As a genetic counselor, what do you say when a family is struggling with infertility, or their unborn fetus has been diagnosed with a genetically-transmitted disease? How do you broach these subjects with Arab patients, or Haredi patients, or patients from different countries, where it is not acceptable to talk in public about issues relating to the child-bearing process? And how does the medical interpreter, who himself often comes from that community but is not trained in the discipline, deal with these questions?
Medical interpreting for genetic counseling was the subject of a recent workshop we facilitated for 18 Jerusalem-based medical interpreters from Hadassah (Ein Kerem and Mount Scopus) and Sha’are Zedek (main hospital and Bikor Holim, which is now part of Sha’are Zedek) – Russian, Amharic, Yiddish and Arabic-speakers in addition to Hebrew. We’re proud to have been a major part of the training and assimilation process of medical interpreters in Jerusalem, which the hospitals now consider an integral part of their care. (We’ve written here and here about these trainings in the past.) Like other aspects of professional healthcare, it is important for medical interpreters to maintain their skills through periodic professional development, and this workshop was part of an ongoing process of supervision and mentoring of the medical interpreters.
We chose to concentrate on genetic counseling because of its multi-layered complexity. According to the US-based Centers for Disease Control and Prevention, in genetic counseling, “specially-trained professionals help people learn about genetic conditions, find out their chances of being affected by or having a child or other family member with a genetic condition, and make informed decisions about testing and treatment.” Because it brings together many different scientific disciplines, it is very difficult to understand, even for someone who studied advanced science. In addition, meetings with genetic counselors are stressful from the get-go, since one is consulted only when there is a problem (or a potential problem) in the child-bearing process – either before conception, during pregnancy, or after the birth of a child with genetic problems. Add to this the different approaches and viewpoints that different cultures have to the different stages of the child-bearing process, as well as their outlook on children with special needs – and the meeting with the genetic counselor is even more tension.
And when the medical interpreter is tasked with being the agent of communication during such a stress-filled meeting, it can be one of the more challenging of situations. Medical interpreters are trained to translate for all types of medical issues from cardiology to orthopedics to oncology, and are not trained as genetic counselors themselves. Sometimes, they feel uneasy with the subject matter, since it often breaches sensitive issues such as birth defects, sex, ending of a pregnancy, and sometimes their initial reaction is to skip over probing questions. At the same time, these questions are vital to the genetic counseling process, and it is critical that an experienced interpreter translate everything.
In the meeting we approached the subject from a number of different angles. After an opening exercise that focused on professional dilemmas in interpretation, participants heard a lecture from Shachar, a genetic consultant from Sha’are Zedek. They learned about the field of genetic counseling, for whom it’s targeted, the challenges in meeting with patients and the challenges in interpreting for patients. The genetic counseling process seeks to understand and evaluate medical and psychological information as well as family complexities related to genetic diseases. In addition to understanding the situation, genetic counselors also try to understand the different options appropriate for each patient and their families. This is why interpersonal communication, and interpreting into the patients’ native language, is of utmost importance.
After the lecture the interpreters discussed a number of challenges they’ve faced. In one example, a patient, who didn’t have the patience to hear what the genetic counselor was saying, told the interpreter, “Just tell her [the genetic counselor] whatever you want.” Such an answer is sometimes difficult to translate, and makes the interpreter feel uncomfortable, but from the standpoint of the genetic counselor it is actually important information in the communication process between them. In this case, the interpreter must overcome his or her discomfort and translate exactly what was said.
They also discussed mediating and advocacy in medical interpretation – two terms that mean a deeper involvement of the interpreter in the meeting. They discussed situations in which these unusual cases might take place, and especially how to do it correctly.
In the end, they broke up into groups according to non-Hebrew language, and different lecturers taught terms specific to genetic counseling, pregnancy and birth in Arabic, Russian, Amharic, and Yiddish.
We hope to have additional peer learning sessions for medical interpreters in Jerusalem – they deserve it! We’ll keep you posted here!
Many thanks to the Jerusalem Foundation for its continued support of cultural competency in health care in Jerusalem.