Medical Interpretation Field Small but Growing

By Aisling Maki

In his 50s, Julio Cepeda left his career as a chemical engineer to embark on a new one using his increasingly valuable interpreting skills to help bridge communication gaps for the Memphis area’s growing Spanish-speaking community.

He started his career as an interpreter in the courts, but said he didn’t like being in the middle of “the antagonism between the defendant and the plaintiff.”

The Chilean-born, Argentina-raised Cepeda, 61, instead found his calling interpreting for families of pediatric patients at Le Bonheur Children’s Hospital.

“I prefer the medical interpreting because we all work as a team. There’s no antagonism; everything is for the well-being of a patient – in my case, a child,” he said. “It was a drastic change, but I enjoy every minute of it. Engineers work with numbers and material things, but in the medical interpreting profession, we have to be very sensitive with what’s going on with the patient.”

When Cepeda started at Le Bonheur six years ago, bilingual fluency was the only real requirement for becoming a medical interpreter. In 2006, Le Bonheur enrolled Cepeda in a 40-hour medical interpreter training course at the University of Tennessee Health Science Center, where he was educated in standard practice, codes of ethics and the legal implications of being an interpreter.

Although programs have been available – the University of Memphis School of Public Health offers one – for people interested in training as medical interpreters, there has been no required universal form of certification for interpreters in the U.S. That changed in 2009 when the National Board of Certification for Medical Interpreters launched a national certification program.

In addition to proven language competency, candidates are tested using comprehensive written and oral exams that cover areas including medical terminology, medical specialties, medical interpreter ethics, cultural competency, standards of practice and legislation and regulations.

In September, Cepeda became the first certified medical interpreter in the Memphis area and one of the first in Tennessee.

He was followed in December by Constantina Fronimos-Baldwin, interpreting services coordinator with Methodist Le Bonheur Healthcare, who was certified the same day as Marc Friedman, coordinator of interpreter services at St. Jude Children's Research Hospital.

Fronimos-Baldwin, a native of Greece who’s fluent in Spanish, leads a team of four interpreters, including two others who are working toward their certification.

“We live in a diverse community, and within our hospital walls we embrace each unique culture,” said Gary Shorb, CEO of Methodist Le Bonheur Healthcare. “Having highly qualified medical interpreters greatly improves effective communication between medical staff and patients with limited English proficiency and elevates patient safety and optimizes outcomes.”

When interpreters are needed, they meet with the clinician to understand the patient’s condition. During a pre-session, interpreters establish the rules: Everything said must be interpreted and with accuracy. The interpreter must speak in the first person as if they were the doctor or patient.

“Many people in the health care environment do not know how to work with a qualified interpreter,” Fronimos-Baldwin said. “You have to remind the health care provider and the patient to address each other as if they were both speaking the same language. Many times they tend to address the interpreter as if he or she is the only person in that room, and that is not correct or appropriate.”

She said many health care providers are still learning that interpreting goes way beyond language proficiency.

“Many health care providers think they can walk into a room and grab the first person who speaks English – and that could be a minor or a friend or a neighbor who is visiting – and asking them to interpret the diagnoses, explain the procedure that they may be about to do, or even communicate bad news. That’s something that happens and we just need to eradicate that and educate.”

Medical interpreters must possess a strong cultural understanding of the community for which they’re interpreting language, but they’re also required to be well-versed in medical terminology, including specialties, illnesses, procedures, pharmacology and the rules and regulations of the U.S. health care system.

Cepeda said he has “accumulated a tremendous experience and I’ve learned a lot about medicine. When I don’t have patients to interpret for, I study medical terms and illnesses. We learn every day. I learn something new every day, and that’s very satisfying.”

Cepeda said he finds many aspects of his job satisfying, although at times it can be emotionally challenging.

“When you see that a child is doing badly and that he or she may die, and you have to interpret at the end of life, it’s tremendously stressful, to have to give bad news to the parent,” he said. “On the other hand, when a child has been extremely ill and becomes well, to tell the parents their child is doing well and is going to be discharged after months in the hospital is the most wonderful news that you can give someone.”

Fronimos-Baldwin said she would like more bilingual individuals to consider a career as a medical interpreter. There’s an increasing need for interpreters of Arabic, Vietnamese, Mandarin and Cantonese.

“Even though we do have speakers of those languages in the community, we don’t have qualified medical interpreters,” she said.