To Advocate (or not to Advocate) as a Medical Interpreter by Andy Beggs - Massachusetts ...
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The Interpreter
To Advocate (or not to Advocate)
as a Medical Interpreter August 18, 2021
by Andy Beggs
Whenever we as medical inter- an individual that goes beyond Inside this issue:
preters talk about advocacy in facilitating communication To Advocate (or not to Advo- 1
a health care encounter, we are with the intention of support- cate) as a Medical Interpreter
likely to find ourselves en- ing good health out-
gaged in a lively discussion. comes.” (NCIHC, 2021) If an Written Translation by the 2
Department of Quality and
This is in part because advoca- interpreter has a valid and veri- Patient Experience
cy is often misunderstood and fiable reason to suspect that a
thought to involve the individ- patient’s physical or emotional
ual “stepping outside of the health is at risk, the interpreter Some Familiar Faces! 3
role of the medical interpret- may consider engaging in ad-
er.” However, according to a vocacy, while maintaining Interpreter Profile: 4
recent paper by the National transparency (so that both pro- Elsa Benavides
Council on Interpreting in vider and patient know what is
Health Care, “When being said), identifying who
healthcare interpreters appro- has the responsibility and au-
priately engage in an act of thority to address the interpret- As I interpreted, I waited for
advocacy, they are not step- er’s concern, and explaining the PT to notice that and re-
ping outside the healthcare the concern “in terms of the position the utensils. When it
interpreter role. Rather, they shared goal of the encounter – didn’t happen and the pro-
are acting within the accepted the health and wellbeing of the vider was ready to leave the
range of behaviors and expec- patient.” (NCIHC, 2021) room, I discreetly mentioned
tations for their role as they that the patient still needed
interact with the roles of pa- Gustavo, one of our Spanish her utensils.” Thankful for
tient and healthcare provid- medical interpreters, mentions Gustavo’s input, the thera-
er.” (NCIHC, 2021) a recent case in which a Physi- pist corrected the situation.
cal Therapist was assisting a
The paper goes on to say that patient with limited mobility Gustavo took some im-
“When the patient’s health, with their food tray. “I noticed portant steps: (1) He deter-
well-being, or dignity is at that… the utensils were in the mined that the patient’s well-
risk, the interpreter may be back and kind of hidden. In her being was at risk if he didn’t
justified in acting as an advo- condition, the patient wouldn’t speak up, (2) He was reason-
cate. Advocacy is understood be able to find them easily and ably certain that no one else
as an action taken on behalf of might not eat for that reason.
To Advocate (or Not to Advocate), cont on p 2
Page 2 The Interpreter
To Advocate (or not to Advocate) cont from p 1
would recognize and correct the problem, and (3) ers, mentions an interesting case. “In a previous
He waited for an appropriate time to bring up the interpretation session, I had asked the patient
issue. He also followed the ethical principle of how far he went in school and found out he was
“beneficence…a moral obligation to act for the illiterate and had very limited knowledge of num-
benefit of others.” (NCIHC, 2021) bers and letters. The doctors wanted him to go
home with IV antibiotics and they were going to
Jonathan, another of our Spanish medical inter- give him education on how to do it. When asked
preters, says that “I interpreted for a patient who about wanting to go home with IV antibiotics, he
was desperately trying to contact her cardiologist just nodded and said he might need some help.
to get the green light for orthopedic surgery. The Knowing about the patient's level of literacy, I
patient was persistent, she left several voicemails pulled the provider aside and explained that the
and was told someone would get in touch with patient did not know how to read and write and
her. Time was running out as her surgical date maybe they might consider other options than
was quickly approaching. The second time we having him and his family do this at home.”
