Translation: A transcultural activity

Andrea Rossi the meaning of a source-language text through an “colere ”, which means to tend to the earth and Consultant in Medical Writing, equivalent target-language text”. 3 The Cambridge grow, or to cultivate and nurture. 8 Culture Communications, and Scientific Affairs, Nyon, definition is “something that is translated, or the encompasses the social behaviour and norms Switzerland process of translating something, from one found in human societies, as well as the know - language to another”. 4 Others define the same ledge, beliefs, arts, laws, customs, capabilities, and activity as “an act through which the content of a habits of the individuals in these groups. 9 The Correspondence to: text is transferred from the source language into intangible cultural heritage of each society Andrea Rossi the target language”, “a mental activity in which includes science, together with practices of R.te de St. Cergue, 6 the meaning of given linguistic discourse is political organisation and social institutions, 1260 Nyon rendered from one language to another”, or “the mythology, philosophy, and literature. 10 Humans Switzerland act of transferring the linguistic entities from one acquire culture through the processes of +41 793022845 language into their equivalents into another enculturation and socialisation, resulting in the [email protected] language”. 5 diversity of cultures across societies. In contrast to other languages, English When writing about health, translation of distinguishes between translating (a written text) scientific texts plays a special role aimed at public Abstract and interpreting (oral or signed communication education and prevention of diseases as well as Effective communication is the goal of any between users of different languages). According saving mental and physical health. For instance, professional medical and communication to this distinction, translation can begin only after when the readers are specialised healthcare writer. Transferring the correct messages from the appearance of writing within a language providers, the language to be used is usually well one language to another is a task that is community; 6 it does not apply to texts that are coded to assure the reader of the expertise of the increasingly covered by software, but expected to be used without the use of non- author in the specific field. Some medical texts, translation machines cannot confer the written signs. especially when published in peer-reviewed feeling of people with a different background. journals, regulatory documents, or specialised Any medical translation is not just a Is translating enough to effectively books, are exceedingly difficult to read by non- transformation of the text from the source communicate? specialised readers, meaning they can even be language to the output one: a translated text Communication is derived from the Latin cum difficult for a physician with a different area of must communicate the exact meaning in the (with) and munire (link), and the Latin word specialisation. source language and, thus, has to fit with the communico means to “share, let This scientific style provides reader’s culture. participate”. The term “communi - information, presents exact and cation” has the common In contrast to relatively complete scientific meaning “to impart or other languages, English knowledge, and addresses a Introduction exchange information, distinguishes between relatively small group of The word translation derives from the Latin ideas, or feelings”. Thus, translating (a written text) professionals well acquain - translatio , which itself comes from trans - and fero , communication is a and interpreting (oral or ted with the subject. It is together meaning “to carry across” or “to bring process that involves what characterised by the matter across”. The modern Romance languages use a receiver understands or signed communication of fact, being clear, explicit, words for translation derived from that and the thinks of something 7 and is between users of different unambiguous, precise, and alternative Latin traduco (“to lead across”). The successful when all parties have languages). concise; it must have stereo - Germanic (except Dutch) and Slavic languages the same understanding of what typical lexicology and syntax and likewise use calques of these Latin sources. 1 The has been communicated (Figure 1). Ancient Greek term for translation, μετάφρασις This is one of the most difficult tasks a (metaphrasis , “a speaking across”), has supplied scientific communicator must face. Figure 1. The fundamentals of successful English with the term “metaphrase” (a “literal”, Effectively communicating when using communication or “word-for-word”, translation) – as opposed to different languages is paramount. If you feel “paraphrase” (“a saying in other words”, from communicating in another language is difficult, l Communication is a two-way παράφρασις , paraphrasis ). 1 Metaphrase corresp - you are a candid communicator: each language process onds, in one of the more recent terminologies, to developed in different human populations and “formal equivalence”; and paraphrase, to continuously evolves with the culture of its l Success is attained when ALL “dynamic equivalence”. 1 speakers. Any effective communication must be parties involved have the SAME The traditional Oxford definition of trans - targeted to the reader’s culture to be effective. understanding of what has been lation as “the process of translating words or text This means that you have to know your readers’ communicated from one language into another” 2 has been culture. extended to “translation is the communication of The word “culture” derives from the Latin

