Education and Language

Medical translation service – sign language isn’t always enough

© www.triaphon.orgScreenshot from a short movie explaining Triaphon © www.triaphon.org

Every day in Germany emergency patients are treated too slowly, incorrectly or not at all. Often the reason is that they cannot describe their symptoms because they don’t speak German. Doctors therefore often have to carry out lengthy examinations to make a diagnosis. Sometimes that takes too long.


Who does not know from his stays abroad the fascination of being able somehow to cope with most situations through gestures and signs, even without a knowledge of the national language. This must be how it is for people in Germany who don’t speak German. But there are also situations in which “somehow” and “sometimes” are simply not enough.

Language can save lives

It was not enough, for instance, for a young boy in Berlin in 2015: he died of a brain tumour while medical staff were working on diagnosing a gastrointestinal virus. The boy’s mother, a non-German-speaking Vietnamese, had taken her son to the emergency room the day before he died. She could communicate only with gestures that her son had been vomiting. What was lost in the sign language was the information about how long the vomiting had already persisted. With gestures alone, the mother was unable to convey that the three-year-old had vomited again and again for weeks in the morning and on an empty stomach. Had the doctors known that, they would have immediately thought of a tumour.

Guessing games and pantomime instead of medical work

In the hospital where this tragic event took place, the medical student Lisanne Knop was completing her practical year. Very soon she was irked by the fact that the everyday professional life of a doctor often had little to do with her studies because of the numerous communication problems. “I had the impression of spending more time in guessing games and pantomime than in medical work”, says the now thirty-one-year-old physician. In 2015, at the height of the so-called “refugee crisis”, 23 per cent of her patients were non-German speakers. But even today, three years later, she still experiences at least one linguistic bottleneck per hospital shift. In many cases, language barriers have made small hurdles into real, time-consuming problems. Knop refused to accept this state of affairs any longer, and developed a solution.

Simple questions of great importance

The solution is called Triaphon, and is a non-profit organized translator service. Knop set it up together with a friend and colleague, Dr Korbinian Fischer, and a volunteer team of programmers and organizers. The Triaphone service helps by telephone when it comes to clarifying in just a few seconds simple but decisive questions arising with non-German-speaking patients, such as: When did you last eat something? Where exactly does it hurt? Since when have you had these symptoms? The answers save the emergency service staff and the patients many diagnostic examinations. The Sana Clinic Lichtenberg, where Knop works today, is one of two hospitals in Germany that officially integrated Triaphon in October 2017 into their care for non-German-speaking patients.

On call, around the clock

Professional interpreters cannot step in on call for three-minute emergencies. Triaphon, however, is on call around the clock. If a patient arrives at the Sana Clinic Lichtenberg who understands only Arabic, Farsi, Vietnamese, Romanian, Russian or Turkish, the staff on duty will call the Triaphone hotline. They will then be forwarded to the currently available specialists in the required language. These are bilingual individuals trained in medical translation by the Triaphon project who work in the project on a volunteer basis. They are either professional translators, themselves people with a migrant background or have lived abroad for a long time. Via a web planning tool they can coordinate when they want to be on duty. Thus the 24-hour readiness is distributed on many shoulders.

Anyone who does not understand German can be rejected by the emergency staff

According to the Patients’ Rights Act, physicians are obliged to inform persons to be treated comprehensively about the type of treatment and its alternatives, risks and chances of success. If this is not possible due to communication difficulties, the treatment can either be denied or an interpreter can be called in, and the costs for this are theoretically borne by those treated. Fortunately, in practice this often looks different. Some large hospitals employ contract interpreters and assume the translation costs. It is also not uncommon for family members or caregivers brought by patients to do the translating. A uniform regulation, however, which ensures medical care for all, is still pending.

The costs for the Triaphon hotline are mostly covered by donations. Also, the doctor’s offices and clinics using Triaphon are paying a minor monthly flat charge. Because of this arrangement, it doesn’t matter if a call lasts three minutes or an hour – or if there is a follow up call because of a small detail. In either case, the service is free for the patients.

Lisanne Knop is enthusiastic about the volunteer support for the Triaphon project. Still, she believes: that it should not be a job for volunteers. She sees the responsibility lying with the health insurance companies and the state, but in this initiative she has received little more than a benevolent pat on the back.


Corinna Mayer
is a freelance editor in the area of culture and society.

Translated by Jonathan Uhlaner
Copyright: Goethe-Institut e. V., project migration and integration

September 2018

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