Language, Access, and Ethics in Healthcare with Professor Alexander Rainof

Transcript

• 00:00Commercial treaties. But what
• 00:02is most important to me is that,
• 00:06oh wait, is there a problem?
• 00:13What is most important to me in
• 00:17this area is that they were a vital
• 00:20link in the spread of knowledge,
• 00:22and even more than knowledge in
• 00:24the spread of culture and this
• 00:27cultural aspect of interpreters.
• 00:30May is one of the great difference
• 00:33between forensic interpretation,
• 00:34that is interpretation in the court and
• 00:37interpretation in the medical sector,
• 00:40so we'll discuss that later.
• 00:49So these are three books which I want you to
• 00:57be aware of because they're lovely books.
• 00:59And they will give you a general idea
• 01:01of translation and interpretation.
• 01:03And strange enough, all three books are
• 01:07published by the University of Ottawa,
• 01:10the University of Ottawa Press.
• 01:13You can read the titles by yourself.
• 01:16The third book is on that
• 01:20sounds a bit too loud.
• 01:21The third book is on the Nuremberg trial and
• 01:25it's again a very well put together book.
• 01:28The books are reasonable.
• 01:30They are pretty looking books and it's fun.
• 01:33So if you ever want a fun book to read,
• 01:36I recommend all three of them.
• 01:38Here is 1 and here is the other one.
• 01:43And this is the guide book by the way,
• 01:47the young lady in front.
• 01:49Gazed upon with adoring eyes by the person
• 01:52next to her was the French interpreter
• 01:55and the queen bee of the aquarium,
• 01:58if I can mix my metaphors.
• 02:01So we're moving now to the important
• 02:09laws buttressing translation
• 02:12interpretation in the United States.
• 02:16I'll go again fairly fast through those
• 02:18because I'm sure all of you are aware
• 02:20of it and I have a lot more to cover.
• 02:23But in the United States,
• 02:25both State Constitutions and
• 02:28the US Constitution,
• 02:30as well as the Civil Rights Act of 1964,
• 02:34Title 6 and Executive Order 13166,
• 02:38which is a reiteration by
• 02:41President Clinton in 2000 of the.
• 02:44Civil Rights Act.
• 02:46Essentially all of these undeniably affirm
• 02:50that language rights are civil rights.
• 02:53This is the key issue that
• 02:58underlines everything else.
• 03:00I want to mention a an article I read
• 03:04which I will keep coming back to,
• 03:07but the article makes a very
• 03:10important point and that is that.
• 03:14Many people have to imagine what being in the
• 03:18country where you don't speak the language,
• 03:21where you are,
• 03:22either you yourself or your family
• 03:26going through unremitting trauma,
• 03:30where the physicians around
• 03:31you don't speak the language.
• 03:34It must be one of the most terrifying
• 03:36things that any human being can go through,
• 03:39the anguish the suffering is.
• 03:43Essentially so acute that it's
• 03:47hard to imagine Okay.
• 03:49Well,
• 03:49that's what you know many people don't have,
• 03:52so they don't realize how intense the
• 03:56suffering of people in this situation is.
• 04:00Camille in one of his
• 04:03essays called Reflexionsure,
• 04:05Laguyotin has this incredible sentence.
• 04:10He says, Conor, Limagenation dog.
• 04:13Limo sevied the Larsans.
• 04:15When imagination sleeps,
• 04:17words lose their meaning,
• 04:19and then he goes on to explain
• 04:22what they wants.
• 04:23That to society is in very vivid
• 04:26anatomical terms when a person
• 04:29is being decapitated.
• 04:32So access political ideologies,
• 04:37administrative strategies
• 04:39and control of funding.
• 04:43Language is an emotional issue.
• 04:45We all know that.
• 04:47That explains why funding in the
• 04:52last 40 years has switched 180
• 04:56degrees from one administration
• 04:59to another in terms of funding,
• 05:03depending on which political
• 05:05party was in power.
• 05:07Ronald Schmidt has this very important book.
• 05:12That was published in 2000,
• 05:15where he analyzes the political
• 05:18situation and impact on language access.
• 05:22Essentially in our country this is
• 05:26the book and it's a very fine book.
• 05:29He has published a couple more
• 05:32books subsequently that essentially
• 05:34still deal with the same material.
• 05:37Now he says one group,
• 05:38the pluralist,
• 05:39wants the power of the government.
• 05:42To be used in favor of minority languages,
• 05:46of people who are non speakers
• 05:50of English because they need
• 05:52help and they say that's only
• 05:54fair and it's based on everybody
• 05:57being equal in front of the law.
• 06:01The pluralist that particular group
• 06:05believe that the other group is
• 06:08essentially one that discriminates.
• 06:12Against Minorities is prejudiced
• 06:15and uses arguments that essentially
• 06:19hide A white supremacist agenda
• 06:25in political terms, says Schmidt.
• 06:28Democrats for the most part,
• 06:30have embraced and supported
• 06:33A pluralist point of view,
• 06:35which means also funding for language access,
• 06:39amongst other things.
• 06:40The other groups, you assimilationists,
• 06:43have some strong arguments too.
• 06:46They say, you know,
• 06:48when people come to this country,
• 06:50they have to be socialized,
• 06:52which means they have to
• 06:53learn to speak English.
• 06:55They have to become Americans,
• 06:57and that means speaking the
• 06:59language of the country.
• 07:00If you think that this group is forceful,
• 07:04try France. Okay. So.
• 07:07And I grew up in France,
• 07:09so I know what I'm talking about.
• 07:11And the other thing is that this
• 07:14group feels that if there is a whole
• 07:16bunch of people who speak different
• 07:19languages and don't speak English,
• 07:21and they're not culturally Americans,
• 07:24this weakens our defense
• 07:26and our national unity.
• 07:29And consequently,
• 07:30these people have to be socialized.
• 07:32They have to learn English.
• 07:37However, not is both groups really
• 07:39these being political groups,
• 07:41are concerned with the allocation
• 07:43of power and material benefits
• 07:46for the implementation of their
• 07:50respective ideologies. Yes,
• 07:56you know, I have a hard time hearing you.
• 07:59Did it do something strange?
• 08:07But
• 08:10do you think it is **** advantages
• 08:13or disadvantages to be a homogeneous
• 08:15country or a heterogeneous country
• 08:17like one language or multiple language?
• 08:20You know what, I'm going to ask
• 08:22everybody because because we have
• 08:23an hour presentation already,
• 08:24If if if you can wait and we'll have
• 08:26question and some exchange at the
• 08:27end of the talk, I'm going to ask
• 08:29Professor Reynolds just to keep going,
• 08:30I apologize, but I'm going to ask you
• 08:31just to keep going for now, Alice.
• 08:33OK. Thank you so much.
• 08:35I think I will answer all the questions
• 08:37at the remember your question.
• 08:39OK. So in political terms,
• 08:44the Republicans for the most part have
• 08:47been assimilation, assimilationist.
• 08:48And by the way,
• 08:51there is an extreme wing of the
• 08:54Republican Power Party that
• 09:00wants English to be the only official
• 09:03language used in this in the country.
• 09:06And the extreme people in that
• 09:09extreme wing of the Republican Party,
• 09:12people like Hayakawa and Tanton who wanted.
• 09:160 gross population and a
• 09:18variety of other things. Really.
• 09:20We're skirting and sometimes
• 09:23even falling into racism Now,
• 09:26Is racism something we have in this country?
• 09:32You bet. There is a book by
• 09:38James Whitman published in 2017.
• 09:42He's a professor here at law school.
• 09:46That is a very total and a scary
• 09:49book where he discusses the influence
• 09:52of American racism in between the
• 09:56two world wars on Nazi philosophy.
• 09:59And it's scary because obviously,
• 10:02and he documents it totally,
• 10:04there was a very strong racist
• 10:08component to what was going on in
• 10:12certain circles in this country.
• 10:15It's still here. Very recently,
• 10:18KFC actually had this special on their
• 10:24chicken to celebrate crystal nest.
• 10:28Need I say more?
• 10:30I mean outrageous.
• 10:32Now I'm going back to this article I
• 10:37mentioned before about imagination
• 10:39jotters and it's a short article,
• 10:42but it's a very good one.
• 10:45Talk about patients whose LP
• 10:48experiencing both distributive injustice,
• 10:51that is,
• 10:53poor health outcomes and relational
• 10:57injustice,
• 10:57which involves essentially a racism
• 11:01and evaluation of identities,
• 11:04sometimes not even consciously,
• 11:06but it's there.
• 11:08Patients who do not speak English
• 11:10might be seen by some as outsiders.
