Informal Interpreters in Medical Settings

The Translator.
Volume 18, Number 2 (2012), 311-38
ISBN 978-1-1905763-35-1
Informal Interpreters in Medical Settings
A Comparative Socio-cultural Study of the Netherlands

and Turkey
Downloaded by [University of Massachusetts] at 11:09 05 March 2015
BARBARA SCHOUTEN
University of Amsterdam, Netherlands
JONATHAN ROSS
Boazii University, Turkey
RENA ZENDEDEL
Utrecht University, Netherlands
LUDWIEN MEEUWESEN
Utrecht University, Netherlands
Abstract. Between 2008 and 2010, academics in five European
countries collaborated on an EU-funded project, Training Intercultural and Bilingual Competences in Health and Social Care
(TRICC). Among TRICCs aims was to deepen understanding of
informal interpreting through eliciting the perspectives of interpreters themselves. To identify commonalities and differences in
the experiences, attitudes and practices of informal interpreters
in distinct settings, the Dutch and Turkish partners interviewed 15
young migrant adults in the Netherlands and 15 Kurdish speakers
in Istanbul respectively, asking them about emotional and technical aspects of interpreting, and about their expectations and roles,
communicative challenges and actions. Thematic analysis of the 30
interviews corroborated the findings of previous research namely,
that informal interpreters are highly visible, use diverse communicative strategies, adopt various roles, and occasionally speak as
primary interlocutors. Noticeable differences between the two sets
of interpreters included their attitudes towards interpreting and
their preferences for informal versus professional interpreting,
both of which can be better understood in the light of the cultural
backgrounds of the interpreters and the institutional and political
frameworks within which they interpret. This comparative study
appears to support Angelellis (2004a) claim that interpreted events
are heavily influenced by socio-political and cultural contexts.
ISSN 1355-6509
St Jerome Publishing Manchester
312
Keywords. Informal interpreting, Healthcare, The Netherlands, Turkey,

Kurds, Policy.
Many medical interactions that take place throughout the world involve
healthcare providers and patients of different cultural, linguistic and ethnic
backgrounds. In some cases, the patient is a migrant, refugee, tourist or temporary visitor, in other cases, the member of an indigenous or long-established
minority. When a healthcare provider has to deal with a patient with no or
limited knowledge of the dominant language, the lack of a shared language
can seriously threaten the interaction. Several studies have shown that the inability of patients to speak and understand their doctors language leads to a
number of negative consequences for both parties, such as an increased chance
of non-compliance, feelings of fear and despair, and problems in achieving
rapport, all resulting in a lower quality of care as compared to the healthcare
received by patients who share their doctors cultural, linguistic and ethnic
background (Bhopal 2007, Ramirez 2003, Stronks et al. 2001).
In many countries, the number of patients from diverse backgrounds is
significant. For instance, in the Netherlands around 20% of the population
(about 3 million citizens) consists of first or second-generation migrants (Central Bureau of Statistics 2012), half of whom are from Western and half from
non-Western countries, mostly Turkey, Morocco, Surinam and the Antilles.
Research on the latter population has suggested that around half of this group
have limited proficiency in Dutch. A study conducted in Rotterdam, a city
where almost half of the citizens are of non-Western background, showed that,
irrespective of whether or not interpreting is provided, one in three medical
consultations between general practitioners and non-Western migrant patients
is characterized by poor communication and misunderstanding, which ultimately results in low patient satisfaction (Harmsen et al. 2008:11). Although
there are currently no official figures concerning the use of interpreters in
Dutch general practice, preliminary results suggest that the majority of general practitioners make use of informal interpreters in communicating with
those non-Western migrant patients who lack sufficient proficiency in Dutch
(Meeuwesen and Twilt 2011:15).
In Turkey, on the other hand, it is the existence of a sizable indigenous
minority, the Kurds, which poses the biggest challenge for medical communication involving multiple languages. Statistics for the Kurdish population
vary enormously, partly due to the lack of reliable official demographic data,
partly because of the highly politicized nature of the Kurdish question, which
has encouraged people, including scholars, to downplay or exaggerate the
numbers. Back in 1996, for instance, the Kurds were estimated to make up
between 5 and 25% of a population of around 60 million (Mutlu 1996:517),
and the debate on figures continues (Gzel 2009). According to one recent
study, 46% of Kurdish mother-tongue speakers in Turkey have not completed
B. Schouten, J. Ross, R. Zendedel and L. Meeuwesen
313
their primary education, and 33% of this group have limited or no competence
in Turkish, with women making up 90% of the total (Grsel et al. 2009:3, 6).
Since many healthcare providers, including those of Kurdish origin, do not
speak Kurdish, patients limited proficiency in Turkish frequently results in
the need for interpretation. In a survey conducted in 2008 and 2009 among
253 doctors in the region of Diyarbakr, the most populous city in the East of
Turkey, just under half of the doctors questioned reported having to seek the
help of a member of staff or companion of the patient in order to communicate
with the patient (Diyarbakr Tabip Odas 2009).
To deal with the above-mentioned communication problems, governments
and NGOs have sought to expand the provision of professional interpreting
and advocacy services. In the Netherlands, medical interpreting and translation
services have been organized by the government since 1976 and provided for
free since 1983. As the Dutch healthcare inspectorate regards the use of professional interpreters as the golden standard, and the Law on Medical Treatment
(1995) places the onus on healthcare providers to communicate in a language
the patient can understand, ethnic minority patients in the Netherlands with poor
language proficiency in Dutch have the right to a professional interpreter free
of charge. The expenses are covered by the Ministry of Health, Social Welfare
and Sport, and the interpreting is provided by the Dutch Interpreter and Translator Service, which supplies professionally-trained interpreters working in over
130 languages. In daily practice, however, Dutch healthcare providers do not
frequently deploy these professional interpreters, mainly because they are not
familiar with the service. Instead, they tend to make use of family members and
acquaintances the patients bring along to help them communicate with the doctor (Meeuwesen and Twilt 2011:15). Furthermore, in the coming years, the use
of these informal interpreters is likely to increase, because the free provision of
professional interpreting services will soon be scrapped. In a letter dated 25 May
2011, the Dutch Minister and Secretary of State responsible for health informed
the Lower House that all funding for interpretation and translation services in
healthcare would be withdrawn from the beginning of 2012. The main argument used to justify these cuts is that patients/clients (or their representatives)
are responsible for their own command of the Dutch language (Schippers and
Veldhuijzen van Zanten-Hyllner 2011:4).
Whereas in the Netherlands official policy had aimed (at least on paper)
to cater to the needs of inhabitants with limited proficiency in Dutch, up until
the 1990s the Turkish state tried to solve the problem of inadequate communication between Turkish speakers and speakers of other mother tongues
simply by insisting that the latter learn and use Turkish. This policy reflected
the civic nationalist ideology of the Republic, which was encapsulated in the
slogan One state, one nation, one flag, one language. The policy of stringent
The East of Turkey will subsequently be used to encapsulate the geographical regions
of Eastern and Southeastern Anatolia.
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monolingualism climaxed in 1983 with the passing of Law 2932, nominally

