Transcultural Transcultural Competency:Competency:

Applying Applying Principles to Principles to Patient CarePatient Care

E. Scott King, Director / Atlanta Academy of Languages

““Transcultural”Transcultural”

The relatively new word “The relatively new word “transculturaltranscultural” ” implies reaching across cultural boundaries implies reaching across cultural boundaries with one “foot” planted in the familiar ground with one “foot” planted in the familiar ground of one’s own life experiences…reaching across of one’s own life experiences…reaching across the sometimes explicit but often implicit space the sometimes explicit but often implicit space between ourselves and another human being. between ourselves and another human being. It validates both a deeper awareness of and a It validates both a deeper awareness of and a growing appreciation for one’s own culture, as growing appreciation for one’s own culture, as well as a willingness to learn about another’s well as a willingness to learn about another’s culture in the process of seeking true culture in the process of seeking true communication! communication!

- E. Scott King- E. Scott King

Bafá BafáBafá Bafá

A Cross Culture SimulationA Cross Culture Simulation

Welcome!Welcome!

You are about to You are about to play a game!play a game!

The name of the The name of the game is Bafá game is Bafá

BafáBafáDon’t worry…you’ll understand the title of the game later!Don’t worry…you’ll understand the title of the game later!

The purpose of The purpose of this game is to:this game is to:

–Create a situation Create a situation where you can where you can

explore the idea of explore the idea of cultureculture

–Create feelings Create feelings similar to traveling to similar to traveling to

a different culturea different culture

Let you have the Let you have the experience in observing experience in observing

and interacting with a and interacting with a different culture different culture

Get ready!Get ready!

We’re going to We’re going to divide you all into divide you all into

2 groups!2 groups!

One group will be theOne group will be the

ALPHAS ALPHAS

The other group will be The other group will be thethe

BETASBETAS

Now it’s time to divide Now it’s time to divide into teams and follow into teams and follow

your group leader!your group leader!

Discussion and AnalysisDiscussion and Analysis

Now it’s time to discuss Now it’s time to discuss what we discovered in what we discovered in the game…the game…please sit please sit

together with your own together with your own group!group!

for the BETAS…for the BETAS…

Please give me words Please give me words which describe the which describe the

Alpans:Alpans:

now for the ALPHANS…now for the ALPHANS…

Please give me words Please give me words which describe the which describe the

Betans:Betans:

……for you Betans:for you Betans:

How did the Alphans appear How did the Alphans appear to you when they visited to you when they visited

your group?your group?

……for you Alphans:for you Alphans:

How did the Betans appear to How did the Betans appear to you when they visited your you when they visited your

group?group?

Betans, please answer:Betans, please answer:

Describe your feelings Describe your feelings and thoughts when and thoughts when you you

visitedvisited the Alpha culture?the Alpha culture?

Alphans, please answer:Alphans, please answer:

Describe your feelings Describe your feelings and thoughts when and thoughts when you you visitedvisited the Beta culture?the Beta culture?

To any one member of the Alpha To any one member of the Alpha Culture:Culture:

Explain the Beta Culture Explain the Beta Culture to all of us!to all of us!

To any one member of the Beta To any one member of the Beta Culture:Culture:

Explain the Alpha Culture Explain the Alpha Culture to all of us!to all of us!

Now, one of you Alphans:Now, one of you Alphans:

Please explain the Alpha Please explain the Alpha Culture to the entire Culture to the entire group…and answer group…and answer questions about the questions about the

Alpha culture…Alpha culture…

Now, one of you Betans:Now, one of you Betans:

Please explain the Beta Please explain the Beta Culture to the entire Culture to the entire group…and answer group…and answer questions about the questions about the

Alpha culture…Alpha culture…

To all of you:To all of you:

In which culture would you In which culture would you prefer to live? Why?prefer to live? Why?

to Women:to Women:

If you said you prefer the Alpha culture…If you said you prefer the Alpha culture…why do you do so when the rules why do you do so when the rules discriminate against women?discriminate against women?

Are there indeed situations and Are there indeed situations and conditions in the “real world” conditions in the “real world” which make it difficult to ask which make it difficult to ask about the rules of another about the rules of another

culture?culture?

A few possibilities:A few possibilities:

Language may be a barrier!Language may be a barrier!

Reluctance to ask so as not to appear rude!Reluctance to ask so as not to appear rude!

Sometimes people within a culture aren’t Sometimes people within a culture aren’t even aware of the reasons or behaviors seen even aware of the reasons or behaviors seen by others as different.by others as different.

Example: Personal SpaceExample: Personal Space

Example: Expression of Thanks to CustomersExample: Expression of Thanks to Customers

Thanks for playing!Thanks for playing!Remember that real cultures are infinitely Remember that real cultures are infinitely more complex that either of our “pretend” more complex that either of our “pretend” cultures.cultures.

Remember today that as we discuss other Remember today that as we discuss other cultures, we’ll be making references to our cultures, we’ll be making references to our experiences together in the game of Bafá experiences together in the game of Bafá Bafá to help us learn about others from Bafá to help us learn about others from new perspectives!new perspectives!

What is Culture?What is Culture?

The word The word cultureculture implies an integrated pattern of implies an integrated pattern of human thoughts, communications, actions, customs, human thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, beliefs, values and institutions of a racial, ethnic, religious or socioeconomic group.religious or socioeconomic group.

It’s tempting to think of culture only in terms of what It’s tempting to think of culture only in terms of what experts refer to as “Culture with a Capital C” – in other experts refer to as “Culture with a Capital C” – in other words, art, music, & literature! words, art, music, & literature!

But culture with a “little c” includes the daily routines and But culture with a “little c” includes the daily routines and expectations in a society, and might include how to order food from a expectations in a society, and might include how to order food from a drive-through, use an ATM machine, order a meal, appear to an drive-through, use an ATM machine, order a meal, appear to an interview, drive a car, or act in a hospital! interview, drive a car, or act in a hospital! These things are often the These things are often the more implicit behaviors of a group of individuals, and therefore are more implicit behaviors of a group of individuals, and therefore are frequently viewed as the most mysterious barriers between us!frequently viewed as the most mysterious barriers between us!

Cultural KnowledgeCultural Knowledge

Cultural knowledgeCultural knowledge involves involves increased familiarization with increased familiarization with

selected cultural characteristics, selected cultural characteristics, history, values, belief systems, and history, values, belief systems, and

behaviors of the members of another behaviors of the members of another ethnic group. (Adams, 1995)ethnic group. (Adams, 1995)

It’s a life-skill!It’s a life-skill!

Cultural SensitivityCultural Sensitivity

Cultural sensitivityCultural sensitivity is knowing that is knowing that cultural differences cultural differences as well as as well as

similaritiessimilarities exist without exist without automatically assigning values to automatically assigning values to

those differences, i.e., better /worse, those differences, i.e., better /worse, right /wrong. right /wrong.