• 11:13Each other
• 11:20is and I'm quoting to devalue and
• 11:23depersonalize them and to make damaging
• 11:27assumptions about their intelligence,
• 11:29their religion, their culture and so on.
• 11:33By the way, this article has a 44 entries
• 11:37bibliography that is very thorough and
• 11:41every assertions they make it has good note.
• 11:45Two articles that butters and substantiated
• 11:51something interesting happened at
• 11:53Brigham and Women's Hospital in Boston.
• 11:56By the way, at the beginning of the pandemic,
• 12:01administrators noticed that there was
• 12:03a higher death rate amongst Latinos,
• 12:07and they wondered why?
• 12:10What were the what were
• 12:13those disparities due to?
• 12:18Was it just just standard 1% going
• 12:24up of nosocomial and I throw,
• 12:31I throw genic reasons was it or was
• 12:36there something else and one of the
• 12:41people connected with the hospital?
• 12:43Actually stated that it may have either
• 12:48consciously or non or non consciously
• 12:55racist possibilities and I'm quoting
• 13:00him as he's quoted in this article.
• 13:04If we don't name and start to
• 13:06talk about racism and how we
• 13:09intend to dismantle it or undo it,
• 13:11we will continue to place
• 13:13band aids on the problem.
• 13:15And not actually tackle
• 13:17the underlying causes.
• 13:21The causes are there,
• 13:23and often they are not even part of a
• 13:28conscious awareness, but they are there.
• 13:31Interestingly enough, and very briefly,
• 13:34I took two examples to show
• 13:37how indeed political ideologies
• 13:41impact distribution of power.
• 13:45Impact Allocation of money.
• 13:47The first one is Title 42,
• 13:49which is just ended.
• 13:52Last week Title 42 was started.
• 13:55Budget was revisited by
• 13:57the Trump administration.
• 13:59It was based on the meningitis
• 14:02case in the 20s, I believe,
• 14:04in the United States,
• 14:06when it was set to prevent sailors from
• 14:10a ship where meningitis had occurred.
• 14:14To come to port and land,
• 14:20it had disappeared for many,
• 14:22many years.
• 14:22And then it came back under the Trump
• 14:26administration as a way of preventing
• 14:29people from entering the border,
• 14:31which they got every right to
• 14:34do under international law.
• 14:36So, interesting enough, the one judge.
• 14:40That stood up against Title
• 14:4342 was Judge Emmett Sullivan,
• 14:46a Clinton appointee.
• 14:48Notice a Democrat, by the way,
• 14:51who called Title 42 unlawful,
• 14:54arbitrary and capricious,
• 14:55and in violation of federal laws.
• 14:59The Flores case is an even
• 15:02more interesting case.
• 15:03Flores was a young woman after
• 15:07going through a horrendous.
• 15:092500 miles from her native Central
• 15:12American country to the US border.
• 15:15She was 15, and you can't even
• 15:19imagine what those 2500 miles can be.
• 15:22She was arrested,
• 15:24handcuffed,
• 15:25taken in and treated very shably all
• 15:30along so badly that actually there
• 15:34was a whole set of legal cases.
• 15:38Predicated on that,
• 15:40that subsequently brought the
• 15:43whole issue to the board.
• 15:45But the interesting thing is that
• 15:47the judge that did the most in
• 15:50those terms was Judge Dolly G Judge
• 15:54Dolly G was dominated by President
• 15:58Clinton to the federal bench.
• 16:01The Senate was Republican.
• 16:03So her nomination wasn't even looked at.
• 16:06It was sent back to to Clinton.
• 16:09And when President Bush came
• 16:11to the White House,
• 16:12he nominated John F Walter to the position.
• 16:16The Senate was Republican and he,
• 16:21John F Walter, became a federal judge.
• 16:23It was not until 2009,
• 16:26when President Obama came to the White House,
• 16:29that Dolly G was nominated again.
• 16:33This time it was the Senate was
• 16:37Democratically controlled and
• 16:38her nomination went through well.
• 16:41She is the one who, amongst other things,
• 16:46was incredibly influential to change
• 16:50the focus of the federal courts
• 16:54when it came to children in 2017.
• 16:58She found that children who are
• 17:00in custody of the US Customs and
• 17:04Border Protection like food,
• 17:05clean water, basic hygiene items,
• 17:10were sleep deprived.
• 17:12They couldn't see medical doctors,
• 17:14etcetera, by doing one thing.
• 17:16And I think that doctor Marietta
• 17:20Vasquez might be here later on, but she was.
• 17:25Nominated to the court as an advisor,
• 17:29and I would be very interested to
• 17:32see what she has to say about it.
• 17:34She's on the faculty at the medical
• 17:37school here, but she's bilingual.
• 17:39She did her medical work in Puerto Rico,
• 17:43and she speaks both languages.
• 17:45She even insists,
• 17:45as you can see,
• 17:47to have an accent on the way of Vasquez.
• 17:50Esuna Palabra is Duhula.
• 17:52It's a penultimate. Stress syllable.
• 17:57She is bilingual and she was one of the
• 18:01very few people I know who holds a medical
• 18:05degree and was nominated to a crucial
• 18:08position because she was bilingual,
• 18:11involving monolingual
• 18:12Spanish speaking children.
• 18:15If she comes in later, I would like very
• 18:18much to have some input from her okay.
• 18:22So that is the. Political situation.
• 18:26As you can see there are two groups.
• 18:29They have political agenda
• 18:31based on political ideologies.
• 18:33It's in control money distribution
• 18:36which controls access for in as far
• 18:40as language mediation is concerned.
• 18:43So now very briefly I'm citing this very
• 18:48important article in Pediatrics because INS.
• 18:54Had a conflict of interest.
• 18:57It was supposed to take care of
• 18:59children while arresting them,
• 19:00and that was found not to be okay.
• 19:03So it was redivided,
• 19:07reorganized very briefly.
• 19:09This is organization,
• 19:10It's available in this article,
• 19:13and it tried to separate the two
• 19:18functions to be fair to the children.
• 19:21I don't think it did actually
• 19:23avoid conflict of interest.
• 19:25As you will see subsequently,
• 19:27it's still there in a lot of activities.
• 19:30So yes, immigration is a serious issue.
• 19:35This was taken in 2019.
• 19:38People crossing the Rio Grande,
• 19:40as you can see, there is an immense influx.
• 19:44This, by the way,
• 19:46was taken just this February
• 19:48and this into that yen gap,
• 19:51the gap that goes from Colombia to Panama.
• 19:55Which is one of the most dangerous
• 19:57areas and where this long journey
• 19:59that ends up on that bridge over the
• 20:02Rio Grande start and the journey
• 20:05is horrendous by all the reports.
• 20:08Now this, by the way,
• 20:09is a very interesting article
• 20:11if you have a chance to read it.
• 20:13It's one of the best articles I have read.
• 20:16The interesting thing about it too,
• 20:18it's that it's a bilingual journal,
• 20:21the other language being Catalan.
• 20:23This is the only journal I know of that
• 20:26is bilingual bilingual English Catalan,
• 20:30but the article without any question
• 20:35states that the United States is
• 20:38obliged to recognize valid claims
• 20:42for asylum both under the 1951
• 20:45Convention Relating to the Status
• 20:48of Refugees and the 1967 Protocol.
• 20:57The time that Iceland seekers spend at
• 21:00primary holding facilities, however,
• 21:01is a dire one. Say the others.
• 21:05Mothers and children have no other
• 21:07option but to sleep on the floor.
• 21:09They are poorly fed,
• 21:11their medical needs are not addressed,
• 21:13and they are not afforded even
• 21:16minimal privacy to use the restroom.
• 21:19This is substantiated by an amazing.
• 21:23Woman Warren Binford.
• 21:24I don't know if anyone here
• 21:27knows about Warren Binford,
• 21:29which has been a child welfare
• 21:32advocate and a person deeply involved
• 21:36in the biomedical ethics for many,
• 21:40many years.
• 21:41I'll discuss her a little bit
• 21:43more in a bit, but she
• 21:50substantiates the fact.
• 21:53That these children are poorly fed,
• 21:58their medical needs are not addressed.
• 22:01Minimal privacy to use the restroom.
• 22:05Humiliating xenophobic remark
• 22:08from some CBP officer.
• 22:12To give you an idea,
• 22:13these children are held in amongst
• 22:16other detention facilities,
• 22:18ones that are owned by core Civic.
• 22:22Core Civic has 170 detention facilities.
• 22:28In 2015 its profit was 1.79 billions and
• 22:36they are the ones that house these children,
• 22:39in many cases under contract
• 22:41with the federal government.
