Morales, Restum, Ceron, Roston 1

Camila Morales, Denise Restum, Emily Ceron, Sydney Roston

ENGL297
Professor Ania-Bialas
23 April 2018

Ethnographic Report - Technical Communication in Medical Translation

Introduction
Health conditions and illnesses do not discriminate based on the language one speaks although
different countries speak different languages. In the field of medicine, language barriers often pose a
challenge between healthcare professionals and their patients, making medical translation an essential
aspect of patient care that many people overlook. In fact, the life of a patient depends on the medical
interpreters and translators just as much as it depends on the healthcare professional. For this reason,
medical interpreters and translators must be able to accurately transform the words or texts of one
language to its equivalent in the target language. The main objective of this form of technical
communication is to have the patient read the translated work as if it were the original document or
understand an interpreter’s words as if they were the doctor’s words.
This study examines the verbal and writing processes involved with medical translation and
interpretation. More specifically, this study explores medical translation from the perspective of Subject
1, a Spanish professor at the University of Maryland, and medical interpretation from the perspective of
Subject 2, a Spanish translator at the University of Maryland Health Center. Through the collection of
artifacts, field notes, and interviews, we were able to analyze the methods by which medical translators
and interpreters use technical communication. The data collected was analyzed to create a heuristic that
details the various aspects that allow for effective cross-cultural communication in the healthcare field.

Research Question
How is the healthcare industry using language and professional writing to improve the quality of care for
Spanish speaking populations?

The objective of this ethnographic study is to bridge the gap between professional writing and the
healthcare profession by specifically addressing the importance of English-Spanish translation. With the
growing population of Spanish-speaking patients in the United States, the healthcare industry must adapt
to better serve the needs of this population. This language barrier affects the quality of care that a
healthcare professional can provide and the patient’s satisfaction with their visit to the doctor. More
specifically, the language barrier prevents a high level of trust between the healthcare provider and the
patient, impairs the patient’s understanding of medical documentation and consent forms, and decreases
the efficiency of visits to the doctor. Overall, these factors contribute to the health disparity for the
Spanish speaking population in the United States. Therefore, this ethnographic report will answer the
question of how the healthcare industry is adapting to a more diverse population through the use of
professional writing such as medical translation and interpretation. In doing so, this project will complete
a detailed investigation into the aspects that contribute to effective medical translation and interpretation.

Research Subjects
 Morales, Restum, Ceron, Roston 2

For an in-depth study of medical translation, we interviewed two research subjects in order to
analyze information both a medical translation and a medical interpretation. The first research subject,
Subject 1 is a senior lecturer in the Spanish department at the University of Maryland. One of the classes
that she teaches is titled “Spanish for the Health Professions”, and it covers the language skills and
cultural competency required for a health professional to treat a Spanish-speaking patient. As a professor,
she compiles resources for students and teaches the topics that are important for a medical translator. She
uses real-world scenarios as well to simulate what a doctor-patient interaction in Spanish involves.
Our second research subject, Subject 2 is a translator who works for the University of Maryland
Health Center. She is a native Spanish speaker and has worked as a translator for 26 years, seeing 2-3
patients a day. Subject 2 had taken one course called “How to be an Interpreter?” at the beginning of her
career from Clinica Del Pueblo. Currently, she does not hold a degree or certification for medical
translation. She explained that during the time when she became a Medical Translator, it was not required
to hold either. As of more recently, she said that a certification is required for translating but the person
does not need to hold any specific degree in a medical field. Much of her knowledge is acquired through
experience on the job. Her work requires only interpretation which means all of the language translation
that she does is out loud, instead of written down. Therefore, instead of using written works as artifacts,
this data collected from this research subject focuses on the real-world application of medical translation.
With these two perspectives, our ethnographic report answers our research question from
different angles. The first angle involves understanding what skills are important for someone practicing
to be a medical translator and this will be studied using the artifacts and information from Subject 1. The
second angle involves putting these skills into a real-world context, the day-to-day work of a medical
translator, to understand how the skills learned in a medical translation class get applied to the actual task
of medical translation.

