Title Development of Medical Interpreting in the United States Author(s) 竹迫, 和美 Citation Issue Date Text Version ETD URL https://doi.org/10.18910/33997 DOI 10.18910/33997 rights Note Osaka University Knowledge Archive : OUKA https://ir.library.osaka-u.ac.jp/ Osaka University Development of Medical Interpreting ininin the United States ~From Oral Histories of Medical Interpreters~ Doctoral Dissertation KAZUMI TAKESAKO Human Sciences in the Graduate School Osaka University, Japan March 25, 2014 ABSTRACT Title Development of Medical Interpreting in the United States From Oral Histories of Medical Interpreters With globalization proceeding apace, resulting in the increased movement of people across national borders, countries around the world are searching for ways to ensure that their societies remain harmonious despite the different languages, lifestyles and cultures of people. Medical institutions find it necessary to ensure accurate and speedy communication between patients and medical professionals, but only a limited number of countries have professionally trained medical interpreters to facilitate communication in medical settings. This study will attempt to clarify the process of development of medical interpreting in the United States, where medical interpreting services have long been provided at no cost to patients based on federal law. Chapter One outlines the situation in Japan and other countries around the world. In Japan, the number of foreign residents has been increasing steadily since the immigration control law was amended in 1990. Recently, however, the number of foreign visitors has grown dramatically, but the development of medical interpreting has just started. Some local governments have taken the initiative to train interpreters and build their own systems to employ them, but there has yet to be a national blueprint for doing so. In Europe, known historically as a destination for refugees and immigrants, most medical institutions rely on volunteers or bilingual staff for interpreting. With medical interpreting becoming an international issue, this study has chosen the United States, an advanced country in this area, as the place for field research. This study aims to analyze oral histories of medical interpreters in order to identify stakeholders who subjectively contributed to developing the profession and to figure out what roles they have played in the process. Chapter Two reviews the research literature with a focus on communication in medical settings. I found that physicians have written numerous papers on themes ranging from language and cultural barriers, and ethnic disparities to access to health care and the challenges facing medical interpreting services. Most of them shed light on issues through the viewpoints of physicians, and medical interpreters have merely been the targets of such studies. I discovered only a few research studies conducted by medical interpreters themselves. Since many countries classify medical interpreting as i a kind of community interpreting, I have primarily reviewed papers authored by linguists and researchers on interpreting studies. Most of their work has involved discourse analysis in medical encounters, and development of medical interpreting as a profession has been treated as a secondary issue. As a result, I decided to clarify the entire development process, from the 1970s when the first in-house medical interpreters were employed until today, by identifying how stakeholders, including medical interpreters, were involved in the process. Chapter Three describes my methods. Oral history (OH) has been used by a variety of researchers in the fields of history, anthropology, sociology, and others. The number of oral histories told is uncountable, including narratives of entering the United States by minorities, or student projects to record family stories. Oral histories are considered to be highly useful in research, and this study uses the method to analyze subjective narratives on private issues such as how people became medical interpreters and what challenging experiences they can recall. Due to a lack of written materials regarding the beginning of medical interpreting, I searched for the initial members of medical interpreters associations to obtain materials they have preserved. At the same time, I asked them to introduce me to others. I tried my best to recruit targets with different countries of origin and ethnicity. I have kept in touch with them even after the interviews, during the process from transcribing the recorded interviews to writing up each one’s oral history. My close contact with them enabled me to confirm details. Since oral histories have been criticized due to the unreliability of peoples’ memories and misinterpretation of their meanings, I confirmed with several targets about incidents they experienced together and have meticulously checked their narratives with written materials. Chapter Four first provides general information about a total of 29 OHTs who worked between 1979 and 2013, then outlines each OHT’s oral history and finally provides fours themes found from their oral histories: 1) Advocacy, 2) Stakeholders, 3) Perspectives on the Profession, and 4) Motivations upon analysis of OHTs’ accounts and materials. The targets, who I call Oral History Tellers (OHTs), come from 20 countries and speak 25 languages apart from English. Some speak less common languages such as Khmer, Hmong, Tibetan, Nepal, and Navajo. Fourteen of them were immigrants, five were refugees, and one was a resettler. Seven married U.S.-born citizens and six studied abroad in the U.S or another foreign country. A total of eight were the first staff interpreters at their institutions to promote medical interpreting services by educating ii bilingual staff and volunteers. Ten assumed management positions as directors or coordinators of interpreting services. Since the services are unfunded mandates and medical institutions have to pay all costs without reimbursement, the medical interpreters with management posts had to make the utmost effort to decrease the total cost. A total of 17 have worked as professional trainers, while six were the initial group members of the Massachusetts Medical Interpreters Association, the world’s oldest professional group for medical interpreters, founded in Boston, Massachusetts, in 1986. They recounted how a small group of in-house interpreters gathered to share difficult cases and challenging issues at work, before developing their circle into a professional association. Professional associations publish their own technical standards, including codes of ethics and standards of practice, in order to establish minimum requirements to be professionals. OHTs told how these associations took the initiative in advocacy activities to secure professional status for medical interpreters and created employment opportunities by collaborating with a wide variety of stakeholders. Individual motivation to become a medical interpreter varied depending on each person’s ethnic roots, family environment, language and the cultural barriers they experienced. Despite such differences, their primary role as practitioners has been to work as a bridge to facilitate communication between medical professionals and patients. In their narratives, they commonly said, “I want to help patients in need” and “I feel happy every time I hear patients’ thanks.” Those who started to work in the early stage of medical interpreting, when society as a whole didn’t recognize them as professionals, recalled how difficult it was to deal with the opposition of physicians. They have been untiring in trying to win the respect of their coworkers. APPENDIX (p.156~299) provides 29 OHTs’ oral histories numbered in chronological order (1-29) according to when the person started to work. Chapter Five focuses first on the civil rights movements of the 1960s, which broadly changed social values in the United States. OHTs remembered how Asians, Hispanics and Native Americans carefully observed the civil rights movement of African-Americans, which motivated them to demand equal rights to public services for their ethnic groups. Medical interpreting services gradually came to be considered an important tool for securing equal access to health care for people with limited English proficiency (LEP). Under such circumstances, many stakeholders became involved in the process of developing medical interpreting. This study highlights the coincidence of the influx of immigrants in the 1970s and the introduction of informed consent as a standard practice due to a series of malpractice cases across the country. Together, these iii two factors caused physicians and medical professionals in general to give importance to medical interpreting. I examined stakeholders’ roles based on the accounts of OHTs and the literature and materials they provided. The federal government enacted laws and encouraged state governments to comply with them, establishing two main agencies for this purpose: The Office of Minority Health and the Office for Civil Rights under the Department of Health and Human Services. State governments have varied in their language policies, and they all implemented measures at their discretion. OHTs recounted that the enactment of laws created jobs for them and led society to recognize their professional status to a considerable extent. However, the legal status of professional medical interpreters has not been secure enough in that the laws stipulate that LEP patients must be