Where the Disconnect Is Not

"We are building a bridge." This is the phrase I heard over and over again at the US Conference on African Immigrant Health (USCAIH) this week.

Last week, I blogged on the disconnect. I wrote about how our nation’s leaders were unaware of language’s vital role in healing, how people don’t heal if they don’t understand, how interpreting in of itself is a profession with ethics and rules. The disconnect is there.

But here, with community leaders from all throughout the African Diaspora, the disconnect is not. Instead, there is a concerted effort to bring together aspects of all industries that help people--especially Africans--heal.

I arrived here Wednesday. Our first event was a meet and greet where attendees stood and introduced themselves, explaining what their interest was in African health and what they expected to get from the conference. I identified myself as Terena Bell with In Every Language, said I was here to represent the medical interpreting industry, that I had seen this disconnect and I was here to learn how we could fix it. When I sat down, almost every person in the room said “thank you” and some even clapped. An Ethiopian man walked up to me and instantly started talking about the difficulty of getting trained interpreters in Minneapolis, the need for continued training for those entering the profession. A man from Ghana stood up in front of everyone and talked about how interpreters for Muslim patients need to be culturally aware of faith’s role in healing—and better paid. At Harvard, people wondered why I was even there, had never thought of language as a health-related issue. Here, at the USCAIH, attendees were willing to join with the language industry in its fight.

I am not writing this to compare one conference to the next, or the Alliance for Health in the African Diaspora (the conference organizers) to Harvard. What Harvard does not know is clearly to Harvard’s loss. But, just as I had to point out where the disconnect is, I have to point out where the disconnect is not.

So what makes the difference? Why were these two audiences so different?

I have long said that there are two types of doctors in the world: those who want to make sure their patients understand and those who do not. Perhaps there are similarly two types of people: those who want to help people understand and those who do not. I am not calling the other group cold or cruel. But there are people in this world whose drive and desire to improve their world is innate, unavoidable, a moving, liquid force. I saw that this week in the faces of everyone here. Representatives from all across the African diaspora came together to share, to commune, to--as they put it--build a bridge. They, too, talked about breaking down silos, but they took the time to find out what those silos held.

Friday, I presented on language access for African LEP's. Every single person who heard about my topic said thank you, whether they attended my session or not. Dozens of people said, “We need that.” Most had interpreter stories of their own. A keynote on African Americans living with HIV even had a medical interpreter working from French to English. There is clearly no disconnect here.

But there is a need. They need us. And we need them. After what happened at Harvard, and after the warm reception I received here, I completely changed my presentation. It had initially been on where to get materials, how to get professional translation when materials weren’t there already. But meeting these people and learning more about how active they want to be in every area impacting African American health, I changed it.

There are three factors in LEP patient healing: the patient, the provider, and the language professional. All three must be on top of their game for healing to happen. Like our government, they must be in checks and balances with one another—they must all play their role, but they must also listen. For the patient, I discussed Title VI and HIPAA, the need to know you have a right to a professional, medical interpreter. For the provider, I discussed the need for cross-cultural training in universities and from hospital associations as CME’s. For the language professional, I said we must listen. We must listen to the patient and the provider to learn their need before we can address it. I told the people there that we could not do it without them, that if we as a language profession are wrong, then they must make us stop and listen.

And that’s the difference. As a language industry, we have been speaking, but at Harvard, no one had yet listened. I still believe what I wrote and I stand beside my words. But I also feel cool water flowing from around the rock. We must continue client education, but we must also allow our clients to educate us, listening to each other. If we are truly to build a bridge, we must meet each other in the river with our tools.

Is Our Industry Disconnected from Clients?

There is a disconnect--a divide. The difference between what we know and what our clients know is vast and the gulf that lies between us is insurmountable alone.

This is how I felt walking away from the Harvard Social Enterprise Conference. Held February 28th, its global health track featured leaders from international pharmaceutical companies, the Pentagon, the Obama administration--even George W’s daughter sat a panel under her Global Health Corps role. These, supposedly, were the world’s greatest minds on global health and social enterprise, with Harvard‘s reputation fully stacked behind them. But when it came to language services, they didn‘t know jack.

