ADHA Access April 2012 : Page 22

Michelle Panico, RDH, MA, works with a Spanish-VSHDNLQJFHUWL¿HGPHGLFDO interpreter. Working with Translators and Interpreters By Mariam Pera P atient communication is vital to effective dental hygiene care, and it’s hard enough to accomplish in the same lan-guage. Many dental hygienists work in communities with large populations who do not speak English, and others make dental mission trips abroad. While some hygienists may have additional language skills, explaining oral health issues is very different from simple conversation. In these settings, translators and interpreters play vital roles in helping dental hygienists deliver quality care. According to the Bureau of Labor Statistics, “Interpreters convert one spoken language into another—or, in the case of sign-language interpreters, between spoken communication and sign language,” while “translators convert written materi-als from one language into another.” 1 “It is very common for people to get translating mixed up with interpreting,” said Maria Perno Goldie, RDH, MS, president of the International Federation of Dental Hygien-ists. “It is also common for people to think that anyone who can interpret can translate and vice versa. This is not the case.” Goldie has worked with interpreters primarily in Italy, Spain, Russia, the Ukraine, the Czech Republic, Slovakia and Mexico. She explained that working with interpreters varies with each individual, and that advanced preparation is im-portant when discussions involve technical, legal or sensitive subjects. “In the dental hygiene education world, often the interpreter will request my PowerPoint presentation. I may EHDVNHGWRH[SODLQLPSRUWDQWDQGRUGLI¿FXOWFRQFHSWVDQG points,” she said. “Depending on the language, interpreta-tions may take much longer than the original. I cut my pre-sentations in half. Working with a dental hygienist or dentist interpreter has been the most successful, as they know the oral health ‘lingo.’” Working Abroad Melissa Reese, CDA, RDH, BSDH, is a Lieutenant in the United States Public Health Service (USPHS), whose mission is to deliver public health promotion and disease prevention programs and advance public health science. In May 2010, Reese was deployed aboard the naval hospital ship, the USNS 0(5&<&#0f;DVDWHDPPHPEHURI3DFL¿F3DUWQHUVKLS²DODUJH
 scale humanitarian effort utilizing both military and civilian specialists to deliver medical, dental and other services to six host nations. Her seven-week trip consisted of providing dental hygiene services and oral health education in Vietnam and Cambodia. “I knew providing periodontal treatment and oral hygiene LQVWUXFWLRQZRXOGEHFKDOOHQJLQJ&#0f;´5HHVHVDLG³7KH¿UVW thoughts I had were of my ‘old days’ in private practice when a non-English speaking patient would visit our clinic. Inevitably, one of three things would happen: (1) the staff member would speak louder, as if volume would somehow help the patient understand; (2) the staff member would 'RWWVVD2OLYLD0DUFKLVLR&#0f;5'+&#0f;'+$&#0b;VWDQGLQJRQOHIWDWIURQW&#0c; IURP3LQHUROR&#0f;,WDO\&#0f;IUHTXHQWO\LQWHUSUHWVIRU0DULD3HUQR *ROGLH&#0f;5'+&#0f;06&#0b;VHDWHGDWIURQW&#0c;GXULQJKHUOHFWXUHVLQ,WDO\ 22 APR 2012 access

Special Feature

Mariam Pera

Working with Translators and Interpreters. Patient communication is vital to effective dental hygiene care, and it’s hard enough to accomplish in the same language. Many dental hygienists work in communities with large populations who do not speak English, and others make dental mission trips abroad. While some hygienists may have additional language skills, explaining oral health issues is very different from simple conversation. In these settings, translators and interpreters play vital roles in helping dental hygienists deliver quality care. According to the Bureau of Labor Statistics, “Interpreters convert one spoken language into another—or, in the case of sign-language interpreters, between spoken communication and sign language,” while “translators convert written materials from one language into another.”1 “It is very common for people to get translating mixed up with interpreting,” said Maria Perno Goldie, RDH, MS,President of the International Federation of Dental Hygienists. “It is also common for people to think that anyone who can interpret can translate and vice versa. This is not the case.” Goldie has worked with interpreters primarily in Italy, Spain, Russia, the Ukraine, the Czech Republic, Slovakia and Mexico. She explained that working with interpreters varies with each individual, and that advanced preparation is important when discussions involve technical, legal or sensitive subjects. “In the dental hygiene education world, often the interpreter will request my PowerPoint presentation. I may be asked to explain important and/or difficult concepts and points,” she said. “Depending on the language, interpretations may take much longer than the original. I cut my presentations in half. Working with a dental hygienist or dentist interpreter has been the most successful, as they know the oral health ‘lingo.’” Working Abroad Melissa Reese, CDA, RDH, BSDH, is a Lieutenant in the United States