Category Archives: Atención a la salud

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The right to language access and mental healthcare for forced migrant victims of gender-based violence in US detention centers

Melissa Wallace

University of Texas at San Antonio

Currently in the United States there are over 200 detention facilities holding over 500,000 detained immigrants (Detention Watch Network, n.d.). Mexicans and Central Americans are disproportionately targeted (Provine, 2013; Wallace & Hernández 2017), and the institutional racism at play at the moment of detention extends to additional marginalization and discrimination in the case of LGBTQ+ detainees and victims of gender-based violence (GBV). Such detainees are at considerably higher risk than the general population for mental health disorders such as posttraumatic stress disorder (PTSD), depression, isolation, grief, shame, psychological stress, generalized anxiety, and helplessness, as well as higher rates of sexual violence (Bernardes, Wright, Edwards, Tomkins, Dlfoz and Livingstone, 2010; Hopkinson, Keatley, Glaeser, Erickson-Schroth, Fattal and Nicholson Sullivan, 2017; MADRE, Human Rights and Gender Justice Clinic, Center for Gender & Refugee Studies, and Florence Immigrant and Refugee Rights Project, 2019).  Such forced migrants are often subject to prolonged detention without language-assisted access to mental health services, in spite of general agreement that interpreter services enable patients to talk about problems and feelings and are integral in providing mental healthcare for refugees and forced migrants (Gartley & Due, 2016; Geiling, Knaevelsrud, Böttche and Stammel, 2021; Van de Geuchte & Van Vaerenbergh, 2021). 

Although U.S. Immigration and Customers Enforcement (ICE) claim to provide meaningful language access to LEP detainees in relation to placement in segregation, sexual abuse and assault prevention and intervention, and mental health care, among other things (ICE, 2019: ii-iii, 8), the need for mental health services for LGBTQ+ detainees and victims of GBV is acute, and providers in detention centers report that mental health services are largely inadequate or absent  or even that they come in the form of punitive practices (MADRE et al.: 6-8; Woodman, Kehoe, Saleh and Rappleye, 2019). To that end, this presentation turns a critical eye toward the broken promises between language access to mental health services for victims of GBV in US detention centers and the reality described by the non-profit organizations which serve this population. This presentation calls for compliance and heightened protections for language access for victims of gender-based violence in US detention centers.

References

Bernardes, D., Wright, J., Edwards, C., Tomkins, H., Dlfoz, D., and Livingstone, A. (2010). Asylum Seekers’ Perspectives on their Mental Health and Views on Health Social Services: Contributions for Service Provision Using a Mixed-Methods Approach. International Journal of Migration, Health and Social Care, 6(4), pp. 3-19. https://doi.org/10.5042/ijmhsc.2011.0150

Detention Watch Network. (n.d.). Immigration Detention 101. https://www.detentionwatchnetwork.org/issues/detention-101#:~:text=In%20Fiscal%20Year%20(FY)%202019,and%20Customs%20Enforcement%20(ICE)

Gartley, T., and Due, C. (2015). The Interpreter Is Not an Invisible Being: A Thematic Analysis of the Impact of Interpreters in Mental Health Service Provision with Refugee Clients. The Australian Psychologist, (52), pp. 31-40. https://doi.org/10.1111/ap.12181

Geiling, A., Knaevelsrud, C., Böttche, M., and Stammel, N. (2021). Mental Health and Work Experiences of Interpreters in the Mental Health Care of Refugees: A Systematic Review. Frontiers in Psychiatry, (12), pp. 1-18. https:// doi: 10.3389/fpsyt.2021.710789 

Hopkinson, R. A., Keatley, E., Glaeser, E., Erickson-Schroth, L., Fattal, O., and Nicholson Sullivan, Melba. (2017). Persecution Experiences and Mental Health of LGBT Asylum Seekers. Journal of Homosexuality, (64)12, pp. 1650-1666. http://dx.doi.org/10.1080/00918369.2016.1253392

MADRE, Human Rights and Gender Justice Clinic, Center for Gender & Refugee Studies, and Florence Immigrant and Refugee Rights Project. (2019). Eroded U.S. Asylum Protections for Gender Based Violence Survivors: Published in Advance of the United Nations Human Rights Council’s Universal Periodic Review of the United States of America at the UPR Working Group’s 36th Session. https://www.madre.org/press-publications/human-rights-report/eroded-us-asylum-protections-gender-based-violence-survivors

