中原大學

應用外國語文學系
碩士學位論文

醫療通譯培訓課程初探—
以印尼語—中文醫療通譯培訓為例
An investigation on a Bahasa Indonesia – Mandarin medical interpreting training program in

Taiwan

指導教授：吳碩禹（Dr. Shuoyu Charlotte Wu）

研究生：陳晚霞（Rooswaty）

中華民國 112 年 1 月
 摘要

由於全球化和新移民的湧入，台灣已成為一個多元文化的國家。這些新移民中的大多

數人的中文能力有限，這造成了語言障礙。先前研究指出，語言障礙對台灣中文水平

較低的患者的醫療保健服務具有負面影響（例如，Chen & Chiou，2009；Wang et al.，

2012；Zhang，2009）。解決語言障礙的理想方案是提供訓練有素的醫療通譯員。因此，

自 2015 年起，台灣政府開始設立資助了針對新移民的醫學通譯培訓計畫。除了新移民，

外國來台的醫療遊客也需要語言服務。然而，針對醫療遊客的醫療通譯培訓計劃於

2019 年剛剛開始，首個培訓計畫以越南語和中文雙向通譯為主。從 2020 年開始，新增

了印尼語-中文訓練計畫。本研究旨在探究此印尼語-中文醫療通譯培訓項目中涵括以及

忽略了哪些可促成語言可近性之因素。本研究以培訓計劃學員為對象，實施問卷和半

結構化訪談調查。共有 24 名受試者填答問卷，另有五名受訓人員、兩名講師和一名贊

助人代表接受訪談。本研究共調查了八項促成語言可近性之因素，即：(a)醫療通譯之

訓練；(b)認證體系；(c)結訓醫療通譯員的公共服務提供管道；(d)結訓醫療通譯員的就

業管道；(e)服務報酬；(f)醫療通譯服務使用者之訓練；(g)結訓醫療員通譯之專業發展

和；(h)醫療通譯員之進階培訓。研究發現：(1) 參與者認為培訓課程確實涵括的因素為

a、b 和 c；(2)參與者認為 d、e、f、g 和 h 等為培訓經驗中缺乏的因素；(3) 在課程和教

材涵括的因素為 a、b、c 和 d；(4) e、f、g 和 h 等因素則為課程和教材中受忽視的因素。

關鍵字：醫療通譯、語言可近性、醫療旅遊、醫療通譯培訓

i
 Abstract

Taiwan has become a multicultural country as a result of globalization and the influx of new

immigrants. The majority of these newcomers have limited Mandarin proficiency, which

creates language barriers. Previous studies have shown the negative impact of language

barriers on healthcare delivery to low-Mandarin-proficient patients in Taiwan (e.g., M. L.

Chen & Chiou, 2009; H. M. Wang et al., 2012; Zhang, 2009). The most ideal solution to the

language barrier is the provision of trained medical interpreters. Hence, since 2015, medical

interpreting training programs for new immigrants were established and funded by the

government. In addition to the new immigrants, language access is also needed by medical

tourists in Taiwan. However, medical interpreting training programs for medical tourists

began just recently in 2019, starting with the Vietnamese-Mandarin language pair. Starting

from 2020, the Bahasa Indonesia-Mandarin language pair was added. This study investigates

what language access facilitator factors are identified in the Bahasa Indonesia-Mandarin

medical interpreting training program by the participants, the curriculum, and the teaching

material are identified as conducive and neglected for their professional development. This

study used a survey questionnaire distributed to the trainees of the training program and semi-

structured interviews to collect data. Twenty-four out of the 27 trainees responded to the

questionnaire. Five trainees, two instructors, and a representative of the patrons were

interviewed. The result of the study is: (a) the participants identified ‘training for medical

interpreters’, ‘certification system’ and ‘public provision of trained medical interpreters’ as

conducive to the trainees’ professional development as medical interpreters; (b) the

participants identified ‘employment of the trained medical interpreters’, ‘remuneration’,

‘training for medical interpreter users’, ‘professional development of the trained medical

interpreters’, and ‘advanced training for medical interpreters’ as neglected in the program; (c)

‘training for medical interpreters’, ‘certification system’, ‘public provision of trained medical

interpreters’, and ‘employment of the trained medical interpreters’ are identified as conducive

ii
factors in the curriculum and the teaching materials; (d) ‘remuneration’, ‘training for medical

interpreter users’, ‘professional development of the trained medical interpreters’, and

‘advanced training for medical interpreters’, are identified as neglected factors in the

curriculum and the teaching materials.

Keywords: medical interpreting, language access, medical tourism, medical interpreting

training

iii
 Acknowledgement

After three years of hard work, I finally can see the light at the end of the tunnel. And I

can see the light shining ever so brightly. I have the impression that everyone who has ever

inspired me is cheering me on as I complete my master’s thesis. I want to express my

gratitude to all of them. First of all, I want to thank my advisor, Dr. Shuoyu Charlotte Wu,

from the bottom of my heart. I could not have asked for a better advisor. You are always

extremely patient and encouraging, ready to provide suggestions and guidance, not just for my

research and thesis writing but also in other ways that you might not realize. Additionally, I

want to thank the committee members, Dr. Elaine Lee, Damien Fan, PhD., and Dr. Brenda

Chen for their insightful suggestions. The final thesis structure and contents benefited from

their ideas.

To all the participants in this study, thank you so much for sharing your knowledge

and experiences. To the interviewees who went above and beyond to gather information for

my research. I want you to know how much I appreciate your effort and time. To my fellow

post-graduate students and researchers who helped me pilot the study, this thesis would not

have been completed without your assistance. Thank you!

Finally, I would like to thank my husband and my family. Dr. Dai, you are always

there to support me whenever I feel like giving up. David, Pauline, Andrew, and Matthew,

thank you for being supportive and understanding. My gratitude to my mom and my siblings,

who are always so proud of me, master or not.

Words alone are insufficient. I am grateful to God for giving me this opportunity to

serve the community. Thank you.

iv
 Table of Contents

摘要 ............................................................................................................................................. i
Abstract .....................................................................................................................................ii
Acknowledgement .................................................................................................................... iv
Table of Contents ...................................................................................................................... v
List of Figures ........................................................................................................................viii
List of Tables ............................................................................................................................ ix
Chapter 1 Introduction ............................................................................................................ 1
1.1 Background of the Study ................................................................................... 2
1.1.1 The Drives for Medical Interpreting in Taiwan .......................................... 2
1.1.2 The Need for MI Training Programs .......................................................... 6
1.1.3 MI Training Programs in Taiwan ............................................................... 8
1.2 Purpose of the Study ........................................................................................ 12
1.3 Chapterization .................................................................................................. 13
1.4 Terms and Abbreviations ................................................................................ 13
1.4.1 Terms ........................................................................................................... 13
1.4.2 Abbreviations .............................................................................................. 14
Chapter 2 Literature Review ................................................................................................. 15
2.1 Medical Interpreting Definition ...................................................................... 15
2.2 Significance of MI and Relevant Factors ....................................................... 16
2.3 Roles of Medical Interpreters .......................................................................... 19
2.4 Medical Interpreters: Trained or Untrained? ............................................... 22
2.5 Language Access ............................................................................................... 24
2.6 Summary ........................................................................................................... 31
Chapter 3 Methodology ......................................................................................................... 33
3.1 Research Questions .......................................................................................... 34
3.2 Research Design ................................................................................................ 34
3.3 Participants ....................................................................................................... 35
3.3.1 Sampling ..................................................................................................... 35
3.3.2 Basic Data of the Trainee Participants ...................................................... 36
3.4 Data Collection .................................................................................................. 41
3.4.1 Survey Questionnaire ................................................................................. 41
3.4.2 Interviews .................................................................................................... 42
3.4.3 Documentation............................................................................................ 43
3.4.4 Validity and Credibility ............................................................................... 44
3.5 Data Analysis Procedures ................................................................................ 45
Chapter 4 Results and Discussion ......................................................................................... 47
4.1 Results ................................................................................................................ 47
4.1.1 The BMMITP Design and the Knowledge Gained ................................... 47

v
 4.1.2 The Professional Development .................................................................. 72
4.2 Discussion .......................................................................................................... 86
4.2.1 Training for medical interpreters............................................................... 87
4.2.2 Certification System .................................................................................... 90
4.2.3 Public Provision of Trained Medical Interpreters .................................... 91
4.2.4 Employment of the Trained Medical Interpreters ..................................... 92
4.2.5 Remuneration ............................................................................................. 94
4.2.6 Training for Medical Interpreter Users ..................................................... 95
4.2.7 Professional Development of the Trained Medical Interpreters .............. 95
4.2.8 Advanced training for medical interpreters ............................................... 96
4.3 Responses to the Research Questions ............................................................. 97
Chapter 5 Conclusions and Suggestions ............................................................................. 103
5.1 Conclusion ....................................................................................................... 103
5.2 Suggestions ...................................................................................................... 105
5.3 Limitations and Recommendations .............................................................. 106
References.............................................................................................................................. 109
Appendix A............................................................................................................................ 130
Informed Consent for the Questionnaire ........................................................................... 130
Appendix B ............................................................................................................................ 132
Informed Consent for the Questionnaire in Bahasa Indonesia ........................................ 132
Appendix C............................................................................................................................ 134
Informed Consent for the Interviews for the Trainees ..................................................... 134
Appendix D............................................................................................................................ 136
Informed Consent for the Interviews for the Trainees in Bahasa Indonesia .................. 136
Appendix E ............................................................................................................................ 138
Informed Consent for the Interviews for the Instructors and the Representative of the
Patrons ................................................................................................................................... 138
Appendix F ............................................................................................................................ 140
Informed Consent for the Interview in Mandarin ............................................................ 140
Appendix G ........................................................................................................................... 142
Survey Questionnaire for the Trainees ............................................................................... 142
Appendix H ........................................................................................................................... 147
Survey Questionnaire for the Trainees in Bahasa Indonesia ........................................... 147
Appendix I ............................................................................................................................. 153
Interview Outline for the Trainees...................................................................................... 153
Appendix J ............................................................................................................................ 155
Interview Outline for the Trainees in Bahasa Indonesia .................................................. 155
Appendix K ........................................................................................................................... 158
Interview Outline for the Instructor from T & I Studies ................................................. 158

vi
Appendix L ............................................................................................................................ 160
Interview Outline for the Instructor from T & I Studies in Bahasa Indonesia .............. 160
Appendix M ........................................................................................................................... 162
Interview Outline for the Instructor from Medical Field ................................................. 162
Appendix N............................................................................................................................ 165
Interview Outline for the Instructor from Medical Field in Bahasa Indonesia.............. 165
Appendix O ........................................................................................................................... 168
Interview Outline for the Representative of the Patrons .................................................. 168
Appendix P ............................................................................................................................ 170
Interview Outline for the Representative of the Patrons in Mandarin ........................... 170
Appendix Q ........................................................................................................................... 172
Year 2020 Training Announcement Letter ........................................................................ 172

vii
 List of Figures

Figure 1 Internal and External Pushes for Medical Interpreting in Taiwan .............................. 2

Figure 2 Medical Interpreting Participants and Locations ...................................................... 16

Figure 3 Ozolins’ Four Continuum Stages of Language Access ............................................. 25

Figure 4 Schuster’s Five Stages of Language Access ............................................................. 28

Figure 5 The Questionnaire Participants’ First Languages ..................................................... 37

Figure 6 The Questionnaire Participants’ Second Languages ................................................. 38

Figure 7 The Questionnaire Participants’ Third Languages .................................................... 38

Figure 8 The Questionnaire Participants’ Fourth Languages .................................................. 39

Figure 9 The Questionnaire Participants’ Length of Stay in Taiwan ...................................... 40

Figure 10 Knowledge Learned at the BMMITP ...................................................................... 58

Figure 11 Trainee’s Meet and Share with Fellow Interpreters ................................................ 83

viii
 List of Tables

Table 1 Sample Curriculum by MedInt......................................................................................7

Table 2 Sample Topics by Gulfcoast South Area Health Education Center.............................. 8

Table 3 MI Training Programs in Taiwan................................................................................ 10

Table 4 Ozolins’ (2000) Characteristics of Comprehensive Language Access....................... 26

Table 5 Comparison of Ozolins’, Schuster’s, and Bischoff’s Language Access Models........ 29

Table 6 Factors Investigated in this Study............................................................................... 33

Table 7 Participants in this Study............................................................................................. 36

Table 8 The Time and Venue of the Interviews....................................................................... 43

Table 9 Trainees’ Experiences in Other Interpreting Training Programs................................ 47

Table 10 Year 2020 Bahasa Indonesia-Mandarin Medical Interpreting Training Program for

Medical Tourism Curriculum............................................................................................ 52

Table 11 Year 2021 Bahasa Indonesia-Mandarin Medical Interpreting Training Program for

Medical Tourism Curriculum............................................................................................ 54

Table 12 Trainees’ Perceptions about How Much They Learned about the Topics in the

BMMITP and the Final Assessment................................................................................. 60

Table 13 Trainees’ Perceptions of the Top Three Lessons They Learned at the BMMITP.... 60

Table 14 Reasons for Applying for the BMMITP................................................................... 73

Table 15 Trainee Participants’ Occupations............................................................................ 74

Table 16 Distribution of the 24 Trainees Regarding Experiences as Medical Interpreters......75

ix
 Chapter 1 Introduction

The increasing number of migrant spouses and workers from Southeast Asian

countries in Taiwan, as well as the attempt to promote medical tourism as a part of the New

Southbound Policy1, give rise to the need for language access in medical care because most of

these migrants and medical tourists have limited Mandarin proficiency (henceforth, LMP 2).

Medical interpreting (henceforth, MI) -- the interpreting activity that occurs in medical

settings, such as private practices and hospital settings (Hale, 2007) -- is one of the ways to

provide language access for such patients. In order to meet this need, various medical

interpreting courses have been established to train bilingual talents. Since MI studies are

relatively new in Taiwan3, the practice can hardly be termed as fully professionalized. While

MI training programs particularly established for migrant spouses and funded by the

Taiwanese government have begun in 2006, MI training programs for medical tourists have

just begun in 2019. One of the MI training programs for medical tourists is the Bahasa

Indonesia – Mandarin medical interpreting training program (henceforth, BMMITP), which

was established in 2020. The current researcher is a native Bahasa Indonesia speaker and one

of the instructors in the BMMITP who is responsible for teaching medical terminologies and

interpreting skills. The teaching experience triggered her interest in the training program

design. Hence, this study was conducted to investigate the BMMITP to find out the potential

ideal elements in such a MI training program from the perspectives of the stakeholders (the

trainees, the instructors, and the patron) and the curriculum design so as to give suggestions to

similar programs in the future.

1
New Southbound Policy is created to strengthen Taiwan's relations with its neighbors to the south,
from South and Southeast Asia to Australia and New Zealand (Read on December 17, 2022, from
https://english.ey.gov.tw/News3/9E5540D592A5FECD/2ec7ef98-ec74-47af-85f2-9624486adf49).
2
LMP in this study refers to having a limited or no ability to understand written and spoken Mandarin
to be able to communicate effectively in medical settings, hence, in this study, it refers to the new immigrants
and travelers to Taiwan, especially the medical tourists. The term is adapted from LEP (Limited English
Proficiency) and refers to the same definition as the definition used in the book edited by A. H. Chen (Ed.)
(2003).
3
Academically, MI studies just recently began in Taiwan with the establishment of the International
Medical Translation Program at Fu Jen Catholic University in 2014 (Retrieved November 28, 2022, from FJCU
Research webpage https://spark.fju.edu.tw/content/translation-studies-and-academic-activities).

1
 This chapter provides an overview of the study's background, the drives for MI, and

the need for MI training programs. It briefly introduces existing MI training programs in

Taiwan and identifies real-life issues that necessitate further investigation. Subsequently, the

chapter discusses the study purpose and describes the chapterization. The last section of this

chapter explains terms and abbreviations that frequently appear in this thesis.

1.1 Background of the Study

1.1.1 The Drives for Medical Interpreting in Taiwan

The need for MI in Taiwan can be described as coming from two directions. From

outside Taiwan, the push comes from oversea medical tourists and travelers, while from

inside the country, the push comes from migrant spouses, migrant workers, and international

students. The following subsection describes how these internal and external pushes are

building up the pressing needs for MI in Taiwan (Figure 1).

Figure 1

Internal and External Pushes for Medical Interpreting in Taiwan

Internal Push

Migrant spouses
External Push
Migrant workers Medical Medical Tourists
Interpreting and
Travelers
International students

Note. Arranged by the current researcher

As seen in Figure 1, medical tourists and travelers are the main external push for MI.

Travelers in this study refer to ordinary tourists coming to Taiwan or individuals who are at

2
Taiwan's airports for transit to other destinations but unfortunately fall sick and need medical

care. On the other hand, medical tourism, also known as medical travel (henceforth, MT) is a

worldwide trend in which patients travel across international borders to obtain a wide range of

medical services (Heung et al., 2010). There are a variety of reasons why people seek medical

treatment in another country such as lower cost, higher quality, no waiting line, or the

treatment they need is not available in their country (Dang et al., 2020; Lin, 2011). According

to Grand View Research (2020), a United-States-based market research and consulting

company, the global MT market is expected to grow to around US$ 207.9 billion in 2027. It

also lists Taiwan as one of the fastest-growing MT destinations along with Singapore,

Colombia, and Spain. According to the Tourism Bureau, Ministry of Transportation and

Communications of Taiwan (n.d.), the total number of visitors in 2019 was 11,864,105, with a

total of 55,937 people (0.47%) seeking medical treatment. Compared to 2020 and 2021, when

Taiwan closed its borders to tourists due to the pandemic, the total number of visitors was

1,377,861, with 8,191 people (0.59%) seeking medical treatment in 2020 and 140,479, with

808 persons (0.58%) seeking medical treatment in 2021 (Tourism Bureau, Ministry of

Transportation and Communications of Taiwan, n.d.). The result shows the number of visits

plummeted, but the percentage of people seeking medical care increased slightly. It is hence

fair to suggest that the pandemic did not hinder these tourists to come to Taiwan for medical

help.

The reason MT is booming in Taiwan is that Taiwan’s healthcare system has a great

reputation all across the globe. In 2021, CEOworld Magazine placed Taiwan second in the

magazine’s 2021 Health Care Index. A similar observation was also made in 2020 by Global

Healthcare Resources & International Healthcare Resource Center, which ranked Taiwan

sixteenth in the Medical Tourism Index. In addition, Patients Beyond Borders, a medical

tourism guidebook, and several other international travel magazines also acknowledge the

quality of the healthcare system in Taiwan (Bokur, 2020; Ireland, 2021). Moreover, according

3
to Expat Insider, a global ex-pat network founded in 2007 with more than 4.3 million

members, Taiwan ranks first as the favorite destination with a 96% rate positively for the

quality of healthcare and a 94% positive rate for affordability (Expat Insider, 2021). The

above data shows the promising MT industry in Taiwan.

To promote MT, the Taiwan Task Force on Medical Travel (TTFMT), a platform for

integrating resources and encouraging cooperation across governmental organizations, related

industries, and medical institutions, was launched in 2007 (Taiwan Medical Travel, n.d.-a).

Administered by the Taiwan Nongovernmental Hospitals and Clinics Association (TNHCA)

and supervised by the Ministry of Health and Welfare Republic of China (henceforth,

MOHW), to date (December 2022), TTFMT has brought 113 reputable hospitals and clinics

into an alliance to promote Taiwan’s leading medical services to patients from across the

world. Taiwan promotes its MT by relying on the six main strengths of its healthcare system:

high-quality medical service, comprehensive specialties, leading physicians, advanced

medical technology and equipment, patient-oriented services, and affordability (Taiwan

Medical Travel, n.d.-c). Tourists can find information about medical specialties, hospital

networks, and travel information on TTFMT’s website. In addition, the website also shares

patients’ testimonials4 and provides the site with six languages (Traditional Mandarin,

Simplified Mandarin, English, Vietnamese, Bahasa Indonesia, and Bahasa Melayu),

suggesting that China and certain Southeast Asian countries are the potential sources for

medical service seekers. Local authorities also actively promote MT as was mentioned by the

mayor and the city health director of Kaohsiung as they hosted Kaohsiung’s first medical

tourism preparatory meeting in 2019 (Wang, 2019). In summary, Taiwan has been nationally

and internationally recognized as a strong candidate for developing MT.

Previous studies show that there are many factors determining the success of a

country’s MT industry, including the cost and the quality of health care. One of the criteria for

4
TTFMT website: www.medicaltravel.org.tw

4
the quality of health care is the availability of on-site interpreting services (Connell, 2006;

Liu, 2012; Sung, 2011; Wang et al., 2020). Although the majority of medical tourists in

Taiwan came from China, the other countries that make up the top ten medical tourists in

Taiwan are Vietnam, Indonesia, America, the Philippines, Japan, Hong Kong and Macau,

Malaysia, Myanmar, and Thailand (Taiwan Medical Travel, n.d.-b). Hence, to facilitate the

improvement of the MT industry in Taiwan, the need for MI for medical tourists who do not

speak Mandarin should be addressed (Lin, 2011; Zhong et al., 2021). The above data shows

that the development of the MT industry has caused a pressing need for MI in Taiwan,

particularly for languages spoken by medical tourists from the top ten countries listed above.

In addition to the external push for MI from medical tourists and travelers (as seen in

Figure 1), the increasing number of migrant spouses, migrant workers, and international

students in Taiwan serve as the internal push. There were 575,779 foreigners married to

Taiwanese from January 1987 until October 2022 (Ministry of the Interior National

Immigration Agency Republic of China, n.d.), and the total number of legal foreign workers

in Taiwan by the end of October 2022 was 764,010 (Ministry of Labor Republic of China,

n.d.). In addition, there were 98,200 international students studying in Taiwan in 2020

(Textor, 2021). These migrant spouses, migrant workers, and international students make up

about 6% of Taiwan’s population. The majority of these new immigrants have LMP which

may give rise to a language barrier and hinders their access to medical information and health

care (Chang, 2009; Chen et al., 2008; Chen & Chiou, 2009; Chu et al., 2019; Kuan et al.,

2020; Shen, 2006; Wang et al., 2012; Wu, 2018; Yang & Wang, 2003; Yeh, 2007).

Previous research both overseas and in Taiwan had proved language barriers can

impede effective communication in the healthcare system (e.g., Chang, 2009; Chen, 2013;

Hadziabdic et al., 2011; Haffner, 1992; Jacobs et al., 2004; Karliner et al., 2007; Sun, 2004;

Tien et al., 2010; Yen, 2002), and such studies suggest MI is the facilitating factor for

effective communications. To answer the need for MI, MI training programs are facilitated

5
across the world and in Taiwan. Features, training focuses, and contents of such programs are

introduced in the next subsection.

1.1.2 The Need for MI Training Programs

The importance of medical interpreters was recognized by both the LMP patients (Chu

et al., 2019; Kumar et al., 2014; Lin, 2011) and the healthcare workers (Kuan et al., 2020;

Wang et al., 2007). However, some physicians may question the ability of medical

interpreters and worry about the consequences of mistranslation (Chou, 2019; Wang et al.,

2007). Misinterpreting, mostly committed by untrained medical interpreters, may result in

uncomfortable or unexpected situations (Cambridge, 1999; Elderkin-Thompson et al., 2001).

This implies the need for medical interpreters’ training programs.

Yet, there is a dearth of MI training programs both overseas (Jaeger et al., 2019;

Moreno et al., 2007), as well as in Taiwan (Fan, 2011; Kuan et al., 2020; Tseng, 2019; Yen,

2013). Moreover, the MI training programs available are highly divergent in terms of training

duration and course content (Ertl & Pöllabauer, 2010; Hale, 2007; Yen, 2013). Recently,

various online MI training programs are offered in the United States such as the ones held by

the University of Minnesota, Gulfcoast South Area Health Education Center, Culture

Advantage, Cuesta College, and many more. Some institutions also share their curriculum

online5. For comparison, a sample curriculum for an academic MI training program and an

online MI training program are shown in Table 1 and Table 2. Table 1 shows the sample

curriculum designed by MedInt, a European Commission-funded multinational cooperation

project with a project consortium made up of project partners from four universities in four

countries (Germany, Finland, Austria, and Slovenia) (Ertl & Pöllabauer, 2010). On the other

hand, Table 2 shows the content of two online MI training programs by Gulfcoast South Area

Health Education Center.

5
An example is Cuesta College Online Medical Interpreter Training. The online MI training curriculum
can be seen at https://www.cuesta.edu/communityprograms/online-courses/certificated/medical-interpreter.html
(Read on November 28, 2022).

6
Table 1
Sample Curriculum by MedInt

Course unit name Contact hours ECTS

Introduction to the healthcare system and legal background 15 6
Basic medical knowledge in the L1 and/or L2 15 12
Introduction to intercultural communication 15 6
Introduction to professional ethics
· Professional ethics
20 6
· Interpreting profession
· Legal background
Computer and information-mining skills (15), terminological
15 3
aids (15)
Interpreting training (practical training with case studies) 120 18
Interpreting practicum or mentoring 15 3
Exam: Interpreting a medical examination 2 6
Total 217 60

Note. L1 = Language 1; L2 = Language 2; ECTS = European Credit Transfer and

Accumulation System Points (1 ECTS point = 25–30 hours of student workload).

From Ertl and Pöllabauer (2010, p. 181)

Table 1 shows the courses’ names, the contact hours, and the ECTS Points. The total

hour of the training program is 217 hours. From the 217 hours, 120 hours are allocated to

practical training with case studies, and the second-longest hour is dedicated to "An

Introduction to Professional Ethics". Unfortunately, the sample curriculum from Gulfcoast

South Area Health Education Center (as can be seen in Table 2) does not include the contact

hours of each topic in the training program.

7
Table 2
Sample Topics by Gulfcoast South Area Health Education Center

Course Curriculum Certification

40-hour course - Ethics & Conduct “Professionally Trained
- Basic Skills (from pre-session to post- Medical Interpreter”
session) certificate upon completion
- Positioning
- Terminology
- Modes of Interpreting
- Strategies for Intervention
- Cultural Mediation
16-hour course - Mission of Medical Interpreters No certification mentioned
- Modes of Interpreting
- Code of Ethics & Standards of Practice
- Mediation/Advocacy Techniques
- Liability Risk Reduction
- Skill Advancement Opportunities

Note. From Gulfcoast South Area Health Education Center’s website6

Table 2 shows the content of two online MI training programs by Gulfcoast South

Area Health Education Center. Although there is a huge difference in the course duration of

the three training programs, the contents show some similarities, which denote the importance

of these topics in MI training programs such as: the code of ethics, cultural mediation, and

advocacy.

1.1.3 MI Training Programs in Taiwan

Currently, there are two types of MI training programs in Taiwan, academic and para-

academic training programs. The only academic MI training program for the master’s level in

Taiwan is the International Medical Translation Credit Course Study offered by Fu Jen

Catholic University (Fu Jen Catholic University, 2022). As of today (November 28, 2022),

there are only two language pairs available for the course: English-Mandarin and Japanese-

Mandarin. The other training programs are para-academical offered by interpreter associations

and translation companies such as the International Medical Translators and Interpreters

6
Retrieved November 28, 2022, from https://gsahec.org/access-program/medical-interpreting-training/

8
Association (IMTIA) (International Medical Translators and Interpreters Association, n.d.),

the Association of Language-Service Providers (Association of Language-Service Providers,

n.d.), and Connect Business Services (Connect Business Services, n.d.), and MI training

programs funded by the Taiwan government. The MI training programs offered by IMTIA,

the Association of Language-Service Providers, and Connect Business Services were also for

the same two pairs of languages as were offered by Fu Jen Catholic University.

Currently, there are two types of MI training programs funded by the Taiwan

government. The first is MI training programs for new immigrants’ reproductive health,

which have been held since 2006. The second is MI training programs to promote MT, which

has been held annually since 2019 for the Vietnamese-Mandarin language pair and since 2020

for the Bahasa Indonesia-Mandarin language pair. This study focuses on the Bahasa Indonesia

– Mandarin MI training program (BMMITP). The training program had been conducted

twice, once in 2020 and once in 2021 (by the end of this thesis writing, the third training

course was just completed). The training was conducted on six Sundays in a one-and-a-half-

month period with a total duration of 48 hours each year. All trainees should be fluent in

Bahasa Indonesia and Mandarin languages. The number of trainees was limited to 15

applicants only.

In addition, there was another MI training program that also aimed to promote MT

held at Kaohsiung Medical University and was funded by Kaohsiung City Government Health

Bureau (Kaohsiung Medical University e-News, 2020). Unlike the BMMITP which was for a

specific language pair and all of the trainees should have high proficiency in Bahasa

Indonesia, the trainees in the training program held in Kaohsiung had different language

backgrounds. In addition, while the course in the BMMITP was delivered in both Mandarin

and Bahasa Indonesia, the course at Kaohsiung Medical University was delivered in Mandarin

and the trainees were expected to figure out the equivalent medical terms in their own

language. Although the duration and content of the abovementioned courses were different (as

9
can be seen in Table 3), trainees of all these training programs were given certificates upon

completion.

Table 3
MI Training Programs in Taiwan

Administrator Fu Jen Catholic Interpreter TTMFT - TNHCA NPO – Local

University Association Health Bureau
Students Master level Not specified High school or Any bilingual
above
Language pairs M-English M-English M-Vietnam M-Any
M-Japanese M-Japanese M-Indonesian language
Duration 2 years (20 4X6 6 X 8 hours/course 24 hours
credits) hours/course
Course type Several different Beginner Beginner
level
Schedule Academic year Not specific Annually - (unspecified)
Patronage MOHW+ TNHCA MOI

Note. TTMFT = Taiwan Task Force on Medical Travel; TNHCA = Taiwan Nongovernmental

Hospitals and Clinics Association; NPO = Non-Profit Organization; M = Mandarin; MOHW

= Ministry of Health and Welfare Taiwan; MOI = Ministry of Interior

From Institutions’ websites, Yen (2013), and compiled by this study

Table 3 shows the distinctions of the academic and the para-academic MI training

programs and the differences between the different para-academic MI training programs

themselves. The differences include the requirements for enrolling in the training programs,

the language pairs, the training duration, as well as the funding. The BMMITP was funded by

the MOHW and the TNHCA, while the funding of MI training programs for new immigrants’

reproductive health was from the “New Immigrant Development Fund” of the MOI in the

context of the “Guidance Program for the Training and Utilization of New Immigrant

Interpreters” (Health Promotion Administration, Ministry of Health and Welfare, 2019,

p.124).

The above data suggests the lack of MI training for Southeast Asian languages-

10
Mandarin language pairs in Taiwan, which is just as important as the English-Mandarin and

Japanese-Mandarin language pairs considering most of the migrant workers and spouses here

in Taiwan came from Southeast Asian countries such as Vietnam and Indonesia (Ministry of

Labor Republic of China, n.d.). Moreover, in the last ten years, Indonesian patients have

become the second-largest group of medical tourists in Taiwan (Dang et al., 2020). Only in

the past two years, due to the pandemic, have Vietnamese medical tourists taken the second

position (Taiwan Medical Travel, n.d.-b). The following case shows why MI training in

Bahasa Indonesia-Mandarin language pair matters. In Malaysia, more than 50% of medical

tourists are from Indonesia. Other than geographic proximity and visa-free requirement, the

language has been one of the main reasons Indonesians go to Malaysia for medical care, since

both countries speak very similar languages (Chee & Whittaker, 2019; Yeoh et al., 2013).

This may imply that if given other alternatives, such as language service and better medical

care quality, Indonesians may opt for Taiwan.

In addition, MI training programs, in particular the BMMITP, will benefit not only the

health of the new immigrants and medical tourists from Indonesia but also the children of the

migrant spouses who make up the next generation of Taiwanese. Moreover, the benefit

expands to certain Taiwanese patients who cannot take care of themselves and are taken care

of by migrant caregivers from Indonesia. According to the data from the Ministry of Labor

Republic of China, by the end of October 2022, 161,063 Indonesian migrant workers were

employed as caregivers and domestic workers, making Indonesia the largest contributor of

labor to this industry (Ministry of Labor Republic of China, n.d.). Healthcare workers need to

communicate with these migrant caregivers who have LMP to give information and

instructions in relation to the patients they are taking care of (Chuang, 2009). Considering the

benefits of MI and MI training programs for Indonesian with LMP in Taiwan, the BMMITP

provides an ideal object for observation. It is fair to suggest that the investigation on the

BMMITP may benefit the MT industry, international students, migrant workers’, migrant

11
spouses’ and their children’s health care, and certain Taiwanese cared for by migrant

caregivers.

1.2 Purpose of the Study

Section 1.1 mentions the drives for MI in Taiwan, the need for professional medical

interpreters, the lack of MI training programs across the globe, content samples of MI training

programs overseas, and various MI training programs in Taiwan to overcome language

barriers and provide language access for LMP patients. To date, there is no study examining

para-academical medical interpreting training programs in Taiwan, particularly the BMMITP,

in relation to the curriculum design from the insider’s perspective. The current researcher has

been an instructor in this 48-hour MI training program for three consecutive years (by

February 2023). As both the instructor and a researcher, it is natural for the current researcher

to try to find out which MI facets are facilitated in the BMMITP. This study also attempts to

examine what issues are left unaddressed, what can be added to this program, and what

specific suggestions can be offered to similar future training programs.

This particular training program is chosen because of the importance of Bahasa

Indonesia-Mandarin MI, considering Indonesia is one of the countries with whom the

Taiwanese government wants to build an international connection as is stated in the New

Southbound Policy. In addition, as aforementioned, Indonesian migrant workers and

caregivers make up a relatively high percentage of Taiwan’s population. Moreover, the

Taiwanese government also sees the need for Indonesian language MI from the potentially

high number of medical tourists from Indonesia, hence, facilitating such training programs.