concerned with the prohibition of publications in languages other than Turkish
but also declaring Turkish to be the mother tongue of all Turkish citizens and
attempting to effectively ban people from speaking Kurdish (Kubilay 2004:72).
However, since 1991 (when Law 2932 was repealed, although some limitations
remained) a more flexible approach to minority languages and the Kurdish
issue has prevailed, impacting also on the medical sector. On the one hand,
there has been a marked increase in the number of Kurdish-speaking health
professionals working in the East of Turkey, who now freely communicate with
their patients using one of the two main Kurdish dialects in Turkey, Kurmanji
and Zazaki; on the other hand, Article 18 of the Regulation on Patients Rights
(Hasta Haklar Ynetmelii, 1998) at least shows some acknowledgement of
the possible need for interpretation, stipulating that [i]nformation should be
supplied to the patient in a comprehensible manner, using an interpreter if
necessary (our translation and emphasis). So far, however, next to nothing
has been done to train, accredit or pay professional interpreters, and doctors,
patients and their interpreter-companions (including all those interviewed
in this study) seem largely ignorant of this vague legal obligation. Thus, in
Turkey as in the Netherlands, the use of informal interpreters be they family
members, friends, untrained hospital staff or even fellow-patients persists
as common practice.
1. Research background and objectives
Faced with this reality, between November 2008 and November 2010 scholars
from universities and representatives of non-governmental organizations in
Germany, Holland, Italy, Turkey and the UK collaborated on an EU-funded
multilateral project, Training Intercultural and Bilingual Competences in
Although there is no statistical evidence available to support this claim, many Kurdish
citizens and doctors working in the region have mentioned this development to us. In addition, in the last three years, several meetings aimed at promoting the use of Kurdish in
the medical sector have been organized by non-governmental organizations, events that
would have been unthinkable just five years ago. These include the Mesopotamia Health
Days conferences held in Diyarbakr in 2009, 2010 and 2012 and in Dohuk (Northern
Iraq) in 2011, and the symposium on Mother Tongue and Health, jointly organized by
the Turkish Medical Association and the Union of Health and Social Services Workers in
Ankara on 27 March 2010.

In their pioneering study on community interpreting in Turkey, Ebru Diriker and ehnaz
Tahir-Gralar likewise acknowledge that while numerous laws do mention, and contain
measures relating to, interpreting in different public settings, [t]here are a number of
loopholes and limitations that need to be overcome (2004:85); in particular, the authors
point to the relatively arbitrary way in which interpreters are recruited and the failure of
the Turkish authorities to demand appropriate academic and professional qualifications
from would-be interpreters .
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Health and Social Care (TRICC). The objective of TRICC was to develop,
run and evaluate training programmes and materials for people who had served
or were likely to serve as informal interpreters, as well as for the healthcare
workers and patients with whom they interact. At the same time, TRICC aimed
to draw attention to the perceived inappropriateness of informal interpreting
by minors in particular. Early on in the project, the Dutch partner carried out
a set of structured interviews with informal interpreters. Meanwhile, the Turkish partner was conducting preliminary library and fieldwork on the hitherto
unresearched area of informal interpreting in Turkey, consulting health professionals, patients and interpreters in the East of Turkey. When the Turkish
team shared their findings with their Dutch and other partners in TRICC, they
noted some interesting similarities and differences. To explore them more
thoroughly and systematically, the Turkish group decided to adapt and apply
the questionnaire their Dutch partners had used, in order to gather data that
would enable a more structured comparison of the experiences, practices and
attitudes of informal interpreters in these two countries.
The present paper reports on these data, documenting and discussing both
the parallels and dissimilarities between informal interpreters in these territories at opposite ends of Europe. Our rationale for comparing the two sets
of interpreters, who perform their tasks in such different settings, is to trace
the impact of the socio-political and cultural context on informal interpreters
and on the doctor-patient consultations interpreted by them. Since the 1990s,
a strong tendency has emerged in the literature on interpreting, especially on
community interpreting, to consider the role of interpreters in relation to the
social contexts in which they operate (Angelelli 2004a, Berk-Seligson 1990,
Davidson 2000, Hsieh 2006, Roy 2000, Wadensj 1992). Such research has
been very effective in demonstrating the social and political situatedness of
what Claudia Angelelli terms Interpreted Communicative Events (2004a:8),
but the interpreters whose actions are analyzed tend to be professional interpreters, not informal ones. Moreover, these studies invariably focus on a
single territory and rarely attempt to compare the experiences of interpreters
in different geographical and cultural settings. Even Angelellis Revisiting the
Interpreters Role: A Study of Conference, Court and Medical Interpreters in
Canada, Mexico, and the United States (2004b) reveals surprisingly little about
the relationship between the role definitions of the 293 interpreters surveyed
and the conditions in the country in which they live and work, despite the
fact that these three countries have quite different demographics and distinct
political traditions, histories, institutions and norms with respect to interpreting. Our study aims to address this gap in interpreting research.
Previous research on informal interpreting in medical settings has
largely involved critical analysis of the (recorded) performances of informal
interpreters or discussion of the experiences of health workers and patients who
See http://www.tricc-eu.net/ (last accessed 13 March 2012).
316
rely on these interpreters. The first line of research invariably documents the
negative effects of informal interpreting on communication and on practical
and clinical outcomes. For instance, it has been noted that interpreting errors
are common (Flores et al. 2003), crucial information is lost (Bhrig and
Meyer 2004, Cambridge 1999), important linguistic and discursive features
of the communication are altered by interpreters (Aranguri et al. 2006), and
quality of clinical care is compromised (Karliner et al. 2007). Results of the
second line of research partly reflect these negative effects by commonly
documenting negative experiences from the perspective of healthcare providers
(Hornberger et al. 1997, Pchhacker 2000, Rosenberg et al. 2007), in particular
when children are used as informal interpreters (Cohen et al. 1999). Patients
themselves report more varied experiences, ranging from having more trust
in informal interpreters as compared to formal ones (Edwards et al. 2005)
to preferring professional interpreters because they offer a higher quality of
service (MacFarlane et al. 2009, Ngo-Metzger et al. 2003).
Although these two lines of research have provided valuable insights into the
practice of informal interpreting in healthcare settings, some crucial elements
have so far been neglected. For one thing, we know remarkably little about this
area from the perspective of the interpreters themselves. With the exception of
a few isolated studies (Green et al. 2005, Rosenberg et al. 2008, Valds 2003),
little has been published on how informal interpreters working in medical settings perceive their own roles and performances. In the present article, therefore,
we focus on the interpreters themselves. However, as mentioned earlier, rather
than offering a decontextualized and deterritorialized analysis of interpreters
responses, we aim to examine the situatedness of interactions between healthcare
providers, patients and interpreters in distinct socio-political contexts. In addition, since it is widely recognized that the diverging cultural backgrounds of the
parties involved can have considerable influence on the medical communication
process (Schouten and Meeuwesen 2006:21), we will scrutinize how the cultural
backgrounds of informal interpreters impact on the interpreting situation. At the
same time, we are interested in seeing whether there may nevertheless exist more
universal patterns of behaviour and discourse that stem from the particularities
of the situation where an untrained volunteer interprets in a medical setting for
a patient often the interpreters relative and a health professional.
2. Research design
For the sample in the Netherlands, we attempted to gather data from 20 young
migrant adults through personal contacts and a snowballing method. The main
criterion for inclusion was that they had experience in informal interpreting
as children (at least before the age of 19) and/or currently interpreted on a
regular basis. As we strove to gain a broad picture of the contexts and issues
present in informal interpreting in medical settings, no criteria were set in
terms of their ethnic background; in addition, we approached both men and
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women. Of the 20 interpreters approached, 15 agreed to participate (5 men, 10

