You are on page 1of 14

Morales, Restum, Ceron, Roston 1

Camila Morales, Denise Restum, Emily Ceron, Sydney Roston

Professor Ania-Bialas
23 April 2018

Health conditions and illnesses do not discriminate based on the language one speaks
although different countries speak different languages. In the field of medicine, language
barriers often pose a challenge between healthcare professionals and their patients, making
medical translation an essential aspect of patient care that many people overlook. In fact, the
life of a patient depends on the medical interpreters and translators just as much as it depends
on the healthcare professional. For this reason, medical interpreters and translators must be
able to accurately transform the words or texts of one language to its equivalent in the target
language. The main objective of this form of technical communication is to have the patient read
the translated work as if it were the original document or understand an interpreter’s words as if
they were the doctor’s words.
This study examines the verbal and writing processes involved with medical translation
and interpretation. More specifically, this study explores medical translation from the perspective
of Evelyn Canabal-Torres, a Spanish professor at the University of Maryland, and medical
interpretation from the perspective of Sabina Trejo, a Spanish translator at the University of
Maryland Health Center. Through the collection of artifacts, field notes, and interviews, we were
able to analyze the methods by which medical translators and interpreters use technical
communication.. The data collected was analyzed to create a heuristic that details the various
aspects that allow for effective cross-cultural communication in the healthcare field.

Research Question
How is the healthcare industry using language and professional writing to improve the quality of
care for Spanish speaking populations?

The objective of this ethnographic study is to bridge the gap between professional
writing and the healthcare profession by specifically addressing the importance of English-
Spanish translation. With the growing population of Spanish-speaking patients in the United
States, the healthcare industry must adapt to better serve the needs of this population. This
language barrier affects the quality of care that a healthcare professional can provide and the
patient’s satisfaction with their visit to the doctor. More specifically, the language barrier
prevents a high level of trust between the healthcare provider and the patient, impairs the
patient’s understanding of medical documentation and consent forms, and decreases the
efficiency of visits to the doctor. Overall, these factors contribute to the health disparity for the
Spanish speaking population in the United States. Therefore, this ethnographic report will
answer the question of how the healthcare industry is adapting to a more diverse population
through the use of professional writing such as medical translation and interpretation. In doing
Morales, Restum, Ceron, Roston 2

so, this project will complete a detailed investigation into the aspects that contribute to effective
medical translation and interpretation.

Research Subjects
For an in depth study of medical translation, we interviewed two research subjects in
order to analyze information both a medical translation and a medical interpretation. The first
research subject, Evelyn Canabal-Torres is a senior lecturer in the Spanish department at the
University of Maryland. One of the classes that she teaches is titled “Spanish for the Health
Professions”, and it covers the language skills and cultural competency required for a health
professional to treat a Spanish-speaking patient. As a professor, she compiles resources for
students and teaches the topics that are important for a medical translator. She uses real-world
scenarios as well to simulate what a doctor-patient interaction in Spanish involves.
Our second research subject, Sabina Trejo is a translator who works for the University of
Maryland Health Center. She is a native Spanish speaker and has worked as a translator for 26
years, seeing 2-3 patients a day. Ms. Trejo had taken one course called “How to be an
Interpreter?” at the beginning of her career from Clinica Del Pueblo. Currently, she does not
hold a degree or certification for medical translation. She explained that during the time when
she became a Medical Translator, it was not required to hold either. As of more recently, she
said that a certification is required for translating but the person does not need to hold any
specific degree in a medical field. Much of her knowledge is acquired through experience on the
job. Her work requires only interpretation which means all of the language translation that she
does is out loud, instead of written down. Therefore, instead of using written works as artifacts,
this data collected from this research subject focuses on the real-world application of medical
With these two perspectives, our ethnographic report answers our research question
from different angles. The first angle involves understanding what skills are important for
someone practicing to be a medical translator and this will be studied using the artifacts and
information from Professor Canabal-Torres. The second angle involves putting these skills into
a real world context, the day-to-day work of a medical translator, to understand how the skills
learned in a medical translation class get applied to the actual task of medical translation.