Public Health Service (USPHS), whose mission is to deliver public health promotion and disease prevention programs and advance public health science. In May 2010, Reese was deployed aboard the naval hospital ship, the USNS MERCY, as a team member of Pacific Partnership 10—a largescale humanitarian effort utilizing both military and civilian specialists to deliver medical, dental and other services to six host nations. Her seven-week trip consisted of providing dental hygiene services and oral health education in Vietnam and Cambodia. “I knew providing periodontal treatment and oral hygiene instruction would be challenging,” Reese said. “The first thoughts I had were of my ‘old days’ in private practice when a non-English speaking patient would visit our clinic. Inevitably, one of three things would happen: (1) the staff member would speak louder, as if volume would somehow help the patient understand; (2) the staff member would Speak exceedingly slow; or (3) the staff member would combine an interesting variety of dramatic facial expressions and hand motions to signify key points, such as ‘open wide,’ ‘spit,’ etc. None of the methods were particularly successful. While I was pondering which one of the aforementioned methods to employ [on my trip], I was informed that foreign [interpreters] would be available at the mission sites. The news brought both relief and wariness. Would the [interpreter] understand the information I was providing? Would they accurately relay instructions without errors or improvising?” To Reese’s relief, prior to the first field mission, the team was given a briefing on working through [interpreters]. “The training lessened my anxiety and contributed to the success of the experience. The [interpreters] were easy to work with, helped relay questions and ease patient fears, and allowed for the provision of valuable oral health education to a much underserved population,” she said. “It was a mutually gratifying experience, as they had the opportunity to help us help their people. Typically, by the end of each mission, the [interpreter] was well-versed in teaching oral health education, and I managed to broaden my foreign vocabulary with a few words in Vietnamese or Khmer. Whether working abroad or in the office, having an interpreter to enhance communications for non-English speaking patients can be an effective and surprisingly rewarding experience.” Yvonne Work, RDH, BS, BA, traveled to Braila, Romania with Serving HIM (Health International Ministries), in 2009, 2006, 2005 and 2004—with four dentists and two hygienists among the 20 team members. “Each year seems to be more rewarding than the one before,” she said. Serving HIM has been going over to Braila since 1998, teaming with the Holy Trinity Baptist Church, which owns a health and dental clinic. The clinic serves the local poor free of charge, including children from the orphanage the church runs. “These people suffer from a lifetime of oral neglect, with 95 percent of the adults never having a prophy in their lives. There was lots of periodontal disease, of course, and no anesthetic for the patients. Our cavitrons and suction saved the day! We came away realizing that the preventive and periodontal cleanings we gave them might be the only ones they get in their lives!” Work said. “Our interpreters were high school seniors or college students who attended the church that invited our team over there. They all spoke good English. As I would clean the patient’s teeth and give them dental hygiene education, the [interpreter] would translate everything I had said to the patient. If it had not been for the [interpreters], I would not have been able to educate the patients.” Dana Shaffer, RDH, BS, PHDHP, participated in a dental mission trip to Honduras in March 2010, which was organized by Central American Relief Efforts (CARE)—based in Lancaster, Penn. The volunteers provided screenings and oral hygiene education. There were seven dental hygienists, as well as a husband and wife who helped with educating locals. A local dentist even performed extractions as needed. The team worked through several interpreters: Stephanie, a local college student; Steven, 14, whose family hosted the volunteers; and Marel, who served as the trip’s coordinator. “We would not have been able to get across our message without [the interpreters].” Shaffer said. But there were difficulties. “Especially in the beginning, it was probably a little more difficult because it did slow you down. You had to say a sentence, then let them translate, and sometimes you’d lose your train of thought. We had a lot of visuals as well, which really helped, because as the week went on, we didn’t have to say quite as much; the interpreters kind of knew how we were doing things.” Working in Diverse Communities in the U.S. Michelle Panico, RDH, MA, partnered with Dignity Health, a hospital system in Arizona, to set up a school-based affiliated practice preventive dental clinic. “We now have two clinic sites. One is inside an elementary school and the other is on the grounds of an elementary school in the community health clinic,” Panico explained. “Dignity Health