Medical Interpretation and the Art of Storytelling

In 2021, I arrived in the United States as an international student from Chile. Full of promises and new opportunities, I felt energetic and excited when I started my college journey. However, my lack of English fluency and challenges adapting to a new culture haunted me daily. In the beginning, I thought I knew English, so I prepared myself by taking intensive English classes and taking tests as proof of my second language proficiency. Regardless of all my efforts, it was not enough, or at least it did not feel like it was enough. Every day felt like a new challenge, and I would feel constantly tired because my brain could not handle the new words every day. However, I knew I was not alone. Many other Latine individuals, or anyone who is an English-language learner, face language barriers in different contexts as much or more than I do. In the summer of 2023, two years after my arrival to the United States, I dedicated myself to a journey of community work serving as a medical interpreter in a free clinic in Springfield, Oregon.

Medical interpreters are a vital component of healthcare, above all in communities where Spanish speakers keep exponentially increasing. Without interpreters, these communities would not have access to a variety of basic rights and needs, including healthcare, all because of a language barrier. Medical interpreters not only help with immediate communication; in my experience, they also serve as cultural ambassadors. Drawing on my knowledge of this important dual role, I developed two research questions. How do medical interpretation and the art of storytelling contribute to a larger understanding of our community and allow a space for cultural representation? What needs and opportunities exist to support medical interpreter training? This project contextualizes what medical interpretation is, why it is necessary, and how it contributes to cultural representation and understanding of our community.  To do so, this project includes academic studies and medical interpretation opportunities and, importantly, shares mi testimonio as a medical interpreter. This effort gives insight and emphasizes the complexity of healthcare in this country, highlighting the role of medical interpreters in closing language and cultural barriers.

Interpretation is the act of converting one language into the other instantly to facilitate communication between two or more people who speak different languages (Oxford Dictionary, n.d.). In a clinical setting, this action is hard to achieve precisely because of the hard and technical medical terminology, although possible. Interpreters need to experience extensive preparation to be qualified and capable of interpreting with accuracy. According to conversations among providers in the Willamette Valley, some clinics require a degree or certification to support a person’s ability as an interpreter while others only require people to be bilingual and offer on-site training.

Currently, interpretation can be offered either online or in person. In my experience, and from the testimony of patients I have helped, the best outcome comes when interpreters are in person. Sharing the same physical space allows the patient and interpreter to connect meaningfully, and often, patients feel they can express themselves even better than just talking with the interpreter via a computer. However, it is important to recognize the usefulness of digital interpretation and accessing a broader language pool. In the clinic where I volunteer as a medical interpreter, we often struggle to find people proficient in both Spanish and English with the availability to serve our community. In this sense, communities need more information about what opportunities there are, including which clinics could provide a stipend or wage to interpreters, and those that cannot. This concern with financial support also links to experiences living in low-wealth communities.

The percentage of poor Hispanic families continues to decrease over time. In 2022, the US Census Bureau registered a decrease in Hispanic families living below the poverty line, from 24.3% in 2011 to 15.2%. (US Census Bureau, 2023). The figures above are important because poverty is directly linked to economic opportunities and equity, hence being able to afford medical services and health insurance. The latest statistics show that almost 21% of Hispanics live without medical insurance (CDC, 2023). The figure means that almost 15 million Hispanics, not counting all of those who are undocumented or those yet to come, rely on free clinics such as  Volunteers in Medicine  in Springfield, Oregon. The struggle to find Spanish interpreters, along with the growing demand and necessity of this support, is worrisome. In my experience, many families rely on their kids who have grown up in the United States and speak English to attend their medical appointments to serve in the interpreter role. This family presence somewhat counteracts the low number of interpreters, although relying on children and family to fill this gap perpetuates inequity and does not lead to systemic and structural changes that should provide adequate preparation for interpreting medical information effectively. 

A patient’s life story and medical history are pivotal for healthcare professionals to communicate and deliver the best available treatment. In this sense, many physicians, nurses, nurse practitioners, and other professionals do a wonderful job investigating patient needs and experiences. However, when sharing important cultural details, combined with the lack of English knowledge, patients might omit information. Medical interpreters are an indispensable bridge to co-create a safe cultural environment, given that patients can feel more understood and judgment-free (Heath et al., 2023). Interpreters provide a balance between language and understanding of traditions and culture, something that many US American doctors are not well aware of. Gloria Anzaldúa portrays this feeling of belonging in her poem  “Living in Borderlands.”  In the poem, she expresses how, no matter how long one has been in a foreign country, a person will find something that reminds them where they come from. Anzaldúa specifically talks about a borderland; however, a borderland is not only a physical border (such as the US-Mexico border). Language and cultural differences are also a border that immigrants need to constantly cross and adapt to in their daily lives. Interpreters can remind patients of the opposite: that they do belong here and we, as professionals, are working on providing them with more inclusive and equitable spaces for care.     

