In this episode, Tinu speaks with professional translator, Rafa Lombardino. Together, they discuss the importance of having quality translations of medical documents, what quality translation is, and how language accessibility is a part of the accessibility needs of the American healthcare system.
“You can’t just copy and paste and look up words in the dictionary because there’s culture, there’s a whole context… And when you’re talking about health documents, something that it’s really a matter of life or death, you do have to take a responsibility and have accountability for the message that you’re giving to a target audience that doesn’t speak the original language.” – Rafa Lombardino
- 03:02 Rafa’s three identities and how they relate to her work as a disability and diversity advocate
- 04:51 The difference between translation and interpretation
- 05:48 The challenges of translating English to other languages
- 09:23 The difficulty of translating medical documents for transgender and nonbinary patients
- 10:46 Why Google translate is not always the best option
- 14:32 How punctuation is a factor in translation
- 14:50 The importance of incorporating culture in translation
- 16:27 Ways the medical field can improve translation
- 19:23 Examples of how improper translation can cause problems
- 21:04 Why it is important to have translation options for patients
- 22:33 Why the method of translation is important (written versus verbal)
- 23:59 Common problems with medical documents and translation
- 26:04 What are the components of high-quality medical translation
- 30:22 Rafa’s pet peeves about medical translation
- 35:23 Why bilingual people are not always good translators
- 38:03 Rafa’s hope for the future of healthcare
Translation and interpretation are different skill sets. Rafa, as a translator, focuses on written and audio/visual materials. Interpreters focus on verbal communication.
Translation is more than translating one word into another. It’s about finding the best solution to fit the message as well as taking responsibility and accountability for your target audience.
The cultural and social aspects of documents are often not considered when translating and this is a huge problem. For example, the standard American formatting practice on forms are not necessarily applicable to people of other countries and cultures.
If you are a medical provider, take note of who your target audience is when getting documents translated into other languages. Oftentimes even a general language is too broad. What is the country you are targeting, or the gender? The more specific, the better translation.
If you are considering translating consent forms for your medical practice, account for the time it takes to prepare quality translation. Remember, this process requires a large amount of care and consideration for the language and the culture being addressed and is not typically a quick process.
If you are a patient who would like to see an increase in translation of medical documents, ask your provider if they work with a language or inclusion department. If patients express the desire, hospitals and other medical spaces may be willing to provide additional resources.
Resources Mentioned in the Episode
- LinkedIn: Rafa Lombardino
- Podcast: Translation Confessional
- Youtube: Rafa Lombardino
- Twitter: @RafaLombardino
- Facebook: @ToolsTechnologyTranslation
- Instagram Handle: @rafa_translates
More Information about Laws around Requiring Translation in Medical Settings:
- The Legal Framework for Language Access in Healthcare Settings: Title VI and Beyond – An article about the different laws across the country that require translation and interpretation services in medical facilities.
- HHS Continues to Improve Access for LEP Individuals: More information about recent laws and advocacy that have been done to increase and improve translation and interpretation services.
More Information about how Google Translate can be Ineffective:
- The Pros and Cons of Google Translate Vs. Professional Translation
- 5 Reasons Not to Rely on Google Translate
- Why is Google Translate Inaccurate?
More Information on the Challenges of Medical Translation:
About Rafa Lombardino
Rafa Lombardino was born in Brazil and has been living in California since 2002. She became a professional translator in 1997, is certified by the American Translators Association (ATA) in both English-to-Portuguese and Portuguese-to-English translations and has a Professional Certificate in ES>EN translations from UC San Diego Extended Studies, where she started teaching translation classes in 2010, including “Tools and Technology in Translation,” which was also released in book format. She is the President & CEO of Word Awareness, hosts the Translation Confessional podcast, and specializes in Technology, Marketing, Human Resources, Environment, Health & Safety (EHS), Education, Health & Wellness, Audiovisual, and Literature.
[00:00:06] Rafa: You can’t just copy and paste and look up words in the dictionary because there’s culture, there’s a whole context. There’s social, political things. Sometimes you can use one word in one culture and it’s fine, and not in the other one. So, all these cultural things that build around language itself, it’s very important. And as our job, we have to have both feet, one in one side in each culture to just understand the sensibility of bringing the message from one side to the other, because it is not black and white, it’s not about just replacing words. It’s the whole culture. And when you’re talking about health documents, something that it’s really a matter of life or death, you do have to take a responsibility and have accountability for the message that you’re giving to a target audience that doesn’t speak the original language.
