Health workers: idealistic expectations versus interpreters' competence

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Health workers idealistic expectationsversus interpreters competenceIlse Feinauer a amp Harold M Lesch aa Afrikaans and Dutch Stellenbosch University Cape Town SouthAfrica

Available online 29 Nov 2011

To cite this article Ilse Feinauer amp Harold M Lesch (2011) Health workers idealistic expectationsversus interpreters competence Perspectives DOI1010800907676X2011634013

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Health workers idealistic expectations versus interpretersrsquo competence

Ilse Feinauer and Harold M Lesch

Afrikaans and Dutch Stellenbosch University Cape Town South Africa

(Received 2 February 2010 final version received 17 October 2011)

Health care professionals sometimes have expectations that interpreters cannotmeet In this case interpreters are expected to declare in writing that they assistedthe medical investigator to explain the information in consent forms for parentsof paediatric burns patients and volunteers on antiretroviral therapy Theseconsent forms were translated from English into Afrikaans and isiXhosa Theyalso have to declare that the patients fully understand the content of the relevantdocument and all their questions were satisfactorily answered This investigationshows that the interpreters did not fully understand the information that theyhave to explain None of the interpreters interviewed would like to sign theagreement certifying that they explained the information of the trial in thepatientrsquos mother tongue and that the patient understood it

Interpreters have to take primary responsibility in bringing the message acrossTaking the level of education of the interpreters into account it seems impossiblefor them to explain the medical procedures so that the patients can make aninformed decision They are set up for failure when they are confronted withthis task and these documents The conflict between what is expected of theseinterpreters and the reality of their position is spelled out

Keywords interpreting applied translation interpreting studies

Introduction

This article concerns intercultural communication within the health sector where

health workers are required to communicate across cultural boundaries on a regular

basis South Africa which has 11 official languages is a truly multilingual and

consequently multicultural country This leads to a situation where fellow South

Africans themselves are not able understand one another effectively not simply a

matter of foreign citizens not being understood (Pienaar 2006 p 36) The official

languages in the Western Cape are Afrikaans English and isiXhosa The majority of

residents in the Western Cape are Afrikaans speakers 25 million people use

Afrikaans as their home and first language This amounts to 553 of all Western

Cape residents more than half the population of the province IsiXhosa is the

language spoken by the second largest proportion of the Western Cape population

11 million people which is 237 of the Western Cape population English is

spoken as a first language by only 875000 residents or 193 of the Western Cape

population (Census 2001)

This article discusses the communicative (in)adequacy of the Afrikaans and

isiXhosa target texts translated from English that are used as consent forms for

Corresponding author Email hleschsunacza

Perspectives Studies in Translatology

2011 116 iFirst article

ISSN 0907-676X printISSN 1747-6623 online

2011 Taylor amp Francis

httpdxdoiorg1010800907676X2011634013

httpwwwtandfonlinecom

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parents of paediatric burn patients and volunteers on antiretroviral therapy In these

texts the interpreters have to declare by their signatures that they assisted the

relevant investigator by explaining the information in the document to the parent or

volunteer using the language medium of Afrikaans or isiXhosa They also have todeclare that the parent or volunteer fully understands the content of the document

and has had all their questions answered satisfactorily What will be investigated here

is not whether these texts communicate adequately with the parent or volunteer

but whether the interpreters fully understand the information that they have to

explain to parents or volunteers

The two issues discussed here are

Will the interpreters fully understand the information on the informed consentforms that they have to explain to parents or volunteers

Is it ethical to leave the explaining to the interpreters and then expect that they

should sign the informed consent forms declaring that the content has been

fully understood by the parents or volunteers

The aim of this article is to highlight the conflict between what is expected of the

interpreters and the reality of their position This will be done by reflecting on the

situation in the Western Cape South Africa The structure of the article will be asfollows sketching the situation by diagnosing the problem contextualising the

research within interpreting studies presenting the two sets of data ie the profile of

the interpreters and the comprehension test and finally the discussion of the results

