NCIHC AMM Language Access Café Summary: LGBTQ-Affirming Interpretation Services

I had both the pleasure and privilege to facilitate a session of the Language Access Café at the 2021 Annual Membership Meeting of the National Council on Interpreting in Healthcare. This year’s theme was Trauma, Language, and Social Justice, and I was asked if I could lead a discussion on interpreting for the LGBTQ community. It felt so appropriate and timely to center this discussion around trauma, intersectionality, and providing affirming interpretation services to the LGBTQ community. As such, the title I decided on was admittedly quite lengthy, but focused on all of these issues:

Intersectional Trauma: The Importance of LGBTQ-Affirming Interpreting Services

Many attendees had varying levels of familiarity with the topic, so some of the three sessions focused more on answering questions, whereas others focused more on discussion. The general premise that guided our conversations was:

Members of the LGBTQ community who are in need of interpreting services often have multiple layers of marginalized identities. As a result it is of utmost importance for interpreting professionals to take a trauma-informed approach when serving this population.We will discuss the unique challenges the LGBTQ community faces, especially in terms of mental health, and how we as language professionals can carry out our duties in a more trauma-informed, affirming manner, all within the ethical framework laid out for healthcare interpreting.

Ultimately, we focused on the question: how do we provide LGBTQ-affirming interpretation services?

Session 1: A Focus on Pronouns

In the first session of the AMM’s Language Access Café, I was joined by my friend and colleague Jorge Ungo, who has led many prior AMM Language Access Cafés on LGBTQ topics. He brought up a recent conversation that we had had about when and how to ask for a patient’s pronouns when interpreting for them. I felt this was an important question that has received little to no attention, and as such there isn’t really a set of guidelines or best practices for doing so. Despite this lack of guidance, pronouns are a hot topic when it comes to being affirming!

One attendee suggested asking for pronouns at the beginning of every interpreting encounter. We discussed why and how this may be problematic, including the fact that not everyone understands what a pronoun is and this may lead to the first few minutes of an encounter being spent having a conversation about pronouns. Furthermore, encouraging folks to disclose their pronouns may be uncomfortable. Not everyone wants to share their pronouns, and being put on the spot to disclose them can make someone feel like they’re under pressure to do so. It’s not uncommon for folks to withhold their pronouns or purposefully misgender themselves so as not to “out” themselves.

My Approach to Pronouns in Medical Interpreting Encounters

At the end, I shared my personal approach to asking for and clarifying pronouns. Despite what many people may assume about my approach due to my outspoken advocacy for the LGBTQ community, I don’t ask for a patient’s pronouns up front.

• Don’t assume gender or pronouns.
  Some participants suggested only asking for pronouns if the patient is transgender, nonbinary, or gender non-conforming. The way in which this suggestion was phrased (I can’t recall the exact wording) it seemed like this assumption was being made based on appearance. I think this is the most important component to the pronoun discussion: never make assumptions. Trans, nonbinary, and gender non-conforming folks don’t “look” a certain way. A common retort of mine to experienced interpreters who claim they’ve never interpreted for a trans person is, “Well how do you know?” You don’t, and chances are, if you’re making that claim, a trans person may not feel comfortable to even disclose that they’re trans in your presence.
• Interpret pronouns as they are used.
  The conclusion that Jorge and I came to is that the vast majority of the time, interpreters interpret in first person, and as a result the interpreter will interpret if the provider asks for the patient’s pronouns, as well as the pronouns that the provider uses to refer to the patient. If the patient feels inclined to correct the provider when using incorrect pronouns, the interpreter can facilitate this correction.
  (A previous version of this article mistakenly asserted interpreters interpret in the third person. This was corrected on April 23, 2021.)
• Clarify “conflicting” pronouns.
  If during the course of your interpretation you encounter so-called “conflicting” pronouns and genders (i.e. the patient is describing themselves using masculine adjectives in a gendered language but the provider is using she/her pronouns to refer to the patient, yet ) it may be worthwhile to clarify. That’s not to say it’s not valid for someone to use both she/her and he/him pronouns, but just to make sure that everyone is on the same page in case there is a misunderstanding. Interpreting adjectives from a gendered language like Spanish to a language that generally does not use gendered adjectives, like English, can sometimes result in miscommunication.
• Ask for pronouns in specific settings.
  There are certain settings where asking for pronouns at the beginning of an interaction and/or introducing yourself with your pronouns is the norm. It is in these spaces that I may very well incorporate pronouns into my pre-session or introductions. Some of these settings may include LGBTQ health centers or mental health spaces designated as “LGBTQ safe spaces.” That being said, if I am familiar with that space and know beforehand the provider will incorporate pronouns into the beginning of the encounter, I may not ask for pronouns to allow the provider that chance for valuable rapport-building.

Avoiding Problematic Terminology

One common thread across all sessions was being more affirming by avoiding problematic terminology when speaking in our own voice while in a medical interpreting encounter. That’s not to say if a provider is using these terms that you shouldn’t interpret them, but rather that when speaking in your own voice (switching to third person) it’s important to change your wording a bit to be more affirming. Some problematic phrasing encountered included:

• “Biological male/female”
  The biology of sex and physical sex traits (just one component that plays into the biology of sex!) is not black and white. As such, assigned male/female at birth is a less problematic alternative.
• “Birth sex”
  As mentioned above, the biology of sex is much more complicated than many of us have been led to believe. Sex assigned at birth is a better alternative, because we assign sex as birth based on physical sex traits. This can create all sorts of issues. For instance, someone can assigned male at birth but their chromosomal makeup won’t fit neatly into this little box we’ve decided to call “male!”
• “Identifies as”
  I made this mistake myself, admittedly. We’re socialized to express things in certain ways, and it can be difficult to break these habits. I’m no exception to this rule. Transgender women don’t “identify as” women. They are women. Someone doesn’t “identify as” gay, they are gay. If they’re coming out and telling you, it’s not a preference or some sort of inclination, it’s their reality.