Data Collection Methods

Our focus in bridging the gap between healthcare and professional writing within the
translation of languages relies on collecting information through semi-structured interviews,
field notes, and artifacts that reflect medical translation.
We were able to reach out to Ms. Trejo, a medical translator by contacting the University
of Maryland Health Center. Prior to meeting for the interview we sent previously outlined
interview questions to Ms. Trejo so that she could be better aware of what information we were
trying to acquire. For our interview, we met with her personally in her office located in the
University of Maryland Health Center on Tuesday, March 13. At the door to Ms. Trejo’s office
was an inviting sign that read both English and Spanish, indicating that she was the translator.
After introducing ourselves and the basis of our ethnography project, we conducted the
interview using the questions that we previously outlined. Most of our questions were targeted
at allowing us to get to know more about her education, certification and previous experiences
Morales, Restum, Ceron, Roston 3

as a medical translator. In doing so, we collected information on the day-to-day work of a

medical translator.
We contacted Professor Canabal-Torres through her university email address since she
is a professor at the University of Maryland. She agreed to help us with our project and advised
us to come to her office hours for an informal interview. Her office was located in the Spanish
department which was a welcoming office area with all sorts of Spanish resources. The
conversation began with an explanation of our project and a general idea of what we hope to
learn. Similar to the interview with Sabina Trejo, we had already written a set of questions to
ask Professor Canabal-Torres in order for the interview to flow smoothly. She began by
explaining how she ended up teaching Spanish for the Health Professions and how her
personal medical history opened her eyes to the importance of Spanish interpretation in the
medical field. Various artifacts were collected throughout the interview. For example, Professor
Canabal-Torres provided us with her class syllabus, a hand-out from her class, and her lecture
powerpoints. However, these artifacts only portray medical translation. For deeper insight into
medical interpretation, we gathered information from field visits to the UMD Health Center, John
Hopkins Hospital, Washington Adventist Hospital and Doctors Community Hospital.
After collecting information from interviews, artifacts, and field notes, we chose to focus
our project around Chapter 19 from Solving Problems in Technical Communication. Chapter 19
discusses technical communication in international environments. This chapter is relevant
because it explains the importance of understanding other cultures how this understanding
provides an advantage to technical communicators in the medical field.
At the end of our research, we created a graphic that summarizes all the aspects that
contribute to effective medical translation and interpretation. This graphic takes into account the
information gathered from the interviews, the field notes, the artifacts, and Solving Problems in
Technical Communication.

The interviews conducted with Professor Canabal-Torres as well as Sabina Trejo
provided valuable information on how health care providers use professional writing and
communication to interact with Spanish speaking patients. The important points from these
interviews, along with artifacts reflecting these points, and observations from site visits are
discussed in the following three sections.

Part I - Interview with Professor Canabal-Torres

Throughout the interview with Professor Canabal-Torres, she brought up three important
aspects that affect the quality of medical translation. She discussed: (1) creating an emotional
connection with the patient, (2) understanding extensive medical terminology in both Spanish
and English, and (3) understanding how culture affects communication.
The first topic discussed, creating an emotional connection with the patient, allows us to
build pathos into our research topic. Using the information from the interview, our group was
able to have a deeper understanding in how medical translation and medical interpretation
affects the patient.
To demonstrate how speaking to a patient in their native tongue can increase the
emotional connection with a patient, Professor Canabal-Torres shared a personal story with us.
Morales, Restum, Ceron, Roston 4

