Predatory Interpretation

It happened to me again today. This time there was a scheduling snafu and I was assigned to one child and another interpreter was assigned to the sibling. The mother began to share with the both of us that she didn’t know it was her right to have an interpreter provided to her and her children until very recently. She expressed that she sees flyers all the time in tiendas latinas advertising interpreters to accompany unsuspecting Spanish-speakers to their appointments, and that sometimes they are paid $25, $30, or even $60 an hour out of the patient’s pocket. This mother was in awe that she was not only provided one but TWO interpreters and did not have to pay for either of them for her children.

This Sounds Familiar…

This situation reminds me of another predatory service rampant in the local Hispanic community: ride services or raiteros. You’ll often find their services advertised on repurposed lawn signs, scrawled in permanent marker. Many Spanish-speakers do not have driver’s licenses, so they have one of two options: drive without a license or juggle their transportation needs between family/friends and raiteros every time they need to go somewhere. To be clear, there are Spanish-speaking folks who do offer rides at fair rates and are genuinely doing their best to help out the community. However, these kind souls are few and far between, and most charge obscene amounts for short rides.

As a regular user of Lyft, I know how expensive rides can get, but my $15 ride from my house to a local hospital I frequently interpret at could easily cost someone $60 with a raitero. So why don’t monolingual Spanish-speakers use a service like Lyft or Uber? Let’s rephrase that question: what reasons would you have for being hesitant to take an Uber in a country that spoke a language you couldn’t? Sometimes, even the most basic of interactions seem incredibly intimidating to most of the patients I work with. In addition, many Spanish-speakers just aren’t aware of ride-sharing apps, don’t have a smart phone, or don’t even know how to use their smart phones. Sometimes it’s just a case of not having a credit card to connect to a PayPal, Apple Pay, or Google Play account.

From Bad to Worse

Raiteros are generally bad, but predatory interpreters are worse. They often don’t advertise their services as an interpreter, but instead as a traductor or translator. From the outset, this shows their complete lack of understanding of the profession and is a huge warning sign to any who may be considering using their services. (To be clear: translation is written, interpretation is spoken.) Interpreters who work directly with patients, in 99% of cases, are effectively preying upon the ignorance of unsuspecting Spanish-speakers by ignoring healthcare providers’ responsibility to provide language services free of charge to their patients. It would be like no one telling you about a buy one, get one free sale, someone taking your free item, selling it back to you at a premium, and pretending like they did you a favor.

One of the most basic ethical tenets of medical interpreting is that an interpreter is never allowed to charge the patient for their services.

I mentioned that 99% of these cases are predatory. So what about the other 1%? If an interpreter is only trying to be helpful, unaware that they are providing a service that should be provided for free, this shows that they are entirely lacking in the basics of interpreting. One of the most basic ethical tenets of medical interpreting is that an interpreter is never allowed to charge the patient for their services. What other ethical tenets of interpreting might this person be unaware of that they violate in their everyday practice? Accuracy? Completeness? Privacy? This brings to mind the old adage: the road to hell is paved with good intentions.

Are They Qualified?

I would pose that the majority of these predatory interpreters are not qualified. Even if, by some miracle, they were well-trained and certified, having passed under the radar of their certifying body while practicing by directly charging patients, I’d argue that it doesn’t really matter. People who only seek to take advantage of the marginalized have no business advocating for them. Like it or not, being a medical interpreter means being an advocate, if not just by being faithful in your interpretations. If someone cannot be faithful to the code of ethics of interpreting, they are not living up to the title of interpreter. It is not an interpreter’s job to pick and choose which tenets of our code of ethics to adhere to, but rather to adhere to those tenets because it is in the best interest of your patient.

The Solution: Education, Education, Education!

Most of the time, the use of unqualified interpreters goes unchecked because of a lack of education. Patients don’t know that they have a right to an interpreter and they don’t know how to identify a qualified interpreter. Healthcare staff can also fall victim to ignorance of patients’ rights to a qualified interpreter.

Educating Staff

I’m not going to mince words, here: there is no excuse for staff at a healthcare facility receiving federal funds to be unaware of LEP patients’ rights when it comes to language access. I’ll say it again: there is no excuse. I’m not going to waste your time or what little remains of your attention span since you’ve read this far into this article to explain an obvious point.

The more barriers there are between patients and unqualified, predatory interpreters, the less likely it is that such interpreters will be allowed to interpret and jeopardize patient health care

Educating Patients

The onus shouldn’t be placed on the patient to advocate for their own rights, but unfortunately often is. Patient autonomy is extremely important and knowledge can empower LEP individuals to advocate for themselves if they so choose. Most of the time, the patient or their immediate family is the last line of defense in a situation where an unqualified interpreter (or no interpreter) is about to be used. The more barriers there are between patients and unqualified, predatory interpreters, the less likely it is that such interpreters will be allowed to interpret and jeopardize patient health care.

But when and where do we intervene to provide patient education? How does a patient receive empowering education regarding language access? Unlike healthcare staff, there is no real language access presentation or handbook given to patients. Chances are, if a healthcare facility has a substandard language access program, they likely don’t provide the patient with notification (in their language) that it is their right to have an interpreter, and they likely won’t be receptive to the idea.

As interpreters, we are limited in our ability to communicate with patients on the job, although we possess both the knowledge and the linguistic tools to educate them. It is within our ethical scope to serve as a patient advocate, but this is not a role we are supposed to take on while in the field unless an issue arises during an encounter. So, this leaves us with two options:

1Educate patients (and possibly staff) as a response to a language access issue brought to your attention in the field. Our first solution might look like this: you introduce yourself to your patient as their interpreter in the waiting room. The patient expresses surprise that they were assigned an interpreter, because the last time they had an appointment, they brought a family member. You can take this opportunity to briefly explain to the patient that it is their right to have language services provided to them free of charge, and that family members are not supposed to interpret.

2Educate LEP individuals while not in the field. As far as this option is concerned, there are endless possibilities! An abundance of useful information regarding language access and patient rights is available on the Department of Health and Human Services (DHHS) website in many languages. I usually keep some of this information printed and on hand for my patients, but it could just as easily be posted in places where unqualified or predatory interpreters offer their services. Furthermore, you can identify popular gathering spaces for LEP individuals in your community, such as churches, community centers, or even businesses, and offer to give a brief presentation about language access in healthcare.

This list of solutions is not meant to be the end-all, be-all source of information when it comes to lack of education about interpreters to the general public. What are some strategies you employ to let health care providers and patients know more about interpreters and LEP patients’ rights to language services? What are some other solutions you’ve thought of to curb the problem of predatory interpretation? I’d love to hear your responses, so be sure to comment on this article!