• 22:43A number of people have died in
• 22:46these facilities for what apparently
• 22:48is lack of access to medical care.
• 22:53Here are some of the condition
• 22:55these are known.
• 22:56These are the detention facilities
• 22:58as the Yelleras and Barreras,
• 23:01or coolers and dog pounds.
• 23:06You can see why.
• 23:08Here is another one,
• 23:11this one here.
• 23:12This photograph of that of the
• 23:15previous cage which I showed you
• 23:18was taken when Vice President Pence.
• 23:20Was visiting the facility and
• 23:23this man was shouting to him 40-5
• 23:26days without taking a shower.
• 23:29No shower if that person had not
• 23:31been allowed to shower for 45 days.
• 23:34You can see what language access
• 23:36and medical access that person had
• 23:41in the immigration situation.
• 23:42The key interview is what's known as the
• 23:46credible fear interview in that interview.
• 23:48The person has to prove that the
• 23:52person wants to enter the United
• 23:55States because of fear of death,
• 24:00of torture, and so on.
• 24:03Economic reasons are not acceptable.
• 24:07These people, after crossing 2500 miles,
• 24:11and many of these people are
• 24:13all of them are monolingual.
• 24:15Most of them was three years of
• 24:18elementary school education.
• 24:19They come exhausted, they come sick.
• 24:22They don't have the legal expertise
• 24:25to handle a hearing like this.
• 24:30Furthermore, by law,
• 24:31they are not even allowed to have
• 24:34interpreters because these are
• 24:37immigration cases that are not penal.
• 24:39They are civil,
• 24:40so the government doesn't have to
• 24:43provide an interpreter for civil cases.
• 24:46So you can see now how fair the hearing.
• 24:49Is going to be to start with,
• 24:54by the way, the lady in the
• 24:57left corner of the slide,
• 25:00anatomically speaking, is Warren
• 25:02Bin Ferg as I mentioned her before,
• 25:07and amongst other things,
• 25:09she was instrumental in publishing
• 25:12Hear My Voice, escuchamevot.
• 25:16It's an incredible book.
• 25:18It's a book where she has children.
• 25:22Children talk about what's
• 25:25happening to them in detention,
• 25:28and these are quotations of children
• 25:30in One Direction in Spanish and in
• 25:34the other direction in English.
• 25:36And by the way, it's nonprofit.
• 25:39All the money goes to the children
• 25:42and it's it's an amazing book and.
• 25:47One that I bought 5 copies
• 25:49of it right off the bat,
• 25:51and I should buy five more I think.
• 25:53But the other book on the left
• 25:55is by Jacob Soboroff,
• 25:57and he was one of the first people to
• 26:00also go to these detention facilities
• 26:04and there were claims of torture.
• 26:06There were the things he saw
• 26:08were horrendous as well.
• 26:12What happened though is
• 26:14that when she visited.
• 26:17The facility in Clint, she was horrified.
• 26:23The mistreatment of children,
• 26:25the lack of care was so blatant
• 26:28that eventually she made it known,
• 26:31as did Soborov, and that resulted
• 26:33in the resignation of John Sanders,
• 26:36who was the agency director.
• 26:39Here are some of the quotations
• 26:42from the children. Hear my voice.
• 26:45That's a project Amplify.
• 26:47They took my sister away from me.
• 26:50The immigration agent separated
• 26:52me from my father right away.
• 26:56They took us away from our grandmother,
• 26:58and now we're all alone.
• 27:01We're kept in cages.
• 27:03It is very crowded.
• 27:05There is no room to move
• 27:08without stepping over others.
• 27:10When we try to complain about the condition,
• 27:13they start yelling at us.
• 27:15Saying things like you don't belong here,
• 27:18go back to where you came from.
• 27:20You came here to ruin my country.
• 27:24I'm so hungry that I have woken up in
• 27:26the middle of the night with hunger.
• 27:29Sometimes at 4:00 AM, everyone can
• 27:31see me when I'm using the toilets.
• 27:35At times I feel so embarrassed
• 27:37because there are boys watching me.
• 27:40I have been using the same clothes for days.
• 27:43I have been here without bathing for 21 days.
• 27:47It is cold at night, noisy,
• 27:50and the lights are on all the time.
• 27:55Mark J.
• 27:56Mills,
• 27:57by the way,
• 27:58assessed materials from 420 pages
• 28:03of children's medical records and he
• 28:07said it was like the old Soviet Union.
• 28:10They give them drugs that are so strong that,
• 28:14you know,
• 28:14they have used only for people
• 28:16who are about to plug their eyes,
• 28:18eyes out of their sockets.
• 28:20So, you know,
• 28:22and this is essentially criminal
• 28:25action to to subject children.
• 28:28And in many cases these children were
• 28:31told if you don't take these drugs
• 28:33or these injections of these pills,
• 28:36you won't see your parents.
• 28:39Here are by the way,
• 28:40some of the victims children
• 28:42who died in custody for neglect.
• 28:44This is 1 blatant case where Carlos
• 28:49Gregorio Hernandez Vasquez was in detention.
• 28:52He was sick,
• 28:53he needed medical care,
• 28:55didn't even look at him at 1:24 AM.
• 29:00He fell down and died sometime
• 29:04between 1:24 and 5:48.
• 29:07The press got hold of it,
• 29:09got photographs and showed that
• 29:13essentially no one really looked at him.
• 29:16He was left there to die without
• 29:18anyone checking in on him and I
• 29:21think even though he was sick.
• 29:25Julian Linton, by the way,
• 29:27that's Julie Linton from Pediatric
• 29:31says at times children and families
• 29:33are kept longer than 72 hours.
• 29:36Denied access to medical care and medication,
• 29:39complete histories and physical examinations,
• 29:43including vital signs, are not conducted.
• 29:48And that, by the way, is this very,
• 29:50very important issue of Pediatrics that is,
• 29:55to me, one that I would have
• 29:57all of my students read.
• 29:59And I'm retired now,
• 30:00so that's going to be a bit more difficult,
• 30:02but I think it's an important
• 30:05and important article,
• 30:08another article by Catherine Beck in
• 30:11Joharvas, Latinx Law Review says.
• 30:14And again, it's a very thorough,
• 30:17very focused article on July and
• 30:21how it is being implemented for
• 30:24July 15 years DHS has routinely.
• 30:27Failed to comply with pretty
• 30:29much everything, as you can see.
• 30:33So that happens at the border,
• 30:36amongst other things.
• 30:38How about in the medical sector,
• 30:40more specifically in hospital?
• 30:44Obviously again here there is a
• 30:47mandate to do so or lose federal funds.
• 30:53To me one of the important cases was.
• 30:56The resolution agreement that went
• 30:59on between the hospitals and the
• 31:02government in terms of civil rights,
• 31:06at the time when I first read
• 31:09this article, there were about
• 31:14100,000 medical facilities that came
• 31:17under the purview of the federal
• 31:20government and there were only 300 people.
• 31:25Supposing to inspect them now it's more
• 31:28like 1-9 hundred and some and 350,000 and
• 31:34obviously these people are not going to
• 31:37inspect every facility, it's impossible.
• 31:40So how do these hospitals eventually
• 31:46how are they checked and how are they
• 31:48made to do what they're supposed to do?
• 31:54Or lose federal funding?
• 31:56Well, generally it's only a
• 32:00complaint driven situation.
• 32:02Somebody has to complain.
• 32:04The patients are not going to complain.
• 32:06They are scared monolingual with
• 32:10three years of elementary education.
• 32:14They don't know what's happening.
• 32:15They don't know what records they have.
• 32:17They're not going to complain.
• 32:19So who is going to complain?
• 32:21The physicians.
• 32:22As in this case here,
• 32:25should and often do complain,
• 32:28In my opinion, not nearly often enough.
• 32:33You know, everybody's busy,
• 32:36everybody's under immense pressure,
• 32:39yet things have to happen.
• 32:44Now, this
• 32:47article, the same article
• 32:50that I mentioned before.
• 32:52Says that Joe Espinosa,
• 32:54Derrington article that only 13%
• 32:57of hospitals are compliant with
• 32:59all four national standards for
• 33:02culturally and linguistically
• 33:04appropriate services in healthcare.
• 33:07Actually, it's more than that.
• 33:09There are 15 standards that are
• 33:13summarized injured 3 1/2 lines below,
• 33:17but hospitals are mandated.
• 33:20To provide effective, equitable,
• 33:23understandable and respectful care.
• 33:27And that is crucial and
• 33:31that includes cultural
• 33:36considerations as well.
