor says you mustnteat meat

under any circumstances (our emphases).Several interpreters reported leaving large chunks of discourse uninter-

preted. This occurred when the interpreter deemed the patients talk redundant

and (in the Dutch case) the doctors time ran out. Indeed, interpreters in both

countries mentioned time limitations as an important factor determining

translation strategies. One Zazaki speaker, for example, noted that a doctor in

a state hospital only assigns two or three minutes to each patient; since this

is not enough to relay everything the patient has said, the interpreter presents

a refined and succinct summary of the necessary points based on what

the interpreter has been told by the patient at home.As is evident from the above examples, many of the interpreters we inter-

viewed went far beyond offering a more or less literal rendition of what the

interlocutors said to one another: they reported omitting, adding and modifying

information, exaggerating or toning down, and involving themselves actively

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in the conversation to make sure patients felt understood and received the care

they needed. In the Netherlands, 12 out of the 15 respondents reported un-

dertaking such interventionist actions at one time or the other. Besides seeing

themselves as competent translators, these interpreters perceive their roles asbeing advocates for the patient and persons of trust to whom the patient can

turn for advice, mediation and support.

In Turkey, three interpreters professed having tried to present a word-

for-word rendition of what other interlocutors said. In several cases, this

strategy apparently led to communication difficulties, since the interpreter

provided a literal Turkish rendition of a Kurdish idiomatic expression used

to describe the symptoms of an illness a rendition which the doctor then

struggled to decipher. Alternatively, when faced with a term in Turkish for

which they did not know the Kurdish equivalent, four interpreters simplyrepeated the Turkish word one reported pointing to the relevant part of the

body while doing so an effective strategy (according to two interviewees)

since the patients had some knowledge of basic Turkish medical vocabulary.

On balance, the proportion of interviewees in Turkey who reported taking

steps such as paraphrasing, explaining terms and interjecting questions was

somewhat lower than in the Netherlands (8 out of 15). All the same, at least

four Turkish interpreters acknowledged trying to correct mistreatment or

abuse, as the (US) National Council on Interpreting in Healthcare defines

advocacy (NCIHC 2005:16), when they felt the doctor was not behaving ap-propriately towards the patient. The most striking example of this was when

a young woman, who had her own appointment at a hospital, witnessed a

doctor shouting at an old Kurdish woman and telling her that he would not

treat her if she did not speak Turkish. At this point, the young woman came

over to the patient and offered to interpret for her, while putting it to the doc-

tor in no uncertain terms that what he had said contradicted the Hippocratic

Oath and that she would complain about him to the hospital management and

other authorities.

4. Discussion of the findings

Turning to examine the common threads in the responses of interviewees in

the Netherlands and Turkey, a glance at our data on the technical aspects of

informal interpreting and on the roles of the interpreter confirms the often-

made observation (Arranguri et al.2006, Flores et al.2003, Meyer 1998,

Twilt 2007) that informal interpreters are even less likely than their profes-

sional counterparts to function as invisible, neutral conduits who more or lessinterpret word-for-word. Although several of our interviewees, in particular

the ones in Turkey but also a few in the Netherlands, claim that they (strive

to) translate literally between doctors and patients, probably because of a mis-

guided view that machine-like interpreting is the ideal, their stories clearly

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show a different picture.

Another related finding of this study that has been reported previously

(Green et al.2005, Rosenberg et al.2007, 2008) is that informal interpreters

commonly act as advocates for their patients. The role of an advocate canentail a wide range of actions such as encouraging the healthcare provider to

give more detailed information, manipulating the message of the doctor so

that it will have more of an impact on the patient, resisting what is perceived

to be discriminatory behaviour on the part of the healthcare provider and in

perhaps its most extreme manifestation pushing the patient to say things

that (according to the interpreter) will improve his or her chance of receiving

suitable care. Furthermore, respondents from both countries mentioned cases

where they had diverged further still from the conduit model and responded

to, or addressed, the healthcare provider without being prompted to do so bythe patient; in other words, they had performed primary interlocutor actions

(Meyer 1998:3), a practice common among informal interpreters but less com-

monly evidenced among professional interpreters (Rosenberg et al.2008:92)

and certainly strongly discouraged in codes of ethics and good practice.