(National Maternal & Child Health Center on Cultural Competency, 1997)(National Maternal & Child Health Center on Cultural Competency, 1997)

CompetencyCompetency

CompetencyCompetency implies the capacity to implies the capacity to function effectively.function effectively.

Developing sensitivity and understanding Developing sensitivity and understanding of another ethnic group usually involves of another ethnic group usually involves internal changes in attitudes and values internal changes in attitudes and values and development of openness and and development of openness and flexibility in relation to others. flexibility in relation to others. Cultural Cultural awareness must be supplemented with awareness must be supplemented with cultural knowledgecultural knowledge. . (Adams, 1995)(Adams, 1995)

How do we How do we reallyreally communicate communicate with others?with others?

Objective words with explicit but possibly Objective words with explicit but possibly multiple meanings (shot, tire, cold, sick) multiple meanings (shot, tire, cold, sick) and subjective words with implicit and and subjective words with implicit and deeper meanings (“pretty” bad, “severe” deeper meanings (“pretty” bad, “severe” pain, “horrible” headache)pain, “horrible” headache)Idiomatic expressions (“run down”, “all Idiomatic expressions (“run down”, “all out”, “get to”, “get in”, “get down”) out”, “get to”, “get in”, “get down”) Body Language (Gestures,Eye Contact, Body Language (Gestures,Eye Contact, and Personal Space)and Personal Space)

Barriers to Transcultural Barriers to Transcultural CompetencyCompetency

Barriers may be expected to exist, Barriers may be expected to exist, therefore, in all three areas of therefore, in all three areas of communication:communication:

Language Barriers – “A different language is Language Barriers – “A different language is a different a different viewview of the world!” of the world!” –Federico Fellini–Federico Fellini

Shades of meaning in words Shades of meaning in words even when we even when we have learned the language of the patienthave learned the language of the patient

Body Posture and Gestures may mean Body Posture and Gestures may mean one one thing in one culture and something entirely thing in one culture and something entirely different in another (or nothing at all!)different in another (or nothing at all!)

SuggestionsSuggestions

Ask about words (whether in English Ask about words (whether in English oror another language!) whose meaning or another language!) whose meaning or implications are not quite clear to you…implications are not quite clear to you…

What exactly do you mean by “--------” ? is a great What exactly do you mean by “--------” ? is a great question to ask the patientquestion to ask the patient

Observe consciously and carefully the body Observe consciously and carefully the body language (eye contact and gestures, as well language (eye contact and gestures, as well as personal space allowed) that the patient as personal space allowed) that the patient exhibits…these are clues to their thoughts!exhibits…these are clues to their thoughts!

Distance may indicate either distrust or respect in Distance may indicate either distrust or respect in other cultures!other cultures!

Hot versus Cold Climate Hot versus Cold Climate CulturesCultures

Sarah Lanier’s theory of Hot and Cold Sarah Lanier’s theory of Hot and Cold climate cultures (Lanier, 2002) offers climate cultures (Lanier, 2002) offers easy to understand frames of reference easy to understand frames of reference when working or living with others. The when working or living with others. The generalizations found in this explanation generalizations found in this explanation of cultural differences can serve as a solid of cultural differences can serve as a solid basis for “first-impression” insights into basis for “first-impression” insights into the behavior of others. the behavior of others.

My Own Concept of Hot/Cold Climate CulturesMy Own Concept of Hot/Cold Climate Cultures

HO T C LI MA TE C ULTURES

C O LD C LI MA TE C ULTURES

Lanier points out that there are exceptions found to solely a geographical interpretation of the Hot/Cold-Climate Cultures.

Hot Climate CulturesHot Climate CulturesPeople in and from hot climate cultures People in and from hot climate cultures tend to be:tend to be:

relationship oriented rather than task orientedrelationship oriented rather than task oriented

indirect communicators rather than direct indirect communicators rather than direct communicatorscommunicators

group-identity seekers rather than individual-identity group-identity seekers rather than individual-identity seekersseekers

inclusive of many others rather than highly regarding inclusive of many others rather than highly regarding of individual privacyof individual privacy

high-context members of their society (everything high-context members of their society (everything matters) rather than low-context members of their matters) rather than low-context members of their society (not much matters; anything goes-within society (not much matters; anything goes-within reason)reason)

not highly oriented to the clock rather than time not highly oriented to the clock rather than time oriented. oriented.

Cold Climate CulturesCold Climate Cultures

People in and from cold climate cultures People in and from cold climate cultures tend to be:tend to be:

task oriented rather than relationship orientedtask oriented rather than relationship orienteddirect communicators rather than indirect direct communicators rather than indirect communicatorscommunicatorsindividual-identity seekers rather than group-identity individual-identity seekers rather than group-identity seekersseekershave high regard of individual privacy over the have high regard of individual privacy over the inclusive of many others in affairsinclusive of many others in affairslow-context members of their society (not much low-context members of their society (not much matters; anything goes-within reason) rather than low-matters; anything goes-within reason) rather than low-context members of their society (everything matters) context members of their society (everything matters) time oriented to the clock rather than flexible in their time oriented to the clock rather than flexible in their concept of time concept of time

Our PatientsOur Patients

Patients from Cold-Climate Cultures seem Patients from Cold-Climate Cultures seem to appreciate logic, efficiency, and to appreciate logic, efficiency, and information-loaded atmospheres. Respect information-loaded atmospheres. Respect for others is best expressed by respect for for others is best expressed by respect for another’s time and privacy.another’s time and privacy.Patients from Hot-Climate Cultures seem Patients from Hot-Climate Cultures seem to thrive on being relationship based to thrive on being relationship based where a “feel good” atmosphere is where a “feel good” atmosphere is created. People take priority over created. People take priority over efficiency and time, and “small talk” is an efficiency and time, and “small talk” is an well-developed and highly valued art!well-developed and highly valued art!

Our PatientsOur PatientsPatients from Cold-Climate Cultures seem Patients from Cold-Climate Cultures seem to use short and direct questions and to use short and direct questions and answers, and a “yes” is usually a “yes”, answers, and a “yes” is usually a “yes”, and a “no” a “no”. If they say nicely what and a “no” a “no”. If they say nicely what they really think, you won’t be expected to they really think, you won’t be expected to take it too personally!take it too personally!

Patients from Hot-Climate Cultures seem to Patients from Hot-Climate Cultures seem to value being friendly above being honest, value being friendly above being honest, and even avoid taking any chance of and even avoid taking any chance of offending or embarrassing others. Their offending or embarrassing others. Their “yes” or “no” may simply be an indication “yes” or “no” may simply be an indication that they will consider further the situation, that they will consider further the situation, not that they will comply, act upon, or are not that they will comply, act upon, or are answering honestly your request or answering honestly your request or question. question.

