English Chinese translation:
Gayle Tang remembers the time she thought she was speaking English but only realized she had lapsed into Cantonese when one of her doctors spoke it back to her. That was 14 years ago, but she recalls the uneasy feeling of not knowing what was wrong with her and undergoing tests for heart palpitations. The doctor's words in the language she needed to hear and speak at that sensitive time moved her, she said. "It was very natural, very comforting," Tang said. "I was able to express myself and it was emotional. I felt, wow this person really cared about me."
盖尔唐现在仍然记得在医院的一次经历，当时她本以为自己在用英语讲话，其实是不由自主地讲着广东话，而这时其中一位医生竟开始用她的母语同她交流。这是14年前的事了，但她还能想起自己当时做心悸检查不知所措的感觉，医生在她紧张的时刻使用她能听懂和表达的语言与她交流，让她感到很感动。“那种感觉非常自然，令人舒服，”唐说，“我能够表达自己，这令人很激动。我觉得，哇，这个人真的是很关照我。”
The experience gave Tang insight into what patients who speak languages other than English may face when they're frightened and in the throes of medical treatment. "It's very exhausting to try to communicate your most personal information in a language you may not be as comfortable in when you're under stress," said Tang, director of national linguistic & cultural programs for Kaiser Permanente in Oakland. "When people are under duress, they may lose their language skills," she said. "It's not like going to the bank and making a banking transaction or going to the grocery store and buying food."
这次经历让唐了解到，不会讲英语的病人在恐慌和疼痛时会面临什么样的麻烦。“在压力下以自己不是很习惯的语言来讲述个人信息是一件非常辛苦的事，”担任位于奥克兰的凯泽公司民族语言和文化项目部主任的唐说。“人们在胁迫下可能会失去自己的语言技能，”她说，“这与到银行做笔交易或去杂货店买食物的情况不同。”
Kaiser Permanente has been on the forefront of a movement toward greater linguistic and cultural competence in health care. Kaiser routinely asks patients which language they prefer to speak, and developed a voluntary physician assessment tool that lets health-care organizations determine if doctors have enough foreign-language proficiency to speak with patients in that language independent of an interpreter. About 1,000 doctors have taken the test so far. As the nation's population grows and ages, the demand for language services in hospitals, doctor's offices and other health-care arenas is booming, experts say.
凯泽公司在推动医疗领域完善语言与文化服务方面一直走在前列。他们会例行地询问病人希望使用的语言，并为医疗机构制定了自愿者医师评估工具，以便他们能判断是否医生具备在无需译员帮助下能够同讲外语的病人较好沟通的能力。目前大约有1000名医生参加了这项评估测试。 专家们介绍，随着国家人口的增长和老龄化，医院、医生诊所和其他卫生保健领域对语言服务的需求正日益增加。
Federal law mandates that any entity that receives federal funding, whether it's Medicare reimbursement or research grants, must provide a patient with limited English proficiency an interpreter at no cost to the patient. In early 2009, California enacted a language-services law requiring all health plans and insurers to provide an interpreter for limited-English speaking patients at no cost to the patients. The House of Representatives' health-reform bill calls for a study into how the Medicare program makes use of language services for beneficiaries who have limited English proficiency. If a health-care overhaul expands coverage as promised, an influx of newly insured people into the Medicaid program also may increase demand for medical interpreters. An estimated 15,000 to 17,000 people perform medical interpreting work in the U.S., according to Common Sense Advisory, a Boston-based research firm. Interpreters typically earn $15 to $30 an hour.
联邦法律明文规定，任何获得诸如医疗保险或研究补助金等联邦资助的单位，必须向英语能力有限的病人免费提供翻译人员。 2009年初，加利福尼亚州颁布了一项语言服务法律，要求所有医疗计划和保险人向英语能力有限的病人免费提供口译人员。 众议院的医疗改革法案还在安排一项研究，用来了解医疗项目如何利用语言服务为英语能力有限的病人带来福利。如果医疗改革按照预定的那样扩大覆盖范围的话，新获得医疗保险的一大批人的涌入同样会增加对医疗口译员的需求。根据一家位于波士顿的调查公司“Common Sense咨询服务公司”统计，在美国有大约15000至17000人在从事医疗口译工作，口译员一般收入为每小时15至30美元。
Driven to standardize
走向标准化
As hospitals look to boost patient safety and limit their exposure to potential lawsuits if a crucial detail gets lost in translation during a fast-paced medical response, some are open to a new national certification standard for the people they hire to provide medical interpretation. In October, a nonprofit group launched a first-of-its-kind national interpreting standard that will allow interpreters working in the medical field to be tested and credentialed as certified medical interpreters, or CMIs. The CMI designation first will be available to Spanish language interpreters, with national certification for several other languages starting next year.