Theoretically, the BMMITP is intended to train professional medical interpreters with

the necessary skills and knowledge to provide language access in Taiwan’s healthcare system,

particularly for LMP medical tourists who speak Bahasa Indonesia. However, in reality, it is

highly probable that not all issues were addressed with equal weight in the planning and

execution of the program. This study seeks to discover which factors have been focused on

12
and which issues have been neglected by evaluating the teaching materials, the curriculum,

and the experiences of the instructors, trainees, and patrons of the training program. Detailed

research questions will be provided in section 2.7.

1.3 Chapterization

The first chapter of this thesis describes the background and the purpose of the current

study. The second chapter reviews studies on related topics such as the definition and

significance of MI, the roles of medical interpreters, the benefits of employing trained medical

interpreters, and the language access models. The third chapter presents the research questions

and describes the methodology starting with the research design, followed by the description

of the participants recruited, the data collection methods, and the data analysis. Chapter four

presents the results and discussion of the study, and responses to the research questions. The

conclusion, suggestions, limitations of the study, as well as recommendations for future

research, are presented in the last chapter.

1.4 Terms and Abbreviations

This thesis may contain ambiguous terms. This section explains what the current

researcher means by specific phrases used in this thesis. Additionally, although reading an

abbreviation may be irritating, reading what it stands for each time may be just as annoying.

The second subsection lists the abbreviations found in this thesis.

1.4.1 Terms

1. Patient – In this study, “patient” in the healthcare worker-patient communication context

oftentimes refers to the patient him/herself or other people accompanying the patient such as

family members, friends, employers, caregivers, et cetera.

2. Trainees – Unless specified otherwise, trainees in this study refer to the trainees of the

BMMITP who participated in this study.

3. Subjects and Topics – In this study, subject refers to the broader categories of knowledge

taught in the BMMITP such as medical tourism and relevant matter, medical knowledge and

13
terminology, medical interpreting knowledge, and medical interpreting ethics; while topics

refer to more specific matters discussed in the same subject. For example, note-taking is a

topic included in the subject “medical interpreting knowledge”.

1.4.2 Abbreviations

1. BMMITP – Bahasa Indonesia-Mandarin medical interpreting training program

2. IMTIA – International Medical Translators and Interpreters Association

3. LMP – Limited Mandarin proficiency and sometimes refers to limited Mandarin proficient

4. MI – medical interpreting

5. MT – medical tourism or medical travel

6. MOHW – Ministry of Health and Welfare Republic of China, Taiwan

7. MOI – Ministry of Interior

8. T&I – Translation and Interpreting

9. TNHCA – Taiwan Nongovernmental Hospitals and Clinics Association

10. TTFMT – Taiwan Task Force on Medical Travel

14
 Chapter 2 Literature Review

Although interpreting in the healthcare system is not new, academically, MI studies

just recently began in Taiwan with the establishment of the International Medical Translation

Program at Fu Jen Catholic University in 2014, which was promoted to master’s level in

2015. Although there are several para-academical MI training programs that began earlier,

research about MI training programs in Taiwan is still scarce. To better understand the

significance of the BMMITP in Taiwan’s healthcare system, this chapter will briefly review

the definition of MI and its significance, the roles of medical interpreters, and the benefits of

employing trained medical interpreters. Subsequently, several language access models will be

presented.

2.1 Medical Interpreting Definition

In general, interpreters are professionals who mediate communication between people

speaking different languages (Setton & Dawrant, 2016). According to the Oxford Dictionary,

‘to mediate’ means “to influence something and/or make it possible for it to happen” (Oxford

Advanced Learner’s Dictionary, n.d.). This definition highlights the complicated task of an

interpreter in helping people of different languages communicate, which needs not only

language competency but also other skills such as communication skills, social and cultural

awareness, etc. (Setton & Dawrant, 2016). Contrary to the complexity involved in

interpreting, the current definitions of medical interpreting are relatively vague. MI,

sometimes known as ‘healthcare interpreting’, was defined by Hale (2007) as community

interpreting in the medical context. Roat and Crezee (2015) construed MI as interpreting that

“takes place during interactions related to health care” (p. 237). Hsieh (2016) added that MI

includes both signed and spoken languages performed by “varying degrees of

professionalism” (p. 10). Other researchers (e.g., Amato, 2007; Arocha & Joyce, 2013) just

refer to MI as interpreting in medical encounters.

For the purpose of this study, an operational definition of MI is synthesized from

15
several key studies (e.g., Angelelli, 2004; Cambridge, 1999; Hsieh, 2003; Wadensjö, 2013) as

a goal-oriented, interactive, and dynamic interpreting activity in the healthcare system that

occurs in real-time and takes form as a triadic interaction either face-to-face on-site (at

hospitals, private practice, or patient’s home), over the audio-phone, or video-mediated, using

spoken or signed language performed by a trained or untrained interpreter, for a healthcare

worker as interlocutor A speaking language A (see Figure 2) and a patient as interlocutor B

speaking language B.

Figure 2

Medical Interpreting Participants and Locations

Medical Interpreter Location:

On-site

Telephone-mediated

Healthcare Worker Patient Video-mediated

(Language A) (Language B)

Note. From Angelelli (2004, p 8).

Figure 2 shows that medical interpreting can take place on-site where all three

participants are present physically in the vicinity of each other as well as through a phone or

video call. It also shows the nature of the interaction between the three participants. The

healthcare worker and the patient rely on the interpreter for communication, emphasizing and

echoing the indispensable role of medical interpreters in medical communications, whose

significance is further discussed in the next session.

2.2 Significance of MI and Relevant Factors

16
 The significance of MI arises from the threat that language barriers pose to medical

treatment. When healthcare workers and patients do not speak the same language, a language

barrier occurs, and proper communication is hampered. Language barriers have been linked to

fewer visits (Kang et al., 2019), delays in receiving non-emergency but necessary healthcare

(Rader, 1988), lower scores for physical examinations (Martin et al., 2014), less use of

preventive medicine such as flu vaccination (Fiscella et al., 2002), breast, cervical, and colon

cancer screening (Jacobs et al., 2005; Martin et al., 2014; Woloshin et al., 1997), less likely to

be given a follow-up appointment (Sarver & Baker, 2000), a less empathic connection

between health care provider and the patient (Woloshin et al., 1995), lower patient satisfaction

(Wang et al., 2012), less health education, worse interpersonal care (Ngo-Metzger et al.,

2007), and problem understanding medical-related information (Chen et al., 2008; Huang &

Mathers, 2008; Kuan et al., 2020; Wilson et al., 2005). Yang and Wang (2003) summed it up

clearly: “Language barriers affecting access to and application of health-related knowledge

and doctor-patient interaction.” (p. 172). These findings suggest the highly negative impact of

the language barrier on a medical service seeker’s well-being.

There are two basic approaches to overcome this language barrier: pairing the patient

with a healthcare provider who speaks the same language as the patient or employing an

interpreter (Jacobs et al., 2006). Although having language-concordant healthcare providers

results in higher patient satisfaction (Lee et al., 2002), they are not always available; hence,

necessitating the employment of medical interpreters. With the help of MI, clinical services

(such as office visits, ongoing nursing, prescription written and filled, and medical

management), as well as preventive services (such as rectal exams, mammograms, fecal

occult blood testing, and flu vaccination), are increased (Blay et al., 2018; Fiscella et al.,

2002; Jacobs et al., 2001). Moreover, satisfaction with health care is also enhanced due to

improved care quality (Flores, 2005; Holden & Serrano, 1989; Kuo & Fagan, 1999; Lee et al.,

2002; Squires, 2018).

17
 However, merely the availability of MI may not fully address the significance of this

practice. Other than availability, previous researchers also addressed further issues such as

urgency and accuracy as well as miscommunication that may arise in medical interpreting

processes. Urgency means working under time pressure, and studies in various contexts

proved it a significant aspect of MI (Donovan, 2004; Dubslaff & Martinsen, 2005; Valero

Garces, 2005). Other than the pressure of urgency, accuracy is highly requisite because

misinterpreting can lead to misunderstandings and miscommunication. Both of these, as

studies have proven, may contribute to poor healthcare results, and harmful, or even life-

threatening outcomes (Al-Amer et al., 2015; Dysart-Gale, 2007; Ebden et al., 1988; Flores et

al., 2003; Gany et al, 2007; Launer, 1978; Price-White, 2008; Roat & Crezee, 2015).

Moreover, miscommunications in MI are not always caused by linguistic errors alone.

They can also be caused by unfamiliarity with medical language (Roat & Crezee, 2015).

Medical language is a highly developed, career-specific, technical, and cultural language for

specific purposes, and is a universal concept known by health professionals and their allies

(Hull, 2016). It does not always include the complicated Latin names for human anatomy or

diseases, but it does include phrases like “stool” that are commonly used in everyday life.

Stool may relate to a piece of furniture in layman’s terms, but it refers to excrement in

medical language. Medical language has also been identified as a sophisticated subset of the

language that may be found in any language, independent of the country's official language

(Hull, 2016), which means medical language also exists in Mandarin, Bahasa Indonesia, and

all other languages of medical professionals. Therefore, it is important to understand the

medical language of the language pair in MI.

Since accuracy is one of MI’s most distinctive features, it is worth mentioning that the

significance of MI extends beyond concerns about miscommunication causing harm, to

difficulty in interpreting emotional vocabularies in mental health treatment settings that rely

mostly on verbal communication (Elghezouani, 2007; Smith et al., 2013). This is mentioned

18
here because previous studies have shown that new immigrants are more likely to suffer from

mental health problems (Baker, 1981; Bhugra et al., 2011; Cantor-Graae & Selten, 2005;

Chen et al., 2013; Lindert et al., 2009; Nesterko et al., 2019; Sack et al., 1986; Thompson et

al., 2002; Westermeyer, 1990; Yang & Wang, 2003). These findings underscore the nature of

the difficult task of a medical interpreter, which could be physically, intellectually, and

psychologically exhausting.

In conclusion, MI is significant because of the negative impacts of language barriers

on effective healthcare delivery to LMP patients. Miscommunication can result in a minor

delay in diagnosis up to fatality. Miscommunications can occur due to a variety of situations

including language problems, unfamiliarity with medical language, different cultures, and

lack of understanding of medical procedures. In addition, language competency required for

MI includes proficiency not only in medical languages or different language usage due to

cultural differences, but also mastery of emotional expressions in both languages. Moreover,

there is a need for urgency as well as accuracy in MI. The significance of MI emphasizes the

need for trained medical interpreters.

2.3 Roles of Medical Interpreters

“Role” refers to “a set of interconnected and socially expected duties, rights, beliefs,

values, and behaviors associated with specific positions in society” (National Council on

Interpreting in Health Care, 2021, p.10). Every position in society has its own role set in

relation to other roles in the social arrangements integrating expectations for each other’s

responsibilities (Merton, 1957). The role set of MI consists of the medical interpreter, the

healthcare worker, and the patient (National Council on Interpreting in Health Care, 2021).

A variety of terms have been used to describe medical interpreters’ roles by different

researchers. Medical interpreters have been seen as conduits, language interpreters, language

specialists, linguistic agents, message converters, metalinguistic negotiators, culture brokers,

culture specialists, message clarifiers, cultural clarifiers, integration agents, advocates, patient

19
advocates, physicians’ allies, patients’ empowerers, system agents, community agents,

informants, collaborators, institutional therapists, institutional gatekeepers, and therapy

conduits (Alvaro Aranda et al., 2021; Angelelli, 2004, 2006; Avery, 2001; Brisset et al., 2013;

Cambridge, 1999; Crezee & Jülich, 2020; Davidson, 2001; Drennan & Swartz, 1999; Dysart-

Gale, 2007; Hsieh, 2007; Kaufert and Koolage, 1984; Kent, 2007; Krystallidou, 2016; Leanza

2005; McDowell et al., 2011; Pöchhacker, 2000; Putsch, 1985; Wadensjö, 2013). The current

study will use Avery’s (2001) explanation of medical interpreters’ roles, which is a continuum

range of roles from language conduit, message clarifier, and culture broker to advocacy

because these are the roles most mentioned by previous researchers and also mentioned in

most MI professional associations’ code of ethics such as the International Medical

Interpreters Association (IMIA) and the National Council on Interpreting in Health Care. The

first organization to establish a code of ethics for medical interpreters is the IMIA

(International Medical Interpreters Association, n.d.). The National Council on Interpreting in

Health Care, on the other hand, is a multidisciplinary organization whose mission is to

promote and enhance language access in health care in the United States (National Council on

Interpreting in Health Care, 2004).

The first recognized role for medical interpreters is a language conduit which means a

communication facilitator between healthcare providers and patients. As a language conduit,

utterances from both interlocutors have to be translated completely without omission or

addition (Avery, 2001). The conduit role requires the medical interpreter to maintain

accuracy, confidentiality, and impartiality (Dysart-Gale, 2005; Hale, 2007; Kaufert et al.,

1999). In short, the language conduit role restricts medical interpreters from performing duties

beyond translating utterances between two interlocutors who speak different languages.

The second role is a message clarifier, which refers to the action of clarifying a

potentially misunderstood message that happens because of linguistic differences. The

message then has to be clarified using the medical interpreter’s own words after informing

20
both the healthcare provider and the patient of the possibility of misunderstanding. Both

healthcare providers and patients expect medical interpreters to act as message clarifiers when

there is a misunderstanding (Hale, 2007; Pöchhacker, 2000). As opposed to the dyadic

communication implied by the language conduit role of an interpreter, when a medical

interpreter acts as a message clarifier, the communication becomes a triadic interaction

(Angelelli, 2004).

The third role of a medical interpreter is a culture broker. Patients, families, and

caregivers’ ethnocentric ideas and personal beliefs impact day-to-day medical

communication. As a culture broker, a medical interpreter helps clarify intercultural

uncertainties (Dysart-Gale, 2007), such as when healthcare providers and family members

have different emphases on medical decisions about end-of-life care (Kaufert et al., 1999;

Norris et al., 2005). Patients’ beliefs and cultures are respected by healthcare providers and

medical interpreters are expected to explain any aspects of the patients’ culture that may be

relevant to the medical procedure (Pöchhacker, 2000). Medical interpreters, on the other hand,

should be careful not to stereotype all patients as holding the same beliefs; instead,

clarification should be made by first questioning the patients (National Council on

Interpreting in Health Care, 2004).

The fourth role of a medical interpreter is advocacy. Advocacy is an action taken by

medical interpreters on behalf of a client that goes beyond facilitating communication to

support positive health outcomes (National Council on Interpreting in Health Care, 2004;

Roat & Crezee, 2015). Roat and Crezee (2015) argued that advocacy is mostly done on behalf

of a patient; however, it may be performed to help both interlocutors (National Council on

Interpreting in Health Care, 2021). The National Council on Interpreting in Health Care

emphasizes that advocacy must only be undertaken “after careful and thoughtful analysis of

the situation and if other less intrusive actions have not resolved the problem” (National

Council on Interpreting in Health Care, 2004, p. 3). In a similar vein, the California

21
Healthcare Interpreting Association (2017) emphasizes that advocacy is “an optional role

which must be left to the careful judgment of trained, experienced interpreters to decide

whether to pursue in a given situation” (p.14). This implies the importance of MI training for

medical interpreters to understand which situations need advocacy.

In sum, the four main roles of medical interpreters mostly mentioned by previous

researchers and included in the codes of ethics are language conduit, message clarifier, culture

broker, and advocacy. It is important for medical interpreters to understand their roles to

ensure ethical-professional relationships with the other members of the medical role set when

practicing MI (Crezee & Jülich, 2020; Davidson, 2001; Drennan and Swartz, 1999; Fan,

2011; Feinauer & Lesch 2013; Kai et al., 2011; Kaufert & Koolage, 1984; Merton, 1957). In

addition, although no consensus about the roles has been reached, the expected roles of

medical interpreters can be revealed from the code of ethics the medical interpreters abide by.

For example, medical interpreters in the United States abide by the NCIHC Code of Ethics

and the NCIHC Standards of Practice, which state that the medical interpreters’ role

“encompasses all the values, ethical principles duties, tasks, and behaviors established in the

NCIHC Code of Ethics and the NCIHC Standards of Practice” (National Council on

Interpreting in Health Care, 2021, p.11). This implies the importance of including the

knowledge of medical interpreters’ different roles in the training program and the importance

of a code of ethics for medical interpreters, namely, to define their responsibilities with regard

to standard practices in healthcare facilities and to govern how they coordinate their work

with other personnel in the healthcare environment (Dysart-Gale, 2005).

2.4 Medical Interpreters: Trained or Untrained?

As previously mentioned, interpreting in medical settings was often handled by

untrained medical interpreters. The sources of untrained medical interpreters are abundant,

such as employers, bilingual friends, relatives, students, housekeepers, strangers from waiting

rooms, nonclinical hospital employees (e.g., janitors, clerks), hospital clinical staff (including

22
other bilingual physicians and nurses), social workers, volunteers, et cetera (Elderkin-

Thompson et al., 2001; Flores et al., 2012; Rader, 1988). Untrained medical interpreters are

employed mostly due to their availability, familiarity (Kuo & Fagan, 1999), no addition to

cost (Bischoff & Loutan, 2004), and lack of awareness or understanding of the interpreting

service or booking system (Chou, 2019; Gray et al., 2011; Huang & Philips, 2009).

However, past studies show commissioning untrained medical interpreters poses

several risks such as inaccurate translations (Ebden et al., 1988; Elderkin-Thompson et al.,

2001; Flores et al., 2003; Flores et al., 2012; Karliner et al., 2007; Rader, 1988), incomplete

translation or omission of important messages (Bischoff et al., 2003; Haffner, 1992; Rader,

1988), and misunderstandings (Haffner, 1992), all of which may lead to delayed or wrong

diagnosis and treatment plan. In addition, asking clinical or non-clinical hospital staff to

interpret may interrupt their real obligations (Rader, 1988), and asking children to interpret

emotionally laden matters may increase their risk to be harmed psychologically7 (Haffner,

1992; Jacobs et al., 1995; Nielsen et al., 2020). Moreover, patients often report reluctance to

have friends or family interpret confidential or embarrassing medical matters (Bischoff et al.,

2003; Butow et al., 2010; Rader, 1988) and will be more satisfied with professional medical

interpreters (Lee et al., 2002).

The above-mentioned potential risks of employing untrained medical interpreters

highlight the importance of trained medical interpreters that are qualified and competent.

Accordingly, training will benefit these bilingual untrained medical interpreters since they are

already having the advantage of being bilingual. The training will further improve their

linguistic and communication skills. In addition, the trainees will gain knowledge about

medical interpreting such as the boundaries of their roles in mediating the interaction between

7
California Bill Information prohibits the use of children as interpreters as written in the 2003’s bill
Section 1c. “The involvement of children as interpreters is difficult, both for the children and for the associated
adults, and may lead to an agency, organization, entity, or program being misinformed as a result of a child’s
ignorance or shame. The involvement of children as interpreters can also be traumatizing to the children.”
(California Legislative Information, 2003).

23
healthcare providers and patients who do not use the same language for communication

(Please refer to section 2.4 for roles of medical interpreters). Training will also reduce

interpreting errors and improve MI quality (Ono, 2014), as well as develop empathy and

humanism (Vargas-Pelaez et al., 2018). In sum, learning medical interpreting theories in the

training program builds up an ethic of professionals and gives the trainees the opportunity to

integrate theory with practice (Tebble, 2014).

2.5 Language Access

As mentioned, language barriers hamper effective communications in the healthcare

system and potentially lead to harmful outcomes. Therefore, language access is needed for

situations where language barriers exist. MI as a form of language access is one of the most

agreed solutions to language barriers in healthcare settings. The progression of language

access provision in the public sector takes place through several developmental stages

(Bischoff, 2020; Ozolins, 2000, 2010; Schuster, 2013). Researchers attempt to investigate

these stages and understand factors that impact the development of one stage to the next.

Three clearly organized models of language access development are the ones proposed by

Ozolins (2000), Schuster (2013), and Bischoff (2020).

According to Ozolins (2000), language access development is a continuum of

responses to the need for interpreting services provision (as shown in Figure 3) starting with

stage “None”, where there are no interpreting services available, and moving on to stage

“Untrained Interpreters”, where language service relies on untrained interpreters with little

thought given to training, accreditation, or registration. The next stage is “General Language

Services”, where efforts are made to meet the demands of the public sector, such as by

employing interpreters as hospital workers. The last stage is the “Comprehensiveness” where

generic language services are supported by credentials, interpreter training, and training for

the professionals working with interpreters.

24
Figure 3
Ozolins’ Four Continuum Stages of Language Access

Legalistic

General
Untrained
None Language Comprehensiveness
Interpreters
Services

Note. From Ozolins (2000, p. 22)

As can be seen in Figure 3, legalistic approaches are needed in both stages 2 and 3 to

reach the last stage where people have rights to language access in institutions. Ozolins (2000)

suggested three primary and six secondary characteristics of the comprehensiveness of

language access. The three primary characteristics are organized language services, training,

and certification system. Organized language services refer to the provision of language

services in all government-subsidized institutions as a crucial component of their service

delivery. However, even when these three characteristics are gained, problems still exist that

hamper the achievement of more comprehensive language access. The problems are mostly

related to the development of the interpreter profession (Ozolins, 2000). For ultimate

comprehensive language access, six secondary characteristics are posited by Ozolins namely,

professional development, training for interpreter users, policy planning, inclusion of all

languages, private and public provision, and development of a profession (please refer to

Table 4).

25
Table 4
Ozolins’ (2000) Characteristics of Comprehensive Language Access

Organized Language
Services
Training
Certification System
Professional Development
Users Training
Policy Planning
Inclusion of All Languages
Private and Public Provision
Development of a Profession
Primary Characteristics
Government departments and agencies are required to
provide language access as an integral part of their service
Academic and para-academic training
Certification, registration
Secondary Characteristics
In-service training, meet and share, share information about
clients, terminology, et cetera.
As part of the mainstream professional training program,
part of professional development, institution-specific (e.g.,
hospital staff)
Legislature, standards of practice
Including sign language and indigenous languages
Mostly language services are provided by public sector
Strong training, accreditation, professional ethics,
legislature, remuneration

Note. From Ozolins (2000, p. 22)

Ozolins’ (2000) model of language access stages shows us the tight connection

between language access and the development of the MI profession (please refer to the last

point of the secondary characteristics in Table 4). Theoretically, it can be assumed that the

development of language access in the healthcare system is closely related to the progression

of the MI profession since MI is the most agreed solution to language barriers in the

healthcare system (as mentioned in Section 2.2).

While Ozolins (2000) described the four stages of language access and the

characteristics of each stage, Schuster (2013) posited a five-stage language access

development model in the community and identified factors that impact the development of

the stages. Although Schuster’s model was used to analyze community interpreting in Israel at

the time, the model may be utilized to comprehend similar processes anywhere (Schuster,

2013). The five stages are “Chaos”, “Emerging Awareness”, “Piloting Professional

Interpreting Services”, and “Decisive Phase”- which can continue into three different paths:

“Disappearance of the Service”, “Small-Scale Projects Continued”, or “Expansion,

26
Duplication and Institutionalization”, and “Spillover” (see Figure 4).

To view the development of language access in the healthcare system from Schuster’s

(2013) model, it can be understood that no language service is available at the “Chaos” stage.

Patients who need interpreters have to resort to untrained interpreters. Some institutions may

provide interpreters for one language but not others. There is no perceived need for

professional MI. At the “Emerging Awareness” stage, healthcare workers and decision-

makers become aware of the importance of professional interpreters. MI at the “Piloting

Professional Interpreting Services” refers to the stage where institutions and organizations

begin to employ professional interpreters. There are three different paths in the next stage- the

“Decisive” stage. Either the MI service disappears and returns to the state of chaos, remains a

small-scale service, or expands further. The last stage is the “Spillover” stage where

interpreting services are part of the healthcare system.

27
Figure 4
Schuster’s Five Stages of Language Access

Note. From Schuster (2013, p. 64)

Figure 4 shows the stages of the provision of language access and how facilitating

factors can help progression to the next stage, while hindering factors may result in a return to

the previous stage. The figure also shows that partnerships are crucial in stage three (Piloting

Professional Interpreting Services). Schuster (2013) mentioned partnerships with three main

stakeholders: academia, professional associations, and patrons. Partnership with academia

leads to professionally trained interpreters, while partnerships with professional associations

and patrons may lead to better marketing and monitoring of medical interpreters. Hence,

28
Schuster’s model further depicts the strong relationship between language access in the

healthcare system with the progression of the MI profession.

Contrary to Schuster (2013), who based the language access development model on

models posited by previous researchers, Bischoff (2020) identified five stages of MI services

after researching the history of interpreting services at Geneva University Hospital,

Switzerland, from 1992 to 2017. Bischoff’s (2020) five stages are “Service Initiation”,

“Growth and Formalization”, “Ensuring Quality”, “Institutionalization”, and “Equity”. In the

first stage, only a tiny percentage of patients receive interpreter services. The “Growth” stage

illustrates the point at which additional interpreter services are available throughout the

hospital’s medical departments. The significance of trained, qualified medical interpreters is

recognized in the third stage, which leads to the fourth stage, namely “Institutionalization”. At

this fourth stage, institutions deal with funding and clarifying the interpreters’ roles. The last

stage is reached when medical interpreter services are integrated into a larger framework of

equal healthcare standards. Although the methods used for building the three models are

different, the stages are relatively similar, as can be seen in Table 5.

Table 5
Comparison of Ozolins’, Schuster’s, and Bischoff’s Language Access Models

Stages of Ozolins’ model Stages of Schuster’s model Stages of Bischoff’s model

1. None
No interpreting services are
available
2. Untrained Interpreters
Rely on untrained interpreters
3. Generic Language Service
Efforts are made to meet the
demands of the public sector,
such as by employing
interpreters as hospital workers
1. Chaos
Almost no language
service is available
2. Emerging Awareness
Awareness of the
importance of professional
interpreters
3. Piloting Professional
Interpreting Services
Begin to employ
professional interpreters
1. Service Initiation
A tiny percentage of patients
receive interpreter services
2. Growth and Formalization
Interpreter services are
available throughout the
hospital’s medical departments
3. Ensuring the Quality
Significance of trained,
qualified medical interpreters
is recognized

29
 Stages of Ozolins’ model
4. Comprehensive
Language services are
supported by credentials,
interpreters training, and
training for the professionals
working with interpreters
Stages of Schuster’s model
4. The Decisive Phase
May lead to 3 different
paths
5. Spillover
Interpreting services are
part of the healthcare
system
Stages of Bischoff’s model
4. Institutionalization
Funding and clarifying the
interpreters’ roles
5. Equity
Interpreter services are
integrated into the healthcare
system

Note. Arranged by the current researcher based on Ozolins’ (2000), Schuster’s (2013), and

Bischoff’s (2020) language models

As seen in Table 5, all three language access models start at almost zero interpreter

stage and end with an integrated MI stage. The three models imply that the facilitation of

language access in the healthcare system is a long process. Bischoff (2020) analyzed what

happened in each stage, the main challenges, and what could have been done, and gave

suggestions. To facilitate the progression of the process, Bischoff recommends focusing on

the quality of care by the provision of medical interpreters (including for chronic disease

care), training both interpreters and interpreter users, and institutional policy based on equity.

Bischoff also suggests that training contents include interpreters’ roles, specifics of different

healthcare types, and transcultural competence.

On the other hand, Schuster (2013) elaborated factors that facilitate and hinder the

transition from stage to stage. Factors that facilitate the transition from stage 1 to stage 2

include support from academic research, awareness of other countries’ solutions to the

language barriers, advocacy, political pressure, and media coverage. Factors that hinder the

progress into stage 2 include lack of supporting factors, lack of demographic information on

patients who need MI, institutions’ fear that provision of MI for one language causes demand

for other languages, lack of funding, and lack of organizations’ advocacy to promote language

access. With the help of supporting factors, language access may progress into stage 3.

At stage 3, professional interpreting services may be part of profit or non-profit

organizations or public services. Schuster (2013) listed six criteria that differentiate the

30
professional from untrained interpreter service namely “screening, training, marketing,

monitoring and assessment, setting of working procedures, and arranging legal issues relating

to the interpreters and their work” (p. 66). Factors that facilitate the progress into stage 4 are

partnerships. Partnership with academia to ensure reliable MI service, partnership with

professional associations to help recruit, train, and evaluate interpreters, and provide a code of

ethics and standard of practice, and partnership with patrons to fund MI training programs and

operations. A lack of supportive factors in stage 4 will eventually take the status of MI back to

the first stage while the availability of facilitating factors will propel MI into stage 5. The

supporting factors include healthcare workers and the public’s awareness of professional MI

benefits, positive feedback, and pressures from MI users and researchers for legislation on

MI. Factors that hinder the progression into stage 5 encompass a lack of expansion and

institutionalization of MI services, lack of funding, lack of a coordinating body to manage the

fund for MI services, lack of training and research, and lack of quality control.

In sum, while Ozolins (2000) only listed characteristics of language access stages,

Schuster (2013) identified impacting factors, and Bischoff (2020) identified problems and

gave suggestions for each stage. However, they all mentioned the importance of awareness of

interpreters’ roles, funding, legislation, as well as training for both interpreters and the

professionals working with interpreters. The primary distinction between the three models is

the three different possible paths at stage four of Schuster’s model, which highlights the

necessity of understanding the factors that hinder and facilitate language access stage

development.

2.6 Summary

Previous research has demonstrated the impact of language barriers in health care

delivery and the importance of MI in facilitating communication across language barriers.

Previous studies have also highlighted the necessity of understanding medical interpreters’

roles and the scope of their responsibilities in order to avoid conflicts that may affect

31
interpersonal relationships and disrupt MI activities. In addition, studies have shown the

importance of medical interpreter training owing to the significance of MI and the potential

hazards of employing untrained medical interpreters to both patients and the untrained

medical interpreters themselves. Moreover, as mentioned in Chapter 1, the government and

stakeholders in Taiwan have answered the need for bridging the language barriers between

healthcare workers and LMP patients by holding MI training programs for new immigrants

and medical tourists.

In sum, the importance of trained medical interpreters in facilitating communication

between healthcare providers and LMP patients is recognized by institutions as well as the

authorities as shown by various MI training programs held. However, little is known about the

design of the training program’s curriculum and subsequent developments of the trainees with

regard to what and how the key factors mentioned in the language access models above are

actually included in MI training programs. With these in mind, research questions were raised

in the next section to identify which language access facilitating factors are catered by the

BMMITP.

32
 Chapter 3 Methodology

The above literature review suggests the close relationship between MI service

provision, MI training and language access, which brings the current researcher to her design

of the study. While the single study on a single training program may not really reflect

whether the overall language access has been improved, this study attempts to look into the

BMMITP to examine whether some of these facilitating factors are identified or neglected as

a way to uncover how such a training program actually works to facilitate potential MI

service.

As mentioned in Section 2.5, although Ozolins (2000), Schuster (2013), and Bischoff

(2020) have different concerns, common concerns and factors are still identified in these

models throughout the development of language access, such as the training and employment

of medical interpreters, the certification, the professional development of the trained medical

interpreters, and the remuneration. After reviewing the three models, the current researcher

identified eight common language access facilitating features ideal to be investigated in this

study (as listed in Table 6).

Table 6
Factors Investigated in this Study

Important Factors Affecting Language Access

1. Training for medical interpreters
2. Certification system
3. Public provision of trained medical interpreters
4. Employment of the trained medical interpreters
5. Remuneration
6. Training for medical interpreter users
7. Professional development of the trained medical interpreters
8. Advanced training for medical interpreters (which contents include interpreters’ roles,
professional ethics/standards of practice, specifics of different healthcare types, and
transcultural competence)

Note. From Ozolins (2000), Schuster’s (2013), and Bischoff’s (2020)

Table 6 shows the factors this study investigates. As aforementioned, the language

33
access models describe the stages of MI service provision in facilitating communication in the

healthcare system. By identifying whether the BMMITP caters to these factors in terms of

how professional medical interpreters are trained and whether it is considered as helpful for

their professional development after the training, this study aims to assist in developing future

curricula for similar MI training programs and attempts to justify the BMMITP as the

embodiment of the government’s endeavor for the provision of professional medical

interpreters as a means for language access to achieve health equity for all.

3.1 Research Questions

With the aims mentioned above, a survey questionnaire and semi-structured interviews

were conducted to answer the following questions:

1. Which of the above eight factors are identified as conducive to language access for LMP

Indonesian in Taiwan’s healthcare system by the trainees, the instructors, and patrons

(henceforth, the participants)?

2. Which of the above eight factors are identified as neglected by the participants?

3. Which of the above eight factors are identified as conducive in the curriculum and the

teaching materials?

4. Which of the above eight factors are identified as neglected in the curriculum and the

teaching materials?

3.2 Research Design

This study focuses on the design and stakeholders’ views on the BMMITP. To answer

the research questions, this study investigates the curriculum, the teaching materials, and the

participants’ experiences in relation to the BMMITP or similar training programs. To ensure

the validity of the study’s findings, the researcher applied a triangulation procedure to

generate data using various methods from diverse sources (Gall et al., 2003). This study

generated data from the BMMITP trainees, two of the training program’s instructors, and a

patron representative using questionnaires, semi-structured interviews, and documentation.

34
 The questionnaire was distributed using Google Forms through social media groups.

The interviews with the trainees were conducted after the data from the questionnaires was

collected. Semi-structured interviews were employed for all of the interviews conducted in

this study to allow for unanticipated issues to be expressed, addressed, and explored, while

remaining focused on the main subject of the training program to limit the scope of data to be

analyzed (Winstanley, 2009). The documents needed for the study, the teaching materials, and

the training program curriculum were obtained from the instructors.