Our PatientsOur PatientsPatients from Cold-Climate Cultures seem Patients from Cold-Climate Cultures seem to cherish their own right to an opinion to cherish their own right to an opinion and to independence, and take initiative and to independence, and take initiative within a group, making decisions on their within a group, making decisions on their own. Their “own space” is important.own. Their “own space” is important.

Patients from Hot-Climate Cultures seem Patients from Hot-Climate Cultures seem to seek their identity within a group, avoid to seek their identity within a group, avoid appearing “pushy” by taking too much appearing “pushy” by taking too much initiative, seek the support and protection initiative, seek the support and protection of many others, and expect clear direction of many others, and expect clear direction from the provider. One’s possessions from the provider. One’s possessions should be shared, and one rarely desires should be shared, and one rarely desires solitude. solitude.

Our PatientsOur PatientsPatients from Cold-Climate Cultures seem to Patients from Cold-Climate Cultures seem to appreciate planning and advanced notice. appreciate planning and advanced notice. Spontaneity must be brought under control. Spontaneity must be brought under control. Hospitality is a special event and a serious Hospitality is a special event and a serious matter.matter.

Patients from Hot-Climate Cultures seem to Patients from Hot-Climate Cultures seem to believe that hospitality is a spontaneous believe that hospitality is a spontaneous gift, and is the context for gift, and is the context for all all relationships. relationships. Gifts are usually expected. Food and drink Gifts are usually expected. Food and drink play a major role in kindness and play a major role in kindness and appreciation.appreciation.

In a Cold-Climate culture, who you In a Cold-Climate culture, who you know matters, but not nearly so know matters, but not nearly so much as much as what you knowwhat you know. Cold-. Cold-Climate cultures usually do not Climate cultures usually do not expect Hot-Climate Cultures to know expect Hot-Climate Cultures to know their their rules of behavior, rules of behavior, nor are they nor are they that interested in knowing the rules that interested in knowing the rules of the other culture. of the other culture.

In a Hot-Climate culture, honor and In a Hot-Climate culture, honor and respect often outweigh freedom and respect often outweigh freedom and casualness. Manners are of the casualness. Manners are of the utmost importance for success!utmost importance for success!

When working with patients from another culture, When working with patients from another culture, misunderstandings may occur if you and your misunderstandings may occur if you and your

patient have a different understanding of:patient have a different understanding of:

the epidemiological and etiological factors within a culture the epidemiological and etiological factors within a culture or peopleor people

a directive versus an options-oriented treatment and a directive versus an options-oriented treatment and patient carepatient care

the family involvement expectations of a culturethe family involvement expectations of a culture

pain and the expression of pain pain and the expression of pain

the standards of modesty and personal spacethe standards of modesty and personal space

the the truetrue language barriers between you language barriers between you

the diet and food preparation norms and preferences the diet and food preparation norms and preferences within culturewithin culture

body language and gesturesbody language and gestures

the purpose of the interpreterthe purpose of the interpreter

the religious customs and beliefs of the religious customs and beliefs of this specific patientthis specific patient

the socioeconomic impacts and implications of a treatmentthe socioeconomic impacts and implications of a treatment

10 Brief Tips for Providing Culturally Competent 10 Brief Tips for Providing Culturally Competent CareCare

1.1. Know where the patient was bornKnow where the patient was born

2.2. Know what language they speak, and their Know what language they speak, and their true true level of English…level of English…be careful to avoid confusing be careful to avoid confusing idiomsidioms

3.3. Know about any specific dietary patternsKnow about any specific dietary patterns

4.4. Know the role of spirituality in the patient’s life Know the role of spirituality in the patient’s life and any specific prohibitions of their religionand any specific prohibitions of their religion

5.5. Know the level of independence the patient is Know the level of independence the patient is accustomed to having and if it’s a problem or an accustomed to having and if it’s a problem or an assetasset

10 Brief Tips for Providing Culturally Competent 10 Brief Tips for Providing Culturally Competent CareCare

6.6. Know the support system that exists in the Know the support system that exists in the patient’s life and surroundings and its implications.patient’s life and surroundings and its implications.

7.7. Have the patient describe how the illness is Have the patient describe how the illness is handled at home.handled at home.

8.8. Know the importance of individualizing each case, Know the importance of individualizing each case, based on the myriad of cultural issues that can based on the myriad of cultural issues that can arise.arise.

9.9. Assess the emotional state of the patient and if Assess the emotional state of the patient and if there is a cultural dimension that support this there is a cultural dimension that support this current state of emotions.current state of emotions.

10.10. Allow the patient to assist you in learning words Allow the patient to assist you in learning words that describe his/her illness.that describe his/her illness.

Thank you for participating!Thank you for participating!Additional resources:Additional resources:

www.ggalanti.comwww.ggalanti.com

www.culturaldiversity.orgwww.culturaldiversity.org

www.nccccurricula.info/resources.htmlwww.nccccurricula.info/resources.html

www.diversityrx.orgwww.diversityrx.org

www.hispanichealth.orgwww.hispanichealth.org

www.pewhispanic.orgwww.pewhispanic.org

Foreign to Familiar, Foreign to Familiar, by Sarah A. Lanierby Sarah A. Lanier

ISBN# 1-581580-022-3, McDougal ISBN# 1-581580-022-3, McDougal

Publishing Publishing

Towards Transcultural Towards Transcultural Competency in the Treatment Competency in the Treatment of of Hispanic / LatinoHispanic / Latino Patients Patients

What is “transcultural competence” What is “transcultural competence” in dealing with Hispanic/Latino in dealing with Hispanic/Latino

healthcare issues?healthcare issues?

Transcultural competency implies effective Transcultural competency implies effective communication ! communication !

Not Not justjust Spanish words ! Spanish words !

Cultural knowledge/awareness is Cultural knowledge/awareness is crucial crucial !!

These knowledge-based skills These knowledge-based skills can be learnedcan be learned ! !

““Hispanic” versus “Latino”Hispanic” versus “Latino”

HispanicHispanic is defined as Spanish-speaking is defined as Spanish-speaking– Definitely NOT a racial term!Definitely NOT a racial term!

LatinoLatino is defined as being related to or is defined as being related to or

from the Spanish-speaking countries offrom the Spanish-speaking countries of

North America, or from Central, Latin, or North America, or from Central, Latin, or

South AmericaSouth America

Identity / NationalismIdentity / Nationalism

Of extreme importance and significance to Of extreme importance and significance to almost every Spanish-speaker is the almost every Spanish-speaker is the country country from which they or their family have from which they or their family have immigratedimmigrated ! !