spoke yet another coordinator told her that her
provider’s assistant had stepped away from the The situation that Claudia was in was a tricky
desk and that she would receive a call back. In- one, but the aforementioned NCIHC paper says
stead of having the patient wait for a call back, I this: “Healthcare interpreters who interpret for
asked if we could kindly wait on the line for the the same patient across multiple encounters may
coordinator to come back. We did so, and the pa- occasionally be the only ones in the encounter
tient was able to get the answer that cardiology aware of relevant information…(which) may lead
had cleared her for surgery.” them to be concerned about a potential for seri-
ous imminent harm if that information is not
Jonathan did not simply facilitate communication made known and addressed in a timely man-
between the two parties, he actively pursued, on ner.” (NCIHC, 2021)
behalf of the patient, the direct conversation with
the provider’s assistant, and it worked out to the The right time for the medical interpreter to ad-
patient’s benefit. So, this too could be considered vocate will continue to be debated, but the recent
advocacy, following the ethical principal of be- NCIHC paper sheds new light and analysis on
neficence. this topic.
Claudia, another of our Spanish medical interpret- Source: NCIHC, “Interpreter Advocacy in Healthcare En-
counters: a Closer Look”, February 2021.
Written Translation by the Office of Quality and Patient Experience
MGH has had the fortune of having a Translation Against Racism campaign, has been overseeing the
office for at least the past two decades which is written translation of upwards of 5,000 documents into
currently run by our Translation Specialist, Anna six languages just this year. This includes not only
Pandolfo. Throughout the years Anna has re- translation of Patient Gateway into Spanish, Portu-
ceived requests from across the Mass General guese, Haitian Creole, Traditional Chinese, and Arabic,
Brigham (MGB, formerly Partners) system. It has but also translation of the messages and letters that go
always been a challenge to balance the internal out to the patients through Patient Gateway, and the
and external requests being one of the only trans- questionnaires on the tablets that we as interpreters
lation specialists in the entire system. In response have become accustomed to filling out together with
to the number of health care disparities that were the patients, perhaps most notably in Orthopedics.
uncovered during the COVID-19 pandemic, MGB
chose to put equity at the forefront of its mission Ferney Munera, Program Manager for Language Ac-
and establish a new office to meet translation de- cess in Quality and Patient Experience (QPE), was the
mands. perfect person to manage this effort. Ferney worked for
years in medical interpreting at Brigham and Women’s
The Office of Quality and Patient Experience Hospital, between 2006 and 2020. During that time, he
(QPE) at MGB, under the efforts of the United held the roles of medical interpreter, dispatcher, and
Written Translation, cont on p 3
Page 3
Some Familiar Faces!
We have all been spread out a bit more than usual dur-
ing the pandemic, and we thought it would be good to
see some familiar faces all in one place!
Written Translation cont from p 2
finally Coordinator of Interpreter Services. He the MGB level. And, QPE is currently extending their
also brings to the job the experience he gained as written translation to the Patient Gateway team, to
Operations Manager of the Burn and Trauma translate all messages from patients to the providers
ICU under COVID-19 during 2020. He took on and vice versa, while the services are growing and the
his current position in January of 2021. department is hiring the staff that is needed.
As interpreters we have all, at one time or anoth- Our patients with LEP are very fortunate to have two
er, wondered if the information on those tablets allied groups working for them: The medical interpret-
was ever seen or used by anyone. Ferney admits ers at the various MGB hospitals, and those working
that when he was an interpreter, he had the same specifically on written translation at the MGB level.
doubts. However, in his current role he has
learned that the information on everything from
housing to health issues is fully analyzed by the On a final note, many of us as interpreters have strug-
office of Digital Health and generates calls to gled with the issue of patients with LEP not having
patients, as well as being shared with the pa- active Patient Gateway accounts or the knowledge
tients’ physicians. Some of the information is base to use them to participate in virtual visits. To re-
also used in research. solve the issue of patients with LEP not having digital
access, Ferney says, MGB will soon be sending 2,000
The office is expanding. In addition to Ferney as IPADs into patients’ homes, so that “If patients don’t
the Program Manager, there is a full time Span- come to us, we will go to them.” So far, the efforts of
ish translator and a full time translation special- MGB to reach out to our patients with LEP to sign
ist, who is at the same time working as Portu- them up on Patient Gateway have yielded some suc-
guese translator, while the department is recruit- cess. Currently about 58% of patients who have ap-
ing a full time Portuguese translator and 10 more pointments scheduled in Epic show that they have acti-
per diem translators for the Russian, Haitian Cre- vated Patient Gateway accounts. While this is pro-
ole, Arabic and Chinese positions. In the future, gress, much ground needs yet to be covered.