• 33:40Now this one person wrote this article she.
• 33:48Together with Angela Alde,
• 33:49who is an internist at Duality
• 33:52Healthcare, It's from Oregon,
• 33:54but to me it was representative of a
• 33:57variety of cases in numerous places.
• 34:01Oregon has about 3500,
• 34:05three 1500 medical interpreters.
• 34:09I'm using quotation mark
• 34:12of these only about 100.
• 34:17Are certified.
• 34:20That means tested and
• 34:23approved medical interpreters.
• 34:26So you have a 3% chance of getting a
• 34:31qualified or certified interpreter.
• 34:33Actually less because qualified
• 34:34is a little category.
• 34:36They managed to sneak in saying, well,
• 34:39if you have passed the written part
• 34:41of the exam but not the oral part,
• 34:44you are qualified and you can interpret.
• 34:46Until you pass the auto part,
• 34:50if you do it within a certain amount of time,
• 34:52like six months, sorry,
• 34:54I would hate to have a qualified
• 34:58surgeon instead of a certified one,
• 35:01you know so
• 35:05So it's less than a 3% chance of
• 35:08getting a qualified interpreter.
• 35:12She also adds a point that's very important.
• 35:15It makes a lot of time to
• 35:18become a certified interpreter.
• 35:21It costs a lot of money.
• 35:22There aren't that many schools and now
• 35:25fewer that provides adequate training.
• 35:29And then, ladies and gentlemen,
• 35:32medical interpreters are paid much less than
• 35:36court interpreters or other interpreters.
• 35:39So if I have paid a lot of money,
• 35:43worked very hard.
• 35:45Gotten certification.
• 35:47Why should I go to a place that pays
• 35:50me much less and frankly gives me
• 35:54less respect and consideration when
• 35:57there are other jobs available,
• 35:59for instance in the court?
• 36:01And the other thing is that
• 36:03medical interpreters as well as
• 36:05forensic interpreters deal like.
• 36:08Medical doctors with life and
• 36:11death situations constantly.
• 36:13So you need people that are mature,
• 36:15that have a certain level of understanding
• 36:18of human beings and the human condition.
• 36:22And you know what that means that all of
• 36:26the people I trained were graduate students.
• 36:30It is a graduate type of training,
• 36:34clearly so.
• 36:35That's why we have a great
• 36:37shortage of medical interpreters,
• 36:40of qualified, no, sorry,
• 36:44certified medical interpreters.
• 36:47They're not paid enough,
• 36:48It takes too long and there isn't enough
• 36:53to attract them in the medical sector.
• 36:56And that's tragic.
• 36:57It really is a tragedy.
• 37:03And look what happens.
• 37:05I'll give you a couple of examples
• 37:07of what happens when you don't have
• 37:10a adequately trained interpreter
• 37:11and when you have children.
• 37:13Interpreting, Think of the absurdity
• 37:16of the monstrosity of having a child,
• 37:19having to tell his parents that there is a
• 37:23cancer diagnosis that has just been stated,
• 37:27or things involving.
• 37:30Family balance, questions,
• 37:33things involving confidentiality, intimacy.
• 37:38It's just unsustainable to have
• 37:42children used as interpreter.
• 37:44It's an ethical well,
• 37:48in this case, 18 year old Willie Ramirez
• 37:52was taken to a South Florida hospital.
• 37:55His family said he was intoxicado.
• 37:58Intoxicado in Spanish, means poisoned.
• 38:02It doesn't mean intoxicated.
• 38:04Intoxicated is a false cognate.
• 38:07The children who didn't know any better,
• 38:09said intoxicated.
• 38:10The medical staff thought that
• 38:13the kid had taken some drugs and
• 38:17prescribed treatment, sent him home.
• 38:20The kid came back two days later and
• 38:25he was he had a brain hemorrhage.
• 38:28He ended up quadriplegic and that
• 38:32essentially on a mistranslation
• 38:34of a false cognate That led to a
• 38:39misdiagnosis that led to mistreatment.
• 38:44Now I have quoted about 5-6 articles here,
• 38:49but I have done something which
• 38:51I think is important.
• 38:52This is a great article,
• 38:55one of the best I have read.
• 38:57But it was 28 years ago.
• 39:01It was 28 years ago,
• 39:03and it said things that needed
• 39:04to be said and noticed.
• 39:06It's by a group of physicians.
• 39:11Ad hoc interpreters are bad consequences
• 39:16of language barrier information from
• 39:19patient to physician impaired misdiagnosis.
• 39:25Greater dependence on diagnostic tests,
• 39:28less access to important
• 39:31cross cultural information.
• 39:33We'll come back to culture and I'll
• 39:36talk about amphetamine in a little bit.
• 39:38Information from physician to
• 39:40patient in the other direction,
• 39:42impaired instructions misunderstood,
• 39:45poor compliance with medication
• 39:48and appointment.
• 39:49Those are the practical one.
• 39:51But there are some very serious ethical,
• 39:53ethical problems as well.
• 39:55Informed consent might not be truly informed.
• 39:59Patient autonomy is violated.
• 40:02Medical histories are both
• 40:04inaccurate and incomplete.
• 40:06There are conflicts of interest.
• 40:09And think of all the psychological
• 40:12ramifications of that okay 28 years ago,
• 40:1626 years later.
• 40:17That is an article.
• 40:19Years earlier.
• 40:20That's a Spinosa again and
• 40:24Derrington article.
• 40:25Look again at what the article says.
• 40:29It sounds like an echo of the
• 40:31other one in every single item.
• 40:38Decreased comprehension of medication.
• 40:40Instructions less comfortable
• 40:42with post discharge.
• 40:44Poor communications.
• 40:48Complicate the diagnosis that
• 40:51pretty much the same thing.
• 40:54Nothing seems to have changed in 26 years.
• 40:59And this is a very good article and I put
• 41:02the footnotes in the red so that you can see,
• 41:05as I have said before,
• 41:06that every claim is
• 41:08substantiated and extensively. So
• 41:12who are the primary victims of
• 41:15that woman and children? Why?
• 41:17Mainly because the man generally go to work,
• 41:20they speak a little bit more English.
• 41:23The woman stay at home and
• 41:25it's some neighborhoods,
• 41:26they don't have to use English.
• 41:28Everybody speaks Spanish,
• 41:29like in San Fernando,
• 41:30for instance, you know,
• 41:32you go in the streets there,
• 41:34you hear Spanish, you don't hear English.
• 41:37So the woman out there,
• 41:38the woman who take care of children,
• 41:42who, if a child is ill,
• 41:44who's going to take the child?
• 41:45Generally not the.
• 41:46Father, because he's at work,
• 41:48even though he speaks
• 41:49English a little bit more.
• 41:50It's a woman who doesn't
• 41:52speak English very well,
• 41:53or at all,
• 41:54for that matter.
• 41:58And the women themselves,
• 41:59of course, are are victims.
• 42:03This was a famous North Carolina
• 42:06case where women were not given
• 42:09epidurals when they should have been.
• 42:12And they were allowed to
• 42:15suffer for 2-3 days or more.
• 42:18And the reason was that they had
• 42:21not signed consent forms and they
• 42:24haven't signed consent forms because
• 42:26the consent forms were not available
• 42:29in Spanish or any other line.
• 42:32They're only available in English.
• 42:34Eventually there was a challenge to this.
• 42:39And the hospital stood to lose,
• 42:41I think something like $4,000,000
• 42:45in federal funding.
• 42:46Apparently they very promptly had a
• 42:51very good interpretation department.
• 42:56Okay, another one, this article,
• 42:58which is again a very good
• 43:01article 23 years ago,
• 43:04including again using a child
• 43:07interpreter 14 years later.
• 43:11Look at that 10 year old gynecology.
• 43:17A woman doesn't want her little boy to,
• 43:19you know,
• 43:20be Privy to her gynecological problems.
• 43:29So this shows that children
• 43:33are screened less and when.
• 43:38There are no interpreters.
• 43:40Children will be used and that
• 43:44results in child greater children
• 43:47death and serious complication.
• 43:50Here is a child that died from
• 43:54a reaction to the drug Reglan.
• 43:57The children served as interpreters
• 43:59so there is no awareness here that
• 44:02the child was allergic to Reglan.
• 44:08Now very briefly,
• 44:09translation on phones that we
• 44:11don't have enough interpreters.
• 44:13What about phone translation?
• 44:15And especially if you have a video component,
• 44:19that's, yes, it's a possibility,
• 44:23it's not a good one.
• 44:25And there has been extensive
• 44:27literature on the subject.
