Translator vs. Interpreter vs. Cultural Broker
The difference between translators and interpreters can often be confusing. The general rule of thumb is that translators work with the written word while interpreters work with the spoken word.
Traditionally, the role of the interpreter has been the “black box” or “translation machine,” where the interpreter impartially transmits the words of the patient and the physician back and forth, giving no advice or guidance to either side of the encounter (Dysart-Gale, 2007). This means that the interpreter translated the literal words said during the encounter without providing any explanation or insight to the cultural context of the words being exchanged.
However, a culturally sensitive encounter with an individual who has a different native language is more than ensuring they are able to understand the words used in a session. Culture clearly plays an important role in the perception of health, affecting both medical logic and communication patterns. Cultural brokers are individuals (who are often also interpreters) who can assist providers in going beyond the language barrier to bridging the cultural gap. Cultural brokers are familiar with both the target culture and the culture of biomedicine, and therefore serve to not only interpret the words being said, but also the cultural meaning behind them in the context of the goals of the genetic counseling appointment. An extensive document on cultural brokers is available here. In the health care system today, various kinds of community health workers provide assistance when clients and providers are from different cultures. These individuals offer support in ways similar to a cultural broker. Click here to read more about a variety of additional support positions, which may be unique to specific communities.
There has been considerable debate in the interpreting community about where the field should fall on the continuum between “black boxes” and cultural brokers. Four different roles of interpreters have been described. These roles may be employed by a single interpreter in different settings. These four roles are the interpreter as conduit, the interpreter as manager of the cross-cultural/cross language mediated clinical encounter, the incremental intervention model, and the interpreter as embedded in her cultural-linguistic community. It is extremely important to clarify with the interpreter beforehand which role she usually adheres to and when she feels it is necessary to take on another role. Different interpreter roles assume different responsibilities, therefore modulating the role of the provider in the encounter.
The interpreter as conduit is the most traditional and circumscribed role of the interpreter. This approach limits the interpreter to mediating only the linguistic aspects of the communication between the provider and the patient. It is entirely up to the provider to make sure the message being translated is effective and culturally sensitive. “The interpreter is there as a ‘bridge’ [but] what is brought across the bridge is not up to [the interpreter]. It is not up to the interpreter to provide cultural explanations or to serve as a cultural broker” (Beltran Avery, 2001, p. 6). Interpreters using this role will only intervene in an encounter if cultural differences are making the words impossible to be translated. This model works best when providers are fully culturally competent.
The interpreter as manager of the cross-cultural/cross language mediated clinical encounter allows the interpreter to intervene as necessary to point out and assist in exploring cultural barriers to care. The interpreter may serve as a “communication” advocate, making sure that both parties understand the messages being relayed, but may also serve as a “referral” advocate, making sure the patients receive the services they need. The interpreter, however, respects the medical expertise of the physician and will not speak for the patient or the provider during the encounter.
The interpreter that employs incremental intervention sees the role of the interpreter as flexible along the continuum of interpreter as conduit to cultural broker to advocate. Each interpreter that follows this role will have different threshold for when they move along the continuum, so further discussion with an interpreter who follows this role will help clarify their beliefs. This model is employed when providers are trained in working with interpreters, but are not fully culturally and linguistically competent.
The farthest end of the continuum is the interpreter as embedded in her cultural-linguistic community. This kind of interpreter serves multiple roles outside of interpreter and is responsible for fulfilling various social roles beyond her/her role as an interpreter. Some examples would include an individual who functions as a community leader, or as an alternative health care provider, or as a community liaison for the cultural group. Someone who is otherwise actively engaged in advocacy or support of a cultural group is often a member of this cultural group.
Some interpreters also assume another role, patient advocate, when a patient’s health, safety or dignity is at risk. In terms of safeguarding patients’ health, this may include providing physicians with information that the medical interpreter has learned from previously working with the patient that could be crucial, such as a life-threatening allergy. In terms of respecting patient dignity, the patient advocate role may also include speaking to clinic personnel or hospital administrators if they believe there is a pattern of mistreatment of individual patients or members of certain patient populations.
As there is no consensus within the interpreting community as to the scope of the role of interpreter, it can be somewhat confusing to know exactly how to work with an interpreter and how much of the responsibility for a culturally competent encounter falls on the provider versus how much falls on the interpreter. At a minimum, you can expect your interpreter to convey your message to a patient as if you were speaking the same language; including alerting the provider to possible cultural conflicts and helping the provider resolve these conflicts (Code of Ethics, NCIHC). All interpreters respect the importance of the patient-provider relationship and strive to provide the best care for the patient possible while minimally intervening in the patient-provider relationship. Beyond this minimum standard, each interpreter differs on their personal philosophy of the scope of their role as interpreter.
Although some providers may be tempted to rely on interpreters’ expertise in cultural competency issues, the more providers progress in their development of cultural and linguistic competence, the more success they will have with their diverse patient population. Additionally, for all the expertise interpreters possess, they are not trained in medical genetics and genetic counseling and cannot guide the medical component of your sessions.
