Lost in translation? The importance of qualified interpretation
- Anne Kristine Bergem
- Jan 6, 2018
- 16 min read
Updated: 1 day ago
Interview with Professor Berit Berg
The Nordic Psychiatrist have been fortunate to get hold of professor Berit Berg, a professor with in-depth knowledge of people’s experiences of communication via interpreters and how to improve the use of interpreters in the healthcare sector and other public services. Her experience is that many people's first reaction is that there are many problems associated with the use of interpreters. Professor Berit Berg was the main author of the report "Experiences of minority language speakers with interpreting in encounters with public services" published in February 2023.
You can read a summary of the report below by expanding the chapters.
Please click on the arrow ">" to expand:
Summary
The purpose of the project
Challenges
Recommendations
Berit Berg: "I would like to quote a colleague who investigated the use of interpreters in conversations between psychologists and patients. He starts his lectures with the rhetorical question: "Is it better not to understand what the other person is saying?" Of course, there are greater challenges in communication when you cannot speak directly to each other. You also lose body language, which supplements what is being said while it is being said. However, I believe we must focus on the opportunities. The alternative to using an interpreter is not being able to communicate at all."
In the report she was the lead author of, they looked at minority language speakers in a broad sense, including people from other countries who have come to Norway, indigenous peoples, and the hearing impaired.
In the new Norwegian Interpreting Act, public institutions are required to provide an interpreter.
"Unfortunately, the law is not a rights-based law, which means that people are not entitled to an interpreter when dealing with private actors, such as private psychologists and psychiatrists. The only ones who have a legal right to an interpreter are the hearing impaired."
Professor Berg believes that it is a major problem that interpreting is not a right for individuals, as this means there is no requirement for private service providers to provide an interpreter. She believes that society must take responsibility.
"There are many important private actors who work with minority language speakers, ranging from large organizations to individual therapists. I wish that everyone, regardless of size, accounted for the use of interpreters in their budgets."
Since the Sámi languages, the languages of the Indigenous people, are official languages under the Constitution, Sámi speakers have the right to communicate in their own languages. The same rights do not apply to people who come from other countries.
"The development of interpreting services has been rather haphazard. There is a public interpreting service, and municipalities have their own. In addition, there are several private providers. Increased immigration has led to a greater need for interpreting services."
Interpreting in mental health
In Norway, 20% of the population are minority language speakers, and in Oslo, the figure is 30%. Most have a short period of residence and do not master Norwegian very well beyond basic "everyday communication."
"One can be quite good at Norwegian without mastering the repertoire necessary to be understood in conversations related to mental health and psychological issues. The same can apply to interpreters. They may be very proficient in Norwegian, but without mastering the terms and concepts related to psychiatry."
Since in several countries there is a stigma attached to mental health issues, it can become three times more difficult to talk about mental health:
"They cannot speak in their native language, they lack the necessary vocabulary, and on top of that, they are limited by taboos and may not really know how to approach difficult topics."
Professor Berg emphasizes that she has never worked as a therapist, but that in the 1980s, she participated as a social worker in a project aimed at preventing health issues among people who fled Chile after the coup.
"I worked alongside a psychiatrist who spoke fluent Spanish. In addition, we had an interpreter who followed the project throughout. He mentioned that he had to translate words and concepts he had never encountered before. The topics were experienced as anything from embarrassing to painful and difficult. For me, it was a gift to have the opportunity to research the use of interpreters later."
One of the experiences Professor Berg has had is that it is not appropriate to use individuals who are familiar to the patient as interpreters.
"In the beginning, we thought it might be easier to gain trust that way, but it has become very clear to me that being a good interpreter is not just about being bilingual or proficient in multiple languages. Being an interpreter must almost be considered a profession, I would argue. When you study to become an interpreter, you learn about the role of the interpreter and receive education on many levels, which is verified through exams. The qualification requirements are well described in the report."
Professor Berg now believes that it is almost worse to use an unqualified interpreter than to use none.
"There are urban legends about people having had the wrong leg amputated due to misunderstandings. In the field of mental health, a well-known problem is that mental disorders and intellectual disabilities are often mixed up or confused. A mother may be concerned about her child and end up with a referral for assessment in mental health care, when the child has an intellectual disability. The rest of the conversation becomes meaningless if such a misunderstanding occurs at the start."