women). These 15 interpreters had either migrated to the Netherlands as young
children or were born in the country. Most (11) of them belong to the two largest ethnic minority groups in the Netherlands: Moroccans (8) and Turks (3).
Other ethnic backgrounds in the Dutch sample were Azeri (2), Iranian (1) and
Italian-Colombian (1). Three of the Moroccan interpreters interpret between
Dutch and Berber, three between Dutch and Arabic, and two between Dutch,
Berber and Arabic. The three Turkish respondents interpret between Turkish
and Dutch, the two Azeris between Russian and Dutch, the Iranian between
Farsi and Dutch, and the Italian-Colombian between Italian and Dutch. The
mean age of the interviewees was 23 (the age range being 19-34), and all had
been educated to at least secondary vocational level, with 10 being students
or graduates of vocational education institutions or universities. The youngest age at which they had started to interpret was 6, the oldest 18. Length of
experience in interpreting ranged from 5 to 16 years, with a mean of just over
10 years. The frequency with which the interviewees currently interpret varies
greatly: some interpret just a few times a year, others interpret several times
a week. All but one of them still interpret, mainly for one or both parents, or
for other relatives. Two also interpret for acquaintances.
In terms of ethnicity, the group of respondents in Turkey was more
homogenous than that in the Netherlands. All 15 interviewees (6 women, 9 men)
were born in Turkey and live in or near Istanbul. They are connected with either
of the two main groups commonly classified as Kurds: 9 are members of the
Kurmanji-speaking minority, 4 are ethnic Zazas, and 2 are of mixed heritage.
Eleven interpret between Turkish and Kurmanji, two between Turkish and Zazaki,
and two between Turkish and both Kurdish dialects. At the time of the interviews,
they were mostly in their twenties (ten respondents), three in their 30s, and two
were 40, resulting in an average age of 28 (the age range being 22-40). As with
the sample from the Netherlands, the majority of respondents (ten) were in, or
had completed, tertiary education. However, in order to gain some insight into
the experiences of less-educated Kurdish-speaking informal interpreters, who
are probably more representative of those performing this activity at large, four
people who had left school at or before the age of 14 were also interviewed. The

In
the Netherlands, people of Moroccan descent are estimated to number around
67,000, while there are around 91,000 individuals of Turkish descent (Central Bureau
of Statistics 2012).

It has long been a controversial, heavily politicized issue in Turkey whether the Zazas
(estimated to number somewhere between 500,000 and 3 million) should be considered part
of the Kurdish minority, alongside the much larger group of Kurmanji-speakers, or whether
they constitute a community quite distinct from them (van Bruinessen 1994). This debate
parallels, and feeds on, the discussion on whether Zazaki is a Kurdish dialect that is a close
relative of Kurmanji or an entirely different language (Scalbert-Ycel 2006). However, since
many Zazas
including our respondents seem
to identify themselves subjectively as Kurds

(van Bruinessen 1994:1), we decided to include Zazas among our respondents.
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mean age at which respondents had started interpreting was around 13, with the
range being between 4.5 and 21, although most (9 out of 15) started at some
point between 11 and 16. The interviewees had been interpreting for an average
of more than 15 years. Similarly to the Dutch sample, there was great variation
in the frequency with which respondents interpret, with the students generally
only interpreting when they return to their hometowns in the summer, and the
two housewives interpreting in different contexts on an almost daily basis. Seven
of the interviewees said that they had only interpreted for older female relatives,
while eight reported assisting both male and female relatives. Eight respondents
(i.e. around half of the sample) mentioned cases where they had interpreted for
strangers they met at the hospital or even on the way to the hospital.
The data we gathered from the interviews are accounts of the issues our
respondents chose to talk about, guided by a broad topic list (see Table 1 for a summary), to ensure that themes known to be relevant from the literature on informal
interpreting were discussed. Interviews, lasting about 45 minutes, were thus held
in a semi-structured in-depth format, to leave enough room for the respondents to
tell their own stories, although themes were discussed in the same order in every
interview. The questions addressed their background, personal history of interpreting, experiences of and feelings about interpreting (as well as feelings reported
by those they interpreted for), roles, strategies and actions in the triad, and other
emotional and technical aspects of their performances as informal interpreters. The
resulting corpus of 30 interviews was subjected to a thematic content analysis. The
most common or striking themes and issues are outlined below.
Language and family background
Which languages do you speak at home, at the doctors office, with
friends, etc.?
How proficient are you in these languages?
How often do you speak these languages?
For which family members have you interpreted?
Do other members of your family interpret?
Interpreting experiences: general
From what age have you been interpreting and for whom?
In which situations?
Are there differences between these situations? If so, why?
Technical aspects of interpreting
Do you consider yourself a good interpreter?
Are there specific topics that you find harder to interpret than others?
Do you always succeed in interpreting, and if not, when and why does it
go wrong?
And what goes well?
Can you describe a situation in which miscommunication occurred? Why
did this happen and how did you solve it?
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Emotional aspects of interpreting

What aspects of interpreting do you like?
What aspects of interpreting dont you like?
What are the easier and more difficult emotional aspects of interpreting?
Communication, attitudes and roles
During medical conversations, how do you get on with the doctor and
the person you are interpreting for?
How would you describe your role as an interpreter?
Can you describe a situation in which a conflict arose during a medical
conversation you were interpreting?
What causes communication problems between the doctor and the patient
(language, cultural issues, etc.)?
What do the doctor and patient expect from you?
In your opinion, what could be improved during medical conversations
with you as an interpreter?
Would you prefer to have formal interpreters interpret for your family?
Do you think your family prefer formal interpreters? Why?
Table 1. Topic list for interviews
3. Interview results
The results of the interviews can be summarized under three headings: technical and emotional challenges; communication and attitudes; and role(s) of
the interpreter.
3.1 Technical and emotional challenges
Two thirds (10) of the Dutch interpreters considered themselves good interpreters and felt they had sufficient command of both languages to give an adequate
translation of the conversation. As a whole, the interviewees in Turkey seemed
slightly less satisfied with their performances, with eight claiming that they
interpret successfully and seven evaluating themselves negatively. Technical
challenges of interpreting were mentioned in all the Dutch interviews, though
particularly frequent reference was made to the difficulty of translating medical terms, such as those relating to medication, body parts or diagnoses. Like
their counterparts in the Netherlands, many (ten) of the interviewees in Turkey
recalled facing difficulties rendering the names of body parts, illnesses and
medical procedures into Kurdish. While eight attributed this to the limitations
of their own vocabulary and to the fact that they had acquired Kurdish only
within the family and community, not receiving any academic or specialist
education in it, two stated that their mother tongue, Zazaki, was itself a village language (ky dili) that lacked specialist terminology, since it had not
320
had the chance to develop and to be applied in different fields. Dutch-speaking