Both Both country and regioncountry and region are important because the culture are important because the culture and expectations of each may differ significantly from one and expectations of each may differ significantly from one area to another.area to another.

Example : MEXICO has three (3) distinct regions and 31 Example : MEXICO has three (3) distinct regions and 31 states! Northern, Central (City), and Southern states vary states! Northern, Central (City), and Southern states vary in history, ethnic background, and culture.in history, ethnic background, and culture.

There are many cultures represented in the There are many cultures represented in the broad terms “Hispanic” and “Latino” !!!broad terms “Hispanic” and “Latino” !!!

How well do we really How well do we really communicatecommunicate with each other?with each other?

Communication is more than simply Communication is more than simply words. In fact, words dowords. In fact, words do “often get in the “often get in the way”!way”!

Communication is Communication is often non-verbaloften non-verbal!!

What are some examples of Latin non-What are some examples of Latin non-verbal communication that might convey verbal communication that might convey unspoken messages of discomfort or fear?unspoken messages of discomfort or fear?

Gestures and Body LanguageGestures and Body Language

Hand signs – these differ so be carefulHand signs – these differ so be careful “ “OK” gestureOK” gesture

“ “Come here” gestureCome here” gesture

Personal Space – extremely different!Personal Space – extremely different! Latin versus Anglo “personal space”Latin versus Anglo “personal space”

Other Body Language SignalsOther Body Language SignalsThe so called “Latin nod” – don’t make The so called “Latin nod” – don’t make presumptions!presumptions!

Eye contact Eye contact

Potential Areas of Potential Areas of MisunderstandingMisunderstanding

Epidemiological and Etiological UnderstandingEpidemiological and Etiological Understanding

Directive versus Options-oriented healthcareDirective versus Options-oriented healthcare

Family InvolvementFamily Involvement

Perception of symptoms and expression of painPerception of symptoms and expression of pain

Standards of modesty and Personal SpaceStandards of modesty and Personal Space

Linguistic challenges and barriersLinguistic challenges and barriers

Diets and food issuesDiets and food issues

Folkloric MedicinesFolkloric Medicines

Did you know?Did you know?

Mexican Americans have a Mexican Americans have a higher incidence of higher incidence of diabetes, heart disease, diabetes, heart disease, hypertension, pernicious hypertension, pernicious anemia and tuberculosis anemia and tuberculosis exposure.exposure.

Did you also know?Did you also know?

‘Small talk’ before serious discussion may ease tension and increase comfort level with Spanish-speakers.

Courtesy is valued; arguments are considered rude. One does not openly question authority without fear of offending. Question: What implications are there for the physician?

What do you know about What do you know about Latins/Hispanics and…Latins/Hispanics and…

directive care versus “options”?directive care versus “options”?

attitudes towards Physicians?attitudes towards Physicians?

attitudes toward diseases?attitudes toward diseases?

gender expectations?gender expectations?

the implications of the gender of the the implications of the gender of the interpreters?interpreters?

their formal educational level ?their formal educational level ?

……about Latinos/Hispanics about Latinos/Hispanics and…and…

their true knowledge of English?their true knowledge of English?the cultural “baggage” they bring with them the cultural “baggage” they bring with them that might affect healthcare?that might affect healthcare?the folklore medicine and home remedies the folklore medicine and home remedies that they have seen used or have that they have seen used or have experienced themselves?experienced themselves?their general tastes in clothing, styles, foods, their general tastes in clothing, styles, foods, and cosmetics/appearance?and cosmetics/appearance?their “polychronic” versus our their “polychronic” versus our “monochronic” view of events and time?“monochronic” view of events and time?

And What’s More…And What’s More…

Many Spanish-speakers consider it either rude Many Spanish-speakers consider it either rude or humiliating to indicate that they do not or humiliating to indicate that they do not completely understand you (in both Spanish and completely understand you (in both Spanish and in English). in English). Be sure to always clarify and get a Be sure to always clarify and get a positive response from a Spanish-speaker positive response from a Spanish-speaker before you assume that they understood you before you assume that they understood you completely!completely!

This will accomplish the very effective but blunt, This will accomplish the very effective but blunt, non-Latino style discourse among Americans non-Latino style discourse among Americans expressed aptly by the word “expressed aptly by the word “HuhHuh???”!???”!

It’s all in learning about the details!It’s all in learning about the details!

Touch is very important, especially in caring for children.

Have narrowed ‘personal space’ & may see one’s distancing as aloof and unfriendly.

Smiling & handshakes are important, trust-establishing interactions.

Modesty is valued.

Family lifeFamily life

Mexican and Latin American culture is mainly a Mexican and Latin American culture is mainly a nuclear family culture. 73% of families are nuclear family culture. 73% of families are married-couple families.married-couple families.

Matriarchal /matriafocal society with oldest Matriarchal /matriafocal society with oldest female responsible for family cohesiveness, female responsible for family cohesiveness, most health matters and family names.most health matters and family names.

Father, however, is often the decision-maker. ut Father, however, is often the decision-maker. ut Mother most approve or there will be little Mother most approve or there will be little enforcement of decisions.enforcement of decisions.

…….more about the family.more about the family

The elderly are highly respected and live with their children.

Extended family also plays visible role in health and illness situations.

People of this culture may be hesitant to seek help / support outside of the family.

Other issues…Other issues…

Working with InterpretersWorking with InterpretersFamily member versus professionalFamily member versus professional

Seasoned professional versus “convenience”Seasoned professional versus “convenience”

Issues of accuracyIssues of accuracy

Issues of sharing and discussingIssues of sharing and discussing

Unauthorized recommendations/guidanceUnauthorized recommendations/guidance

Standards do exist!!!Standards do exist!!!Refer to the Massachusetts Medical Interpreter Refer to the Massachusetts Medical Interpreter Association (MMIA) Association (MMIA)

Illness and DiseaseIllness and Disease

Good health may be seen as good luck, a reward from God Good health may be seen as good luck, a reward from God or a universal equilibrium with balanced forces of hot/cold, or a universal equilibrium with balanced forces of hot/cold, wet/dry, etc.wet/dry, etc.When family member is ill, may practice religious rituals, When family member is ill, may practice religious rituals, i.e., lighting candles, praying.i.e., lighting candles, praying.When in pain, many are stoic and exhibit great self-control; When in pain, many are stoic and exhibit great self-control; perceived as having high pain tolerance.perceived as having high pain tolerance.Prefer company of others, especially family, when in pain.Prefer company of others, especially family, when in pain.Folk medicine is practiced by some. “Folk medicine is practiced by some. “CuranderosCuranderos””Illnesses /Death / grief are considered “God’s will;” saying Illnesses /Death / grief are considered “God’s will;” saying the rosary with family is common for several evenings after the rosary with family is common for several evenings after a death. a death.