[00:01:01] Tinu (Recorded): Hello, and welcome to Health in the Margins. Health in the Margins is a podcast that hosts conversations between experts and community members to investigate disparities and uncover solutions related to diversity and disability in healthcare.
[00:01:22] I’m your host, Tinu Abayomi- Paul.
[00:01:22] [Music Ends]
[00:01:22] Today, we’ll be speaking with professional translator, Rafa Lombardino. She is certified by the American Translators Association in both English to Portuguese and Portuguese to English translations. She is also the president and CEO of the translation company, Word Awareness and host the Translation Confessional podcast.
[00:01:45] The topic of translation is very important to me. As my grandmother, a Nigerian immigrant, got older I noticed her difficulties, understanding paperwork once before a doctor’s office visit. She was an English teacher and understood English quite well. But as she aged, it seemed she would’ve been more comfortable reading things in Yoruba, our native language.
[00:02:08] My mother would receive medical information for her in the mail, and I surmised that it was difficult to translate medical jargon properly to make sure my grandmother fully understood the paperwork she was given. Witnessing this showed me the value of having documents properly translated because even with medical professionals in my family, not everything that was stated in one language could be smoothly translated into another, on the fly. In our conversation Rafa and I will discuss the importance of having quality translations of medical documents and how language accessibility is part of the accessibility needs of the American healthcare system.
[00:02:52] Tinu: Welcome to Rafa Lombardino!
[00:02:57] [Music Ends]
[00:02:57] Tinu: Hi, Rafa. How are you doing?
[00:02:59] Rafa: Pretty good.
[00:03:00] Tinu: It is great to meet you. Everybody has a variety of aspects that make up who they are. If you had to distill your identities down to three, what would they be and how do they kind of relate to what you do for a living as a disability advocate and diversity advocate specifically?
[00:03:22] Rafa: I believe that I’m very organized, so that helps me during my translation work, because I need to have projects back to back and help as many clients as I can throughout the week and throughout the month. Organization is key. I’m also multicultural. I am from Brazil, but I’ve been living in California for 20 years now.
[00:03:43] I also have family in Italy and I’m really interested in Latin culture in general, so, friends from all over Latin America and from Spain. So, having this very strong sense of multiculturality is very important to understand people from different backgrounds, which also contributes to my work as a translator.
[00:04:07] And I would say that I’m a lifelong learner. I love learning new things. I’m very curious about researching information. And as a translator, I have to do it every day. There’s always something new that I have to look up and read about so I can translate it accurately. So, I think that boiling down to three, that would be it.
[00:04:27] Tinu: Yeah, that sounds really good because curiosity – I’m very curious as well. I end up reading about stuff that I just never even knew existed. and that must be really fascinating in the area of translation, because you’ll be, for example, translating things about diseases that you’ve never even heard about before, and then have to express that to someone in a different language. What is really the difference between being an interpreter and being a translator?
[00:04:57] Rafa: I do everything that you can read, not that is spoken. When you have to actually go from one language to another and you have to render the message verbally, that’s something that I cannot do. Yeah. It would be a disaster. I’ve been a translator for 25 years and I could not interpret accurately because it takes a different set of skills. I just do it between, for example, my husband, who’s American and my family in Brazil, because I can tell them to shut up and give me time. [Laughs]
[00:05:16] It’s a different thought process. And I just, I watch my friends in awe when they’re interpreting, because it takes a different part of their brain. I only work with written documents or with audio visual materials. I do a lot of subtitling, a lot of transcription. So, not only fiction series and movies, but also some training webinars.
[00:05:51] Tinu: Oh, wow. That is a long time. You have a lot of experience. That’s really great for us. I was wondering, documents here, of course, in America, are produced in English typically. So, what is the process for you when you’re translating them to another language? Do you run into things where things don’t necessarily have a translation in other language? I know we use a lot of idioms and colloquialisms and they’re starting to show up in medical documents. Do you run into that?
[00:06:19] Rafa: Yes. I think there are different challenges that we have to face when we deal with health related documents. First of all, is that we receive a lot of them in PDF. Because that’s how they create them. That’s easy to print and send, but when we receive the document, we need to convert it back into an editable format, so we can actually type the translation on top of what is there instead of recreating a document from scratch, from PDF, into something else. So the first thing is just having clients understand that we need something that we can edit so we can type the translation.