respondents made a similar point about the Berber language, which they see
as a language for the home that lacks equivalents to Dutch medical terms.
In addition to mentioning these technical challenges, both sets of interviewees referred to negative affective dimensions of their interpreting work. Among
the interpreters in the Netherlands, the number of such aspects mentioned in the
interviews was three times higher (51 comments) than the number of positive
emotional aspects (17 comments). Two thirds found it particularly challenging
to interpret topics connected with sexuality, as they and/or the patients felt
embarrassed to talk about sex, genitals and diseases related to sexuality:
Well, it is about being embarrassed, isnt it? You feel embarrassed
towards the patient and also towards the doctor, you know. Once,
there was this woman ... and she said: A doctor is a doctor, you can
just [translate]. But I was so ashamed! I just could not [do it], but
anyway, I had to tell everything, and she even started to talk about sex,
that when she slept with that man it hurt .... At one point I thought: do
I really have to translate all this? And she started to say where exactly
it hurt, and then I thought: oh, these kinds of things are hard.
Likewise, a significant majority (12) of the interviewees in Turkey either

recalled their own awkward experiences of interpreting for a patient with a
problem affecting their genitalia or with some other condition perceived as
embarrassing or shameful, or speculated that such a situation would make them
and the patient feel uncomfortable. One interpreter, for instance, recounted
the difficulties he faced in getting his father to talk openly about a prostate
condition. The grandmother of another interpreter had complained at home
about having a burning sensation when urinating but told the doctor she had
had a headache and mentioned some symptoms related to her ongoing diabetes
and heart problem. According to several respondents in Turkey, patients and
interpreters were especially uneasy about discussing taboo topics when the
interpreter and/or doctor were of the opposite gender to the patient. A total of
eight male interpreters mentioned occasions when they felt awkward about
interpreting for a woman with a gynaecological problem or stated that they had
not had such an experience but knew that they would find it very embarrassing
or even impossible to deal with. Five respondents made the point that there
are many patients who are ashamed of talking about such matters with a doctor of the opposite sex. However, those respondents in Turkey who addressed
this issue gave the impression that what disturbed the relatives for whom they
had interpreted was not so much being examined by a doctor of the opposite
sex as talking about gynaecological and similar matters in the presence of a
Unless noted otherwise, all subsequent translations from the Dutch and Turkish are
our own.
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young relative. Three respondents emphasized, moreover, that this seemed

more disconcerting for female patients who were around the same age as their
interpreter than it did for patients from an older generation.
A noticeable difference between the two groups of interpreters concerns their
attitudes towards having to interpret for family members and acquaintances.
Six interpreters in the Netherlands reported experiencing feelings of conflict
between their obligation to interpret for their parents and their own, often
hectic, schedules such feelings were not voiced by any of the respondents in
Turkey. Furthermore, two Dutch-speaking interpreters expressed annoyance at
the fact that their parents did not learn Dutch themselves: Sometimes I think:
why dont you have command of the [Dutch] language? I understand that it is
quite a difficult language, but it would really make things easier if my parents
could speak Dutch. In contrast, a clear majority of the interviewees (12) in
Turkey made it very clear that what upset them about performing this role was
having to interpret at all for a person whose mother tongue (i.e. Kurdish) was
actually the most widely-used language in that area, whereas the doctor was
speaking Turkish, the mother tongue of a minority in Southeastern Anatolia, but
the sole official language nationwide. Five interviewees commented on how
sorry they felt that their parents and elders were in the humiliating position of
having to rely on them. All 12 of the above-mentioned interpreters noted that
it would be preferable if the patient and doctor conversed in Kurdish, so that
there would be no need for an interpreter. As they saw it, getting someone to
interpret between a Kurdish-speaking patient and a Turkish-speaking doctor
effectively meant upholding the exclusive dominance of Turkish in the public
sphere, whereas they wanted to see a higher degree of parity between these
two languages. In the words of one of them, In fact, interpreting means doing
something that is forced on you by the state.
Although interpreting was generally regarded as a burden, in particular
by the Dutch-speaking interviewees, none of our interviewees had ever
thought of refusing a request to interpret. At the very least, they felt they had a
responsibility to help those in their family or community less capable of communicating with the healthcare providers. Thus, respondents in both countries
had ambivalent feelings about their interpreting work. Eleven interpreters in
the Netherlands mentioned that it was normal to give something back to their
parents or other family members, and that the act of interpreting was part of
This
position concurs with the policy backed by activists and supporters of the former Peace
and Democracy Party (BDP), the most popular party in many areas of the East of Turkey. The
same idea underlies the efforts of the Diyarbakr Chamber of Medicine, who are engaged in
various projects to develop Kurdish as a language of medicine and to improve the Kurdish
competence of doctors working in the region. In 2009 the Chamber published a book, Krte
Anamnez / Anamneza bi Kurmanc (Anamnesis in Kurdish), which presents Kurmanji and
Turkish versions of the questions general practitioners and specialists will need when taking
a patients history (Blbl et al. 2009). This was followed in 2010 by the publication of a
manual for obtaining informed consent from Kurmanji-speaking patients.
322
their responsibility to take care of them. In the Turkish case too, providing
interpretation was regarded very much as part of everyday family life. Talking about interpreting as a child, one woman commented, You see it like
any other request, like Take this glass to the kitchen and bring an ashtray
something usual normal a striking illustration of how interpreting is
lumped together with the various other tasks children in Turkish and Kurdish
societies are expected to perform for their seniors. This concurs with the finding of Rosenberg et al. concerning various family interpreters in Canada, for
whom [i]nterpreting is just one of many family [sic] roles family interpreters
carry out (2007:92).
Moreover, ten of the Dutch-speaking interpreters and seven of those in
Turkey said that they actually derived satisfaction from helping people through
interpreting. One of the latter, who grew up in a small village where very few
people spoke Turkish, emphasized that being able to interpret heightened his
status within the family and community and made him feel rather special. Other
positive consequences mentioned were the fact that the interviewees had the
opportunity to improve their own social, communicative and linguistic skills:
It is instructive. . You learn specific words you never use, for instance in
Russian or the other way around: I know the word in Dutch, but I dont
know how to say it in Russian .... It was instructive to [interpret].
3.2 Communication and attitudes
Twenty-two fragments in the Dutch interviews refer directly to the medical
communication process: 11 in positive terms, 11 in negative terms. In general,
the interpreters in the Netherlands commented positively on their experience of
communicating with general practitioners. Most of them were patients of the
same GPs as their parents, so the family had established a relationship of trust
with their doctor. In contrast, the negative fragments refer to communicating
with medical specialists, with whom such a relationship is absent. According
to the Dutch interviewees, specialists are impatient, use too much medical
jargon, and seem to be annoyed by the fact that the interpreted communication
takes up too much time.
The interviewees in Turkey pointed to three kinds of responses from doctors.
Nine interviewees had not personally experienced any uneasiness or aggressive
demeanour on the part of doctors when it became clear that the patient could
not speak Turkish and that the interviewee was there to interpret. However, two
respondents felt that the doctor was reluctant to communicate with them, giving
the impression that he or she was thinking Ive got enough on my plate without
having to deal with you lot, as one interviewee put it. The remaining four interviewees mentioned occasions when they had actually ended up arguing with
doctors: in two of these instances, the interpreter believed the doctor was not
giving the patient the attention they deserved, whilst in the other two the doctor
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simply insisted that the patient address him or her in Turkish, even though it
was patently impossible for them to do so. Notwithstanding these quite extreme
examples of conflict, the picture the respondents paint of doctors responses is
probably very different from what one would have witnessed in Turkish hospitals
and clinics twenty years ago, when doctors who communicated with patients in
Kurdish faced persecution (Maviolu 2010:20).
Turning to interpreters perceptions of the process of communicating with
the patient, ten Dutch-speaking interpreters reported negative experiences.
They felt that patients demanded too much from them, for instance by getting them to repeat the same information over and over, or by asking them to
translate information which was, in the interpreters opinion, irrelevant. They
also sensed that patients were frustrated and distrustful, feelings that stemmed
from them being entirely dependent on the interpreter. As for the interpreters in
Turkey, although ten claimed that they had a good rapport with the patient during the consultation, four admitted that they often found elderly relatives rather
stubborn, demanding and sceptical. One respondent related the story of when
she had gone to see an eye specialist with her grandmother-in-law, who was
hoping to have an operation to correct her sight. When the respondent relayed
the doctors judgement that such an operation was too risky given the patients
age, the grandmother-in-law accused the interpreter of deliberately adding this
message in order to avoid the costs of such an operation. Another interpreter
similarly recalled being accused by her own grandmother, who lived with her,
of making up the doctors advice that she diet in order to save on food expenses.
Such examples reveal the potential for problems when the informal interpreter
has multiple and possibly conflicting interests with respect to the patient a
situation all the more likely when the two are connected by the strong bonds of
an extended family. As is evident from the two examples, things become more
complex still when the patient has little grasp of health issues.
Suggestions made by interpreters in the Netherlands to improve doctorinterpreter-patient communication ranged from doctors allocating more time to
these triadic conversations and showing more concern for their patients, to organizing formal interpreters in their practices, for instance by having them available
a couple of hours each week. For two-thirds (10) of the interviewees in Turkey,
the optimal solution was that Kurdish-speaking doctors should be employed or
Turkish doctors coming to the area should learn Kurdish. For the most part,
their prime demand was not that the Turkish state should provide professional
interpreters but that the indigenous population should be able to communicate
with doctors in their own language. As one student put it rather passionately,
With regards to areas outside the East with large Kurdish populations, three interviewees
suggested that Kurdish-speaking doctors could be deliberately hired there and Kurdish
speakers would naturally gravitate towards such doctors. For a real-life example of the
latter-mentioned phenomenon, see Maviolu (2010), a portrait of a Kurdish-speaking
doctor working in Istanbul.
324
Im not asking for my family to have a formal interpreter. because