Provine, D.M. (2013). Institutional Racism in Enforcing Immigration Law. Norteamérica, Year 8, Special Issue 2013, pp. 31 – 53. https://doi.org/10.1016/S1870-3550(13)71782-8

U.S. Immigration and Customers Enforcement (ICE). (2019). National Detention Standards for Non-Dedicated Facilities. https://www.ice.gov/detain/detention-management/2019#

Van de Geuchte, S., and Van Vaerenbergh, L. (2021). A non-native-speaking patient with and without an interpreter: what is the difference? A case study in mental health. The Interpreters’ Newsletter (26), pp. 29-51. https://doi.org/10.13137/2421-714X/33261  

Wallace, Melissa; Hernández, Carlos Iván. 2017). “Language access for asylum seekers in borderland detention centers in Texas.” Revista de Llengua i Dret, Journal of Language and Law, issue. 68, 2017, p. 143-156. https://doi.org/10.2436/rld. i68.2017.2940

Woodman, S., Kehoe, K., Saleh, M., and Rappleye, H. (2019, May 21). Thousands of Immigrants Suffer in US Solitary Confinement. International Consortium of Investigative Journalists. https://www.icij.org/investigations/solitary-voices/thousands-of-immigrants-suffer-in-us-solitary-confinement/

Melissa Wallace is an Associate Professor at the University of Texas at San Antonio (U.S.A), where she directs the graduate certificate program in translation and interpreting studies. A certified court interpreter and certified healthcare interpreter, she is currently serving her second term as appointed member of the Licensed Court Interpreter Advisory Board of the Judicial Branch Certification Commission for the Supreme Court of Texas. She is a board member of the Society for the Study of Translation and Interpretation (SSTI), the non-profit educational and research foundation of the National Association of Judicial Interpreters and Translators(NAJIT). Her research focuses on indicators of aptitude on court interpreter certification exams, accreditation exam models, and non-professional interpreting and translation in legal and public services. Wallace carried out research on court interpreting certification models in Finland in 2016 as the Fulbright-University of Tampere Scholar. 

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La interpretación sanitaria en Gran Canaria, ¿un privilegio o un derecho?

Mónica del Carmen Santana García

En el archipiélago Canario podemos encontrar población extranjera que reside en las islas y turistas, por lo que la presencia de extranjeros en las Islas Canarias no es algo nuevo. Mucho antes de que se hablara de interpretación en los Servicios Públicos ya se daban casos de personas que, sin hablar español, visitaban nuestras islas con el fin de mejorar su salud, esto es lo que hoy se conoce como turismo sanitario. Estos dos grupos de personas, en algún momento, tienen que hacer uso de los servicios sanitarios públicos de las islas y se encuentran con el problema de que no existe un servicio de interpretación para poder comunicarse adecuadamente. Hemos entrevistado al personal perteneciente a los dos hospitales públicos de Gran Canaria y hemos apreciado que estos, muchas veces, deben encontrar soluciones para que la comunicación con los pacientes extranjeros pueda desarrollarse. Del mismo modo, hay que destacar que la situación ocasionada por la crisis sanitaria de la COVID-19 ha puesto de manifiesto que la asistencia sanitaria al paciente extranjero en las islas es una asignatura pendiente, además ha exacerbado en nuestro entorno la llegada de inmigrantes que llegan a las islas, de manera irregular, huyendo de sus lugares de origen por diferentes motivos. Si bien no se trata de un fenómeno nuevo, las actuales medidas de seguridad hacen que estas personas se conviertan en pacientes al llegar a nuestras fronteras. Finalmente, debemos aprovechar esta oportunidad para que la profesión del intérprete sanitario reciba el reconocimiento que se merece y se puedan llevar a cabo medidas para solucionar la falta de un servicio de interpretación sanitaria y concienciar a todos de que sin una buena comunicación no puede existir una sanidad de calidad. 

Palabras clave: interpretación en los Servicio Públicos, interpretación sanitaria, COVID-19.

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Language Access Equity and Inclusion in Pediatric Interpreted Medical Encounters

Amy Olen, PhD; Paulina S. Lim, MS; Charles «Barry» Rothschild, MD

Research has documented the prevalence of health disparities between non-English speakers and English speakers in the United States. To address disparities, medical interpreters bridge the language gap between medical treating teams and patients and their families receiving medical services. Studies demonstrate the positive impacts of language access services on reducing language-related health disparities. However, little is known about encounter-level factors that promote or inhibit equitable language access in interpreted medical encounters (IME). 