Data Collection Methods

Our focus in bridging the gap between healthcare and professional writing within the translation
of languages relies on collecting information through semi-structured interviews, field notes, and artifacts
that reflect medical translation.
We were able to reach out to Subject 2, a medical translator by contacting the University of
Maryland Health Center. Prior to meeting for the interview we sent previously outlined interview
questions to Subject 2 so that she could be better aware of what information we were trying to acquire.
For our interview, we met with her personally in her office located in the University of Maryland Health
Center on Tuesday, March 13. At the door to Subject 2’s office was an inviting sign that read both English
and Spanish, indicating that she was the translator. After introducing ourselves and the basis of our
ethnography project, we conducted the interview using the questions that we previously outlined. Most of
our questions were targeted at allowing us to get to know more about her education, certification and
previous experiences as a medical translator. In doing so, we collected information on the day-to-day
work of a medical translator.
We contacted Subject 1 through her university email address since she is a professor at the
University of Maryland. She agreed to help us with our project and advised us to come to her office
hours for an informal interview. Her office was located in the Spanish department which was a
welcoming office area with all sorts of Spanish resources. The conversation began with an explanation of
our project and a general idea of what we hope to learn. Similar to the interview with Subject 2, we had
already written a set of questions to ask Subject 1 in order for the interview to flow smoothly. She began
 Morales, Restum, Ceron, Roston 3

by explaining how she ended up teaching Spanish for the Health Professions and how her personal
medical history opened her eyes to the importance of Spanish interpretation in the medical field. Various
artifacts were collected throughout the interview. For example, Subject 1 provided us with her class
syllabus, a hand-out from her class, and her lecture powerpoints. However, these artifacts only portray
medical translation. For deeper insight into medical interpretation, we gathered information from field
visits to the UMD Health Center, John Hopkins Hospital, Washington Adventist Hospital and Doctors
Community Hospital.
After collecting information from interviews, artifacts, and field notes, we chose to focus our
project around Chapter 19 from Solving Problems in Technical Communication. Chapter 19 discusses
technical communication in international environments. This chapter is relevant because it explains the
importance of understanding other cultures how this understanding provides an advantage to technical
communicators in the medical field.
At the end of our research, we created a graphic that summarizes all the aspects that contribute to
effective medical translation and interpretation. This graphic takes into account the information gathered
from the interviews, the field notes, the artifacts, and Solving Problems in Technical Communication.

Results
The interviews conducted with Subject 1 as well as Subject 2 provided valuable information on
how health care providers use professional writing and communication to interact with Spanish speaking
patients. The important points from these interviews, along with artifacts reflecting these points, and
observations from site visits are discussed in the following three sections.

Part I - Interview with Subject 1

Throughout the interview with Subject 1, she brought up three important aspects that affect the
quality of medical translation. She discussed: (1) creating an emotional connection with the patient, (2)
understanding extensive medical terminology in both Spanish and English, and (3) understanding how
culture affects communication.
The first topic discussed, creating an emotional connection with the patient, allows us to build
pathos into our research topic. Using the information from the interview, our group was able to have a
deeper understanding in how medical translation and medical interpretation affects the patient.
To demonstrate how speaking to a patient in their native tongue can increase the emotional
connection with a patient, Subject 1 shared a personal story with us. We asked what sparked her interest
in medical translation and she responded “When I was doing my masters, I got Hodgkin’s. And I started
researching and then also did it in Spanish and started looking at what kind of information we have. Then
I lost a sister to Hodgkin’s and even though we are both bilingual, there is some sort of emotional
something that when they tell you in Spanish, it’s different.” In other words, Subject 1 strengthened the
importance of our research with her own personal anecdote of receiving health information in her native
tongue. This provides us with insight on the emotional aspect that plays a role in medical translation.
Not only does a medical translator or interpreter need to have language knowledge, but they also have to
use this language in a way that emotionally appeals to the patient in order to effectively communicate.
Subject 1 also presented a poem titled Papi Working by Julia Alvarez that articulates the effect of
speaking to a patient in their native language. The poem reads:
 Morales, Restum, Ceron, Roston 4

Papi Working
By Julia Alvarez

The long day spent listening

to homesick hearts,
the tick tock of the clock --
the way Americans mark time,
long hours, long days.
Often they came only to hear him
say nada in their mother tongue.
I found nothing wrong.
To dole out jarabe for the children’s coughs,
convince the doña to stay off that leg.

In his white saco Mami ironed out,

smoothed the tired wrinkles
till he was young again,
he spend his days, long days
tending to the ills of immigrants,
his own heart heavy with what was gone,
this new country like a pill
that slowly kills but keeps you from worse deaths.
What was to be done?

They came to hear him say

nada in their mother tongue.