Now let’s practice what we’ve Now let’s practice what we’ve learned or need to learn!learned or need to learn!

Situation 1: Situation 1:

You’re interviewing a patient and reminding You’re interviewing a patient and reminding them of how important it is to “stick with” them of how important it is to “stick with” the diet you prescribed for them during the diet you prescribed for them during their last visit. The patient will most likely their last visit. The patient will most likely think that………………………think that………………………

More fun!More fun!

Situation 2Situation 2

You struggle to communicate that a patient You struggle to communicate that a patient needs to be sure to advise you needs to be sure to advise you immediately should their symptoms return immediately should their symptoms return or worsen. The patient smiles and nods or worsen. The patient smiles and nods their head their head indicating……………………………………indicating…………………………………………..……..

Even more!Even more!

Situation 3Situation 3

Your interpreter, Pablo, is assisting you Your interpreter, Pablo, is assisting you with Mrs. Rodríguez, who is in her third with Mrs. Rodríguez, who is in her third trimester of pregnancy and experiencing trimester of pregnancy and experiencing some bleeding and pain.some bleeding and pain.

Pablo will Pablo will ………………………………………… …………………………………………

More situations…More situations…

Situation 4:Situation 4:

You notice that a child patient has what You notice that a child patient has what appear to be ashes in his/her ears. Most appear to be ashes in his/her ears. Most likely…………………………..likely…………………………..

Another…Another…

Situation 5:Situation 5:

You are visiting a Hispanic/Latino patient You are visiting a Hispanic/Latino patient for Home Healthcare. S/he offers you for Home Healthcare. S/he offers you something to drink. You do not want something to drink. You do not want anything because you just had a large anything because you just had a large drink before arriving. You should explain drink before arriving. You should explain that……………………………that……………………………

More situationsMore situations

Your patient walks into the lobby and/or Your patient walks into the lobby and/or waiting/reception area. You are busy taking waiting/reception area. You are busy taking information or explaining how to complete forms information or explaining how to complete forms to another patient. The Hispanic/Latino to another patient. The Hispanic/Latino will/may……………………………………………will/may……………………………………………

Your nurses notice that all the Latino children Your nurses notice that all the Latino children seem to be running “wild” in the waiting seem to be running “wild” in the waiting room/reception area. The best way to correct room/reception area. The best way to correct this is this is by……………………………………………………..by……………………………………………………..

Transcultural SnapshotsAfrican – American Culture…African – American Culture…

The African-American culture is rooted in the 16 th – 19th centuries when millions of Africans were brought to the US and bonded as slaves. The culture uniquely developed as a blend of African and American traditions displayed in the art, music, language, literature, diet and health practices of its people. Spirituality is very important and most are Protestant. This culture comprises about 15 percent of the US population.

There is an increased incidence of hypertension and sickle cell anemia. The two leading causes of death are coronary artery disease and diabetes.

The African-American culture is celebrated during the month of February – “Black History Month.” Kwanzaa, or “first-fruit” in Swahili, is celebrated from December 26 – January 1 in recognition of African harvest festivals.At a Glance…At a Glance…Communication:•Use of “Mr., Mrs., Ms.” and last name is a sign of respect.

•Some have different words for medical conditions, (i.e. ‘sugar’ for diabetes).

•Expressive use of gestures, facial expressions or other body language.Family:•Nearly ½ of all African-American families are headed by females and the woman is primary protector and decision maker although the man is to be included.

•Many have large extended families who are very supportive during crisis or illness.

Perceptions of Illness:•May feel illness due to bad luck, natural or evil forces or punishment from God.

•Some believe herbs and spices are required to treat some illness.

•May believe the body’s health is related to nature, (i.e., moon phases, seasons).

•Some practice folk medicine, voodoo and may use folk medicine ‘practitioners’ or ‘Hougans’.

Religion:•Often have strong religious system.

•Church plays important role in support, maintenance of self-esteem and promotion of culture.

•May believe prayer is the main treatment for illness.

Cultural DiversityCultural Diversity

Asia is a vast continent comprised of many different nationalities of people, each with their own cultures and traditions. These nations include Chinese, Japanese, Filipinos, Vietnamese and Korean people to name a few. Asians are the fourth largest patient population at GHS. The majority of Asian people in our area are Vietnamese, and therefore, will be the focus of this discussion.

At a Glance…At a Glance…Communication:•Vietnamese is the national language; some speak English or Chinese.

•Prefer formal, polite communication.

•Touch is limited. Many believe touching the head is disrespectful.

•Avoiding eye contact when talking with someone of higher standing, older age or opposite gender is a sign of respect as is slightly bowing the head in front of the elderly.

•Nodding / smiling may reflect desire for personal harmony rather than agreement or understanding.

Family:•Family is the basic unit of society; often extended family to help support.

•Family loyalty and obedience / honor toward parents are valued. 73% families are married-couple families.

•Children’s education highly valued.

•Emphasis on social harmony; may prevent full expression of concerns / feelings.

Perceptions of Illness:•Illness due to many causes: natural (spoiled food), supernatural (demons, spirits), metaphysical (imbalance of hot/cold) and germs

•Some may practice folk medicine: rubbing coins on skin, pinching skin, aromatic oils, ointments, herbal teas, etc.

•Drawing blood may cause much anxiety as some believe the body will suffer a permanent loss.

•Unexplained clergy visits / flowers to the sick may be interpreted as serious sign & associated with death.

•Some expect authoritative, direct and detached communication from healthcare professionals.

•Tendency to deny pain; believe this may make pain go away. Hesitant to ask for pain meds because it inconveniences the caregiver.Diet:•Common staples include rice, salty fish and dark green, leafy vegetables.

•Meat is rare in traditional diet, but fairly common for US Vietnamese.

•Lactose intolerance is more common among Vietnamese-Americans, therefore use of milk/milk products may be limited.

Cultural DiversityCultural DiversityThe Asian Cultures…The Asian Cultures…

KoreaKorea

Vertical SocietyVertical Society – Six levels of status, three up and three downSix levels of status, three up and three down– Status determined by age (10,20,30 years Status determined by age (10,20,30 years

older; 10,20,30 years younger) older; 10,20,30 years younger) – Status determines level of speakingStatus determines level of speaking

Great respect for elders (even one year Great respect for elders (even one year older)older)

KoreaKorea

Many beliefs can be traced back Many beliefs can be traced back to Tangun myth.to Tangun myth. – This story of the son of god of Heaven This story of the son of god of Heaven

delineates the importance of harmony, human delineates the importance of harmony, human welfare, and national identitywelfare, and national identity

KoreaKorea

A strong bond exists among A strong bond exists among family and extended familyfamily and extended family–responsible for each otherresponsible for each other

–see themselves as a cohesive unit see themselves as a cohesive unit

–ancestors are honored (Chu-sok ancestors are honored (Chu-sok holiday)holiday)

KoreaKorea

BuddhismBuddhism - as seen in - as seen in architecturearchitecture

ConfucianismConfucianism – as seen in – as seen in calligraphy and paintingscalligraphy and paintings

Christianity Christianity – introduced in – introduced in mid 1890’smid 1890’s

KoreaKorea

A smile does not always mean A smile does not always mean happiness in Korea. It can be happiness in Korea. It can be used as a greeting or to mean used as a greeting or to mean “I’m sorry.” It is not typical to smile “I’m sorry.” It is not typical to smile at strangers.at strangers.