The situation

The research on the informed consent forms concerned for the two projects was

conducted at the Tygerberg and Red Cross state hospitals respectively TygerbergHospital is linked to Stellenbosch University as a tertiary-level medical institution

The hospital was opened in 1976 and employs 1715 nurses and 536 doctors It treats

approximately 56000 in- and 590000 out-patients per year (Capegateway public

info 2009) The staff mainly has Afrikaans as their mother tongue with a small

proportion using English as first language The patients are also mainly Afrikaans

speakers with a small proportion with English as mother tongue IsiXhosa is the

predominant language among black patients (Williams 2005 in Saulse 2009 p 24)

Informed consent forms and information leaflets were distributed here among HIV-positive volunteer mothers who were using antiretroviral therapy with the title (see

Appendix1 Text 1) lsquoA DOUBLE-BLIND PLACEBO CONTROLLED RANDO-

MISED STUDY TO INVESTIGATE THE EFFICACY AND SAFETY OF LOW-

DOSE L-CARNITINEMAGNESIUM SUPPLEMENTATION IN PREVENT-

ING HYPERLACTINEMIA AND LACTIC ACIDOSIS IN HIV-INFECTED

SOUTH AFRICAN WOMEN ON STAVUDINE CONTAINING COMBINED

ANTIRETROVIRAL THERAPY (cART)rsquo

The Red Cross War Memorial Childrenrsquos Hospital is the only child healthinstitution in South Africa and is located near Cape Town It treats approximately

19700 in- and 216000 out-patients per year (Capegateway public info 2009) This

hospital is linked academically to the University of Stellenbosch the University

of Cape Town and the Faculty of Dentistry of the University of the Western Cape

The staff use both English and Afrikaans in equal proportions while the language

2 I Feinauer and HM Lesch

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among patients is very diverse with English Afrikaans and isiXhosa being used on

an almost equal basis (Williams 2005 in Saulse 2009 p 24) Informed consent

forms were distributed here among the parents or legal guardians of burns patients

entitled (see Appendix 1 Text 2) lsquoVIRTUAL REALITY FOR PAIN RELIEF IN

PAEDIATRIC BURNS PATIENTSrsquo

Feinauer (2003) discussed the profile of typical state hospital patients in the

Western Cape they were mostly lay people from a low socio-economic level who are

language impoverished have low or no level of schooling lack communication skills

sometimes do not use the standard varieties of Afrikaans English or isiXhosa they

are economically deprived they have low concentration levels they are ill are

intimidated by the unfamiliar environment and are without any medical knowledge

(Feinauer 2003 pp 216217) Feinauer and Luttig (2005) find that sometimes the

gap between the source-text recipients and the target-text recipients is too big

to be bridged by merely changing the translation approach from linguistic to

functional An empirical study was undertaken on how to present information on

primary ailments (HIVAids and TB) in an accessible form to lay people Actual

target texts in both Afrikaans and isiXhosa were assessed in terms of their

communicative success by using questionnaires amongst state hospital patients

who were on a much lower level of literacy or knowledge than that of the source text

recipients

The main communicative problems were ascribed to the fact that these target

texts were almost exact replicas of the source texts in other words the translators

still used the linguistic approach The source texts were retranslated using the

functionalist approach by translators who played a much more important role in

designing the target texts keeping the target readers in mind the whole time The

target texts were reassessed using the same questionnaires but with different

respondents The respondents however were on the same level of literacy or

knowledge as that of the first group of respondents Then the big disappointment

came comprehension did improve slightly but after all the effort and time that went

into the retranslation the improvement was not statistically significant What did

become apparent in this research is that a target text as such irrespective of the

translation approach is not the means to convey the necessary knowledge to these

target recipients

This should be kept in mind to contextualise the enormity and the responsibility

of the task assigned to the interpreters Before we look at the profile of the

interpreters at these two hospitals and their understanding of the relevant

documents let us look at what is generally expected from health care interpreters