its my country Im living in . My family has been living on their
own land for thousands of years. Thats why I want them to have
their own doctors, using their own language. Were not Turks living in Germany; were Kurds living in Kurdistan . Were the real
owners of this land . Im not demanding [professional interpreting
services]; in fact I want exactly the opposite.
Aside from such ideological considerations, another reason why informal

interpreters and their families in Turkey have doubts about the viability of
interpreting as a solution to their communication problem is arguably the
damage that negative experiences of informal interpreting have done for the
reputation of interpreting in general. Based on a history of interpreting by
inappropriate people10 with poor competence in both languages, with little
biomedical knowledge, with no training in effective interpreting methods,
and scant awareness of ethical issues such as confidentiality, transparency
and accuracy, ordinary citizens and health professionals alike tend to tar all
interpreters with the same brush. Thus, in the editors preface to Anamnesis
in Kurdish, we find the comment Patient histories and complaints conveyed
to doctors through an interpreter are unreliable and may give rise to wrong
diagnoses and treatments (Adem Avckran, in Blbl et al. 2009:8). This
generalization of course flies in the face of successful interpreting practices
in healthcare settings elsewhere in the world.
While Dutch-speaking interpreters acknowledged the superior (language)
skills of professional interpreters, 13 preferred to interpret themselves, giving
both practical and affective reasons for this. Besides feeling obliged to help
their relatives by interpreting, they also incorrectly assumed that it was too
expensive to hire a professional interpreter, as well as overly complicated. In
contrast, according to one interpreter, informal interpreting is simple: you
ask your son and he goes with you. Or you have to arrange a [professional]
interpreter, and I dont know, it sounds much more complicated than can
you come with me, do you have time?. The misconception that patients
themselves are responsible for solving their language problems, which is also
widespread among healthcare practitioners, might have been leading these
interviewees to resort to doing the interpreting themselves. However, many
of their remarks also reflected a general sense of mistrust towards formal
interpreters; they were, in essence, seen as outsiders. Doubts were expressed
about professional interpreters ability to convey the patients emotions to the
doctor. Respondents mentioned that patients disliked relating intimate details
to formal interpreters and preferred to keep such things within the family:
For example, a child, or the husband of a woman who has come to see a psychiatrist
about her marital problems.
10
325
In particular when it is through the telephone. Because then, my mother

will think What am I saying here to someone I dont know at all? ...
You often talk about personal things with your doctor, and I dont know,
I am almost 100% sure that my mother will think No, to arrange an
unknown person for things like this goes way too far.
Almost all the interpreters in the Netherlands (13) stated that they would rather
accompany their family members themselves, as they feel they are better able
to do the job than professional interpreters, because they have firsthand knowledge of their relatives medical problems: I know about the whole situation,
while a [professional] interpreter doesnt know my mother at all. He or she
does the job and goes home. But I know my mothers complaints and when
she suffers from them.
In marked contrast to their counterparts in the Netherlands, no fewer than
ten of the respondents in Turkey looked positively on the possibility of trained
professionals interpreting for non-Turkish-speakers, although, for the most
part, they saw this as a second-best alternative to monolingual communication
in Kurdish between the doctor and the patient. They thought that interpretation
by a person appointed by the state an option that does not currently exist in
the Turkish health system11 would be more reliable than interpreting done
by family members. Two interpreters acknowledged that their seniors would
be reluctant to divulge intimate and potentially embarrassing information to a
stranger, but even more interviewees were of the opinion that those for whom
they interpret would have more confidence in officially trained and appointed
interpreters. Five interviewees felt that patients mistrusted their capabilities
and motives, with some recalling specific occasions when an elderly patient
did not believe their junior was fully and accurately recounting in Kurdish
what the doctor had said in Turkish. One explanation proposed for this by
an interpreter is that, for older generations, in rural areas of the Southeast in
particular, being able to speak Turkish seemed like a fantastic achievement,
one that they found difficult to associate with their own children.
3.3 Role(s) of the interpreter
While interviewees did tend to resort to fairly hackneyed metaphors of neutral
and objective
transfer to characterize their role, referring to themselves as