[00:06:53] Second of all, depending on the language you’re translating into, it will be larger than English. I work with Portuguese. I don’t translate into Spanish and Italian, but I translate from Spanish and Italian. So, I have colleagues that work into those languages. So, if they send something in English to us and they need in Portuguese, Spanish, and Italian, the three of us will have a translation that is longer than the original format. So, we have to tell clients that they either have to hire someone or hire us, pay for extra time so we can format a document. Because if they necessarily have to have one page, we have to make some adjustments because Portuguese, Spanish, and Italian could be a little wordier than English, right?
[00:07:52] Besides that, one thing that we’ve encountered nowadays, that we talk about more about visibility, about inclusion, about pronouns is the problem that English – it’s not a problem, but is a problem for translators – English is very neutral. You may not think about it, but English is very neutral. We think about some efforts to have a more neutral language, as far as not saying Congressman and Congresswoman, but Congress member or member of Congress, which is neutral, but necessary in a lot of languages, you will have male and female gender nouns in articles, in adjectives.
[00:08:14] So, these are things that also happen when we’re translating a document and we have to ask the client if there’s anything that they want to consider when having a translation because when they create the document in English, they’re not thinking about how, “oh, when someone reads this in Portuguese or Spanish, it would be all in male nouns and adjectives”. So, it’s very important for us to talk about that.
[00:08:37] And I think the closer example that I can give to some of the clients to bring them into this reality, because they are monolingual English speakers, it’s tell telling them about researchers that they say, “when you hear the word doctor, what do you think? You think of a man? When you hear the word nurse, what do you think? Do you think of a woman? Those words are completely, they have no markers for gender in English. Doctor or nurse can be used interchangeably, but in Portuguese, in Spanish, we have médico for man, for doctor, médica for woman doctor, but English document could be completely neutral by the translation. We have to see how we will render that in a way that will not have any gender markers, which is very important for patients to identify when they’re answering the information on the form, for example.
[00:09:32] Tinu: I start to think about how that would manifest for trans people, but then I thought, are they even really at the point where they’re referring to people in medical documents with the they/them pronouns. Have you noticed whether they’re doing that or not yet?
[00:09:51] Rafa: No, I have not noticed. I don’t have any experience translating anything that was already thought for the transgender community. I have translated a lot of personal documents where there have been same sex marriage, which is great. Those documents coming in now, but not specifically for transgender forms, consent forms and medical information.
[00:10:05] One thing that we can use is “patient”, because it’s a neutral word, even in Portuguese, for example. But it is maybe something that they could consider having two sets of forms. One for the male gender, one for the female gender, just to make the patient feel comfortable in answering questions.
[00:10:33] So, I think that that’s something that may take a little more work because it’s twice the work of translating something and then adapting to the male or female gender, but definitely for the level of comfort, I’m pretty sure that transgender patients would feel more comfortable answering according to their identity.
[00:10:51] Tinu: That is true. That’s what I was thinking, but it seems like it would be tricky thing to handle. I was also thinking about people who – just it’s been my experience – the last time I worked with the language translation company – that there are people who don’t really understand the need for quality translation.
[00:11:06] They’ll say, “well, we’ll just use Google translate”. And that doesn’t really work. Like if you’re looking for like a phrase, if you wanna say goodbye to somebody, that’s one thing, but you can’t use Google translate for like a whole document. What do you say to people when they say things like that to you?
[00:11:22] Rafa: I think the main thing is when you’re monolingual, when you don’t know another language, you don’t know what you don’t know. When you need something in Google translate or any other platform, and you say, “oh, that looks good. That looks Spanish enough. That looks German enough”. But if you don’t know, you don’t know, and you may be very offensive. You may, most of all do a disservice to the target language reader. You may be saying something that is completely far removed from your message.
[00:11:51] And you have to keep that in mind that for the sake of your comfort, just to speed things up, just to not pay for professional services, you may really hurt physically or really taking the accessibility out of the equation. It may look like a very nice, and fast, and cheap solution. Would you do the same thing about, you know, hiring a plumber or a lawyer or a doctor, right?
[00:12:18] Unfortunately, language is seen as something that you can just, you know, brush off as “oh, someone, you know, had a two weeks abroad or six months abroad, and they can do it”. It’s not that. I mean, like I said, I’ve been working as a translator for 25 years and I learn new things every day because it’s not about just turning one word into another. Because that doesn’t exist. It’s about actually finding the best solution that will fit the message. Computers cannot do that. Not yet. [Laughs]
[00:12:48] Tinu: Yeah. I mean, I really know that’s true from my own personal experience, because the way I started working with the language translation company, and this was like 15 years ago, was that I had this really popular website. And I saw that there was this plugin that you could use to translate your site into different languages. So, I got really excited because, you know, I had a couple of friends who like some were from Korea, some from Singapore, I had people from Africa, so I put the translator up and then my traffic shot up.