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must remain im personal and objective. Known for any centrally authorised product, Annex II, communicate their contents in the different concepts are referenced to other texts, whereas Annex A, SmPC, labelling, or package leaflet, as target languages. new findings are presented as diagrams, charts, well as Annex IV and Annex 127a, if applicable, When translations are needed for clinical trial sketches, or illustrations expressing numerical be translated from the original English to all other documents (e.g., patient informed consent), the data. Ideally, the personality of the author does European language. Each translation undergoes ethics committee or institutional review board not need to emerge to emphasise the results, as a linguistic review by the member state, and the can request a back-translation. 15 In this case, a the results are far more important than their European Medicines Agency ensures that all comparison of the back-translation with the implications in clinical practice. comments have been implemented for each original text is used to check the accuracy of the We all know this is not the most attractive translated document before their final approval. 14 original translation, with the same rationale that style for the general reader. Some writing These reviews are performed by selected a mathematical operation is checked by reversing practices suggest “telling a story” when reference centres (so-called “contact points for the operation, although such back-translations describing a study and its results to make it most translations review”), which provide a qualitative are not always fully reliable 16 because, unlike attractive for the reader. 11 But when technical opinion on the quality of the translated version mathematical symbols, some words can be wording is maintained, the general reader is of each document (very good, good, acceptable, ambiguous. Thus, subjective evaluations seem generally not attracted by this text. Improving the unacceptable) and the nature of comments the preferred way to check the quality of reader’s health literacy to let them appreciate the (missing words or sentences; scientific incorrect translated clinical trial and health product-related text is a long and not always successful translations [e.g., terminology]; inaccuracies documents. option: 12,13 when translating a text for the [incorrect translations – including spelling, general reader, the translator needs to adapt to punctuation, grammatical mistakes]; and Cultural translations their thinking and language level. editorial, stylistic changes [e.g., rephrasing]). Why are literal translations dangerous? Although the timelines and roles are well It is impossible to provide effective communi - The legal and regulatory requests established, no guidance is provided on how to cation in a target language using word-for-word The European Medicines Agency requests that ensure that the translated documents correctly translation. This is one of the reasons why

www.emwa.org Volume 29 Number 4 | Medical Writing December 2020 | 41 Translation: A transcultural activity – Rossi

machine translation, where a computer program perfect Italian, it is un acceptable for any Italian version of translation because it provides more analyses a source text and produces a target text because Italians do not have a “little friend”. than simple word-to-word conversion. without human intervention, is not yet a reliable Italian men are Latin lovers, so even if a virgin, 95 Cultural translation also adds a consultancy and professional option. A growing number of years old, or a chaste Catholic priest, our dimension to translation. It is a deeper version of software options are available on the internet “friends” are not “little”. Even Italian women translation, so the translator is an important actor such as Babel Fish, Babylon, FoxTranslate, would not accept this. And your “friend” never in a company’s expansion abroad. Translators are Google Translate, Lingo, TransPerfect, StarDict, “leaves you alone” – it might be ill, but he is entrusted with a cultural mission; they are not U.S. Translation Company, and Yahoo! Also, always with you! For any Italian, this is hilarious. only experts in the target medical area but are companies like Ectaco, TimeKeffle, and eFlyTek When we finally stopped laughing, we called also asked to effectively communicate to produce pocket translation devices. our Swiss colleague to ask him what he had been healthcare providers and the general public. In Communication in human language is thinking. We asked about the “little friend”, and addition to translating and adapting graphics, context-dependent, and it takes a person to he could not understand what we were talking currencies, date formats, addresses, phone comprehend the context of the original text. about: he was shocked by our reaction to his numbers, colour choices, punctuation, and so on, Thus, even if artificial intelligence has greatly translation. He finally explained they had they must ensure that communication in the enhanced the ability of translations systems to translated from the original German version, target language is pro fessional. This implies interpret natural language, translations per - which might have been “Wenn dein kleiner rethinking the structure of the text. Thus, a key formed by a machine must be substantially Freund dich alleine lässt…” (German speakers aspect of cultural translation in health revised by a human, although the work can be please stop laughing, I was unable to find the management is that the final com munication reduced when the translation system is integrated original version and it is what Google Translate must be understood, avoid conflict, and align with a translation-memory or globalisation- said!) Probably, it is a good way for com - with the targeted needs. management system. 17,18 municating the concept of erectile dysfunction Even human-generated translations, however, to the Swiss Italian-speaking general public. Who is the right translator? are prone to error. Therefore, to ensure that a Medical translators are essential for preventing machine-generated translation will be useful and How to assess the quality of translations misunderstanding or miscommunication of that the translation is of publishable quality, they A translation must consider cultural aspects. healthcare information. International organi sa- must be reviewed and edited by a human with the Knowing a culture allows for a better mani - tions, researchers, and companies are increasingly appropriate cultural background to appreciate pulation of the language: being familiar with becoming aware of the importance of translation the tone and the deep meaning of the text in both customs and traditions makes it easier to find professionals in considering the different cultural the source and output languages. distinctions, double meanings, and embarrassing approaches. A cultural translator must know the phrasing. Consequently, cultural translation cultural background of the source text and must A crazy example of cultural mistranslation. involves a deeper comprehension of both the live in the culture of the targeted health care A few years ago – about 15 (sigh, I am old) – my target and source languages. We could professionals. professional responsibilities included the even say that it is a more preparation and approval of promotional advanced Conclusion materials to be used by the Italian affiliate of my In my experience in collaborating with people company. As you probably know, Italian is in North and South America, I have found spoken by about 60 million Italians and by that many people living there do not about 720,000 people in the Italian-speaking consider the importance of different cantons of Switzerland. 19 Thus, when a new cultural backgrounds. I have seen that drug for the treatment of erectile dysfunction some well-known and respected top was close to being approved in Italy, we managers are hardly able to distinguish asked Swiss colleagues to review the one European country from another, material they were to use to for the product and they barely know that we speak in Switzerland. Upon opening the different languages. Luckily, the vast document, my colleague was unable to stop majority of North and South Americans laughing, even though she is a deeply serious know and appreciate the “Old World” and professional person, so we all were cultures and languages. On the other surprised. She pointed her finger at the hand, as Europeans have become computer screen, unable to say anything exposed to New World cultural models, because of the unstoppable laughter. We read differences between countries have “Quando il tuo piccolo amico ti pianta in decreased. And although a growing asso…” (literally “When your little friend number of healthcare pro viders world leaves you alone…”) and all of us started wide speak English, non-native English laughing uncontrollably. Although it is speakers often do not recognise the