• 44:28What happens that often some of
• 44:30the patients are older patients,
• 44:33they don't hear very well.
• 44:35So the phone thing.
• 44:37I know that I hear less well
• 44:40than when I was younger.
• 44:41There is a decrease ability to listen
• 44:45to what's going on and then it's
• 44:48confusing to two older people who are
• 44:52a large segment of the population.
• 44:56So there is a whole variety of
• 44:59psychological problems involved,
• 45:00but then there is also the
• 45:02technical problems that come up.
• 45:04We have had the proof today here, right?
• 45:08So I mean the positioning of the camera,
• 45:12the angle, the light.
• 45:14So yes, maybe in an extremely urgent case,
• 45:20possibly, but not as a general rule.
• 45:23And by the way,
• 45:25there is interestingly enough,
• 45:27right now a case in New Jersey where the.
• 45:33The defendant, Oscar Huracan Huracan,
• 45:36doesn't speak Spanish.
• 45:38He speaks Jack Chickel.
• 45:41There's only one interpreter in Cat Chickel,
• 45:46and that interpreter is in California.
• 45:49So the Administrative Office of the
• 45:52Courts in New Jersey and the judge said fine,
• 45:55we'll do it online.
• 45:57That's fine, no problem.
• 46:00So.
• 46:03The defendant said no,
• 46:05I I'm sorry, I'm scared.
• 46:07I don't know online it confuses me,
• 46:09his lawyer said. You know,
• 46:12Joel actually doesn't say anything about
• 46:16if there isn't an in person interpreter,
• 46:19you can do it online.
• 46:21You have to do it online by law,
• 46:24so you better bring that interpreter
• 46:26in so that one to do appellate court.
• 46:29And it's being adjudicated now, I think.
• 46:31And I don't know what's going to happen,
• 46:34but the ramifications
• 46:36are extremely important.
• 46:39If it goes further on on appeal,
• 46:42chances are that there will be a
• 46:44ruling that says you have to always
• 46:47use only in person interpreters.
• 46:49That would be momentous,
• 46:55so.
• 46:59Errors made by ad hoc
• 47:01interpreters are significant,
• 47:03significantly more likely to have
• 47:08potential clinical consequences.
• 47:10So what do we do about that?
• 47:12Well, for one thing, speaking 2 languages
• 47:15does not make you an interpreter,
• 47:18like having two cut two hands
• 47:20does make you a concert pianist,
• 47:22and the training is rigorous.
• 47:25I'm going to give you a very short
• 47:28segment on interpreter training.
• 47:31Interpreters have to learn about
• 47:3414 glossaries that consist
• 47:37of about 300 words each.
• 47:40If you look at the
• 47:43glossary illustration here,
• 47:47you will see that all of these,
• 47:50you could call them petals, refer to areas.
• 47:55Of specialized terminology for which
• 47:59there are specialized dictionaries.
• 48:01However, there is an area where
• 48:04all of these areas overlap,
• 48:06and that is the area in yellow.
• 48:09That is the basic specialized
• 48:13terminology that every interpreter
• 48:15should know in order to function.
• 48:18Legal terms, basic medical terms,
• 48:20etcetera, etcetera.
• 48:21And then there is a little red dot.
• 48:24That's more for the conference interpreter.
• 48:28It means situations where you
• 48:30have to have such a specialized
• 48:33terminology that you have to study
• 48:35it before you do the conference.
• 48:38I have done conference
• 48:40interpretation for many, many years.
• 48:42I never had a conference on,
• 48:45let's say Paramesia of the Lord Eudinum,
• 48:48which would be fairly specialized,
• 48:51but they have had similar things.
• 48:53I learned the terminology
• 48:54and I promptly forgot it.
• 48:57Thank God.
• 48:57But this is the area where
• 49:00this is very special,
• 49:02so the interpreter should really be
• 49:05very good at the yellow part of this.
• 49:09So imagine this as a flower and the
• 49:15interpreter must pluck this flower.
• 49:19But be aware.
• 49:24This flower is, well,
• 49:25to do sweat, blood and tears,
• 49:27and that's what makes for competence.
• 49:33So what are the problems for the interpreter,
• 49:35besides having the talent to interpret,
• 49:38having learned a lot of terminology,
• 49:42I published a while back a book in the
• 49:45American Translators Association Chronicle.
• 49:48But I have shown that there are 19
• 49:53major dialects of Spanish, that is,
• 49:57from Argentina to Venezuela,
• 49:5919 countries speak Spanish.
• 50:01There is no such thing in
• 50:03linguistics as the Spanish language.
• 50:10There are dialects of Spanish and
• 50:12the sum total of this dialect
• 50:14make the Spanish language and.
• 50:18In these countries,
• 50:20often the same words mean different things
• 50:25or different words mean the same thing.
• 50:28I gave you as an example,
• 50:29for instance popcorn.
• 50:30I think a popcorn is a good example of
• 50:34how it changes from country to country.
• 50:36I also gave you an well, you know,
• 50:39not only do we have dialectal variation,
• 50:43but then there's a question of register.
• 50:45Then should you are aware of that?
• 50:47When medical terms are used,
• 50:49the patients will not necessarily
• 50:52understand them, especially if it's,
• 50:54you know, a person with a three
• 50:58years elementary school education.
• 51:00So what happens here?
• 51:01For instance, the legal arena?
• 51:03The interpreter cannot go from
• 51:05one register to the other.
• 51:07The interpreter has to stay at the
• 51:10same register. The faceful echo.
• 51:12The patient doesn't understand it,
• 51:14or the defendant or the witness.
• 51:17Too bad.
• 51:19In the medical area you have more wiggle
• 51:22room and you can say he doesn't understand.
• 51:26You use,
• 51:27you know,
• 51:28an easier word so you know for instance the
• 51:33difference between axilla and dumped it.
• 51:36How many people would know axilla?
• 51:38In Spanish the same thing.
• 51:39It would be sobacco,
• 51:41probably the term that the
• 51:45patient would know.
• 51:47I published a book a while back,
• 51:50I mean an article that showed just
• 51:53for a word such as penis or phallus,
• 51:57the number of equivalents in all of
• 52:00the different countries and you.
• 52:02As you can see, the interpreter
• 52:04has to be aware both of dialectal
• 52:07variations and of register
• 52:11the other area, which is important
• 52:14especially in psychiatric evaluations.
• 52:16Is knowing for instance proverbs?
• 52:19Because often a proverb will be used to
• 52:23see if the patient understands this as
• 52:27an abstraction or takes it literally.
• 52:30You know, think of somebody saying oh
• 52:32you are a real John of Arc and the
• 52:35person goes and burns herself taking the
• 52:38statement that is metaphorical literally
• 52:43PRJ system to deal with.
• 52:46Intellectual age is important.
• 52:49Interpreters often will be in
• 52:52psychiatric hearings sent by the court
• 52:55to evaluate the age of the defendant
• 52:59and the level of responsibility there.
• 53:03So in knowledge of proverbs is
• 53:05going to be absolutely vital.
• 53:07So we're going to do a little exercise,
• 53:10see how good you are.
• 53:12I chose the Proverbs in Japanese.
• 53:15Because it's less likely
• 53:16that you will know them than,
• 53:18let's say Spanish or French,
• 53:20I will not read them in Japanese,
• 53:23mainly because I might be kicked out
• 53:25of here by some Japanese speakers
• 53:27for mispronouncing the language.
• 53:29So here it is.
• 53:31Here is the first one
• 53:35not speaking is the flower.
• 53:37What would be the equivalent in English?
• 53:41Here I'll give you that one.
• 53:45OK, here goes another one.
• 53:48Poke A Bush's snake comes out.
• 53:57Bravo, you get a buen Punto.
• 54:00OK, here goes another one.
• 54:02By the way, a coban is an
• 54:06old coin in medieval Japan.
• 54:09A coin to a cat.
• 54:12I give you equivalents in that
• 54:14in both English and Spanish.
• 54:16OK, I'll give it to Spanish
• 54:17in Spanish first,
• 54:18no es la miel para la Boca de lasno. Or
• 54:29here goes another 1A beat to a crying
• 54:34face when it trains, it calls condo,
• 54:38you have a weve a Canada.
• 54:39And here comes my favorite ones,
• 54:41the last one of the series.
• 54:45Break wind. close buttocks.
• 54:47What do you think the equivalent
• 54:51of that is? Here goes.
• 54:58But you see, all of this is part
• 55:00of the training of an interpreter.
• 55:03That flower is a tough flower to pluck.
• 55:06OK, so now we're coming to the
• 55:09heart of ethics, which is,
• 55:11how do you train these interpreters
• 55:13and what do you want from them?