In this presentation, we draw from qualitative interviews with 13 medical interpreters and 37 providers (physicians, nurse practitioners) in a medium-size pediatric hospital in the United States to explore perspectives on behaviors and attitudes that facilitate, or create barriers to, effective communication and language access in IME.

Interpreters noted they feel like outsiders with regard to medical care teams and believe that providers experience negative emotions related to the additional time commitment required for IME. Interpreters often perceive microaggressions toward patients and families and reported “absorbing” these provider attitudes to protect patients and families. Physician perspectives largely corroborated that they feel IME are “tricky,” “time-consuming,” and “frustrating.”  Further, physicians identified inequity of information sharing for IME, acknowledging both less frequent communications and large boluses of information to “take advantage of the fact that the interpreter is there.” A minority of providers saw IME as an opportunity to improve cultural understanding and equity of care.

The interview data suggests that language use biases regarding IME and within IME prevent equitable language access despite language services provision. Simply providing interpreting services is insufficient for attaining equitable, inclusive health communication and healthcare provision, and positive health outcomes. We identify opportunities for interpreters and in-hospital language services allies (e.g., physicians, psychologists), to advocate for and educate treating teams on language access equity and inclusion, not only in language services provision, but also within and during IME themselves.

Keywords: Language Access, Equitable Language Access, Inclusive Language Access, Interpreted Medical Encounters, Medical Interpreting.

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Communication in the public sector and linguistic justice: overcoming language barriers in healthcare

Nicole Marinaro

The proposed presentation would outline some preliminary findings of a study focusing on the extent to which language policy in selected European states are effective in reducing language barriers in the public healthcare sector. I do this in the wider framework of an interdisciplinary study aimed at evaluating the management of communication towards autochthonous and allochthonous minority language speakers.

A rich body of literature deals with the problems that can arise due to ineffective communication in healthcare, which, as Mamadouh and el Ayadi (2018, p.92) point out, “can threaten the individuals’ life or basic human rights”. Therefore, the need “to ensure equality of treatment by providing access to the service through the user’s language” seems particularly compelling (Dunbar and McKelvey, 2018, p.95).

The main ways to overcome language barriers in the short term are the provision of interpretation services and translation of documents, and/or reliance on bilingual medical staff, the benefits of these measures having widely been shown (cfr., among others, Flores, 2005 and Karliner et al., 2007). Nonetheless, “the absence of a statutory framework or comprehensive binding policy creates the conditions for inconsistency in provision” (Dunbar and McKelvey, 2018, p.95; see Dunbar, 2006; Phelan, 2012); existing initiatives often “represent ad hoc responses to linguistic realities” relying on the action of single providers.

The methodology employed in the study would draw on the framework of policy evaluation (see, for instance, Grin and Gazzola, 2013). The evaluation of  the effectiveness of language policy in reducing language barriers builds on the concept of “linguistic unease” (Iannàccaro et al., 2018), which has the potential to connect linguistic justice to the sociolinguistic context in which the speaker lives, and allows to shift the focus to the consequences for the actors affected by the policies examined rather than to the formal compliance with abstract rights.


References


Dunbar, R. (2006) Is there a duty to legislate for linguistic minorities? Journal of Law and Society, 33(1), 181–198. https://doi.org/10.1111/j.1467-6478.2006.00354.

Dunbar, R. and McKelvey, R. (2018) Must states provide services to migrants in their own languages?. In: Grin et al., ed. The MIME Vademecum: Mobility and Inclusion in Multilingual Europe, Geneva: MIME Project, 94–95.

Flores, G. (2005) The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Research and Review, 62(3), 255–299. https://doi.org/10.1177/1077558705275416.

Grin, F., Conceição, M.C., Kraus, P.A., Marácz, L., Ozolina, Ž, Pokorn, N.K. and Pym, A. (eds.) (2018) The MIME vademecum: Mobility and inclusion in multilingual Europe, Geneva: MIME Project.

Grin, F. and Gazzola, M. (2013) Assessing efficiency and fairness in multilingual communication: theory and application through indicator. In: Berthoud, A.-C., Grin, F. and Lüdi F., eds. Exploring the dynamics of multilingualism. Amsterdam: John Benjamins, 365-386.

Iannàccaro, G., Dell’Aquila, V. and Gobbo, F. (2018), The assessment of sociolinguistic justice: parameters and models of analysis. In: Gazzola M., Wickström, B.-A. and Templin, T., eds. Language Policy and Linguistic Justice: Economic, Philosophical and Sociolinguistic Approaches. Berlin / New York: Springer, 363-391.