Reducing the risk of misunderstandings
Qualified interpreters are also trained to ask clarifying questions if there is something they do not understand. For unqualified interpreters, it can be easy to guess instead.
"Unqualified interpreters may have a greater need to "prove" that they are competent and might believe that asking clarifying questions means they are not good enough. This poses a significant risk of incorrect translations and contributes to misunderstandings."
Preparing interpreters before sessions is also important, and it is the therapist's responsibility.
"It is easier to translate accurately if one can prepare in advance. Perhaps one can review specific words and concepts. When using sign language interpreters, it is quite common for the interpreters to be given context before interpreting. If a lecture is to be interpreted, it is standard practice for the lecturer to send their PowerPoint presentation to the interpreters beforehand, and the interpreters can reach out if they need additional information to do the best possible job. It should be the same in all interpreting situations."
In some situations, phone interpreting may be preferable. For example, in gynecological examinations, many people find it beneficial to avoid having a stranger present in the room.
"Many professionals may be skeptical about using interpreters over the phone or via a screen, but in user surveys, many prefer this form of interpreting and find it less disruptive. It becomes easier to remember that you are communicating with the person sitting in front of you. The advantage is also that this method always allows for access to highly qualified interpreters. It is easier to get a good phone interpreter than an interpreter who must come in personGeography no longer becomes a determining factor for availability."
Professor Berg says she often hears statements like "It's so difficult to get an interpreter," but it turns out that the professionals haven't tried.
Professor Berg believes that the interpreter also gains significance for those they interpret for, beyond just being a translator.
"This is not something we can demand, and it's not really part of the role, but sometimes we see that the interpreter means something more. I remember a reception center for unaccompanied minor asylum seekers. We used a lot of phone interpreters, but one day the interpreter came in person. A little boy exclaimed with joy, "It's the voice!" For him, it was important to have a face to relate to."
Confidentially and trust
Professor Berg experiences that healthcare professionals hide behind confidentiality in situations that require an interpreter.
"Confidentiality was never meant to hinder good communication. If one truly wants to help a patient, it is necessary to ensure that the interpreter is well-prepared so that the conversation is helpful to the patient."
Professor Berg believes that it is not difficult to obtain the patient's consent to make the necessary preparations.
"When scheduling a conversation and agreeing to use an interpreter, it is possible to agree that the interpreter will have the opportunity to prepare for the words and concepts related to the topics that will be discussed in the conversation."
She also believes that it is wise to evaluate interpreted conversations afterwards.
"Many interpreters can provide valuable feedback on what could be done differently next time. An interpreter with extensive experience has a lot to teach. If the therapist and patient are satisfied with the interpreter, it often works well to get the interpreter's phone number directly to decide for the continued process. It is beneficial to have the same interpreter throughout the entire process."
In her work with minorities, Professor Berg has experienced that patients appreciate interpreters who not only can translate between two languages but also have a strong understanding of culture.
"I remember an elderly Sámi man who referred to "the good interpreter," meaning the one who knew something about reindeer herding. Reindeer herding was not the topic of the conversation, but for the elderly man, it instilled trust that the interpreter understood the significance of reindeer herding in Sámi culture."
Respect for others and their way of life is central to being a good interpreter.
"Sometimes, people may have been in Norway for a long time without learning the language. If the interpreter becomes impatient or expresses frustration or irritation over the patient not having learned the language "yet," it can be very painful for the patient. There can be many reasons why this has happened: limited schooling, mental exhaustion, or other factors. I have experienced interpreters physically present expressing frustration with the patient. That is not acceptable."
Professor Berg has good experience with the public interpreting services in Norway. The experience with private providers is somewhat more varied.
"Once, I experienced a company listing a level 6 for their interpreters. There are only 5 levels for interpreters in the public sector. They refused to disclose the interpreter's education. Of course, the interpreter could have shared their education with me if I had met them in person, but it is problematic when private actors do not adhere to the system."
All good interpreters are registered in the interpreter register. As a practitioner, you can check whether an interpreter offered by a private provider is registered. If they are registered, they should be qualified.
If someone is skeptical about using an interpreter in conversations, Professor Berg encourages them to speak with colleagues who have used interpreters frequently.
Those who are skeptical are often people who have never used an interpreter. Once you gain some experience, you can see all the benefits. □
