In this encounter the health professional is talking to a new patient about nutrition. No interpreter has been employed for this session (this staff member now uses interpreters frequently to achieve more effective communication with her clients). This patient speaks very little English. His sister speaks fluent conversational English but was not trained in medical interpreting at this time (she has since undertaken further training and is working as an interpreter).
In this video clip, the educator wants to find out what the patient understands about dialysis. This attempt fails because the patient's sister misunderstands the educator's question - even though her English is relatively fluent - and asks 'how does it make you feel? to which the patient responds 'good'. The educator knows her attempt has failed but doesn't know why.
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Subtle differences are easily missed - even by fluent speakers of English. Interpreters are trained to focus on the accuracy of their interpretation but there is always a risk of misinterpretation. It is therefore very important for staff to also be skilled in monitoring the effectiveness of communication - and repairing problems when they occur.
In the next example, the educator repeatedly uses terms and concepts that depend on a high level of Western cultural knowledge to make sense. She said:
Now that machine that you're on it cleans your blood but as well as taking away the waste or the rubbish it takes away some of the goodness from you.
The patient's sister translated this as:
This is what she said - for example, like the medicine (referring to the machine), that medicine helps you, cleaning your blood inside, the food that you have been eating, it takes out all of that.
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The educator did not provide a sufficiently clear explantion for the
patient's sister to then explain clearly to Baŋa[i. For example, what
did the educator mean by 'waste or rubbish' and what did she mean by 'goodness'?
These concepts were not meaningful to the patient's sister but she did
her best to translate the message from the words that were familiar. As
well, there are profound differences between Yolŋu and Balanda understandings
about blood. Even though the patient's sister speaks good English a lot
of the information was 'invisible' or 'hidden' and she was unable to effectively
interpret this information.
Another factor also caused communication difficulties in this encounters.
There are strong restrictions about what can be discussed between a brother and sister. As Baŋa[i's illness was serious, Baŋa[i's family felt that this sister was the best person to assist him due to her extensive experience with Western health services. However, she was extremely uncomfortable about breaking such strong Yolŋu cultural protocols and struggled to balance the need to communicate with the need to avoid certain topics.
Employment of an appropriate interpreter would have greatly reduced their difficulties.