KoreaKorea

Korean women are commonly Korean women are commonly seen holding hands. Boys and seen holding hands. Boys and men may put arms around men may put arms around shoulders.shoulders.

KoreaKorea

Korean men typically bow then Korean men typically bow then shake hands when greeting each shake hands when greeting each other. Women bow but do not other. Women bow but do not shake hands with men.shake hands with men.

KoreaKorea

Women often cover their mouths Women often cover their mouths when laughing.when laughing.

KoreaKorea

Koreans do not usually apologize Koreans do not usually apologize for burping, sneezing, coughing, for burping, sneezing, coughing, or even accidentally passing gas. or even accidentally passing gas. However, none of these However, none of these occurrences is considered occurrences is considered appropriate.appropriate.

KoreaKorea

Often Koreans will not look an Often Koreans will not look an authority figure in the eye because authority figure in the eye because doing so is considered rude.doing so is considered rude.Striving not to offend, it is common Striving not to offend, it is common that Koreans remain silent even if that Koreans remain silent even if they do not understand. Koreans they do not understand. Koreans often believe that “silence is golden” often believe that “silence is golden” and that it is better to remain silent and that it is better to remain silent than to encourage conflict.than to encourage conflict.

KoreaKorea

It is risky to write a person’s It is risky to write a person’s name in red ink. This may be name in red ink. This may be taken as a sign that the other taken as a sign that the other person’s mother will die.person’s mother will die.

KoreaKorea

KimchiKimchi is the national food of is the national food of Korea. It is a very spicy pickled Korea. It is a very spicy pickled cabbage.cabbage.

KoreaKorea

In general, Koreans are addressed by In general, Koreans are addressed by last name plus any appropriate title.last name plus any appropriate title.

First names are very important in the First names are very important in the Korean culture but it is not typical to Korean culture but it is not typical to call someone by first name until given call someone by first name until given permission to do so. This is reserved permission to do so. This is reserved for friends of the same age.for friends of the same age.

““Older brother” is used by younger siblings!Older brother” is used by younger siblings!

KoreaKorea

Children show respect to their Children show respect to their parents by demonstrating parents by demonstrating obedience to themobedience to them

Take off shoes in Korean homeTake off shoes in Korean home

Offer seat to elderly and rise Offer seat to elderly and rise when they come into the roomwhen they come into the room

VIETNAMVIETNAM

Great importance on family. Family Great importance on family. Family members and extended family members members and extended family members are a team, and will first seek one are a team, and will first seek one another’s advice in times of need, and another’s advice in times of need, and family interests are considered when family interests are considered when making even individual decisions. Family making even individual decisions. Family celebrations form the basis of Vietnamese celebrations form the basis of Vietnamese social life.social life.

VietnamVietnam

Influenced by Confucianism, Buddhism, Influenced by Confucianism, Buddhism, Taoism, and Christianity.Taoism, and Christianity.

Great honor given to elders and parents.Great honor given to elders and parents.

VietnamVietnam

Traditional Vietnamese family roles are Traditional Vietnamese family roles are clear; the wife is subordinate to the husband, clear; the wife is subordinate to the husband, the children are subordinate to their parents, the children are subordinate to their parents, and younger children are subordinate to and younger children are subordinate to elder children. The man is the provider, the elder children. The man is the provider, the woman ensures a smoothly run household, woman ensures a smoothly run household, including managing the family finances. A including managing the family finances. A wife is supposed to care for the husband’s wife is supposed to care for the husband’s parents.parents.

VietnamVietnam

Sometimes three generations are in one Sometimes three generations are in one household. household.

Ancestor veneration is common.Ancestor veneration is common.– Homes may have altars to ancestors.Homes may have altars to ancestors.– Ancestors desires considered in decisionsAncestors desires considered in decisions– Attempt to bring honor to ancestorsAttempt to bring honor to ancestors

VietnamVietnam

Having children is important Having children is important – They will take care of the elderlyThey will take care of the elderly

VietnamVietnam

The Vietnamese people love to sing.The Vietnamese people love to sing.– Long tradition of putting literature and poetry Long tradition of putting literature and poetry

into song to be passed down form generation into song to be passed down form generation to generation. to generation.

– Workers often sing in the fields.Workers often sing in the fields.– Even in urban areas, workers tend to hum at Even in urban areas, workers tend to hum at

work and make up songs.work and make up songs.– Karaoke is popular therefore!Karaoke is popular therefore!

VietnamVietnam

In general, very polite and reservedIn general, very polite and reserved

Known for hard work and resourcefulness.Known for hard work and resourcefulness.

Tendency to be trustworthyTendency to be trustworthy

A broken promise is a serious social A broken promise is a serious social offense.offense.

Great deal of emphasis on educationGreat deal of emphasis on education

VietnamVietnam

Rare to ask questions during interview, but Rare to ask questions during interview, but usually afterward. May be reluctant to ask.usually afterward. May be reluctant to ask.

Bow when greeting. A simple head nod is Bow when greeting. A simple head nod is OK when person is of equal social status; OK when person is of equal social status; however is much more formal (with however is much more formal (with crossed arms) when greeting people of crossed arms) when greeting people of greater authority and stature.greater authority and stature.

VietnamVietnam

Women do not shake hands in Vietnam, Women do not shake hands in Vietnam, neither with women nor with men. Men neither with women nor with men. Men may shake hands when greeting each may shake hands when greeting each other.other.

Males and females have little or no Males and females have little or no physical contact with one another in physical contact with one another in public. It is rare to see a couple holding public. It is rare to see a couple holding hands and kissing in public is unheard of. hands and kissing in public is unheard of. Women may link arms to other women.Women may link arms to other women.

VietnamVietnam

Smiling is the same as with Korean Smiling is the same as with Korean culture, often NOT indicating pleasure.culture, often NOT indicating pleasure.

angeranger

embarrassmentembarrassment

acceptance of a complimentacceptance of a compliment

attempt to cover up a display of emotion, which is attempt to cover up a display of emotion, which is considered a private matter.considered a private matter.