Ferney foresees 5 FTEs working on translation at
MGH
The MIS Newsletter was created in response to the need for a new and
GRB 015G
55 Fruit St improved mode of inter-departmental communication. The information
Boston, MA 02114 shared in this publication is intended for the use of MGH MIS staff and
Phone: 617-726-6061 freelance interpreters.
Fax: 617-726-3253 We are always looking for information and ideas for articles that would
E-mail: ckirwan@partners.org
interest our readers. Please submit any contributions that you might have
to Andy Beggs at the email address given to the left.
Visit us on the web:
Whether you have an important event that impacts our profession, an
massgeneral.org/interpreters
article that might be of interest, or general information that the depart-
The Interpreter is published once quarterly by MGH Medical Inter- ment might find useful, please help to make this instrument an effective
preter Services. method of communication.
Publisher: Chris Kirwan, Director MGH MIS
Managing Editor: Andy Beggs, abeggs@partners.org Thank you!
Interpreter Profile: Elsa Benavides enormous difference they can make
in a person’s life.
Language: Spanish
Country of Origin: Mexico In 2014, she completed her training
At MGH Since: May 2020 in medical interpreting and worked
for four years at UMass Memorial
Elsa was born in Manuel Benavides, Chihuahua, Hospital. One year into that job, she
Mexico, a small town named after her great grand- became a Certified Healthcare Inter-
father who fought and died in the 1910 Mexican preter (CHI™). She also has experi-
Revolution. The funny part of her story came about ence interpreting in agencies focus-
when her father, named after him, was the Justice of ing on Department of Children and
the Peace and signed her birth certificate. The town, Families, disability services, adolescents and children
her father, and the judge had the same name on the with autism and mental health clinics. Elsa became a
certificate! Elsa lost count of how many times she Bulfinch temp at Spaulding, and when the pandemic hit,
had to confirm “yes, it is correct”. she worked at The MGH Chelsea Revere COVID Isola-
tion Center under the direction of Dean Xerras, MD.
Elsa has an educational and professional back-
ground in the sciences and in Quality Systems. In Following this experience, Elsa joined the MIS team. The
Mexico, she obtained her bachelor’s degree in the impact interpreters have on patients and providers has
Sciences with a focus on Microbiology and Hema- always made an immense impression on Elsa: “To be
tology and began working as a Medical Technolo- able to convey the message with transparency, knowledge
gist, supervising hospital laboratory activities. After and kindness and be appreciated by the provider is
some time, she got married and God blessed them breathtaking. When the patients compliment my service,
with three healthy and beautiful babies. Later, she it means I made a difference in their lives”.
would pursue both a Master and a Doctoral degree
in Engineering Administration. The leadership of our Director Chris Kirwan makes Elsa
recall her doctoral dissertation which proved that only the
In 1994, Elsa and her family moved to Texas and best leaders get this chain of behaviors among the em-
she continued her work in Quality Systems. She ployees:
spent a sabbatical year in the École Nationale Supé-
rieure des Mines de Nantes teaching Management MotivationInvolvementCommitmentTotal
and Optimization of Supply Chains. In 2007 the Participation
family moved to Massachusetts. Elsa worked for
four years with Marsh & McLennan as a bilingual Elsa is certain this is a heartening, continuously improv-
representative. She learned about the diversity in ing & maximum productivity process at work in our de-
New England and realized the important role inter- partment and concludes: “I’m proud of being part of this
preters have as the voice of the community and the team.”
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