The California Healthcare Interpreting Association (CHIA) celebrated its 8th Annual Conference in Costa Mesa, California during the weekend of April 11-12. BY JUDIT MARIN

The theme of this year’s Conference was “From Grass Roots to Redwoods: the Growth of Healthcare Interpreting in California.” In her welcoming remarks, Elizabeth Nguyen, CHIA’s newly elected President, noted that during the past few decades, tremendous demographic changes have continued to present new challenges as well as opportunities for healthcare providers, language providers, individual interpreters, and educational institutions to work together towards the common goal of improving access to health care for our diverse communities.

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With rates under increasing pressure from globalization and other trends, many translators are turning to specialization. But the leap is not always easy.


This article was inspired by recent postings from several NCTA members inquiring about transitioning into certain fields, and the respective pay rates that one might expect. In today’s general translation marketplace, with more competition and lower pay, translators are looking to focus their content expertise, and specifically in the specialized fields of medical and legal interpreting.

Many translators and interpreters are what I would call generalists. A random peek into their profiles shows the ability to work in a variety of fields, ranging from finance, engineering, and education to telecommunications, law, medicine, and science. These professionals tend to work on a few projects in each area, allowing them to (justifiably) tout the range of their capabilities.

Other translators and interpreters, however, specialize in one or two fields at the most. A specialist can be a generalist, but not vice versa: even the slightest interpreting errors in fields such as medicine and law can have grave consequences for the limited English-proficient (LEP) client. As an interpreter in these two highly specialized disciplines, I know that success requires significant dedication, study, and training. It can take anywhere from four to six years to be a proficient interpreter in either of these fields.

The best medicine

Working as a medical interpreter, I am of course well-versed in medical terminology but am also familiar with many medical procedures as well. When a doctor gives an NOP order, I know exactly what that is (no oral products). When a patient requests a DNR order, I also know that he does not want to be resuscitated in a life-threatening circumstance. It’s not reasonable to expect a translator who doesn’t have such training—a generalist—to walk into a medical interpreting setting and be able to know what these terms refer to.

Other times, the medical translator specialist will be required to work in emotional and stressful conditions such as emergencies or life-and-death situations. There was an occasion where I interpreted a religious prayer conducted by a hospital chaplain for a terminally ill patient. This event had nothing to do with medical interpreting, yet of course it was an important part of the job.

Rules of law

In the field of legal interpreting, many will find the compensation fairly good. Legal interpreting is one of the most comprehensive interpreting fields in that it requires broad knowledge of numerous other subfields. For example, family and probate law will require knowledge of financial terms. Criminal cases will require knowledge of science and medicine pertaining to forensic evidence. Civil suits involving worker’s compensation or personal injury will require knowledge of medical, vehicle, and insurance terms. Immigration, small claims, juvenile, and other specialized areas all have their own terminology. And, needless to say, courtroom interpreting can be challenging and intensive when opposing lawyers, witnesses, and judge are all talking at once.

When generalists take on the work of specialists without the proper training, few of them will be able to render acceptable translations or interpretations. Once, a medical glossary translated by a generalist provided me with incredulous comic relief. The term athlete’s foot was literally translated as “the foot of an athlete”; hives was translated as “disease of beehives”; and speed (methamphetamine) was translated as “velocity.”

The client comes first

A generalist may go into a medical or legal interpreting setting believing that he can render an interpretation without the adequate training, and thinking that no one will know if he makes an interpretation error, but this may not be the case. I have known of some interpreters being sent away in the middle of a job for poor performance.

On one occasion, I provided interpretation for a couple whose child was hospitalized. At the end of the session, the father posed several questions to the doctor in perfectly good English. I inquired afterwards why they needed my services if the father was proficient in English. The father answered that my services were for the benefit of the mother, who did not understand English; that even though the father’s English was good, it did not mean that he could accurately interpret for his wife. They were more comfortable employing an interpreter. Another time, while interpreting in a deposition, the client, client’s attorney, and I all spoke the same native language. If an interpreting error was made, the client’s attorney would definitely have noticed.

Some generalists will accept assignments that they are not qualified to do for financial reasons. I view being a translator or interpreter as a noble profession that is rewarding in so many ways. We are the conduits that enable LEP clients to have fair access to a number of services that might not have been possible because of language barriers. Without them, we wouldn’t be working. Therefore, we owe it to them to be properly trained and qualified so that we can deliver the exceptional service that they deserve.

Healthcare Interpreting

By Judit Marin

CHIA (California Healthcare Interpreting Association) Vice President Rosario Nevado and Executive Director Don Schinske joined more than 69 attendees for a day-long forum on national certification May 1 in Boston. The event, which was hosted by Language Line Services, highlighted both some of the promise and problems in creating and implementing a universal standard for healthcare-interpreting competency.  The Boston gathering came off only after many weeks of discussions and negotiations. Representatives attended from all three of the main associations—CHIA, MMIA (now IMIA) and NCIHC—plus several smaller ones.