Although the data from our interviewees do point to similarities of this kind

across the two countries, which concur with the findings of previous research,

there are also significant differences. Our analysis was based on a small sample

of two sets of 15 interpreters, so at this stage we can only speculate as to the

relationship of our findings to the situation and socio-cultural attributes ofyoung migrant informal interpreters in the Netherlands on the one hand and

their Kurdish-Turkish counterparts on the other hand. All the same, given the

quite marked differences between the two sets of respondents with respect to

some aspects of interpreting experience and behaviour, it seems reasonable

to propose some tentative explanatory claims.

Our findings appear to corroborate the claims of Angelelli (2004b),

Inghilleri (2003), Wadensj (1992) and others, namely, that interpreted com-

municative events and the agents involved in them are heavily influenced by

socio-political and cultural contexts. To demonstrate this, we may consider the

factors behind the different attitudes informalinterpreters in the two countries

seem to have towards the task of interpreting. Our finding that interviewees in

Turkey were on the whole and notwithstanding their preference for mono-

lingual communication in healthcare settings rather less negative about

interpreting for their elders or others than their Dutch counterparts, seeing

it as more normal and less of a burden, might be seen as evidence for the

influence of the cultural context and understood in terms of Hofstedes (2001)

differentiation between individualistic and collectivistic tendencies. ManyKurds in Turkey, especially in rural areas, continue to assign great importance

to the (extended) family and to respecting and assisting elders. This could be

one reason why the interviewees in Turkey have never refused to interpret

and, as adults, generally refrained from blaming patients for their inability

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explicitly checking patients understanding, and repeating the same informa-

tion several times. In the interviews from Turkey, we find relatively more

cases where interpreters offered meaningless word-for-word renditions or

supplied information independently without indicating they were doing so.To be sure, it is quite likely that the Dutch-speaking interpreters recourse to

such measures primarily reflects factors such as a higher educational level

and greater competence in both languages. However, even though none of the

interviewees made a concrete link between their experiences of professional

interpreting and their own interpreting performances, it may be speculated

that the interpreters who employed such methods had witnessed, or heard

about, the way professional interpreters did their job and were aware that ef-

fective interpreting required a variety of communicative techniques and was

more than just linguistic recoding, the latter being what many of the Kurdishspeakers seemingly thought.

The attitudes of the two sets of interviewees on the question of informal

versus professional interpreting differed in another notable way. Whereas one

of the main objections to professional interpreting mentioned by respondents

in the Netherlands was that, in this kind of arrangement, another outsider

besides the doctor was party to the intimate details of the patient, the inter-

viewees in Turkey thought quite differently; they predicted that they and their

clients would feel more comfortable if an outsider were there with the doctor

than if the interpreter were a family member a view that is arguably rootedin cultural conceptions of what is acceptable and unacceptable for people

to talk about in the presence of younger relatives and/or of relatives of the

opposite sex. As one respondent put it, Us Anatolian folk, and especially us

Kurds, are much more conservative. A woman a mother even if shes

a hundred years old, cant speak about some subjects comfortably with her

children. Theres no way my sister can do that.

5. Conclusion

This small-scale study offers some rare insights into the experiences,

attitudes and behaviours of informal interpreters from the perspective of

the interpreters themselves. Some points to emerge from the interviews

were common to respondents in both the Netherlands and Turkey, as

well as familiar from the literature on non-professional interpreting. As

such, they suggest the existence of common, cross-national tendencies in

informal interpreting in medical settings, a possibility worthy of exploring

more thoroughly in future research on this topic (see below). Besidescommon features, we also identified differences in the feelings, thoughts and

practices reported by respondents in the two territories. Among these were the

contrasting attitudes towards professional interpreting services, the greater

use of quasi-professional strategies by respondents in the Netherlands, and

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Kurdish-speaking interpreters unquestioning willingness to interpret for

their elders but at the same time their resentment at having to interpret in

the first place. In the Kurdish-Turkish context, moreover, taboo subjects

appeared to complicate communication between the doctor, patient andfamily interpreter in a quite distinct way. Although previous research

has acknowledged that the role of interpreters should be considered in

relation to the social contexts in which they operate, to date no study has

contrasted the experience of informal interpreters in different geographical

and cultural settings. To the best of our knowledge, this study is thus the

first to suggest by means of comparison how the attitudes and practices of

informal interpreters might be influenced by the conditions in the country

in which these interpreters live and work.

