Healthcare interpreters are to be engaged in all health care situations where communication is essential for people who are not fluent in English.
NSW Healthcare Interpreting Services provide access to professional interpreting services 24 hours, seven days a week.
The Interpreters – Standard Procedures for Working with Health Care Interpreters policy must be adhered to by all NSW Health staff.
Role and contribution
The interpreter is required to:
- act as a conduit of information
- interpret exactly what is being said
- never modify or change information.
However, they may ask the clinician or the client questions to ensure they are interpreting the information correctly.
How to access interpreters
Interpreters can be engaged in person or via phone or video. There can be limited access to face-to-face interpreters in regional areas, so clinicians may need to rely on phone or video interpreting.
The main interpreting services used by health workers are:
- NSW Healthcare Interpreting Services, NSW Health
- The translating and interpreting services (TIS), Australian Government Department of Home Affairs
Working with an interpreter
Provide training for all health staff, including reception and administration staff, that covers:
- accessing interpreters and interpreting services
- working with interpreters.
When you set up a refugee health service, develop policies and processes to guide staff on what to do if an interpreter is not available or if a client refuses to use an interpreter.
Resources
Interpreters – Standard Procedures for Working with Health Care Interpreters – provides instructions and best practice on what to do if a healthcare interpreter is not available.
Source: NSW Health
Communication and interpreters – an article on the importance of working with credentialed interpreters.
Source: Australian Refugee Health Practice Guide
Guide for Clinicians Working with Interpreters in Healthcare Settings – a comprehensive step-by-step manual for working and engaging with an interpreter.
Source: Migrant and Refugee Health Partnership
HNEkids interpreter services – a video introducing interpreter services for consumers.
Source: Hunter New England Local Health District (LHD)
Interpreters and virtual care
Resources
Using health care tele-interpreters – Dr Murray Webber talks about interpreter services at Hunter New England LHD
Source: Hunter New England LHD
Virtual care – Translated user guides for myVirtualCare
Source: NSW Agency for Clinical Innovation
Telehealth video interpreting for medical consultations
Source: Translating and Interpreting Service, Australian Government Department of Home Affairs
Dos and don'ts of engaging an interpreter
| Dos | Don'ts |
|---|---|
| Do always ask if a client would like an interpreter. | Don’t assume that a person who is able to engage in a general conversation does not need an interpreter. |
| Do check if your client would prefer an interpreter to attend the appointment or be on the phone (if the option is available). | Don’t assume the client will only prefer one option. Some clients prefer telephone interpreting to protect their anonymity. Others may feel more comfortable speaking to an interpreter in person. |
Do use a qualified interpreter to communicate with clients. | Don’t use family members, especially a child or young person, to interpret for clients. |
| Do ask the client the language and dialect they wish to speak. | Don’t assume the language they wish to use. Many people of refugee backgrounds speak multiple languages and may have a preferred language to use for different situations. |
| Do ask the client if they have a preference for the gender of the interpreter. You can request the gender of the interpreter when using Translating and Interpreting Services (TIS). | Don’t assume that you cannot request the gender of an interpreter. |
| Do explain to your client that the interpreter is bound by confidentiality. | Don’t assume that your client is aware of confidentiality or privacy in Australia. |
| Do check that your client is comfortable with the interpreter. | Don’t assume that they are comfortable with the interpreter. In small community groups, they may know or even be related to the interpreter and may not want to discuss some subjects. |
| Do use short sentences in plain English as much as possible. | Don’t talk in long sentences or use jargon or complex language. |
| Do check clients understand phrases or words. | Don’t assume that, even with interpreting, clients understand health concepts. For example, some clients might not understand what counselling means. |
| Do introduce the interpreter to your client and explain their role. | Don’t assume the client understands the role of the interpreter or who they are. |
| Do face the client and talk directly to them. | Don’t focus on the interpreter. The interpreter is there to facilitate open dialogue. |
| Do assess whether the client has understood the information through teach-back methods. | Don’t assume that the client has understood the information, even with the use of an interpreter. |
Resources
Useful tips on how to conduct the interpreting session – fact sheet for clinicians and care providers
Source: Queensland Health
Warning for clinicians
Clinicians need to be careful when using interpreters. The Interpreters – Standard Procedures for Working with Health Care Interpreters policy must be adhered to by all NSW Health staff.
The policy outlines the times in which interpreters are required.
The following actions may breach NSW Health policy:
- Use of unofficial web-based translation tools, such as Google Translate, unofficial apps and other online machine translation services to interpret health information or discussions with clients can breach policy. Many web-based translation applications are not able to interpret complex information. Exceptions include official web-based apps that translate appointment reminders and information.
- Using family members, partners and unqualified community members to interpret for a client. Family members may not have the training to interpret complex information and may not have the vocabulary to interpret certain words. They may withhold information because they feel they are protecting the client. They may feel uncomfortable interpreting information or may interpret the wrong information if they do not understand the information.
- Using a minor as an interpreter. Minors may lack fluency in both languages. They may provide inaccurate information due to a lack of understanding or not wanting to upset family members. They may be exposed to complex and disturbing information about parents, such as serious illnesses, domestic and family violence and sexual health. They may miss school or social events to attend appointments with their parents. They may not be able to obtain informed consent from a parent or client.
Gozal's story: the impact of using a minor as an interpreter
When I first came to Australia five years ago, I didn’t know a single word in English. It was very hard, but within six months I caught on and I had already started translating for my parents. This could be shopping, talking to an Australian person and even in hospitals with doctors at the age of 12.
I had to interpret for my parents because their English wasn’t as good. They can get around just fine, but in a more professional field, such as the hospital, it’s hard for them. Also, the hospitals rarely get a translator and, even if they do, they get the wrong ones!
Our mother language is Uzbeki, but there’s no translator in that language, so we ask for the second language we learnt in our country which is Dari. For some reason, they get the wrong one. They get Farsi, and Farsi is somewhat different from Dari. It’s hard for us to understand.
A few years ago, they got the wrong language, and the translator said a totally different thing to what the doctor had said. My father couldn’t really understand her and he was too scared to ask or tell them that this wasn’t the right language. Because of that, he’s been waiting for a tooth implant for two years. He lives in hope, but in reality that’s not what was spoken about.
Interpreting has had a major effect on me and my brother. I haven’t been able to socialise much with friends. That’s why I’m not so connected with them anymore. I feel mentally ill knowing all my parent’s sicknesses; having to hear it before them and keeping a straight face and translating. I have been behind on schoolwork and so the list goes on.
This has a major negative impact on parents, their children and the government. Health should do something effective not just listen and think, ‘yeah it must be hard’.
Tips from clinicians
- Always inform the interpreter of the topic being discussed, especially when information may be confronting. Ensure they feel comfortable interpreting.
- In regional locations, clients may know or be related to the interpreter. Check with your client whether they wish to have an interpreter present in-person or have the interpreter on the phone.
- Always check that the client is comfortable with the interpreter, early and often, throughout the conversation. When working with survivors of domestic abuse, consider the use of hand signals to check the client is comfortable with the interpreter.
- Vulnerable community members prefer phone interpreters.
- Interpreter training should be provided to all staff, including administration and reception staff.
- Pre-book your interpreter whenever possible.