An Interview with Medical Interpreter Kelly Hoover
Kelly Hoover, B.A. '06, is a nationally certified medical interpreter of Spanish. She currently works in Queens, NY where she coordinates a language assistance program at Jamaica Hospital.
Q: How did you become interested in medical interpretation?
A: I’ve loved languages for as long as I can remember and knew I wanted to be an interpreter while I was in high school. After graduating from NMU with my degree in Spanish I was hired by a medical interpreting company in Appleton, Wisconsin. It was then that I realized that there was a lot more involved than just being bilingual and I wanted to learn all that I could about the field.
Q: What further education was required in order to become a medical interpreter?
A: In addition to my Spanish degree, I received two weeks of on the job training in medical terminology, the medical interpreter Code of Ethics and skills like memory retention and note taking in my position in Appleton. In 2010 I completed a 45 hour medical interpreting course through Culture Connect and attended a workshop to enhance my knowledge. Since then, I have completed a Train the Trainers program for the City University of New York in medical interpreting and am shadowing in preparation to be an instructor of this course in spring of next year. Medical Interpreting is a relatively new field and has been evolving a great deal, so it’s important to keep up with your knowledge about trends in the field.
Q: How did the opportunity to become an instructor for the City University of New York come about?
A: When I was looking for a job I saw an advertisement, sent my résumé and was called. I had an opportunity to meet the author of the training book the class uses and am still shadowing current instructors to learn how to teach the material.
Q: Can you explain the process of becoming a nationally certified medical interpreter?
A: There are two different bodies that are granting this credential, the National Board of Certification for Medical Interpreters (NBCMI) and the Certification Commission for Healthcare Interpreters (CCHI). I did my testing through the NBCMI. If you have the prerequisites you send them your documents to review and you can be approved to take the first exam, which is written. The first exam has nothing to do with linguistics; it covers systems of the body, medical terminology, the role of a medical interpreter, the Code of Ethics, etc. You know immediately if you pass or not; if so you are automatically approved to take the oral exam at a later date. I took my oral exam in Manhattan. I had just moved here in June and was not employed yet so I used that time to study terminology and practice interpreting every day. During the oral test you have a headset on which records you and proceeds whether you’re ready to or not! You hear a recording of a physician speaking to his patient or vice versa. When the recording stops you have to interpret into the target language exactly what was said, without changing, adding to or omitting any of it. The clock is ticking, if you are still speaking when the time runs out it automatically moves on to the next recording, which I found to be the most frustrating part. The test also includes site translation, which is when you read a document (for example, a consent form) in English, and interpret it into Spanish at the same time. The exam lasted a little less than an hour and both the written and oral exam were harder than I expected. As of right now, at the registry found at certifiedmedicalinterpreters.org, there are only two interpreters in the state of Michigan with this qualification, and none in the Upper Peninsula – one of you could be the first!
Q: How did you end up in Brooklyn?
A: After working as a full-time medical interpreter in Appleton, I moved to South Korea to be an ESL teacher for a year. When I came back to the U.S., I moved to Georgia and was there for three years, doing more medical interpreting at a burn center and volunteering with a non-profit Hispanic service organization. Recently my fiancé accepted a pediatric dentistry residency here in Brooklyn - we have been here since June and I work as a Coordinator of the Language Assistance Program for a hospital.
Q: What is a Language Assistance Program?
A: As of 2006, hospitals in New York State (NYS) are required to develop a Language Assistance Program and designate an LAP Coordinator. This was a big victory for the field of medical interpretation but long before this came Title VI of the Civil Rights Act of 1964 which stated that recipients of federal funds have a responsibility to ensure meaningful access by persons with limited English proficiency (LEP) to their programs. For us this means that any patient that communicates with our hospital has a right to an interpreter in their preferred language. What we do here in the Language Assistance Program is to make sure our hospital is compliant with Title VI as well as Joint Commission standards, NYS laws and our own hospital’s policies regarding LEP patients. We educate our employees, qualify them to interpret when possible, train them on how to use a telephonic interpreter, translate many of our documents including consent forms, perform departmental In-Services as well as yearly medical interpreting workshops and much more.
Q: What is the Language Assistance Program like where you work?
A: We serve our employees as well as our patients; we have two hospitals in our network and over 3,000 employees. We contract two different companies to service our medical interpretation needs and train staff to be dual-role interpreters. Queens County, where our hospital is located, speaks 138 languages per the last Comptroller’s report! At my hospital our primary languages are Spanish, Bengali, Punjabi, Mandarin and Haitian Creole, meanwhile the other hospital in our network not far from us has Chinese, Korean, Spanish, Italian and Greek as its primary languages. We are in one of the most language diverse counties in the United States. I am always learning about languages I had never heard of before, like Esperanto.
