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(By Amy Sarah Marshall. Originally posted on Healthy Balance, a blog about UVA and your healthcare.)

My interview with a hospital interpreter proved revealing.

As an English speaker, I am privileged. When I go to the grocery store, to my job, to the bank, to my kids’ school, I don’t need to worry that I’ll encounter people who don’t understand me. The clerk, the boss, the teller, the teacher — they all speak English, like me. I don’t even think about it.

The same cannot be said for many of the immigrants, refugees and others who live here in Virginia but do not speak English. Every aspect of their existence has an inherent level of vulnerability because of the language barrier.

Languages at UVA Hospital
At UVA, a group of full-time, on-site hospital interpreters, supplemented by remote contractors, work to make the world of healthcare — from doctor appointments to hospital visits — less intimidating and overwhelming. They give the non-English speakers a vital resource: a voice.

These interpreters provide services in 14 of the most prevalent languages in the region, including Spanish, Farsi, Nepali, Mandarin Chinese, Vietnamese, Arabic and Russian. The contracted services offer interpreters via phone or video for over 200 languages.

Still, “we are busy all the time,” says Sylvana Fernandez-Ellauri, a certified medical interpreter at UVA. Once a pediatrician in Uruguay, Fernandez-Ellauri emigrated to the U.S., and after working at a number of non-medical jobs, found herself once again in a clinical setting, this time as an interpreter.

What is a Hospital Interpreter?
First thing, Fernandez-Ellauri explains the difference between interpreters and translators.

“There’s a misunderstanding,” she says. Translators deal with “written communication, converting a written message in one language into a written message in the target language.”

Interpreters, on the other hand, “facilitate conversion of the oral message from one language to another.”

But just because she learned English as a girl and served as a doctor in Uruguay didn’t mean Fernandez-Ellauri could automatically work as a hospital interpreter. “I was just a bilingual person. I had to train to become an interpreter.”

This training involved earning a national certification, learning the “techniques, rules, standards of practices and code of ethics.”

Rules of Interpretation
Fernandez-Ellauri says that, at the beginning of each medical appointment, she sets ground rules of her role with both the patient and the doctor.

She explains:

• Everything is confidential.
• Doctors should speak directly to their patients, not to her.
• Patients should speak directly to the doctor, not to her.
• She will interpret everything: “If you say something you don’t want me to interpret, don’t say it.”

Fernandez-Ellauri finds her work requires constant education. “Ten minutes after you’ve set the ground rules, they forget everything and they’re looking at you, not at each other.”

Another rule she finds she has to enforce: Using a minor as a hospital interpreter is against the law. “You cannot use a minor to interpret for anybody. They are not prepared for that. But some parents don’t take a child to school, because they have an appointment, and they think that the child will interpret for them.”

More Than Words
Part of interpreting goes beyond what people say with their words but includes the whole “tone and the intention of the message,” Fernandez-Ellauri says.

This requires setting aside personal opinions. Accuracy is the goal.

“We may like or dislike the way you are saying it, but we have to relay the message you are conveying, honoring the message you are trying to convey. I may disagree with the way you speak to this patient, but I have to be accurate. All that you say has to be interpreted exactly, without omitting, without adding and without embellishing.”

That is, there’s more to being an interpreter than people think. When she accompanies a patient to a medical appointment, Fernandez-Ellauri feels she acts as a bridge between “two people who not only don’t share a language, they don’t share a culture.”

Medical Terminology
Often, Fernandez-Ellauri finds that, in addition to language barriers, medical jargon hinders clear communication.

She may interrupt a conversation if she senses confusion. For instance, if a doctor talks about a water pill, or diuretic, a Spanish speaker may be baffled. “Even ‘water pill’ in Spanish doesn’t mean anything.” At that point, Fernandez-Ellauri will intervene and say, “The interpreter would like to make sure the patient understood what water pill means.” She’ll ask the doctor to offer a definition.

Fernandez-Ellauri and the other hospital interpreters do their best to keep up with medical terminology. At a teaching hospital like UVA, which constantly develops new techniques and research, “There’s always something different, something you don’t know, an acronym you have no idea what it is, and you have to ask for personal clarification. If you don’t understand the message, what a poor hospital interpreter you would be!”

Emotional Challenges & Boundaries
Then there’s the times when patients turn to her for help. They see Fernandez-Ellauri “as an ally who will understand them better. They look at us to save them, like we’re a rope.”

Maintaining her professional boundaries can prove difficult.

“The stories I’ve heard,” sighs Fernandez-Ellauri. “Of people lost; children killed by the gangs in Honduras or Guatemala. Mothers who had children with drug problems; a child who hates the mother and father for taking them away from their country and relatives. Girls who were raped in the process of coming here. I’ve seen so much suffering.”

But as an interpreter, Fernandez-Ellauri has to stay objective and neutral. “The challenge is to survive with dignity and help the best you can and do it in a professional way. You are there to give them equal opportunity as a native speaker of a language. You just have to be their voice and allow them to express their concerns, or cry, their sorrow, their grief, their questions, their anger. It’s marvelous. It’s tough. Very tough.”

The Importance of a Hospital Interpreter
Fernandez-Ellauri emphasizes, “In healthcare, communication is crucial. Minor things you never think of could make a difference between if you get the financial assistance or you don’t get it. Or what if you make it to your appointment, and you don’t understand you have another appointment in another facility that same day?” Travel is expensive. Helping make sure these people have clarity around their appointments and prescriptions is critical.

Working as a hospital interpreter has “made me a better person in general,” Fernandez-Ellauri admits. She understands what it’s like to be navigating a healthcare system in an unfamiliar country and culture. “In healthcare, it’s even more difficult because people are in panic mode or they are feeling very poorly or they have so many problems in their minds, finances, family.”

But it’s worth it. “It feels good when you’re told by someone, ‘thank you so much, I understood.’ Or doctors say, ‘thank you, this was difficult, I’m so glad you were here, I feel like this person got it.’”