[00:13:18] And especially in Korea. So, I asked my Korean friends, what is it about this page that is so popular? So, she pulled it up and she started laughing uncontrollably. Like for two minutes, I could not get her to talk to me. So, she took a breath. Finally, she said, “the way that this translates, especially for people who know both English and Korean makes you sound like a crazy person, [Laughs] you have no idea what you’re doing when this gets translated. It sounds ridiculous. So, I read the original and then she spoke the translation to me in Korean and I laughed too, because it just didn’t sound right. It was as if a child was trying to translate every three words. So, the sentences didn’t even sound right. Like the words were correct, but then the sentences sounded ridiculous.
[00:14:05] So, I don’t think that people really understand, especially, like you said, if they only know one language, and I should’ve known better because I know three, if you only know one language you just don’t really think about, oh, there’s things like idioms, there’s things like colloquialisms, there’s things long phrases, and like you said, some nouns are gendered. All of these things don’t necessarily translate. So, you really have to get someone who knows what they’re doing, especially when it has to do with something so important, like medical information.
[00:14:37] Rafa: Exactly it can become gibberish. Just nobody will understand it. Even more importantly, sometimes punctuation is different. I had to educate clients when they were upset because there was a colon at the end of a sentence, and we wouldn’t use it in Portuguese or vice versa. They want the translation to mirror the original and you can’t really mirror the original, but if you put someone, an American in the middle of, I don’t know, Germany, they will have a completely different experience than people that have been living there all along.
[00:15:09] So, it’s the same thing with language and you can’t just copy and paste and look up words in the dictionary because there’s culture, there’s a whole context, there’s social, political things. Sometimes you can use one word in one culture and it’s fine, and not in the other one. One example that I can think of is for example, the word black. Black is a word that is, I would say, even celebrated in English, the black culture, but there are comfort levels in Brazil, for example, that people, my generation, so 40 and over, they wouldn’t refer to someone as being black, as “preto”, the same name as the color. It’s “negro”. And then, if you say something like this in English, “negro” is so dated and it can be very offensive.
[00:16:17] So, all these cultural things that build around language itself, it’s very important. And as our job, we have to have both feet, one in one side on each culture to just understand the sensibility of bringing the message from one side to the other, because it is not black and white. It’s not about just replacing words. It’s the whole culture. And when you’re talking about health documents, something that it’s really a matter of life or death, you do have to take a responsibility and have accountability for the message that you’re giving to a target audience that doesn’t speak your original language.
[00:16:37] Tinu: Yeah. Let’s talk more specifically about healthcare for a while. What are some ways that you think the medical field could prioritize translating the kind of information that comes up in healthcare to people who are non-native English speakers? How can they do a better job with that?
[00:16:56] Rafa: First of all, it goes with how they prepare the document. Most often they may clear with the legal department, with marketing to have the logos correctly and all the visual aspects of it. They should also have a cultural consultant. Even if it’s not someone for each language, but just someone that has a background in language and will look at the document in English and say, “okay, these are the problem areas that you can find when translating into other languages”.
[00:17:25] For example, if you have a term that is very technical and you’re trying to talk to patients that don’t have medical knowledge, maybe you have to replace that word and water it down. Or as we say, lower the register of the language so it’s not something complicated that only other medical professionals will understand. You have to communicate that to the patient.
[00:17:44] And it’s the same thing when I see my friends who are interpreters talking about something that happened at their latest assignment of how the doctor thinks that they can speak mostly Spanish, ‘cause I’m talking about friends in California, or the nurse thinks that they can speak some Spanish and they’re just not communicating well with the patient. And that’s why the professional is there. Because if the patient says something that is not a medical term, for example, instead of saying my stomach hurts and say belly, or say tummy, you have to kind of communicate that same level of the language back and forth with a doctor and with a patient.
[00:18:32] If the doctor says something completely complicated, you will have to make sure that the patient understands. And I would say that that goes also with the monolingual communication. Some doctors may even, talking to patients that speak English, go at a higher register when they’re communicating. So, I think that accessibility all across the board should be more of a priority in healthcare.
[00:18:49] Tinu: Definitely because people, in this country especially, have so many different languages and cultures it’s meant to be a melting pot. But it seems like we don’t really address the fact that people speak different languages, have different cultures, are from different areas. And that all of these things are equally as valid as English. We need to have people able to, even if they speak English well, to be able to access something in your primary language is not only comforting, but it helps you to know that you definitely understand what is going on instead of maybe 70% or 80% get it.