VietnamVietnam

Direct eye contact often considered disrespectful Direct eye contact often considered disrespectful and can be interpreted as a challenge.and can be interpreted as a challenge.

Touching the head is considered disrespectful. Touching the head is considered disrespectful. Only an elder can touch a child’s head.Only an elder can touch a child’s head.

Standing in an upright position with a raised Standing in an upright position with a raised chest and squared shoulders is considered chest and squared shoulders is considered arrogant. Vietnamese prefer a humble posture arrogant. Vietnamese prefer a humble posture with lowered shoulders.with lowered shoulders.

VietnamVietnam

Rude to summon a person of equal status Rude to summon a person of equal status with an upright hand or finger. Use entire with an upright hand or finger. Use entire hand with fingers down.hand with fingers down.

Use two hands to offer things to and to Use two hands to offer things to and to accept things from a respected person. accept things from a respected person. Handing something to someone with just Handing something to someone with just one hand is considered disrespectful.one hand is considered disrespectful.Excessive gestures = impoliteExcessive gestures = impolite

VietnamVietnam

Family name comes first, then the middle Family name comes first, then the middle name, followed by the given name. Women name, followed by the given name. Women tend to keep their maiden name.tend to keep their maiden name.

Speaking in a loud voice is rude.Speaking in a loud voice is rude.Personal questions are OKPersonal questions are OKVery few Vietnamese women smoke or drinkVery few Vietnamese women smoke or drinkArriving late is not rude. They may not want Arriving late is not rude. They may not want to appear too enthusiastic or frightened.to appear too enthusiastic or frightened.

Medical InterpretingMedical Interpreting

It’s an It’s an meaningful meaningful art!art!

The ChallengeThe Challenge

You need to be able to provide a complete You need to be able to provide a complete and convincing argument for the use of and convincing argument for the use of professional interpreters in the medical professional interpreters in the medical field as opposed to non-trained speakers field as opposed to non-trained speakers of languages!of languages!

What is involved in interpreting for What is involved in interpreting for the patient and the healthcare the patient and the healthcare

professional?professional?

A keen and real recognition that yours is A keen and real recognition that yours is also a profession, not just a skill!also a profession, not just a skill!A calm attitude that responds to stress in A calm attitude that responds to stress in helpful ways, using practiced, learned helpful ways, using practiced, learned skills.skills.A good sense of each situation…i.e., A good sense of each situation…i.e., “sizing up the situation”“sizing up the situation”

Skills-BasedSkills-Based

Becoming an Effective Becoming an Effective Interpreter in the Medical Field Interpreter in the Medical Field is a learned, lifelong, skills-is a learned, lifelong, skills-based process.based process.

Skill Areas Required to be a Skill Areas Required to be a Professional Medical Interpreter:Professional Medical Interpreter:Linguistic ExpertiseLinguistic Expertise– Spanish and English and “Spanglish”Spanish and English and “Spanglish”– Grammar and Common UsageGrammar and Common Usage– Colloquialisms/Slang/Some JargonColloquialisms/Slang/Some Jargon– Ever-Increasing Knowledge of Regional Ever-Increasing Knowledge of Regional

DifferencesDifferences– CircumlocutionCircumlocution– Awareness of Contextual CluesAwareness of Contextual Clues– Awareness of Some LimitationsAwareness of Some Limitations

ColloquialismsColloquialisms

A A colloquialismcolloquialism is an expression not used in formal is an expression not used in formal speechspeech or writing. Colloquialisms or writing. Colloquialisms can include words (such as "gonna" or "grouty"), phrases (such as "ain't nothin'" and can include words (such as "gonna" or "grouty"), phrases (such as "ain't nothin'" and "dead as a doornail"), or sometimes even an entire "dead as a doornail"), or sometimes even an entire aphorismaphorism ("There's more than one ("There's more than one way to skin a cat"). Dictionaries often display colloquial words and phrases with the way to skin a cat"). Dictionaries often display colloquial words and phrases with the abbreviation abbreviation colloq.colloq. Colloquialisms are often used primarily within a limited Colloquialisms are often used primarily within a limited geographical area.geographical area.In some areas, overuse of colloquialisms by native speakers is regarded as a sign of In some areas, overuse of colloquialisms by native speakers is regarded as a sign of substandard ability with the language. However, in the mouth of a non-substandard ability with the language. However, in the mouth of a non-native speakernative speaker, they are sometimes taken as signaling unusual facility with the language as they , they are sometimes taken as signaling unusual facility with the language as they may be more difficult for non-native speakers to understand.may be more difficult for non-native speakers to understand.A colloquialism can sometimes make its way into otherwise formal speech, as a sign A colloquialism can sometimes make its way into otherwise formal speech, as a sign that the speaker is comfortable with his or her audience, in contrast to slang, which if that the speaker is comfortable with his or her audience, in contrast to slang, which if used in formal speech is more likely done so consciously for humorous effect.used in formal speech is more likely done so consciously for humorous effect.Words that have a formal meaning may also have a colloquial meaning that, while Words that have a formal meaning may also have a colloquial meaning that, while technically incorrect, is recognizable due to common usage.technically incorrect, is recognizable due to common usage.

SlangSlangSlangSlang is the non-standard or non- is the non-standard or non-dialectaldialectal use of words in a use of words in a languagelanguage of a particular of a particular social groupsocial group, and sometimes the creation of new , and sometimes the creation of new wordswords or importation of words from or importation of words from another language. It is a type of another language. It is a type of neologismneologism. Slang can be described as way of deviating . Slang can be described as way of deviating from standard language use, and is very popular with from standard language use, and is very popular with teenagersteenagers. Slang functions in two . Slang functions in two ways; the creation of new language and new usage by a process of creative informal use ways; the creation of new language and new usage by a process of creative informal use and adaptation, and the creation of a secret language understood only by those within a and adaptation, and the creation of a secret language understood only by those within a group intended to understand it. As such, slang is a type of group intended to understand it. As such, slang is a type of sociolectsociolect aimed at excluding aimed at excluding certain people from the conversation. Slang initially functions as certain people from the conversation. Slang initially functions as encryptionencryption, so that the , so that the non-initiate cannot understand the conversation, or as a further way to communicate with non-initiate cannot understand the conversation, or as a further way to communicate with those who understand it. Slang functions as a way to recognize members of the same those who understand it. Slang functions as a way to recognize members of the same group, and to differentiate that group from the society at large. Slang terms are often group, and to differentiate that group from the society at large. Slang terms are often particular to a certain particular to a certain subculturesubculture, such as , such as musiciansmusicians, skateboarders, and drug users. , skateboarders, and drug users. Slang generally implies playful, informal speech. Slang is distinguished from jargon, the Slang generally implies playful, informal speech. Slang is distinguished from jargon, the technical vocabulary of a particular profession, as jargon is (in theory) not used to exclude technical vocabulary of a particular profession, as jargon is (in theory) not used to exclude non-group members from the conversation, but rather deals with technical peculiarities of non-group members from the conversation, but rather deals with technical peculiarities of a given field which require a specialized vocabulary.a given field which require a specialized vocabulary.Four now widely accepted characteristics of slang were identified in the paper "Is Slang a Four now widely accepted characteristics of slang were identified in the paper "Is Slang a Word for Linguists," 53 Word for Linguists," 53 American SpeechAmerican Speech 5, 14-15 (1978), by Bethany K. Dumas and 5, 14-15 (1978), by Bethany K. Dumas and Jonathan Lighter. Slang usually shares at least two of the following traits.Jonathan Lighter. Slang usually shares at least two of the following traits.First, it is markedly lower in dignity than Standard English. First, it is markedly lower in dignity than Standard English. Second, it tends to first appear in the language of groups with low status, meaning they Second, it tends to first appear in the language of groups with low status, meaning they may have little power or little responsibility. may have little power or little responsibility. Third, it is often taboo and would be unlikely to be used by people of high status. Third, it is often taboo and would be unlikely to be used by people of high status. Fourth, it tends to displace a conventional term, either as a shorthand or as a defense Fourth, it tends to displace a conventional term, either as a shorthand or as a defense against perceptions associated with the conventional term. against perceptions associated with the conventional term.