(HCIs) as well as the role that the interpreters are supposed to play during the

communication process

Interpreting theory

Obligations of health care interpreters

According to Angelelli (2006 p 186) health care organisations sometimes have

expectations (which are sometimes even included in job descriptions) beyond the

interpreterrsquos control One of her respondents reacted by noting that lsquoproviders can

easily put us in the position of doing other things which we are not entitled to

do we donrsquot have the training we donrsquot have the capacity to do those thingsrsquo

Perspectives Studies in Translatology 3

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(Angelelli 2006 p 189) One of the reasons why HCIs are so often misused is because

it is so difficult to define their role in the system Angelelli (2006 p 175) says lsquoOne

of the most problematic issues is the role of interpreters Presumably this role should

be simple to describe the interpreter faithfully conveys a message from one

language to another while maintaining neutralityrsquo Angelelli (2006 p 182) identifies

the following roles that interpreters can play as they perform their task message

converter message clarifier cultural clarifier patient advocate

System agent

All four of these roles could be operative here but in this case the roles of message

converter and clarifier or as Jalbert (1998 in Leanza 2007 pp 1314) calls it the

role of bilingual professional will be the primary role Whatever role the interpreter

takes on here will be within the overarching role of the interpreter as the healthcare

provider or acting on behalf of the institutional or medical system Leanza (2007 p

17) refers to the interpreter playing the role of lsquosystem agentrsquo Here the interpreter is

in essentially the same (symbolic) position as the health care provider

The researchers want the interpreters to be translating machines in other words

to act as linguistic agents but to simultaneously act as health system agents since

they want the interpreter to get the parents or the volunteers to sign the informed

consent forms in order to be able to conduct their research The researcher explains

the relevant information on the informed consent forms to the interpreter(s) and

then the interpreter is left with the patient in a situation of dialogue and not in a

situation of trialogue which is usually the default situation for HCIs As Leanza

(2007 pp 1314) puts it the interpreter becomes the healthcare professional The

fact that the interpreter has to sign that the information was conveyed clearly to the

patient and that the patient understands the information implies that there is an

agreement between the health care provider and the interpreter before the discussion

starts between the interpreter and the patient The interpreterrsquos signature will indicate

that she has kept to the agreement

This is in direct opposition to the view that the interpreter is usually part of

the lsquotreating teamrsquo but is not regarded as the person with the primary responsibility

for the care and treatment of patients The interpreter is usually regarded as acting in

a secondary or supporting role The United States National Council on Interpreting

in Health Care (NCHIC 2004 16) states

Interpreters in health care understand that they are not there as primary participants inthe interaction and therefore are not in a position to make decisions to advise orcounsel Their function is that of a communication facilitator and as such theirresponsibility is to the process of communication and the facilitation of a mutualunderstanding of meaning It is not within the interpreterrsquos set of duties to give advice orto counsel either party with respect to the goals of the health care encounter

Here however the interpreter is pushed into the primary role and has to take

primary responsibility This according to Angelelli (2004 pp 78) would mean that

the interpreter aligns with the system and the interpreter alone has to construct the

conversation This means that the task for bringing the message across is the sole

responsibility of the interpreter This is not a new role for interpreters as seen from

various publications on the role of the interpreter such as the book by Pochhacker

4 I Feinauer and HM Lesch

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and Shlesinger (2007 p 2) where one of the roles of the interpreter is described as

someone who could take over the interview and the article by Anthonissen (2008

p 171) which describes the mediating role of the interpreter as providing lsquoguided

constructive interventionrsquoThis more visible interpreter could only successfully step into the shoes of the

health care provider whilst also acting as message converter message clarifier and

cultural clarifier if she were able to fully understand the documents The interpreter

should provide the most faithful rendering possible of what these document say This

does not only entail an accurate translation of the words spokenwritten but also a

translation that formulates the information in such a way that it becomes coherent

within the world view of the patient In order to do this the interpreter needs to have

a deep and thorough knowledge of the subject matter as well as the language usedwithin that field It is obvious that the more explication needs to go into the