[00:19:48] I’ve noticed that a lot with my grandmother, she used to teach English, but her primary language is Yoruba. Now that she’s older, I’ve noticed that sometimes it’s better for her to get things in Yoruba than it is to get things in English sometimes. And I can understand that because that’s the language that she thinks in. And I think in English, so I appreciate seeing and getting things in English, but there’s also things that I can understand why she would want to get things in her primary language. We kind of take that for granted here. So, we should really be providing that for other people as well.
[00:20:10] Rafa: Of course, I completely agree. And it doesn’t have to do with health, but as you were mentioning, this particular thing of someone aging and feeling more comfortable with their own language. I just remember that I was renewing my green card 15 years ago I guess, and there was an older Mexican lady sitting next to me. And she had her son and her grandson there to help, and she was very upset because the system had changed of how you renew your documentation for immigration purposes. And now you have to get your fingerprints. You have to get your picture, the biometrics, right? She was really upset because she thought that she was being booked like a police station.
[00:20:50] Tinu: Oh my goodness.
[00:20:52] Rafa: The documentation didn’t explain that that well. I don’t know which paperwork she got because I didn’t receive the same thing as she did in Spanish, but I could understand English so I was prepared for it. I know that they’re going to take my fingerprints. They’ll take my picture. But just watching as the son and grandson are trying to calm her down so that everything’s okay. She’s not being deported. She’s not being taken by the police.
[00:21:10] So just imagine, not only that, which is already a serious thing about belonging to a place where you live with your family, but just imagine at a hospital. Imagine if you have emergency procedures, they have to go through. Of course, they have to just help that person in whatever language they feel comfortable. And you can’t just assume, that because they’ve been here in this country for forever, people can have different levels of language proficiency.
[00:21:32] As we age, we may have the comfort level of just wanting to access information in our own original language. So, it’s very important that we don’t have this bias about, “oh, you’re here so you have to understand and do everything in English. But what if we choose not to? It would be the same thing as you, as an American tourist in another country, and people just refusing to help you in English at all. If you just put yourself in those people’s shoes, you can understand how uncomfortable you would feel and at a hospital setting, I can only imagine how frightening it must be.
[00:22:16] Tinu: It must be very frightening and there’s really no reason for it because, and a lot of people don’t realize this, America doesn’t have an official language. People keep trying to pass that law, but it fails because of the idea of us being a melting pot that welcomes all kinds of different people. So, we don’t really have an official language.
[00:22:35] Although at the federal level, there are some laws that make it English for federal documents, and some states have English as the official language. But because of that, I personally believe that we should be more accommodating for all different types of people. Especially since sometimes you may be really proficient in spoken English, but not in written English. I worry about that a lot for people. Do you run into that a lot?
[00:23:02] Rafa: I do because conversational language is one thing, but if you have to write down information or read information, it is different. So, it’s just about being aware of how language is not an extreme it’s either this or that. There is a gray area. People have different knowledge, different proficiency in different languages. So, it’s very important to just make sure that you provide the accessibility in the language that you are comfortable with.
[00:23:18] Once again, it has to go through a professional filter in a way, which is us as translators and interpreters, that’s what we can provide because we have experienced both cultures. And we can think of the problems that you don’t even know that exist in communication, because we know how the two languages interact with one another when we’re trying to have the message go through this filter. Yeah. I think that removing this bias and removing this idea that it has to be this way. What is more important for you to make a point that English is the language you have to understand, or for you to provide critical care to someone who needs it?
[00:24:12] Tinu: What kind of problems do you face when you’re filtering the English language to other specific languages? Are there things that keep coming up that you could advise doctors to handle differently? Or the people who write, say medical consent forms, to handle differently so it’d be easier to make the translations?
[00:24:31] Rafa: I would say the first of all the format, definitely in them understanding that we have to work with a document, not just with the content of the language, but how it looks. Sometimes providing more space on a form. Let’s just talk about how in English and the United States, we have, you know, name, middle name, last name, but in other cultures we have a lot of names. I had three last names before I got married and I picked one as my middle name. And then I took my husband’s name and that’s how my kids also took their names.