We asked what sparked her interest in medical translation and she responded “When I was
doing my masters, I got Hodgkins. And I started researching and then also did it in Spanish and
started looking at what kind of information we have. Then I lost a sister to Hodgkins and even
though we are both bilingual, there is some sort of emotional something that when they tell you
in Spanish, it’s different.” In other words, Professor Canabal-Torres strengthened the
importance of our research with her own personal anecdote of receiving health information in
her native tongue. This provides us with insight on the emotional aspect that plays a role in
medical translation. Not only does a medical translator or interpreter need to have language
knowledge, but they also have to use this language in a way that emotionally appeals to the
patient in order to effectively communicate.
Professor Canabal-Torres also presented a poem titled Papi Working by Julia Alvarez
that articulates the effect of speaking to a patient in their native language. The poem reads:

Papi Working
By Julia Alvarez

The long day spent listening

to homesick hearts,
the tick tock of the clock --
the way Americans mark time,
long hours, long days.
Often they came only to hear him
say nada in their mother tongue.
I found nothing wrong.
To dole out jarabe for the children’s coughs,
convince the doña to stay off that leg.

In his white saco Mami ironed out,

smoothed the tired wrinkles
till he was young again,
he spend his days, long days
tending to the ills of immigrants,
his own heart heavy with what was gone,
this new country like a pill
that slowly kills but keeps you from worse deaths.
What was to be done?

They came to hear him say

nada in their mother tongue.

In this poem, a young girl is reflecting on a day of work for her father as a doctor. The
girl and her family are of hispanic origin, meaning that her father is able to talk to his patients in
Spanish. In the poem, the immigrants come specifically to the father for medical attention since
he is able to speak to them in their “mother tongue.” The illnesses that these patients have
seem to be chronic and not easily fixed by medicine which means they are coming to the doctor
just to hear him break the news in their mother tongue. In other words, similar to how Professor
Canabal-Torres said that receiving health information in Spanish had a greater impact than in
Morales, Restum, Ceron, Roston 5

English due to Spanish being her first language, the immigrants in this poem are experiencing
the same effect. However, this is only possible if the healthcare provider has the skills to
communicate with the patient in his or her native tongue. The rest of the interview with
Professor Canabal-Torres discussed ways in which an individual can improve as a medical
translator and medical interpreter through language and culture education.
After sharing this personal anecdote and poem, Professor Canabal-Torres discussed the
structure of her class and how it teaches a student about medical translation. She mentioned
that throughout each semester, she provides handouts to use as examples of terminology
required for medical translation in various fields. One handout, a bookmark with information on
breast cancer prevention, has one side in English and the other in Spanish. An image of this
bookmark can be found in the appendix. This bookmark includes the Spanish words for medical
terms such as “Clinical breast exams” (Exámenes clínicos de seno), “Cervical cancer screening”
(Detección del cáncer de cuello uterino), and “Health education workshops” (Talleres de
educación para la salud). If these phrases were to be translated using a computer program
such as Google Translate, the translations come out to be: “Exámenes clínicos de mamas,”
“Examen de cáncer cervical,” and “Talleres de educación sanitaria.” Comparing the translations
on the bookmark to translations from a computer program proves that a human understanding
of the Spanish language and medicine greatly improves the quality of a translation. In addition,
computer translators that are choppy or incorrect can decrease the confidence that a patient
has in the doctor.
The syllabus for Professor-Canabal Torres’ class is a powerful example of how the class
ties together medical terminology and cultural competency, the third theme discussed
throughout the interview. The syllabus lists topics such as: la vocabulario de la salud, la
enfermedad, y el cuerpo (the vocabulary of health, sickness, and the body); la competencia
cultural (cultural competency); la paradoja latina (the Latin Paradox); especialidades médicas
(medical specialties); la nutrición (nutrition); cardiología (cardiology); cirugía (surgery);
prevención (prevention); la salud mental (mental health); enfermedades venéreas (venereal
diseases); la tercera edad (old age); enfermedades medioambientales (environmental
diseases); tecnología médica (medical technology); y salud dental (dental health).
An essential component to these topics is the way in which Professor Canabal-Torres
incorporates cultural competency into each one. For example, she mentioned that when
learning the Spanish terminology for the nutrition unit, she emphasizes the importance of culture
in food choices. With this cultural awareness, speaking to a Spanish speaking patient about his
or her nutrition habits can be more effective. Cultural competency does not only affect medical
interpretation during a patient interaction. It also affects medical translation in documents such
as medical pamphlets with nutritional information. Translating the document word-for-word
could be ineffective if the reader follows a diet that is influenced by his or her culture. However,
cultural awareness allows the translator to alter the document in order to better appeal to the
Hispanic population.
Finally, to reiterate the importance of cultural competency, Professor Canabal-Torres
discussed cultural humility: “Cultural humility means that we don’t know everything from people.
People change. Cultural competency is having always the humility to be able and wanting to
learn and question yourself in terms of language and culture.” In other words, bilingualism and
biculturalism go hand in hand. When speaking to a patient in Spanish (medical interpreting) or
Morales, Restum, Ceron, Roston 6