Q: What do you most like about the medical interpreting profession?
A: Every day is completely different. One day you may be in the Emergency Room, the next in the delivery room, and the next at an oncology appointment, or all in the same day! You are involved in intimate moments of the patient’s life that very few people witness.
Medical interpreting is very rewarding; the patients are always grateful to be able to communicate healthcare information with their healthcare team. In addition to being a linguist, it’s the interpreter’s job to understand the cultures of the population they interpret for and be ready to step in and explain them when interpreting the words isn’t enough. For example, the terms in healthcare of “mal de ojo”, “santería” or “empacho” are used by people from various countries in Latin America and may still impede communication with an interpreter present.
I am also passionate about educating people on what it takes to be an interpreter. I enjoy assessing my hospital’s employee’s language skills and getting them excited about being a “Qualified Medical Interpreter”, which means that in addition to their primary role they can also serve as a medical interpreter for our patients.
Q: What is the most difficult part about the medical interpreting profession?
A: The most difficult part is getting “buy-in” from physicians, administration and other employees regarding why it’s so important to use a qualified medical interpreter when communicating with patients. Many physicians think that it’s ok to practice their language skills or get by with what little they know – recently we found a resident using an application on their smart phone to communicate with a patient instead of getting an interpreter!
Here in New York City it seems everyone is multilingual, but in reality there is a lot of over-confidence and false fluency here which is dangerous to everyone involved when someone with limited language skills is “interpreting” for healthcare patients. Many times people are serving as interpreters and they are not even truly bilingual! There is a lot of misinformation about fluency in general. It is common to find people that think that just because someone was born in a certain part of the world or even have a certain sounding last name, that they have advanced proficiency in another language and automatically qualify to interpret medical information.
There are many well known cases in healthcare in which a qualified medical interpreter was not used, leading to horrific outcomes. Such was the case of young Willie Ramirez in Florida - his family attempted in limited English to tell the ER physician that he was “intoxicado” which, combined with other factors lead the physician to incorrectly treat him for an intentional drug overdose. He had never taken drugs, but was instead suffering from an intracerebellar hemorrhage. The physician never consulted a neurologist because he felt the family confirmed that the patient had tried to harm himself due to a fight with his girlfriend and at the same time Willie’s family felt it inappropriate due to cultural reasons to tell the physician that Willie would have never taken drugs, that he was a star athlete and took good care of himself. Willie woke up a quadriplegic. Had a qualified Spanish interpreter been called, the physician would have known that when the family used the word “intoxicado”, they thought he had food poisoning, not that he was intoxicated or drugged. An interpreter also could have stepped in to advocate for the patient when the family thought they were out of line in telling the physician they didn’t agree with his diagnosis, and that Willie never used drugs. The physician later stated if he had known that, he would have reconsidered his diagnosis.
Learn more: the Willie Ramirez case
Q: What would you recommend as the next step for a graduating NMU student interested in pursuing a career in medical interpretation?
A: Definitely check out the International Medical Interpreter Interpreters Association (IMIA) at imiaweb.org and their group on LinkedIn. Become an IMIA member and list yourself in the directory; I get contacted frequently because of my information there. Also, the organizations that I mentioned above regarding the national credential have websites and you would be at the top of your game as a nationally certified medical interpreter.
Know and understand the laws associated with Language Assistance in healthcare. Hospitals need to be compliant so this can go a long way in getting you hired. Many interpreters work from home as telephonic interpreters - check out companies that provide these services. If any company offers to hire you or contract you for freelance work without assessing your interpreting skills, walk away. Being an interpreter is much more than being bilingual and good companies recognize and reward that - be proud of your skills!
Q: Similarly, what advice would you give any NMU student who is exploring medical interpretation as an option?
A: Taking a certificate course is a must. They are normally at least 40 hours and will teach you the basics. After you are familiar with the vocabulary, the Code of Ethics, the National Standards of Practice, etc, an option is to inquire about volunteer work for a hospital. This has helped me immensely; I have volunteered countless hours for Latin Clinics as well as translated many documents for non-profit organizations. Get a native speaker to proofread your work and give you feedback.
Medlineplus.com is the best website I’ve found for bilingual health information, and they have interactive tutorials, this was my primary tool when studying for my test. For Spanish interpreters, the University of Arizona’s website has a practice kit for medical interpreters; it is very high quality and comes with cds so you can practice interpreting without needing a partner.
Q: Is there any other advice you would like to share?
A: There is a fascinating and enlightening non-fiction book called The Spirit Catches You And You Fall Down about a Hmong patient and her family’s struggle with the Western medicine world. I recommend it to anyone interested in medical interpreting.
Q: Can students contact you for more information?
A: If you want to discuss anything, don’t hesitate to email me at firstname.lastname@example.org.