Multilingualism in Clinics
Interpreting In Hospitals

In their everyday working lives a lot of nurses and hospital orderlies who are bilingual often have to help out as amateur interpreters. But being bilingual does not necessarily qualify someone as an interpreter.

“Ms Aziz, you speak Arabic, can’t you? Could you just come over and quickly translate for me?” – this is how interpreting jobs for cleaning personnel, chefs or orderlies usually begin every day in German hospitals. Multilingual clinic staff mostly have to facilitate communication between the doctor and the patient. The conversations they have to interpret are very often serious and could have grave consequences – for example, a patient’s case history has to be translated accurately to arrive at the right diagnosis. The patients are often migrant workers of yesteryear who are now old, sick and in need of nursing care. It is this generation in particular whose knowledge of German was often weak. This also applies to patients from abroad who like to come to Germany to be treated, as well as more and more to refugees who are so ill they need they need to undergo medical treatment.

The consequences of poor interpreting are obvious

The way the clinics deal with this demand for interpreters ranges from spontaneous, ill-prepared solutions, lists of people working at the hospital who could possibly interpret and staff training courses up to paying for the services of a professional interpreter. This has been established by two conversation analysts from Hamburg, Bernd Meyer and Kristin Bührig. Within the framework of a project sponsored by the DFG (German Research Foundation) called “Interpreting in Hospitals” the two linguists were able to ascertain that “not only could the interpreting done by family members vary considerably and at times even be inadequate, but also that of the medical personnel.”

The consequences of poor interpreting or no interpreting at all are obvious – there are translation mistakes that lead to the patient possibly not understanding the implications of a diagnosis, to the patient not following the recommendations for a therapy or to them not being given enough information about their forthcoming operation. All these things can lead to health problems for the patients and can have legal consequences for the clinic. These conversations between doctor and patient often deal with very personal, distressing content that furthermore may be assessed in very different ways, depending on the culture the patient comes from. Another problem is the institutional communication, as  orderlies are not necessarily familiar with the typical  procedure involved in a medical briefing.

Workable and cost-effective solutions

Despite all this, Meyer and Bührig are still in favour of using bilingual orderlies – even if at the moment it is the lesser of the other evils. In 2003 they integrated the results of the research project on interpreting into an in-service training course for hospital orderlies. These two-day workshops were held in numerous hospitals, for example, in Nuremberg, Cologne and Heilbronn.

The position of the Federal Association of Translators and Interpreters (BDÜ in German), on the other hand, is quite clear, “Only professionals should be employed to do the interpreting, as in the end it could potentially be a matter of life and death. Employing professionals would also ensure legal security for the doctors,” explains Monika Eingrieber, Vice-President of the BDÜ and an interpreter herself. The clinics, however, very often have to forego the services of a professional medical interpreter for financial reasons, as, up to now, they have not been able to  issue an invoice for interpreting services. This is why they were forced to look for other solutions that were as workable and as cost-effective as possible.

An in-house interpreting service

Every month the Städtische Klinikum München (Munich Municipal Hospital) treats a large number of migrants – on average 1,300 patients who are not of German nationality. It has a specialist department for intercultural care, which in 1995 introduced its own in-house interpreting service – a pragmatic solution that has already been adopted by other clinics. Over 100 specially trained, multilingual members of staff that have had a basic training in medical care provide interpreting services for both patients and relatives in 32 languages at the moment.

Elisabeth Wesselman, specialist for intercultural care at the hospital in Munich, is keen to ensure that these in-house language mediators work with defined contact persons in a structured setting and are given time off as compensation. Before the language mediators start working they are given a comprehensive briefing on the procedures and legal aspects. This is when they learn, for example, how important it is to sit next to the patient when they are interpreting, so that the doctor can have direct eye contact with the patient and not just with the interpreter. They are also encouraged to address  communication problems. Every year all the orderlies and carers who interpret also have to take part in a one-day further training program. The program focuses above all on self-reflection and an intensive exchange of experience on the basis of case studies. Elisabeth Wesselman is satisfied – “Our interpreting service is highly appreciated and used a lot. Our in-house language mediators are highly motivated, eager to learn and proud of the work they do.” In this way it is not just the patients who benefit from the migration-related multilingualism of the hospital employees, but also the employees themselves as their work is also seen as a plus by their employer and is recognised accordingly.

The Städtische Klinikum München is successful with the interpreting service, nevertheless solutions have to be found on a political level. For quite some time the BDÜ has been demanding “Dolmetschen auf Krankenschein” –  that the costs for interpreting should be borne by the insurance companies. “In view of the high degree of responsibility that doctors have to bear this would be entirely justified,” emphasises Monika Eingrieber.