Congratulations!

Once a year I spend a week in Antigua, Guatemala, with a group that does free surgeries for people for whom even the almost-free national health care system is too expensive.  My part is to do Spanish-English interpreting.  You can read about some of the mechanics of a surgical mission at this link.  To give you a feel for what the interpreting part of it is like, here is the introduction to a manual for our interpreters.

Congratulations!

Congratulations on being selected as an interpreter for Surgicorps!  If you went through the work of applying to go on a mission, I don’t have to convince you what a rewarding experience this will be. As Dr. David Kim, our medical director, put it: “Interpreters play an integral part in the Surgicorps mission, assuring nervous patients and their families—at a very frightening point in their lives—that they will be heard and understood if they are in pain, and that they will be able to understand pre- and post-operative instructions—it is a big comfort to them.”

The purpose of this manual is not to teach you medical Spanish.  Rather, its purpose is to give you some suggestions about how to prepare for your Surgicorps mission.  The manual will cover some aspects of medical interpretation in general, medical interpretation for Surgicorps in Guatemala in particular, and some of the vocabulary that is specific to the hospital in which we operate that you are likely to need.  In addition, some Central American Spanish grammar and vocabulary will be discussed, as well as general advice on how to comport yourself in a surgical setting.

If you’re not insanely hubris-ridden, you are already starting to worry about whether or not you are up to the task.  You can more productively spend your time preparing, rather than worrying, and the more prepared you are, the less anxious you get to feel when you arrive in Guatemala.

What to expect when you’re expecting a mission in Guatemala

Where expectations are concerned, the most important thing to be aware of is not your expectations, but the practitioners’ expectations of you.  The practitioners will expect you to be proficient in Spanish, but they will not expect you to be proficient in medical Spanish.  You are probably not proficient in medical English, and you will not be expected to be proficient in medical Spanish, either.  You should, however, be quite familiar with anatomical terms.  This book will cover some medical vocabulary in Spanish; it will be much easier for you to learn it if you know what it means in English, and you should consult a good book on English medical terminology if you are not familiar with it.  .  Remember, though: the only way that the practitioners will expect you to be familiar with medical vocabulary is if you pretend that you are.

An important expectation is that you will be honest and forthcoming when you are not sure what is being said.  This applies equally if you are not sure how to interpret what a patient is saying to the practitioner, and if you are not sure how to interpret what the practitioner is saying to the patient.  I guarantee you that the practitioners will trust and respect you more if they know that you will make clear when you do not understand, and will ask for clarification, than if they think that you are trying to bluff your way through something.

General advice for behavior in the hospital

There are a number of principles that should guide your behavior in the hospital.  The ones that are listed here come from general principles for safe and ethical behavior in health care settings, as well as experience on Surgicorps missions.  I’ll list them briefly here, and then expand on them below:

• Do not run, ever.
• Be familiar with principles of confidentiality.  Think hard before you post something about the mission on social media.
• Be familiar with proper dress and behavior in the operating suite and associated spaces.  (The OR staff will help you with this.)
• Be familiar with proper dress and behavior around sterile fields.  (See above about the OR staff.)
• In case of doubt, follow the most recent instruction.
• Develop a highly refined sense of smell.
• Know your limits in interpretation situations.\item Know your limits in clinical situations.
• Never answer a patient’s or family member’s question with anything other than some version of “I’m not a doctor, I don’t know—I’ll go find out.”
• Clarify, clarify, clarify.
• Nothing is ever about you.  Everything is always about the patient.

Do not run, ever

If you’re a health care professional, the first thing that you learn is probably not first aid, but rather this: never run in a hospital.  It just freaks everyone out and creates a commotion that will probably hurt the situation more than it will help it.  Plus, if you trip, go flying headlong, and crack your head open, you are not going to be any help whatsoever, and your coworkers are now going to have two patients in crisis, not just one.  In case of emergency: just walk quickly.

In case of doubt, follow the most recent instruction

In the unlikely event of a serious situation where your help is needed, sometimes someone will tell you to do one thing, and then someone else will tell you to do something else.  The rule of thumb in this situation is: follow the most recent instruction.  The person who gave you the second instruction sees that you’re doing something—if they tell you to do something else, you should operate on the belief that they know that what they’re asking you to do is more important.  Someone tells you to do something, and someone else tells you to do the opposite?  It’s likely that something about the situation has changed, and the needs are different now.

Develop a highly refined sense of smell

Think not just about what is allowed, but about what things look like, what they sound like.  Could that tweet be misinterpreted?  You probably shouldn’t send it.  Not sure if it would be a good idea to…  Don’t.

Nothing is about you.  Everything is about the patient.

It can be really easy to suspect that someone doesn’t think that your Spanish is good enough, or that they’re upset with you, or whatever.  Maybe a nurse will walk right by you and ask another interpreter to help them, or you’ll be interpreting for a surgeon, and they’ll ask for another interpreter.  That can be hurtful, obviously.  The thing to keep in mind: don’t take anything personally.  Nothing here is about you, ever.  What the providers want is the best possible care for their patients, and that should be the only thing that you want, too.  Besides, you’re making some assumptions here—with no evidence whatsover.  You’re interpreting this as that nurse doesn’t like me, that surgeon thinks that I don’t speak Spanish well—but, it’s actually a lot more likely that the nurse was thinking about something else and didn’t see you standing there, or that the surgeon was about to ask the patient a question that she knows the patient would be more comfortable answering in front of an interpreter who is older/younger/skinnier/fatter/taller/shorter/maler/femaler than you—you really don’t know until you ask, and if it’s important to you to know, then ask you should.  But, ultimately, the point is that this is not about you—it’s about what the patient needs in that moment, and that is all and everything that matters.