3.3 Participants

The trainees of the training program, two instructors, and one patron representative

were the three categories of participants involved in this study. Due to the fact that the

BMMITP had only been held twice (up to September 2022), a total of only 27 trainees have

completed the training program. Hence, the questionnaire was distributed to all 27 trainees.

3.3.1 Sampling

Out of the 27 trainees, 24 responded to the questionnaire. Subsequently, a purposeful

sampling approach was employed to select trainee participants for interviews to ensure that

essential data was obtained (Creswell, 2013). To obtain further information about the impact

of the program, trainees with medical interpreting experiences prior to or after the BMMITP

were further interviewed. Seven trainees that reported having related experiences were invited

to be interviewed based on their questionnaire responses. One trainee opted out for personal

reasons, while another one canceled the interview due to private matters. Only 5 trainees were

interviewed in the end (see Table 7).

There were two instructors interviewed in this study. The first one was the medical

field instructor who was selected because he was bilingual and taught medical language both

in Mandarin and Bahasa Indonesia. In addition, he had the longest teaching hours and

participated in designing the final assessment in this BMMITP. The second instructor was

from the Translating and Interpreting field. The first and second-year T&I instructors were

35
different. The T&I instructor interviewed in this study was the instructor from the second year

and was selected because of availability. The patrons’ representative was chosen from Shin

Kong Wu Ho-Su Memorial Hospital, one of the members of the Taiwan Nongovernmental

Hospitals and Clinics Association (TNHCA). As mentioned in Subsection 1.1.3, TNHCA

collaborates with MOHW in funding the BMMITP. The representative was selected because

she was personally involved in the BMMITP as an instructor as well as part of the assessment

constructor.

Table 7
Participants in this Study

Participant Category Method Number of Participants Code

Trainee Questionnaire 24 Q1-Q24
Interview 5 T1-T5
Instructor Interview 2 I1 & I2
Patron Interview 1 P

Note. Arranged by the current researcher

Table 7 shows the three participant categories and the codes used to maintain

participant anonymity. The respondents to the questionnaire are coded Q1 through Q24, while

the instructors from the T&I and medical fields are coded as interviewee I1 and I2,

respectively. The interviewee P code represents the patrons’ representative. The 24

respondents to the questionnaire were used to select the five trainee interviewees coded as T1

through T5, making a total of 27 participants in this study.

3.3.2 Basic Data of the Trainee Participants

The basic data of the participants collected in the questionnaire include gender, age,

marital status, ethnicity, languages, religion, educational level, and length of stay in Taiwan.

Twenty of the 24 respondents to the questionnaire identified as females, and four as males.

36
Five of the participants were under the age of 40, ten were between the ages of 41 and 50, and

nine were above the age of 50. 75% of respondents were married. The majority of the

participants were Chinese Indonesians, while only two were of different ethnicities (Batak and

Javanese), while one was from Malaysia. However, when it came to the language section,

which was an open-ended question, nine respondents admitted to being fluent in four or more

languages, nine respondents listed three languages, and two respondents only wrote down two

languages. It is a norm for Indonesians to be multilingual, at least they are fluent in two

languages, Bahasa Indonesia, and their local language. However, four participants only wrote

down one language, which the current researcher believes was a misunderstanding on the

participants’ part. They highly probably thought that they were asked the language they knew

other than Bahasa Indonesia (see Figure 5 through Figure 8). For practical considerations and

because the participants were asked to write down the languages they speak in order of

proficiency, the languages are listed here as first, second, third, and fourth languages.

Figure 5

The Questionnaire Participants’ First Languages

FIRST LANGUAGE
Teochew (1)
Hakka (1)
Javanese (2) Mandarin (6)

English (1)

Bahasa Indonesia
(13)

Note. Arranged by the current researcher

37
Figure 6

The Questionnaire Participants’ Second Languages

SECOND LANGUAGE
Javanese (1)
English (1)

Bahasa Indonesia
(6)

Mandarin (12)

Note. Arranged by the current researcher

Figure 7

The Questionnaire Participants’ Third Languages

THIRD LANGUAGE
Hakka (1)
Hokkian (2)
Mandarin (5)

Javanese (1)

Bahasa Indonesia

English (8)

Note. Arranged by the current researcher

38
Figure 8

The Questionnaire Participants’ Fourth Languages

FOURTH LANGUAGE
Hakka (1) Mandarin (1)

Javanese (1)

English (5)

Note. Arranged by the current researcher

As shown in Figure 5, the majority of the participants’ first language is Bahasa

Indonesia. This makes sense since Bahasa Indonesia is the official language taught and used

in schools, universities, and institutions in Indonesia. The respondents who listed Mandarin as

their most proficient language are likely to have studied and resided in Taiwan for a longer

period of time than they did in Indonesia. Figure 6 demonstrates that the majority of the

participants who listed Bahasa Indonesia as their primary language also selected Mandarin as

their second language and vice versa. Figures 7 and 8 show that after Bahasa Indonesia and

Mandarin, English is the third most common language. It is understandable because, in

Indonesia, English is taught in schools as a second language. Bahasa Indonesia was the

second proficient language for those who chose their local or tribal language as the most

fluent language, such as Javanese, Hakka, and Teochew. Only the first four languages are

presented in this study because the researcher believes the following ones are insignificant for

this study.
39
 As for religion, out of the 24 participants responding to the questionnaire, only one

participant was Moslem, the others were Christians (8), Catholics (2), and Buddhists (10).

Three participants opted for “others” for their religion. Regarding the participants’ education

level, three graduated senior high school and 21 had a university degree. This complies with

the educational level criteria for registration of BMMITP. Although it is not always the case,

the length of stay in Taiwan generally reflects one’s Mandarin proficiency level. The

respondents’ length of stay in Taiwan is presented in Figure 9.

Figure 9

The Questionnaire Participants’ Length of Stay in Taiwan

Years in Taiwan
10
9
8
Number of Participants

7
6
5
4
3
2
1
0
5-10 years 11-15 years 16-20 years > 20 years

Years in Taiwan

Note. Arranged by the current researcher

Figure 9 shows that the majority of the participants had resided in Taiwan for more

than 10 years. Only 16.7% had stayed in Taiwan for fewer than 10 years. All of the nine

respondents who had stayed in Taiwan for more than 20 years listed Mandarin as either their

first language or their second language.

40
3.4 Data Collection

Data in this study comes from three sources – a survey questionnaire, semi-structured

interviews, and documentation. The following subsections describe the three types of data

collection. The questionnaire was sent out to all 27 targeted trainees, and 24 responded within

nine days. The three trainees who did not respond were two Taiwanese nurses who did not

speak Bahasa Indonesia and one Taiwanese who could speak Bahasa Indonesia but could not

be contacted. The semi-structured interviews were executed with five trainees, two

instructors, and a representative of the patrons. The interviews with the trainees were

conducted after they responded to the questionnaires. The documentation was obtained from

the two instructors.

3.4.1 Survey Questionnaire

The questionnaire includes a total of 27 questions with the first nine questions

regarding the participants’ demographic data and the next 18 questions regarding inquiries

about the MI training program and their interpreting experiences. The demographic data

includes gender, age, marital status, ethnicity, languages they speak, religious belief8,

education level, years in Taiwan, and occupation. It is important to understand the ethnicity,

languages, and religious beliefs of the trainees because Indonesians consist of various ethnic

groups and religions. Different ethnic groups speak different languages and have different

traditional values and norms. These backgrounds may affect their expectations for the training

and for MI in Taiwan. Questions about what they learned from the program are meant to

investigate whether and what knowledge-based skills were gained. Questions about other

training programs are meant to understand whether there are any attempts for professional

development. Questions about employment assignments (or lack thereof) after the program,

and other similar interpreting experiences in medical settings are asked to understand whether

8
Religion is addressed because past studies (e.g., Shih, 2020) indicated religion may influence the
participant’s expectations for the training programs or medical interpreting in general.

41
there is an organized language service. Please refer to Appendix G or H (in Bahasa Indonesia)

for the questionnaire.

3.4.2 Interviews

Interviews were conducted with three categories of participants- trainees, instructors,

and the representative of the patrons. Interviews with trainees explored their learning

experiences in the BMMITP to understand how they learned and their perceptions of the

certification. In addition, the trainees were inquired about their interpreting experiences to

understand their employment in healthcare facilities, the public and private provisions of

language services, and their remuneration. Please refer to Appendix I or J (in Bahasa

Indonesia) for the outline of the interview with the trainees.

Separate in-depth semi-structured interviews with the two instructors were conducted

to obtain information about their teaching experiences and their opinions on the certification

of medical interpreters. Moreover, the instructors were inquired about their medical

interpreting experiences and their perceptions about language access in Taiwan’s healthcare

system. The instructors were asked to give suggestions relating to the employment of trained

medical interpreters in Taiwan’s healthcare system. Please refer to Appendices K and M or L

and N (in Bahasa Indonesia) for interview outlines for the instructor from the T&I field and

the instructor from the medical field, respectively.

An in-depth semi-structured interview with a representative of Shin Kong Wu Ho-Su

Memorial Hospital as one of the patrons was conducted to obtain information about the

training programs, the driving forces behind the training programs, the training programs

patronage, who was involved in the creation of the curriculum, the certification, and their

concerns about language access and MI. Moreover, the representative of the patrons was also

asked about the talent pools to better understand to what extent the talent pools benefit the

employment plan for the trainees. The outline for this interview can be seen in Appendix O or

P (in Mandarin).

42
 Following is the description of how the interviews were conducted. The interviewees

were offered to determine the place and time of the interviews most convenient for them.

Please refer to Table 8 for the time, duration, and place of the interviews.

Table 8
The Time and Venue of the Interviews

Code Date Time Duration Venue

T1 03/09/2022 09.00 40 minutes Google Meet
T2 03/09/2022 15.00 35 minutes Google Meet
T3 04/09/2022 10.20 44 minutes McDonald in Taoyuan City
T4 06/09/2022 14.00 48 minutes Google Meet
T5 08/09/2022 10.00 55 minutes Google Meet
I1 30/08/2022 15.00 30 minutes Google Meet
I2 24/09/2022 13.00 30 minutes A cafe at the interviewee
workplace
P 23/09/2022 10.00 50 minutes Google Meet

Note. Arranged by the current researcher

As can be seen in Table 8, most interviewees opted to be interviewed online due to the

pandemic and for practical reasons. However, interviewees T3 and I2 opted to have a face-to-

face meeting. Interviewee T3 chose McDonald, a fast-food restaurant near the interviewee’s

residence, while interviewee I2 opted for a cafe in the same building as the interviewee’s

workplace. All interviews were conducted in Bahasa Indonesia except the interview with the

patron representative, which was conducted in Mandarin. With the interviewee’s consent, the

current researcher was accompanied by an interpreter at the interview with the patron

representative to ensure more accurate and reliable data, and to acquire the proper responses

from the interviewee. The duration of the interviews varied depending on the conversation

and the amount of information the interviewees were willing to share.

3.4.3 Documentation

The documentation collected for this study was the training program’s curriculum and

the teaching materials which were provided by Instructors I1 and I2 two weeks before the

43
interviews. After studying the documentation, related questions were prepared by the current

researcher for the interviews such as how the teaching material was designed and whether or

not the conversation samples were authentic. The curriculum and the teaching materials also

gave information about how much time was dedicated to which subject and which topic was

neglected.

3.4.4 Validity and Credibility

To ensure the validity and credibility of the questionnaire and interview questions, the

following steps were taken. The questionnaire was translated by the current researcher into

Bahasa Indonesia. To ensure the credibility of the translation, the English and the translated

version were reviewed by an Indonesian postgraduate student. Later, the questionnaire was

piloted by two bilingual postgraduate students and a bilingual social worker who were not

participants in this study. After adjustments were made, an updated version questionnaire was

uploaded to Google Forms. To ensure reliability, the Google Form questionnaire was

carefully designed to avoid misunderstandings by bolding key terms, such as “before”,

“after”, or “medical interpreting”. Additionally, the option to be able to select only one

answer or may check more than one answer was set for each question accordingly. A fellow

bilingual post-graduate student then piloted the Google Form questionnaire once again. As the

questionnaire was being piloted, the amount of time needed to answer all the questions was

calculated before the questionnaire was distributed.

The interview outline for the trainees was piloted with a bilingual Indonesian

postgraduate student to ensure the clarity of the questions. A Mandarin native-speaker

postgraduate student assisted with the piloting of the interview questions for the patron

representative. The outlines of the interview questions were sent to the two instructors and the

patron representative one week in advance so they could appropriately prepare their answers

and reduce the interview time. Additional questions were asked during the interviews based

on the interviewees’ responses. The semi-structured interviews with five of the trainees were

44
conducted in the span of one week (see Table 8). Prior to the interviews, the interviewees

were once more informed of the recording and their rights to terminate the interview

whenever they felt uncomfortable. The interviewees were also informed that they may request

a copy of the study upon completion. Only one out of the eight interviewees requested a copy.

As was suggested by Miles and Huberman (1994), throughout the interviews, the researcher

took notes of particular information and new ideas that needed to be explored further and

given more attention during the subsequent interviews.

3.5 Data Analysis Procedures

Descriptive analysis was used to analyze the responses in the survey questionnaire to

understand the percentage of response distributions. For example, the percentage of

participants choosing “to help other new immigrants” and “to learn more about medicine” as

the reason for enrolling in the BMMITP are the same, that is 75%. Meanwhile, only 37.5%

chose “to be able to support the family financially”. As for the five-point Likert scale

questions, the number of participants with the same level of agreement was counted and

presented. For example, there were 20 participants who chose “strongly agree” for “medical

knowledge and terminology” as the topic they learned at the BMMITP, while three

participants chose “agree”, and only one chose “neutral”. This means most of the participants

strongly agree that they learned a lot about the medical knowledge and medical terminology

after enrolling in the BMMITP.

The interview recordings in Bahasa Indonesia were transcribed verbatim within two

weeks of each interview by the current researcher. On the other hand, the interview with

participant P in Mandarin was transcribed and translated into English by a professional

translator who was a Mandarin native speaker. Subsequently, the transcriptions were coded to

identify themes and detect similarities and differences in the participants’ descriptions and

responses to the interview questions. To ensure consistency, the transcripts were analyzed

three times on unmarked copies with one-week intervals in between. According to Hsieh and

45
Shannon (2005), “with a directed approach, analysis starts with a theory or relevant research

findings as guidance for initial codes” (p. 1277). Hence, directed content analysis, an analysis

based on the theoretical framework was applied for transcription coding. The transcripts were

coded according to the eight factors mentioned at the beginning of this chapter.

All excerpted quotes in Indonesian were translated into English by the current

researcher and reviewed by another Indonesian bilingual researcher. As for the curriculum

and the teaching materials, they were read and analyzed to understand which topics were

given more attention and which topics were neglected. Results from the analysis are presented

in the next chapter.

46
 Chapter 4 Results and Discussion

The results of the questionnaire, the interviews, and the documentation are presented

in the first section of this chapter. The findings are categorized into information generated by

this study about the training program and the follow-up development of the trainees after the

training program. In the second section of this chapter, the findings of this study are discussed

and interpreted by the current researcher from the perspective of an insider. The last section of

this chapter deals with the responses to the research questions.

4.1 Results

4.1.1 The BMMITP Design and the Knowledge Gained

This subsection presents information gathered from this study’s participants regarding

the BMMITP design such as the application requirements, the instructors, the curriculum, the

knowledge gained from the trainees’ perspectives, the final assessment, and issues raised in

the interviews related to topics discussed in this subsection. It is worth mentioning that many

trainees had also enrolled in other interpreting training programs. The information is intended

to gauge the trainees’ level of experience and delve into their perceptions about the distinction

between medical and other types of interpreting. Table 9 presents the trainees’ other

interpreting training.

Table 9
Trainees’ Experiences in Other Interpreting Training Programs

Number of Participants
Other interpreting training programs 15
Other medical interpreting training before 7
programs after 1

Note. Arranged by the current researcher

Table 9 shows that 15 participants had enrolled in other interpreting training programs

such as interpreting for the police, the court, and the immigration institutions. In addition,

47
several participants had been trained in other medical-related interpreting training programs

such as medical interpreting for new immigrants’ reproductive health and one participant had

been trained in Psychological Counseling Bilingual Interpreter Training Program. Upon

completion of all these training programs, certificates were issued.

The BMMITP’s Application Requirements. According to the documentation

provided by interviewee I2, to be accepted into the BMMITP, applicants must be at least 18

years old, native speakers of Bahasa Indonesia, have completed at least senior high school

level of education, and have attained Mandarin proficiency at least at level B1 of the CEFR or

be able to demonstrate their Mandarin proficiency in other ways. All trainee participants in

this study met the requirements. Furthermore, as mentioned in Subsection 3.2.2, only three of

the trainee participants are senior high school graduates. The rest have university degrees.

Interviewee T3 opined that the minimum requirement of education level is not high.

She admitted to telling friends to apply because the application requirement may get more

complicated in the future.

“I told my friends, ‘You have to apply while it’s still easy now. For now, you have to

graduate from senior high school. Who knows in the future, maybe the minimum

requirement will be university graduates, or maybe have a certain education

background like... language-related or medical-related maybe?” (T3)

While interviewee T3 persuaded her friends to apply for the BMMITP because of the

minimum requirement of education level, interviewees I1 and I2 emphasized the importance

of checking the language background of the applicants.

“... the Bahasa Indonesia proficiency... I was thinking... why are you even here? The

problem is the Bahasa Indonesia proficiency. I am not even talking about medical

language, I mean... common language, everyday language. So, why bother taking an

interpreting course? So, I suggest the admin be more selective next time.” (I1)

“The applicants should be limited to bilinguals only. Proficient in both languages.”

48
 (I2)

The BMMITP’s Instructors. According to interviewee P, the TTFMT tried to select

the best instructors it could find. The documentation provided by interviewee I2 shows that all

instructors in the BMMITP are professional in their fields- professional interpreter, doctors,

and head nurses, most of whom are directors of various departments. Interviewee T5 shared

her opinion about the instructors when asked about the significance of the BMMITP

compared with other interpreting training programs she had enrolled in.

“Because this training program... First of all, I personally think that all the

instructors are professionals, all have degrees, real professionals. The other courses I

had enrolled in... the instructors were like... you know... common teachers. For

example, I don’t mean to underestimate that particular instructor, but it seems like she

was asked to be the instructor just because she is an interpreter, she knows how to

interpret, like that... So, in those other training programs, it feels like most of the

instructors were just sharing, sharing their experiences as interpreters, not teaching.

On the other hand, in this training program, the instructors are professors, this

doctor, that doctor, or director of this, and director of that. I feel like I can’t ... you

know... I had to focus and serious all the time (laugh)...” (T5)

Of all the instructors in the BMMITP, only interviewees I1, I2, and the current

researcher are native speakers of Bahasa Indonesia. Interviewee I1 is a language teacher and a

freelance translator and interpreter at various translation agencies for more than 10 years.

Interviewee I1 is also a member of a private association focusing on language service

provision that is responsible for the regular medical interpreting tasks I1 performs for a non-

governmental clinic in northern Taiwan.

“...I interpret regularly for clinic X...in Taipei.... The patients are from Indonesia.

Come here only for medical check-ups. Very VIP. I think they signed a contract which

is around NT$600,000, a collaboration with a hospital in Indonesia. So, every three

49
 months the patients come here...” (I1)

While interviewee I1 is a professional interpreter, interviewee I2 is a physician at a

hospital in northern Taiwan for almost 22 years. The current researcher is a non-clinical

physician, an active Indonesian health blogger, and a Bahasa Indonesia teacher. While

interviewee I1 was invited to teach at the BMMITP by a private language service group where

I1 works as a freelance translator-interpreter, interviewee I2 was invited through the hospital

where I2 works. The hospital is a member of the TNHCA.

“... that last year program (2021)... actually I was contacted by translation agency X...

freelance... I am free-lancing at many translation agencies.” (I1)

“... Taiwan Task Force for Medical Travel contacted me through hospital Z (where I2

worked) after the case of a migrant worker who fell down from the 8th floor of a

building. I was the physician who flew back to Indonesia with the patient, who cannot

speak Mandarin until we arrived at the hospital there for further treatment.” (I2)

On the other hand, the current researcher was introduced by instructor I2 to the

TTFMT considering the current researcher’s knowledge of medicine, medical interpreting

theory, and Bahasa Indonesia proficiency level. Interviewee I2 and the current researcher

taught together at the BMMITP as a team. Hence, the teaching materials of instructor I2 and

the current researcher are integrated into one and are presented according to their expertise

with both instructors present at the time of the teaching.

The BMMITP’s Curriculum and the Teaching Materials. According to

interviewee P, although government-funded medical interpreting training programs have

existed for several years, the Vietnamese-Mandarin language pair’s medical interpreting

training program had only recently begun in 2019. The MOHW wants to encourage medical

tourism by implementing a “one nation - one health center” strategy in addition to the New

Southbound Policy. This necessitates an overall enhancement in service, including language

services. The language pair Bahasa Indonesia-Mandarin was included in the second year of

50
this program due to the fact that the majority of LMP medical tourists come from Vietnam

and the second most come from Indonesia.

“ ... so, in 2017, for this New Southbound policy, we started to promote this one nation

- one health center plan, which was established in 2018. At first, there were only 6

countries. I believe Indonesia was one of them. In 2019, we added Myanmar. And for

the language part, surely, we wish that these people can get professional medical

interpreters when they are here. So, the MOHW entrusted us... the Taiwan

Nongovernmental Hospitals and Clinics Association, which I told you just now... it has

this Taiwan Task Force for Medical Travel... to undertake this task. So, starting in

2019 we had this first Vietnamese-Mandarin Medical Interpreting Training

Program.” (P)

Throughout the development of the curriculum that was delivered to the Taiwan Task

Force for Medical Travel, collaborations were developed with a number of institutions

including professional associations. To investigate what subjects are taught in the BMMITP,

the current researcher requested the curriculum from interviewee I2. In addition, both

interviewees I1 and I2 also provided their teaching materials. The curriculum for the

BMMITP year 2020 is shown in Table 10.

51
Table 10
The Year 2020 Bahasa Indonesia-Mandarin Medical Interpreting Training Program for

Medical Tourism Curriculum

Week Topic Syllabus

1 Course Description, Student
Interaction – 30 minutes
Introduction to International Medical
Services – 1 hour 30 minutes
Introduction to Interpreting Skills – 2 1. Retelling, summarizing, and narrating
hours
Introduction to Indonesian Medical
Tourists Circumstances – 1 hour
Interpretation and sight translation
skills drill – 3 hours
2 Introduction to Hospital Environment 1. Medical Specialties Terms and Job
and International Medical Service
Procedures – 2 hours
International Medical Consultation
and Admission Drills – 2 hours
Common Medical Terms Practice – 4 1. Common medical terms translation
hours
3 Introduction to Medical Treatment
Seeking Procedures – 2 hours
Introduction to Medical Examination Names of related diseases, corresponding
and Treatment Procedures – 2 hours
Surgery Department – 4 hours
Classroom Regulations, Meet and Greet
1. Top nine medical treatments in Taiwan
and the current status of their promotion
2. Introduction to members of Taiwan’s
international medical service
institutions.
skills
2. Interpretation and sight translation
skills exercise
Indonesian medical tourists’ needs,
international medical insurance, and
international medical intermediary situation
Medical terminologies translation
(Mandarin, English, Indonesian)
Description
2. International patient referral process
and medical treatment visa application
procedure
3. International medical service FAQs and
dialogue translation
4. On-the-spot understanding of
international patient reception space
and traffic flow
Group practice of international medical
consultation and admission
2. Common medical situations simulation
Basic medical treatment seeking
procedures, professional nursing
knowledge, terms translation
symptoms, examination equipment, and
treatment terms and dialogue translation
1. Introduction to Taiwan featured
surgeries
2. Names of related diseases,
corresponding symptoms, examination
equipment, and treatment terms
translation

52
 Week Topic
4 Cancer Treatment and Care
Procedures – 8 hours
5 Health Checkup Procedures and
Ethics – 4 hours
Explanation of Blood Tests and
Microscopic Examinations – 2 hours
Explanation of Blood Test Report – 2
hours
6 Hospital Procedures Drill – 4 hours
Training Results Acceptance – 4
hours
Syllabus
1. A general theory of cancer
2. Common cancer symptoms and
treatment
3. Common cancer treatment terms and
screening tests
1. Integrated care services for cancer
patients
2. The treatment procedures for cancer
patients (on-site visitation)
1. Health checkup basic procedures and
terms translation
2. Health checkup service ethics
3. Health checkup FAQs translation
Blood tests description and results
explanation
Other medical tests description and
explanation
Physicians lead the trainees to the actual
health checkup site to conduct simulated
dialogues and drills
Interpreting simulation in the hospital by
the trainees, evaluation, and feedback by
physicians

Note. Provided by participant I2

As seen in Table 10, the training was held for 6 sessions (only on Sundays) for a total

of 48 hours. The overall time dedicated to medical-tourism-related topics was six and a half

hours, for medical-knowledge-related topics was 32 hours, and only five hours were dedicated

to interpreting skills. The instructor would take the trainees on tours around the hospital

during training for certain topics to provide them with a more authentic learning experience.

Such topics include Hospital Procedures Drill and Introduction to Hospital Environment and

International Medical Service Procedures. The final assessment was held in the last four

hours.

As seen in Table 10, the training was held for 6 sessions (only on Sundays) for a total

of 48 hours. The overall time dedicated to medical-tourism-related topics was six and a half

hours, for medical-knowledge-related topics was 32 hours, and only five hours were dedicated

to interpreting skills. The instructor would take the trainees on tours around the hospital

53
during training for certain topics to provide them with a more authentic learning experience.

Such topics include Hospital Procedures Drill and Introduction to Hospital Environment and

International Medical Service Procedures. The final assessment was held in the last four

hours.

In the second year, there were minor adjustments to the curriculum for weeks 1, 2, and

3, as can be seen in Table 11.

Table 11
The Year 2021 Bahasa Indonesia-Mandarin Medical Interpreting Training Program for

Medical Tourism Curriculum – Adjustments

Week Topic Syllabus

1 Course Description, Student
Interaction
Introduction to International Medical
Services – 2 hours
Introduction to Indonesian Medical
Tourists Circumstances – 2 hours
Introduction to Interpreting Skills – 4
hours
Classroom Regulations, Meet and Greet
1. Top nine medical treatments in Taiwan
and the current status of their
promotion
2. Introduction to members of Taiwan’s
international medical service
institutions
Indonesian medical tourists’ needs,
international medical insurance, and
international medical intermediary
situation
1. Retelling, summarizing, and narrating
skills
2. Interpretation and sight translation
skills exercise

54
 Week Topic
2 Introduction to Medical Treatment
Seeking, Examinations, and
Treatment Procedures – 4 hours
Introduction to Hospital Environment
and International Medical Service
Procedures – 4 hours
3 Training of Common Terms in
Surgery Department – 4 hours
Training of Common Terms in
Internal Medicine Department – 4
hours
Syllabus
1. Basic medical treatment-seeking
procedures, professional nursing
knowledge, terms translation
2. Names of related diseases,
corresponding symptoms, examination
equipment, and treatment terms and
dialogue translation
1. Medical Specialties Terms and Job
Description
2. International patient referral process
and medical treatment visa application
procedure
3. International medical service FAQs
and dialogue translation
4. On-the-spot understanding of
international patient reception space
and traffic flow
1. Introduction to Taiwan featured
surgeries
2. Names of related diseases,
corresponding symptoms, examination
equipment, and treatment terms
translation
3. Common medical terms translation
and medical situations simulation

Note. Provided by participant I2

As seen in Table 11, the adjustments are minor. Mostly, there are just little

adjustments to the topics’ titles and categorization. However, the time allotted to medical

tourism was increased by one and a half hours, while the time for medical interpreting skills

was reduced by one hour. The final scheduled time in the second year of the BMMITP was

eight hours for medical-tourism-related topics, 32 hours for medical-knowledge-related

topics, and only four hours dedicated to interpreting skills. Overall, there were no significant

changes in terms of the topics covered in the curriculum, unless changes were made

individually by the instructors to their teaching materials.

As for the teaching materials, both instructors provided their PowerPoint slides which

were discussed during the interviews. The topic taught by interviewee I1 is an introduction to

interpreting skills, including shadowing, retelling, and sight interpreting. In addition,

55
interviewee I1 also shared strategies such as preparation before interpreting. Interviewee I1

made sure the trainees understood that it would be best to get informed about the case, and the

medical procedure, and gauge the case’s difficulty level before interpreting.

“... you have to make sure what the case is about... not just check-up, there are many

kinds of check-up, the basic ones, the more detailed ones. You have to know the

vocabulary needed for the case. So, before you accept the case, understand it first -for

example, colonoscopy. Several days before the colonoscopy, you have to follow a low-

residue diet, 低渣飲食. You have to understand what 低渣飲食 means. How to

translate it into Bahasa Indonesia. Yeah... mostly for the cases I teach, I get from my

own experience. I always tell my translator agency, hey, you have to let me know first

what kind of health checkup the patients are going to have. Then I will study it, so I

won’t be devastated later in the location because I don’t know specific terms.” (I1)

While interviewee I1 teaches interpreting theory, interviewee I2 is responsible for

three subjects: medical tourism, medical knowledge and language, and interpreting drills.

Interviewee I2 stated that all the conversations used in the drills are authentic conversations in

the hospital. In addition, instructor I2 admitted that while teaching, he often inserts ethical

issues, shares his own experiences, and mentions frequently misinterpreted phrases.

“I organized my teaching material starting with an introduction to medical

interpreting, the significance of medical interpreters, and basic interpreting

techniques. Then I wrote down dialogues that often occur in medical settings, from the

registration counter, outpatient clinic, laboratory, radiology department, pharmacy,

and inpatient department. After that, I arranged medical knowledge and related

terminologies including medical procedures. I also included medical ethics and

interpreting ethics that I know of. I am also responsible for the interpreting drills and

the final assessment.” (I2)

“I frequently mention ethical issues and share my experiences about phrases or

56
 conditions often misinterpreted, for example, a tumor is often misinterpreted as

cancer, while not all tumors are cancerous. Once, I was interpreting for a doctor in

the ICU. The patient had a brain hemorrhage and fractures and was in critical

condition. He needed a ventilator and surgery. I had to interpret the critical condition,

things that might happen, including resuscitation and ‘do not resuscitate’, tube

removal, the surgery itself, the complications that might happen, the informed consent

form that had to be signed, the cost, and the insurance stuff. With that much

information, the patient’s family thought the ‘do not resuscitate and tube removal’

meant the patient was beyond treatment. I had to explain once again, more

elaborately.” (I2)

As for the course duration, interviewee I1 believes the time allotted for each subject is

ideal since the training program is intended for beginners. On the other hand, interviewee I2

admitted that the time is insufficient but that it is understandable.

“Actually, most of the trainees are beginners. I mean, they haven’t had a lot of

experience yet. So, for new interpreters, I think the teaching material is enough. If we

teach too much new information, they will be confused and cannot absorb it all. So, I

think for their level... it’s enough.” (I1)

“Yeah... not really enough, but it can’t be extended due to various reasons such as

budget. However, I personally think that there should be advanced training in the

future for the trainees so they can keep improving... or maybe something like... in-

service training.” (I2)

However, the majority of the trainee interviewees remarked that the time for

interpreting exercises was too short.

“... the time was too short if I may say... yeah... I understand maybe they have

problems organize for the training locations also... yeah... I still feel the practice time

is too short.” (T5)

57
 In addition, the instructors (I2 and the current researcher) always conduct an error

analysis and give feedback to the trainees after each interpreting drill. Sometimes this is done

through the social media group where the trainees and the three Bahasa Indonesia-speaker

instructors are members. Significant errors are corrected immediately. To save time, sight

interpreting is recorded individually by the trainees with their own mobile phones and sent to

the current researcher to be analyzed later at home. Feedback is given through the same social

media group.

The Knowledge Gained. The above data shows the many topics in the BMMITP’s

curriculum and the two instructors’ teaching materials. However, the trainee participants

could have a different perception of the knowledge they had gained. To understand what new

knowledge the participants perceived they had actually acquired, several questions were asked

in the questionnaire. For the first question, the participants were allowed to select more than

one subject they had learned most. Their selected choices are listed in Figure 10.

Figure 10

Knowledge Learned at the BMMITP

Knowledge Learned

23
25
20
19
Number of Participants

20 16
13
15

10

0
Medical Tourism Medical Medical Interpreting Interpreting
Knowledge Language Knowledge Ethics

Knowledge Learned

Note. Arranged by the current researcher

58
 Figure 10 shows that medical tourism is the most selected option, which is not

surprising given that it was the first subject addressed to the trainees. Moreover, it is the

primary reason for the BMMITP’s existence. Unexpectedly, one participant (Q9) did not

select medical tourism. Participant Q9 selected medical knowledge, medical language, and

interpreting knowledge. However, it does not highly impact the number of participants who

selected interpreting knowledge and interpreting ethics, which are relatively low compared to

the first three options.

Additionally, the “others” option is also available for the question about knowledge

learned in the training program. Only two participants checked “others”. The first respondent

(Q1) who selected ‘others’ also ticked all the other options and explained the “others” option

as “names of body organs that I did not know before”. The second participant (Q23) who

selected “others”, described “others” as “interaction with related institutions”. However, this

“others” option is not depicted in the figure because the current researcher believes “names of

body organs that I did not know before” is actually part of medical knowledge; and

knowledge about “interaction with related institutions” is included in the medical tourism

teaching material, which the participant already opted.

The answers to the following four Likert-scale questions on the trainees’ perceptions

of how much they learned about the subjects in the BMMITP support the responses regarding

the trainees’ perceived knowledge learned. The last Likert-scale question concerns the

trainees’ perceptions of the final assessment (as seen in Table 12).