• 55:15And how good these trainings
• 55:18protocols are. There are two
• 55:25codes that are particularly important.
• 55:28One is a legal 11 is a medical one and
• 55:32there are only two that are national
• 55:35in association that are national,
• 55:38the one in California for legal.
• 55:42Interpreters is by far the most complete
• 55:46and there have been subsequent additions.
• 55:50I put 2008, but and by the way,
• 55:52it's available online.
• 55:54You can just download it.
• 55:58It doesn't cost you anything.
• 56:01I'm just showing a couple
• 56:03of the segments of the code.
• 56:05Of course, no additions.
• 56:08Everybody can understand that.
• 56:10The Florida court, by the way,
• 56:11follows it closely.
• 56:14Another one is no missions you you.
• 56:16So in other words,
• 56:17you have to say what you hear.
• 56:22Register has to be maintained.
• 56:25For instance, if the person says heroin,
• 56:27you say Rowena.
• 56:28If the person says smack, you say Chiva.
• 56:31And so on and so forth.
• 56:33Police, policia, cops, Lahura.
• 56:37Los chartis, etcetera.
• 56:39So you have to maintain that.
• 56:41I remember in one case in East LA,
• 56:46the witness spoke only in Calo slang,
• 56:50nothing else,
• 56:51and the judge of course spoke only judicial.
• 56:54But in East LA,
• 56:56many of the judges are put on the
• 56:58bench with the knowledge of Spanish
• 57:01because of the prevalence of Spanish.
• 57:03And I remember the judge asked this man.
• 57:07Do you have any priors?
• 57:08So I asked do you have any prior?
• 57:11And he said,
• 57:12what did you say dude in in Spanish.
• 57:15So I looked at the judges,
• 57:16I said what did you say dude?
• 57:18So then the judge said, okay doctor Ryan,
• 57:20if you tell him that in his own words.
• 57:23So I said how many times were
• 57:25you busted for this beef, man?
• 57:27He understood both those the essays.
• 57:31So but it's very important because.
• 57:34Sometimes communication
• 57:35breaks down In medical terms.
• 57:38It is even more important now.
• 57:44Ambiguity is.
• 57:44The last thing I want to hear was I have
• 57:48taken some of it for Steven Pinker's
• 57:50wonderful book The Language Instinct,
• 57:53which is a very clever,
• 57:55very nice book.
• 57:58Iraqi had six arms.
• 58:02How are you going to translate that?
• 58:04Or Queen Mary has her bottom scrape or
• 58:10drunk gets nine months in violent case.
• 58:16I'll give you a couple in Spanish too.
• 58:18How many people here, If any, speak Spanish?
• 58:22Well then I will skip that. Okay.
• 58:26The equivalent in the medical sector is the.
• 58:33Publications by the National Council
• 58:36on Interpretation in Healthcare.
• 58:39That's a national interpreters association
• 58:42that has come out with two very good books.
• 58:47One has basic principles and
• 58:50the other one has standards.
• 58:53The books were published one year apart,
• 58:56but the standards 34 of them, 32 of them.
• 59:00We're connected with the 9 basic principles.
• 59:04I'll give you an example of it.
• 59:07Here is the I have put them together
• 59:09so you can see how it works.
• 59:11And again, this is very similar
• 59:14to the legal code.
• 59:16As you can see these are the principles
• 59:19and these are the standards.
• 59:26As you can see, it's pretty much
• 59:28of A repetition of the legal one.
• 59:33OK, am I free to move to the next line?
• 59:36OK, but here for instance
• 59:38is 1 big difference.
• 59:40Notice that they are now going
• 59:43to talk about advocacy and you
• 59:45cannot advocate in the legal arena,
• 59:49but here you you may, and you are
• 59:51even at times encouraged to do so.
• 59:55So it overlaps a great deal, but.
• 01:00:00There are three areas in which there
• 01:00:03is a radical difference, and the most
• 01:00:06important one is cultural expertise.
• 01:00:09Now why are the two so different?
• 01:00:11Well, think of what legal
• 01:00:15cases are They're adversarial.
• 01:00:17They're adversarial.
• 01:00:18They you try to prove the other person wrong.
• 01:00:22The other person is the enemy.
• 01:00:24It's not really always just seeking justice.
• 01:00:28It's an adversarial system
• 01:00:30by its very nature.
• 01:00:32What is the medical situation
• 01:00:35as opposed to that? Well,
• 01:00:38the triathic encountered the medical one.
• 01:00:42Physician, patient,
• 01:00:43language mediator is a cooperative one.
• 01:00:47It's not an adversarial 1.
• 01:00:50You are there for the good of the patient.
• 01:00:54So the difference changes
• 01:00:57everything in how many of you
• 01:00:59have heard of the Rosa Lopez case?
• 01:01:02That was a famous case in California.
• 01:01:06OJ Simpson was involved in that.
• 01:01:09You know, the OJ Simpson doesn't think about.
• 01:01:12Well, well, whatever it was,
• 01:01:14at one point they were going to
• 01:01:16ask me to be a. Cultural expert.
• 01:01:21And I refused. I said no.
• 01:01:24I don't even consider me.
• 01:01:25Why?
• 01:01:25Because had I been put up there
• 01:01:28as a cultural expert about a
• 01:01:31woman witness from El Salvador,
• 01:01:35I know full well that the cross examining
• 01:01:40would have been Doctor I enough.
• 01:01:43Are you a sociologist? No.
• 01:01:45Are you a Latin American specialist? No.
• 01:01:50Are you a specialist in women's studies?
• 01:01:53No. Have you ever been in El Salvador?
• 01:01:57No.
• 01:01:59How are you an expert to talk
• 01:02:01about cultural problems with a
• 01:02:03woman from El Salvador? Doctor.
• 01:02:06I'm thank you.
• 01:02:07No,
• 01:02:08thank you.
• 01:02:09It says this book that my wife and I were
• 01:02:12looking at that Atticus that is titled Wow.
• 01:02:16No,
• 01:02:16thank you.
• 01:02:21So
• 01:02:24see, that's what I just stated.
• 01:02:26The two systems are radically different
• 01:02:30and the three major interpreters
• 01:02:33association in the medical sector,
• 01:02:37the national one,
• 01:02:38the one in Massachusetts and
• 01:02:41the one in California all agree
• 01:02:45that the interpreter should be.
• 01:02:47A cultural expert actually,
• 01:02:49they stated, falls upon the healthcare
• 01:02:52interpreter to be cognizant of and
• 01:02:55able to alert both the patient
• 01:02:57and the provider of the impact of
• 01:03:01culture in the healthcare encounter.
• 01:03:03Now this is a wonderful book.
• 01:03:05I love this book.
• 01:03:08I I'm sure many of you have read
• 01:03:11it when my daughter Mila entered
• 01:03:14the medical school here at Yale.
• 01:03:17This was a required reading for
• 01:03:19all entering freshman, as it was,
• 01:03:21by the way, at Harvard School of Medicine.
• 01:03:25The book has garnered, as you can see,
• 01:03:27a lot of accolades,
• 01:03:31and it's really a wonderful book.
• 01:03:33But one of the points the book
• 01:03:36makes on and on and on relentlessly
• 01:03:39is that the interpreter is.
• 01:03:42Obligated to participate as a cultural
• 01:03:45expert in the triadic encounter
• 01:03:53NCIHC. When the patient's health,
• 01:03:56well-being, or dignity is at risk,
• 01:03:58the interpreter may be justified
• 01:04:01in acting as an advocate.
• 01:04:04Chia, that's California.
• 01:04:06It may appear a contradiction.
• 01:04:10With the ethical principle of
• 01:04:12impartiality on a deep level,
• 01:04:14advocacy goes to the car heart
• 01:04:16of ethical behavior for all
• 01:04:19those involved in healthcare.
• 01:04:21And I believe that finally gifts Shank for
• 01:04:26bottom absolutely not allowed in court.
• 01:04:29However, it is allowed in the
• 01:04:33medical suck sector if if you
• 01:04:36were to refuse in a little gift.
• 01:04:38The person that offers it might take offense.
• 01:04:41On the other hand,
• 01:04:43if the gift is used for manipulative
• 01:04:47purposes and all these too expensive gift,
• 01:04:52no, the interpreter is not
• 01:04:53supposed to touch that.
• 01:04:57So we have seen that there is a lot of codes.
• 01:05:01How good are these codes?
• 01:05:02There is this wonderful book by Moira,
• 01:05:05Moira Indileri.