In multiple sessions, we talked about the importance of acknowledging your own biases and assumptions. We also discussed how this is especially important as an interpreter trainer. Even unconscious biases can play out and be passed along to your interpreting students, essentially amplifying your biases.

Session 2: Autonomy, Personal Growth, and Culture

In session 2 about LGBT-Affirming Interpretation Services, we talked at length about the importance of respecting a patient’s autonomy and ability to advocate for themselves. That’s not to say that as interpreters, we should never advocate and allow patients’ health, well-being, or dignity come to harm, but rather we need to exercise caution when stepping into the advocate role and recognize that the patients we interpret for are perfectly capable of making their own decisions. The goal is to empower people who utilize interpretation services, not rob them of their agency.

We also spoke about how being religious and LGBTQ (or an ally to the community) are not mutually EXclusive. Whenever I speak about anything LGBTQ-related, I always have this voice in the back of my head that is terrified; terrified that someone is going to use that platform to invalidate the humanity of a community I hold so dear (and of which I am a member). This is why, when an attendee shared that they were attending this session as a deeply religious person who wanted to learn more about how to be an ally to the community, I felt a sense of relief and gratitude.

This led us to discuss the importance of being open to learning new concepts. I shared that I firmly believe that part of being a medical interpreter is dedicating yourself to being a lifelong learner. We all talked about just how much there is to learn about the LGBTQ community, even if you’re a member of it yourself! Also, cultural competence isn’t just about being knowledgeable about cultures from other countries. Being a lifelong learner is leaving yourself open to experiencing and understanding many different cultures that you may encounter in your work as an interpreter, such as LGBTQ culture and other subcultures.

Session 3: Soft Skills and Acknowledging Trauma

I was joined in session 3 by quite a few folks who had a really solid foundation in understanding trauma and LGBTQ issues. An overarching theme in almost everything we discussed centered around soft skills in providing LGBTQ-affirming interpretation services, such as being empathetic, knowing when to advocate, and managing potentially confrontational situations (i.e. an LEP parent misgendering their child). One participant shared an especially powerful quote, stating that interpreting is about “getting across someone’s emotional truth.” I feel that this embodies the spirit of providing LGBTQ-affirming interpreting services, and it does require a lot of empathy and understanding.

We ended our discussion acknowledging the unique challenges that LGBTQ folks have been facing during this pandemic. One participant commented that they’ve really seen an uptick in adolescent psych encounters with LGBTQ patients. The fact is, a sustained traumatic experience, like the COVID-19 pandemic, can really exacerbate some of the existing disparities we see in the communities we serve as interpreters. Many members of the LGBTQ community (including minor children who still live with their parents) have been stuck in a living situation that is anything but ideal, in quarantine or lockdown with family or roommates who are NOT affirming of their identity. They may even be actively hiding who they really are to protect themselves.

Do No Harm

By the time LEP LGBTQ patients show up to a healthcare encounter, they already have enough trauma. As interpreters, we should take a trauma-informed approach and, at the very least, seek to minimize adding to that trauma burden. One way we can do this is by providing LGBTQ-affirming interpretation services. At the end of each discussion, I shared my proposed three-prong approach:

1. Interpreting Accurately
   (NCIHC Core Value: fidelity)
   If a provider is NOT being affirming (for instance: using incorrect pronouns), I still interpret accurately and completely. The patient has the right to know that someone is not respecting them! Furthermore, if the provider is utilizing affirming language, interpret it. It doesn’t matter if there isn’t a term in the dictionary for your target language for the concept that is being expressed. I guarantee you that people who use neopronouns in your target language have a solution.
2. Advocate when Necessary
   (NCIHC Core Value: beneficence)
   I advocate when I need to but I don’t let the advocacy role take precedence over the patient’s autonomy and their ability to advocate for themselves. Remember: the NCIHC core value of beneficence says we may be justified in advocating when the patient’s health, well-being, or dignity is at risk, only after we’ve exhausted less intrusive interventions. Let’s say the provider repeatedly misgenders the patient. Perhaps switching to third person and reminding all parties of the patient’s pronouns is a smart first move before coming out swinging!
3. Respect.
   (Core value: for the importance of culture and cultural differences)
   Respect isn’t just about having basic respect and human decency, but also about respecting culture. Just as we respect different cultures from other countries that may be different from our own, we should also respect LGBTQ culture (yes, that’s a thing!) and treat it just as we would any other culture or subculture we may encounter in our line of work as interpreters. Also, as I previously mentioned, autonomy absolutely plays into respect! Patients are able to make their own decisions and choices, and we should respect that.

Again, I am absolutely humbled to have been invited by the NCHIC to facilitate a discussion on this topic that is so incredibly important. I am by no means an expert on such issues, and as such, please feel free to weigh in on any of the points discussed here if I have made a mistake, conveyed something incorrectly, or can perhaps phrase something in a better way. I very much want this topic to be an ongoing dialogue about how best to serve the LGBTQ community in terms of language access, and part of that dialogue is being open to making and admitting mistakes. I am no exception to this.

I would also like to take this opportunity to thank a wonderful community that has been there for me and taught me so much, helping me to grow both as an interpreter and as a human being: Queer-Friendly Interpreters and Translators. Y’all are rockstars and I have learned so much (and know I will continue to learn) from our tight-knit little group!