The formal program included presentations from:  

•  Holly Mikkelson, Adjunct Professor of Translation and Interpretation, Monterey Institute for International Studies, who gave an overview of the primary issues facing certification.
•  Martin Conroy, Director of New York’s Bureau of Hospitals and Primary Care, spoke on the likely need for having a certification process in place prior to securing adequate funding for language services
•  Gary Buck, PhD, Test Design consultant
•  Sam Campisi, manager of the Australian government’s national certification agency
•  Demetrio Gutierrez, Office of Minority Health, Oklahoma State Dept. of Health, who developed Oklahoma’s new state certification process.

Small-group discussions in the afternoon helped to define some of the main questions around the development, cost, and administration of a national certification process. When polled at the end of the meeting, the majority of attendees expressed interest in continuing the discussions. However, it remains unclear what path the discussions will now take. Nor is it clear which key stakeholders should work together to give the process some early shape.

CHIA believes there are compelling reasons to keep the conversation rolling:

1)  State policymakers are allowing room for certification. California’s new language-access (SB 853) regulations, which are now being finalized by the Departments of Managed Health Care and Insurance are expected to favor the use of certified interpreters once a certification process is implemented. Similarly, early discussions by the State’s Medi-Cal Language Access Services Task Force (of which CHIA is a member) have leaned toward recommending that a certification process be developed. At the same time, the State of California—perhaps the only entity with the resources to develop and roll out a California-specific certification—has shown no interest in developing certification itself.   

2)  Adequate funding is unlikely to appear without certification. Other states and various health systems have shown great creativity in securing funding to pay for at least part of the language services they provide. However, in an era when healthcare payers are insisting on measuring and paying for quality, it’s improbable that payment for interpreting services would arrive without an accepted guarantee of minimum competency.  

3) Adequate training is unlikely without certification. Opinions on this issue vary.  Some feel that a certification process unsupported by an adequate number of training programs will create shortages that could only be solved quickly  by a dilution in standards. Others feel that sufficient training will materialize almost naturally once the certification standards are announced, and some lead time is allowed before implementation. Regardless, a full supply of trained interpreters won’t materialize without adequate demand for trained interpreters, almost by definition.  And it is hard to see how demand could be fully generated without certification. 

4) Some states (WA, OK) have developed their own certification. Others (OR) are in the process. Some (MA) seem nearly ready. In California and many other states, it is likely that healthcare systems would create their own assessment tools (and many have done so already) or adopt commercial ones, such as Language Line’s. These trends aren’t wrong or bad. In terms of patient care, these changes generally represent an improvement over what has gone on before. But the piecemeal approach can not produce a single, portable standard that would be useful and meaningful for all stakeholders, including interpreters. And it is bound to yield wide inconsistencies in quality.

CHIA’s vision for healthcare interpreting is that it be a viable profession, with a valid certification process that will provide interpreters with the professional standing they deserve and assure their competency to those who use their services. CHIA’s leadership is willing not just to participate, but to help lead a serious push for national certification. 

Don Schinske (CHIA Executive Director)
Katharine Allen (CHIA President)

The Minnesota Panel

For three days between June 13th and June 15th, 2007, The “Expert Panel on Testing and Certification of Interpreters” event took place in Plymouth, Minnesota hosted by the Interpreting Stakeholder Group (ISG) and administered by Century College and the University of Minnesota through a grant from the Bush Foundation as part of a project named the Linking Voices project.

The meeting brought to the table major stakeholders intent on working together on issues of common concern around interpreter certification, and also attracted a local “gallery” of observers from the field. The “invitees” formed an eclectic mix of technical experts in test development and individuals with experiences in a variety of arenas such as designing, implementing, or building a support system for certification process.

CHIA was honored to be one of the “guests” among some of the major constituencies such as the National Council on Interpreting in Health Care (NCIHC) and the International Medical Interpreters Association (IMIA), formerly known as the Massachusetts Medical Interpreters Association (MMIA), together with state government representation from some of the states that have begun a certification process of their own such as the states of Indiana, Iowa, Oklahoma and Oregon.

From plenary sessions to workgroup sessions, the event hosted a variety of activities such as: sharing lessons learned from respective experiences with national or state certification initiatives; describing current efforts and outcomes; and discussing the implications of such lessons for the specific tasks assigned to the workgroup sessions.

State representatives from Indiana, Iowa, Oklahoma, Oregon and Minnesota provided perspectives on their state’s current efforts. At the national level, invaluable recommendations were received from the spokespersons for well-known and established programs such as the Registry of Interpreters for the Deaf, the National Center for Interpretation Testing, Research and Policy at the University of Arizona, and the National Center for State Courts/Consortium for State Court Interpreter Certification regarding the Federal Court Interpreter Certification Program.

At the state level, we heard feedback from the Interpreter and Translator Testing and Certification Program for the Washington State Department of Social and Health Services. CHIA also had the opportunity to contribute, alongside IMIA, our perspective from a state initiative standpoint by sharing lessons learned from the joint certification pilot project between the two associations, which took place in 2003 under the auspices of the NCIHC and with funding from the Office of Minority Health (OMH).  

