美国为何好的翻译人才很稀缺 Why Is Proper Translation Still Scarce

美国医院不提供翻译服务是违法的。那么为什么适当的翻译仍然是稀缺的呢？（软件机器翻译不能和人工付费翻译相媲美）

 

你能流利地说第二语言吗？有点流利吗？或者你可能部分地记得高中西班牙语？好吧，在错误的医院和合适的朋友见面，你也可以成为一名医学翻译：让他们知道你可以说几句话，这份工作可以是你的。

听起来很疯狂，医院会给你一份你不具备的工作，特别是对某人健康有严重影响的工作。但是，医学翻译的状况意味着这种情况太频繁了。早在1996，埃默里大学医学院的研究表明，76%的西班牙语患者在急诊室没有翻译。关于这一问题的数据很少，但坊间证据表明几乎没有变化。纽约西奈的一位医生，一个经常看到不懂英语的病人的医院，告诉我她的同事经常要求她解释阿拉伯语，她甚至不说话，因为她有中东姓氏（她因专业原因要求匿名）。这是一个特设系统的一部分，通常意味着如果提供翻译的话，很可能是来自一个旁观者、一个家庭成员或朋友，不知道如何用外语来表达“二尖瓣脱垂”之类的话。

 

为什么？你可能会怀疑这是因为急诊医生必须迅速拯救生命，找到一个翻译可能导致延误。这听起来很合理，但是医院有很多协议可以帮助他们快速地完成复杂的结果，语言访问应该是其中之一。也不是因为医学口译员不存在或者找不到。Instead, underuse of medical interpreters seems to stem from misunderstanding how proper translation improves medical outcomes, and that it’s not only fiscally possible, it’s actually fiscally prudent, since it’s illegal not to offer.

医学口译员应该被认证。接受卫生保健口译员认证委员会和国家医学口译员认证委员会的资格证书。要获得额外资格，你可以在全国各地的大学攻读口译硕士或研究生证书。像医生一样，口译员也被要求每年继续接受教育。It’s in the National Council on Interpreting in Health Care (NCIHC) Code of Ethics: “The interpreter strives to continually further his/her knowledge and skills.”

 

医院永远不会想到让病人的朋友动手术仅仅是因为她能拿手术刀。但他们要求双语亲属随时解释，忽视沟通对病人护理的重要性。得到一个错误的后果可以是生活的改变：在员工误解了intoxicado（西班牙语“中毒”）为“醉了，”佛罗里达州的少年Willie Ramirez收到了错误的护理和最终瘫痪。In Oregon, Elidiana Valdez-Lemus died after 911 misinterpreted her address. 正确翻译缺乏外部突发事件的后果，太：Erika Williams，一个二年级医学生的哈佛医学院的研究表明，当有一个语言障碍，患者接受更少的预防保健，“不要吃药”规定，并更有可能离开医院对医生的意见。

 

联邦民权法规定，医院必须向所有人提供平等的护理机会，而不考虑“种族、肤色或国籍”，这是第六章中使用的短语，即与专业口译员有关的第一条法律。如果“国家起源”并没有明确指出语言是一个甄别者，那么在行政命令13166中，比尔·克林顿总统含蓄地表示，任何接受联邦基金的组织，如医疗补助或医疗保险，都必须提供“有意义的语言准入”，如果他们不这样做，设备就应该失去这些资金。

但这并不总是发生。克里斯·卡特对语言的企业协会会长，为翻译提供美国贸易组织，说医院很少主动顺从的：“不幸的是，在ALC会员公司近年来已经注意到医疗机构通常会等到他们的[正义]部门的审计，发现不符合[支付得起的医疗] 1557节或其他法律才从特设的服务执行一个组织语言的访问计划。”

 

提供翻译是否昂贵？不在于医疗费用和昂贵的错误。从2005到2015，我拥有一家口译公司。我们开业时，一位现场西班牙语翻译每小时25美元。如果你想找人打电话，每分钟1.50美元。口译服务还可以通过某些类型的保险来报销。但是，我们从医院管理人员那里听到的第1个销售异议是专业口译太贵了。

根据ACA，未能提供一个医疗口译可以得到70000美元罚款每遇到一个病人。这意味着不提供翻译的费用，即使它不会导致错误，是天文学上高于支付的成本。

至少现在。作为美国ACA豁免文件，他们不只是选择了Obamacare最有名的部分。他们也给医院许可减少有限的英语为母语的人的关心。的确，第六章是可以追溯的，但它很少被武断地强制执行。It’s the ACA’s hefty fines that have been the impetus forcing hospitals to change: Carter says that since ACA audits began, interpreting companies have seen many hospitals working with professional interpreters for the first time, an improvement he’s noticed industrywide.

卡特说：“风险太高了，我们不能放弃，也不能说美国的每个人都无法做到高质量的解释。”。

 

了解医生对你身体的作用的权利是根本的。知道自己诊断的权利是基本的，知道什么时候进行手术，了解人们为什么把针管和针管放在你里面。口译不是太贵，提供准确的医疗服务是必要的。医院没有意识到这一点和采取行动，这不是我们仅仅为了预算而应该放弃的失败。这是种族主义的一种表现，在我们的社会中不再有一席之地。（软件机器翻译不能和人工付费翻译相媲美）

 

It’s Illegal for Hospitals to Not Provide Translation Services. So Why Is Proper Translation Still Scarce?