Here’s what made me realize this:

I was sitting in the back row listening to a panel made up of Barbara Bush, the director of the International Health Specialist Program for the Pentagon (Lt Col Mylene Huynh), Merck’s director of global affairs (Kris Natarajan), Management Services for Health‘s CEO (Jono Quick), and two professors from the Harvard School of Public Health (Drs Jessica Cohen and Till Barnighausen). The topic was “Breaking the Silos: Collaborations That Impact Complex Global Health Issues.” According to the program summary, the session’s goal was to bring together people and information from different fields, all with the goal of improving global health.

When it came time for Q&A, I raised my hand. “People don’t heal if they don’t understand,” I said. “The rest of the world does not speak English.” I then asked what we could do as a language industry to help connect with the global health one.

There was a long pause. Too long. Then Lt Col Huynh from the Pentagon spoke. Bilinguals and heritage speakers need to learn medical terminology. Sure, I thought, that’s a given. The military, she claimed, does not have systems in place to teach medical linguists medical language terms. Okay. Fair enough. She’s acknowledged their need and is speaking out. That, we can address; lessons, we can do.

But then Harvard’s Dr Barnighausen spoke up. And his response made me wonder what I’ve been doing with the last four years of my life, what our industry has been doing the last ten. He told a story about the one time he had worked with a “translator.” He asked the “translator” to ask the patient if his stomach hurt. The “translator” and the patient had a long back and forth conversation before the “translator” said, “No.” Dr Barnighausen’s reaction was to stop working with translators (which is good, as he needs interpreters instead) because “they’re all like that.”

I wanted to weep. I sincerely and utterly wanted to weep. The moderator went on to the next question while I sat there in shock. The camera Harvard was using to record it all (Harvard, conveniently enough, was unable to locate the video upon request) panned away from me and back toward the panel as they continued, but I didn‘t hear a word. I was too in shock. This “expert,” this Dr Barnighausen, wasn’t an expert on language‘s crucial role in health care at all.

This was Harvard. These people were supposed to know what they were doing.

After the session, I ran to the front to try and catch Dr Barnighausen. If, for some reason, our entire industry, the multiple associations that we have, the whole of both certification movements, had not been able to reach him, I would. But I didn‘t. The moderator carted him away before we had the chance to talk. I did get to speak with Lt Col Huynh, though. I told her how glad I was she articulated her answer so clearly, how much I appreciated the information. I told her how much Dr Barnighausen’s remarks had pained me, then what she said pained me even more. “But he’s right. They’re all like that.”

I immediately started gushing about the National Council on Interpreting in Health Care, its code of ethics, the certification for medical interpreters expected this fall. “You mean there are ethics?” she said, “This is a profession?”

This woman works for the Pentagon. She is in charge of our entire military’s medical efforts.

Clearly, there is a disconnect. It is wide and vast and sprawling.

As a language industry we are working hard--harder than ever before--to develop interpreting as a profession. We have more trade associations than ever before, more conferences than in years past, more training opportunities than before. But do they help? And, if so, whom?

There is a disconnect. When representatives of our own government, professors at the country’s purported top school--when our nation’s leaders have never heard of us--when they stand aghast at the sheer principle of our having ethics--when they think we’re all bilingual quacks who summarize--what are we doing wrong? Who are our efforts for?

Conference after conference, session after session, we talk, but to each other. We must talk to the client. We must talk to those who need to listen. Instead of teaching Bridging the Gap, we should be bridging the gap between us and our clients.

But how? In the past, this has fallen on the freelancer, on the LSP, on the person selling the services. That’s why we call it client education. But the LSP can not tackle this great gap by itself. The language industry is being squeezed. Rates are falling, client demands are going up. If the LSP refocuses its effort to focus on client education, the burning of resources will mean there is no LSP left. We need our associations to help us. Clients do not always believe freelancers or LSP’s because they assume we have something to sell. But if the associations would work together to sell clients on our industry, there’s no telling who or how many people we could help.

We must close the disconnect. We must stop thinking intrinsically and think externally. Educational PSA’s on YouTube, an NCIHC booth at global health conferences. Our associations must market this industry just as we LSP’s market our services. There should be no excuse for our nation’s leaders to know so little. Again, there should be no excuse for our nation’s leaders to know so little!

Where are we going wrong? How can we take this talking together and make it working together to educate the client? How do we bridge the disconnect?