translating medical documents to Spanish (medical translating), both the language and the
culture need to be accounted for.

Part II - Interview with Sabina Trejo

Through our interview with Sabina Trejo, a medical translator at the Univeristy of
Maryland, we were able to identify three factors that affect translation in the medical field: (1)
adherence to HIPAA legislation and professional conduct, (2) the ability to constantly learn and
adapt, and (3) the ability to cater to the individual patient.
Ms. Trejo first stressed that as a translator, she must remain impartial during situations
of emotional stress. She emphasized that her job is to simply relay information from the patient
to the doctor and vice versa, not act as an advocate on the patient's behalf. This relationship
and strict adherence to HIPAA legislation allows for the establishment of professional
boundaries in the field of translation. Trejo explained that there can be instances where there is
an urge to become emotionally attached to the patient’s situation, such as a cancer diagnoses.
However, her job requires only the interpretations of the patient’s words to the doctor; her own
feelings must remain strictly on the basis of factual information including medicines, condition
symptoms, treatments and so on.
The second point that Ms. Trejo focused on was the idea that not all translation can be
developed with education and training. She explains that a translator advances by continually
learning through experience and practice. Ms. Trejo discussed how she learns new terminology
and medical concepts through the doctors and nurses that she works with. She explained that
many of situations she has encountered over her twenty-year career are situations that cannot
be taught in a classroom. With the idea of constantly learning new terminology, medical
concepts and possibly even new translating techniques through experience and practice, the
importance of a medical translator to be able to conform and adapt to various situations and
environments is evident. A medical translator often has to deal patients that have illnesses that
the translator has never encountered before. The lack of familiarity and understanding of these
medical terms and concepts make it more difficult for them to relay information accurately to
their patients. Hence, their ability to be an effective medical translator is heavily reliant on the
communication between the doctors and nurses that they work with as well as the patient.
Finally, she clarified that the accuracy of translation requires an extensive knowledge of
Spanish sub-dialects. In her interview, she explained that a variety of words change meanings
based on a person’s country of origin. Understanding these terms or asking for clarification can
make the difference between miscommunication and ideal patient care. She stressed the
importance of asking for clarification by being able to speak with doctors and nurses or directly
asking the patient in order to deliver excellent patient care. She explained that this is not a field
in which a translator can afford to be shy with their questions as the patient is entirely
dependant on the accuracy of information. Ms. Trejo explained that she always asks for
clarification from the patient when they use slang or cultural terms she is unfamiliar with as
words can change meaning from country to country. Ideally, Trejo expressed that accuracy
depends on the translator’s knowledge of the Spanish language and their ability to judge when
to ask questions in situations of confusion. Additionally, she says “in that case you come in and
learn more new words.” Therefore, medical interpretation is a continuous learning process
through experience and communication with patients, doctors, nurses, and other hospital staff.
Morales, Restum, Ceron, Roston 7