[00:25:02] It’s interesting that you have to think about those things because it’s not just a cookie cutter kind of idea, this is how we do in English. It’s how we do for Americans. So, let’s know we have to change it for other cultures. Once again, the bias of not knowing what the other side needs, just because you did something like this and you cleared with, I don’t know the legal department, but what are the other implications for the cultural and social aspects so you can actually serve another community? Once you set yourself as an organization to talk to a target audience that speaks another language, you must really put yourself in their shoes and you must really provide that access. So that your message goes through to them correctly, the way you intended.
[00:25:52] Tinu: I love that answer, especially because you brought up names. [Laughs] I am a Yoruba and you know, I was born here, but that’s my culture. I have two middle names and a hyphenated last name that I was born with. And I can’t tell you how much trouble that has caused me, especially with medical forms my whole life. So that is such an excellent point. I’m so glad you brought that.
[00:26:11] So also talking about doctors when you express the term quality medical translation, so that doctors would know the difference between like just not getting the whole package and getting quality translation. What is the difference? How would you define that? What does it look like?
[00:26:34] Rafa: Like what we’re just talking about with Google translate, there is something cheap and fast that can help you for informal purposes. But once you need something professional, that’s when a quality process comes through. I work with some forms, some questionnaires – you ask patients about how they’ve been feeling. Maybe as a way to screen them to start taking medication or after they start taking a medication. So, these are very low level, patient level language, because I don’t do clinical medical scientific articles. I’m not a doctor, so I wouldn’t be able to do it well.
[00:27:18] I have friends who actually have a medical degree or have a law degree so they do translations in those kind of specialties. But I myself am a patient I’ve been in those shoes. So, I can actually help people understand a questionnaire when I’m translating into Portuguese, for example. It’s very important to have an idea of the whole process because we have the translator, then you have a reviewer, then you have maybe test subjects that will go through and answer, especially if you’re talking about an online form, to see if there’s any technical difficulties.
[00:27:50] So there are different levels of professionals involved to provide an overall quality system before that final version of the document gets to the target audience. It’s not something they can just press a button and it’s not something they can just do overnight. Sometimes clients that have no idea, they send us whole brochure about all the procedures and services they can get, or for insurance purposes. These are all the plans that we have available to you. And they send us 10, 15, 30 pages and they think that we can just do in a couple of hours and that’s not it. [Laughs]
[00:28:33] I mean, I always ask them, “well, how long did it take you to put this document together in English?” And they’d say, “oh my gosh, it took us like a month. We had to clear it with legal. We had to go to marketing because the colors were not right. And our logo has to be shown a certain way”. And I’m like, “yes, exactly. So, if you took you that long, it may not take us a whole month to translate something, depending on the size of the original document, but we still have to make decisions”.
[00:28:55] There’s still a decision-making process involved in word choices and how to present information. So, just the same amount of care that you put into creating this document from scratch will have to be done in another language. So, of course we already have a template to go by and we have to be faithful to the words that you put to paper, but we still have to have a kind of decision-making process to see how the target audience will understand it.
[00:29:25] Do we have to make it more informal in language? Because, for example, my experience with Portuguese is you can have a very high register in intelligence, so to speak, language that it will look beautiful. But if people cannot read and understand it right away, it just, you know, it’s like reading Shakespeare – yeah it’s beautiful, but how accessible is it for you to understand what is being said to understand the message?
[00:30:07] Quality is not just about something that was done fast or cheap. It’s about the entire process. As much as I serve my client who actually pay the bill, my main client is the target audience. It’s the people who are going to be used the product of my translations. Sometimes we have to sit down with the paying client and tell them, “that’s not the right way to do it. This is what will work for your target audience”. It takes some client education sometimes.
[00:30:23] Tinu: Sometimes you have to be able to tell someone that, “okay, the way that you envision this going is not the way that it’s gonna work out”. That makes me think you have 25 years of experience. What have been your pet peeves with the process of getting a medical document translated? Like what keeps coming up that you wish would stop coming up?
[00:30:47] Rafa: Well, I would say that what I’ve encountered is just lack of knowledge about the target audience though. So, I’m from Brazil. I translate for Brazilian Portuguese. Portuguese comes from Portugal. [Laughs] There’s a whole history of colonization that I’m not gonna get into, but the language I speak in Brazil is completely different from the language spoken in Portugal. We can understand one another.
[00:31:22] There will be some kind of misunderstandings as far as some words or expressions that, even though I’ve been speaking Portuguese all my life, I will have to ask someone from Portugal, “what do you mean by that?” So, the main thing is, what is your target audience? Don’t tell me it’s general Portuguese. It’s neutral Portuguese. No. If you’re planning this for Brazilians, I can do it. If you’re planning this for Portuguese people, I have my colleague I’ve been working with for 18 years. It’s longer than a lot of marriages and we’ve been working together, so she’s the one that takes care of Portugal for Europe.