The comparison is all the more interesting because of the very differentsocial and political contexts surrounding medical interpreting in the two

countries. In the case of the Netherlands, we have a prosperous and famously

tolerant country where the state has until now favoured and funded profes-

sional interpreting services targeted at migrants. Turkey, on the other hand,

can be described as an economically less developed country, in which for

many decades nationalist assimilationism and rigid monolingualism helped

hinder the provision of interpreting services, which would have benefited

above all Turkish-born citizenswith limited proficiency in Turkish. The lack

of professional interpreting services and of health workers competent inminority languages, combined with the previously hostile attitude towards

doctor-patient communication in these languages, led to widespread recourse

to informal interpreting. As we hope to have shown, traces of these distinct

contexts can be discerned in the responses of our interviewees. All the same,

while in terms of official policy the Netherlands and Turkey seem to belong

to different stages on Uldis Ozolins four-stage international spectrum of

response to multilingual communication needs in interpreting (2010) with

Turkey edging from Neglect to Ad hoc and the Netherlands poised some-

where between Generic language services and Comprehensiveness thereality on the ground in these two territories is not so different; in both, the

use of untrained informalinterpreters is common.

Since our analysis is based on two narrow samples, in order to arrive at

more conclusive findings concerning interpreters from specific localities

or communities, future research would have to include larger groups of

respondents and reduce the variables related to the group(s) under examination,

as Lucy Tse did in her 1996 study of 64 Chinese- and Vietnamese-Americans.

A more true-to-life picture of the performance of informal interpreters could

also emerge from analysis of actual doctor-patient-interpreter discourse, whichwould provide primary evidence of informal interpreters translation strategies,

procedures and decisions (Bhrig and Meyer 2004, Cambridge 1999, Flores

2005). A further method to gain more insight into the experiences of informal

interpreters and the socio-cultural influences on their performances would

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be stimulated recall, which involves showing interpreters video recordings

of their own performances and asking them to comment on their thoughts,

feelings and roles during the interaction (Leanza 2005).

Outcomes of such studies might also point to possible ways of improvingthe communication process between doctors, patients and informal interpreters.

Development of training materials for bilingual laypersons and healthcare staff

who frequently function as interpreters might be a solution, one for which the

experience of TRICC proves illuminating (Meeuwesen and Twilt 2011:83). At

the same time, in the face of the cuts to translation and interpreting services

currently being made in the Netherlands and across the crisis-hit world, it is

vital to push the case for professional interpreting and translation services. It

is also important to educate professionals and laypeople alike about working

with interpreters, whether professional or informal. An intervention studycarried out in Switzerland, which aimed to improve communication between

physicians and patients who speak a foreign language, is a good example of

how physicians might be trained in using professional interpreters effectively

(Bischoff et al.2003).

As for the Turkish situation in particular, the tendency in the Southeast does

seem to be towards monolingual doctor-patient communication in Kurdish and

the sidelining of the informalinterpreter. There is arguably even greater need,

and more potential, for the development of interpreting facilities (involving

Kurdish, other minority languages, and the languages spoken by refugees) inthe major cities of Western Turkey, which could include the training of health

workers, or other interested parties, as interpreters (Gven 2011). This was

the conclusion drawn in a report by the vice-president of the Turkish Human

Rights Association (IHD), who noted that the problem of medical communi-

cation was particularly acute in areas where Kurdish was not widely spoken,

above all in Istanbul (Erbey 2007).

The use of informal interpreters in healthcare is a reality in a country

such as the Netherlands, where professional facilities are well-established,

just as it is in a country like Turkey, where not even the groundwork for suchfacilities has been laid. Until now, much of the interpreting and translation

studies community has disapprovingly turned a blind eye to non-professional

interpreting, including interpreting in healthcare settings. However, non-

professional interpreting is not just a fascinating subject and a rich source of

research material, but also part of the everyday life of millions of people across

the world, regardless of what official policies prescribe and what solutions

interpreting scholars would prefer to see implemented. As such, it demands

greater attention from the scholarly community.

BARBARA SCHOUTEN

Department of Communications Science, Amsterdam School of Communication

Research, University of Amsterdam, Kloveniersburgwal 48, 1012 CX

Amsterdam, The Netherlands. [email protected]

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