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definitions and models. BMC Public Health. 2012;12:80. 13. Park R. Power to the people: Make gains by focusing on health literacy. 2016 [cited 2020 April 28]. Available from: https://www.medicalwriters.com/power- to-the-people-make-gains-by-focusing-on- health-literacy/ . 14. European Medicines Agency. Human Medicines Evaluation Division. The linguistic review process of product information in the centralised procedure- human. 2017 [cited 2020 November 4]. Available from: https://www.ema.europa.eu/en/ documents/regulatory-procedural- guideline/linguistic-review-process- product-information-centralised- procedure-human _en.pdf difference between British, American, Australian, https://dictionary.cambridge.org/ 15. Grunwald D, Goldfarb NM. Back and Canadian English, each of which has its own dictionary/english/translation . translation for quality control of informed cultural background. 5. Translation Journal. Definition of consent forms. J Clin Res Best Pract. We all need to understand our limits. Cultural translation. 2020 [cited 2020 April 28]. 2006;2:6. translation is not an option for health Available from: 16. Sfetcu N. Back-translation - SetThings. communication professionals; it is the only way https://translationjournal.net/October- 2009 [cited 2020 November 4]. Available to achieve an effective translation. 2017/definition-of-translation.html . from: https://www.setthings.com/ 6. Carlson HG. Problems in play translation. en/back-translation/ . Acknowledgements Educ Theatr J. 1964; 16:55. 17. Wołk K, Marasek K. Enhanced bilingual The author thanks Aurelie Gobet and Paolo Rega 7. Anolli L. Fondamenti di psicologia della evaluation understudy. 2012 [cited 2020 for their thoughtful revision and Lisa comunicazione, 2nd ed. Bologna, (Italy): November 4]. Available from: Chamberlain James, and Phil Leventhal for their Il Mulino; 2012 https://arxiv.org/ftp/arxiv/papers/1509/ linguistic and transcultural review. 8. Zimmerman KA. What is culture? 1509.09088.pdf . Definition, meaning and examples. 2013 18. Vashee K. Statistical machine translation Disclaimers [cited 2020 April 28]. Available from: and translation memory: An integration The opinions expressed in this article are the https://www.livescience.com/21478-what- made in heaven! ClientSide News Mag. author’s own and not necessarily shared by his is-culture-definition-of-culture.html . 2007;7:18–20. employers or EMWA. 9. Tylor EB. Primitive culture: Researches 19. Wikipedia. Lingua italiana in Svizzera into the development of mythology, [article in Italian]. 2020 [cited 2020 Conflicts of interest philosophy, religion, language, art, and April 30]. Available from: The author has no conflicts of interest related to custom. 6th ed. London (UK): John https://it.wikipedia.org/wiki/Lingua _ this article. Murray. Available from: italiana _in _Svizzera . https://archive.org/details/ References primitiveculture01tylouoft/page/n8/ 1. Kasparek R. The translator’s endless toil. mode/2up . Pol Rev. 1983;28:83–7. 10. Macionis JJ, Gerber LM. Sociology. North 2. Lexico. Definition of translation. 2020 York (ON): Pearson Education Canada; Author information [cited 2020 April 28]. Available from: 2011. Andrea Rossi has more than 30 years of https://www.lexico.com/en/definition/ 11. Medicalwriters.com. About Wesley experience in clinical trials, has been working translation . Portegies. [cited 2020 April 28]. Available on medical writing activities for the last 20 3. Bhatia N. In: The Oxford Companion to from: https://www.medicalwriters.com/ years, and co-leads the Scientific Communi - the English Language. 1992;1:051–4. author/wesleyportegies/ cation Special Interest Group. He is a 4. Cambridge English Dictionary. Definition 12. Sørensen K, Van den Broucke S, Fullam J, workshop leader, an EMWA ambassador, and of translation. 2020 [cited 2020 April 28]. et al. Health literacy and public health: a past president of EMWA. Available from: a systematic review and integration of

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