59
Table 12
Trainees’ Perceptions about How Much They Learned about the Subjects in the BMMITP and

the Final Assessment

Subjects A B C D E Total
Medical tourism and relevant matters 18 6 - - - 24
Medical knowledge and terminology 20 3 1 - - 24
Medical interpreting knowledge 19 4 1 - - 24
Medical interpreting ethics 15 6 3 - - 24
Final assessment reflects trainees’ interpreting 16 6 2 - - 24
ability

Note. A = strongly agree, B = agree, C = neutral, D = disagree, E = strongly disagree

Arranged by the current researcher

Table 12 shows that the majority of the trainee participants chose “strongly agree” that

their knowledge of medical tourism and relevant topics, medical knowledge and terminology,

medical interpreting knowledge, and medical interpreting ethics had improved as a result of

their training in the BMMITP. However, six participants selected “agree” and three selected

“neutral” for “medical interpreting ethics”. Additionally, the current researcher also asked the

participants to list three lessons they had learned during the training to confirm the accuracy

of the replies to the close-ended questions about the knowledge they had learned during the

program. The participants’ answers are listed in Table 13.

Table 13
Trainees’ Perceptions of the Top Three Lessons They Learned at the BMMITP

Lessons Learned Number of Participants

Medical language and terminologies: 21
- Medical language 9
- Medical terminologies 10
- Medical terminologies in Bahasa Indonesia 1
- Accurate medical language in Bahasa Indonesia 1

60
 Lessons Learned Number of Participants
Medical Knowledge: 15
- Medical Knowledge 9
- Hospital scenarios 2
- Hospital procedures 4
Medical interpreting knowledge: 13
- Interpreting tips 3
- How to communicate better 3
- How to avoid misunderstandings 2
- Note taking 1
- Medical interpreting drills 1
- How to help their task 1
- More familiar with translating 1
- Make times for learning new things 1
Medical interpreter ethics: 6
- Medical interpreter ethics 4
- Have empathy for patients 2
Medical tourism: 8
- Medical tourism 5
- Procedures for medical tourists to seek medical help in 1
Taiwan 1
- Medical tourism SOP 1
- Medical tourism costs

Note. Arranged by the current researcher

Table 13 shows the top three lessons the trainee participants perceived they had

learned at the BMMITP. To match the basic subjects in the training program curriculum, the

current researcher organized the answers into five categories namely, medical language and

terminologies, medical knowledge, medical interpreting knowledge, medical interpreter

ethics, and medical tourism. The total answer should have been 72 items, but there are only 63

items on the list because not all participants provided three answers. However, Table 16

shows the top three lessons are medical language and terminologies, medical knowledge, and

medical interpreting knowledge. The participants’ answers might be mediated by the teaching

hours allocated to these subjects.

As seen in the curriculum, a lot of time is allocated to medical-related knowledge. It

may be the reason why trainees perceive it as the most learned subject. Interviewee T5

mentioned the benefits of learning different types of pain and the terms in both languages.

61
Interviewee T3 talked about different types and the progression of hepatitis.

“Before I enrolled in the BMMITP... when I interpreted for a patient with a

stomachache, I did not know how to describe the pain and the location of the pain to

the doctor. Now I know that the location and the type of pain matter to the physician

and I understand how to pinpoint the exact location and the type of pain in both

languages such as ‘cenut-cenut/denyut-denyut’ (搏動性痛) or ‘menusuk’ (刺痛)... or

‘kram’ (絞痛).” (T5)

“In the past when the doctor said A, we said, okay. When the doctor gave us medicine,

we said, okay. We didn’t know that liver disease could progress; we didn’t know how

hepatitis A, B, or C spread; what we should pay attention to. Now we know. It feels

powerful to know such things so when the patient doesn’t understand or becomes

anxious, we can explain.” (T3)

Overall, most of the trainee interviewees expressed how they enjoy learning medical

knowledge and terminologies in both languages. In addition, interviewee T3 mentioned how

they appreciate the instructors’ feedback while practicing interpreting drills. As the instructor,

the current researcher does provide feedback and corrects the trainees’ translation and

interpreting errors both during practice sessions and later through messages in the social

media group.

In the teaching material from interviewee I1, there is a topic about note-taking. When

asked what the trainee interviewees found the most useful topic in the BMMITP, one of the

answers was note-taking. On the other hand, interviewees T3 and T4 found topics related to

MT to be the most useful.

“Ah, that lesson about... So, when we have to interpret long sentences, we need to take

notes quickly. We learned to use something like codes for that. In my opinion, that is a

new skill for me, and it is a useful skill.” (T1)

“How to write codes in notetaking so we can do it fast enough. It is difficult. I have to

62
 keep practicing and that is so useful when taking the final exam.” (T5)

“I think the most important when interpreting is grasping the most important

messages and remembering them, so nothing is missed. But we also have to be fast, or

we miss what people say. So, the lesson about taking notes in codes is important.”

(T2)

“This program is about promoting MT, right? Several years ago, my friend came to

Taiwan to seek medical treatment. They didn’t have a medical interpreter and that

hospital just told her the cost without explaining anything. It was a huge sum of

money, more than NT$ four million. Of course, my friend was in shock. She felt like

they were doing business. We need to use a medical interpreter to explain to medical

tourists, so they will come again and tell their friends back home about our service. I

am a tour guide, so, knowing about this MT stuff is very useful so I can tell the

Indonesian tourists about Taiwan’s medical strength. To inform them of the

comparison with Singapore and Malaysia.” (T3)

“I have this kind of experience, that’s why during training I thought... ah... this is

really useful... we didn’t only learn about translating and interpreting but also the

channel, so I can inform Indonesians who want to seek medical treatment here how to

do it, where to go, what to prepare, et cetera.” (T4)

Since medical interpreters’ roles and codes of ethics are not included in the

curriculum, the current researcher tried to understand how the trainee interviewees perceive

the significance of medical interpreters. The trainee interviewees were asked about the

distinctions between interpreting for patients in medical encounters and interpreting for other

purposes. Interviewee T1 stated that sometimes patients may need to have medical terms

explained to them.

“Because layperson may not understand medical terms, so, when we interpret,

sometimes we have to also explain... so they can understand. If we use medical terms,

63
 sometimes they are not educated enough. I pity them if they don’t understand. When I

interpret, I want them to fully understand.” (T1)

Since the medical interpreter’s code of ethics was not mentioned in the BMMITP,

interviewee T3’s answer is unexpected.

“If we have decided to work in this field (medical interpreter), we have to have this

kind of heart, you know... treat the patients like our family, then we... er... will be able

to provide the best service for them. But we can’t do the same in the police

department. We cannot have pity for them (the ones dealing with the police).” (T3)

On the other hand, T2 believes the rule for interpreting is the same for every purpose.

“I think it’s all the same, right? He says A, we have to convey A. Do not add or omit

anything. However, if he (the patient) does not understand, we still have to explain.”

(T2)

When questioned whether the trainee participants will advocate for the patients,

interviewee T3 admitted she would if the patients were relatives or friends. On the other hand,

interviewee T5 emphasized that medical interpreters may not make friends or give

suggestions to the patients to maintain “neutrality” and “confidentiality” and admitted that she

learned about it from other interpreting training programs.

Considering that this study seeks to improve future MI training programs, the current

researcher believes it is reasonable to also ask the trainees which of the BMMITP’s topics

they regard as not as significant as the others. Most of the interviewees replied that all the

topics are important. However, interviewees T3 and T4 criticized the “too professional”

medical terminologies. In addition, interviewee T3 stated that the topic of health checkup

procedures took too much time.

“I don’t think we need to memorize the names of all those parts of our brain, right?

Or the medical terms for every disease. Even if we use that specific medical

terminology, the patient may not understand. We still have to explain it or use a

64
 simple term that the patient can understand.” (T3)

“Sometimes the terms are too professional. Actually, it’s difficult for us to memorize

them, right? Besides, patients come with different kinds of conditions, and different

kinds of diseases. We, as interpreters, cannot understand them all. So, just teach the

most frequently seen, the most frequently used terms.” (T4)

“The lecture about health checkup procedures took too long. I don’t understand. We

live here, right? Obviously, we know how to get a health checkup.” (T3)

The Final Assessment. In the interview, the instructors were asked how the final

assessment was conducted and if the final assessment reflected the trainees’ interpreting

competency. Interviewee I1 admitted that it was too early to judge the trainees’ competency

after such a short training time, while interviewee I2 gave a more subtle answer.

“The final assessment was divided into three rounds. In the first round, the trainees

were asked to interpret a short paragraph containing about three to four sentences

from Bahasa Indonesia to Mandarin read by the instructor who was a Bahasa

Indonesia native speaker. In the second round, the trainees were asked to interpret

short dialogs from Mandarin to Bahasa Indonesia, read by one of the instructors who

was a Mandarin native speaker. At the third round, trainees were expected to take

turns interpreting in role plays with previously prepared authentic conversations. All

the exam problems are simulation of daily conversation in healthcare services.” (I2)

“The final assessment only reflects part of the trainees’ interpreting competency.

Stress factor also influences their test results. Besides, as they interpret more at

healthcare facilities, they will improve.” (I2)

When the trainees were asked about their perceptions of the final assessment, the

answers varied. T1 opined that the final assessment was great, “according to its proportion”

(T1). T4 found the final assessment was average. On the other hand, T2, T3, and T5 claimed

that in comparison to previous training programs they had ever engaged in, this program’s

65
final test was the hardest one.

“That one when you have to interpret immediately after you listen to the statement.

That one is so difficult!” (T2)

“This one class, I can say, the class with the most difficult final exam that I had been

gone through.” (T3)

“The final exam was so difficult... I was so nervous (laugh)...” (T5)

Certification. The trainees at the BMMITP will receive certificates after completing

the program (attending at least 40 hours of training) and successfully passing the final

assessment. The certificates are distributed by the officials of the MOHW and the TTFMT. It

is important to note that the certified trainees will be given priority in future employment

recruiting, as is mentioned in the training announcement letter.

“The officials from the Ministry of Health and Welfare were also here to issue the

certificates. They wish that with this .... more... more comprehensive training, the

trainees will become more qualified medical interpreters and make fewer mistakes

when interpreting for medical purposes.” (P)

When the trainees were asked about their perceptions of the certificate, the answers

varied. Interviewee T1 opined that the certificate served as evidence that “we had been

trained at this training program for this amount of time.” (T1). Interviewee T3 claimed that

the certificate is very valuable, and it would be unfair if healthcare facilities still employ

uncertified medical interpreters.

“For me, this certificate is very useful, very valuable. Especially because it is issued

by the government. And I will be very frustrated if, for example, out there ... at the

hospital or anywhere... when they need an interpreter, they just employ anyone ... or...

the migrant workers’ agent, they think because they are the ones accompany the

migrant, then they can understand everything ...” (T3)

Interviewee T2 had a similar opinion.

66
 “... he (potential employer) would inquire... which types of training have you

received? Where? Who conducted the training course? It makes sense that people may

question the training program if the institution running it is unqualified, right?” (T2)

However, interviewee T2 also complained about the lack of detailed information on

the certificate.

“A fellow trainee said that the certificate was useless because there were no grades. I

asked what the scores are for ... Yes... at least we know our weaknesses and strengths.

Not just showing that we had completed the course. And I kind of agree with her.”

(T2)

While the other participants only saw the certificate as evidence of training, T4 made a

connection between the certificate and professionalism.

“The certificate? Useful! Because it proves professionalism. This occupation is

professional. So, we need a certificate. Imagine, we... we... the ones who understand

Bahasa Indonesia, right? The ones who were born in Indonesia, right? To teach

elementary students... the schoolbook... only “Selamat pagi, Ibu Guru!” (English

translation: Good morning, Teacher!), we have to be trained and certified, let alone

medical interpreters... ha ha ha...” (T4)

Registration. Interviewee P stated that following certification, the trainees’ data will

be registered to interpreters’ talent pools on the immigration department’s and the TTFMT’s

websites.

“... the talent pool is categorized into a variety of languages spoken by these talents.

The talent pool is linked to the immigration department’s database, and every

healthcare facility affiliated with TTFMT has access to this database.” (P)

The existence of these talent pools was confirmed by other interviewees.

“... and then our names were entered into... what was it called? The immigration....

the translators.... it’s a platform for translators and interpreters...” (T1)

67
 “Our names were registered into two talent pools, the immigration department’s and

the TTFMT’s...” (T3 and T4)

Interviewee T5, who had worked for government-affiliated institutions such as those

providing foreign workers’ and migrant spouses’ protection for more than six years, recounted

the history of this talent pool.

“There was a mister Chen from the immigration department... he established this

interpreters’ employment database. After the training program, our names were

included in the database so when anyone or any institution needs an interpreter, they

can search in that database.” (T5)

However, despite the fact that numerous public and private organizations had access to

the immigration department's talent pool, all trainee participants in this study- with the

exception of two participants (Q21 and Q22)- confessed that they had never been offered to

interpret for healthcare facilities through such talent pool. Even interviewee P admitted that as

far as she knew, Shin Kong Wu Ho-Su Memorial Hospital had never employed the trainees

from the BMMITP.

“No! As far as I know, no. Because, to put it this way, these people are actually

migrant workers, they will still be brought by the employer or their agent, or he has

friends in Taiwan. Besides, there is a physician in our hospital who came from

Indonesia, and he is always willing to help patients who speak Bahasa Indonesia.” (P)

Many interviewees questioned the effectiveness of the talent pools. It seems like there

is an under usage of the talent pools for finding trained medical interpreters. This can be seen

in the case of interviewee T2 who works as a medical interpreter in a public health center in

northern Taiwan. The interesting part is that interviewee T2 was introduced to the public

health center as a certified medical interpreter by a nonprofit organization that works closely

with new immigrants rather than being recruited from the talent pool on the immigration

department’s website. Other participants such as interviewee T5 and participant Q14 also

68
interpret for governmental health facilities. While interviewee T5 is asked to interpret because

her name is in the immigration department talent pool for community interpreting (even

before she was enrolled in the BMMITP), participant Q14 is called mostly due to her

familiarity with the clients.

Most participants (four out of the five interviewed trainees) believe that the talent pool

is not ideal enough. Interviewee T2 stated that the immigration department’s talent pool is for

all community interpreters, not only medical interpreters. Three out of the five trainees

interviewed believed that the healthcare system should have its own trained medical

interpreter talent pool.

“There should be a database specifically for medical interpreters. Like that of the

police... the police department has the data for everyone trained at the interpreter

training programs for the police department.... which training program, what year,

what language... the district, they can find it there.” (T2)

“Talent pool specifically for medical interpreters! We are trained as medical

interpreters. So, we should be grouped into one group made specifically for medical

interpreting purposes. Because I know there is a group specifically for court

interpreting. Only people trained in court interpreting are called to interpret in

court.” (T4)

Interviewee T5, who had a lot of experience translating and interpreting for

government institutions, acknowledged that requests to interpret (not necessarily for medical

purposes) came from a variety of locations, including Keelung, Taoyuan, and Hsinchu.

Interviewee T5 offered a suggestion for a better-organized language service for Taiwan’s

healthcare system.

“... because we cannot predict the precise location in which a medical interpreter will

be needed, we hope that there will always be medical interpreters at healthcare

facilities... if the government will. Every hospital should have its own talent pool, for

69
 example, hospital X should have ... say... five medical interpreters working shifts. They

must be present, standing by, whether or not there is a patient who needs an

interpreter.... Not calling an interpreter only when there is a patient. Commuting from

our house also takes time, you know... It’s similar to an immigration office. The

interpreter is standing by.” (T5)

Raised Issues. During the interviews, there were four raised issues related to the

training of medical interpreters: medical interpreting ethics, psychological issues, cultural

issues, and other possible benefits of training MI for Bahasa Indonesia-Mandarin language

pair.

1. Medical Interpreting Ethics – The issue of ethics had been brought up while discussing the

difficult aspects of interpreting in the healthcare system. Interviewee T1 mentioned the

importance of knowing what medical interpreters can do to gain the trust of both the patients

and the healthcare workers. The majority of the trainee interviewees believed they should be

informed about what medical interpreters should and should not do in certain situations.

“I think it’s very important (learning about medical interpreting ethics). Sometimes

when the patients suffer serious illness, we have to know how to tell them, so they

won’t be too scared. I think we should be taught the strategy to talk to patients with

sensitive cases. Our language, our gestures, how we communicate, our expressions...

all are very important because they are going to look at us, the medical interpreter,

and how we deliver so they can trust us. So, this is very important!” (T1)

When asked what they would like to suggest for future BMMITP, interviewee T2

suggested to include medical interpreting ethics, while interviewee T3 gave an interesting

opinion about outfits.

“Ethics! And if there is ever... advance training class, it must be taught again... to be

reminded again. Sometimes interpreters like to forget. Yes...” (T2)

“Clothing! I had seen other interpreters’ poor choices of outfits. In the company

70
 where I work, we have dress code. White shirt, black pants, et cetera. Personally, I

think the way we dress shows our professionalism too.” (T3)

2. Psychological Issues – Interviewee T4 was asked to share her interpreting experience and

she told this story:

“Once I helped interpret for a patient, I saw another patient with cancer. I thought

‘what if I have to interpret for that patient? What if the cancer is at the terminal

stage? As an interpreter, I believe our feelings will be affected too. When the patient is

devastated, it’s impossible for me to not feel anything at all. We may feel deeply sorry

and that will affect us emotionally. This is hard for me. I used to enroll in the court

interpreting training program. There was a psychologist giving a lecture. What we

should do if we are faced with, for example, a murder case? Scary, right? Something

like that... We should have the same lecture in MI training programs.” (T4)

3. Cultural Issues – During the interview, instructor I2 mentioned cultural differences. He

elaborated:

“This happens quite often. When patients want to talk about genitals or sexuality, they

often struggle for words, and the interpreter also struggles to interpret. Maybe the

interpreter feels reluctant to talk about it. This should be addressed in the training

program. The trainees should understand that professional medical interpreters

should know how to handle this kind of emotion. They have to understand that this is

professional communication.” (I2)

4. Other Possible Benefits of Bahasa Indonesia-Mandarin MI Training Programs – During

the interview, interviewee T4 mentioned the possibility of medical interpreters’ employment

to cater to immigrants who have resided in Taiwan for a long time.

“... that is great that you often use your mother tongue at home now with your

husband. My husband cannot speak my first language and I use it in my thoughts. I

think when I am old, and I am not so alert anymore, maybe I will only speak using my

71
 mother tongue, and I will need an interpreter then.” (T4)

On the other hand, interviewee I2 mentioned the possibility that in the future, it is

possible that medical interpreters for other languages will be needed more than Mandarin-

English.

“... this training program is important, also..., if you remember about that ... er...

Taiwan Bilingual 2030 Plan? Most physicians can speak English nowadays, and

maybe all healthcare workers too in the future, at least if the Bilingual 2030 Plan

works out.” (I2)

The above data shows the trainees’ positive experiences with the BMMITP; however,

they also have concerns about their future development. The following subsection presents the

trainees’ professional development after the training program as a way to depict how effective

the training was to the participants.

4.1.2 The Professional Development

This subsection presents information gathered from this study’s participants regarding

the factors that reflect a trained medical interpreter’s professional development such as the

trainees’ motivation for enrolling in the BMMITP, the employment experiences, the

remuneration, legislation and funding, their professional development in terms of in-service

training and meet and share, and issues raised in the interviews related to topics discussed in

this subsection.

Trainee Participants’ Motivation. The trainees’ motivations for enrolling in the

BMMITP may show their enthusiasm for being a medical interpreter, which hopefully reflects

their passion and will further encourage professional development. This helped the researcher

understand the trainees' experiences with the BMMITP and their perceptions of the training

program. The participants were allowed to select more than one motivation. The responses

from the trainees are shown in Table 14.

72
Table 14
Reasons for Applying for the BMMITP

Reasons Number of Participants Percentage

I want to have other job options 17 70.8%
To be able to support the family financially 9 37.5%
To help other new immigrants 18 75%
To learn more about medicine 18 75%
Others 3 12.5%

Note. Arranged by the current researcher

Table 14 shows 75% of the participants chose “to help other new immigrants” and the

same amount chose “to learn more about medicine”. It does not necessarily mean the same

participants opted for both. While 70.8% of the participants chose “to have other job options”,

only 37.5% chose “to support the family financially”. In addition, three participants selected

‘others’ and also provided explanations for the choice. All of the options including “others”

were checked by participant Q1, who stated that the “knowledge obtained may be useful for

my family”. Participant Q17 selected “to help other new immigrants” and “others”.

Participant Q17 explained the “others” option as “want to also help Indonesians who seek

medical care in Taiwan”. Another participant (Q23) selected only “others” and stated that

“language ability certification in medical care” was the reason for applying for the training

program.

While interviewee T1 acknowledged that the curriculum “looked great” as the reason

for enrolling, T3 had other considerations:

“First, because it is medical-related. Medical implies professional, right? Second, the

certificate is the one I truly want. Because it comes from the MOHW’s international

medical task force, if I am not mistaken, right? Typically, private institutions require

our government-issued certificate when we seek jobs as interpreters there.” (T3)

Other trainee interviewees gave a similar reason - to expand their knowledge,

particularly in the medical field. The above data shows the trainees’ altruistic attitude and

73
their high motivation to be medical interpreters.

Employment Experiences. The information about the participants' occupations and

how frequently they had interpreted in medical settings is initially offered in order to

comprehend the participants' employment experiences. As it is not uncommon for individuals

to have more than one occupation, the participants were encouraged to check more than one

option of occupation if necessary. The respondents’ occupations can be seen in Table 15. For

the purpose of this study, the trainee participants’ interpreting experiences in healthcare

facilities do not have to be professional encounters. Any relevant experience is considered

interpreting in the healthcare system, whether simply assisting a few migrant workers who are

seeking medical treatment or being paid to interpret for a clinic that serves migrant spouses or

medical tourists. The trainee participants’ interpreting experiences in the healthcare system

are listed in Table 16.

Table 15
Trainee Participants’ Occupations

Occupations Number of Participants Percentage

Paid Medical Translator/Interpreter 7 29.2
Volunteer Medical Translator/Interpreter 5 20.8
Interpreting in healthcare facilities full time 3 12.5
Self-employed 4 16.7
Work in a company/factory 9 37.5
Domestic Worker 2 8.3
Others 13 54.2

Note. Arranged by the current researcher

As seen in Table 15, most participants ticked both “others” along with other options.

The other occupations include language teachers, research assistants, graphic designers, and

tour guides. Actually, the data in Table 14 is revised information as a result of private

messaging with the participants. The current researcher found some inconsistencies in the

participants' responses. For example, there were five participants (Q11, Q14, Q16, Q18, and

74
Q23) who only chose “medical interpreter” as their occupation. However, their responses to

other questions did not match. Upon further investigation, it appeared that participants Q11,

Q16, and Q18 made incorrect choices. Participant Q11 works as an interpreter but not a

medical interpreter. While participant Q16 is an employee at a corporation, participant Q18 is

a language teacher. Participant Q14, on the other hand, has been employed as a medical

interpreter for 11-15 years and has provided services more than 30 times interpreting for

migrants, but never for medical tourists. Participant Q23 is a physician who primarily aids

migrants as a medical interpreter. Considering the number of participants, this study could not

afford to lose any respondents, therefore, private messaging was used to inquire about the true

answers.

Table 16
Distribution of the 24 Trainees Regarding Experiences as Medical Interpreters

Experience Number of Participants

Years interpreting in medical settings Never 4
< 5 years 12
6-10 years 5
11-15 years 2
16-20 years 1
Times interpreting in medical settings for Never 6
migrants 1-10 times 8
11-20 times 1
21-30 times -
> 30 times 9
Times interpreting in medical settings for Never 20
medical tourists 1-10 times 4
Have ever interpreted for friends or family Yes 10
without pay Never 14

Note. Arranged by the current researcher

As in Table 15, the data in Table 16 is also revised information after private

messaging with the participants to ensure the accuracy of the information they shared. Table

16 shows that the majority of the participants have interpreted in healthcare facilities only for

75
less than five years. In addition, only three participants have ever interpreted for medical

tourists. Although a total of 83.3% (20 out of 24) participants have provided medical

interpreting, only 29.2% of the participants identify being a paid medical interpreter as one of

their occupations. The unpaid tasks include interpreting when accompanying friends to

hospitals for medical treatments; interpreting for migrant workers who worked for the same

company when they needed medical treatment at hospitals or clinics; interpreting for friends

having health check-ups at hospitals; interpreting for a patient with gastritis at Mackay

Hospital and interpreting for an uncle who underwent catheterization at Tzu Chi Hospital.

All of the interviewees acknowledged that most of the time Taiwan’s healthcare

facilities do not employ trained medical interpreters. According to interviewee P, patients are

frequently accompanied by someone who serves as their interpreter, and that is one of the

reasons trained medical interpreters are rarely employed.

“... as a matter of fact, this (employment of trained medical interpreters) happens

rarely. Mostly because the patients bring their own acquaintances acting as

interpreters, maybe because they thought their condition is not severe, as long as they

do not eat the wrong medicine, it will be okay.” (P)

Interviewee P’s statement was confirmed by other interviewees. Interviewee I2 shared

how he communicates with LMP patients from Southeast Asia without trained medical

interpreters, while interviewee T3 admitted that she often accompanied migrant workers who

lived nearby seeking medical treatment even before enrolling in any medical interpreting

training program.

“I often treat patients from Vietnam, Thailand, the Philippines, and Indonesia.

Usually, when the patient cannot speak Mandarin, the employer or the agent will

bring an interpreter. However, when the interpreter is not good enough, I have to use

very simple phrases and sign or body language, or even visual aids... to avoid

misunderstanding.” (I2)

76
 “... they usually told me, my this or that hurts... what should I do? I would tell them

where the closest clinic or hospital is located and they would say, ahh... I can’t speak

Mandarin... So, I would accompany them when I had time...” (T3)

Another intriguing practice among healthcare providers is calling the hotline set up by

the government for foreign workers’ protection and asking the employer on duty to interpret

for them.

“When I worked for a hotline service for foreign workers, I often received calls from

hospitals. Err... would you please help me interpret? What does this patient say?

Usually, they are migrant workers. So, I interpreted for them... So, I think it is very

important that hospitals have their own interpreters.” (T2)

On occasions when an interpreter is really needed, some healthcare providers will ask

their bilingual staff to help with interpreting for LMP patients, as was told by interviewee I2:

“... also, when there is no medical interpreter around, I will have to leave my work to

interpret for them...” (I2). When asked how often interviewee I2 has to interpret for co-

workers, the answer was “... around once a week to once a month.”

On the other hand, some healthcare facilities have bilingual volunteers who may act as

interpreters when needed, as was told by interviewee T1:

“There are many now... some friends are volunteers standing by at the hospital,

right?... such as public health centers, it is great actually...”

While participants such as Q14 and interviewee T5 are often called to interpret for

LMP patients at random facilities, they are not full-time employees at any particular

healthcare facility. Fortunately, some clinics do employ trained medical interpreters full-time.

At the time of the interview (September 2022), interviewee T2 works as a part-time

interpreter at an institution and also has been employed in a clinic in northern Taiwan as a

medical interpreter for about four months.

“Currently I am working at a clinic in northern Taiwan as a paid medical interpreter.

77
 But we work on shift... scheduled times.” (T2)

Being called to interpret in healthcare facilities without an appointment can be

frustrating at times. Medical interpreters may need time to prepare especially for novices.

Even veteran medical interpreters will appreciate knowing the case in advance. Being

prepared improves communication. Interviewee I1 emphasized to the trainees that whenever

possible, they need to ask about the case in advance. However, the majority of trainee

interviewees admitted that most of the time they were never told about the case.

“If the call is from hospitals, they usually just ask ‘Can you please come here right

away? There’s a foreigner in need of medical attention here.’ Simply that... However,

whether interpreting for the police, the judicial system, or the health department, they

often inform us about the case in advance. For example, the health department may

contact me, ‘There’s an Indonesian, who just arrived here, oh... he has COVID, so you

need to interpret about quarantine, etc...’ Yeah... and in the police department, they

have a case and may need to conduct an interrogation, they will let me know what

questions they are planning to ask.” (T5)

“For the judicial system, they always inform me in advance of the case’s specifics,

and why the person seeks legal aid. A friend who works as a court interpreter told me

that they even allowed her to read the decree so she can prepare in advance.” (T4)

The above information implies the need for medical interpreter users to understand

how to collaborate with medical interpreters. They need to be aware that medical interpreters

are colleagues rather than employees of the healthcare providers. If everyone works as a team,

communication will improve. As mentioned before, communication is crucial in medical care.

Remuneration. This study finds that there is no standard remuneration because

different interviewees gave different numbers. For example, interviewee P indicated NT$300-

500 per hour for untrained medical interpreters.

“...about NT$300-500 per hour for untrained medical interpreters. Naturally, this

78
 compensation can be increased the more qualified the interpreter is and the more they

contribute to improved communication....” (P)

However, interviewee T5 who is an experienced and trained medical interpreter

complained because she receives more or less the same amount as the untrained interpreters.

On the other hand, interviewees T1 and T2 gave different information. Interviewee T2 works

on shift and receives monthly payments, but also receives hourly pay when called outside of

the shift hour. Furthermore, she also expressed her frustration with the payment system.

“At the police department, the fee is NT$350 per hour, then there is an additional

NT$500 for the transportation fee. However, for this medical interpreting, after so

much difficult training and exam, the fee is still the same with the other untrained

interpreters. I think it is so unfair.” (T5)

“I receive a monthly wage and work in shifts. But I have heard that some medical

interpreters get NT$800 per hour. Other types of interpreters such as those who work

for the police are only paid NT$300 per hour plus some transportation fee. However,

the most absurd and unfair scenario is when the location is quite far away and then

we have to wait... and then we only get to interpret for, say... an hour. We lost so much

time without pay!” (T2)

“Around NT$800-1,000. I only get around NT$500 for interpreting in the police

department.” (T1)

Contrary to other interviewees, interviewee T3 admitted to higher remuneration.

“I am paid NT$800 per hour as well as an additional NT$800 for the transportation

fee. But this transportation fee depends on the location, the hourly rate is fixed. So,

NT$1,600 for two hours, but that is reasonable, right? I believe that the pay for

medical interpreters should be at least NT$1,200.” (T3)

While other participants believe medical interpreters are paid the most among the

community interpreters, interviewee T4 has different information. According to T4, of all

79
community interpreters, those in the judicial system are paid the most.

“Interpreter friends who work in the judicial system are paid well. Several friends told

me they can earn up to NT$4,000, more or less. That is why when they are already in

the circle... interpreting for the judicial system, they remain there. As I told you

before... they stay there because the salary is good.” (T4)

The above data shows that there is no standard remuneration for medical interpreters.

The fees vary widely with different employers and in different locations. According to

interviewee I1, this may lead to fewer people wanting to continue working as medical

interpreters.

“Yeah... maybe it is difficult to find trained medical interpreters because the reward is

not attractive enough to stay in the profession. Maybe because the government doesn’t

provide enough budget for this.” (I1)

Legislation and Funding. Interviewee P claimed that, unlike the legal system, there is

no stringent legislation governing the employment of medical interpreters in healthcare

facilities, and that is one of the reasons there are no standard medical interpreters’ fees.

“.. at the immigration department, at courts, it is pellucid. I want this regulation. But

in the medical system, as a matter of fact, there is no such strict regulation yet. It’s

true.” (P)

When discussing the legislation of employing trained medical interpreters in

healthcare facilities, interviewee T4 provided many instances of the employment

circumstances for interpreters working for various institutions in Taiwan and compared them

with the healthcare system.

“... for young children coming here from Indonesia, who cannot understand enough

Mandarin yet. They have to go to school, right? Cannot understand what the teachers

say, so we were sent there to translate. The teacher explains, and we interpret. Or at

exams, they cannot read the questions. We help them translate. That is funded by the

80
 ministry of education through foundations. The foundation trains us. After training

and passing the test, we can work at schools to help that kind of student. Another

example is migrant spouses. They were just married, right? Maybe they have problems

with their husbands, problems with documents, right? There are things they do not

understand, they just arrived from other countries, just arrived in Taiwan, they still

feel unfamiliar, still don’t understand, right? Still haven’t adjusted. So, they can go to

the new immigrant association where interpreters are on standby.... We were trained

in this medical interpreting training program... we should be grouped into medical

interpreters. Because I know, for the judicial system, for the court, they have a special

group. Only people trained in their court interpreting training program will be called

to interpret in courts. So, the same regulation should be applied to medical

interpreters, right? I mean, we are specifically trained, we should be specifically

called, just like those interpreters in the judicial system.” (T4)

The majority of the interviewees believe the main reason for the lack of employment

and legislation is the lack of budget for medical interpreters.

“When I worked at a hotline for migrant workers support, I frequently received calls

from hospitals asking for help interpreting. It’s not easy interpreting through

telephone calls. I think hospitals should employ their own medical interpreter. Like

that for the police department, they must have a budget to provide medical

interpreters.” (T2)

“... hospitals should have a policy, should have a budget... for medical interpreters.

They should have their own interpreters’ data pool categorized by languages or

locations, district, or city, so it will be easier to find a medical interpreter when

needed. Or... for example, during this pandemic time, we can interpret online. Several

days ago, I substituted at a public health center in northern Taiwan and saw a

computer on a table. They said the computer is there specifically for sign language

81
 interpreters. We cannot use it for anything else. And I thought, cool... just for online

interpreting, just for sign language interpreting... Maybe other languages need this

kind of tool too. That was what I thought.” (T2)

The above data shows the participants’ concerns about legislation and funding as

obstacles to the development of a medical interpreter’s career.