[00:32:06] And then if people don’t know a lot of countries also speak Portuguese outside Brazil and Portugal, for example, Angola and Mozambique. These are two countries that also speak Portuguese, and then we’re going into another area of how they use different spelling. So, it’s very close to Portugal, but it’s different spelling. So, there are different levels of how to make sure that we can serve the correct target audience. But I guess that’s the main challenge that’s seeing time and time again.
[00:32:24] I’ve just had this document right now – only 400 words, it’s something short. We can do it in one day. No problem at all. But it had been sitting here because the client couldn’t decide, where is this document going to go to? Is it for Brazil? I’ll do it myself. I’ll send it to you by the end of the day. Is it for Portugal? Okay, so we have the time zone cuz I’ve got to send it to Portugal. It ends up that it’s for Angola. So, we had to just use the older spelling and some other different rules.
[00:32:42] All this goes into making sure, even before we translate the first word, that we’re doing correctly. So, the client will have to order the same thing twice and pay twice because different people had to work on the document. So, this is a big challenge, especially talking about my main target language Portuguese.
[00:33:05] I won’t even go to the fact that sometimes someone that speaks Spanish thinks that they can review my translation in Portuguese, because there’s so many differences between Portugal and Brazil as far as language. Can you imagine between Portuguese and Spanish and then Spanish itself has a lot of differences between all the countries that speak Spanish.
[00:33:22] So, I guess that’s one of the main things that clients have to understand the specific target audience and where the purpose of their translation, where it will be used. It’s something that comes up all the time. Where will this translation be used? If you tell me that information, don’t tell me something general. If you tell me that information, I’ll make sure that the right person works on it.
[00:33:51] Tinu: That makes sense. That makes a lot of sense. It’s not just the language it’s who is the audience. If you have people from Brazil coming into your practice, then that’s a certain kind of Portuguese. If you have people from Africa, that’s a different kind of Portuguese.
[00:34:06] I think a lot of it has to do with the fact that Americans are monolingual, like you said. Typically, we speak one language and we get kind of arrogant about the fact that, you know, we’re not in other countries, so we’re not speaking other languages and not making accommodations for other people, but it’s really, really necessary for us to, especially for systems that serve all Americans, for all Americans, and all people who use American systems, to be able to understand things that are so important, like medical documentations. It’s not something that I really thought about.
[00:34:40] I would never expect that people would not be able to, not only access, but be able to read or understand a document that has to do with their health. I would be horrified. I would be absolutely horrified and frightened if I had to sign a consent form or read something. It’s already so challenging when you go to the hospital and there’s all this jargon in the document where you’re trying to figure out, “okay, what does this mean in English?” Like in plain English, but to have it in a whole other language that I didn’t understand. And then on top of that, I would be very upset on top of already being sick. So, I think this really needs to be a priority in doctor’s offices given how much of a diverse culture we have in America. Another question about your 25 years of experience. Is there a favorite experience that you’ve had or something where things went so well, you wish everybody would do it this way?
[00:35:48] Rafa: That’s a tough question. One thing that I would say that goes both with educating the client and educating other translators, is that just because you speak tqo languages doesn’t mean that you can do it. Just because you’ve got a degree in translation, it doesn’t mean that you can do it. And we can relate that with the medical profession that, you know, you have different levels of specialty and medical fields. So, just because you got a specialization in one side and you’re an OBGYN, it doesn’t mean that you can operate, you know, heart surgery.
[00:36:24] So it’s the same way with languages, just because you speak the language, it doesn’t mean that you can do it. It takes a lot of practice. And as long as we take a humble approach and just understand that there are things that we don’t know, [Laughs] we always research and we always study and we always learn more about it.
[00:36:42] And just observing. I think that translators are a lot of like novelists that they watch people so they can create their characters. We are the same way. We watch people, we watch the language in the wild to see how people are using that language. And we can also use that when a problem presents to us in a language setting. So, you find solutions sometimes in a conversation, watching TV, listen to the radio. There is that one word that can come to you and that will solve all your problems when you’re translating. I think that’s one of the things that I always go back to in 25 years.
[00:37:02] Just remembering that even though, of course I’m not the same kind of professional that I was in my first year as a translator. But one thing that has always been with me is this, I want to look it up. I want to find information. [Laughs] I started in ‘97, that’s pre-Google. Google was created in ‘98 and talking, especially with the younger generation, they’re like, “oh, what? There was no Google back then?” I’m like, “yeah, that’s how old I am. [Laughs] There was no Google back then”.