In this poem, a young girl is reflecting on a day of work for her father as a doctor. The girl and
her family are of Hispanic origin, meaning that her father is able to talk to his patients in Spanish. In the
poem, the immigrants come specifically to the father for medical attention since he is able to speak to
them in their “mother tongue.” The illnesses that these patients have seem to be chronic and not easily
fixed by medicine which means they are coming to the doctor just to hear him break the news in their
mother tongue. In other words, similar to how Subject 1 said that receiving health information in Spanish
had a greater impact than in English due to Spanish being her first language, the immigrants in this poem
are experiencing the same effect. However, this is only possible if the healthcare provider has the skills to
communicate with the patient in his or her native tongue. The rest of the interview with Subject 1
discussed ways in which an individual can improve as a medical translator and medical interpreter
through language and culture education.
After sharing this personal anecdote and poem, Subject 1 discussed the structure of her class and
how it teaches a student about medical translation. She mentioned that throughout each semester, she
provides handouts to use as examples of terminology required for medical translation in various fields.
One handout, a bookmark with information on breast cancer prevention, has one side in English and the
other in Spanish. An image of this bookmark can be found in the appendix. This bookmark includes the
Spanish words for medical terms such as “Clinical breast exams” (Exámenes clínicos de seno), “Cervical
cancer screening” (Detección del cáncer de cuello uterino), and “Health education workshops” (Talleres
de educación para la salud). If these phrases were to be translated using a computer program such as
Google Translate, the translations come out to be: “Exámenes clínicos de mamas,” “Examen de cáncer
 Morales, Restum, Ceron, Roston 5

cervical,” and “Talleres de educación sanitaria.” Comparing the translations on the bookmark to
translations from a computer program proves that a human understanding of the Spanish language and
medicine greatly improves the quality of a translation. In addition, computer translators that are choppy
or incorrect can decrease the confidence that a patient has in the doctor.
The syllabus for Subject 1’s class is a powerful example of how the class ties together medical
terminology and cultural competency, the third theme discussed throughout the interview. The syllabus
lists topics such as: la vocabulario de la salud, la enfermedad, y el cuerpo (the vocabulary of health,
sickness, and the body); la competencia cultural (cultural competency); la paradoja latina (the Latin
Paradox); especialidades médicas (medical specialties); la nutrición (nutrition); cardiología (cardiology);
cirugía (surgery); prevención (prevention); la salud mental (mental health); enfermedades venéreas
(venereal diseases); la tercera edad (old age); enfermedades medioambientales (environmental diseases);
tecnología médica (medical technology); y salud dental (dental health).
An essential component to these topics is the way in which Subject 1 incorporates cultural
competency into each one. For example, she mentioned that when learning the Spanish terminology for
the nutrition unit, she emphasizes the importance of culture in food choices. With this cultural awareness,
speaking to a Spanish speaking patient about his or her nutrition habits can be more effective. Cultural
competency does not only affect medical interpretation during a patient interaction. It also affects
medical translation in documents such as medical pamphlets with nutritional information. Translating the
document word-for-word could be ineffective if the reader follows a diet that is influenced by his or her
culture. However, cultural awareness allows the translator to alter the document in order to better appeal
to the Hispanic population.
Finally, to reiterate the importance of cultural competency, Subject 1 discussed cultural humility:
“Cultural humility means that we don’t know everything from people. People change. Cultural
competency is having always the humility to be able and wanting to learn and question yourself in terms
of language and culture.” In other words, bilingualism and biculturalism go hand in hand. When
speaking to a patient in Spanish (medical interpreting) or translating medical documents to Spanish
(medical translating), both the language and the culture need to be accounted for.

Part II - Interview with Subject 2

Through our interview with Subject 2, a medical translator at the University of Maryland, we
were able to identify three factors that affect translation in the medical field: (1) adherence to HIPAA
legislation and professional conduct, (2) the ability to constantly learn and adapt, and (3) the ability to
cater to the individual patient.
Subject 2 first stressed that as a translator, she must remain impartial during situations of
emotional stress. She emphasized that her job is to simply relay information from the patient to the doctor
and vice versa, not act as an advocate on the patient's behalf. This relationship and strict adherence to
HIPAA legislation allows for the establishment of professional boundaries in the field of translation.
Subject 2 explained that there can be instances where there is an urge to become emotionally attached to
the patient’s situation, such as a cancer diagnoses. However, her job requires only the interpretations of
the patient’s words to the doctor; her own feelings must remain strictly on the basis of factual information
including medicines, condition symptoms, treatments and so on.
The second point that Subject 2 focused on was the idea that not all translation can be developed
with education and training. She explains that a translator advances by continually learning through
experience and practice. Subject 2 discussed how she learns new terminology and medical concepts
 Morales, Restum, Ceron, Roston 6