clarification of the message the better the interpreter ought to know the subject field

and its discourse The ability to interpret accurately and completely is to a large

extent dependent on how much background knowledge the interpreter has of the

content and context of the communication Romero (2008 p 19) states with respect

to court and legal interpreters that interpreters cannot interpret what they do not

know or understand Communication in the legal setting is guided by an under-

standing of the use of legal arguments protocol procedures laws and traditions Ifinterpreters are not prepared to handle this task they will get in the way or perform

poorly The same applies to HCIs especially if they don the white coat of the health

care provider

According to NCHIC (2004 p 18)

The ethical obligation of interpreters is to possess enough understanding of culture andcultural practices and beliefs to be able to facilitate communication across culturaldifferences seeking to minimize and if possible avoid potential misunderstanding andmiscommunication based on cultural assumptions andor stereotyping Under certainconditions such as clashing cultural beliefs or practices a lack of linguistic equivalencyor the inability of parties to articulate the differences in their own words the interpretershould assist by sharing cultural information or helping develop an explanation thatcan be understood by all (our emphasis)

NCICH (2004 pp 1314) also states that the language used by the provider is asource of data for the patient The patient therefore should be able to access both

the technical information and the information about the kind of relationship the

provider is attempting to establish in order to make decisions that will impact on

his or her health and wellbeing Here this is relevant since the parents or volunteers

have to sign informed consent forms In order for the parents or volunteers to

internalise the necessary information to make the correct and informed decision the

interpreter would have to have succeeded in making all the information clearly

understood

Community agent

The interpreters in this situation could also act as community agents who play an

advocacy role This is the counterpart of the role of system agent where the

interpreters are agents of the institution and spokespersons for the healthcare system

and its discourse As community agents the interpreters may act in accordance with

Perspectives Studies in Translatology 5

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the cultural norms and values of their own community If the role of advocate is

adopted it presupposes once again that the interpreter is well informed about the

laws rules and procedures that need to be relayed (Leanza 2007 p 14) The task

of the interpreter is twofold here disclose all relevant information necessary for

making an informed choice about proposed procedures and ensure that the patient

understands the information received and the implications of giving consent (adapted

from Johnstone 1999 p 235 who applied this to the role of the nurse regarding

informed consent) Since this research deals with informed consent the interpreterrsquos

role here should rather be that of an advocate for parents and volunteers improving

their level of understanding and in that way helping them to make an informed

decision about taking part in the research or not

What is informed consent According to Robertson (1981 p 102 in Johnstone

1999 pp 210211)

The doctrine of informed consent although having a profound ethical dimension isessentially a legal doctrine developed partially out of recognition of the patientrsquos right toself-determination and partially out of the doctorrsquos duty to give the patient lsquolsquoinformationabout proposed treatment so as to provide him or her with the opportunity of makingan informed or rational choice as to whether to undergo the treatmentrsquorsquo

Johnstone (1999 pp 224225) also feels that the term lsquoinformed consentrsquo should be

abandoned in favour of lsquoinformed decision-makingrsquo Unlike the notion of lsquoinformed

consentrsquo this formulation seems to invite continuous re-evaluation of any decisions

made about care and treatment options Patients must also be informed of their

right to refuse a recommended medical or nursing procedure and should be kept

up to date on the relevant details pertaining to their cases This should be done

by interpreters who adopt the role of patientrsquos advocate Details which are not

readily understood should be explained (in understandable language) and reinforced

through planned patient health education programmes something that nurses

interpreters are educationally prepared to undertake Many factors can deter patients

from exercising informed and voluntary choices amongst which is poor commu-

nication The patientrsquos ability to understand entails whether the patient is able to

comprehend the risks benefits and alternatives to a proposed medical procedure as

well as the implications of giving consent The question could be asked concerning

just how sophisticated a patientrsquos understanding needs to be and in this case

how sophisticated the interpreterrsquos understanding needs to be in order to really

