From the last decade of the twentieth century, increasing migration flows as well as people movements across borders for business, education, or tourism have changed the panorama of those who may be in need of medical assistance. For quite a while, health care services have coped with the need to assist patients who have little or no knowledge of the language spoken by the medical staff. Thus, translating between clinicians’ and patients’ languages has developed as an interpreting practice in hospitals and doctors’ surgeries.
Interpreting conversations in health care is a multifaceted task and “interpreters”, those who actually provide translation service, range from professionally certified interpreters, to experienced bilinguals with some training in intercultural communication, to family or staff members providing help on an occasional basis. While ample debate has developed about what type of professionalism actually guarantees the best service, a parallel line of studies has inquired into what actually happens when a bilingual interpreter participates in talk between health care professionals and patients speaking different languages. This line of studies, developed after Cecilia Wadensjö’s volume Interpreting as Interaction (1998), is based on analysis of audio or video recorded conversations, carefully transcribed to provide evidence of how interlocutors react to each other’s utterances, showing understanding (or non-understanding), (in)competence, empathy and support (or lack of) and possibly trust.
These studies have revealed that linear or turn after turn translation is not always possible or even desirable. Effective translation to a standard expected by both clinicians and patients often involves complex communication processes: encouraging the patients to speak and tell more, to “interpret” their worries when not explicitly expressed, to interact with the doctors to help them explain technicalities in simpler words, and encouraging collaboration between clinicians and interpreters in communicating with patients by taking their perspective.
The collection of papers published in this special issue of Health Communication falls within the latter line of studies. Several papers (Anderson & Cirillo; Baraldi & Gavioli; Gavioli & Wadensjö; Rossi) report the results of a two-year research project funded by the University of Modena and Reggio Emilia (Italy) and run in collaboration with the health care services of nearby areas, all areas characterized by high migration flows and a high number of residents with a migration history. During the research period, conversations among patients, clinicians, and experienced bilingual professionals (so-called “intercultural mediators” in Italy) were audio-recorded together with a parallel collection of similar conversations conducted through the use of a lingua franca (French, English, or Italian) without interpreting help. The collected data were transcribed accurately so as to give evidence of possibly meaningful details like pauses before patients’ answers, hesitations, high or low voice volume, and the like. The corpus of audio-linked transcripts was then shared and discussed with a team of international experts, including the authors of the papers in this issue, and compared with other clinician-patient, interpreter-mediated conversations, recorded in services in France (Niemants, Ticca & Traverso), South Africa (Watermeyer, Thwala & Beukes) and other areas of Italy (Dal Fovo & Falbo).
The research project was concluded in 2016 and the debate which followed seemed to provide interesting material for the health care services to both better understand how to organize interpreting and how to prepare clinicians to work with interpreters. It thus seemed sensible to offer the main insights from our research to others involved in health care improvement and access. We thank Health Communication for helping us with this achievement.
This issue is dedicated to the memory of Professor Claire Penn, whose competence, commitment, and enthusiasm for this project have provided a powerful stimulus to research. Claire left us on the July 21, 2018: the studies collected in this issue would not have been completed without her encouragement.
A note on transcripts
Transcripts of talk have now long been used in research on interaction and a set of standard symbols has developed to capture meaningful features of conversation such as hesitation, overlap, voice volume and “noises” such as “mhm”, “oh”, “ah” showing interlocutors’ understanding, surprise, affiliation, or disaffiliation. These symbols are not exactly the same in each transcript because the symbol selection depends on the features that are put under the lenses of individual analyses (see http://ca-tutorials.lboro.ac.uk/intro1.htm, for some hints about the epistemology of transcribing talk). The following symbols are however widely shared:
[utterance] – square brackets indicate overlapping talk
(0.6) – indicates pause, the number in round brackets provides pause length in seconds
: – syllable lengthening in pronunciation
(??) or (slb) – inaudible or non transcribable utterance(s)
°utterance° – very quiet or low voice volume
UTTERANCE – loud or high voice volume
In order to improve international understanding of the analyses, a line in italics has been added under each turn at talk providing a textual translation in English of what is said in other languages.