Clarify, clarify, clarify

No one expects you to know what cholelithiasis means.  You’re not sure?  Ask.  No one expects you to know what every single word of Spanish means—you don’t know what every word of English means, right?  So, you’re not sure what a person just said?  Clarify.  People will be glad to know that if you don’t understand something, you’ll ask.  It bears repeating: people will only expect you to know everything if you pretend that you do.

Never answer a patient’s or family member’s question with anything other than…

Never answer a patient’s or family member’s question with anything other than some version of “I’m not a doctor, I don’t know—I’ll go find out.” You can bet that the first time that you think that you know the answer because you have chased down someone to answer the question five times already that day and so you decide to answer it so that you do not bother the doctor or nurse again, this will turn out to be some sort of special case, and you will have made a completely unnecessary mistake—one that could be harmful.

Know your limits in interpretation situations

You will not feel equally comfortable in every clinical area or communicating every kind of message.  If you are much more comfortable with gynecology vocabulary than with anesthesia screening vocabulary: say so.  If you don’t think that you can translate and stay calm when translating for a physician who is going to tell someone that we can’t help their child: say so.  The Surgicorps medical personnel will respect you far more for communicating your limits than they will for trying to take on something that you’re not sure you can do in a way that will be safe for everyone.  Also, if people know that you need help with something, then they can try to give it to you—if they don’t know that you need help, then they won’t try to give it to you.  In general, people like to be helpful.

Know your limits in clinical situations

You may occasionally be asked to help out in an operating room in a pinch.  If you don’t feel competent to help, do not hesitate to say so .  It is far, far less of a problem to say “no” than it is to screw something up.  Peope will forget the one, but you will never forget the other.

Working with your fellow interpreters

Surgicorps brings a finite number of interpreters to Guatemala, and while it sometimes seems as if you are all standing around with nothing to do, it is more often the case that there are not quite enough of us.  Consequently, it is important to try to work together to make sure that all  of the needs of the medical and administrative personnel are covered, and that none of your fellow interpreters is overwhelmed—or starving to death while the rest of us are hanging out in the lunchroom. So, coordinate lunch breaks and the like.  Tell someone if you are leaving for the day—if you disappear and no one knows about it, we not only run short on interpreters sometimes, but someone will be taken out of the game to go look for you and make sure that you are not lying in a bloody heap somewhere.

Another way to help all of us do a better job is to share information about which patients do not speak Spanish well—not all of our patients, or their parents, are fluent in Spanish, and it is important to pass along the word to such patients to the other interpreters.

Surviving the Zombie Apocalypse: The dreaded back door

One of the most helpful things that you can do in Guatemala is to handle the knocks at the back door.  This might sound trivial, but it is also one of the most difficult things to do in Guatemala, and if you find yourself having zombie nightmares while you are here, that back door is probably the reason why.   People show up at the back door for a lot of reasons, ranging from looking for a family member, to dropping off receipts and results of laboratory tests, to showing up for non-surgical treatments like steroid injections or to have a brace made.
You will also go to the back door to call for family members after a surgery, and then translate for the surgeon while they explain how things went.
When people bring forms to the back door, smile, take the form, and give it to one of the local nurses in the pre-op area.

As always, do not answer questions—tell the family members that you are not a doctor, and will go find out whatever it is that they are asking about.
When in doubt about what to do in these situations, remember: you cannot be most helpful by getting tied up trying to solve the problems that appear there.  You can be most helpful by finding, or asking someone free to find, the appropriate person who knows how to deal with the issue, and then making yourself available to interpret.  Most of the time, this will be one of the local nurses.

Some things to think about when you find yourself crying in the bathroom

I presume that you are not a medical professional and do not have much experience with professional-grade compartmentalizing.  Even if you are a professional, if you are human, you are probably going to find yourself crawling off somewhere to cry at some point in your mission.  I can’t deny that life sucks and is unfair, but here are some things that you might think about at these times:

• • • We cannot fix everything for everyone, but we can fix a hell of a lot for someone.
    • There are a lot of people who we are not going to be able to help, but every single person that we can help is going to benefit enormously from what Surgicorps does—probably for the rest of their life.
    • As bad as life looks for some of the people that you are going to see, it is infinitely better for a kid with a handicap to be in a place like Obras (the facility where we do our surgeries) than to be lying in the corner of a dirt-floor hut in the jungle somewhere.

No English notes this time, sorry!  Enjoying these posts from Guatemala?  Why not make a small donation to Surgicorps International, the group with which I come here?  You wouldn t believe how much aspirin we can hand out for the cost of a large meal at McDonald‘s–click here to donate.  Us volunteers pay our own way–all of your donations go to covering the cost of surgical supplies, housing for patients’ families while their loved one is in the hospital, medications, and the like.