Providing truly patient-centred care: Harnessing the pragmatic power of interpreters

Abstract

In order to achieve the aims set out in South Africa’s National Policy on Quality in Health Care (2007:4), the gap between standards and actual practice must be measured, reduced, and ultimately, eradicated. One of the most obvious gaps in our health service is the failure to ensure that patients and healthcare professionals understand each other. Without successful communication, the provision of quality patient-centred care will always hang in the balance. Healthcare professionals in South Africa have to improvise when treating patients who do not speak their language – generally by using ad-hoc interpreters, who may be nurses, refugees, family members, or even children. A number of studies (Cambridge 1999, Meyer et al. 2003, Penn 2007) have found that using ad-hoc interpreters to overcome language barriers is often problematic. In this article, a specific intervention is described which takes the form of a professional development workshop for counsellors and community workers working with refugees, aimed at reaching a better understanding of how to work with interpreters. An ad-hoc interpreter participated in a role play with a therapist and refugee client, and was then substituted by a professional liaison interpreter. The workshop participants (who could not understand French or Lingala, the languages spoken by the refugee client and the refugee interpreter) commented on the differences between the two interpreters’ performances and their impressions of the power dynamics between participants, caused in part by factors such as positioning and eye gaze. The researcher then conducted a conversation analysis to supplement these findings. Aspects considered include the effect of procedural factors (control of turn length, attribution of roles and briefing of participants, use of the first person, memory management and overload) as well as linguistic aspects of the communication flow. The analysis indicated that it was the ad-hoc refugee interpreter’s lack of knowledge regarding the procedural aspects of the interpreting process that impacted most on the communication flow, rather than any possible transference or re-telling of her own story, as has previously been indicated in the literature. The trained interpreter’s linguistic knowledge and awareness of procedural aspects led to smoother communication between participants. It is recommended that interpreters in therapeutic contexts be trained to participate as active co-participants so that they may control turn duration, be aware of role attribution and positioning, and extend their memories to enable them to interpret accurately in the long consecutive mode.