• 01:05:07That is specifically with the flows
• 01:05:11and limitations of codes,
• 01:05:14saying that there is a higher level
• 01:05:16ethical level than the level of the code.
• 01:05:19And why? Because codes are deontological.
• 01:05:24There are three main systems of ethics,
• 01:05:27one based on Aristotle,
• 01:05:29one in utilitarian one,
• 01:05:31and one that is based on Kant's philosophy.
• 01:05:35And can't establishes A deontological
• 01:05:40or duty centered code of ethics.
• 01:05:44That's what most codes are.
• 01:05:46They're deontological codes.
• 01:05:47This is a book, by the way,
• 01:05:50I always show you to cover to
• 01:05:52try to entice you to pursue.
• 01:05:57By the way, she also writes very well,
• 01:05:59she says for interpreters
• 01:06:01and their interlocutors.
• 01:06:02Those for whom and with whom they speak,
• 01:06:05codes of ethics and codes of
• 01:06:07practice serve as non binding.
• 01:06:09This is the key point.
• 01:06:11Non binding contractual agreement
• 01:06:13that aim to ensure the truth and
• 01:06:17accuracy of all interpreted utterances.
• 01:06:20Non binding duties central in ethics
• 01:06:26and binds humans to the categorical
• 01:06:29imperative to respect others.
• 01:06:32It comes from the Greek Dion,
• 01:06:34which is duty.
• 01:06:37So she explores the sources of
• 01:06:41these ethical system that assumes a
• 01:06:45link between duty and neutrality,
• 01:06:48which results in a mandate to just translate.
• 01:06:51You are the faithful echo,
• 01:06:55But what about abuses of power,
• 01:06:59Cases of personal conscience?
• 01:07:03That go against what the code says.
• 01:07:08The duty to remain impartial,
• 01:07:11the faithful echo of an interpreter,
• 01:07:14is so often understood as a duty to remain
• 01:07:19silent even in the face of injustice.
• 01:07:24So that alligatory in Gary.
• 01:07:29State something which to me
• 01:07:31is the crux of the situation.
• 01:07:35Interpreters might find themselves in
• 01:07:38circumstances where it is professionally
• 01:07:40acceptable to act partially,
• 01:07:45but then
• 01:07:50you are behaving ethically.
• 01:07:52Or it is professionally acceptable
• 01:07:55to act impartially but you behave.
• 01:07:58Unethically, that means you
• 01:08:00are not following the code.
• 01:08:02So to interpret, finds himself,
• 01:08:05and I'm quoting on a challenging
• 01:08:09and perplexing gradient going from
• 01:08:13reprehensibly frozen to culpably flexible.
• 01:08:21So, and that's the key point she makes,
• 01:08:26breaking with duty.
• 01:08:29There are attempts to balance 1
• 01:08:32ethical obligation against another.
• 01:08:36I'm going to quote Martin Luther King now.
• 01:08:39Many abuses of power clock their
• 01:08:42brutality and ill intent in legal
• 01:08:44and linguistic manipulation.
• 01:08:49Martin Luther King in many of his speeches
• 01:08:53has given a clear description of this tactic.
• 01:08:56Calling them, and I love this use of words,
• 01:08:59niceties of complexities.
• 01:09:02It just catches exactly what's happening.
• 01:09:07Right, right on it.
• 01:09:09We have seen these abuses of power in
• 01:09:13detention at the border and elsewhere,
• 01:09:16in the courts and in clinical environment.
• 01:09:21There was one case where
• 01:09:23there was a raid in Postville.
• 01:09:25Of a meat packing facility,
• 01:09:29300 people were arrested.
• 01:09:31They were processed by
• 01:09:33federal court in groups of 10.
• 01:09:35They were manipulated.
• 01:09:37The decisions were predetermined.
• 01:09:40The lawyers were not specialists in
• 01:09:43immigration, 26 interpreters came,
• 01:09:45and some of them like Kameid Frakes,
• 01:09:49who is the head of translation and
• 01:09:52interpretation at Miami International.
• 01:09:54Eventually said no, that's not acceptable.
• 01:09:57This is actually abuse of power
• 01:09:59and miscarriage of justice.
• 01:10:01Okay.
• 01:10:02Guess what?
• 01:10:03That is
• 01:10:06that nice little piece of wood
• 01:10:10premium non nurturing or non knockery.
• 01:10:14If you want a new Latin pronunciation,
• 01:10:19The Hippocraticals. Now here is the.
• 01:10:22Mother of all codes, right?
• 01:10:25Notice that one swears to hold one's
• 01:10:30teacher equal to one's parents and to
• 01:10:34make him a partner in one's livelihood,
• 01:10:37to teach in turn his sons.
• 01:10:40Without indenture or fee,
• 01:10:45That's the first tenant.
• 01:10:46Then the second one is never treat
• 01:10:49anyone who's a view to injury.
• 01:10:51And wrongdoing.
• 01:10:52Then we go down to six and it says
• 01:10:56not use the knife and sufferer
• 01:10:59from stone and give place to
• 01:11:01search as our Craftsman, the rain.
• 01:11:06All right, that's the code.
• 01:11:09However, it comes with an agenda.
• 01:11:12It is significant that the first issue
• 01:11:14it brings up is that one should hold
• 01:11:18one's teacher equal to one's parent.
• 01:11:21And that one should teach in
• 01:11:23turn his sons the teachers,
• 01:11:25without the indenture or fees to do the harm,
• 01:11:30comes only in second place,
• 01:11:32in the order of the precepts of the code.
• 01:11:36Also number six, once again,
• 01:11:39stepping on the toes of
• 01:11:41another professional group,
• 01:11:43those who use the knife to remove
• 01:11:46kidney stones, do other peers,
• 01:11:48first of all, to be concerned.
• 01:11:50With the interests of the
• 01:11:52profession of the establishment.
• 01:11:54In this respect it is all business.
• 01:11:57The remaining 5 precepts cover
• 01:12:01personal behavior, confidentiality,
• 01:12:03and what has been interpreted as a
• 01:12:08prohibition to assist in suicide.
• 01:12:11So interpreters work with physicians and
• 01:12:14that term is they were the first people that.
• 01:12:18Drafted the code so the codes have an agenda.
• 01:12:22Those codes also,
• 01:12:23by the way, change.
• 01:12:25For instance,
• 01:12:26let's take the American
• 01:12:28Nursing Association code,
• 01:12:32here is Florence Nightingale
• 01:12:33and the basis of it.
• 01:12:36And here is all the dates in
• 01:12:40red when the code was modified.
• 01:12:44Okay. It's important to see how many
• 01:12:46times this has happened, especially
• 01:12:48the bottom 2 lines of the slide.
• 01:12:53So the myth that interpreters are not
• 01:12:58participants in the interpretation situation,
• 01:13:00that they just interpret, is untenable.
• 01:13:04They are facilities.
• 01:13:07There is only one code in the
• 01:13:09United States that recognizes that.
• 01:13:12And that's the code of ethics of the
• 01:13:15Massachusetts trial codes in 4.02.
• 01:13:19It states code interpreter shall
• 01:13:22use their professional judgment
• 01:13:24in applying the code.
• 01:13:26That's amazing.
• 01:13:27And it's amazing that
• 01:13:29only one code states that.
• 01:13:34So in conclusion, the code that the
• 01:13:38ontological OK, they are duty based.
• 01:13:42The codes have a supervisory bias.
• 01:13:44We have seen that starting with
• 01:13:48the hippocratical, the codes on
• 01:13:50top of that are living documents.
• 01:13:53They are not carved in stone.
• 01:13:55You have seen that they are
• 01:13:57all modified and changed.
• 01:13:58So it's not, you know, chiseled.
• 01:14:03They failed to recognize for
• 01:14:06interpreter participation.
• 01:14:08So the ontological with the supervisory bias.
• 01:14:11Living documents don't recognize
• 01:14:15interpreter participation.
• 01:14:16So to court Martin Luther King,
• 01:14:19one may well ask how can you advocate
• 01:14:22breaking advocate breaking breaking
• 01:14:24some laws and obeying others?
• 01:14:27The answer lies in the fact that there
• 01:14:29are two types of laws, just and unjust.
• 01:14:32I would be the first to advocate
• 01:14:35obeying obeying just laws.
• 01:14:37One has not only a legal,
• 01:14:39but the moral obligation.
• 01:14:42To obey just laws.
• 01:14:45Conversely,
• 01:14:46one has a moral responsibility
• 01:14:49to disobey and just law.
• 01:14:51I would agree with Saint Augustine
• 01:14:54that an unjust law is no law at all
• 01:14:58and just law is a man made code
• 01:15:00that squares with the moral law.