relayers of messages from one language into another, the stories they told
suggest that they were much more active and interventionist while interpreting,
In July 2011, the Turkish Ministry of Health announced plans to develop medical care,
advice and interpreting services in English, German, Russian and Arabic, starting with
the establishment of pilot projects in four resort areas in Western Turkey (Cantrk 2011).
These measures, however, are targeted not at indigenous minorities but at the 30 million
tourists who visit Turkey every year.
11
326
sometimes filtering out information and orienting the medical consultation in

a manner that no professional code of ethics would recommend.
For instance, an interpreter in Turkey commented that his grandmother,
who lived with his family, had been ill for a long time and had constantly been
complaining about her symptoms. Up until three days before their visit to the
doctor, he listened to her complaints and arrived at his own diagnosis, but then
stopped paying attention to her grievances. When it came to the appointment
itself, he did not listen very carefully to the responses his grandmother gave
to the doctor and essentially reported only the symptoms he had remembered,
which did not include the most recent ones. The interpreter claimed that his
behaviour, as reprehensible as it may be, was by no means unique. He argued
that those who live with the people for whom they interpret believe they are
familiar (and perhaps even fed up) with the patients complaints and think
they know which ones are genuine and which are invented or irrelevant. The
interpreter, today a medical student, admitted that he translated in a much more
faithful and ethically acceptable way when his client was a stranger in the
hospital where he was doing the rounds together with his professor. All the
same, the case involving his grandmother certainly ties in with the findings
of several researchers that untrained, informal interpreters are particularly
likely to slip into the role of the primary interlocutor and ask questions and
supply information of their own volition, rather than restricting themselves to
relating what the other interlocutors have said (Baker et al.1998, Hasselkus
1992, Meyer 1998).
In another example, in order to give a patient more appropriate care, a
Dutch-speaking interpreter advised the healthcare provider about the proper
medication dose for her mother. This interpreter, who has a background in
biomedical science, felt that she was more capable of assessing the right treatment for her mother than the nurse treating her:
The nurse did not consider increasing the dose for my mother, so I asked,
Is it possible to increase the dose? She originally wanted to give my
mother another medicine .... Since then my mother has been using that
[increased] dose and it works perfectly for her. I can quite accurately
assess what they need, what they want, and how they want it to be
improved. So I sometimes talk based on my own feelings .... I want the
best medicine, yes, the correct medicine, the optimal solution.
A further example indicating the responsibility the interpreters might feel to

act on behalf of the patient, even when they hardly know him or her, was recalled by a Dutch interpreter who had accompanied an old lady to the general
practitioner to discuss a heart problem. To make sure the patient obtained a
referral to a cardiologist, this interpreter directed the patient to exaggerate
her complaints:
327
I once went to the doctor with this old lady and [the doctor] said: I
only give a referral if she suffers because of her heart at night ....
But the old lady said, I dont have any pain at night. Then I said
to her in my own language, You do have pain at night, dont you?.
Then she said, Yes?. I said, You just told me that you have pain at
night. Because she desperately wanted a scan of her heart, but the
doctor did not want to do that, so I was thinking: I feel sorry for her,
lets just do that, maybe there is something wrong. But then the old
lady said, It hardly hurts at night. I said, Just say you are in pain
at night!. Because I knew what the doctor had just said to me, you
know, so I said: Yes, she is in pain at night, but not as much as during
the day. And then he said, Okay, if she is suffering at night, then I
will write a referral.
In the interviews in both countries, we also heard about several cases where
an interpreter claimed to have carried out rather more subtly selective and
manipulative renditions in order to ensure that, within the limited time allowed
by the medical interaction, the uneducated and elderly patient received what
the interpreter believed to be the appropriate information about the illness
and also acted in the way recommended by the doctor. For instance, one of
the Zazaki-speaking interpreters in Turkey tended to use general expressions
to render the doctors comments on the severity and consequences of the
illnesses, partly not to shock the patients and partly because his language supposedly lacked the terms needed to describe a medical condition in detail. He
translated fairly technical diagnoses with sentences like Theres no need to
worry, Its a very simple problem, or This needs to be taken seriously.
Another respondent in Turkey conceded that he had sometimes exaggerated
the warnings or advice given by the doctor, since his father was not taking
sufficient care of his health. For example, when a doctor said You shouldnt
eat red meat, in Kurmanji this became, The doctor says you mustnt eat meat
under any circumstances (our emphases).
Several interpreters reported leaving large chunks of discourse uninterpreted. This occurred when the interpreter deemed the patients talk redundant
and (in the Dutch case) the doctors time ran out. Indeed, interpreters in both
countries mentioned time limitations as an important factor determining
translation strategies. One Zazaki speaker, for example, noted that a doctor in
a state hospital only assigns two or three minutes to each patient; since this
is not enough to relay everything the patient has said, the interpreter presents
a refined and succinct summary of the necessary points based on what
the interpreter has been told by the patient at home.
As is evident from the above examples, many of the interpreters we interviewed went far beyond offering a more or less literal rendition of what the
interlocutors said to one another: they reported omitting, adding and modifying
information, exaggerating or toning down, and involving themselves actively
328
in the conversation to make sure patients felt understood and received the care
they needed. In the Netherlands, 12 out of the 15 respondents reported undertaking such interventionist actions at one time or the other. Besides seeing
themselves as competent translators, these interpreters perceive their roles as
being advocates for the patient and persons of trust to whom the patient can
turn for advice, mediation and support.
In Turkey, three interpreters professed having tried to present a wordfor-word rendition of what other interlocutors said. In several cases, this
strategy apparently led to communication difficulties, since the interpreter
provided a literal Turkish rendition of a Kurdish idiomatic expression used
to describe the symptoms of an illness a rendition which the doctor then
struggled to decipher. Alternatively, when faced with a term in Turkish for
which they did not know the Kurdish equivalent, four interpreters simply
repeated the Turkish word one reported pointing to the relevant part of the
body while doing so an effective strategy (according to two interviewees)
since the patients had some knowledge of basic Turkish medical vocabulary.
On balance, the proportion of interviewees in Turkey who reported taking
steps such as paraphrasing, explaining terms and interjecting questions was
somewhat lower than in the Netherlands (8 out of 15). All the same, at least
four Turkish interpreters acknowledged trying to correct mistreatment or
abuse, as the (US) National Council on Interpreting in Healthcare defines
advocacy (NCIHC 2005:16), when they felt the doctor was not behaving appropriately towards the patient. The most striking example of this was when
a young woman, who had her own appointment at a hospital, witnessed a
doctor shouting at an old Kurdish woman and telling her that he would not
treat her if she did not speak Turkish. At this point, the young woman came
over to the patient and offered to interpret for her, while putting it to the doctor in no uncertain terms that what he had said contradicted the Hippocratic
Oath and that she would complain about him to the hospital management and
other authorities.
4. Discussion of the findings
Turning to examine the common threads in the responses of interviewees in
the Netherlands and Turkey, a glance at our data on the technical aspects of
informal interpreting and on the roles of the interpreter confirms the oftenmade observation (Arranguri et al. 2006, Flores et al. 2003, Meyer 1998,
Twilt 2007) that informal interpreters are even less likely than their professional counterparts to function as invisible, neutral conduits who more or less
interpret word-for-word. Although several of our interviewees, in particular
the ones in Turkey but also a few in the Netherlands, claim that they (strive
to) translate literally between doctors and patients, probably because of a misguided view that machine-like interpreting is the ideal, their stories clearly
329
show a different picture.