through the doctors and nurses that she works with. She explained that many of situations she has
encountered over her twenty-year career are situations that cannot be taught in a classroom. With the idea
of constantly learning new terminology, medical concepts and possibly even new translating techniques
through experience and practice, the importance of a medical translator to be able to conform and adapt to
various situations and environments is evident. A medical translator often has to deal patients that have
illnesses that the translator has never encountered before. The lack of familiarity and understanding of
these medical terms and concepts make it more difficult for them to relay information accurately to their
patients. Hence, their ability to be an effective medical translator is heavily reliant on the communication
between the doctors and nurses that they work with as well as the patient.
Finally, she clarified that the accuracy of translation requires an extensive knowledge of Spanish
sub-dialects. In her interview, she explained that a variety of words change meanings based on a person’s
country of origin. Understanding these terms or asking for clarification can make the difference between
miscommunication and ideal patient care. She stressed the importance of asking for clarification by being
able to speak with doctors and nurses or directly asking the patient in order to deliver excellent patient
care. She explained that this is not a field in which a translator can afford to be shy with their questions as
the patient is entirely dependent on the accuracy of information. Subject 2 explained that she always asks
for clarification from the patient when they use slang or cultural terms she is unfamiliar with as words can
change meaning from country to country. Ideally, Subject 2 expressed that accuracy depends on the
translator’s knowledge of the Spanish language and their ability to judge when to ask questions in
situations of confusion. Additionally, she says “in that case you come in and learn more new words.”
Therefore, medical interpretation is a continuous learning process through experience and communication
with patients, doctors, nurses, and other hospital staff.
All three of these factors share the end goal of providing a positive experience for the patient.
Chapter 19 of Solving Problems in Technical Communication deals heavily with the understanding of
intercultural communication as it relates to the audience. The chapter stresses the importance of
respecting cultural norms and adjusting to disparities created by cultural differences. Subject 2 explained
that she must protect the patient’s privacy throughout the interaction, dedicate herself to constant learning
in order to benefit the patient, and tailor her translation to each patient. This focus on the audience or in
this case, the patient, reflects the main idea of chapter 19 which states that the audience is the core
determinant in how cross-cultural communication presents itself.

Part III - Field Notes and Observations

The field notes taken at various hospitals prove that translation is commonly used within these
facilities both in verbal and visual ways. For example, we noticed that the exit signs and bathroom signs
in Washington Adventist Hospital and Doctors Community Hospital were translated into Spanish.
Bathrooms and exits are essential places for a patient to recognize and locate and the fact that they were
translated in Spanish shows the prevalence of the Spanish language in the United States. Another resource
available to Spanish speaking patients at these hospitals were the ability to receive the Spanish version of
documents and paperwork as well as the option to request a formal translator. Due to this, patients are
able to understand the papers that they are required to sign and the health information that they receive.
Ultimately, through these field note observations, we can conclude that translation is widely implicated in
hospitals and clinics and serves a significant purpose in getting patients the aid that they need. The field
notes collected throughout this project can be found in the appendix.
 Morales, Restum, Ceron, Roston 7

Data Interpretation
Image 1. Factors that play a role in effective medical translation.

To answer our original research question of how health care professionals use technical
communication in cross cultural settings, we compared and contrasted the information gathered by our
interviews, field notes, and artifacts with our selected chapter in Solving Problems in Technical
Communication. The above image summarizes the conclusions that our group was able to make from our
research. In addition, the following paragraphs provide further detail about the real-world application of
our research by discussing parts of the chapter in Solving Problems in Technical Communication.
First, the chapter highlights complications addressed when designing “credible materials for
international audiences,” (Johnson-Eilola and Selber 481). With Spanish being one of the most common
second languages spoken in the United States, many pamphlets and informationals are available in both
Spanish and English. This is relevant to not only written materials found within doctor’s office but also
online materials with the option of translation.
Second, the book explains cultural disparities in terms of status; “In the worldview of some
cultures, status -- and status differences --- are very important, and communication behavior must reflect
this importance” (Johnson-Eilola and Selber 482). For medical translators, reading and understanding
these differences can create either a memorable experience where both cultural and professional
boundaries are respected, making translation effective, or a negative experience in which the patient feels
demeaned.
Third, the book explains that various cultures have different methods for achieving the same
goals within communication. For a medical translator, understanding various Spanish dialects and
manners of addressing medical matters is an important piece of effective translation. The translator must
be willing to ask question of the patient and of the doctor to ensure that there are no miscommunications
and that information has been distributed accurately.
 Morales, Restum, Ceron, Roston 8

To summarize, language, culture, and medical knowledge all converge to form effective
translation and interpretation in the heath field. This cross-cultural communication must portray
credibility, social status, and cultural humility in order for the patient to trust the health care provider.

