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Rapid Responses: Rapid Responses published:
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Translation? Let's talk about critical consciousness
- Trisha Greenhalgh (24 February 2007)
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Are translation costs to the Government set to decrease?
- Gavin Wheeldon, Gavin Wheeldon (27 February 2007)
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Translators and Interpreters
- Margaret A Fryer (28 February 2007)
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Language Line
- SIMON D PRICE (1 March 2007)
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Translation services: A waste of Patient Funds
- Dr Ikhlaq Din (8 July 2007)
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Trisha Greenhalgh, Professor of Primary Health Care University College London
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David Jones is correct that many limited English speakers seeking NHS care are vulnerable, sick, disempowered, and have good reasons why they cannot immediately or easily learn English.(1) Kate Adams is also correct that providing a free translation service creates a perverse incentive for people to resist the social integration that could improve their health and well being.(2) But the BMJ has set up an Aunt Sally. Translating what is said is often the least problematic task faced by the professional interpreter, whose multiple (and inherently conflicting) roles also include those of advocate, cultural adviser, negotiator, broker of trust, professional friend, teacher, taxi service, and citizens advice bureau.(3- 6) Translation without careful attention to the patient’s health literacy, receptiveness and personal priorities (e.g. for right of residence, housing, and so on) may erode rather than enhance doctor- patient communication.(4;5) Before we all lock horns over “paying for translation”, let us shift the debate to more fruitful territory. I propose we start with three principles: (a) people most in need of healthcare are least likely to seek it or receive it;(7) (b) citizen engagement is essential if society is to enjoy maximum health and productivity;(8) and (c) education plays a critical role in creating engagement and liberating society’s most vulnerable members from oppression.(9) Perhaps it is time to stop using NHS interpreters as bilingual parrots in medical consultations and instead develop them as community educators. My team is currently testing such an approach in a randomised trial (see http://www.newhamuniversityhospital.co.uk/poseidon/). Reference List (1) Jones D. Should the NHS curb spending on translation services? BMJ 2007; 334:399. (2) Adams K. Should the NHS curb spending on translation services? BMJ 2007; 334:398. (3) Greenhalgh T, Robb N, Scambler G. Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective. Soc Sci Med 2006; 63:1170-1187. (4) Robb N, Greenhalgh T. "You have to cover up the words of the doctor": the mediation of trust in interpreted consultations in primary care. J Health Organ Manag 2006; 20:434-455. (5) Angelelli C. Medical Interpreting and Cross-cultural Communication. Cambridge: Cambridge University Press; 2005. (6) Leanza Y. Roles of community interpreters in pediatrics as seen by interpreters, physicians and researchers. Interpreting 2005; 7(2):167- 192. (7) Hart JT. The inverse care law. Lancet 1971; 1:405-412. (8) Wanless D. Securing Our Future Health: Taking a Long-Term View. London: H.M.Treasury; 2002. (9) Friere P. Education for critical consciousness. New York: Continuum; 1974. Competing interests: None declared |
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Gavin Wheeldon, CEO Applied Language Solutions, Gavin Wheeldon
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In December it was reported that the NHS was spending £55 million each year on translation services. The articles by Kate Adams and David Jones successfully portray two sides of the argument as to whether the NHS should curb their spending on translation; which then leads to the other question of how will this affect those non-English communities with the right to access UK services? There is another side to the argument, proving that there are ways and means to lawfully provide services to non-English speaking communities at less cost to the Government. Cultural and language diversity is part of society and translation will not go away; only grow due to increasing immigration numbers and EU expansion. Linguistic diversity is a precious resource that isn’t as widely available as it should be. Therefore, translation and interpretation is a way of helping the non-English community to integrate into our society and grasp an understanding of our culture whilst they are learning to communicate in English. In the meantime, they must also be able to access services, such as health and medical, again highlighting the necessity of providing instant access to their language through translation and interpretation services. What is obvious is that language barriers shouldn’t hinder the access of foreign communities to our health services, but that the Government should be seriously looking at introducing a more cost-effective translation and interpretation scheme. In being the CEO of a leading UK-based translation and interpretation agency, Applied Language Solutions, I work closely with the NHS and Government departments who are required by the law to provide health services to all citizens in the UK, regardless of their native tongue. However, I do agree that a review of money spent on language services is required, especially as it is set to further increase by 5%, and identify processes that can be implemented to decrease the cost of translation to taxpayers. What I am able to recognise from working with the different NHS departments and other public sector bodies is that much of the text that is translated by each department is the same. However, each department continues to source translation and purchase separately. For example, a hospital in the North of England will have the same or very similar information translated than a hospital in the South, yet still pay for it on an individual basis. Rather than gaining access to that information already translated. This is obviously a massive contribution to the cost for the Government. To try and improve this situation, we have developed a unique translation memory software tool, GovMem. This is designed to store existing translation so that it is readily available to other health departments without them having to pay for the full cost of the translation again, therefore dramatically decreasing turnaround time and cost. We are currently in talks with public health services and other Government departments to implement this tool so that all departments have access to relevant translations. The amount spent could easily be reduced by up to 70% if the Government looked to using advanced translation memory technology, such as GovMem. Competing interests: None declared |
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Margaret A Fryer, translator (medical and general) home
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In discussing this article it is essential not to confuse translators and interpreters. The training and skills needed are quite different. A translator turns *written* texts into or out of another language. An interpreter communicates *orally* between one language and another. So, if you want to speak to a patient who has no English you need an interpreter. If your patient has a written text, from a hospital, say, you need a translator. Some linguists are both translators and interpreters. Many are either one or the other. The term 'translator' should never be used loosely to cover interpreting as well, even though the media often make this mistake. Best regards, Margaret Fryer, Member of the Institute of Translation and Interpreting Competing interests: Member of the Institute of Translation and Interpreting |
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SIMON D PRICE, GP ST.JULIANS MEDICAL CENTRE, NEWPORT NP10 9HW
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This is a great resource that I would not be without.£55M is a great deal of money but not so much as the £500M overpaid to drug companies, perhaps some sponsorship? One of my partners, a non-native english speaker, uses 2yrs as a rule of thumb. Over 2yrs in the country and the consultation is in english or if not why not? Competing interests: gp uses language line |
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Dr Ikhlaq Din, Research Fellow University of Bradford, School of Health Studies BD5 0BB
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Dear Sir/Madam, Spending huge amounts of money on translation services is waste of NHS funds which I am sure most patients (including non-English) would like to have this money spend on their medical treatment instead. In my professional experience of researching minority ethnic communities particualry Pakistanis I know that very few patients/non-patients ever read translated material in fact or indeed have the ability to read information in translated formats. Dr Ikhlaq Din e-mail: ikhlaqdin@hotmail.co.uk Competing interests: None declared |
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