Organizing Dialogue, Experience and Knowledge for Complex Problem-Solving

Fadiman on interpreting

October 25th, 2007

“It is one thing to read in medical school that the ideal doctor-patient-interpreter ‘seating configuration’ is a right triangle, with the patient and interpreter forming the hypotenuse, and another to recollect the diagram in a roomful of gesticulating Hmong toward the end of a twenty-four-hour shift” (272). The Spirit Catches You and You Fall Down.

Interpreters face similar dilemmas when they move from the training ground to the field of independent practice. 🙂

When a patient refused surgery for stomach cancer, “I had expected the resident to move heaven and earth to bring in a decent interpreter. instead, I found him in the Preceptor Library, his head bowed over four articles on poorly differentiated gastric adenocarcinoma” (273).

Interesting on several levels: that there was not an interpreter to begin with and/or that the point of crisis invokes the need/desire for interpreters. Also because we see Fadiman’s priority (communication with the patient) in contrast with the resident’s (learn more about this medical condition).

“At Harvard, all first-year students are required to take a course called “Patient-Doctor I” (significantly, not “Doctor-Patient I”) in which they learn to work with interpreters, study Kleinman’s eight questions, and ponder…conundrums…” (271)

Fadiman’s commentary is on the primary of the doctor’s role/personhood instead of the patient’s. I am, of course, curious what the students are taught about working with interpreters.
Footnote, p. 266 on “sensitive bicultural interpreting” (photocopy).

“A middle-aged man in Merced, hospitalized for an infection, was asked by an interpreter who was filling out a routine nursing admission form whether he wished, in case of death, to donate his organs. The man, believing that his doctors planned to let him die and take his heart, became highly agitated and announced that he was leaving the hospital immediately. The interpreter managed to calm him and assured him that the doctor’s intentions were honorable. The man stayed until his recovery a few days later, and a sympathetic hospital administrator, anticipating similar misunderstandings with other Hmong patients, fought successfully to have the organ donor box removed from the admission form.” (264)

The way this passage is framed is fascinating. Did “the interpreter” ask the question, or did the interpreter interpret a question from the form that the hospital asked? Fadiman presents this in a common sense style, but this is a quagmire for interpreters at the level of theory and practice. When & how are we actors in the situation – as in agents with responsibility and accountability for outcomes – and when are we the (“neutral” or “passive”) conveyors of other’s actions/intentions? How does one distinguish these levels of interaction, when, why, and on the basis of what criteria? Did the interpreter violate the standard code of ethics about not giving opinions or mediate in a culturally-appropriate way? Had the interpreter erred in the presentation/delivery and needed to correct a misunderstanding that they had caused? The problem-solving of the administrator is also remarkable; such accommodations in order to prevent that kind of institutional/cultural clash are rarely undertaken, let alone accomplished.

Fadiman generated a list of “what ifs” that she presented to one of the health care providers, who “was less interested in the Depakene than in the interpreters. However, he believed that the gulf between the Lees and their doctors was unbridgeable, and that nothing could have been done to change the outcome. ‘Until I met Lia,’ he said, ‘I thought if you had a problem you could always settle it if you just sat and talked long enough. But we could have talked to the Lees until we were in blue in the face – we could have sent them to medical school with the world’s greatest translator – and they would still think their way was right and ours was wrong'” (259).

The conflation between “interpreter” and “translator” is problematic, even though this is a common sense combination. Technically, interpreters deal with spontaneous language production and reproduction (in speech or sign language), while translators deal with written texts (with the luxury of time for research and thoughtful consideration of parts in relation to the whole). In this context, the assumption may be between “interpretation” as tending toward paraphrase and/or the metaphorical, with “translation” invoking an attitude of literality (as if direct, exact equivalents ever exist).

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