Professional Development. As mentioned in section 2.5, professional development

refers to the development of trained medical interpreters by means of in-service training, meet

and share, information sharing about new medical terminologies, et cetera. As for the trainees

of the BMMITP, there is no in-service training or formal meet and share organized regularly,

and no information sharing either. None of the participants is a member of any professional

medical interpreters’ association. When asked whether they routinely meet and share with

other interpreters, which is typically the first step in the formation of a professional

association, 71% answered “sometimes” (please see Figure 11 for how often participants meet

and share with fellow interpreters). This question is also intended to explore the trainee

participants’ enthusiasm to become part of the interpreting community despite the number of

cases they had worked on.

82
Figure 11

Trainee’s Meet and Share with Fellow Interpreters

MEET AND SHARE WITH OTHER INTERPRETERS

Regularly Sometimes Never

Regularly
Never 8%
21%

Sometimes
71%

Note. Arranged by the current researcher

Figure 11 shows that 21% of the participants have never met and shared with fellow

interpreters, whereas more than 70% occasionally do so. Only 8% of the participants meet

and share routinely with their fellow interpreters. Despite the circumstances, personal

professional development based on participants’ motivation was detected in the study as was

told by interviewees T2 and T3. Both interviewees talked about reading as many health

articles as possible or listening to health-related news or speech for personal development.

“The interpreter’s certificate for interpreting in the police department expires after

two years. The training program to be an interpreter at the police department is held

frequently. We are expected to apply every year, at least once every two years. That

way we won’t forget what we had learned and the chance to be given an interpreting

job is higher if you are actively joining the training program.” (T2)

“If we are in this kind of profession, we should read a lot of medical... I mean... health

articles, right? If we read every day, over and over again, it will be easier to

83
 remember (medical terms).” (T3)

Raised Issues. There were four unexpected issues raised in the interviews related to

the professional development of trained medical interpreters: how healthcare facilities select

the interpreters they employ, the rights of LMP patients for language services, advanced

training courses, and professional association.

1. How healthcare facilities select the interpreters they employ - It is an issue of “relation”,

according to interviewee T3, not whether one is certified as a trained medical interpreter.

“... because they have known the interpreter before, because they think... ah... she

often accompanies migrant workers, or she is a volunteer... she knows Bahasa

Indonesia, then she must also know Indonesian medical language, and can interpret in

the hospital. They don’t care about certified or not. And I don’t agree. You see... why

do you establish this training program? We work hard, spend much of our time, we

really learn hard. I can say, this course’s exam is the hardest one. Yet, we don’t get

that employment opportunity?” (T3)

2. The rights of patients for language services – The patients’ unawareness of their rights to

language service, according to interviewee I2, is one of the factors contributing to the

underutilization of trained medical interpreters. Interviewee I2 offered a suggestion that

would benefit LMP patients without placing an undue financial burden on healthcare

providers.

“... as far as I know, trained interpreters will be provided for people with LMP in

police stations. I think hospitals should provide trained medical interpreters, too. At

least, patients should be asked if they need an interpreter. If they say so, then a trained

medical interpreter should be provided.” (I2)

The above data shows that there is no organized system for the employment of trained

medical interpreters in Taiwan’s healthcare system. Healthcare providers do not pay attention

to whether the medical interpreters are trained, and the talent pools are not used optimally.

84
Moreover, there is no attention paid to the rights of LMP patients to language services.

3. Advanced Training Courses – During interviews, participants were very passionate about

their professional development. While interviewee T2 proposed regular renewal of

certificates, interviewees T3, T4, T5, as well as I2, suggested advanced training.

“The certificates for interpreters who have received training in interpreting for the

police state that the credentials are only valid for two years. So, you have to enroll

every two years, so you won’t forget. If you do, the chance to be called is higher.”

(T2)

“Advanced class! Right? And then... if it is feasible, right... if we want to be really

professional, I think, for example, errr... once a year, or twice a year.... we arrange to

err... give reports or whatever... something medical-related... you know... So, it won’t

be like, after this training, and then... nothing. We could lose our medical language

proficiency without a career in medical interpreting and from a lack of use. However,

if there is, for example, class A1, A2, and higher, we are forced to learn and learn

again.” (T3)

“It would be great if we have in-service training. As a beginner, we can be very

nervous interpreting for physicians for the first time, so in-service training will be very

helpful. Especially for cases involving sophisticated procedures which Taiwan’s

healthcare can do better than Singapore or Malaysia, right? We can emphasize

interpreting for this field of treatment.” (T4) – who is very passionate about MT.

“If only we belong to an organization that regularly manage short training for

information updates. Because there are always updates in the medical field, right?

New products, new stuff... those need updates.” (T5)

4. Professional association – Although interviewee T5 used the term “organizations” rather

than “professional association”, the current researcher believes they are similar in this context.

“... organizations to arrange courses, to update information. There is always

85
 something new in the medical field, right? There are always new products, new

things... for example, new disease names, these things need updating.” (T5)

4.2 Discussion

As aforementioned, this study aims to investigate eight factors that impact language

access development, namely:

1. Training for medical interpreters

2. Certification system

3. Public provision of trained medical interpreters

4. Employment of the trained medical interpreters

5. Remuneration

6. Training for medical interpreter users

7. Professional development of the trained medical interpreters

8. Advanced training for medical interpreters (which contents include interpreters’ roles,

professional ethics/standards of practice, specifics of different healthcare types, and

transcultural competence)

In this section, this study’s findings are discussed and interpreted to answer these

research questions:

1. Which of the above eight factors are identified as conducive to language access for LMP

Indonesian in Taiwan’s healthcare system by the trainees, the instructors, and patrons

(henceforth, the participants)?

2. Which of the above eight factors are identified as neglected by the participants?

3. Which of the above eight factors are identified as conducive in the curriculum and the

teaching materials?

4. Which of the above eight factors are identified as neglected in the curriculum and the

teaching materials?

The study’s findings are discussed in eight separate subsections according to the eight

86
factors investigated. It is worth mentioning that while the number of questionnaire

respondents from the first year (2020) and the second year (2021) are the same, 80% of the

interviewed trainees are from the first year. It denotes that they have had their certificates for

a longer period of time and are more likely to have had experience interpreting in healthcare

facilities. In addition, considering that there is only one Moslem participant and based on this

participant’s past experience, the religious factor does not seem to play a role in this medical

interpreting program as was suggested by previous studies (Chen & Chiou, 2009; Shih, 2020).

However, this one participant may not represent the overall population of Moslem medical

interpreters in Taiwan.

4.2.1 Training for medical interpreters

The various medical interpreting training programs conducted by various private

institutions as well as the Taiwanese government in which the participants in this study had

participated prove attempts are made to train more qualified medical interpreters. One of the

training programs funded by Taiwan’s MOHW is the BMMITP. However, there are many

factors that may impact the level of training such as the application requirements, the choice

of instructors, the content of the training, and the length of the training course.

As mentioned in Subsection 4.1.1, the application requirements for enrolling in the

BMMITP include native speakers of Bahasa Indonesia, having completed at least senior high

school, and having attained Mandarin proficiency at least at level B1 of the CEFR. Lin and

Yang (2021) also suggested level B1 of CEFR for Mandarin proficiency as the minimum

requirement for interpreters. All trainees met the application requirements. Moreover, out of

the 24 trainee participants in this study, three graduated from senior high school and 21 had a

university degree. This is contrary to Lin and Yang’s (2021) finding. Lin and Yang stated that

it was difficult to find interpreters with a college degree or above in Southeast Asian

languages. Although Lin and Yang did not mention Indonesian interpreters, they specifically

stated that most of the Vietnamese interpreters in the immigration department’s talent pool

87
had an education level of middle school and high school.

In addition to qualification requirements, the choice of instructors also impacts the

overall quality of training results. Other medical interpreting training programs (e.g., the

Multilingual Talents Special Training Class for International Medical in Kaohsiung and the

reproductive health interpreting training program) are taught in Mandarin for trainees

speaking different languages. These trainees from different language backgrounds are

expected to find the equivalent medical terms for their languages on their own. At the

BMMITP, three instructors are native speakers of Bahasa Indonesia and teach in both

Mandarin and Bahasa Indonesia. Learning medical terms through a non-native speaker may

pose challenges and potentially cause misuse of terms. For example, one of Shih’s (2020)

participants stated that she never heard of Bacille Calmette-Guerin (BCG) vaccine in

Indonesia; while in reality, BCG vaccines had been given to Indonesian babies for decades. It

is quite likely that a native speaker instructor who is proficient in the medical language of

Bahasa Indonesia will be aware of this information.

The following is another example of the importance of a medical language instructor

who understands Bahasa Indonesia’s medical language. Every year, all the BMMITP trainees

of that year are members of a social media group where trainees can communicate with the

three Bahasa Indonesia-speaker instructors. One of the trainees asked for the translation of 蕁

麻疹(hives or urticaria). Another trainee answered with “gabakan”, which actually means

“measles”. The current researcher told them the correct answer, which is “biduran”. The

mistranslation of “hives” into “measles” is too risky to be ignored.

The length and the content of the training also impact the quality of the trainees. The

total training time of the BMMITP is 48 hours, of which eight hours are devoted to topics

related to medical tourism, four hours are dedicated to medical interpreting skills, and 32

hours are to medical knowledge and medical language. The medical-related knowledge taught

in the BMMITP is more comprehensive, while the interpreting training program for the

88
reproductive health of migrant spouses focuses mainly on the migrant spouses’ fertility issues,

pregnancy, childbirth, and childcare (Chang et al., 2014; Fan, 2011; Lin & Yang, 2021). The

top five topics included in the interpreter training programs listed by Chang et al. (2010) were

breastfeeding, antenatal consultation, contraception education, newborn care, and

understanding baby foods. Training medical interpreters exclusively in these areas is probably

insufficient since there are more migrant workers than migrant spouses in Taiwan. Given that

the goal of this training program was to promote medical tourism, it is understandable that

there were so many hours allotted for topics such as international medical services and

various medical knowledge. It is very likely that the teaching hours of these topics are related

to the trainee participants’ perceived knowledge learned (as presented in Subsection 4.1.1).

Another significance of the BMMITP is the use of authentic scenarios for role plays in

medical interpreting drills as was also suggested by Shih (2020). Following the interpreting

drills, the instructors (I2 and the current researcher) always perform error analyses and

provide feedback to the trainees in accordance with Refki et al.’s (2013) suggestion. The role

plays were also utilized in the final assessment. The BMMITP’s final exam is a three-part

assessment: interpreting short paragraphs from Bahasa Indonesia to Mandarin, short dialogs

from Mandarin to Bahasa Indonesia, and interpreting in role plays with simulated real-life

medical communications. On the other hand, the oral final test of other interpreting training

programs used pre-recorded text that was read by a native speaker (Lin & Yang, 2021).

However, there are important subjects that the BMMITP does not cover such as

medical interpreters’ code of ethics and intercultural communication. These two subjects are

usually covered in MI training programs abroad. Although Bischoff (2020) and Ozolins

(2000) suggested including topics such as interpreter roles, ethics, and standard of practice in

training programs, the curriculum and teaching materials provided by I1 and I2 showed no

such topics. As an insider, the current researcher found that some trainees equate the code of

ethics for MI with that of other types of community interpreting. The importance of this topic

89
was also mentioned by Taiwan’s researchers such as Chang et al. (2014) and Fan (2011). In

addition, while Chen (2013) posited that most physicians ignored cultural differences,

interviewee I2 did give an example of how cultural differences may affect communication.

Moreover, participants in this study also mentioned the need to include cultural and

psychological subjects in the training program.

There are two possible reasons for omitting the code of ethics and standard of practice

from the BMMITP: to avoid overlapping with other community interpreting programs and the

absence of a recognized code of medical interpreter ethics in Taiwan. Other community

interpreting programs in Taiwan might include such topics as was mentioned by several

trainee interviewees, particularly those who enrolled in other interpreting training programs

before the BMMITP. The same concern was mentioned in Lin and Yang’s (2021) study. Lin

and Yang found that each department organized its own training according to its own needs

resulting in no coordination between departments and overlap of topics. However, considering

the significance of medical interpreting, the code of ethics and the standard of practice might

be different from other community interpreting codes of ethics. This may need further

attention from Taiwan’s professional association for medical interpreters.

The above data implies the importance of a well-designed training program to

generate qualified medical interpreters and the need for partnership with other related

departments to avoid wasting resources. Trained medical interpreters are beneficial for many

reasons already mentioned in previous chapters including for elders who have resided in

Taiwan for a long time and used to have good Mandarin proficiency. Previous studies showed

that second language ability may decline in senior citizens. Migrants who learn and use a new

language in their new countries may later in life return to using their first language as their

dominant language (McMurtray et al., 2009; Schmid & Keijzer, 2009). The government and

the public have to get ready for this later demand for medical interpreters.

4.2.2 Certification System

90
 As was mentioned earlier, the BMMITP issues certificates for the trainees who attend

at least 40 hours of training and pass the final assessment. According to the participants of

this study, the BMMITP’s certificate is valuable to show future employers that they had been

trained in the BMMITP which is funded and established by Taiwan’s MOHW. Although

interviewees I1 and I2 hinted that the certificates do not reflect the trainees’ MI competency,

the trainees perceive the certificate to be invaluable as the BMMITP’s final assessment was

the most difficult interpreting exam they ever had.

Despite the fact that the certificate was issued by the government, it is not a license

and cannot ensure that future employers will choose the BMMITP’s trainees above other

interpreters without MI credentials as medical interpreters. Hence, the BMMITP’s certificates

do not guarantee the trainees’ employment opportunities. To overcome this problem,

interviewee T4 recommended a policy requiring healthcare facilities to only hire certified

medical interpreters. However, previous researchers believed that just improving the

certification system would benefit Taiwan’s medical interpreting profession (Chang et al.,

2014; Lin & Yang, 2021).

In sum, the certificate cannot support the trainees’ employment opportunities without

legislation, no matter how excellent the certification system is. According to Ju (2009),

without licensure, assessment for certificates seems like a proficiency test. This lack of

medical policies for LMP patients’ language services was also mentioned by Wu (2018).

Policy planning was included in the secondary characteristics of comprehensive language

access (Ozolins, 2000) and Schuster (2013) also identified the lack of legislation as one of the

hindering factors for the progression of language access.

4.2.3 Public Provision of Trained Medical Interpreters

Upon certification, the trainees’ data was registered in the immigration department’s

and the TNHCA’s talent pools as was suggested by Chang et al. (2014) to meet the public

demand for trained medical interpreters. Unfortunately, the talent pools do not seem to

91
provide many MI assignment opportunities for the trainees. The majority of the trainees had

never been contacted through the talent pools. The under usage of the talent pools was also

mentioned by Chang et al. (2014) and Lin and Yang (2021). According to Chang et al. (2014),

this was due to the fact that most healthcare facilities had their own channel for locating

medical interpreters. On the other hand, the majority of the trainee interviewees claimed that

the websites were challenging to navigate.

It is worth mentioning that a new application was launched in July 2020 to

accommodate the demand for better tools to find trained interpreters (Lin & Yang, 2021). It is

highly probable that the trainees were not made aware of this new application since the

BMMITP’s administrators were also uninformed. It was only found out by the trainees when

interviewee T5 visited the immigration department’s website and was directed to download

the application. Subsequently, interviewee T5 informed other trainees in the social media

group. Interviewee T5 claimed that after installing the application, she discovered that she had

missed a lot of invites since she had not been receiving alerts before the application was

downloaded.

Despite the talent pools’ limited advantages for the BMMITP’s trainees, it is still too

early to say that they are completely useless. As interviewee P stated, it is possible that the

pandemic and a dearth of medical tourists are to blame. It may take some time to determine

whether the talent pools are being utilized to their full potential.

4.2.4 Employment of the Trained Medical Interpreters

As was mentioned in Subsection 4.1.1, twenty out of 24 trainee participants in this

study have provided medical interpreting with three participants having interpreted for

medical tourists in Taiwan’s healthcare facilities. In addition, the majority of the participants

have been interpreting in healthcare facilities for less than five years even though they have

lived in Taiwan for a long time. This might indicate that employing trained medical

interpreters is a very new concept in Taiwan. The data shows the role played by the BMMITP

92
in the employment of trained medical interpreters, despite the fact that only 29.2% of the

participants identified being a paid medical interpreter as one of their occupations.

This study identified a number of potential causes for the lack of trained medical

interpreters’ employment although the trainees are certified and registered in the talent pools.

First, healthcare providers usually hire the same regular interpreters, as was mentioned by

interviewees P and T3. The same situation was discovered by previous researchers such as

Yang et al. (2010). Second, the stakeholders’ unawareness of both the importance of trained

medical interpreters and the provision of language services (interviewees P and I2; Chang,

2014). While many physicians are not aware of the distinction between trained and untrained

medical interpreters (as was also mentioned by Chou, 2019), most migrant workers are

unaware of the language service they can ask for (Wu, 2018). Chang (2014) found that most

LMP patients are unable to locate a medical interpreter. Employing a medical interpreter

should be the healthcare provider’s concern since it is more likely the LMP patients are the

ones lacking resources. Third, the absence of strict regulations to provide language services

and employment of certified medical interpreters as was stated by most interviewees of this

study and Wu (2018). Fourth, the lack of funding for interpreters’ fees. The lack of funds as

the reason for the inability to employ trained interpreters was also mentioned by previous

researchers such as Chang (2014), Kuan et al. (2020), Lin (2008), Pei (2011), and Shih

(2020). The fifth possibility identified by this study is the pandemic. According to interviewee

P, the pandemic may have prevented the BMMITP’s trainees from receiving invitations to

interpret as Taiwan was closed to visitors at the time.

In sum, although most of the trainees are employed as trained medical interpreters,

they do not get their employment through the talent pools. This is contrary to the promise in

the training announcement letter that certified trainees will be prioritized to be employed.

Moreover, they still have concerns including low and unstable income, building rapport with

healthcare providers, and their professional development in terms of medical interpreting

93
skills. All of these will be discussed in the following subsections.

4.2.5 Remuneration

As mentioned before, the remuneration received by the participants in this study for

medical interpreting activities varied in different counties/cities. In addition, different

institutions pay different transportation fees. The average medical interpreter’s salary in the

US is US$25.31 per hour9 (about NT$775), while in Canada, the average is C$31.96 per

hour10 (about NT$718) and €25 per hour11 (about NT$807) in Germany. It may appear as

though the remuneration of Taiwan’s trained medical interpreters is similar to those three

countries; however, the lower pay and fewer cases the BMMITP’s trainees receive lead to

lower overall income.

Participants in this study suspected lack of budget as the cause of low remuneration

and lack of employment opportunities. Lin et al. (2016) and Wu (2018) also mentioned a lack

of budget for employing trained medical interpreters. This poor and uncertain remuneration

compelled many trainees to seek other employment. Participants I1 and T1 argued that

interpreters’ income was not attractive enough for many people to stay in the profession. This

low commitment to interpreting caused by poor interpreters’ income was also mentioned by

Fan (2011) and Dubslaff and Martinsen (2005). Interviewees T2 and T5 mentioned how

frequently they were asked to provide free language services in medical settings. Yen (2013)

also pointed out that public health units in Taiwan still regard interpreters as volunteers. The

current researcher believes healthcare facilities expect bilingual volunteers in healthcare

facilities to be interpreters. Even Chen et al. (2008) suggested the government recruit more

immigrants to be volunteers so they could help with the LMP patients.

It is worth mentioning that the trainees were told during the training course that they

would receive NT$800 per hour as certified interpreters. However, interviewee T5 admitted

9
Retrieved December 10, 2022, from https://www.indeed.com/career/medical-interpreter/salaries
10
Retrieved December 10, 2022, from https://ca.indeed.com/career/medical-interpreter/salaries
11
Retrieved December 10, 2022, from https://www.erieri.com/salary/job/medical-interpreter/germany

94
she still only earns NT$350 per hour. Although no standard remuneration is known, on

average, the BMMITP trainees earn between NT$350-800 per hour for MI. The current

researcher considers it crucial that trainees understand their value and the proper remuneration

for their service as certified medical interpreters.

4.2.6 Training for Medical Interpreter Users

Interviewee I1 emphasized the importance of preparation and discussion with

commissioners before engaging in interpreting activities. However, all trainees admitted they

never had that opportunity. Discussions with employers denote teamwork that can happen

only if all participants in the activity understand the importance of teamwork. This is why

Bischoff (2020) and Ozolins (2000) emphasized the importance of training for medical

interpreter users. Service users need to know how to collaborate with medical interpreters and

understand the scope of medical interpreters’ responsibilities as also mentioned by Chang et

al. (2014), Fan (2011), and Yen (2013). The medical interpreters’ responsibilities in Fan’s

(2011) study included measurements of patients’ height and weight, assisting in vaccination

clinics, and several other tasks not related to interpreting. In addition, to be educated about the

medical interpreters’ roles, both medical interpreters, as well as the service users, need to be

informed about the medical interpreters’ code of ethics (which will be discussed further in

Subsection 4.2.8).

However, none of the participants in this study had heard of training for medical

interpreter users. As far as the current researcher knows, there is no study concerning this

topic either. In terms of MI, this is a significant neglected factor.

4.2.7 Professional Development of the Trained Medical Interpreters

As can be seen in Table 4, by professional development, Ozolins (2000) meant in-

service training, meet and share, and other means to develop the profession-related knowledge

of the individuals. However, the BMMITP did not provide in-service training or anything

similar such as internships. This resulted in no opportunity to integrate theory into practice. In

95
addition, the BMMITP did not offer an organization or an association for the trainees to be

able to meet and share. This is a disadvantage considering the high motivation the participants

had when applying for the BMMITP. It is worth mentioning that the only medical interpreter

association in Taiwan, IMTIA, was founded to improve the quality of international medical

care in Taiwan. However, none of the trainees of the BMMITP was invited to join the IMTIA,

even though the training program was funded and certified by the MOHW for the same

purpose – medical tourism.

In conclusion, there is no way for the BMMITP’s trainees to develop professionally

unless they do it independently, as the participants in this study suggested – either by reading

a lot or forming their own organization.

4.2.8 Advanced training for medical interpreters

This study’s findings show the trainees’ positive experiences with the BMMITP;

however, they also expressed concern about their professional development. The BMMITP’s

trainees are worried that, if no efforts are made to retain and enhance their newly acquired

knowledge and skills, such skills may eventually vanish. As a result, the participants gave

several suggestions including advanced training and a medical interpreter organization.

Previous studies mentioned overlapping interpreting training programs and suggested

different levels of training which also improve the certification system at the same time (e.g.,

Chang et al., 2014; Lin & Yang, 2021). However, such studies include all community

interpreting training programs in Taiwan such as the reproductive health interpreter, judicial

interpreter, immigration counseling interpreter, et cetera. As far as the current researcher

knows, there is no study that mentions the BMMITP.

As shown in Table 4, Ozolins (2000) suggested advanced training to include

interpreters’ roles, professional ethics/standards of practice, specifics of different healthcare

types, and transcultural competence. Such topics would be perfect for the Bahasa Indonesia-

Mandarin Advanced Interpreting Training Program, should one ever exist, given the

96
BMMITP does not cover them. However, a medical interpreting code of ethics should already

exist before adding it to the training program. As far as the current researcher knows,

Taiwan’s medical interpreters do not have their own code of ethics yet. This issue was also

mentioned by Pei (2011). Pei discovered that the interpreters employed by a Non-Profit

Organization in Taiwan used social work ethics to regulate community interpreters, including

medical interpreters. Hence, Pei proposed that Taiwan’s academics draft a code of ethics for

community interpreting. However, the current researcher believes, medical interpreters should

have their own set of codes of ethics.

4.3 Responses to the Research Questions

The BMMITP is a 48-hour training program funded by the MOHW to meet the

demand for more trained medical interpreters in Taiwan, particularly for the MT industry.

While previous research on MI is mostly concerned with reproductive health interpreters

funded by Taiwan Ministry of Interior, as far as the current researcher knows, there is no

study on the BMMITP funded by the MOHW. Lin and Yang (2021) briefly mentioned the

BMMITP read from the new immigrant development training information website12.

However, it seems that Lin and Yang were not aware that the training program focuses on

medical tourism. Hence, this study aims to investigate the BMMITP in relation to the eight

factors of language access facilitator factors, namely: (a) training for medical interpreters; (b)

certification system; (c) public provision of trained medical interpreters; (d) employment of

the trained medical interpreters; (e) remuneration; (f) training for medical interpreter users;

(g) professional development of the trained medical interpreters; and (h) advanced training for

medical interpreters. The research questions are:

1. Which of the eight factors are identified as conducive to language access for LMP

Indonesian in Taiwan’s healthcare system by the trainees, the instructors, and patrons

12
The link to the website was provided but the information could not be found when visited on
November 28, 2022.

97
 (henceforth, the participants)?

2. Which of the eight factors are identified as neglected by the participants?

3. Which of the eight factors are identified as conducive in the curriculum and the teaching

materials?

4. Which of the eight factors are identified as neglected in the curriculum and the teaching

materials?

According to the questionnaire responses, the trainee participants in this study met all

application requirements for the BMMITP including education level and language

proficiency. The documentation shows that the BMMITP has longer training hours and more

comprehensive medical-related knowledge than other para-academic medical interpreting

training programs in Taiwan. The subjects included in the BMMITP curriculum are medical

tourism, medical knowledge, medical language, medical interpreting skills, and medical

interpreting drills. Although it seems that most resources are allocated to medical tourism

rather than to migrants’ medical needs, there is no restriction that the trainees may only

interpret for medical tourists. The most distinct aspect of the BMMITP is that it is designed

for a particular language pair (Bahasa Indonesia-Mandarin) with three Bahasa Indonesia

native-speaker instructors. These three instructors teach in Bahasa Indonesia and Mandarin

which denotes the accuracy of medical terminologies. Interviewee P stated that all of the

instructors in the BMMITP are experts in their fields. The teaching materials provided by

interviewees I1 and I2 show that the topics presented are in accordance with those specified in

the curriculum. Most of the trainees admitted they learned a lot about all the subjects included

in the curriculum.

As stated in the training announcement letter, certificates were given to trainees who

successfully complete the program with at least 40 hours of attendance and pass the final

assessment. Two of the trainee participants did not get the certificates because they did not

have perfect attendance. A medical interpreting training certificate is the best evidence that

98
one has received medical interpreting training because there is no requirement for an MI

license in Taiwan. All of the participants in this study agreed that a BMMITP certificate from

the MOHW is extremely helpful when looking for a career in translation and interpreting.

Comparatively, interviewee T5 displayed a certificate from the Psychological Counseling

Bilingual Interpreter Training Program to a prospective employer who observed that it is not a

government-approved certificate.

Upon certification, the trainees’ data was registered in the immigration department’s

and the TTFMT’s talent pools. The interviews and the questionnaire responses show that most

trainees (20 out of 24) have interpreted in healthcare settings. However, only eight of them are

paid interpreters and the other 12 trainees have interpreted in healthcare settings for friends

and coworkers. Moreover, the eight paid interpreters got their medical interpreting

assignments through regular employers and the immigration department’s talent pool. None

of the trainees have received interpreting assignments from the TTFMT’s talent pool. It seems

that during this pandemic, the trainees mostly provided interpreting services for migrants.

As was described in previous sections, most of the MI assignments the trainees

received did not come from the talent pools. The trainees were trained, passed the final

assessment, and were certified. They were equipped with MI skills and knowledge of proper

rates for trained medical interpreters, yet they got rewarded differently for their services.

Despite the fact that it is stated in the training announcement letter that the certified trainees

will be prioritized for employment if an opportunity arises, interviewee P acknowledged that

the hospital where she works had never hired a medical interpreter from the TTFMT's talent

pool. The promise should be more than just an incentive to recruit more trainees.

Without many employment opportunities and further training, the trainees were

concerned about their professional development. Advanced training is not mentioned in the

curriculum, and neither are the instructors aware of it. Interviewers I1 and I2 agreed that as

the trainees are only beginner medical interpreters, they need additional practice interpreting

99
and education regarding medical interpreting, including medical interpreters’ roles and code

of ethics.

The following are the responses to the research questions considering the findings of

this study as mentioned above:

1. Which of the above eight factors are identified as conducive to language access for LMP

Indonesian in Taiwan’s healthcare system by the participants?

From the description above, it is obvious that the participants identify factors (a)

training for medical interpreters, (b) certification system, and (c) public provision of trained

medical interpreters, as conducive to their professional development. All the participants

agreed that the training equipped the trainees with the knowledge and skills to be a novice-

trained medical interpreter. Whether the trainees will become veteran-trained medical

interpreters depends on their professional development.

Both the trainees and the instructors in this study agreed that the certificates issued by

Taiwan’s MOHW for the BMMITP’s trainees are highly valuable because only those who

have perfect attendance and pass the final exam are awarded the certificates. Moreover,

certificates issued by Taiwan’s government are valued by future employers. Following

certification, the trainees’ data was registered in the talent pools which are accessible to the

public. Whether the public makes use of the talent pools depends on other factors such as

public awareness.

2. Which of the eight factors are identified as neglected by the participants?

Factors (d) employment of the trained medical interpreters, (e) remuneration, (f)

training for medical interpreter users, (g) professional development of the trained medical

interpreters, and (h) advanced training for medical interpreters, are identified as neglected by

the participants. Interviewee P admitted that the hospital she works at never employs the

BMMITP’s trainees although they frequently have LMP Indonesian patients. The trainees

mentioned that the MI assignments they received were from the immigration department’s

100
talent pool not because they were registered as the BMMITP’s trainees but as the trainees of

another interpreting program they enrolled in before. Other trainees’ medical interpreting

tasks are either unpaid or through their regular channels.

Despite being informed during training that certified medical interpreters are paid

differently than untrained ones, some trainees do not get enough remuneration. The worth of

their certificates and abilities should be emphasized to the trainees and the users of their

service. None of the participants in this study had ever heard of training for medical

interpreter users. Users of medical interpreters’ services who have received training are likely

to have greater respect for the trained medical interpreters. As aforementioned, the study's

participants acknowledged that the trainees at the BMMITP do not receive in-service training

or have opportunities to meet and share. When some trainees responded that they occasionally

meet and share with fellow interpreters, it does not mean the meet and share was promoted by

the BMMITP. The BMMITP does not include advanced training.

3. Which of the eight factors are identified as conducive in the curriculum and the teaching

materials?

Factors (a) training for medical interpreters, (b) certification system, (c) public

provision of trained medical interpreters, and (d) employment of the trained medical

interpreters, are identified as conducive to the curriculum and the teaching materials. As

aforementioned, the BMMITP curriculum covers practically every subject a novice medical

interpreter needs – medical tourism, fairly comprehensive medical knowledge, medical

terminologies, and medical interpreting skills. Moreover, all of the topics that the instructors

are expected to teach are included in their teaching materials. The curriculum and the teaching

material provide all the knowledge required to pass the final exam and get certified. In turn,

the certified trainees get to be registered in the talent pools which means the trainees are

available to meet public demand. Additionally, employing BMMITP trainees denotes that the

healthcare provider is employing trained medical interpreters.

101
4. Which of the eight factors are identified as neglected in the curriculum and the teaching

materials?

Factors (e) remuneration, (f) training for medical interpreter users, (g) professional

development of the trained medical interpreters, and (h) advanced training for medical

interpreters, are identified as neglected in the curriculum and the teaching materials. Topics

related to remuneration are not covered in the curriculum or the teaching materials. The

instructors did advise the trainees to consult with the healthcare providers before engaging in

any interpreting activities, but they did not emphasize the significance of training for those

who will be employing medical interpreters. Additionally, in-service training and advanced

training topics such as medical interpreters’ roles, code of ethics, specifics of different

healthcare types, and transcultural competence are not included in the curriculum or the

teaching materials.

The four answers to the research questions reveal the only difference in factors

perceived by the participants and identified in the curriculum is factor (d) employment of the

trained medical interpreters. Although factor (d) is identified in the curriculum, most of the

participant do not experience being invited through the talent polls following the training. The

potential reason may be that it is mentioned in the training announcement letter (please refer

to Appendix Q). As shown in Table 14, 70.8% of the participants acknowledged that having

other job options was one of their motivations for applying for the BMMITP. Hence, despite

learning how to find employment has not been officially taught, it is a strong incentive for the

participants. Therefore, it is perceived by the trainees as a gap, leading them to perceive that

employment is not a conducive factor as they expected.

102
 Chapter 5 Conclusions and Suggestions

This chapter summarizes the findings of this study and offers several suggestions to

stakeholders. Subsequently, the study’s limitations are presented. Recommendations for

future research are provided at the end of this chapter.

5.1 Conclusion

Medical interpreting (MI) is interpreting activities that occur in healthcare settings

conducted to facilitate communications when there is a language barrier. In Taiwan, the need

for MI comes from both inside and outside of the country. From inside the country, there are

migrant workers, migrant spouses, and international students; while from outside the country,

there are medical tourists or travelers who fall sick during their time in Taiwan. Healthcare

facilities should provide language access for these patients with limited Mandarin proficiency

by employing medical interpreters. To ensure the quality of the language services, these

medical interpreters should be trained professionally. Therefore, since 2006, Taiwan’s

government has funded many medical-related interpreting training programs, including the

Bahasa Indonesia-Mandarin medical interpreting training program (BMMITP) which started

in 2020.

For application requirements, the BMMITP necessitates a minimum high school level

of education, native speakers of Bahasa Indonesia, and level B1 of CEFR for Mandarin. Of

the 24 trainee participants in this study, 21 have university degrees. Instructors in the

BMMITP are either physicians or nurses with the exception of the instructor from the T&I

field. Three of the instructors are bilinguals and teach in Bahasa Indonesia and in Mandarin to

ensure accurate medical language and terminologies. Moreover, the course duration is

relatively long and includes MT-related topics. The medical-related knowledge taught in the

BMMITP is more comprehensive and covers almost all health problems frequently faced by

patients. However, the BMMITP does not include topics related to medical interpreters’ code

of ethics.

