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

June 08, 2023

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May 17, 2023

Language, Access, and Ethics in Healthcare

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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.