explain these procedures and to really support these parents and volunteers in

making their decisions

Data

Two phases of data collection were involved Both were done during one

consultation with the interpreters The first phase aimed at compiling a profile of

the relevant interpreters whereas the second phase entailed completing a compre-

hension test ie an exercise to ascertain whether the interpreters understand the test

that they were supposed to explain to the patient

6 I Feinauer and HM Lesch

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Profile of interpreters

The interpreters of the Tygerberg and Red Cross state hospitals were visited by the

researchers and asked to complete questionnaires on their training background

comprehension of the target text etc At Tygerberg only one interpreter was found

and at Red Cross only two Therefore we also visited the Groote Schuur state

hospital where another three interpreters were interviewed although the informed

consent forms were not meant for this hospital The Groote Schuur hospital has a

similar profile to that of the Tygerberg hospital The results of the survey are listed in

Table 1

Regarding the languages offered for TBH and RXH no interpreters were found

for Afrikaans whilst in both hospitals Afrikaans was either the most spoken

language or used on an equal basis with English and isiXhosa All six interpreters are

mother-tongue speakers of isiXhosa with English as their second language At

RXH Sesotho and isiZulu are offered as third languages and at GSH two of the

interpreters offer Afrikaans as their third language Regarding the interpretersrsquo

qualifications none has a tertiary education and not all have even completed their

secondary education Regarding their training as interpreters and the period that

they were interpreting the interpreter at TBH had no training but she was a nursing

ancillary who later just moved into an interpreting lsquopositionrsquo She has been doing

this for the past eight months on a freelance basis at the Tygerberg hospital

The two interpreters at RXH have been performing interpreting duties for the

past seven years They are full-time interpreters and had training in interpreting for

two years on an ad hoc basis from an NGO (non-governmental organisation)

namely the National Language Project (NLP) Apart from language and interpreting

skills they also had some training in counselling They presented themselves as very

professional The three interpreters at GSH had been doing lsquoformalrsquo interpreting

in this hospital for the past two years but were doing interpreting on an ad hoc

basis at the hospital for at least 10 years before that even though their job

description was that of lsquocleanerrsquo When they were appointed as interpreters they

underwent training for six weeks

Table 1 Interpreters consulted

HospitalNumber ofinterpreters Gender Age Qualifications Languages

Interpretertraining

Tygerberg(TBH)

1 Female 33 Matric Wasnursing ancillary

EnglishisiXhosa

None

Red Cross(RXH)

2 Female 35 53 Matric Post-matric studies(Adult basiceducationAncillary socialwork)

EnglishisiXhosaisiZuluEnglishisiXhosaSesotho

Two-yeartrainingSometraining incounselling

GrooteSchuur(GSH)

3 MaleFemale(2)

43 46 48 Busy with matricWere cleaners

EnglishisiXhosaEnglishisiXhosaAfrikaansEnglishisiXhosaAfrikaans

6-weektraining

Perspectives Studies in Translatology 7

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Comprehension test

They were also tested on their comprehension of the English source texts since

all of them offered English and since the source-text documents would have

been explained to them in English The translations into Afrikaans and isiXhosa

are very close linguistic translations of the original so if they did not understand

the source text they would not understand the target text either Questions were

also put on textual issues such as sentence and paragraph length paragraph

coherence and stylistic and lexical suitability (Table 2)

According to Gile (1995 p 34) the following criteria for quality can be applied

universally to all interpreting acts ideational clarity (the message of the sender

should be clear and comprehensible to the receiver) linguistic acceptability (the

interpreter should use grammar which is acceptable for the situation and the other

participants) and terminological accuracy (the interpreter should use the correct

target language equivalent for medical terms in the source language) From the

responses it can be deduced that none of these criteria could be met here

Question 1 addresses the ideational clarity and no interpreter completely agreed

that they clearly understood the message of the senders Linguistic acceptability

and terminological accuracy are addressed by questions 5 and 6 and here no one

agreed that the vocabulary and style of these texts was appropriate for this

situation Other remarks on the texts as such are that they found the texts too

long to explain but they did not think they themselves would be able to paraphrase

them in order to shorten the time with the patients Only one the male interpreter

from GSH felt that if he were given enough time to work with the texts he would

be able to explain the contents to the parents or volunteers The other interpreters

did not feel comfortable explaining the information of the texts so that the patients

or their parents could come to an informed decision as to whether they should sign

the document or not Needless to say none of the interpreters would like to sign

the agreement certifying that they explained the information of the trial in the

patientrsquos mother tongue and that the patient understood what was explained See