如果一个关键的细节没有在快节奏的医疗问询中被清楚翻译的话，病人的安全就会受到威胁，医院还会存在潜在的诉讼风险，医院为了避免类似问题发生正着力寻求解决途径。目前，一部分医院已经开始采纳针对医疗口译人员的国家认证标准。10月份，一家非营利性组织开始制定了历史首次的国家口译服务标准，允许医疗领域工作的口译员参加考试并获得医学口译证书（CMI），这项认证首先在西班牙语口译员中试行，明年起在其它几种语言中推广。
At M.D. Anderson Cancer Center in Houston, interpreters have to have at least one year of experience doing medical interpretation. They then go through three months of in-house training including medical and oncological terminology and technical aspects of interpretation, said Cesar Palacio, manager of the language assistance department. "Right now when we hire someone we have to take a very good look at their credentials and verify that they really know what they're doing," he said. "If we have national or state certification, at least we'll have a benchmark for establishing credentials."
在休斯敦安德森癌症中心，口译员必须有至少一年的医疗口译经验。他们还要通过三个月的内部训练，包括医疗和肿瘤方面的术语及口译技术问题，语言协助部门经理帕拉西奥介绍说。“现在我们雇人时，都要仔细地了解他们的资格，并确认他们真的知道自己在做什么，”他说，“如果我们有国家或州一级的认证，至少我们会有一个衡量基准。”
The field of medical interpretation has come a long way from when patients would rely solely on their minor children or when hospital staff would comb their ranks for candidates or ask if anyone in the waiting room spoke Polish, for example, said Dr. Eric Hardt, medical consultant to interpreter services at Boston Medical Center. "They would tap these people completely untrained," he said. "Today we would think of it as an instant [health-care privacy] violation. That standard has long been gone." "Now the issue is what about your secretary who's fully bilingual? If she's not been evaluated, had some training, I don't think it's safe for you to use her to interpret" for low-English proficiency patients, Hardt said. "If something went wrong, you're increasingly likely to be liable."
“医疗口译已经走过了很长的路，以往病人仅能靠他们尚未成年的子女同医生沟通，亦或医院想办法在医务工作者中挑选会外语的人员，甚至向排号等待看病的人中询问是否有会波兰语的人。”在波士顿医疗中心担任译员咨询专家的哈特埃里克博士说。“他们会让这些完全未经训练的人做口译，”他说，“而今天，我们会立即把这种行为看作是对医疗隐私的侵犯。旧的标准早已过时了。”“现在的问题是，如果你的秘书就能熟练掌握双语，但她没有获得评估或受过训练，是否可以胜任这份工作？我觉得让她为低英语水平的病人做口译仍然是不安全的。”哈特说，“如果出了问题，你需要承担责任的几率会大大增加。”
Of course, such services don't come cheap. At M.D. Anderson, the annual price tag comes to $2 million, Palacio said. The cancer-treatment center has 25 staff interpreters covering nine languages, but it provides services in about 30 languages by tapping a phone-based medical interpreting agency. About 60% of M.D. Anderson's non-English business is Spanish; another 28% is Arabic. Turkish, Vietnamese and Mandarin Chinese round out the top five languages it hears. "Providing these services is a very good risk-management tool," Palacio said. "There have been settlements for language-related problems amounting to tens of millions of dollars because of one word or phrase used incorrectly."
当然，口译服务并不便宜。在安德森中心，每年的花费会达到200万美元，帕拉西奥说。癌症治疗中心有25名工作人员，涵盖9种语言翻译，额外还能通过电话代理方式提供约30种语言的口译服务。安德森中心受理的非英语业务大约有60％是西班牙语，28％为阿拉伯语，它们连同土耳其语、越南语和汉语普通话构成了主要外语的前5位。“提供这些服务是一个很好的风险管理工具，”帕拉西奥说，“因为经常有由于一个词或短语没有使用准确而导致数千万美元赔偿的案例。”
Offering interpreters also pays off in public-relations gains. "We have many patients who were not even expecting to find this kind of service here," he said, "but they find the service very useful, very rewarding."
提供口译员服务也体现公共关系的成果。“我们有许多病人原本并没有期待可以在这里获得这种服务，”他说，“但他们发现这项服务非常有用，非常有价值。”
Judgment calls
如何去判断
Health care makes up about a third of the business at Language Line Services, which provides telephone-based interpreting services for $1.50 a minute on average. Its president, Louis Provenzano, said the company serves more than 170 languages by staffing interpreters in 18 time zones who are available to customers by phone or sometimes video at all hours. More than half its staff is based in the U.S.