• 01:15:02The law of God and unjust law is a code
• 01:15:05that is out of harmony with the moral law.
• 01:15:08Any law that uplifts
• 01:15:11human personality is just.
• 01:15:14Any law that degrades human
• 01:15:17personality is unjust.
• 01:15:20That's again Martin Luther King.
• 01:15:22We should never forget that everything
• 01:15:25out of Hitler did in Germany was legal
• 01:15:29and everything the Hungarian freedom
• 01:15:31fighters did in Hungary was illegal.
• 01:15:34It was illegal to eat and comfort
• 01:15:37the Jew in Hitler's Germany.
• 01:15:40Even so, I'm sure that had I
• 01:15:42lived in Germany at the time,
• 01:15:44I would have aided and comforted
• 01:15:47my Jewish brothers.
• 01:15:49Now coming to this program,
• 01:15:53which I'm honored to participate
• 01:15:56with in every presentation,
• 01:15:59as Mark knows,
• 01:16:01I have brought up the fact that.
• 01:16:03Language access was not
• 01:16:05part of the presentation.
• 01:16:07You know it was like this fly buzzing
• 01:16:10around saying where is language
• 01:16:12presentation here where is language
• 01:16:15mediation here in surrogate decisions.
• 01:16:17In the whole presentation on surrogate
• 01:16:21decision to speak up get a wonderful
• 01:16:24talk was proudly announcing that
• 01:16:27he created a new team to deal with
• 01:16:31surrogate decision spoke about.
• 01:16:33The people that integrated the team,
• 01:16:36This team not once was a language
• 01:16:39mediator ever mentioned as
• 01:16:40part of the team in
• 01:16:44the talk about language
• 01:16:47mediation in the jails.
• 01:16:50A strikers no language mediation eventually
• 01:16:53came out that there was a language
• 01:16:56mediation line for Spanish speakers,
• 01:16:58but no one ever picked it up at
• 01:17:01the other end. In Pediatrics,
• 01:17:03that wonderful article 55 pages,
• 01:17:06there is a three line mention of
• 01:17:09language mediation on page 30.
• 01:17:11That's it in Emmanuel's excellent
• 01:17:14Which Country Has the Best World?
• 01:17:18Here No language mediation mention.
• 01:17:21A book that came out last month.
• 01:17:23Zeliko's On the COVID Crisis.
• 01:17:28No mention anywhere.
• 01:17:29About language mediation and the
• 01:17:32group of the people who did this are
• 01:17:35Daniel Allen from Harvard in Ethics,
• 01:17:40Nicholas Christakis, whose book is Amazing.
• 01:17:45Apollo's Arrow, Emmanuel,
• 01:17:47the members of the group.
• 01:17:49No mention of language mediation.
• 01:17:52Actually,
• 01:17:52Apollo's arrow makes a very good point,
• 01:17:57Christakis says. That when he did
• 01:18:00his residency in Philadelphia,
• 01:18:03I believe his mentor said hospital
• 01:18:07admission is not a benign procedure.
• 01:18:11Possibly as many as 1% of patients
• 01:18:15admitted to American hospitals
• 01:18:17die from medical mistakes.
• 01:18:19Brigham and Women's Hospital that I
• 01:18:22mentioned before had already an inkling
• 01:18:25of that if lack of language mediation.
• 01:18:29Access standards,
• 01:18:30sufficient staffing where to
• 01:18:32be added to or combined with
• 01:18:35iotrogenic and not so commun not
• 01:18:39so communal mortality statistics.
• 01:18:42What percentile would emerge,
• 01:18:46I don't know.
• 01:18:48So patients and families have
• 01:18:51problems in terms of accessing their
• 01:18:54monolingual and this is my last slide.
• 01:18:56Healthcare organizations and
• 01:18:58clinicians have a moral imperative
• 01:19:01to reduce and ultimately eliminate
• 01:19:04the injustice experience by
• 01:19:07patients whose LEP in this country
• 01:19:10and this is my presentation.
• 01:19:19You want to sit down.
• 01:19:20You've been working a bit.
• 01:19:21You can welcome to sit.
• 01:19:22You're welcome to stand up here that
• 01:19:25that was a marvelous presentation and
• 01:19:26you know and it it it ends right where
• 01:19:29this program lives which is justice.
• 01:19:32I think that's fantastic.
• 01:19:33You know the hours late I'm going to
• 01:19:36see take one or two questions just from
• 01:19:37the group in here and then we'll go.
• 01:19:39I know you you folks have been
• 01:19:40kind and stayed and I'm sorry for
• 01:19:42the late start but there was one
• 01:19:45gentleman who had a question and
• 01:19:47I asked him to wait till the end.
• 01:19:49Do we have a microphone?
• 01:19:56Well, if you wait for the microphone
• 01:19:57so that the folks on Zoom can
• 01:19:58hear you as well, if you would.
• 01:20:00I was asking whether it is
• 01:20:02advantages or disadvantages to have
• 01:20:04a homogeneous or heterogeneous
• 01:20:05population multiple language is it?
• 01:20:08Is it advantages or disadvantages
• 01:20:11for a country?
• 01:20:12For a country it is advantages
• 01:20:15or disadvantages if the.
• 01:20:18Population is homogeneous
• 01:20:19or language is same.
• 01:20:20It is advantages or disadvantages
• 01:20:22for a country.
• 01:20:27I think he's asking is it better
• 01:20:29to have a homogeneous society
• 01:20:32or a non homogeneous society.
• 01:20:35From my standpoint, from my experience
• 01:20:40I would say that they hit their genius.
• 01:20:42Society is always far better.
• 01:20:45I think that you exchange culture and
• 01:20:48ideas and customs. You are more open.
• 01:20:51Yeah, well, take my case.
• 01:20:52I mean, my God.
• 01:20:53I was born in Romania,
• 01:20:55went immediately to Bulgaria of a
• 01:20:58Russian mother and the Bulgarian
• 01:21:00Romanian father who met at the
• 01:21:03University of Strasbourg in France.
• 01:21:05Then when the communists came,
• 01:21:08we escaped to Italy, then France,
• 01:21:10then Mexico, then heterogeneous, absolutely.
• 01:21:15Thank you Alex.
• 01:21:16I guess the last comment which I'll,
• 01:21:19I'll, I'll go ahead and take
• 01:21:20the the moderators prerogative.
• 01:21:21Early on in the talk you talked
• 01:21:23about the the pluralists versus
• 01:21:25the assimilationists and and I
• 01:21:27thought that was and it and it
• 01:21:29strikes me and and I want to just
• 01:21:30get your sense of that and then
• 01:21:32we'll wrap it up here for the night.
• 01:21:33But that that that you know people
• 01:21:36can disagree on this fact but perhaps
• 01:21:39among other settings the healthcare
• 01:21:41setting should be one place where.
• 01:21:44We are where we can all agree
• 01:21:49that that there should be some
• 01:21:53some accommodation for folks needs that
• 01:21:55that if we say that somebody should learn
• 01:21:57English or perhaps when they're sick or when
• 01:22:00they're frightened or when they're traveling,
• 01:22:02that that's not the time to to enforce that.
• 01:22:04I agree with you 100% of that.
• 01:22:07To me, the most important thing
• 01:22:10is the welfare of human beings.
• 01:22:12And I think that Martin Luther King
• 01:22:14just hits it right on the nail.
• 01:22:17I don't like niceties of complexities that
• 01:22:21are all too often used in a political arena.
• 01:22:25The most important thing, right,
• 01:22:26especially in a medical sector, is try to
• 01:22:30palliate the suffering of people right,
• 01:22:32to help them where they are needed. You know,
• 01:22:35I have an immense amount of respect.
• 01:22:38For Martin Luther King, I think he was one
• 01:22:41of the most amazing human beings around.
• 01:22:43And the things he says are
• 01:22:47so often absolutely right on.
• 01:22:50And when he says, you know, yeah,
• 01:22:52there is two types of justice.
• 01:22:54I mean, there's badger laws and good laws
• 01:22:57and good laws are the ones that are good
• 01:23:00for people that elevate human being.
• 01:23:02That's what it's at. I think.
• 01:23:04I think we'll end with that thought.
• 01:23:05Thank you so much, President Alex Frank.
• 01:23:12Thank you, folks. We'll
• 01:23:13see you in a couple weeks.
• 01:23:17Oh, Alex we have. Thanks.
• 01:23:20Thanks man. We have just a gift
• 01:23:22some some yellow items for you
• 01:23:24as our honored guest tonight.
• 01:23:26Thank you so much.