Karliner, L. S., Jacobs, E. A., Chen, A. H., and Mutha, S. (2007) Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature. Health Services Research, 42(2), 727–754. https://doi.org/10.1111/j.1475-6773.2006.00629

Mamadouh, V. and el Ayadi, N. (2018) Is English sufficient to reach out to newcomers before they learn the local language(s)?. In: Grin et al., eds. The MIME Vademecum: Mobility and Inclusion in Multilingual Europe, Geneva: MIME Project, 92-93.

Phelan, M. (2012) Medical Interpreting and the Law in the European Union. European Journal of Health Law, 19(4), 333–353. https://doi.org/10.1163/157180912X650681

Keywords: language policy, linguistic justice, healthcare, minorities, translation and interpreting, public sector.

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Speak my language! The important role of Community Translation in the promotion of health literacy

Prof. Dr. Ineke Crezee

Based on my background as a translator, interpreter, health professional and interpreting and translation researcher, I will explore the role of Community Translation in the promotion of health literacy. I will share some of my experiences as a Fulbright New Zealand Scholar (Public Health) at the Center for Diversity and Health Equity at Seattle Children’s Hospital in Seattle, WA. Next I will explore the concept of health literacy and the many factors which impact on this, focusing also on the refugee and migrant populations for whom we translate and touching on some of the many barriers to accessing health information. I will briefly outline different approaches to Translation Studies in general, involving a product or process approach, before moving to reception studies involving a participatory action research approach in the area of health translation. I will then move to my own preferred approach to community translation as part of health promotion efforts, providing glimpses into the different experiences that took me there. I will explain my belief that sometimes a little is better than too much and how this requires working with the commissioners of the translation, who may need persuading that densely printed pamphlets may not be the answer. I will finish by exploring what we might need to do to achieve ‘just right’ when engaged in CT for the purposes of health literacy and how this should involve the end-users of the translations – whatever form this might take.

Bionote

Ineke Crezee, PhD, is Aotearoa New Zealand’s first full Professor in Interpreting and Translation at Auckland University of Technology. In 2020 she was appointed an Officer of the New Zealand Order of Merit by Her Majesty Queen Elizabeth II, for services to interpreter and translator education.

Ineke completed a postgraduate degree in Translation Studies at the University of Amsterdam, with James Holmes as one of her lecturers. She also completed undergraduate and postgraduate degrees in English language and literature and trained as a registered nurse in a large general hospital in Amsterdam, interacting with many migrant patients. After arriving in New Zealand in 1989 she became involved in developing health interpreting courses on the heels of the large cervical cancer inquiry. She has published extensively on interpreter and translator education and continues to work as a translator, interpreter and educator. Among her publications are Introduction to Healthcare for Interpreters and Translators (John Benjamins, 2013) (a special iteration for Spanish-speaking interpreters and translators appeared in 2015),  Multicultural Health Translation, Interpreting and Communication (Routledge, 2019), and “Action research and its impact on the translation and interpreting classroom” (Routledge Handbook of Translation and Pragmatics) and Interpreting in Legal and Healthcare Settings: Perspectives on research and training (John Benjamins, 2020). 

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Does Communication hinder the Access to Public Health?

Carmen Pena-Díaz

As stated in Article 19 of the Universal Declaration of Human Rights, communication is not just a right for people who can communicate effectively within their dominant culture, but public information is a democratic right for all citizens and it thus has to be available and accessible to all. 

Immigration is a phenomenon which has been on the increase in Spain for over two decades and yet the access to public services by users with linguistic and cultural difficulties has not been tackled by authorities. In fact, linguistic and cultural issues are often not recognised as an integral part of migratory movements or social integration. While professionals of interlinguistic and intercultural communication know that language and culture are key components to achieve immigrant integration and consolidate a truly multilingual society, policy makers at local, national, or supranational levels do not always seem aware of the risks and costs of not providing interpreting and translation services, particularly those affecting the health of users. In healthcare, there are currently no effective provisions for communication problems at present in Spanish hospitals. An example that suggests the poor management of the situation in relation with the migrants’ access to public healthcare is the fact that relying on a family member in medical consultations is one of the main practices that affects communication. 

This paper will present a Narrative Inquiry analysis obtained from interviews collected from a sample of eight clinicians about their experiences communicating with foreign users who cannot communicate in Spanish and thus their problems accessing health services and receiving the adequate services. 

Keywords: language rights, access to public services, interpreting and translation, health