In addition, a brief overview of three existing assessment tools was offered. Two of the tools in question were proprietary products created respectively by two corporations, Language Line Services and Network Omni Multilingual Communications, while the third tool was considered “vested in the public domain” due to being developed with funding from The California Endowment, by a consortium of non-profit organizations named the Connecting Worlds Partnership.
As the event concluded, a consensus seemed to have emerged from the workgroups with regard to the preliminary steps necessary to move towards the design of a certification test. The consensus called for “an empirical research that includes an interpreter job analysis, a review of existing standards of practice for interpreters, a survey of terminology and a legislative review.”

As an organization committed to advancing the profession of healthcare interpreting in the service of the public, CHIA prides itself in continuously finding common grounds on which to foster and nurture meaningful and successful relationships with its constituents as well as with all partners and stakeholders. To that end, CHIA looks forward to continue collaborating with our counterparts and all other parties in the field in a true spirit of inclusion and mutual support.

Lively CHIA Takes San Jose

By Judit Marin

On March 2 and 3, the California Healthcare Interpreters Association celebrated its seventh Annual Conference in San Jose. With a wide range of presentations, events, vendors, and networking opportunities, this dynamic organization continues to make a difference.

The theme of this year’s conference, Competency or Complacency? Let’s Stand Up for Quality, offered a wealth of activities for anyone working in the healthcare interpreting field or concerned with overcoming language barriers to quality healthcare.

Some of the conference highlights included training sessions for interpreters on consecutive interpreting skills, mental health interpreting, creating effective resumés, telephonic interpreting, and standards of practice. Other sessions were specifically tailored to trainers and managers, addressing bilingual employee skill development, language access tools, performance measures, and web-based training. Two highly informative panel discussions about certification and recent legislative developments relating to healthcare interpreting were well attended and sparked lively conversations. This year’s conference presenters, vendors, and attendees came from all over the United States and represented key stakeholders in many disciplines within our budding profession.

Certification and Awards
The issue of a certification test for healthcare interpreters took center stage. The panel on certification issues helped attendees to explore the highly complex nature of a nationwide certification process, one with legitimacy and credibility. In what represents a significant step forward, the National Council on Interpreting in Healthcare and the telephonic interpreting company Language Line Services, Inc., reported on separate initiatives that are under way to bring stakeholders together in a series of meetings to start planning for a certification process, the details of which are still being worked out. The field sorely lacks any formal mechanism for measuring competency and skill. These announcements are the first concrete step toward filling that gap.

One of the most exciting events of this year’s conference was the presentation of the first annual CHIA Trainer and CHIA Interpreter of the Year Award. Nora Goodfriend Koven, MPH, coordinator and lead instructor for the Healthcare Interpreter Program within the department of Health and Community Health Studies at City College of San Francisco, was honored for her hard work and dedication as a healthcare interpreter trainer, educator, and curriculum author. A five-member interpreting team from Stanford Medical Center, including NCTA member Charo Valesquez, received the Interpreter of the Year Award. It is particularly fitting that this award go to a team of interpreters, who, with their combined efforts, help ensure equal access to healthcare services for a wide variety of community members from diverse cultural and linguistic backgrounds.

Another highlight of the conference was the Friend of CHIA Award, which was presented to Freek Lankhof, founder and owner of Intrans Book Service, a primary source for monolingual, bilingual, and multilingual dictionaries, language and translation study materials, and related publications for professional translators and interpreters. Freek was honored for his deep professional and personal commitment to helping interpreters acquire the professional tools they need to better perform the complex work they do.

The Competency or Complacency conference theme could not have been more timely. As the healthcare interpreting profession moves forward, the issue of ensuring accessible and quality services has never been more urgent. This year’s conference succeeded in providing continuing training, education, and networking opportunities for those who work hard to eliminate the barriers that prevent access to quality medical care for limited-English-proficient communities.3

Interpreter Services at San Francisco General Hospital

by Debra Wilson

If the example of San Francisco General Hospital is any indication, the city’s many non-English speaking medical patients may soon better understand the treatments and medications involved in their health care during their stay in local hospitals. Arising from a difficulty on the part of hospital personnel to communicate with patients who speak only Spanish, Cantonese, Vietnamese and various other languages, “the officials of the San Francisco General Hospital applied for and received federal funds through the mayor’s office to train interpreters in the city’s languages and in medical terminology”, according to a report in the San Francisco Chronicle of May 16, 1978.

Twenty-seven men and women were trained for this program, in which they are assigned to the various hospital units depending upon the language needs at that particular time. In addition, the interpreters remain on an on-call basis for all other units should the need for their particular language arise elsewhere. Though they are non-medical, the interpreters participate in some aspects of patient care such as grooming, taking vital statistics, and, assisting in light daily exercise. In spite of the fact that the program will be financed only until September through the mayor’s Office of Employment and Training, there is still hope among hospital officials that the funding will continue for at least one year.