[00:37:44] Looking up things – it’s so much easier nowadays, and things can be expedited. We don’t translate 50 pages in one hour, but it is expedited because we can look up information. It’s not like, you know, you have to wait ‘til the library opens and go to the library, or you have to call someone and ask, you know, do you know this? Do you know that? Of course, it’s easier with technology, but yeah, just making sure they use technology to your advantage and always research.
[00:38:14] Tinu: What is a hope that you have for the future of healthcare, for it to become more equitable for all people, not just marginalized people, but for everyone?
[00:38:23] Rafa: Well, at a professional level, I would just emphasize on accessibility and making sure that everybody can access the information the same way. And being professional about how we go about it, not using Google translate, like we talked about. So, the first thing that I would need is people to realize that it is about the patient. Giving access to them in whatever language they need, in whatever system they need, if they need large print, if they need audio visual material. So, it’s very important to do that just as you do with the English-speaking patients also do with everybody else.
[00:38:51] At a personal level, I would like to see healthcare not be for profit because I just think about, you know, I have a good level of English. I can read all the documentation. I can communicate with my doctor, but one thing that we always worry about, and I see a lot of people around me that, you know, middle class, we are afraid of going to the hospital because we don’t know what the bill is gonna be. So I think that that’s the one thing of just making sure that health is a right. That we can take care of ourselves and make sure that we are healthy and not be afraid of going to the hospital and maybe be bankrupt.
[00:39:35] Tinu: Great answer. I really enjoyed talking to you and learning so much and realizing, just sitting here how many of my friends need, and just people that I know who I might not even be close to, need this service of having documents that they can be comfortable reading, understanding, and especially agreeing to legally. It’s very important that we had you here and thank you so much for coming.
[00:40:00] Rafa: Thank you so much. And thank you so much for the work that you’re doing. It’s amazing. And I loved participating in it, cuz it’s something I’m very passionate about.
[00:40:10] Tinu (Recorded): Thank you for joining my conversation with Rafa Lombardino. One of the most important components of translating Rafa spoke about was that language and accessibility are intrinsically linked. Access is not just about physical access to a building. It’s about us being able to access the world, to access culture and work, and to be able to fully participate in the American experience as equals. In receiving medical documentation, it is imperative that we fully understand what we are reading and consenting to so that we may make the most informed decisions for our health.
[00:40:42] The takeaway learnings from this episode are:
[00:40:42] 1) Translation and interpretation are different skill sets. Rafa, as a translator, focuses on written and audio/visual materials. Interpreters focus on verbal communication.
[00:41:14] 2) Translation is more than translating one word into another. It’s about finding the best solution to fit the message as well as taking responsibility and accountability for your target audience.
[00:40:42] 3) The cultural and social aspects of documents are often not considered when translating and this is a huge problem. For example, the standard American formatting practice on forms are not necessarily applicable to people of other countries and cultures.
[00:41:38] The actionable tips from this episode are:
[00:41:38] 1) If you are a medical provider, take note of who your target audience is when getting documents translated into other languages. Sometimes even a general language is too broad. What is the country you are targeting, or the gender? The more specific, the better translation.
[00:42:09] 2) If you are considering translating consent forms for your medical practice account for the time it takes to prepare quality translation. Remember this process requires a large amount of care and consideration for the language and the culture being addressed and is not typically a quick process.
[00:42:39] 3) If you are a patient who would like to see an increase in translation of medical documents ask your provider if they work with a language or inclusion department. If patients express the desire, hospitals and other medical spaces may be willing to provide additional resources.
[00:41:38] For more information on Rafa, check out our show notes.
[00:43:06] Every episode of Health in the Margins has a page on empoweredus.org, where you can find the extended show notes, including tips and takeaways, transcripts, and relevant resource links.
[00:41:38] If you would like to share your own tips related to this topic or connect with us, please visit the Empowered Us contact page or reach out to us on our social channels.
[00:43:31] Health in the Margins is an Empowered Us original, presented by Good Days, hosted by me, Tinu Abayomi-Paul. Be sure to rate and subscribe to this show wherever you get your podcasts.
[00:43:44] As we move from the margins to the center, I wish you the best possible health for your mind, body and soul. You are worthy of the best. And please remember you do not need to earn sleep or rest.
[00:43:54] [Music Ends]
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