Foreign tongues


foreign-tonguesWhen treating non-English-speaking patients, it’s vital that you make yourself understood by going through a professional interpreter, writes Samantha Trenoweth.

Sometimes you have to tell it straight—there’s no sugar-coating the condition of those teeth—but what do you do when the patient’s English is poor and the family member they have brought along to interpret isn’t familiar with the language of dentistry or is in the habit of deferring bad news? What about those legal forms that need to be understood before they’re signed? A miscommunication in the surgery can lead to over-communication in the lawyer’s rooms. So, who you gonna call? An interpreter.

Interpreting is becoming increasingly important as Australia welcomes more migrants. Associate Professor Ravi Srinivas is the director of Oral Health Services for the South Western Sydney Local Health District (SWSLHD) and has seen rapid change over recent years.

“South-western Sydney has one of the most multicultural, diverse populations in the state and we have a large non-English-speaking community,” he explains. “We have a lot of migrants in areas like Fairfield, people come from many different cultural backgrounds, and many of them are coming from very difficult circumstances. They need to understand their rights and responsibilities.”

(Patients can contact interpreters through the SWSLHD website.)

If the patient goes through preliminary triage on the phone, then their language status is recorded on file. So in future contact with the service, an interpreter will be pre-arranged, either on the phone or on site.

“From the point of triage, we will know what language the person speaks,” says Srinivas. “If they had to use a telephone interpreter service to go through a triage questionnaire and make an appointment, it’s safe to assume that person will require an interpreter in the clinic. So an interpreter will be booked for that appointment—preferably a face-to-face interpreter. When the patient arrives for an appointment, they may have family members there, which is fine, but the interpreter will be there as well.”

In the public system, Srinivas explains, the use of interpreters is mandatory. “The policy directive is that any patient can request an interpreter and the clinic or hospital must provide one.”

In private practice too, he says, “a dentist is obliged to ensure that a patient is fully cognisant of their treatment plan, the treatment proposed, the risks and benefits, the cost—all that stuff.”

“South-western Sydney has one of the most multicultural, diverse populations in the state and we have a large non-English-speaking community.” – Associate Professor Ravi Srinivas

It wouldn’t take long for a professional interpreter to interpret those details but what happens, most often in private practice, is that a family member helps out by summarising what is said, but does not faithfully interpret every utterance. “Is that ideal?” asks Srinivas. “Probably not.” Having family members sitting in on a consultation can be both a blessing and a curse. If a dentist is explaining a complex procedure, the family member may not understand it themselves and will unlikely be able to interpret it into the other language faithfully, having had no interpreting training. There may also be all kinds of family histories or sensibilities which preclude the complete transfer of medical information.

“People who can’t communicate in a common language need to do it through a professional, competent interpreter,” says Professor Sandra Hale from the University of New South Wales and the president of The Australian Institute of Interpreters and Translators (AUSIT). “I say ‘professional’ because a lot of people take family and friends to help them communicate and that can lead to miscommunication and may mask the issues. A bilingual may be speaking on behalf of their relative or friend and they may be saying some of what is being said but they will not interpret everything accurately, and much of the information will be lost, without anyone noticing. If they have to sign a consent form, which is a legal document, a professional interpreter must be hired.”

“Essentially a dentist needs to be able to ensure that in the communication process with the patient, they are able to obtain from, and provide to the patient, accurate information so that informed consent is obtained prior to commencing dental treatment,” says Associate Professor Sharon Liberali, a representative of the Australian Dental Association and a specialist in special needs dentistry. “You need to be confident that if you are relying on an interpreter to assist with this communication process, whether it be the patient’s family member or friend, or a professional interpreter, that he or she comprehends and communicates accurately all of the information you have provided to the patient, as well as the information provided by the patient.

The risk of using a family member or friend as an interpreter is that their comprehension may be limited, resulting in an incomplete or inaccurate translation of the content of the conversation, or the patient may not divulge information you require in order to be able to treat safely due to privacy concerns.”

In south-western Sydney, the main languages other than English are Arabic, Vietnamese and Mandarin. Elsewhere in Australia, there are other language groups, especially in rural areas with Aboriginal communities. Deaf people right across Australia also need Auslan sign language interpreters.

AUSIT’s website features an easily searchable directory of translators and interpreters, who are formally trained and/or accredited by National Accreditation Authority for Translators and Interpreters (NAATI). Qualified interpreters abide by the AUSIT Code of Ethics. According to Professor Hale: “The main tenet is that interpreters interpret everything faithfully and not deliberately change things to suit what they think should be said or not said. That’s something that happens a lot with untrained interpreters. Untrained interpreters summarise or they don’t say things they think are irrelevant or impolite. A professional interpreter doesn’t do that. A professional interpreter understands that their role is to interpret everything faithfully, regardless of whether it makes sense or is offensive or irrelevant. They are also trained to keep everything confidential and to be impartial. They’re not there to help the non-English speaker and they’re not there to help the medical practitioner.”

“The policy directive is that any patient can request an interpreter and the clinic or hospital must provide one.” – Associate Professor Ravi Srinivas

As time goes on, though, the staff in medical centres, hospitals and dental clinics are becoming more culturally diverse, and Srinivas believes this too contributes to better outcomes for patients whose first language is not English.

“In Fairfield, we have a diversity of cultures amongst the people who work in our clinic that is reflective of the patients who visit,” says Srinivas. “Having people from the same cultural background assists our patients to be more comfortable—they can feel at home. Having an interpreter or someone fluent in their native language is also a great comfort to patients, especially those facing complex, painful procedures.”

So, next time there are complex procedures to explain and you suspect language might be an issue, who you going to call?

How to find an interpreter

  • The Australian Government’s Translating and Interpreting Service (TIS) can provide interpreters on the phone or on site. Some services are free of charge but generally a phone session is $27.15 per 15 minutes. It’s preferable for the practice to be registered with TIS in advance.
  • The Australian Institute of Interpreters and Translators (AUSIT) maintains a list of qualified interpreters and translators. Visit their website or call 1800 284 181
  • The National Accreditation Authority for Translators and Interpreters (NAATI) also maintains a list of accredited interpreters and translators.

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