Appendix 2 for the section of the Informed Consent forms where the interpreters

are required to sign

If these interpreters were to be confronted with this task the ethical response

would be to withdraw from the assignment unless they are supplied with a much

Table 2 Responses on English source texts

No Question1Donrsquot agree

at all 2Donrsquot agree 3Agree4Completely

agree

1 I clearly understand thetexts

GSH 1 TBH 1 RXH 1 GSH 2 RXH 1

2 The length of thesentences is good

GSH 1 TBH 1 RXH 2 GSH 2

3 The paragraphs arecoherent

RXH 1 RXH 1 GSH3 TBH 1

4 The length of theparagraphs is good

RXH 1 GSH3 TBH 1

RXH 1

5 The vocabulary isappropriate

GSH 2 RXH 2 GSH 1TBH 1

6 The style of the text isappropriate

GSH 3 RXH 2 TBH 1

8 I Feinauer and HM Lesch

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simpler document or preferably have a health care provider with them doing the

actual explanation Then they could revert to their more passive role of interpreting

as part of a trialogue The NCICH (2004 p 16) also makes the point that lsquoTo work

within the professional boundaries of the interpreter role also means that interpretersare aware of the limitations of their duties as well as the limitations of their abilities as a

health care interpreterrsquo (our emphasis)

Discussion

Regardless of the role of the interpreter either as system or community agent the

basic goal of medical discourse is mutual understanding Clear verbal commu-

nication is a necessary component of an effective clinical encounter Even when

patients and providers are educated in the same language faulty communication

can lead to distortions and miscommunications between the parties let aloneeducated health care providers and uneducated patients and semi-educated

interpreters (Kaufert amp Putsch 1997 in Angelelli 2004 p 18) Communicative

failure will inevitably be the result here since neither interpreters nor parents or

volunteers have the same level of literacy or knowledge as the compilers of the

source texts in both these instances the compilers were medical researchers The

parents or volunteers would therefore not be able to make informed decisions

about agreeing to take part in the research projects or not

What is equally disturbing is that the interpreters are set up for failure whenthey are confronted with a task of this scope and these types of documents These

target texts will not be comprehensible enough to be viewed as providing an effective

service to the customer According to Gile (1995 pp 7980) one is not able to fully

comprehend something simply on the grounds of knowledge of the language or

extra-linguistic knowledge The content of the speech may be too difficult it may

deviate from generally accepted linguistic standards or the level of knowledge of the

language and extra linguistic knowledge of the receiver may not be high enough

Then it is necessary to analyse the discourse itself to a much greater extent than onewould analyse discourse with regard to comprehension in everyday situations

Therefore to fully comprehend one does not only need knowledge of the language

and extra-linguistic knowledge but the discourse also need purposeful analysis This

type of analysis could not be performed by most of the HCIs in South Africa and

should rather be left to the health care providers or to trained translators working

with the health care providers in rendering a much simpler target text

It is high time to shift the focus in research on health care interpreting to the

way in which the health care provider deals with the HCIs so as not to expectfar more than what their duties entail and their training predicts The education

and career profile of the six interpreters described above is fairly typical of HCIs in

South Africa and health care providers should keep this in mind This is evident

from the following job advertisement for an interpreter with a medical background

but no mention is made of interpreting or translation training The typical

requirements are matric the speaking andor writing skills in the languages needed

and nursing or other medical experience

Mouldmed Locum International Exchange Ltd is looking for a translatorinterpreterwho is able to speak and write three languages fluently (preferably English Afrikaansand Xhosa) The candidate must be able to start immediately and must have a Matric