The fear of being judged for being different was evident to me when I volunteered at the free clinic, especially for those patients who just arrived in the city or the country. It was common to see them looking at me expecting approval while explaining cultural information and other traditions to the physician. The difference between Latine and US (European) American societies is enough to remind people who are newer to the United States of where they come from, and not only those who migrated but also the generations who follow. As interpreters, we have the opportunity to represent different backgrounds and become allies to patients in harsh situations, helping to break the feeling of being left out and foreign. Implementing culture-centered communication is not only feasible in a primary care setting but also in the emergency room or intensive care unit where physicians need to make fast and important decisions crucial to the patient’s life (Suarez et al., 2021). On this point, it is important to also create more opportunities for those who desire to become interpreters, a profession that increases its demand every day, alongside the increase in Spanish-speaking inhabitants. 

Medical interpretation is becoming a critical part of healthcare facilities in both outpatient and inpatient settings. The number of Spanish speakers in the nation keeps increasing while opportunities to study and become a medical interpreter are still limited. Many of the current programs are mostly focused on certificates and accredited courses. In this material, we need more efforts from colleges and universities to increase these opportunities, above all in those regions where the prevalence of English as a new language is higher than the national average. However, the complicated world of medicine and interpreters need more than just a certificate to be fully proficient and able to understand the complexities of medical terminology.  Arizona State University  recently started a program through the foreign languages department to allow students to focus on translation and interpretation (ASU, 2023). This higher education degree allows students majoring in Spanish and other languages to focus on interpretation in a clinical and legal setting. This academic offering helps to take action in closing the gap between Spanish speakers and the medical field. The diverse and mobile diversification of the United States requires a higher effort in undergraduate students, so recent graduates can enter into a field where the demand is high and people can do meaningful work.

Similarly, medical students also need training in interpretation and in how to work in an environment where it is necessary to use a third person to deliver adequate medical attention. In a professional setting, using an interpreter seems easy to work with and straightforward. However, the reality is far from what it seems, and medical professionals often struggle when working with interpreters. Addressing this challenge, universities like the  Mayo Clinic  are training current medical students with medical interpreters in a hands-on clinical experience (Mayo Clinic, 2022). This is a praiseworthy effort to train professionals, and a promising way to close the gap since the complexity of medicine requires formal training in interpretation. The most common mistakes made by medical professionals are talking too fast and using long sentences. These problems lead interpreters to develop translated sentences inadequately, often leading to misinterpretation and confusion for both the patient and healthcare professional. Interpreters need to also be able to work with the physician in a coordinated fashion with visual aids to communicate effectively. Curricula that include interpretation as part of the training will prepare future medical professionals to be ready to work with interpreters and patients successfully.  

The first time I felt I was ready to serve my community as a medical interpreter was in the summer of 2023. It took me about two years, after arriving in the United States as an international student from Chile, to feel comfortable with my English skills. I did not want to fail my patients and doctors. Volunteers in Medicine (VIM) is a free clinic in Springfield, run only by volunteers, including front desk assistants, nurses, doctors, and other healthcare professionals. I still remember calling the language coordinator to express my enthusiasm and desire to become part of the volunteers. I knew I wanted to serve as an interpreter; however, I had no idea what I was getting into in this new role. The first day during the introduction, I was taught how to work with doctors and nurses and how to effectively communicate both verbally and kinetically with them in both, during and after the consult. Quickly I felt overwhelmed by the amount of reading I had to do since they assigned me material to prepare for interpretation, including anatomy, common symptoms, types of medication, and most frequently asked questions at the clinic. When I decided to embrace my journey, I could not stop feeling connected to the book  This Bridge Called My Back , where the authors make a call to not forget your past and embrace your culture, above all in a country where minoritized people suffer the consequences of segregation and discrimination (Moraga & Anzaldúa, 2015). Even when all this new material seemed like a lot to learn during my summer break, I was willing to take this opportunity to pay back to my community and embrace the South American culture to not only help patients but also to serve as a cultural ambassador and teach the staff about Latine and Chilean culture.

I quickly fell in love with my volunteer work since I also identified with the patients' stories and culture, making me feel closer to home during every volunteer shift. Medical cases and patient stories were hard to listen to, but their long journey to get here served as a boost of energy to continue on my path. As a volunteer, I was unaware of the effect that my presence would have on patients; after all, I was just being an interpreter. However, multiple patients after medical appointments would thank me for being there and allowing them to be able to have access to healthcare. “Gloria,” one of the patients I helped during my journey at VIM, shared her story with me on multiple visits and talked to me about the challenges of being an immigrant and her farming life. She made her way from Guatemala years ago, and since day one, her life depended on the free clinic and its interpreters. 

