Stanford Hospital interpreters make health care a universal language

Credit: Norbert von der Groeben

Julia Mogilev [left] sits in on a patient's visit to her doctor, translating the doctor's comments into Russian and then the patient's remarks into English.

'Can you hear me okay?'

From her seat at the back of the hospital classroom, interpreter Amanda Pease whispered, in Spanish, into a tiny handheld microphone. At a conference table a dozen yards away, a young Hispanic man turned in her direction and nodded yes, one finger tapping the ear bud of his receiver.

So far, so good. Then came a torrent of medical phrases, in English, from the coordinator who was leading the orientation session for prospective kidney transplant patients. Human leukocyte antigen. Cross match negative. Urethral stenonis. Nephrotoxicity.

Simultaneous interpreting is a skill that some liken to singing a song you're hearing for the first time, without knowing the words. Not an easy feat, even for those with perfect language pitch. Pease, who works for the Stanford Hospital & Clinics interpreter services, kept up a steady, simultaneous stream, in Spanish, of everything that was said, every slide that was shown. Also in the back of the room were a Vietnamese interpreter and a Chinese interpreter. Wearing the white lab coats that designate them as part of the hospital's medical teams, they whispered intently to the patients who sat next to them.

Pease is one of the 30 or so interpreters involved in translating for patients at the hospital. It is one of the largest medical interpreter services in California, said Barbara Ralston, vice president for international and guest services, and it routinely handles assignments in Spanish, Russian, Mandarin, Vietnamese, American Sign Language, Cantonese, Korean, Japanese, Farsi and Tagalog. For some other languages, such as Hmong, there may be only one request per year, which is handled by an outside agency.

This spring, the service added something new. Interpreters, who must spend part of their traveling between appointments at the psychiatry building on Quarry Road and at the Cancer Center on the main campus, now use a camera and screen video set-up to connect with patients and physicians at another off-site location, the Stanford Medicine Outpatient Center in Redwood City. The four video medical-interpretation stations there will speed the availability of interpreters, Ralston said.

Many of the Stanford interpreters have received intensive training in medical terminology, and some hold degrees in science or in formal interpreting and translation from the Monterey Institute of International Studies. 'We're proud of our diverse staff, who have master's degrees in science as well as in interpretation and translation,' said Ralston. 'They've been influential in shaping best practices and professional standards for the medical interpretation field.'

Interpreter Margarita Bekker, for example, came to the United States from Russia with nursing experience, then studied Slavic languages at UC-Berkeley and currently serves as president of the California Healthcare Interpreting Association. A new state law makes knowledge of CHIA standards mandatory for hospital interpreters, and the organization sends trainers, including Chinese interpreter Jane Tong Delore, throughout the state to educate interpreters.

The core of the hospital program's work is interpreting one-on-one between patients and doctors. More than 70 percent of a physician's diagnosis is based on the physical exam he performs - and the history he takes. 'That tells you how important communication is,' said Luis Alberto Molina, assistant director of interpreter services. 'Our purpose is to encourage and support the direct relationship between the patient and the provider. We cannot be invisible in an examination room, but we can be transparent.'

Molina supervises the hospital's interpreters, and Claudia Soronellas-Brown, translation coordinator of interpreting services, directs the written work of the program's translators. Her office receives requests from physicians, social workers, clinics and researchers. She also works with translators who are constantly fine-tuning pathology reports, medical histories, brochures, research papers, discharge instructions - even hospital signage.

In the Blake Wilbur ophthalmology clinic, interpreter Julia Mogilev recently demonstrated the fine art of greeting a patient and earning her trust, then encouraging the patient to have that same confidence in the physician. Sitting beside a Russian patient who was about to undergo eye surgery, Mogilev voiced the woman's questions and hesitations about the procedure, speaking always in the first person: 'How does it work? Will I be able to go home after it's finished?' She also reflected the patient's feelings. When a resident administered the eyedrops that would be the only anesthesia for the procedure, Mogilev's 'It stings!' carried the same intonations as the surprised patient.

Because they experience their patients' pain on some level, interpreters say the job can be emotionally challenging. The impact of a patient's diagnosis sometimes hits home at the end of the day, and that's when interpreters themselves may need someone to talk to. 'When one of our colleagues comes back to the office, and we can see that something's wrong, we'll ask, 'So, what's going on?'' Pease said. 'Then we'll say, 'Stop. Breathe. Take some time. We'll go to your next appointment for you.''

Interpreters keep up with new terms and technologies by reading online journals and research papers by School of Medicine faculty. But even when they know the answer to a patient's questions about, say, Stanford's Cyberknife, they can't volunteer information.

'I can't say, 'That's a new, non-surgical technique for eliminating certain lesions and tumors,'' American Sign Language interpreter Sheila Rodrigues explained. 'The patient has to ask, 'What's that? What does it do?' And then the physician has to explain it. And only then can I explain it, by interpreting his words.'

Then there are the intimate exchanges that can happen at the very end of an appointment. Patient and interpreter will be leaving a physician's office, and the patient will turn to her new friend, who speaks her language and who now knows the most intimate details of her condition or diagnosis. 'Suddenly, the patient will ask, 'What do you think I should do?'' Pease said.

'Someone who's not familiar with the profession's code of ethics could easily say, 'Well, I know so-and-so, who did this,'' she said. 'But with us, that will never happen. We're trained to make the patient's connection happen with the provider, not with the interpreter.'