Perspectives Studies in Translatology 9

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qualification and a medical background This is a three-month contract with the optionto extend Working hours are 0730 1600 (30-minute lunch) Monday to Friday Thejob entails office work and patient communication A senior assistant nurse with theselanguage requirements would also qualify for the position

Responsibility and ethical behaviour standards towards interpreters should also be

laid down for the health care provider and not only for the interpreter NCICH

(2004 p 19) notes the responsibility of the health care provider lsquoProviders have the

duty to present their knowledge clearly and objectively so that the patient is able

to make informed choicesrsquo If even interpreters are not monitored to meet their

obligations who is going to monitor the health care providers

Further research that could flow from this could be competency testing of the

interpreters to see how well they actually understand the information which had

been communicated by the health care provider and after the interpreters have

explained the information to the patients the same competency testing could be

done on the patientsrsquo understanding This can be established by asking patients

probing questions and inviting them to repeat the information they have received

(Roth et al 1983 p 175 in Johnstone 1999 pp 225227)

A retranslation of the source texts could also be done into Afrikaans and

isiXhosa using the functionalist approach and the interpreters could then be

retested to see whether they now understand the target texts better and whether

they would be able to paraphrase and explain the content better to the patient

Keeping in mind the socio-economic and educational level of the prototypical

patient for whom these informed consent forms are intended we would still

dissuade the interpreters from attempting to convey the message without a health

care provider present and from signing the document

Notes

1 Each of the nine provinces has its own set of official languages eg English Afrikaansand one or more of the indigenous languages On a national level all 11 of these languagesare recognised as official In the case of the Western Cape Province there are thus threeofficial languages as stated

2 Groote Schuur Hospital is linked to the University of Cape Town and situated in theObservatory area in Cape Town a mainly English-speaking area It employs 524 doctorsand 1370 nurses The hospital treats approximately 44000 in-and 575000 out-patientsper year (Capegateway public info 2009) The staff use both Afrikaans and English on anequal basis and a small proportion use African languages The patients are alsopredominantly Afrikaans and English and a large proportion use African or otherlanguages (Williams 2005 in Saulse 2009 p 24)

3 This is the highest level of secondary schooling that can be obtained within the SouthAfrican context This gives access to tertiary education

Notes on contributors

Ilse Feinauer is associate professor in the Department of Afrikaans and Dutch and isresponsible for teaching Translation Studies and Practice to undergraduate and postgraduatestudents She also teaches Afrikaans linguistics She is coordinator for the MPhil inTranslation Studies She has extensive experience both as a translator and scholar intranslation theory

Harold Lesch is a senior lecturer also in the Department of Afrikaans and Dutch and holds aqualification in Translation Studies He is currently coordinator of the Post Graduate Diploma

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in Translation and Interpreting and is responsible for teaching Interpreting Studies andPractice

References

Angelelli C (2004) Medical interpreting and cross-cultural communication CambridgeCambridge University Press

Angelelli C (2006) Validating professional standards and codes Challenges and opportu-nities Interpreting 8 175193

Anthonissen C (2008) On interpreting the interpreter experiences of language practitionersin mediating for the TRC Journal of Multicultural Discourses 3 165188

Capegateway public info (2009) httpwwwwesterncapegovzaengyour_gov5987Census (2001) Primary tables 1996 and 2001 compared Accessed at httpwwwstatssagovza

census01htmlC2001PrimTablesaspFeinauer I (2003) TB or not TB The communicative success of translated medical texts in

South Africa In W Botha (Ed) n Man wat beur rsquon Huldigingsbundel vir Dirk vanSchalkwyk (pp 213223) Stellenbosch Buro of the WAT

Feinauer I amp Luttig L (2005) Functionalism is not always the remedy Perspectives Studiesin Translatology 13 123131

Gile D (1995) Basic concepts and models for interpreter and translator training AmsterdamJohn Benjamins