All three of these factors share the end goal of providing a positive experience for the
patient. Chapter 19 of Solving Problems in Technical Communication deals heavily with the
understanding of intercultural communication as it relates to the audience. The chapter stresses
the importance of respecting cultural norms and adjusting to disparities created by cultural
differences. Trejo explained that she must protect the patient’s privacy throughout the
interaction, dedicate herself to constand learning in order to benefit the patient, and tailor her
translation to each patient. This focus on the audience or in this case, the patient, reflects the
main idea of chapter 19 which states that the audience is the core determinant in how cross-
cultural communication presents itself.

Part III - Field Notes and Observations

The field notes taken at various hospitals prove that translation is commonly used within
these facilities both in verbal and visual ways. For example, we noticed that the exit signs and
bathroom signs in Washington Adventist Hospital and Doctors Community Hospital were
translated into Spanish. Bathrooms and exits are essential places for a patient to recognize and
locate and the fact that they were translated in Spanish shows the prevalence of the Spanish
language in the United States. Another resource available to Spanish speaking patients at these
hospitals were the ability to receive the Spanish version of documents and paperwork as well as
the option to request a formal translator. Due to this, patients are able to understand the papers
that they are required to sign and the health information that they receive. Ultimately, through
these field note observations, we can conclude that translation is widely implicated in hospitals
and clinics and serves a significant purpose in getting patients the aid that they need. The field
notes collected throughout this project can be found in the appendix.

Data Interpretation
Morales, Restum, Ceron, Roston 8

Image 1. Factors that play a role in effective medical translation.

To answer our original research question of how health care professionals use technical
communication in cross cultural settings, we compared and contrasted the information gathered
by our interviews, field notes, and artifacts with our selected chapter in Solving Problems in
Technical Communication. The above image summarizes the conclusions that our group was
able to make from our research. In addition, the following paragraphs provide further detail
about the real-world application of our research by discussing parts of the chapter in Solving
Problems in Technical Communication.
First, the chapter highlights complications addressed when designing “credible materials
for international audiences,” (Johnson-Eilola and Selber 481). With Spanish being one of the
most common second languages spoken in the United States, many pamphlets and
informationals are available in both Spanish and English. This is relevant to not only written
materials found within doctor’s office but also online materials with the option of translation.
Second, the book explains cultural disparities in terms of status; “In the worldview of
some cultures, status -- and status differences --- are very important, and communication
behavior must reflect this importance” (Johnson-Eilola and Selber 482). For medical translators,
reading and understanding these differences can create either a memorable experience where
both cultural and professional boundaries are respected, making translation effective, or a
negative experience in which the patient feels demeaned.
Third, the book explains that various cultures have different methods for achieving the
same goals within communication. For a medical translator, understanding various Spanish
dialects and manners of addressing medical matters is an important piece of effective
translation. The translator must be willing to ask question of the patient and of the doctor to
ensure that there are no miscommunications and that information has been distributed
To summarize, language, culture, and medical knowledge all converge to form effective
translation and interpretation in the heath field. This cross-cultural communication must portray
Morales, Restum, Ceron, Roston 9

credibility, social status, and cultural humility in order for the patient to trust the health care