Another related finding of this study that has been reported previously
(Green et al. 2005, Rosenberg et al. 2007, 2008) is that informal interpreters
commonly act as advocates for their patients. The role of an advocate can
entail a wide range of actions such as encouraging the healthcare provider to
give more detailed information, manipulating the message of the doctor so
that it will have more of an impact on the patient, resisting what is perceived
to be discriminatory behaviour on the part of the healthcare provider and in
perhaps its most extreme manifestation pushing the patient to say things
that (according to the interpreter) will improve his or her chance of receiving
suitable care. Furthermore, respondents from both countries mentioned cases
where they had diverged further still from the conduit model and responded
to, or addressed, the healthcare provider without being prompted to do so by
the patient; in other words, they had performed primary interlocutor actions
(Meyer 1998:3), a practice common among informal interpreters but less commonly evidenced among professional interpreters (Rosenberg et al. 2008:92)
and certainly strongly discouraged in codes of ethics and good practice.
Although the data from our interviewees do point to similarities of this kind
across the two countries, which concur with the findings of previous research,
there are also significant differences. Our analysis was based on a small sample
of two sets of 15 interpreters, so at this stage we can only speculate as to the
relationship of our findings to the situation and socio-cultural attributes of
young migrant informal interpreters in the Netherlands on the one hand and
their Kurdish-Turkish counterparts on the other hand. All the same, given the
quite marked differences between the two sets of respondents with respect to
some aspects of interpreting experience and behaviour, it seems reasonable
to propose some tentative explanatory claims.
Our findings appear to corroborate the claims of Angelelli (2004b),
Inghilleri (2003), Wadensj (1992) and others, namely, that interpreted communicative events and the agents involved in them are heavily influenced by
socio-political and cultural contexts. To demonstrate this, we may consider the
factors behind the different attitudes informal interpreters in the two countries
seem to have towards the task of interpreting. Our finding that interviewees in
Turkey were on the whole and notwithstanding their preference for monolingual communication in healthcare settings rather less negative about
interpreting for their elders or others than their Dutch counterparts, seeing
it as more normal and less of a burden, might be seen as evidence for the
influence of the cultural context and understood in terms of Hofstedes (2001)
differentiation between individualistic and collectivistic tendencies. Many
Kurds in Turkey, especially in rural areas, continue to assign great importance
to the (extended) family and to respecting and assisting elders. This could be
one reason why the interviewees in Turkey have never refused to interpret
and, as adults, generally refrained from blaming patients for their inability
330
to communicate on their own. In contrast, some interpreters in the Netherlands, including those of Turkish origin, whose identifications of citizenship
are multidimensional and who have inevitably taken on traits of the more
individualistically-inclined indigenous culture alongside those of their heritage culture (Phalet and Swyngedouw 2002), expressed irritation towards the
demands of their parents and frustration with having to spend time and effort
assisting their relatives. They also mentioned they wished that their parents or
other family members for whom they interpret would learn Dutch.
Rather than applying merely a cultural model to understand such differences, though, we also need to see the interpreters professed thoughts
and actions within the framework of their specific political and institutional
constellations. The Kurdish-speaking interviewees non-judgemental approach
to patients who cannot speak Turkish, for instance, is no doubt linked to their
generally strong ethnic affiliation and to the accompanying belief that the onus
should be on doctors to speak to their patients in Kurdish. As for the impact
of institutional differences, the existence of the GP system in the Netherlands
might explain why Dutch-speaking interpreters appeared far more satisfied
with their encounters with GPs than with their meetings with specialists.
Like their clients, they have probably built up a relationship of trust with the
GP following frequent visits, whether as interpreters or patients. In Turkey,
however, a system of family doctors was only established across the country
in November 2010. Prior to that, and even now, it was (and is) very common
for patients to refer themselves to the relevant department in the hospital. This
system meant that patients and interpreters had less likelihood of coming into
contact with the same doctor and thus building trust, unless they visited the
same department in the hospital on a regular basis.
Whereas our interviewees and their relatives in the Netherlands appeared
to prefer informal over professional interpreting, in Turkey the opposite was
the case. There, the option of a professional service provided by individuals
trained for the job appears to be relatively attractive to people who have only
ever experienced interpretation done by their relatives and acquaintances.12
At the same time, the availability of professional interpreting services in
the Netherlands and their absence in Turkey might well have influenced the
manner in which the two sets of respondents interpreted. As has been noted,
the interpreters in the Netherlands expressed greater satisfaction with their
performances and recalled deploying methods that suggest a quite serious and
competent approach to their interpreting work. About half of the interviewees
reported endeavouring to enhance communication and understanding between
parties by taking along dictionaries, making drawings, recapping information,
In a survey conducted among 54 patients at two Southeastern Anatolian state hospitals
in 2009, 48% of respondents rated the interpreting they had received not very successful
while 15% thought it was unsuccessful, leaving just 47% who were satisfied to some
degree (Ross and Dereboy 2009).
12
331
explicitly checking patients understanding, and repeating the same information several times. In the interviews from Turkey, we find relatively more
cases where interpreters offered meaningless word-for-word renditions or
supplied information independently without indicating they were doing so.
To be sure, it is quite likely that the Dutch-speaking interpreters recourse to
such measures primarily reflects factors such as a higher educational level
and greater competence in both languages. However, even though none of the
interviewees made a concrete link between their experiences of professional
interpreting and their own interpreting performances, it may be speculated
that the interpreters who employed such methods had witnessed, or heard
about, the way professional interpreters did their job and were aware that effective interpreting required a variety of communicative techniques and was
more than just linguistic recoding, the latter being what many of the Kurdish
speakers seemingly thought.
The attitudes of the two sets of interviewees on the question of informal
versus professional interpreting differed in another notable way. Whereas one
of the main objections to professional interpreting mentioned by respondents
in the Netherlands was that, in this kind of arrangement, another outsider
besides the doctor was party to the intimate details of the patient, the interviewees in Turkey thought quite differently; they predicted that they and their
clients would feel more comfortable if an outsider were there with the doctor
than if the interpreter were a family member a view that is arguably rooted
in cultural conceptions of what is acceptable and unacceptable for people
to talk about in the presence of younger relatives and/or of relatives of the
opposite sex. As one respondent put it, Us Anatolian folk, and especially us
Kurds, are much more conservative. A woman a mother even if shes
a hundred years old, cant speak about some subjects comfortably with her
children. Theres no way my sister can do that.
5. Conclusion
This small-scale study offers some rare insights into the experiences,
attitudes and behaviours of informal interpreters from the perspective of
the interpreters themselves. Some points to emerge from the interviews
were common to respondents in both the Netherlands and Turkey, as
well as familiar from the literature on non-professional interpreting. As
such, they suggest the existence of common, cross-national tendencies in
informal interpreting in medical settings, a possibility worthy of exploring
more thoroughly in future research on this topic (see below). Besides
common features, we also identified differences in the feelings, thoughts and
practices reported by respondents in the two territories. Among these were the
contrasting attitudes towards professional interpreting services, the greater
use of quasi-professional strategies by respondents in the Netherlands, and
332
Kurdish-speaking interpreters unquestioning willingness to interpret for