requires that a certified medical interpreter be present during the dental clinic hours because our patient population is primarily Spanish-speaking and the dental hygienists speak English.” The interpreters are hospital system employees, meaning they are hired, trained and certified as medical interpreters by the hospital. The hospital schedules them to be available at sites wherever patient care is occurring (e.g., hospitals, urgent care, community outreach clinics). The clinics also utilize translators. “When we set up the clinic and created the forms, we had all of our forms translated by a certified medical translator company,” Panico said. Cecilia Hickam, RDH, BS, Med, worked at a community health clinic in Boise, Idaho for the underserved, including patients from Iraq, Iran, Afghanistan and Ukraine. The clinic offered an incomebased pay scale, with the remaining fees partially funded by the federal government. “Since I worked in a public health setting, the state had organizations we worked with to set up [interpreters] for hire and transportation for them. Medicaid helped frequently. Sometimes it was difficult to get my message across as a health care professional because there were some words in English that could not be translated. I used a lot of visual aides … and made sure they understood. Even the [interpreters] would get involved, asking questions about the information I was giving the patients,” Hickam explained. She added that there was a ‘noticeable cultural difference,’ when it came to understanding the value and importance of proper oral health Care. “They did not understand the connection between the mouth and the whole body.” But once the significance was explained in a way that the patients understood, they readily complied. “They wanted to learn all they could during the appointment for the betterment of their health. When I was done with their treatment, they were very appreciative of the thoroughness and quality [of care] I gave them. They wanted to make sure they came back for the next appointment because they noticed a difference in how things felt in their mouths and wanted to maintain it. Some even said their health improved,” Hickam said. “Working with different cultures was very rewarding; it opened my eyes to the need of [explaining] the importance of the mouth and body connection to … quality of life. I felt I made a difference.” Daisy Patino is one of two Spanish-speaking dental hygiene students at Southern Illinois University Carbondale (SIUC), where none of the faculty speak Spanish. Patino explained that the language barrier hinders many facets of care, and not being able to communicate is frustrating both for patients and practitioners. “I have found that most of the time I have [interpreted] there is not much connection with the doctor and the patient. The doctor relies on me to get his message across, as does the patient, and most of the time there is no eye contact [between them]. It puts me in an awkward position, because my goal is to keep seeing these patients in the future and to build a relationship. When I give a patient specific post-op instruction or explain … treatment procedures by the doctor, I try my best to translate word for word, although it is difficult when I am not familiar with certain dental terminology in Spanish. The patients most of the time seem pretty confident in what I have just explained and are okay to begin.” Although some things are difficult or impossible to interpret, Patino says patients are receptive to the care. “Even though there is the language barrier, I feel these patients are very thankful … for being able to communicate their needs and concerns. I can connect with them because my mother speaks no English and has been in the U. S. for 30 years. I have always [interpreted] for my mother when she has needed me and, at this point in my life, it is normal for me, so I don’t mind doing it. But how exactly is a relationship built if the language is a barrier? It is possible, but with my experience, I feel the patients still don’t feel that connection.” Patino suggested that language skills are important to develop for faculty and health care providers who work with minority communities. “I have been blessed to have been born to Mexican parents that taught me their native language and have been able to use it for the benefit of my work and education. Having to find my own patients for clinic requirements, I have found many Latino patients with the use of my native language. Some have been international students while others patients live in the Carbondale area. There have been times [when] I have been in lecture and a clinic instructor has come looking for me to translate for a student. It’s not a problem for me, but I feel a Spanish-speaking faculty member should be hired to assist with barriers like this.” Patino also works in the Community Dental Center in Carbondale, where she is the only Spanish-speaking employee. “It has been very rewarding to help those around me, as well as my patients, and I hope to continue to broaden my career opportunities in the future with the use of my bilingual skills.” Amy Soss, RDH, is