103
 The BMMITP uses role plays for medical interpreting drills and the final assessment.

Like other interpreting training programs, the BMMITP also provides certificates for trainees

who attend at least 40 hours of training and pass the final exam. Upon certification, the

trainees’ data was registered into the immigration department’s and the TTFMT’s talent

pools. However, most of the trainees’ interpreting assignments were not from these two talent

pools and most were unpaid. This study identified several possibilities as the cause of the lack

of trained medical interpreters’ employment, namely: (a) healthcare providers usually hired

the same regular interpreters; (b) lack of awareness of the importance of trained medical

interpreters and the provision of language services; (c) lack of legislation; (d) lack of funding;

and (e) pandemic.

Furthermore, this study found that the real-life problems currently are:

1. It is not a lack of trained medical interpreters; rather, it is a lack of trained medical

interpreters’ employment opportunities as a result of underutilization of the immigration

department’s and the TNHCA’s talent pools for trained medical interpreters, stakeholders’

lack of awareness of the importance of employing trained medical interpreters, a lack of strict

regulation, and lack of funding. There was almost no demand for trained medical interpreters

through the talent pools, particularly from non-governmental healthcare institutions.

2. It is not a lack of medical interpreting training programs; rather, it is a lack of carefully

planned training programs in length and content of the course, and choices of instructors.

3. There is no advanced training for trained medical interpreters.

4. It is hard to find qualified bilingual instructors.

5. There are no training programs for medical interpreter users.

In conclusion, the training, the certification, and the public provision of trained

medical interpreters are perceived as conducive by the participants and in the BMMITP’s

curriculum. However, the remuneration, the training for medical interpreter users, the

professional development of the trained medical interpreters, and advanced training for

104
medical interpreters, are identified as neglected both by the participants and in the curriculum.

While employment of trained medical interpreters, especially that for medical tourists, is

perceived as conducive in the curriculum, it is perceived as neglected by the participants,

which may reflect the impact of the pandemic in the past three years.

5.2 Suggestions

The results of this study indicate that there is still much room for improvement in

Taiwan's language access in the healthcare system, particularly in relation to medical

interpreter training programs. Hence, several suggestions are presented based on this study’s

findings, the raised issues in the interview, and the participants’ suggestions.

Suggestions for Future Similar Training Programs

1. Employ qualified bilingual instructors for teaching medical terminologies.

2. Include “intercultural communication”, “code of ethics”, and “employment seeking” in

the curriculum.

3. Establish a medical interpreters’ professional association for each language pair to be able

to provide professional development for that particular language pair’s medical

interpreters.

Suggestions to the Authorities

1. Recruit healthcare workers who are Bahasa Indonesia native speakers to be trained as

future BMMITP instructors.

2. Require healthcare facilities to provide certified medical interpreters for LMP patients and

make this information widely known to the public.

3. Promote the popularity of medical interpreters’ talent pools.

4. Re-evaluate certified medical interpreters’ fees.

5. Allow experienced but untrained medical interpreters to continue working as qualified

medical interpreters by providing free training programs and/or certification exams.

Suggestions to the Related Institutions

105
1. Professional association for medical interpreters should draw up a code of ethics and

standards of practice for Taiwanese medical interpreters.

2. Raise awareness of the cruciality of trained medical interpreters.

3. Establish short courses for healthcare workers on the necessity of supporting cultural and

linguistic diversities in this globalization era and how to communicate efficiently with

LMP patients while working as a team with medical interpreters for the health of the

patients. The necessity for healthcare workers to comprehend the interpreters’ roles and

responsibilities was also mentioned by Chang (2014), Fan (2011), and Shih (2020).

4. Healthcare providers should inquire every LMP patient if they need a medical interpreter-

free of charge.

5. Employ on-shift, on-site certified medical interpreters for the languages mostly

encountered at that particular healthcare facility. Provide several modes of interpreting for

different needs such as phone interpreting for emergencies and video interpreting when

on-site medical interpreters cannot be provided in time. The need to improve the MI

system in healthcare facilities was also mentioned by Chang (2014) and Fan (2011).

6. Provide first-visit registration forms and other health information leaflets in the most

spoken languages in Taiwan as provided in Mandarin. Most hospitals have registration

forms only in Mandarin and English (Tseng, 2019). Healthcare institutions’ websites

should have pages in various languages.

5.3 Limitations and Recommendations

This study investigates the design and stakeholders’ views on the BMMITP to

understand which language access factors are identified as conducive and which are neglected

in the training program. However, since the training program was only executed twice when

this research was conducted, the number of participants is very limited. Moreover, because of

the pandemic, there were not many cases when hospitals had medical tourists that needed

medical interpreters. Therefore, the trainees had almost no opportunity to interpret for medical

106
tourists. Fortunately, several trainees had opportunities to interpret for migrants. In addition,

the only Moslem in this study stated that there was no need to teach trainees about specific

religious terms since most Taiwanese were aware of the religion. This opinion from only one

participant could not be generalized to other medical interpreters’ perceptions since a different

finding was found by Shih (2020). The participants in Shih’s (2020) study admitted that they

often had to explain religion-related matters.

Since the current researcher is one of the instructors in the BMMITP, this study

provides an insider’s perspective of the training program. There are several advantages to

being an insider. For example, with the participant’s consent, the current researcher is able to

ask for more information even after the questionnaires were responded to and the interviews

were over. The information about the mobile application for medical interpreters’

employment was obtained after the interviews were done. The current researcher’s teaching

experiences in the BMMITP also have influenced this study. Being the instructor in the

BMMITP brought certain aspects to light, such as the importance of bilingual instructors for

teaching medical terminologies. However, aside from being advantageous, being an insider

may have disadvantages as well. The current researcher may have a biased perception of the

final assessment quality. Moreover, the trainee participants might not be completely honest

when answering the questions about what knowledge they truly learned since they might not

want to disappoint their instructor. To prevent this, the current researcher tried to build an

encouraging environment for the trainees to provide input by making it clear that the

interview’s purpose was to get feedback and suggestions for improving the future training

program, and it was a researcher, not an instructor, who interviewed them. Moreover, the

trainees were reminded that since they already had their certificates, the interviews would not

harm them.

Furthermore, unexpected issues were raised during the interview process. However,

due to the time of investigation, the current researcher cannot go back and ask for further

107
elaboration. The raised issues would be a good starting point for future research. For example,

when the participants mentioned how healthcare facilities always hire the same regular

interpreters. This statement warrants an investigation of the real situation. Furthermore,

research may also be expanded to include the Vietnamese-Mandarin or other South-bound

language pairs. There may be more interpreting cases after Taiwan opens for tourists again.

Investigating this BMMITP made me wonder about the impact of other government-funded

medical interpreting training programs on language access in the Taiwan healthcare system.

There must be a lot of bilinguals trained in those programs, but how many of them do work as

medical interpreters? Furthermore, exploring medical interpreting programs and the policy of

medical interpreters’ employment in relation to medical interpreting professionalization in

Taiwan will make a great contribution to medical interpreting academicians and practitioners.

108
 References

Al-Amer, R., Ramjan, L., Glew, P., Darwish, M., & Salamonson, Y. (2015). Translation of

interviews from a source language to a target language: Examining issues in cross-

cultural health care research. Journal of Clinical Nursing, 24(9-10), 1151–1162.

https://doi.org/10.1111/jocn.12681

Á lvaro Aranda, C., Gutiérrez, R. L., & Li, S. (2021). Towards a collaborative structure of

interpreter-mediated medical consultations: Complementing functions between

healthcare interpreters and providers. Social Science & Medicine (1982), 269, 113529.

https://doi.org/10.1016/j.socscimed.2020.113529

Amato, A. (2007). The interpreter in multi-party medical encounters. In C. Wadensjö,

Dimitrova, B. E., & Nilsson, A. L. (Eds.), The critical link 4 - Professionalisation of

interpreting in the community (pp. 27-38). John Benjamins.

Angelelli, C. V. (2004). Medical interpreting and cross-cultural communication. Cambridge

University Press.

Angelelli, C. V. (2006). Validating professional standards and codes: Challenges and

opportunities. Interpreting, 8(2), 175-193. https://doi.org/10.1075/intp.8.2.04ang

Arocha, I.S., & Joyce, L. (2013). Patient safety, professionalization, and reimbursement as

primary drivers for national medical interpreter certification in the United

States. Translation & Interpreting, 5(1), 127-142. https://doi.org/ti.105201.2013.a07

Association of Language-Service Providers. (n.d.). 遠距醫療外語培訓. Retrieved November

28, 2022, from https://connect.org.tw/國際醫療逐步口譯培訓班/

Avery, M. P. (2001). The role of the health care interpreter: An evolving dialogue (Working

Paper Series). The National Council on Interpreting in Health Care. Retrieved May 10,

2022, from

https://memberfiles.freewebs.com/17/56/66565617/documents/The%20role_of_health

_care_interpreter.pdf

109
Baker, N. G. (1981). Social work through an interpreter. Social Work, 26(5), 391–397.

http://www.jstor.org/stable/23712203

Bhugra, D., Gupta, S., Bhui, K., Craig, T., Dogra, N., Ingleby, J. D., Kirkbride, J., Moussaoui,

D., Nazroo, J., Qureshi, A., Stompe, T., & Tribe, R. (2011). WPA guidance on mental

health and mental health care in migrants. World Psychiatry, 10(1), 2–10.

https://doi.org/10.1002/j.2051-5545.2011.tb00002.x

Bischoff, A. (2020). The evolution of a healthcare interpreting service mapped against the

bilingual health communication model: A historical qualitative case study.

Public Health Reviews, 41(1), 1-19.

Bischoff, A., Bovier, P. A., Rrustemi, I., Gariazzo, F., Eytan, A., & Loutan, L. (2003).

Language barriers between nurses and asylum seekers: their impact on symptom

reporting and referral. Social Science & Medicine (1982), 57(3), 503–512.

https://doi.org/10.1016/s0277-9536(02)00376-3

Bischoff, A., & Loutan, L. (2004). Interpreting in Swiss hospitals. Interpreting, 6(2), 181–

204. https://doi.org/10.1075/intp.6.2.04bis

Blay, N., Ioannou, S., Seremetkoska, M., Morris, J., Holters, G., Thomas, V., & Bronwyn, E.

(2018). Healthcare interpreter utilisation: analysis of health administrative data. BMC

Health Services Research, 18(1), 348-348. https://doi.org/10.1186/s12913-018-3135-5

Bokur, D. (2020, May 5). Taiwan: A hot spot for health. Global Traveler.

https://www.globaltravelerusa.com/taiwan-health-hospitals-medical-travel-high-tech/

Brisset, C., Leanza, Y., & Laforest, K. (2013). Working with interpreters in health care: a

systematic review and meta-ethnography of qualitative studies. Patient Education and

Counseling, 91(2), 131–140. https://doi.org/10.1016/j.pec.2012.11.008

Butow, P. N., Lobb, E., Jefford, M., Goldstein, D., Eisenbruch, M., Girgis, A., King, M., Sze,

M., Aldridge, L., & Schofield, P. (2010). A bridge between cultures: Interpreters'

perspectives of consultations with migrant oncology patients. Supportive Care in

110
 Cancer, 20(2), 235–244. https://doi.org/10.1007/s00520-010-1046-z

California Healthcare Interpreting Association. (2017). California standards for healthcare

interpreters - Ethical principles, protocols, and guidance on roles & intervention.

California Healthcare Interpreting Association.

California Legislative Information. (2003). Interpreters: Prohibition on use of children.

California Assembly Bill 292. Retrieved November 28, 2022 from

https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=200320040AB292

Cambridge, J. (1999). Information loss in bilingual medical interviews through an untrained

interpreter. The Translator, 5, 201-219.

https://doi.org/10.1080/13556509.1999.10799041

Cantor-Graae, E., & Selten, J. P. (2005). Schizophrenia and migration: A meta-analysis and

review. The American Journal of Psychiatry, 162(1), 12–24.

https://doi.org/10.1176/appi.ajp.162.1.12

Chang, C., Cheng C., & Lin, K.-J. (2014). Research on Functional Analysis, Training

Courses and Certification System Planning of Interpreters for Foreign Spouses.

Ministry of the Interior National Immigration Agency Republic of China (Taiwan).

https://www.immigration.gov.tw/media/43516/外籍配偶通譯人員職能分析與訓練

課程及認證制度規劃之研究.pdf

Chang, J. Y. (2014). A self-described story of a Southeast Asian migrant community

interpreter [Master’s thesis, National Taiwan Normal University].

https://etds.lib.ntnu.edu.tw/thesis/detail/951033c06dcb8934417cb931b40c2f9f/

Chang, T.-C. (2009). The knowledge and construction of diverse cultural care --- The

perception, communication and disparity between Vietnam’s mothers and nurses

during children’s hospitalization [Master’s thesis, Kaohsiung Medical University

School of Nursing]. National Digital Library of Theses and Dissertations in Taiwan.

https://hdl.handle.net/11296/wktxr6

111
Chang, W.-Y., Chen, P.-L., Yeh, Y.-P., & Chen, H.-H. (2010). Evaluation of the effectiveness

of language interpreters, the impact factors of the use of interpreter, and outcomes of

interpreter service intervention on prenatal care for foreign spouses. Government

Research Bulletin No. RG9905-0124.

http://grbsearch.stpi.narl.org.tw/search/planDetail2?id=1963936

Chee, H. L., & Whittaker, A. (2019). Moralities in international medical travel: moral logics

in the narratives of Indonesian patients and locally-based facilitators in Malaysia.

Journal of Ethnic and Migration Studies, 46(20), 4264-

4281. https://doi.org/10.1080/1369183X.2019.1597476

Chen, A. H. (Ed.). (2003). Language barriers in health care settings: An annotated

bibliography of the research literature. The California Endowment.

Chen, H.-Y. (2013). The doctor-patient interaction in cross-cultural medical care-Views from

clinical physicians [Master’s thesis, National Chi Nan University]. National Digital

Library of Theses and Dissertations in Taiwan. https://hdl.handle.net/11296/34n6pg

Chen, J.-C, & Lin, H.-F. (2011). The status of translation and interpretation service and

hospital bilingual service for foreigners in Taiwan's hospitals: A case study. Taiwan

Medical Humanities Journal, 12(1&2), 89-103.

https://doi.org/10.30097/FJMH.201105.0007

Chen, M.-J., Tang, C.-H., Jeng, H.-M., & Chiu, A. W.-H. (2008). The maternal and child

healthcare needs of new immigrants in Taipei. The Journal of Nursing

Research, 16(4), 307–320. https://doi.org/10.1097/01.jnr.0000387318.50880.b5

Chen, M.-L., & Chiou, J.-Y. (2009). The health care accessibility and medical-seeking

behavior of foreign labors in Taiwan - Case of the labors from Thailand worked in

central Taiwan’s small and medium size manufacturing factories. Hung Kuang

Journal, 55, 97-110. http://dx.doi.org/10.6615/HAR.200904.55.08

Chen, W., Shiao, W.-B., Lin, B. Y.-J., & Lin, C.-C. (2013). Rural and urban married Asian

112
 immigrants in Taiwan: Determinants of their physical and mental health. Journal of

Immigrant and Minority Health, 15(6), 1038–1047. https://doi.org/10.1007/s10903-

012-9750-z

Chou, Y.-F. (2019). Medical interpreting in Taiwan: Physicians’ perspective [Unpublished

master’s thesis]. National Taiwan Normal University.

Chu, F.-Y., Chang, H.-T., Shih, C.-L., Jeng, C.-J., Chen, T.-J., & Lee, W.-C. (2019). Factors

associated with access of marital migrants and migrant workers to healthcare in

Taiwan: A questionnaire survey with quantitative analysis. International Journal of

Environmental Research and Public Health, 16(16), 2830.

https://doi.org/10.3390/ijerph16162830

Chuang, W.-C. (2009). Cross-cultural communication between nurses and foreign health

caretakers [Master’s thesis, Tzu Chi University]. Tzu Chi University Institutional

Repository. https://hdl.handle.net/11296/73722s

Connect Business Services. (n.d.). Course. Retrieved November 28, 2022, from

https://www.translator.com.tw/category/%e8%aa%b2%e7%a8%8b/

Connell, J. (2006). Medical tourism: Sea, sun, sand and … surgery. Tourism Management,

27(6), 1093-1100. https://doi.org/10.1016/J.TOURMAN.2005.11.005

Creswell, J. W. (2013). Qualitative inquiry and research design – Choosing among five

approaches (3rd ed.). Sage Publications.

Crezee, I., & Jülich, S. (2020). Exploring role expectations of healthcare interpreters in New

Zealand. In E. N. S. Ng, & I. H. M. Crezee (Eds.), Interpreting in legal and healthcare

settings: Perspectives on research and training (pp. 211-241). John Benjamins.

https://doi.org/10.1075/btl.151.09cre

Dang, H.-S., Nguyen, T.-M.-T., Wang, C.-N., Day, J.-D., & Dang, T. M. H. (2020). Grey

system theory in the study of medical tourism industry and its economic

impact. International Journal of Environmental Research and Public Health, 17(3),

113
 961. https://doi.org/10.3390/ijerph17030961

Davidson, B. (2001). Questions in cross-linguistic medical encounters: The role of the

hospital interpreter. Anthropological Quarterly, 74(4), 170-178.

https://doi.org/10.1353/anq.2001.0035

Donovan, C. (2004). European masters project group: Teaching simultaneous interpretation

into a B language. Interpreting, 6(2), 205 – 216. https://doi.org/10.1075/intp.6.2.06don

Drennan, G., & Swartz, L. (1999). A concept over-burdened: Institutional roles for psychiatric

interpreters in post-apartheid South Africa. Interpreting, 4(2), 169-198.

https://doi.org/10.1075/intp.4.2.03dre

Dubslaff, F., & Martinsen, B. (2005). Exploring untrained interpreters' use of direct versus

indirect speech. Interpreting, 7(2), 211-236. https://doi.org/10.1075/intp.7.2.05dub

Dysart-Gale, D. (2005). Communication models, professionalization, and the work of medical

interpreters. Health Communication, 17(1), 91-103.

Dysart-Gale D. (2007). Clinicians and medical interpreters: negotiating culturally appropriate

care for patients with limited English ability. Family & Community Health, 30(3),

237–246. https://doi.org/10.1097/01.FCH.0000277766.62408.96

Ebden, P., Carey, O. J., Bhatt, A., & Harrison, B. (1988). The bilingual consultation. Lancet

(London, England), 1(8581), 347. https://doi.org/10.1016/s0140-6736(88)91133-6

Elderkin-Thompson, V., Cohen Silver, R., & Waitzkin, H. (2001). When nurses double as

interpreters: a study of Spanish-speaking patients in a US primary care setting. Social

Science and Medicine, 52(9), 1343-1358. https://doi.org/10.1016/S0277-

9536(00)00234-3

Elghezouani, A. (2007). Professionalisation of interpreters - The case of mental health care. In

C. Wadensjö, Dimitrova, B. E., & Nilsson, A. L. (Eds.), The critical link 4 -

Professionalisation of interpreting in the community (pp. 215-225). John Benjamins.

Ertl, A., & Pöllabauer, S. (2010). Training (medical) interpreters - The Key to good practice.

114
 MedInt: A Joint European training perspective. The Journal of Specialised

Translation, 14, 165-193.

Expat Insider. (2021). Where expat life is great: The quality of life index. Retrieved November

28, 2022, from https://www.internations.org/expat-insider/2021/quality-of-life-index-

40109

Fan, M.-Y. (2011). Healthcare interpreting in Taiwan: A case study of healthcare interpreters

in public health centers in New Taipei City [Master's Thesis, National Taiwan Normal

University]. National Digital Library of Theses and Dissertations in Taiwan.

https://hdl.handle.net/11296/t98945

Feinauer, I., & Lesch, H.M. (2013). Health workers: Idealistic expectations versus

interpreters' competence. Perspectives, 21(1), 117 - 132.

https://doi.org/10.1080/0907676X.2011.634013

Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparities in health care by

race, ethnicity, and language among the insured: Findings from a national

sample. Medical Care, 40(1), 52–59. https://doi.org/10.1097/00005650-200201000-

00007

Flores, G. (2005). The impact of medical interpreter services on the quality of health care: A

systematic review. Medical Care Research and Review, 62(3), 255-299.

https://doi.org/10.1177/1077558705275416

Flores, G., Abreu, M., Barone, C. P., Bachur, R., & Lin, H. (2012). Errors of medical

interpretation and their potential clinical consequences: A comparison of professional

versus ad hoc versus no interpreters. Annals of Emergency Medicine, 60(5), 545–553.

https://doi.org/10.1016/j.annemergmed.2012.01.025

Flores, G., Laws, M. B., Mayo, S. J., Zuckerman, B., Abreu, M., Medina, L., & Hardt, E. J.

(2003). Errors in medical interpretation and their potential clinical consequences in

pediatric encounters. Pediatrics, 111(1), 6–14. https://doi.org/10.1542/peds.111.1.6

115
Fu Jen Catholic University. (2022). Fu Jen Catholic University International Medical

Translation Credit Program. https://imtip.weebly.com/20462269893521521063.html

Gall, M. D., Borg, W. R., & Gall, J. P. (2003). Educational Research: An Introduction (7th

ed.). Pearson Education.

Gany, F., Kapelusznik, L., Prakash, K., Gonzalez, J., Orta, L. Y., Tseng, C. H., & Changrani,

J. (2007). The impact of medical interpretation method on time and errors. Journal of

General Internal Medicine, 22 Suppl 2(Suppl 2), 319–323.

https://doi.org/10.1007/s11606-007-0361-7

Grand View Research. (2020). Medical Tourism Market Worth $207.9 Billion By 2027 |

CAGR: 21.1%. Retrieved November 28, 2022, from

https://www.grandviewresearch.com/press-release/global-medical-tourism-market

Gray, B., Hilder, J., & Donaldson, H. (2011). Why do we not use trained interpreters for all

patients with limited English proficiency? Is there a place for using family members?

Australian Journal of Primary Health, 17(3), 240–249.

https://doi.org/10.1071/PY10075

Hadziabdic, E., Heikkilä, K., Albin, B., & Hjelm, K. (2011). Problems and consequences in

the use of professional interpreters: Qualitative analysis of incidents from primary

healthcare. Nursing inquiry, 18(3), 253–261. https://doi.org/10.1111/j.1440-

1800.2011.00542.x

Haffner L. (1992). Translation is not enough. Interpreting in a medical setting. The Western

journal of medicine, 157(3), 255–259.

Hale, S. B., (2007). Community interpreting. Palgrave Macmillan.

Health Promotion Administration, Ministry of Health and Welfare. (2019). Health promotion

administration annual report 2019. Retrieved November 28, 2022, from

https://www.hpa.gov.tw/1070/12811/e

Heung, V. C. S., Kucukusta, D., & Song, H. (2010). A conceptual model of medical tourism:

116
 Implications for future research. Journal of Travel and Tourism Marketing, 27(3),

236-251. https://doi.org/10.1080/10548401003744677

Holden, P., & Serrano, A. C. (1989). Language barriers in pediatric care. Clinical

pediatrics, 28(4), 193–194. https://doi.org/10.1177/000992288902800408

Hsieh, E. (2003). The communicative perspective of medical interpreting. Studies in English

Language and Literature, 11, 11-23.

Hsieh, E. (2007). Interpreters as co-diagnosticians: Overlapping roles and services between

providers and interpreters. Social Science & Medicine, 64(4), 924-937.

https://doi.org/10.1016/j.socscimed.2006.10.015

Hsieh, E. (2016). Bilingual health communication: Working with interpreters in cross-

cultural care. New York and London: Taylor & Francis Group.

Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis.

Qualitative Health Research, 15(9), 1277-1288.

https://doi.org/10.1177/1049732305276687

Hsieh, M.-T. (2019). An exploratory study of Taiwan-based freelance interpreters’

employability [Master’s thesis, National Taiwan Normal University]. National Digital

Library of Theses and Dissertations in Taiwan. https://hdl.handle.net/11296/9yrm7d

Huang, Y. C., & Mathers, N. J. (2008). Postnatal depression and the experience of South

Asian marriage migrant women in Taiwan: Survey and semi-structured interview

study. International journal of nursing studies, 45(6), 924–931.

https://doi.org/10.1016/j.ijnurstu.2007.02.006

Huang, Y.-T., & Phillips, C. (2009). Telephone interpreters in general practice - Bridging the

barriers to their use. Australian Family Physician, 38(6), 443–446.

Hull M. (2016). Medical language proficiency: A discussion of interprofessional language

competencies and potential for patient risk. International Journal of Nursing

Studies, 54, 158–172. https://doi.org/10.1016/j.ijnurstu.2015.02.015

117
Hung, H.-F. (2013). Research on Community Interpreting for the New Immigrants in Taiwan

[Master’s thesis, Fu Jen Catholic University]. National Digital Library of Theses and

Dissertations in Taiwan. https://hdl.handle.net/11296/mxh6u2

Hwang, J. N., & Kuo, S.-T. (2012). Counselor and interpreter collaboration in counseling

service. Taiwan Counseling Quarterly, 4(2), 12-21.

http://jicp.heart.net.tw/article/TCQ4-2-2.pdf

International Medical Interpreters Association (n.d.). IMIA Code of Ethics. Retrieved

November 28, 2022, from https://healthcareinterpreting.org/international-medical-

interpreters-association/

International Medical Translators and Interpreters Association (n.d.). Latest news. Retrieved

November 28, 2022, from

https://imtia.org.tw/page/news/show.aspx?num=112&kind=24&page=1

Ireland, S. (2021, April 27). Revealed: Countries with the best health care systems, 2021.

CEOWORLD Magazine. https://ceoworld.biz/2021/04/27/revealed-countries-with-

the-best-health-care-systems-2021/

Jacobs, B., Kroll, L., Green, J., & David, T. J. (1995). The hazards of using a child as an

interpreter. Journal of the Royal Society of Medicine, 88(8), 474P–475P.

Jacobs, E. A, Chen, A. H., Karliner, L. S., Agger-Gupta, N., & Mutha, S. (2006). The need for

more research on language barriers in health care: A proposed research agenda. The

Milbank Quarterly, 84(1), 111–133. https://doi.org/10.1111/j.1468-0009.2006.00440.x

Jacobs, E. A., Karavolos, K., Rathouz, P. J., Ferris, T. G., & Powell, L. H. (2005). Limited

English proficiency and breast and cervical cancer screening in a multiethnic

population. American Journal of Public Health, 95(8), 1410–1416.

https://doi.org/10.2105/AJPH.2004.041418

Jacobs, E. A., Lauderdale, D. S., Meltzer, D., Shorey, J. M., Levinson, W., & Thisted, R. A.

(2001). Impact of interpreter services on delivery of health care to limited-English-

118
 proficient patients. Journal of General Internal Medicine, 16(7), 468–474.

https://doi.org/10.1046/j.1525-1497.2001.016007468.x

Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E. L. (2004). Overcoming language

barriers in health care: Costs and benefits of interpreter services. American Journal of

Public Health, 94(5), 866–869. https://doi.org/10.2105/ajph.94.5.866

Jaeger, F. N., Pellaud, N., Laville, B., & Klauser, P. (2019). Barriers to and solutions for

addressing insufficient professional interpreter use in primary healthcare. BMC Health

Services Research, 19(1), 753. https://doi.org/10.1186/s12913-019-4628-6

Ju, M. L. (2009). The professionalization of interpreting in Taiwan: A Critical review of

Tseng’s model. Compilation and Translation Review, 2(2), 105-125.

Kai, J., Beavan, J., & Faull, C. (2011). Challenges of mediated communication, disclosure

and patient autonomy in cross-cultural cancer care. British Journal of Cancer, 105(7),

918–924. https://doi.org/10.1038/bjc.2011.318

Kang, S.-C., Lin, C.-C., Tsai, C.-C., Chang, Y.-C., Wu, C.-Y., Chang, K.-C., & Lo, S.-S.

(2019). The primary care of immigrant workers and their associated characteristics

within a Taiwanese fishing community. International Journal of Environmental

Research and Public Health, 16(19), 3702. https://doi.org/10.3390/ijerph16193702

Kaohsiung Medical University e-News. (2020). International Medical Multilingual Talent

Cultivation Class to Create Medical Interpreters. E-Bulletin, 369.

http://enews2.kmu.edu.tw/index.php/高醫大「國際醫療多語人才培育專班」打造

醫療口譯人才

Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters

improve clinical care for patients with limited English proficiency? A systematic

review of the literature. Health Services Research, 42(2), 727–754.

https://doi.org/10.1111/j.1475-6773.2006.00629.x

Kaufert, J.M., & Koolage, W.W. (1984). Role conflict among 'culture brokers’: The

119
 experience of native Canadian medical interpreters. Social Science & Medicine, 18(3),

283-286. https://doi.org/10.1016/0277-9536(84)90092-3

Kaufert, J. M., Putsch, R. W., & Lavallée, M. (1999). End-of-life decision making among

aboriginal Canadians: Interpretation, mediation, and discord in the communication of

“bad news.” Journal of Palliative Care, 15(1), 31-38.

https://doi.org/10.1177/082585979901500105

Kent, S. J. (2007). “Why bother?”: Institutionalization, interpreter decisions,

and power relations. In C. Wadensjö, B. E. Dimitrova, & A. L. Nilsson, The critical

link 2: Professionalisation of interpreting in the community (pp. 193-204). John

Benjamin.

Krystallidou, D. (2016). Investigating the interpreter’s role(s) The ART

framework. Interpreting, 18(2), 172–197. https://doi.org/10.1075/intp.18.2.02kry

Kuan, A. S., Chen, T.-J., & Lee, W.-C. (2020). Barriers to health care services in migrants

and potential strategies to improve accessibility: A qualitative analysis. Journal of the

Chinese Medical Association, 83(1), 95–101.

https://doi.org/10.1097/JCMA.0000000000000224

Kumar, A., Maskara, S., & Chiang, I-J. (2014). Health care satisfaction among foreign

residents in Taiwan-An assessment and improvement. Technology and Health

Care, 22(1), 77-90. https://doi.org/10.3233/THC-130775

Kuo, D., & Fagan, M. J. (1999). Satisfaction with methods of Spanish interpretation in an

ambulatory care clinic. Journal of General Internal Medicine, 14(9), 547-550.

https://doi.org/10.1046/j.1525-1497.1999.07258.x

Launer J. (1978). Taking medical histories through interpreters: Practice in a Nigerian

outpatient department. British Medical Journal, 2(6142), 934–935.

https://doi.org/10.1136/bmj.2.6142.934

Leanza, Y. (2005). Roles of community interpreters in pediatrics as seen by interpreters,

120
 physicians and researchers. Interpreting, 7(2), 167-192.

https://doi.org/10.1075/intp.7.2.03lea

Lee, L. J., Batal, H. A., Maselli, J. H., & Kutner, J. S. (2002). Effect of Spanish interpretation

method on patient satisfaction in an urban walk-in clinic. Journal of General Internal

Medicine, 17(8), 641–645. https://doi.org/10.1046/j.1525-1497.2002.10742.x

Lee, S. (2018). Exploring the demand for professional interpreting services in Northern

Taiwan’s hospitals: Physicians’ perspectives [Master’s thesis, National Taiwan

University]. National Digital Library of Theses and Dissertations in Taiwan.

https://hdl.handle.net/11296/xx32c7

Lin, C., Chen, T-W., Peng, C., Ho, C-E., Cheng, S., & Wu, P. (2016). Public sector

translation and interpretation: Demand analysis for Taiwan. Compilation and

Translation Review, 9(2), 23-56. http://ctr.naer.edu.tw/v09.2/ctr090202.pdf

Lin, G.-R., & Yang, H.-R. (2021). Research on the Training and Application Mechanism of

New Resident Interpreters. Research Funded by the New Residents Development

Fund of the Ministry of the Interior. https://www.immigration.gov.tw/media/62558/新

住民通譯人員培訓與運用機制之研究-1092f305.pdf

Lin, Y. F. (2008). Analysis of Translators and Interpreters in Taiwanese Non-Governmental

Organizations [Master’s thesis, Chang Jung Christian University].

https://hdl.handle.net/11296/m89cp4

Lin, Y.-Y. (2011). The Gaps between International Medical Marketing Strategy and Factors

of Foreign Customers’ Hospital Selection in Taiwan [Master’s thesis, Taipei Medical

University]. https://doi.org/10.6831/TMU.2011.00007

Lindert, J., Ehrenstein, O. S., Priebe, S., Mielck, A., & Brähler, E. (2009). Depression and

anxiety in labor migrants and refugees - A systematic review and meta-analysis. Social

Science & Medicine, 69(2), 246–257. https://doi.org/10.1016/j.socscimed.2009.04.032

Liu, I.-C. (2012). The research of medical tourism policy network in Taiwan. Sociology Mind,

121
 2(4), 458-464. http://dx.doi.org/10.4236/sm.2012.24059

Martin, Y., Collet, T. H., Bodenmann, P., Blum, M. R., Zimmerli, L., Gaspoz, J. M.,

Battegay, E., Cornuz, J., & Rodondi, N. (2014). The lower quality of preventive care

among forced migrants in a country with universal healthcare coverage. Preventive

Medicine, 59, 19–24. https://doi.org/10.1016/j.ypmed.2013.11.006

McDowell, L., Messias, D. K. H., & Estrada, R. D. (2011). The work of language

interpretation in health care: Complex, challenging, exhausting, and often

invisible. Journal of Transcultural Nursing, 22(2), 137-

147. https://doi.org/10.1177/1043659610395773

McMurtray, A., Saito, E., & Nakamoto, B. (2009). Language preference and development of

dementia among bilingual individuals. Hawaii Medical Journal, 68(9), 223–226.