Conclusion
As shown throughout this ethnography, the ability of healthcare providers to cater to diverse
populations is important because speaking to patients in their native tongue builds trust and an emotional
connection with the healthcare provider. To achieve this, the healthcare industry uses medical translators
to provide resources to patients in Spanish, as well as medical interpreters to relay information from the
healthcare provider in a language the patient will understand. Therefore, this ethnography report answers
the question of how technical communication is used to achieve effective medical interpretation and
medical translation. According to our research, the main factors that play a role in this form of
communication are language knowledge, medical knowledge, and cultural knowledge. All three of these
skills must be present in order to communicate effectively in a cross-cultural setting.
Our data collection methods included interviews, field notes, and artifacts. We interviewed
Subject 1, a Spanish professor who teaches Spanish for the Health Professions, as well as Subject 2, a
Spanish interpreter for the University of Maryland Health Center. Comparing what we learned from these
interviews with chapter 19 of Solving Problems in Technical Communication, provided the framework for
Image 1, a visual representation of the important factors that contribute to medical translation and
interpretation.
According to the 2015 census bureau, 40 million people or about 13.3% of the United States
population speak Spanish. The number of individuals who benefit from effective medical translation and
medical interpretation is increasing, making communication across the cultural and language barrier more
necessary. The framework developed throughout this research applies to all languages and cultures, not
just Spanish. All cultures are susceptible to health conditions and therefore the healthcare industry should
focus on adequate understanding of medicine, language, and culture from a worldview perspective.
 Morales, Restum, Ceron, Roston 9

Works Cited

Canabal-Torres, E. (2018, March 14). Personal interview.

“Chapter 19 - What Do Technical Communicators Need to Know about International

Environments?” Solving Problems in Technical Communication, by Johndan

Johnson-Eilola and Stuart A. Selber, The University of Chicago Press, 2013.

Google Translate, Google, translate.google.com/.

Trejo, S. (2018, March 3). Personal interview.

US Census Bureau. “Newsroom.” FFF: Hispanic Heritage Month 2016, 12 Oct. 2016,

www.census.gov/newsroom/facts-for-features/2016/cb16-ff16.html.
 Morales, Restum, Ceron, Roston 10

Appendix

Item I - Field Notes from Washington Adventist Hospital

 Morales, Restum, Ceron, Roston 11

Item II - Field notes from Doctors Community Hospital

16 March 2018 4:12 PM-5:30 PM Doctors Community Hospital

● Initial - Fairly busy emergency room; Many patients were older (around
impressions mid 40s and up)
- Consisted of mainly patients, family members, nurses doctors,
transport technicians or EMT.
- There are many chairs for the patients and family members to sit
until they are called.

- There are both verbal signs (in both English and Spanish) as well
as visual signs (male, female, disabled universal signs)
- There are signs with arrows or drawings of a hand pointing
● Signs of Spanish
towards the direction of the front desk, the exits and other areas
translation
of the hospital.

- I noticed maybe 2 or 3 nurses that spoke Spanish to a few

patients, but most patients were African American or Caucasian
and only a couple were Hispanic.
- At the front desk they offer documents and paperwork that have a
● Language of Spanish version on the back.
conversation - I asked the person working at the front desk and there is an option
of patients to request a formal medical translator.

- There are many people waiting as opposed to getting called back

to get checked.
● General - There are mainly nurses present checking in patients, etc.
observations assuming most of the doctors are working in the actual
emergency room.
- The room is not as large as I expected it to be and was not as
filled as I thought it would be generally.
 Morales, Restum, Ceron, Roston 12

Item III - Field notes from UMD Health Center

20 March 2018 2:03PM - 3:10PM UMD Health Center

● Initial impressions
● Dimly lit waiting area
● Only 3-4 chairs for waiting; most are unoccupied
● Fairly slow student traffic with few students venturing in and
out
● Front desk attendant calls up students individually

● Signs were present with general directions such as Restroom

● Visual signs of
directions and where to wait
translation
● Spanish print was either located in small print in signs such as
“Waiting Room” and “Restroom” or otherwise not present

● Documents were available in both English and Spanish when

pertaining to general topics (Flu pamphlets/How to access the
Health Center online)
● Spanish-speaking ● In the waiting room, some the nurse registering students for
nurses and Spanish insurance plans spoke Spanish amongst themselves
resources ● Most students spoke English with the nurses

● Most of the traffic consists of UMD students

● One set of parents entered with their student
● Students are primarily inquiring questions to nurses or front
desk staff
● Few students are waiting to be assisted by nurses
● Most students are conversing amongst themselves in English
● General or other languages besides Spanish
observations
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Item IV - SPAN371 Handout