医疗口译占在线语言服务公司 Language Line Services 近三分之一的业务，他们提供在线方式的口译服务，平均每分钟收取1.5美元。其公司总裁路易斯普罗文扎诺介绍，该公司的口译人员来自18个时区的不同地方，大约一半以上的工作人员居住在美国，这些人员可以通过电话或视频的方式24小时为客户提供超过170种语言的翻译服务。
Despite the recession, the company continues to grow, Provenzano said. Spanish drives 70% of the U.S. business volume, and Mandarin Chinese is the second most in-demand language. It's not just acute-care facilities and emergency rooms that are calling for help. New customers are coming on board in the area of preventive care, disease management and needs related to the pandemic H1N1 flu virus, he said. "No matter which side of the fence you sit on immigration, there's a fundamental complexity in terms of the demographics of this country," Provenzano said. "One of every five citizens speaks another language other than English."
尽管经济衰退，该公司的业务却在持续增长。西班牙语占据了他们美国业务的70％，而汉语普通话位列急需语言的第二位。现在不仅仅是急救机构和急诊室打电话过来求助，在预防保健、疾病管理以及与甲型流感有关的需求方面都带来大量的新客户。“不管你对于移民问题持有何种立场，从这个国家的人口统计的角度来看，有一个基本的复杂问题就是，每五个市民里就有一位讲另一种英语以外的语言。”普罗文扎诺说。
Still, doctors often balk at providing medical interpreters because that often means they pay more in interpreter's fees than they are reimbursed for the patient's office visit. The American Medical Association says it understands the need for good patient-doctor communication but objects to the "unfunded mandate" that leaves doctors on the hook for the cost of providing interpreters.
不过，医生往往不愿为病人提供医疗口译人员，因为这常常意味着他们给译员支付的费用要超过为病人看病获得的利润。美国医学协会说，他们清楚为了让医患之间更好的沟通而对口译服务的需求，但对政府不提供此方面资助的规定表示反对，因为让医生支付口译费用会将他们置于两难的境地。
Many patients whose native language isn't English often choose doctors who speak their first language, said Dr. Anmol S. Mahal, a gastroenterologist in Fremont, Calif., and past president of the California Medical Association. Others count on trusted loved ones who accompany them to the visit. "The largest volume of interpreters are loving family members and neighbors and transporters who come with patients and help," said Mahal, who speaks Hindi and Punjabi. Doctors should be able to determine when a family member is appropriate vs. when a professional interpreter is needed, he said.
“许多母语为非英语的病人往往会选择同他们讲相同语言的医生，”在弗里蒙特工作的肠胃病医生、加利福尼亚州医疗协会前主席安莫尔马哈尔说，“另一些人则指望自己信任的亲人陪同他们前往医院。”“前来陪同病人并帮忙翻译的大多数人都是家属、邻居甚至运送人员。”马哈尔说，他本人会讲印地语和旁遮普语。“医生应该能够确定何时家庭成员可以胜任，而何时需要一位专业翻译，”他说。
"If I have someone with a minor illness -- a bronchitis or a cold -- and a family member is interpreting for the patient, I would think the communication level that visit requires could be adequately covered and the quality of care would not be affected," he said. "On other hand, if I had a patient with a malignancy that was quite complicated and I had to describe the extent of the malignancy and options for treatment to determine what further course of action to take, I think it would be more important in that circumstance to have a professional interpreter who could ascertain the patient's understanding."
“如果我的患者只是有轻微疾病，例如支气管炎或感冒，当家属为患者翻译时，我会认为这种沟通水平已经能满足需求了，服务质量也不会受到太大影响，”他说，“但相反，如果我的病人有非常复杂的恶性肿瘤，我就必须描述病情的恶性程度和治疗方案，以确定对病人的进一步治疗行动，我觉得这时找一位能够弄清病人是否理解的专业翻译就更加重要。”
Studies show that people who don't speak English generally receive a lower standard of care, Hardt said. "Our hypothesis is the amount of money that's wasted on language barriers would be enough to cover the cost of good interpretive services," he said, noting that appropriate services could reduce health-care disparities and inefficiencies such as the number of patients who make repeat trips to the emergency room because their original problem wasn't handled properly. "These are all big-ticket items," Hardt said. But that doesn't mean medical interpreting is an easy sell, he noted. "It's the old problem of when you save someone else's money, how can you convince them to pay you back?"
“研究表明，不会说英语的病人受到的治疗标准普遍偏低”，哈特说。“我们的假定是因为语言障碍而浪费的金钱足以用来支付提供较好口译服务的费用。”他同时指出，“适合的口译服务可以减少医疗服务的受众差距和低效率，因为有很多人重复被送到急诊室是因为他们原先的问题没有被很好的处理。这些都是高价的负担，”哈特说，“但这并不意味着医疗口译就会很容易被采用，”他说，“还是那个老问题，当您为别人省了钱的时候，你该如何说服他们给你补偿呢？”
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