JargonJargonJargonJargon is terminology, much like slang, that relates to a specific activity, profession, is terminology, much like slang, that relates to a specific activity, profession, or group. It develops as a kind of shorthand, to express ideas that are frequently or group. It develops as a kind of shorthand, to express ideas that are frequently discussed between members of a group, and can also have the effect of discussed between members of a group, and can also have the effect of distinguishing those belonging to a group from those who are not. Newcomers or distinguishing those belonging to a group from those who are not. Newcomers or those unfamiliar with a subject can often be characterized by their incorrect use of those unfamiliar with a subject can often be characterized by their incorrect use of jargon, which can lead to amusing malapropisms. The use of jargon by outsiders is jargon, which can lead to amusing malapropisms. The use of jargon by outsiders is considered by insiders to be socially inappropriate, since it consitutes a claim to be a considered by insiders to be socially inappropriate, since it consitutes a claim to be a member of the insider group.member of the insider group.Jargon can be distinguished from Jargon can be distinguished from terminologyterminology in that it is informal and essentially part in that it is informal and essentially part of the of the oraloral culture of a profession, with only limited expression in the profession's culture of a profession, with only limited expression in the profession's publications. Many jargon terms have non-jargon equivalents which would be used in publications. Many jargon terms have non-jargon equivalents which would be used in print or when addressing non-specialists; other jargon terms, particularly those which print or when addressing non-specialists; other jargon terms, particularly those which are used to characterise or even ridicule non-specialists, have no such equivalents. are used to characterise or even ridicule non-specialists, have no such equivalents. The everyday use of the word The everyday use of the word jargonjargon to describe any technical terminology to describe any technical terminology incomprehensible to the lay person ignores this distinction between incomprehensible to the lay person ignores this distinction between jargonjargon and and terminologyterminology..Oftentimes, people will use Oftentimes, people will use jargonjargon derisively, meant to indicate disapproval with the derisively, meant to indicate disapproval with the use of words whose meaning is esoteric, and thus exclusionary of people who do not use of words whose meaning is esoteric, and thus exclusionary of people who do not understand their meaning and background, for example in The Jargon of Authenticity understand their meaning and background, for example in The Jargon of Authenticity by Theodore Wiesengrund Adorno. To describe an idea as jargon accomplishes in by Theodore Wiesengrund Adorno. To describe an idea as jargon accomplishes in Bourdieu's terms several tasks. It maintain's the speaker's "distinction" and social role Bourdieu's terms several tasks. It maintain's the speaker's "distinction" and social role as critic and judge, while at time excusing the speaker from listening or reading with as critic and judge, while at time excusing the speaker from listening or reading with attention, and it also expresses a safe, egalitarian attitude.attention, and it also expresses a safe, egalitarian attitude.

IdiomsIdiomsAn An idiomidiom is an expression (i.e. term or phrase) whose meaning cannot be is an expression (i.e. term or phrase) whose meaning cannot be deduced from the literal definitions and the arrangement of its parts, but deduced from the literal definitions and the arrangement of its parts, but refers instead to a figurative meaning that is known only through refers instead to a figurative meaning that is known only through conventional use. In linguistics, idioms are figures of speech that contradict conventional use. In linguistics, idioms are figures of speech that contradict the principle of compositionality.the principle of compositionality.Take the English expression Take the English expression to kick the bucketto kick the bucket. A listener knowing only the . A listener knowing only the meaning of meaning of kickkick and and bucketbucket would be unable to deduce the expression's would be unable to deduce the expression's actual meaning, actual meaning, to dieto die. Although . Although kick the bucketkick the bucket can refer literally to the act can refer literally to the act of striking a bucket with a foot, native speakers rarely use it that way.of striking a bucket with a foot, native speakers rarely use it that way.Idioms hence tend to confuse those not already familiar with them; students Idioms hence tend to confuse those not already familiar with them; students of a new language must learn its idiomatic expressions the way they learn of a new language must learn its idiomatic expressions the way they learn its other vocabulary. In fact many natural language words have its other vocabulary. In fact many natural language words have idiomatic idiomatic originsorigins, but have been sufficiently assimilated so that their figurative senses , but have been sufficiently assimilated so that their figurative senses have been lost.have been lost.

Skill Areas Required to be a Skill Areas Required to be a Professional Medical Interpreter:Professional Medical Interpreter:

Cultural CompetencyCultural Competencymany cultures within a broader linguistic culturemany cultures within a broader linguistic culture

diverse “mini” cultures within one culturediverse “mini” cultures within one culture

attitudes toward healthcare issues may vary from attitudes toward healthcare issues may vary from attitudes the interpreter is exposed to in other attitudes the interpreter is exposed to in other areas of lifeareas of life

etiological and epidemiological factsetiological and epidemiological facts

Skill Areas Required to be a Skill Areas Required to be a Professional Medical Interpreter:Professional Medical Interpreter:

Medical TerminologyMedical TerminologyThe Body and The DiseasesThe Body and The Diseases

The Systems and Their FunctionThe Systems and Their Function

The Symptoms and The AssessmentsThe Symptoms and The Assessments

The Actions in Examination ProcessThe Actions in Examination Process

The ProceduresThe Procedures

The TreatmentsThe Treatments

The Follow-upThe Follow-up

The Medications The Medications