 

Do you speak a second language fluently? Sort of fluently? Or maybe you partially remember high school Spanish? Well, show up with the right friend at the wrong hospital and you too can be a medical interpreter: Let them know you can say a few words, and the job can be yours.

It sounds insane—that a hospital would give you a job you’re not remotely qualified for, especially one that could have serious repercussions for someone’s health. But the state of medical translation means that it is too frequently the case. As far back as 1996, research from Emory University School of Medicine showed that 76 percent of Spanish-speaking patients went without an interpreter in the emergency department. Data on the subject is scarce, but anecdotal evidence indicates little has changed. One doctor at Mt. Sinai in New York, a hospital that often sees patients who don’t speak English, told me her colleagues frequently ask her to interpret Arabic, a language she doesn’t even speak, because she has a Middle Eastern last name (she requested anonymity for professional reasons). This is all part of an ad-hoc system that often means if translation is provided at all, it’s likely from a bystander, family member, or friend with no idea how to say things like “mitral valve prolapse” in a foreign language.

 

Why? You might wonder if it’s because ER doctors have to save lives quickly, and finding an interpreter could cause delays. That sounds reasonable, but hospitals have plenty of protocols that help them achieve complicated outcomes quickly—language access ought to be one of them. Nor is it because medical interpreters don’t exist or can’t be found. Instead, underuse of medical interpreters seems to stem from misunderstanding how proper translation improves medical outcomes, and that it’s not only fiscally possible, it’s actually fiscally prudent, since it’s illegal not to offer.

Medical interpreters are supposed to be certified. Credentials from both the Certification Commission for Healthcare Interpreters and the National Board of Certification for Medical Interpreters are accepted. For additional qualifications, you can pursue a master’s in interpreting or a graduate certificate from universities across the country. Like doctors, interpreters are also required to pursue continued education every year. It’s in the National Council on Interpreting in Health Care (NCIHC) Code of Ethics: “The interpreter strives to continually further his/her knowledge and skills.”

 

Hospitals would never dream of letting a patient’s friend operate just because she can hold a scalpel. But they ask bilingual relatives to interpret all the time, disregarding how critical communication is to patient care. Get one word wrong and the consequences can be life-changing: After staff misunderstood intoxicado (Spanish for “poisoned”) as “drunk,” Florida teen Willie Ramirez received the wrong care and ended up paralyzed. In Oregon, Elidiana Valdez-Lemus died after 911 misinterpreted her address. Lack of proper translation has consequences outside of emergencies, too: Erika Williams, a second-year medical student at Harvard Medical School, summarized research to show that when there’s a language barrier, patients “receive less preventative care,” don’t take medication as prescribed, “and are more likely to leave the hospital against medical advice.”

Federal civil rights laws state that hospitals must provide people—all people—with equal access to care, regardless of “race, color, or national origin.” That’s the phrase used in Title VI, the first law pertaining to professional interpreters. If “national origin” doesn’t indicate language as a discriminator clearly enough, in Executive Order 13166, President Bill Clinton implicitly stated any organization receiving federal funds—like Medicaid or Medicare—must provide “meaningful language access.” If they don’t, facilities are supposed to lose those funds.

But this doesn’t always happen. Chris Carter, president of the Association of Language Companies, the U.S. trade organization for translation and interpreting providers, says hospitals rarely become proactively compliant: “Unfortunately, member companies of the ALC have noticed in recent years that healthcare organizations usually wait until they are audited by the [Department of Justice] and found non-compliant with [Affordable Care Act] Section 1557 or other laws before they shift from ad hoc service provision to implementing an organized Language Access Plan.”

 

Is providing interpretation prohibitively expensive? Not in the context of what medical care costs—and how expensive mistakes are. From 2005–2015, I owned an interpreting company. When we opened, an on-site Spanish interpreter cost $25 an hour. If you wanted someone by phone, it was $1.50 a minute. Interpreting services are also reimbursed by certain types of insurance. But the No. 1 sales objection we heard from hospital administrators was that professional interpreting was too expensive.

Under the ACA, failure to provide a medical interpreter can be met with a $70,000 fine—for each encounter with a patient. Which means that the cost of not providing an interpreter, even if it doesn’t lead to errors, is astronomically higher than the cost of paying for one.

At least for now. As states file ACA waivers, they aren’t just opting out of Obamacare’s better-known parts. They’re also giving hospitals permission to shortchange limited-English speakers’ care. It’s true that Title VI is there to fall back on, but it’s rarely and arbitrarily enforced. It’s the ACA’s hefty fines that have been the impetus forcing hospitals to change: Carter says that since ACA audits began, interpreting companies have seen many hospitals working with professional interpreters for the first time, an improvement he’s noticed industrywide.

“The risks are too high to give up and to say quality interpretation for everyone in America just can’t be done,” Carter says.

 

The right to understand what doctors are doing to your body is fundamental. The right to know your own diagnosis is basic, to know when surgery is being performed on what, to understand why people are putting needles and tubes inside you. Interpreting isn’t too expensive—it’s essential to providing accurate medical care. Hospitals’ failure to appreciate and act on this is not a failure that we should dismiss for mere budgeting. It’s a manifestation of racism that should no longer have a place in our society.