a parttime clinical instructor at New York University College of Dentistry. She helped one of her students overcome a language barrier by using a free app on her smartphone. The patient who presented spoke only Italian, and there were no Italian-speaking doctors or students on the clinic floor at the time. “I decided to sit with my student and use my iPhone Google Translate app,” Soss explained. “You speak into the phone, and it translates into the language of your choice. The app will actually speak back what you said in the other language, as well as spell it out. There are a multitude of language options. I found that this method of communication was extremely helpful in this situation.” Soss said she has actually worked with an [interpreter] in the past, but she was never confident that the [interpreter] was communicating what she was trying to say. “With the [app], I was speaking into the phone and communicating exactly what I intended. The patient appeared to completely understand what I was getting across to him as a health care provider,” Soss said. “I truly believe my student and I would not have understood what type of pain and sensitivity the patient was suffering without the help of the phone. It turned out he was having hot and cold sensitivity and needed root canal therapy on that tooth.” Since then, Soss has applied the same communication technique in her private practice periodontal office, which sees predominantly Russian-speaking patients. Recently, she had difficulty communicating home care instructions. “Then I remembered I have Google Translate! I was able to explain how to use soft picks for implant care and proxy brushes for interdental spaces, as well as recommend that the patient purchase an electric toothbrush for better plaque control,” she said. Typically, Soss would have had to wait for the Russian-speaking dentist to explain this to the patient, but with the her app, she could do it herself. “It made the patient more confident in me as a clinician, as I was now the one explaining to them what they should be doing to improve their oral health, rather than the dentist.” She believes the app immediately made the patients more comfortable. “In both cases, I could sense frustration that they could not communicate as they wished to and, as the health care provider, I also felt frustration that I could not communicate with the patient as I normally can. Once I brought out the device, in both situations, the patients smiled and felt comfortable communicating this way. It even lightened up the mood of the appointment as it was fun using the phone during treatment,” Soss said. “Now, it was not just about getting their teeth cleaned by someone who didn’t speak their language, but rather it opened up the opportunity for both the health care provider and the patient to feel confident and comfortable when they needed to express something.” Laura DeHennis, RDH, PHDHP, vice president of the Pennsylvania Dental Hygienists’ Association, first experienced working with an interpreter at a free clinic where she volunteers. “I have been with this clinic for over 10 years, and I enjoy being able to help people who [recognize] the need for dental care, have now found a way to attain it, and appreciate my effort to help them,” DeHennis said. The patients must meet eligibility requirements to be seen, and clinic Rules specify that patients must present with an interpreter. If not, they must reschedule their appointments. “If there are patients speaking another language, they need to come with someone that understands English,” DeHennis said, adding that communication through an interpreter was not a problem since many aspects of dental hygiene can be demonstrated. “Now we have a Spanish-speaking dental hygienist on staff … so there are no problems with making sure the patients are aware of what to expect during and after treatment. It is great to work together with her.” In conclusion, the dental hygienists interviewed for this article suggested some tips for working with interpreters: • Speak clearly and slowly. • Request the interpreter use your words as precisely as possible, without paraphrasing or improvising. • Don’t forget to introduce yourself to the patient. • Position the interpreter beside you, facing the patient. • Maintain eye contact with, and address remarks to, your patients/ audience and counterparts, not the interpreter. • Pause after about 60 seconds, after a thought is complete, or after major points have been made. • Watch your interpreter to be sure he/she is keeping up with you. • Avoid long, complex sentences, and do not use slang, jargon or colloquial expressions. Keep your language basic, using words the interpreter understands. • Avoid jokes and humorous stories. Humor does not travel well in most cases. • Allow the patient to ask questions as you go. • Understanding the cultures in which you do business is definitely a plus and very helpful when working with interpreters. Reference 1. Bureau of Labor Statistics. Available at: www.bls.gov/oco/ocos175.htm. Mariam Pera is Access’ editorial and graphics assistant.

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