Stories like Gloria’s are common at VIM, and their lives depend not only on the clinic but also on other community-based activities that promote cultural representation. These crucial connections are visible in the case of  Huerto de la Familia , a community garden program that many of the patients I helped are a part of. Huerto de la Familia is a space for cultural representation and a community-building necessity. The gardens provide a space that allows many families to save money at the end of the month, helping not only socially but also economically (Herrera, 2022). Throughout my journey at VIM, I became aware of opportunities available for members of our community, which were not only beneficial for my patients but also for me.

I also understood the importance of communication and teaching a broader audience about new opportunities and science. This understanding is why I agreed to give a Radio interview in August 2023 to talk about my experience as a medical interpreter and a researcher in an on-campus laboratory. I hoped that others might learn from my journey and that my experiences could be an example for those who desire to follow a similar path.

My arrival to the United States was all but smooth, and the transition and culture shock shaped my life to become the person I am today.  Many of the medical problems I saw during my time at VIM were mostly linked to dietary issues. These health problems are linked to the inequitable wages most of the patients earn in a month; this money is not enough to take care of their families and themselves. An unhealthy diet, combined with very hard work, including kitchen, construction, farming, and housekeeping labor, has terrible health outcomes for patients. Changing patients’ diets was a common way to combat the origins of long-term and chronic diseases such as diabetes, a condition I saw in many of our patients. These were the moments I felt my knowledge of South American culture was key during the medical appointment. Many times I explained to the doctors our differences and helped my patients feel understood and culturally supported. My volunteer work was so rewarding emotionally and socially that I have no doubts my journey at VIM will continue. Moreover, my experiences here have made me passionate about healthcare and community outreach, and I hope to continue this work during my future journey as a medical student and as a physician.

Medical interpretation is a necessary tool that allows physicians (and other healthcare professionals) to understand and communicate with patients who, otherwise, would not be able to seek medical attention. Moreover, medical interpretation is a bridge closing cultural barriers, allowing, at the same time, a deeper connection between medical professionals and their patients. Cultural representation plays an important part in a medical setting, and patients often feel more acknowledged and more understood with the presence of an interpreter, who otherwise might accidentally miscommunicate because of cultural differences. In a country where the Spanish-speaking population keeps growing, medical interpretation training opportunities are becoming crucial. We not only have the duty to help those with access to healthcare but also for those uninsured who do not have the opportunity to pay for medical services. Free clinics, such as VIM, are beyond important in our society; these organizations constantly fight to close the gap between language barriers, social risk, and healthcare access. Policymakers and the government must find a way to create better healthcare access and help sustain free clinics around the United States that are key in today’s society. 

Universities around the country, especially in cities and states where the prevalence of English as another language is high, must create programs designed to prepare and serve the community that needs interpreters. This effort should involve training them in Spanish and medical terminology and also requiring that students learn more about South American cultures. In my interpretation journey, this knowledge has been the key to a smoother experience with both the patient and the physician. Finally, I encourage other Spanish speakers in the community to be brave and embrace their cultural understanding and English proficiency to get involved in medical interpretation, a profession that is in increasing demand. As Gloria Anzaldúa (1987, p.195 ) said, we must be willing to dwell within a constantly changing world, changing for good and for us in liminal spaces because “to survive in borderlands, you must live sin fronteras, be a crossroad.”

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Heath, M., Hvass, A. M. F., & Wejse, C. M. (2023). Interpreter services and effect on healthcare - a systematic review of the impact of different types of interpreters on patient outcome. Journal of migration and health, 7, 100162.  https://doi.org/10.1016/j.jmh.2023.100162 .

Herrera, T. M. (2022). COVID, climate change, and carework: Mesoamerican diasporic Indigenous and Latino communities in the Willamette Valley. [Doctoral dissertation, University of Oregon]. Proquest Dissertations Publishin

Interpretation, n. Meanings, Etymology, and more. Oxford English Dictionary. (n.d.), Retrieved April 5, 2024, from  https://www.oed.com/dictionary/interpretation_n 

Mayo Clinic College of Medicine and Science. (2022, June 6). Bridging the language gap: Medical students use interpreters to better connect with patients - news archive - mayo clinic college of medicine & science. https://college.mayo.edu/about/news/news-archive/bridging-the-language-gap-medical-students-use-interpreters-to-better-connect-with-patients/ 

Moraga, C., & Anzaldúa, G. (2015). This bridge called my back: writings by radical women of color. Fourth edition. Albany, State University of New York (SUNY) Press.

Suarez, N. R. E., Urtecho, M., Jubran, S., Yeow, M. E., Wilson, M. E., Boehmer, K. R., & Barwise, A. K. (2021). The Roles of medical interpreters in intensive care unit communication: A qualitative study. Patient education and counseling, 104(5), 1100–1108.  https://doi.org/10.1016/j.pec.2020.10.018 

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US Census Bureau. (September 12, 2023). Share of Hispanic families living below the poverty line in the United States from 1990 to 2022 [Graph]. In Statista. Retrieved December 05, 2023, from  https://www.statista.com/statistics/205175/percentage-of-poor-hispanic-families-in-the-us/