Merton, R. K. (1957). The role-set: Problems in sociological theory. The British Journal of

Sociology, 8(2), 106-120. https://doi.org/10.2307/587363

Ministry of Labor Republic of China. (n.d.). Foreign Workers. Retrieved November 28, 2022,

from https://statdb.mol.gov.tw/html/mon/i0120020620e.htm

Ministry of the Interior National Immigration Agency Republic of China. (n.d). Number of

Spouses of Foreign Descent, Foreign Nationality, and Mainland China in Counties

and Cities. Retrieved November 28, 2022, from

https://www.immigration.gov.tw/5382/5385/7344/7350/8887/?alias=settledown

Moreno, M. R., Otero-Sabogal, R., & Newman, J. (2007). Assessing dual-role staff-

interpreter linguistic competency in an integrated healthcare system. Journal of

General Internal Medicine, 22 Suppl 2(Suppl 2), 331–335.

https://doi.org/10.1007/s11606-007-0344-8

National Council on Interpreting in Health Care. (2004). A national code of ethics for

interpreters in health care. The National Council on Interpreting in Health Care.

Retrieved November 28, 2022, from

122
 https://www.ncihc.org/assets/z2021Images/NCIHC%20National%20Code%20of%20

Ethics.pdf

National Council on Interpreting in Health Care. (2021). Interpreter advocacy in healthcare

encounters: A closer look. The National Council on Interpreting in Health Care.

Retrieved November 28, 2022, from

https://www.ncihc.org/assets/z2021Images/Interpreter%20Advocacy%20in%20Health

care%20Encounters%20A%20Closer%20Look%20F051121.pdf

Nesterko, Y., Turrión, C. M., Friedrich, M., & Glaesmer, H. (2019). Trajectories of health-

related quality of life in immigrants and non-immigrants in Germany: a population-

based longitudinal study. International Journal of Public Health, 64(1), 49–58.

https://doi.org/10.1007/s00038-018-1113-7

Ngo-Metzger, Q., Sorkin, D. H., Phillips, R. S., Greenfield, S., Massagli, M. P., Clarridge, B.,

& Kaplan, S. H. (2007). Providing high-quality care for limited English proficient

patients: The importance of language concordance and interpreter use. Journal of

General Internal Medicine, 22 Suppl 2(Suppl 2), 324–330.

https://doi.org/10.1007/s11606-007-0340-z

Nielsen, D. S., Abdulkadir, L. S., Lynnerup, C., & Sodemann, M. (2020). 'I had to stifle my

feelings' - Bilingual health professionals translating for family members in a

healthcare setting. A qualitative study. Scandinavian Journal of Caring

Sciences, 34(4), 929–937. https://doi.org/10.1111/scs.12800

Norris, W. M., Wenrich, M. D., Nielsen, E. L., Treece, P. D., Jackson, J. C., & Curtis, J. R.

(2005). Communication about end-of-life care between language-discordant patients

and clinicians: Insights from medical interpreters. Journal of Palliative Medicine, 8(5),

1016–1024. https://doi.org/10.1089/jpm.2005.8.1016

Ono, N. (2014). Development and evaluation of a novel education method for training for

healthcare interpreters. The Interpreter and Translator Trainer, 8(1), 148.

123
 https://doi.org/10.1080/1750399X.2014.920580

Oxford Advanced Learner’s Dictionary. (n.d.). Mediate. In OLD Online. Retrieved November

28, 2022, from https://www.oxfordlearnersdictionaries.com/definition/english/mediate

Ozolins, U. (2000). Communication needs and interpreting in multilingual settings: The

international spectrum of response. In R. P. Roberts, S. E. Carr, D. Abraham, & A.

Dufour (Eds.), The critical link 2: Interpreters in the community (pp. 21-34). John

Benjamins.

Ozolins, U. (2010). Factors that determine the provision of public service interpreting: A

comparative perspective on government motivation and language service

implementation. The Journal of Specialised Translation, 14.

https://www.jostrans.org/issue14/art_ozolins.pdf

Pei, S. (2011). The ethics and quality of community interpreting of NPOs in Taiwan: A case

study of Eden Social Welfare Foundation and the Pearl S. Buck Foundation

[Unpublished master’s thesis]. National Taiwan Normal University. Taiwan.

Pöchhacker, F. (2000). The community interpreter's task: Self-perception and provider views.

In R. P. Roberts, S. E. Carr, D. Abraham, & A. Dufour (Eds.), The critical link 2:

Interpreters in the community (pp. 49-65). John Benjamins.

Price-White, G. (2008, November 19). Language, culture, and medical tragedy: The case of

Willie Ramirez. Health Affairs.

https://www.healthaffairs.org/do/10.1377/hblog20081119.000463/full/

Putsch R. W., 3rd (1985). Cross-cultural communication. The special case of interpreters in

health care. JAMA, 254(23), 3344–3348. https://doi.org/10.1001/jama.254.23.3344

Rader G. S. (1988). Management decisions: Do we really need interpreters? Nursing

Management, 19(7), 46–48.

Refki, D., Avery, M. P., & Dalton, A. (2013). Core competencies for healthcare interpreters.

International Journal of Humanities and Social Science, 3(2), 72-83.

124
 http://www.ijhssnet.com/journals/Vol_3_ No_2_Special_Issue_January_2013/8.pdf

Roat, C. E. & Crezee, I. H. M. (2015). Healthcare Interpreting. In H. Mikkelson & R.

Jourdenais (Eds.), The routledge handbook of interpreting (pp. 236–253). Routledge.

Sack, W. H., Angell, R. H., Kinzie, J. D., & Rath, B. (1986). The psychiatric effects of

massive trauma on Cambodian children: II. The family, the home, and the

school. Journal of the American Academy of Child Psychiatry, 25(3), 377–

383. https://doi.org/10.1016/S0002-7138(09)60260-0

Sarver, J., & Baker, D. W. (2000). Effect of language barriers on follow-up appointments

after an emergency department visit. Journal of General Internal Medicine, 15(4),

256–264. https://doi.org/10.1111/j.1525-1497.2000.06469.x

Schmid, M. S., & Keijzer, M. (2009). First language attrition and reversion among older

migrants. International Journal of the Sociology of Language, 2009(200), 83-104.11.

https://doi.org/10.1515/IJSL.2009.046

Schuster, M. (2013). From chaos to cultural competence - Analyzing language access to

public institutions. In C. Schäffner, K. Kredens, & Y. Fowler (Eds.), Interpreting in a

changing landscape (pp. 61-82). John Benjamins.

Setton, R., & Dawrant, A. (2016). Conference interpreting – A complete course. John

Benjamins.

Shen, C.-W. (2006). The influence of medical behavior and barriers of foreign brides from

Southeast Asia: An example of Taichung County. [Unpublished master’s thesis]. China

Medical University.

Shih, Y. T. (2020). Problems posed to and strategies employed by Indonesian-Mandarin

community interpreters in Taiwan [Master’s thesis, National Taiwan University].

National Digital Library of Theses and Dissertations in Taiwan.

https://hdl.handle.net/11296/5m97c9

Smith, J., Swartz, L., Kilian, S., & Chiliza, B. (2013). Mediating words, mediating worlds:

125
 Interpreting as hidden care work in a South African psychiatric

institution. Transcultural Psychiatry, 50(4), 493–514.

https://doi.org/10.1177/1363461513494993

Squires A. (2018). Strategies for overcoming language barriers in healthcare. Nursing

Management, 49(4), 20–27. https://doi.org/10.1097/01.NUMA.0000531166.24481.15

Sun, L.-J. (2004). An exploratory study of the public health nurses - Implementation of family

planning for foreign brides in Miaoli County [Master’s thesis, Taipei Medical

University]. National Digital Library of Theses and Dissertations in Taiwan.

https://hdl.handle.net/11296/f3964p

Sung, T.-Y. (2011). A study of medical tourism in Taiwan-A comparative perspective

[Master’s thesis, I-Shou University]. National Digital Library of Theses and

Dissertations in Taiwan. https://hdl.handle.net/11296/veb343

Taiwan Medical Travel. (n.d.-a). About TTFMT. Retrieved November 28, 2022, from

https://www.medicaltravel.org.tw/Article.aspx?a=18&l=2

Taiwan Medical Travel (n.d.-b). International Medical Statistics Zone. Retrieved November

28, 2022, from https://www.medicaltravel.org.tw/Chart.aspx?a=237

Taiwan Medical Travel (n.d.-c). Taiwan Healthcare. Retrieved November 28, 2022, from

https://www.medicaltravel.org.tw/Article.aspx?a=17&l=2

Tebble, H.A. (2014). A genre-based approach to teaching dialogue interpreting: The medical

consultation. The Interpreter and Translator Trainer, 8, 418 - 436.

https://doi.org/10.1080/1750399X.2014.972651

Textor, C. (2021, June 17). Number of overseas students in Taiwan 2010-2020. Statista.

https://www.statista.com/statistics/1092735/taiwan-total-number-of-foreign-students/

Thompson, S., Hartel, G., Manderson, L., Stirling, N., & Kelaher, M. (2002). The mental

health status of Filipinas in Queensland. Australian & New Zealand Journal of

Psychiatry, 36(5), 674–680. https://doi.org/10.1046/j.1440-1614.2002.01070.x

126
Tien, T.-Y., Tsing, C.-F., & Lee, H.-T. S. (2010). Using the cultural leverage model to care

for the health needs of female Vietnamese immigrants in Taiwan. Tzu Chi Nursing

Journal, 9(4), 65-70. https://doi.org/10.6974/TCNJ.201008.0065

Tourism Bureau, Ministry of Transportation and Communications of Taiwan. (n.d.). Visitor

Arrivals by Purpose of Visit. Retrieved November 28, 2022, from

https://admin.taiwan.net.tw/English/FileUploadCategoryListE003130.aspx?CategoryI

D=4bf18759-da03-4048-9caa-

251e836b0f92&appname=FileUploadCategoryListE003130

Tseng, M.-C. (2019). Comparing the medical system between Taiwan and Japan - the

training of medical interpreter - [Master’s thesis, Tamkang University]. National

Digital Library of Theses and Dissertations in Taiwan.

https://hdl.handle.net/11296/mz2p4h

Valero Garces, C. (2005). Doctor–patient consultations in dyadic and triadic exchanges.

Interpreting, 7(2), 193–210. https://doi.org/10.1075/intp.7.2.04val

Vargas Pelaez, A. F., Ramirez, S. I., Valdes Sanchez, C., Piedra Abusharar, S., Romeu, J. C.,

Carmichael, C., Bascoy, S., Baron, R., Pichardo-Lowden, A., Albarracin, N., Jones, C.

C., & Silveyra, P. (2018). Implementing a medical student interpreter training program

as a strategy to developing humanism. BMC Medical Education, 18(1), 141.

https://doi.org/10.1186/s12909-018-1254-7

Wadensjo, C. (2013). Interpreting as interaction. New York: Routledge.

Wang, H.-M., Su, S.-F., Liu, P.-E., & Wang, J.-D. (2012). Immigrant mother experiences

accompanying their children in the emergency department. Journal of Nursing and

Healthcare Research, 8(1), 14-23. http://dx.doi.org/10.6225/JNHR.8.1.16

Wang, J.-H., Feng, H., & Wu, Y. (2020). Exploring key factors of medical tourism and its

relation with tourism attraction and re-visit intention. Cogent Social Sciences, 6(1),

p.1746108. https://doi.org/10.1080/23311886.2020.1746108

127
Wang, R. (2019, January 31). Han Guoyu hosted the first medical tourism preparatory

meeting to declare 2019 as the first year of medical tourism in Kaohsiung. Liberty

Times Net. https://news.ltn.com.tw/news/life/breakingnews/2688832

Wang, S.-H. (2011). Research of quality indicators for international medical service in

Taiwan [Master’s thesis, National Taipei University of Nursing and Health Sciences].

National Digital Library of Theses and Dissertations in Taiwan.

https://hdl.handle.net/11296/xmhq73

Wang, Y.-M., Han, C.-H., & Huang, M.-C. (2007). The interpreter: Crossing communication

barriers between healthcare providers and international patients. The Journal of

Nursing, 54(4), 73–77. http://dx.doi.org/10.6224/JN.54.4.73

Westermeyer J. (1990). Working with an interpreter in psychiatric assessment and

treatment. The Journal of Nervous and Mental Disease, 178(12), 745–749.

https://doi.org/10.1097/00005053-199012000-00003

Wilson, E., Chen, A. H., Grumbach, K., Wang, F., & Fernandez, A. (2005). Effects of limited

English proficiency and physician language on health care comprehension. Journal of

General Internal Medicine, 20(9), 800–806. https://doi.org/10.1111/j.1525-

1497.2005.0174.x

Winstanley, C. (2009). Writing a dissertation for dummies. John Wiley & Sons.

Woloshin, S., Bickell, N. A., Schwartz, L. M., Gany, F., & Welch, H. G. (1995). Language

barriers in medicine in the United States. JAMA, 273(9), 724–728.

Woloshin, S., Schwartz, L. M., Katz, S. J., & Welch, H. G. (1997). Is language a barrier to the

use of preventive services? Journal of General Internal Medicine, 12(8), 472–477.

https://doi.org/10.1046/j.1525-1497.1997.00085.x

Wu, P.-L. (2018). Multilingual medical interpreters: Imbalanced communication between

doctors and patients. Studies of Translation and Interpretation, 22, 101-126.

Yang, J., Ye, N., & Sha, X. (2010). A Study on the implementation of the platform for

128
 interpreting talent database. The Ministry of the Interior National Immigration

Agency Republic of China (Taiwan).

https://www.immigration.gov.tw/5382/5385/7353/7362/45414/

Yang, Y.-M., & Wang, H.-H. (2003). Life and health concerns of Indonesian women in

transnational marriages in Taiwan. The Journal of Nursing Research, 11(3), 167–176.

https://doi.org/10.1097/01.jnr.0000347633.72476.4a

Yeh, C.-G. (2007). A research study based on the care and guidance on the responsive policy

evaluation for foreign spouse: A case study of Miaoli County’s female foreign spouse

from South East Asia [Master’s thesis, National Taipei University].

https://hdl.handle.net/11296/uuafkk

Yen, C.-C. (2002). A study on the process of adaptation among foreign brides from Southeast

Asia: Interpreting the phenomenon of their lived experiences [Master’s thesis,

National Chiayi University]. https://hdl.handle.net/11296/sga2fx

Yen, F.-T. (2013). Two sides of one coin: Roles of Taiwan’s interpreters and their agency in

doctor-patient communication. Chinese Journal of Applied Anthropology, 2(1), 87-

110. https://doi.org/10.6290/CJAA.2013.0201.06

Yeoh, E., Othman, K., & Ahmad, H. (2013). Understanding medical tourists: Word-of-mouth

and viral marketing as potent marketing tools. Tourism Management, 34, 196-201.

https://doi.org/10.1016/j.tourman.2012.04.010

Zhong, L., Deng, B., Morrison, A. M., Coca-Stefaniak, J. A., & Yang, L. (2021). Medical,

health and wellness tourism research-A review of the literature (1970-2020) and

research agenda. International Journal of Environmental Research and Public

Health, 18(20), 10875. https://doi.org/10.3390/ijerph182010875

129
 Appendix A

Informed Consent for the Questionnaire

Ethics Committee for Behavioral and Social Sciences Research

Chung Yuan Christian University

Study Participants Informed Consent

Dear Participants,

You are invited to participate in this research titled as An investigation on Bahasa

Indonesia – Mandarin medical interpreting training program as a language access facilitator in

Taiwan (醫療口譯培訓與語言可近性關係初探:以印尼語——中文醫療口譯培訓為例).

The purpose of this study is to understand what had been taught in the Bahasa

Indonesia-Mandarin medical interpreting training program and how the training improves

language access in the healthcare system such as hospitals, clinics, et cetera, in Taiwan. The

questionnaire, designed for this research, will take about 10 minutes to answer. In the

questionnaire, you will be asked about your experience in the medical interpreting training

program. There are no anticipated risks related to this research. Your anonymity and privacy

will be protected.

Your participation in this research is voluntary. There will be no direct benefit to you

for answering the questionnaire. However, by participating in this research, you may benefit

people who do not speak Mandarin by raising awareness about the importance of

professionally trained medical interpreters among the public, academicians, interpreters, as

well as healthcare providers. You can freely withdraw your informed consent at any time

during the project without any further consequences or risks.

The results from this research will be read by medical interpreting professionals,

healthcare providers, and authorities to help understand the benefits of medical interpreting

training programs better and find better ways to train qualified medical interpreters.

130
 If you have any questions about this study or wish to receive a copy of the study’s

results, you are welcome to contact the researcher. The contact info is as follows:

Researcher’s name: 陳晚霞 (Rooswaty)

Email address: roswaty65@yahoo.com

Telephone number: 0955 496 478

I have read the above information regarding this research study on the Bahasa

Indonesia-Mandarin medical interpreting training program, and consent to participate in this

study.

__________________________________________

(Date)

__________________________________________

(Signature)

__________________________________________

(Name)

131
 Appendix B

Informed Consent for the Questionnaire in Bahasa Indonesia

Komite Kode Etik Penelitian Ilmu Perilaku dan Ilmu Sosial

Universitas Kristen Chung Yuan

Surat Persetujuan Peserta Penelitian

Peserta yang terhormat,

Anda diundang untuk berpartisipasi dalam penelitian yang berjudul “Investigasi

program pelatihan jurubahasa medis Bahasa Indonesia – Mandarin sebagai fasilitator layanan

bahasa di Taiwan”. Anda diundang karena Anda adalah peserta program pelatihan tersebut

pada tahun 2020 atau 2021.

Tujuan penelitian ini adalah untuk memahami apa yang telah diajarkan dalam program

pelatihan penafsiran medis Bahasa Indonesia-Mandarin dan bagaimana pelatihan tersebut

meningkatkan akses layanan bahasa dalam sistem perawatan kesehatan seperti rumah sakit,

klinik, dan lain-lain. Untuk pengumpulan data, beberapa interview akan dilakukan. Waktu

untuk interview sekitar 30 menit. Dalam interview, Anda akan diminta untuk berbagi

pengalaman semasa menjalani pelatihan dan setelahnya. Juga pengalaman sebagai

penerjemah lisan di layanan kesehatan, jika ada. Interview akan dilaksanakan di tempat dan

waktu yang Anda tentukan dan pembicaraan akan direkam. Tidak ada risiko yang

berhubungan dengan penelitian ini. Anonimitas dan privasi Anda akan dilindungi. Rekaman

pembicaraan akan dihapus begitu selesai dicatat oleh peneliti. Catatan interview tidak akan

mengandung data pribadi Anda.

Partisipasi Anda dalam penelitian ini bersifat sukarela dan Anda akan menerima

NTD600 dalam bentuk kupon belanja di 7-11 sebagai penghargaan atas waktu yang Anda

luangkan. Selain itu, dengan berpartisipasi dalam penelitian ini, secara tidak langsung Anda

membantu orang yang tidak bisa berbahasa Mandarin di Taiwan dengan peningkatan

132
kesadaran akan pentingnya penerjemahan medis di dalam sistem pelayanan kesehatan. Anda

berhak menarik kembali persetujuan Anda selama penelitian berlangsung tanpa konsekuensi

dan risiko apa pun.

Hasil penelitian ini akan dibaca oleh para jurubahasa medis, penyedia layanan

kesehatan, dan pihak berwenang. Dengan membaca hasil penelitian, diharapkan mereka akan

terbantu untuk lebih memahami program pelatihan jurubahasa medis dan menemukan cara

yang lebih baik untuk melatih jurubahasa medis yang berkualitas.

Jika Anda memiliki pertanyaan tentang penelitian ini atau ingin menerima salinan

hasil penelitian, silakan menghubungi peneliti melalui info kontak berikut:

Nama peneliti: 陳晚霞 (Rooswaty) Alamat email: roswaty65@yahoo.com Nomor

telepon: 0955 496 478

Saya sudah membaca penjelasan mengenai penelitian program pelatihan penafsiran

medis Bahasa Indonesia – Mandarin di atas. Dengan demikian saya menyatakan persetujuan

saya untuk berpartisipasi dalam kajian ini.

__________________________________________

(Tanggal)

__________________________________________

(Tanda Tangan)

__________________________________________

(Nama)

133
 Appendix C

Informed Consent for the Interviews for the Trainees

Ethics Committee for Behavioral and Social Sciences Research

Chung Yuan Christian University

Study Participants Informed Consent

Dear Participants,

You are invited to participate in this research titled as An investigation on a Bahasa

Indonesia – Mandarin medical interpreting training program as a language access facilitator in

Taiwan (醫療口譯培訓與語言可近性關係初探:以印尼語——中文醫療口譯培訓為例).

You are invited because you were enrolled in the said training program in year 2020 or 2021.

The purpose of this study is to understand what had been taught in the Bahasa

Indonesia-Mandarin medical interpreting training program and how the training improves

language access in the healthcare system such as hospitals, clinics, et cetera, in Taiwan.

To collect data, this research will interview participants. The interview will take about

30 minutes. In the interview, you will be asked about your experience in the medical

interpreting training program and your interpreting experiences, if any. The interview will be

conducted whenever and wherever you prefer and will be recorded. There are no anticipated

risks related to this research. Your anonymity and privacy will be protected. The recorded

interview will be deleted as soon as the conversation is typed up. The typed interviews will

not contain your private data.

Your participation in this research is voluntary and you will receive 7-11 coupons

worth NT$600 for your time and trouble. Moreover, by participating in this research, you may

benefit people who do not speak Mandarin by raising awareness about the importance of

medical interpreting. You can freely withdraw your informed consent at any time during the

project without any further consequences or risks.

134
 The results from this research will be read by medical interpreting professionals,

healthcare providers, and authorities to help understand the benefits of medical interpreting

training programs better and find better ways to train qualified medical interpreters.

If you wish to receive a copy of the results from this study, or if you have any

questions about this study, you may contact the researcher. The contact info is as follows:

Researcher’s name: 陳晚霞 (Rooswaty)

Email address: roswaty65@yahoo.com

Telephone number: 0955 496 478

I have read the above information regarding this research study on the Bahasa

Indonesia-Mandarin medical interpreting training program, and consent to participate in this

study.

__________________________________________

(Date)

__________________________________________

(Signature)

__________________________________________

(Name)

135
 Appendix D

Informed Consent for the Interviews for the Trainees in Bahasa Indonesia

Komite Kode Etik Penelitian Ilmu Perilaku dan Ilmu Sosial

Universitas Kristen Chung Yuan

Surat Persetujuan Peserta Penelitian

Peserta yang terhormat,

Anda diundang untuk berpartisipasi dalam penelitian yang berjudul “Investigasi

program pelatihan jurubahasa medis Bahasa Indonesia – Mandarin sebagai fasilitator layanan

bahasa di Taiwan”. Anda diundang karena Anda adalah peserta program pelatihan tersebut

pada tahun 2020 atau 2021.

Tujuan penelitian ini adalah untuk memahami apa yang telah diajarkan dalam program

pelatihan penafsiran medis Bahasa Indonesia-Mandarin dan bagaimana pelatihan tersebut

meningkatkan akses layanan bahasa dalam sistem perawatan kesehatan seperti rumah sakit,

klinik, dan lain-lain. Untuk pengumpulan data, beberapa interview akan dilakukan. Waktu

untuk interview sekitar 30 menit. Dalam interview, Anda akan diminta untuk berbagi

pengalaman semasa menjalani pelatihan dan setelahnya. Juga pengalaman sebagai

penerjemah lisan di layanan kesehatan, jika ada. Interview akan dilaksanakan di tempat dan

waktu yang Anda tentukan dan pembicaraan akan direkam. Tidak ada risiko yang

berhubungan dengan penelitian ini. Anonimitas dan privasi Anda akan dilindungi. Rekaman

pembicaraan akan dihapus begitu selesai dicatat oleh peneliti. Catatan interview tidak akan

mengandung data pribadi Anda.

Partisipasi Anda dalam penelitian ini bersifat sukarela dan Anda akan menerima

NTD600 dalam bentuk kupon belanja di 7-11 sebagai penghargaan atas waktu yang Anda

luangkan. Selain itu, dengan berpartisipasi dalam penelitian ini, secara tidak langsung Anda

membantu orang yang tidak bisa berbahasa Mandarin di Taiwan dengan peningkatan

kesadaran akan pentingnya penerjemahan medis di dalam sistem pelayanan kesehatan. Anda

136
berhak menarik kembali persetujuan Anda selama penelitian berlangsung tanpa konsekuensi

dan risiko apa pun.

Hasil penelitian ini akan dibaca oleh para jurubahasa medis, penyedia layanan

kesehatan, dan pihak berwenang. Dengan membaca hasil penelitian, diharapkan mereka akan

terbantu untuk lebih memahami program pelatihan jurubahasa medis dan menemukan cara

yang lebih baik untuk melatih jurubahasa medis yang berkualitas.

Jika Anda memiliki pertanyaan tentang penelitian ini atau ingin menerima salinan

hasil penelitian, silakan menghubungi peneliti melalui info kontak berikut:

Nama peneliti: 陳晚霞 (Rooswaty) Alamat email: roswaty65@yahoo.com Nomor

telepon: 0955 496 478

Saya sudah membaca penjelasan mengenai penelitian program pelatihan penafsiran

medis Bahasa Indonesia – Mandarin di atas. Dengan demikian saya menyatakan persetujuan

saya untuk berpartisipasi dalam kajian ini.

__________________________________________

(Tanggal)

__________________________________________

(Tanda Tangan)

__________________________________________

(Nama)

137
 Appendix E

Informed Consent for the Interviews for the Instructors and the Representative of the

Patrons

Ethics Committee for Behavioral and Social Sciences Research

Chung Yuan Christian University

Study Participants Informed Consent

Dear Participants,

You are invited to participate in this research titled as An investigation on a Bahasa

Indonesia – Mandarin medical interpreting training program as a language access facilitator in

Taiwan (醫療口譯培訓與語言可近性關係初探:以印尼語——中文醫療口譯培訓為例).

The purpose of this study is to understand what had been taught in the Bahasa

Indonesia-Mandarin medical interpreting training program and how the training improves

language access in the healthcare system such as hospitals, clinics, et cetera, in Taiwan.

To collect data, this research will interview participants. The interview will take about

30 minutes. In the interview, you will be asked about your experience in the medical

interpreting training program and your interpreting experiences, if any. The interview will be

conducted whenever and wherever you prefer and will be recorded. There are no anticipated

risks related to this research. Your anonymity and privacy will be protected. The recorded

interview will be deleted as soon as the conversation is typed up. The typed interviews will

not contain your private data.

Your participation in this research is voluntary. By participating in this research, you

may benefit people who do not speak Mandarin by raising awareness about the importance of

medical interpreting. You can freely withdraw your informed consent at any time during the

project without any further consequences or risks.

138
 The results from this research will be read by medical interpreting professionals,

healthcare providers, and authorities to help understand the benefits of medical interpreting

training programs better and find better ways to train qualified medical interpreters.

If you wish to receive a copy of the results from this study, or if you have any

questions about this study, you may contact the researcher. The contact info is as follows:

Researcher’s name: 陳晚霞 (Rooswaty)

Email address: roswaty65@yahoo.com

Telephone number: 0955 496 478

I have read the above information regarding this research study on the Bahasa

Indonesia-Mandarin medical interpreting training program, and consent to participate in this

study.

__________________________________________

(Date)

__________________________________________

(Signature)

__________________________________________

(Name)

139
 Appendix F

Informed Consent for the Interview in Mandarin

(For the Instructors and the Representative of the Patrons)

訪談知情同意書

行為與社會科學研究倫理委員會

中原大學

研究參與者知情同意

親愛的參與者，

邀請您參與這項研究。研究的題目是醫療口譯培訓與語言可近性初探：以印尼

語——中文醫療口譯培訓典型關係。本研究的目的是了解印尼語-中文醫學口譯培訓計

劃中教授的內容，以及該培訓如何改善台灣醫院、診所等醫療保健系統的語言可近

性。

為了收集數據，這項研究將進行訪談。訪談時間約需要 30 分鐘。訪談將問及您

在醫學口譯培訓計畫中的經歷以及您的口譯經歷（若有的話）。訪談將於您選擇的時

間與地點進行，並全程錄音。參與本研究並沒有預期的風險，您的匿名性和隱私將受

到保護，若您於訪談過程中因所談及內容感到不適，希望終止訪談，可隨時提出相關

要求，亦不會有任何連帶風險。錄音內容將被轉錄為文字，以作為研究分析之用，相

關內容不會包含您的個人資訊。

參與這項研究是基於您的個人意願。通過參與這項研究，您可以提高對醫學口

譯重要性的認識，從而使不會說中文的人受益。醫療口譯專業人士、醫療服務提供者

和有關當局將閱讀這項研究的結果，以幫助更了解醫療口譯培訓計劃的好處，並找到

更好的方法來培訓合格醫療口譯員。

140
 如果您希望收到本研究結果的副本，或者您對本研究有任何疑問，您可以聯繫

研究人員。聯繫方式如下：

研究員姓名：陳晚霞（Rooswaty）

電子郵件地址：roswaty65@yahoo.com

電話號碼：0955 496 478

我已閱讀上述關於印尼語-中文醫學口譯培訓項目研究的信息，並同意參與這項

研究。

_________________________________________

（日期）

__________________________________________

（簽名）

__________________________________________

（姓名）

141
 Appendix G

Survey Questionnaire for the Trainees

Research Topic: An investigation on a Bahasa Indonesia – Mandarin medical interpreting

training program as a language access facilitator in Taiwan

Dear Sir/Madam,

Thank you for your time in filling out this questionnaire. You are sent this

questionnaire because you were enrolled in the Bahasa Indonesia – Mandarin medical

interpreting training program. This study’s purpose is to find out the role of “Bahasa

Indonesia – Mandarin Medical Interpreting Training Program” in facilitating the improvement

of language service access in healthcare systems in Taiwan. The questionnaire is for academic

purposes only and your anonymity will be honored. Your answers may help draw the policy

makers’ attention to improve the medical interpreting in Taiwan.

There are 27 questions in this questionnaire and 12 questions for demographic data.

Please answer them all. It will only take about 10 minutes to complete. If you have any

questions, feel free to contact Advisee 陳晚霞 Rooswaty at roswaty65@tyahoo.com. Thank

you again for your cooperation and I wish you good health and all the best!

Applied Linguistics and Language Studies, Chung Yuan Christian University

Thesis Advisor: Charlotte Wu, Shuo-yu Ph.D.

Advisee: 陳晚霞 Rooswaty

Participant’s Name:

Date:

1. Gender

口 Male 口 Female

142
2. Age

口 Under 21 口 21-25 口 26-30 口 31-35 口 36-40 口 41-45 口 46-50 口 Over 50

3. Marital Status

口 Single 口 Married 口 Other

4. Ethnicity (You may choose two most dominant ones)

口 Chinese Indonesian 口 Acehnese 口 Batak 口 Melayu 口 Javanese 口 Minang

口 Other ______________

5. Languages (start from the highest proficiency, e.g., Javanese, Indonesian, Mandarin,

English):

1_____ 2______ 3_______ 4_________

6. Religious belief

口 Moslem 口 Christian 口 Catholic 口 Buddhism 口 Other

7. Education level

口 Elementary school 口 Junior High School 口 Senior High School 口 University or

above

8. How many years have you been living in Taiwan?

口 Under 5 years 口 5-10 years 口 11-15 years 口 16-20 口 More than 20 years

9. Occupation

口 Paid Medical Translator/Interpreter 口 Volunteer Medical Translator/Interpreter

口 Interpreting in healthcare facilities full time. Where __________ (name of the facility)

口 Unemployed 口 Self-employed 口 Work in a manufacturing company

口 Domestic Worker 口 Other ______________.

10. Years Interpreting in Medical Settings

口 Never 口 Up to 5 years 口 6-10 years 口 11-15 years 口 16-20 years 口 More

than 20 years

143
11. Times interpreting in medical settings for migrants

口 Never 口 1-10 times 口 11-20 times 口 21-30 times 口 more than 30 times

12. Times interpreting in medical settings for medical tourists

口 Never 口 1-10 times 口 11-20 times 口 21-30 times 口 more than 30 times

13. What year were you enrolled in this training program?

口 2020 口 2021

14. Have you ever been enrolled in other (general) interpreting training programs before this

one?

口 No.

口 Yes. What is the name of the program? __________

Where? _______

Did you get a certificate upon completion? 口 Yes. 口 No.

15. Have you ever been enrolled in any medical interpreting training programs before this

one?

口 No.

口 Yes. What is the name of the program? __________

Where? _______

Did you get a certificate upon completion? 口 Yes. 口 No.

16. Have you ever enrolled in any medical interpreting training program after this one?

口 No

口 Yes. What is the name of the program? __________

Where? _______

Did you get a certificate upon completion? 口 Yes. 口 No.

17. Why did you apply for Bahasa Indonesia-Mandarin Medical Interpreter training program

for Medical Tourism? (May tick more than one)

144
口 I want to have other job options.

口 I hope to be able to work as an interpreter to support my family financially.

口 I want to help other new immigrants.

口 I want to learn more about medicine.

口 Others _______________________________________

18. What did you learn at the Bahasa Indonesia-Mandarin Medical Interpreter training

program for Medical Tourism? (May tick more than one)

口 Medical tourism

口 Medical knowledge

口 Medical language

口 Interpreting knowledge

口 Interpreting ethics

口 Other not mentioned above __________

19. After being trained in the Bahasa Indonesia-Mandarin Medical Interpreter training

program for Medical Tourism, I know more about medical tourism and relevant matters.

口 strongly agree 口 agree 口 neither agree nor disagree 口 disagree 口 strongly disagree

20. After being trained in the Bahasa Indonesia-Mandarin Medical Interpreter training

program for Medical Tourism, I know more about medical knowledge as well as medical

terminology.