their elders but at the same time their resentment at having to interpret in
the first place. In the Kurdish-Turkish context, moreover, taboo subjects
appeared to complicate communication between the doctor, patient and
family interpreter in a quite distinct way. Although previous research
has acknowledged that the role of interpreters should be considered in
relation to the social contexts in which they operate, to date no study has
contrasted the experience of informal interpreters in different geographical
and cultural settings. To the best of our knowledge, this study is thus the
first to suggest by means of comparison how the attitudes and practices of
informal interpreters might be influenced by the conditions in the country
in which these interpreters live and work.
The comparison is all the more interesting because of the very different
social and political contexts surrounding medical interpreting in the two
countries. In the case of the Netherlands, we have a prosperous and famously
tolerant country where the state has until now favoured and funded professional interpreting services targeted at migrants. Turkey, on the other hand,
can be described as an economically less developed country, in which for
many decades nationalist assimilationism and rigid monolingualism helped
hinder the provision of interpreting services, which would have benefited
above all Turkish-born citizens with limited proficiency in Turkish. The lack
of professional interpreting services and of health workers competent in
minority languages, combined with the previously hostile attitude towards
doctor-patient communication in these languages, led to widespread recourse
to informal interpreting. As we hope to have shown, traces of these distinct
contexts can be discerned in the responses of our interviewees. All the same,
while in terms of official policy the Netherlands and Turkey seem to belong
to different stages on Uldis Ozolins four-stage international spectrum of
response to multilingual communication needs in interpreting (2010) with
Turkey edging from Neglect to Ad hoc and the Netherlands poised somewhere between Generic language services and Comprehensiveness the
reality on the ground in these two territories is not so different; in both, the
use of untrained informal interpreters is common.
Since our analysis is based on two narrow samples, in order to arrive at
more conclusive findings concerning interpreters from specific localities
or communities, future research would have to include larger groups of
respondents and reduce the variables related to the group(s) under examination,
as Lucy Tse did in her 1996 study of 64 Chinese- and Vietnamese-Americans.
A more true-to-life picture of the performance of informal interpreters could
also emerge from analysis of actual doctor-patient-interpreter discourse, which
would provide primary evidence of informal interpreters translation strategies,
procedures and decisions (Bhrig and Meyer 2004, Cambridge 1999, Flores
2005). A further method to gain more insight into the experiences of informal
interpreters and the socio-cultural influences on their performances would
333
be stimulated recall, which involves showing interpreters video recordings

of their own performances and asking them to comment on their thoughts,
feelings and roles during the interaction (Leanza 2005).
Outcomes of such studies might also point to possible ways of improving
the communication process between doctors, patients and informal interpreters.
Development of training materials for bilingual laypersons and healthcare staff
who frequently function as interpreters might be a solution, one for which the
experience of TRICC proves illuminating (Meeuwesen and Twilt 2011:83). At
the same time, in the face of the cuts to translation and interpreting services
currently being made in the Netherlands and across the crisis-hit world, it is
vital to push the case for professional interpreting and translation services. It
is also important to educate professionals and laypeople alike about working
with interpreters, whether professional or informal. An intervention study
carried out in Switzerland, which aimed to improve communication between
physicians and patients who speak a foreign language, is a good example of
how physicians might be trained in using professional interpreters effectively
(Bischoff et al. 2003).
As for the Turkish situation in particular, the tendency in the Southeast does
seem to be towards monolingual doctor-patient communication in Kurdish and
the sidelining of the informal interpreter. There is arguably even greater need,
and more potential, for the development of interpreting facilities (involving
Kurdish, other minority languages, and the languages spoken by refugees) in
the major cities of Western Turkey, which could include the training of health
workers, or other interested parties, as interpreters (Gven 2011). This was
the conclusion drawn in a report by the vice-president of the Turkish Human
Rights Association (IHD), who noted that the problem of medical communication was particularly acute in areas where Kurdish was not widely spoken,
above all in Istanbul (Erbey 2007).
The use of informal interpreters in healthcare is a reality in a country
such as the Netherlands, where professional facilities are well-established,
just as it is in a country like Turkey, where not even the groundwork for such
facilities has been laid. Until now, much of the interpreting and translation
studies community has disapprovingly turned a blind eye to non-professional
interpreting, including interpreting in healthcare settings. However, nonprofessional interpreting is not just a fascinating subject and a rich source of
research material, but also part of the everyday life of millions of people across
the world, regardless of what official policies prescribe and what solutions
interpreting scholars would prefer to see implemented. As such, it demands
greater attention from the scholarly community.
BARBARA SCHOUTEN
Department of Communications Science, Amsterdam School of Communication
Research, University of Amsterdam, Kloveniersburgwal 48, 1012 CX
Amsterdam, The Netherlands. b.c.schouten@uva.nl
334
JONATHAN ROSS
Department of Translation and Interpreting Studies, Boazii University,
Faculty of Arts and Sciences, 34342 Bebek, Istanbul, Turkey.
jonathan.ross@boun.edu.tr
RENA ZENDEDEL
Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB Amsterdam, The
Netherlands. r.zendedel@vumc.nl
LUDWIEN MEEUWESEN
Interdisciplinary Social Science Department, Utrecht University, Heidelberglaan 2, de Uithof, 3584 CS Utrecht, The Netherlands. l.meeuwesen@uu.nl
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Volume 18, Number 2 (2012), 311-38