As shown throughout this ethnography, the ability of healthcare providers to cater to
diverse populations is important because speaking to patients in their native tongue builds trust
and an emotional connection with the healthcare provider. To achieve this, the healthcare
industry uses medical translators to provide resources to patients in Spanish, as well as medical
interpreters to relay information from the healthcare provider in a language the the patient will
understand. Therefore, this ethnography report answers the question of how technical
communication is used to achieve effective medical interpretation and medical translation.
According to our research, the main factors that play a role in this form of communication are
language knowledge, medical knowledge, and cultural knowledge. All three of these skills must
be present in order to communicate effectively in a cross-cultural setting.
Our data collection methods included interviews, field notes, and artifacts. We
interviewed Professor Canabal-Torres, a Spanish professor who teaches Spanish for the Health
Professions, as well as Sabina Trejo, a Spanish interpreter for the University of Maryland Health
Center. Comparing what we learned from these interviews with chapter 19 of Solving Problems
in Technical Communication, provided the framework for Image 1, a visual representation of the
important factors that contribute to medical translation and interpretation.
According to the 2015 census bureau, 40 million people or about 13.3% of the United
States population speak Spanish. The number of individuals who benefit from effective medical
translation and medical interpretation is increasing, making communication across the cultural
and language barrier more necessary. The framework developed throughout this research
applies to all languages and cultures, not just Spanish. All cultures are susceptible to health
conditions and therefore the healthcare industry should focus on adequate understanding of
medicine, language, and culture from a worldview perspective.
Morales, Restum, Ceron, Roston 10

Works Cited

Canabal-Torres, E. (2018, March 14). Personal interview.

“Chapter 19 - What Do Technical Communicators Need to Know about International

Environments?” Solving Problems in Technical Communication, by Johndan

Johnson-Eilola and Stuart A. Selber, The University of Chicago Press, 2013.

Google Translate, Google,

Trejo, S. (2018, March 3). Personal interview.

US Census Bureau. “Newsroom.” FFF: Hispanic Heritage Month 2016, 12 Oct. 2016,
Morales, Restum, Ceron, Roston 11


Item I - Field Notes from Washington Adventist Hospital

Morales, Restum, Ceron, Roston 12

Item II - Field notes from Doctors Community Hospital

16 March 2018 4:12 PM-5:30 PM Doctors Community Hospital

● Initial - Fairly busy emergency room; Many patients were older

impressions (around mid 40s and up)
- Consisted of mainly patients, family members, nurses
doctors, transport technicians or EMT.
- There are many chairs for the patients and family members
to sit until they are called.

- There are both verbal signs (in both English and Spanish)
as well as visual signs (male, female, disabled universal
● Signs of signs)
Spanish - There are signs with arrows or drawings of a hand pointing
translation towards the direction of the front desk, the exits and other
areas of the hospital.

- I noticed maybe 2 or 3 nurses that spoke Spanish to a few

patients, but most patients were African American or
Caucasian and only a couple were Hispanic.
- At the front desk they offer documents and paperwork that
● Language of
have a Spanish version on the back.
- I asked the person working at the front desk and there is an
option of patients to request a formal medical translator.

- There are many people waiting as opposed to getting

called back to get checked.
● General
- There are mainly nurses present checking in patients, etc.
assuming most of the doctors are working in the actual
emergency room.
- The room is not as large as I expected it to be and was not
as filled as I thought it would be generally.
Morales, Restum, Ceron, Roston 13

Item III - Field notes from UMD Health Center

20 March 2018 2:03PM - 3:10PM UMD Health Center

● Initial
impressions ● Dimly lit waiting area
● Only 3-4 chairs for waiting; most are unoccupied
● Fairly slow student traffic with few students venturing in
and out
● Front desk attendant calls up students individually

● Signs were present with general directions such as

● Visual signs of Restroom directions and where to wait
translation ● Spanish print was either located in small print in signs
such as “Waiting Room” and “Restroom” or otherwise
not present

● Documents were available in both English and Spanish

when pertaining to general topics (Flu pamphlets/How
● Spanish-speaking to access the Health Center online)
nurses and ● In the waiting room, some the nurse registering
Spanish resources students for insurance plans spoke Spanish amongst
● Most students spoke English with the nurses

● Most of the traffic consists of UMD students

● One set of parents entered with their student
● Students are primarily inquiring questions to nurses or
front desk staff
● General
● Few students are waiting to be assisted by nurses
● Most students are conversing amongst themselves in
English or other languages besides Spanish
Morales, Restum, Ceron, Roston 14

Item IV - SPAN371 Handout