口 strongly agree 口 agree 口 neither agree nor disagree 口 disagree 口 strongly disagree

21. After the training program, I know more about medical interpreting knowledge.

口 strongly agree 口 agree 口 neither agree nor disagree 口 disagree 口 strongly disagree

22. After being trained in the Bahasa Indonesia-Mandarin Medical Interpreter training

program for Medical Tourism, I know more about medical interpreting ethics (what a medical

interpreter should and should not do).

145
口 strongly agree 口 agree 口 neither agree nor disagree 口 disagree 口 strongly disagree

23. The final interpreting test in the Bahasa Indonesia-Mandarin Medical Interpreter training

program for Medical Tourism reflects my medical interpreting ability accurately.

口 strongly agree 口 agree 口 neither agree nor disagree 口 disagree 口 strongly disagree

24. Have you ever received an invitation to interpret in a healthcare facility after being trained

in the Bahasa Indonesia-Mandarin Medical Interpreter training program for Medical Tourism?

口 No

口 Yes, did you take the assignment?

口 No. Why? __________________

口 Yes. Where? ______________ What was the task? ________________________

(For example: I was asked to interpret for a young man who got injured at work in the ER.)

25. Have you ever interpreted for friends or family without pay?

口 No

口 Yes. Where? ______________What was the scenario?

______________________________

26. Name three things you learned in this program that you think will help you the most in

interpreting for healthcare workers and patients.

1. ________________

2. _________________

3. ___________________

27. Do you meet and share information or experience about medical interpreting with other

interpreters?

口 Regularly 口 Sometimes 口 Never

This is the end of the questionnaire. Thank you again for your time and effort.

146
 Appendix H

Survey Questionnaire for the Trainees in Bahasa Indonesia

Kuesioner untuk Peserta Pelatihan

Judul Penelitian:

Investigasi program pelatihan jurubahasa medis Bahasa Indonesia – Mandarin sebagai

fasilitator akses bahasa di Taiwan

Bapak/Ibu yang Terhormat,

Terima kasih atas waktu yang Anda berikan untuk mengisi kuesioner ini. Penelitian

ini bertujuan untuk mengetahui peran “Program Pelatihan Jurubahasa Medis Bahasa

Indonesia – Mandarin” dalam memfasilitasi peningkatan akses bahasa dalam sistem

pelayanan kesehatan. Kuesioner ini dimaksudkan hanya untuk tujuan akademis di mana

anonimitas Anda akan dihormati. Jawaban Anda dapat membantu menarik perhatian pembuat

kebijakan untuk memajukan layanan penerjemahan lisan medis di Taiwan.

Total ada 27 pertanyaan dan 12 pertanyaan untuk data demografi dalam kuesioner ini.

Mohon kesediaan Anda untuk menjawab semuanya. Waktu yang dibutuhkan untuk

menyelesaikan seluruh pertanyaan tersebut hanya 10 menit saja. Bila ada pertanyaan, silakan

hubungi peneliti 陳晚霞(Rooswaty) di roswaty65@yahoo.com. Sekali lagi, terima kasih atas

kerjasama Anda. Semoga sehat dan sukses selalu!

Applied Linguistics and Language Studies, Chung Yuan Christian University

Pembimbing Tesis: Charlotte Wu, Shuo-yu Ph.D.

Penulis: 陳晚霞 Rooswaty

Nama Peserta:

Tanggal:

147
1. Jenis Kelamin:

口 Laki-laki 口 Perempuan

2. Umur

口 Dibawah 21 口 21-25 口 26-30 口 31-35 口 36-40 口 41-45 口 46-50 口 Diatas 50

3. Status

口 Single 口 Menikah 口 Lainnya

4. Suku (Maksimum pilih dua yang paling dominan)

口 Tionghoa 口 Aceh 口 Batak 口 Melayu 口 Jawa 口 Minang 口 Lainnya

5. Bahasa (mulai dari yang paling fasih, misal: Jawa, Bahasa Indonesia, Mandarin, Bahasa

Inggris):

1__________ 2__________ 3__________ 4_________

6. Kepercayaan

口 Islam 口 Kristen 口 Katolik 口 Buddha 口 Lainnya

7. Pendidikan

口 Sekolah Dasar 口 Setingkat Sekolah Menengah Pertama 口 Setingkat Sekolah Menengah

Atas 口 Universitas atau lebih tinggi

8. Sudah berapa tahun Anda tinggal di Taiwan?

口 Di bawah 5 tahun 口 5-10 tahun 口 11-15 tahun 口 16-20 tahun 口 lebih dari 20

tahun

9. Pekerjaan (Boleh pilih lebih dari satu)

口 Jurubahasa/Penerjemah Medis Berbayar 口 Jurubahasa/Penerjemah Medis Sukarela

口 Jurubahasa/Penerjemah penuh waktu di fasilitas Kesehatan.

口 Menganggur 口 Usaha Sendiri

口 Bekerja di perusahaan/pabrik 口 Pekerja Rumah Tangga 口 Lainnya ____________

10. Lama bekerja sebagai Jurubahasa Medis

148
口 Tidak pernah 口 Di bawah 5 tahun 口 6-10 tahun 口 11-15 tahun 口 16-20 tahun 口 lebih

dari 20 tahun

11. Berapa kali menerjemahkan lisan dalam rangka pelayanan kesehatan untuk migran?

口 Tidak pernah 口 1-10 kali 口 11-20 kali 口 21-30 kali 口 lebih dari 30 kali

12. Berapa kali menerjemahkan lisan dalam konteks pelayanan kesehatan untuk turis medis?

口 Tidak pernah 口 1-10 kali 口 11-20 kali 口 21-30 kali 口 lebih dari 30 kali

13. Tahun berapa Anda mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia –

Mandarin?

口 2020 口 2021

14. Pernahkah Anda mengikuti program pelatihan penerjemahan lisan (umum) lainnya

sebelum mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin?

口 Tidak

口 Ya.

Jika Anda menjawab “Ya” untuk pertanyaan sebelum ini, apa nama program pelatihan

tersebut dan di mana? __________

Jika Anda menjawab “Ya” untuk pertanyaan sebelum ini, apakah Anda memperoleh sertifikat

setelah menyelesaikan pelatihan tersebut? 口 Ya. 口 Tidak

15. Pernahkah Anda mengikuti program pelatihan penerjemahan lisan medis lainnya sebelum

mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin?

口 Tidak

口 Ya

Jika Anda menjawab “Ya” untuk pertanyaan sebelum ini, apa nama program pelatihan

tersebut dan di mana? __________

Jika Anda menjawab “Ya” untuk pertanyaan sebelum ini, apakah Anda memperoleh sertifikat

setelah menyelesaikan program pelatihan tersebut? 口 Ya. 口 Tidak

149
16. Apakah Anda pernah mengikuti program pelatihan jurubahasa medis lainnya setelah

mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin?

口 Tidak

口 Ya.

Jika Anda menjawab “Ya” untuk pertanyaan sebelum ini, apa nama program pelatihan

tersebut dan di mana? __________

Jika Anda menjawab “Ya” untuk pertanyaan sebelum ini, apakah Anda memperoleh sertifikat

setelah menyelesaikan program pelatihan tersebut? 口 Ya. 口 Tidak

17. Mengapa Anda mendaftar untuk mengikuti Program Pelatihan Jurubahasa Medis Bahasa

Indonesia – Mandarin? (Boleh pilih lebih dari satu jawaban)

口 Saya ingin memiliki pilihan pekerjaan lain.

口 Saya berharap dapat bekerja sebagai juru bahasa medis untuk memenuhi kebutuhan

finansial keluarga saya.

口 Saya ingin membantu imigran baru.

口 Saya ingin belajar lebih banyak tentang kedokteran.

口 Lainnya _______________________________________

Jika Anda memilih “Lainnya” untuk pertanyaan sebelum ini, sila terangkan.

_____________

18. Apa yang Anda pelajari dalam Program Pelatihan Jurubahasa Medis Bahasa Indonesia –

Mandarin? (Boleh pilih lebih dari satu jawaban)

口 Turisme medis

口 Pengetahuan kedokteran

口 Bahasa kedokteran

口 Pengetahuan di bidang penerjemahan lisan

口 Etika penerjemahan lisan

150
口 Lainnya __________

Jika Anda memilih “Lainnya” untuk pertanyaan sebelum ini, sila terangkan.

_____________

19. Setelah mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin,

saya jadi tahu lebih banyak mengenai turisme medis dan hal-hal lain yang berkaitan dengan

turisme medis

口 sangat setuju 口 setuju 口 netral 口 tidak setuju 口 sangat tidak setuju

20. Setelah mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin,

saya jadi tahu lebih banyak mengenai ilmu kedokteran dan juga istilah kedokteran.

口 sangat setuju 口 setuju 口 netral 口 tidak setuju 口 sangat tidak setuju

21. Setelah mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin,

saya jadi tahu lebih banyak mengenai penerjemahan lisan medis.

口 sangat setuju 口 setuju 口 netral 口 tidak setuju 口 sangat tidak setuju

22. Setelah mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin,

saya jadi tahu lebih banyak mengenai etika jurubahasa medis (apa yang boleh/seharusnya

dan apa yang tidak boleh dilakukan oleh seorang jurubahasa medis).

口 sangat setuju 口 setuju 口 netral 口 tidak setuju 口 sangat tidak setuju

23. Ujian akhir Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin ini

dirancang dengan baik sehingga bisa menilai dengan baik kemampuan saya sebagai

jurubahasa medis.

口 sangat setuju 口 setuju 口 netral 口 tidak setuju 口 sangat tidak setuju

24. Apakah Anda pernah mendapat undangan untuk melakukan aktivitas penerjemahan lisan

medis setelah mengikuti Program Pelatihan Jurubahasa Medis Bahasa Indonesia – Mandarin?

口 Tidak

口 Ya

151
Jika Anda pernah menerima undangan, apakah Anda memenuhi undangan tersebut? Jika ya,

apa jenis tugas yang diberikan dan di mana? (Misal: Saya mendapat tugas menerjemah lisan

di Ruang Gawat Darurat untuk seorang anak muda yang terluka di tempat kerja). Jika tidak,

mengapa tidak memenuhi undangan tersebut?

_______________

25. Apakah Anda pernah menerjemah lisan dalam konteks pelayanan kesehatan untuk teman

atau keluarga tanpa bayaran?

口 Tidak

口 Ya

Jika Anda menjawab ya untuk pertanyaan sebelum ini, apa jenis tugas yang diberikan dan di

mana?

__________

26. Sebutkan tiga hal yang Anda pelajari dalam Program Pelatihan Jurubahasa Medis Bahasa

Indonesia – Mandarin yang Anda pikir paling berguna dalam aktivitas penerjemahan lisan

untuk petugas kesehatan dan pasien.

1. ________________

2. _________________

3. ___________________

27. Apakah Anda bertemu dan berbagi informasi atau pengalaman tentang penerjemahan lisan

medis dengan jurubahasa lain?

口 Sering 口 Kadang-kadang 口 Tidak pernah

Kuesioner berakhir di sini. Terima kasih sekali lagi atas waktu dan kerjasama Anda.

152
 Appendix I

Interview Outline for the Trainees

This research focuses on Bahasa Indonesia – Mandarin medical interpreting training

program. The main purpose of the research is to investigate the role of the training program in

improving language service access in the Taiwanese healthcare system. This interview will

take about 30 minutes and will be recorded for further analysis. All private information

obtained from this interview will remain confidential and anonymous. The recording will only

be used for this research and will be deleted after the analysis is completed.

1. Please tell me more about the reasons you applied for this training program.

2. Have you ever been enrolled in any other interpreting training program before this medical

interpreting training program? - For example: legal interpreting

How do you think (legal interpreting) is different from medical interpreting?

3. What did you learn in the Bahasa Indonesia – Mandarin medical interpreting training

program?

Do you think medical interpreters should be trained professionally? Why or why not?

What do you think the medical interpreters’ roles are?

Which topic taught in this medical interpreting training program do you think is the most

important? Why?

Which topic do you think is the most useful that had been taught in this medical interpreting

training program? Why?

Which topic did you learn in the program that you think is the least important? Why?

Which topic do you think should be added or changed in the training program? Why?

4. What do you think about the final exam? - Is it too easy? Too difficult?

What do you think should be assessed in the final assessment?

5. I understand that you get a certificate upon completion of this training program. What do

153
you think about that certificate? Is it useful? Do you think medical interpreters should have a

certificate?

6. What do you think is the most difficult aspect when interpreting in the healthcare system?

What do you think should be done to make it easier?

7. Please tell me about your interpreting experiences. Any interpreting experiences. Before

and after the Bahasa Indonesia – Mandarin medical interpreting training program.

At which healthcare facilities have you interpreted?

Did you get information from the commissioner before the interpreting activity? E.g., about

the patient’s disease.

Did you have a discussion with the commissioner before the interpreting activity? E.g., the

expected time frame, what the physician’s expectations and needs are.

When interpreting for a patient, do you help patients ask questions to the doctor even when

they didn’t ask that question?

When interpreting for a patient, do you think you can give the patients or the doctor your

opinion or suggestions?

8. Are you aware of the income of medical interpreters? If yes, what do you think about the

income of medical interpreters? If no, what is your expected remuneration?

9. What do you think about the employment database for medical interpreters?

10. Are you a part of a circle of interpreters where you all share information and experiences

about interpreting? Medical interpreting? Do you think there is the need to form such a group?

Why or why not?

11. Is there anything you would like to add?

154
 Appendix J

Interview Outline for the Trainees in Bahasa Indonesia

Penelitian ini berfokus pada program pelatihan juru bahasa medis untuk Bahasa

Indonesia – Mandarin. Tujuan utama dari penelitian ini adalah untuk menyelidiki peran

program pelatihan dalam meningkatkan akses layanan bahasa di sistem kesehatan Taiwan.

Wawancara ini akan memakan waktu sekitar 30 menit dan akan direkam untuk analisis lebih

lanjut. Semua informasi pribadi yang diperoleh dari wawancara ini akan dijaga kerahasiaan

dan anonimitasnya. Rekaman wawancara hanya akan digunakan untuk penelitian ini dan akan

dihapus setelah analisis selesai.

1. Bagaimana ceritanya sampai Anda ikut program pelatihan ini?

2. Pernahkan Anda ikut program pelatihan juru bahasa yang lain sebelum ikut program

pelatihan juru bahasa medis untuk Bahasa Indonesia-Mandarin? Misalnya, program pelatihan

juru bahasa pengadilan.

Menurut Anda, apa bedanya dengan pelatihan juru bahasa medis?

3. Apa yang Anda pelajari di program pelatihan juru bahasa medis untuk Bahasa Indonesia –

Mandarin?

Menurut Anda, juru bahasa medis dilatih secara pofesional? Mengapa?

Menurut Anda, apa peran seorang juru bahasa medis?

Menurut Anda, topik apa yang paling penting dalam program pelatihan juru bahasa medis ini?

Mengapa?

Menurut Anda, topik apa yang paling berguna dalam program pelatihan juru bahasa medis

ini? Mengapa?

Menurut Anda, topik apa yang paling tidak penting dalam program pelatihan juru bahasa

medis ini? Mengapa?

Menurut Anda, topik apa yang seharusnya ditambah atau diubah dalam program pelatihan ini?

155
Mengapa?

4. Apa pendapat Anda tentang ujian akhir program pelatihan ini? Terlalu mudah? Terlalu

sulit? Menurut Anda, apa yang seharusnya diuji dalam ujian akhir?

5. Setahu saya, Anda semua mendapat sertifikat setelah menyelesaikan program pelatihan dan

lulus ujian. Apa pendapat Anda tentang sertifikat ini? Bergunakah? Menurut Anda, haruskah

seorang juru bahasa medis memiliki sertifikat?

6. Menurut Anda, apa yang paling sulit sewaktu menerjemahkan lisan untuk sistem pelayanan

kesehatan? Apa yang bisa dilakukan agar tidak begitu sulit?

7. Bisakah Anda menceritakan pengalaman Anda menjadi juru bahasa. Sebelum dan sesudah

ikut program pelatihan juru bahasa medis untuk Bahasa Indonesia-Mandarin.

Di fasilitas kesehatan mana Anda pernah menerjemah lisan?

Apakah Anda mendapat informasi sebelum kegiatan menerjemah dimulai? Misalnya, tentang

penyakit pasien.

Apakah Anda ada berdiskusi dengan orang yang memanggil Anda sebelum kegiatan

menerjemah lisan dimulai? Misalnya, kira-kira berapa lama Anda dibutuhkan, apa harapan

dan kebutuhan dokter.

Ketika menerjemah lisan untuk pasien, apakah Anda membantu pasien bertanya kepada

dokter walau mereka sendiri tidak bertanya?

Ketika menerjemah lisan untuk pasien, apakah Anda memberi saran dan pendapat kepada

dokter atau pasien?

8. Apakah Anda tahu pendapatan seorang juru bahasa medis? Jika ya, berapa? Jika tidak,

berapa yang ideal?

9. Apa pendapat Anda tentang database ketenagakerjaan untuk juru bahasa medis?

10. Apakah Anda bagian dari kumpulan juru bahasa di mana anggota saling berbagi informasi

dan pengalaman tentang menerjemah lisan? Juru bahasa medis?

Menurut Anda, pentingkah satu grup seperti itu? Mengapa?

156
11. Ada sesuatu yang ingin Anda tambahkan?

157
 Appendix K

Interview Outline for the Instructor from T & I Studies

This research focuses on Bahasa Indonesia – Mandarin medical interpreting training

program. The main purpose of the research is to investigate the role of the training program in

improving language service access in the Taiwanese healthcare system. This interview will

take about 30 minutes and will be recorded for further analysis. All private information

obtained from this interview will remain confidential and anonymous. The recording will only

be used for this research and will be deleted after the analysis is completed.

1. Can you please tell me your educational background?

2. Can you please tell me how you were contacted by the Taiwan Task Force for Medical

Travel to be one of the instructors in the Bahasa Indonesia – Mandarin medical

interpreting training program?

3. What is your current profession? How long have you been employed there?

Do you have experience as an interpreter? Would you please tell me about that

experience? Did those experiences impact your teaching material design for the Bahasa

Indonesia – Mandarin medical interpreting training program?

4. Let us look at your teaching material for the Bahasa Indonesia – Mandarin medical

interpreting training program. What did you consider when you prepared the teaching

material?

Which topic do you think you have to include in this training program?

What about medical interpreters’ roles? What about codes of ethics?

Did you use your real-life experience in these conversation samples?

What do you think about the time duration given to you for teaching in this training

program?

How do you evaluate the performance and progress of the trainees?

158
5. Do you think medical interpreters should be professionally trained and certified? Why?

Should medical interpreters be certified in order to be permitted to interpret in healthcare

system? Why?

6. What qualifications do you think a medical interpreter should have? Language ability?

Communication? Moral? Research ability? Self-care ability?

7. As you may already be aware that language access means the provision of interpreter

service to facilitate communication between people who do not speak the same language,

how important do you think language access is in terms of healthcare?

8. What are your concerns about this training program in terms of language access in

Taiwan’s healthcare system?

9. Do you have any suggestions for future medical interpreting training programs?

10. Is there anything you would like to add?

159
 Appendix L

Interview Outline for the Instructor from T & I Studies in Bahasa Indonesia

Penelitian ini berfokus pada program pelatihan juru bahasa medis untuk Bahasa

Indonesia – Mandarin. Tujuan utama dari penelitian ini adalah untuk menyelidiki peran

program pelatihan dalam meningkatkan akses layanan bahasa di sistem kesehatan Taiwan.

Wawancara ini akan memakan waktu sekitar 30 menit dan akan direkam untuk analisis lebih

lanjut. Semua informasi pribadi yang diperoleh dari wawancara ini akan dijaga kerahasiaan

dan anonimitasnya. Rekaman wawancara hanya akan digunakan untuk penelitian ini dan akan

dihapus setelah analisis selesai.

1. Bisakah Anda menceritakan sekilas latar belakang pendidikan Anda?

2. Bagaimana ceritanya sampai Taiwan Task Force for Medical Travel menghubungi Anda

untuk menjadi instruktur dalam program pelatihan ini?

3. Apa pekerjaan Anda sekarang? Sudah berapa lama Anda bekerja di sana?

Apakah Anda memiliki pengalaman menjadi juru bahasa? Bisakah Anda menceritakan

sedikit tentang pengalaman tersebut? Apakah pengalaman tersebut mempengaruhi

penyusunan materi pengajaran dalam program pelatihan ini?

4. Sekarang kita lihat materi pengajaran Anda. Apa yang Anda pertimbangkan waktu

menyusun materi tersebut?

Topik apa yang Anda pikir harus Anda sertakan? Bagaimana dengan peran juru bahasa

medis dan kode etik juru bahasa medis?

Apakah contoh dialog ini dari pengalaman nyata?

Apa pendapat Anda tentang waktu yang disediakan untuk Anda mengajar?

Bagaimana Anda mengevaluasi kemajuan peserta pelatihan?

5. Menurut Anda, apakah juru bahasa medis seharusnya dilatih secara professional dan

diberi sertifikat? Mengapa?

160
 Haruskah juru bahasa medis memiliki sertifikat untuk menerjemah di sistem pelayanan

kesehatan? Mengapa?

6. Menurut Anda, kualifikasi apa yang seharusnya dimiliki seorang juru bahasa medis?

Kemampuan bahasa? Komunikasi? Moral? Kemampuan riset? Kemampuan menjaga diri?

7. Seperti yang Anda ketahui, akses bahasa adalah tersedianya layanan bahasa untuk

memfasilitasi komunikasi antar orang yang berbeda bahasa. Menurut Anda berapa penting

akses bahasa dalam pelayanan kesehatan?

8. Apa yang Anda prihatinkan mengenai program pelatihan ini dalam hubungannya dengan

akses bahasa di sistem pelayanan kesehatan di Taiwan.

9. Apakah Anda punya saran untuk program pelatihan yang akan datang?

10. Adakah yang ingin Anda tambahkan?

161
 Appendix M

Interview Outline for the Instructor from Medical Field

This research focuses on Bahasa Indonesia – Mandarin medical interpreting training

program. The main purpose of the research is to investigate the role of the training program in

improving language service access in the Taiwanese healthcare system. This interview will

take about 30 minutes and will be recorded for further analysis. All private information

obtained from this interview will remain confidential and anonymous. The recording will only

be used for this research and will be deleted after the analysis is completed.

1. Can you please tell me your educational background?

2. Can you please tell me how you were contacted by the Taiwan Task Force for Medical

Travel to be one of the instructors in the Bahasa Indonesia – Mandarin medical

interpreting training program?

3. Have you ever been involved in an interpreter-mediated communication with your

patients? Before or after the program?

For what language?

Can you tell me more about that experience?

Based on your experiences with medical interpreters, what do you think a medical

interpreter should and should not do?

In your experience with medical interpreters, what aspects do you think they should also

pay attention to other than just interpreting?

Did those experiences impact your teaching material design for the Bahasa Indonesia –

Mandarin medical interpreting training program?

4. I understand that you are multilingual yourself. Have you ever interpreted for other

healthcare workers or patients? Can you tell me more about that experience?

How often does it happen?

162
 Was it in your free time or when you were on duty at the hospital?

Did it interrupt or enhance your medical duties?

Do you think the hospital should employ a professional medical interpreter? For which

languages? Why?

Did those experiences affect your teaching objections at the Bahasa Indonesia – Mandarin

medical interpreting training program?

5. Let us look at your teaching material for the Bahasa Indonesia – Mandarin medical

interpreting training program. What did you consider when you prepared the teaching

material?

Which topic do you think you have to include in this training program?

What about medical language? What about medical procedures? What about ethics

working in healthcare settings?

What do you think about the time duration given to you for teaching in this training

program?

Are there other topics that you consider should be covered but weren’t?

6. How do you evaluate the performance and progress of the trainees?

What did you consider when designing the assessment tools?

How does the test reflect the trainee's capacity in interpreting?

7. Do you think medical interpreters should be professionally trained and certified? Why or

why not?

8. Do you think healthcare workers should also be informed about how to collaborate with

medical interpreters to obtain maximal communication? Why?

Do you have anything to share about that?

9. As you may already be aware that language access means the provision of interpreter

service to facilitate communication between people who do not speak the same language,

how important do you think language access is in terms of healthcare?

163
10. What are your concerns about this training program in terms of language access in

Taiwan’s healthcare system?

11. Do you have any suggestions for future medical interpreting training programs?

12. Is there anything you would like to add?

164
 Appendix N

Interview Outline for the Instructor from Medical Field in Bahasa Indonesia

Penelitian ini berfokus pada program pelatihan juru bahasa medis untuk Bahasa

Indonesia – Mandarin. Tujuan utama dari penelitian ini adalah untuk menyelidiki peran

program pelatihan dalam meningkatkan akses layanan bahasa di sistem kesehatan Taiwan.

Wawancara ini akan memakan waktu sekitar 30 menit dan akan direkam untuk analisis lebih

lanjut. Semua informasi pribadi yang diperoleh dari wawancara ini akan dijaga kerahasiaan

dan anonimitasnya. Rekaman wawancara hanya akan digunakan untuk penelitian ini dan akan

dihapus setelah analisis selesai.

1. Bisakah Anda menceritakan sekilas latar belakang pendidikan Anda?

2. Bagaimana ceritanya sampai Taiwan Task Force for Medical Travel menghubungi Anda

untuk menjadi instruktur dalam program pelatihan ini?

3. Pernahkah Anda mempunyai pengalaman komunikasi medis yang melibatkan interpreter?

Sebelum atau sesudah program?

Bahasa apa?

Bisakah Anda menceritakan lebih lanjut tentang pengalaman itu?

Berdasarkan pengalaman Anda tersebut, menurut Anda, apa yang seharusnya dilakukan

seorang interpreter medis dan apa yang tidak boleh dilakukan seorang interpreter medis?

Menurut pengalaman Anda, apa saja yang seharusnya diperhatikan seorang interpreter

medis selain menerjemah?

Apakah pengalaman tersebut mempengaruhi penyusunan materi pengajaran Anda dalam

program pelatihan?

4. Pernahkah Anda menerjemah untuk dokter atau pasien lain? Bisakah Anda menceritakan

tentang pengalaman tersebut?

Berapa sering hal itu terjadi?

165
 Apakah itu terjadi pada jam kerja atau di luar jam kerja?

Apakah itu mengganggu atau meningkatkan kinerja kerja Anda?

Menurut Anda, apakah rumah sakit seharusnya mempekerjakan seorang juru bahasa medis

professional? Untuk bahasa apa? Mengapa?

Apakah pengalaman tersebut mempengaruhi pengharapan Anda dalam program

pelatihan?

5. Sekarang kita lihat materi pengajaran Anda. Apa yang Anda pertimbangkan waktu

menyusun materi tersebut?

Topik apa yang Anda pikir harus Anda sertakan?

Bagaimana dengan bahasa medis? Prosedur medis? Etika bekerja di pelayanan kesehatan?

Apa pendapat Anda tentang waktu yang disediakan untuk Anda mengajar?

Adakah topik yang Anda pikir harusnya diajarkan tetapi tidak Anda diskusikan?

6. Bagaimana Anda mengevaluasi kemajuan peserta pelatihan?

Apa yang Anda pertimbangkan waktu membuat soal ujian?

Apakah ujian itu merefleksikan kemampuan menerjemah lisan peserta pelatihan?

7. Menurut Anda, apakah juru bahasa medis seharusnya dilatih secara professional dan

diberi sertifikat? Mengapa?

8. Menurut Anda, apakah pekerja kesehatan seharusnya diberi informasi cara bekerja sama

dengan juru bahasa medis untuk mencapai komunikasi optimal? Mengapa? Ada

pengalaman?

9. Seperti yang Anda ketahui, akses bahasa adalah tersedianya layanan bahasa untuk

memfasilitasi komunikasi antar orang yang berbeda bahasa. Menurut Anda berapa penting

akses bahasa dalam pelayanan kesehatan?

10. Apa yang Anda prihatinkan mengenai program pelatihan ini dalam hubungannya dengan

akses bahasa di sistem pelayanan kesehatan di Taiwan.

11. Apakah Anda punya saran untuk program pelatihan yang akan datang?

166
12. Adakah yang ingin Anda tambahkan?

167
 Appendix O

Interview Outline for the Representative of the Patrons

This research focuses on Bahasa Indonesia – Mandarin language pair medical

interpreting training program. The main purpose of the research is to investigate the role of

the training program in improving language service access in the Taiwanese healthcare

system. This interview will take about 30 minutes and will be recorded for further analysis.

All information obtained from this interview will remain confidential and anonymous. The

recording will only be used for this research and will be deleted after the analysis is

completed.

1. Would you please let me know your educational background and your work experience?

2. Can you please tell me more about the Bahasa Indonesia – Mandarin language pair

medical interpreting training program for medical tourism?

a. When did it begin? How did it begin? Who funded it?

b. What language pairs have been taught so far? Why? Any new language pairs in

plan?

c. At how many locations are similar training programs held and how often? Why?

3. I understand that there are other healthcare interpreter training programs funded by the

government for new immigrants. How is this training program different from those?

4. How were the instructors for this program recruited? How was the curriculum designed?

a. Was there a particular curriculum followed? For example, Japan, US, or maybe the

medical interpreting training curriculum designed by Fu Jen Catholic University.

5. How are the performance and progress of the trainees evaluated?

a. Who was involved in the final assessment for the trainees?

6. I understand the trainees are certified upon completion of the training and final

assessment. By any means, do you have any ideas what the next plans for them are? For

168
 example, about job assignments and remuneration.

a. Are they registered in an employment database? Is there a specific application for

contacting them? Are they ever contacted for interpreting assignments?

b. Have you ever received any feedback about job assignments, renumeration, or

about employment application?

c. By training and certifying these trainees, do you think that in the future, only

certified medical interpreters should be employed in the healthcare system?

d. What do you know about the current policy in terms of providing limited

Mandarin proficiency patients with certified medical interpreters?

e. Are there differences in remuneration for registered certified medical interpreters

trained in this Bahasa Indonesia – Mandarin medical interpreting training program

than other interpreters working in the healthcare facilities?

7. I understand that this training program aims for qualified medical interpreters to improve

language service for medical tourists. So far, how has it worked out?

a. In terms of this hospital where you are working at currently, are you aware of any

employment of the trainees of the Bahasa Indonesia – Mandarin medical

interpreting training program so far? Would you please tell me more about it?

8. So far, what problems had TNHCA encountered in facilitating this Bahasa Indonesia –

Mandarin medical interpreting training program?

9. What plans does TNHCA have in future for similar training programs and the certified

trainees? Does TNHCA keep the alumni in contact?

10. Is there anything you would like to add?

169
 Appendix P

Interview Outline for the Representative of the Patrons in Mandarin

新光吳火獅紀念醫院代表訪談提綱

這項研究的重點著重於印尼文 – 中文醫學口譯培訓計劃。該研究的主要目的是調查培

訓計劃在改善台灣醫療保健系統中的語言服務獲取途徑的成效。此次採訪大約需要 30

分鐘，採訪內容將被記錄下來以供進一步分析。從這次採訪中獲得的所有信息都將保

密和匿名。錄音將僅用於本次研究，分析完成後將被刪除。

1. 請問您的教育背景和工作經歷？

2. 您能告訴我更多關於印尼文 – 中文醫療旅遊口譯培訓計劃的信息嗎？ ————什麼

時候開始的？它是如何開始的？誰資助的？

- 到目前為止已經教授了哪些語言？為什麼？

-未來有沒有計劃新的語言？為什麼？

- 在那些地方舉辦了類似的培訓，多久舉辦一次？為什麼？

3. 我了解還有其他由政府資助的新移民醫療口譯培訓項目。這個新移民醫療口譯培訓

與醫療旅遊口譯培訓有那些不同？

4. 這個項目的導師是如何招聘 Zhāopìn 的？課程是如何設計的？

- 是否有遵循 Zūnxún 特定的課程？比如日本、美國，或者輔仁大學設計的醫學口譯培

訓課程。

5. 如何評估學員的表現和進步？

- 誰參與了學員的最終評估？

6. 我了解學員在完成培訓和最終評估後獲得證書。您對他們的下一個計劃有什麼想法

嗎？例如，關於工作分配和報酬。

170
- 他們是否有被註冊在醫療口譯人員資料庫？有具體的申請方式聯繫 Liánxì他們嗎？有

曾因為口譯任務聯繫過他們嗎？

- 您有沒有收到任何關於工作分配、薪酬或就業申請的回饋？

- 通過對這些學員進行培訓和認證，您認為未來醫療保健系統是否應該只聘用經過認證

的醫療口譯員？

- 您對目前為中文能力有限的患者提供經過認證的醫療口譯員的政策了解多少？

- 在這個印尼文 – 中文醫學口譯培訓計劃中接受培訓的註冊認證醫療口譯員的薪酬是否

與在醫療機構工作的其他口譯員有差異？

7. 我了解本培訓項目旨在培養合格的醫療口譯人員，以提高醫療遊客的語言服務水

平。到目前為止，效果如何？

- 就您目前就職的這家醫院而言，您是否知道目前有任何印尼文 – 中文醫學口譯培訓項

目的學員就業？您能告訴我更多關於它的信息嗎？

8. 到目前為止，TNHCA 在推動印尼文 – 中文醫學口譯培訓項目中遇到了哪些問題？

9. TNHCA 未來對類似的培訓項目和獲得認證的學員有什麼計劃？ TNHCA 是否與校友

保持聯繫？

10.您有什麼要補充的嗎？

171
 Appendix Q

Year 2020 Training Announcement Letter

醫療通譯人才教育訓練課程培訓辦法-印尼語班

172
173
174