Johnstone M-J (1999) Bioethics A nursing perspective Sydney HarcourtLeanza Y (2007) Role of community interpreters in pediatrics as seen by interpreters

physicians and researchers In F Pochhacker amp M Shlesinger (Eds) Healthcareinterpreting Discourse and interaction (pp 1134) Amsterdam Benjamins

Pienaar M (2006) Kommunikasie tussen staat en burgers die stand van tolkdienste SabinetOnline 40 3546

Pochhacker F amp Shlesinger M (Eds) (2007) Healthcare interpreting Discourse andinteraction Amsterdam Benjamins

Romero B (2008) Here are your right hands exploring interpreter qualifications Universityof Dayton Law Review 34 1533

Saulse B (2009) Interpreting within the Western Cape Health Care Sector A DescriptiveOverview (Unpublished masterrsquos thesis) University of Stellenbosch South Africa

United States National Council on Interpreting in Health Care (2004) A national code ofethics for interpreters in health care The National Council on Interpreting in Health CareWorking Papers Series httpwwwncihcorg

Appendix A

Text 1

A DOUBLE-BLIND PLACEBO CONTROLLED RANDOMISED STUDY TO INVESTI-GATE THE EFFICACY AND SAFETY OF LOW-DOSE L-CARNITINEMAGNESIUMSUPPLEMENTATION IN PREVENTING HYPERLACTINEMIA AND LACTIC ACIDO-SIS IN HIV-INFECTED SOUTH AFRICAN WOMEN ON STAVUDINE CONTAININGCOMBINED ANTIRETROVIRAL THERAPY (cART)

Introduction

We are doing a study to see if a l-carnitine magnesium combination product that could help toprevent high blood lactate levels which are known to be one of the side effects of some of themedications used in the treatment of HIV-infection (anti retroviral drugs)

The ability to decrease the way the virus multiplies is achieved by combined anti retroviraltherapy HIV positive (HIV ) patients receiving a combination of these drugs survive by

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keeping the infection under control but not by killing the virus altogether This treatment hasindeed increased the quality of life in HIV individuals

One of the drugs the nucleotidic reverse transcriptase inhibitors (NRTIrsquos) can alter the energyproducing part of cells in the body and this that can lead to effects such as the high bloodlactate Twenty five percent of patients with high lactate levels donrsquot have any symptoms whileonly a smaller percentage less than 10 percent develops symptoms including loss of weightand abdominal pain

What is the purpose of this trial

A previous study showed that the low dose l-carnitine and magnesium was absorbed in healthymale volunteers and that the supplement was safe to administer

We want to determine if a dose of two capsules per day of the study drug over a period of ayear prevents the build up of lactic acid in the blood We also want to show if the l-carnitineand magnesium is absorbed in HIV positive subjects on combined anti-retroviral therapy anddetermine what the concentration levels of the anti-retroviral drugs are after a period of 6months and 12 months

To achieve this the study drug must be compared with a placebo (these are capsules that looksthe same as the study drug which are filled with a harmless compound in this case lactose)An extra 20 ml of blood and 50ml of urine apart from the normal routine bloods will be takenbefore starting anti-retroviral therapy and 30ml of blood and 50ml of urine will be taken 6monthly thereafter up to 12 months

The levels of lactic acid cholesterol triglycerides LDL - HDL- and Lp(a) lipoproteins andanti-retroviral drugs will be determined in the blood and those of the l-carnitine with itssupporting metabolites (the organic acid - amino acid-and major and trace element profileswhich includes magnesium) will be determined in the blood and urine These results of thosesubjects that are on the study drug will be compared with those of the placebo group to show ifthere are statistical relevant differences

Text 2

PARTICIPANT INFORMATION SHEET AND CONSENT FORM FOR USE BYPARENTSLEGAL GUARDIANS

Virtual Reality for pain relief in paediatric burns patients

What is this research study all aboutYour child has been admitted to this unit because of their burn injury Every child in this burnsunit has dressing changes on a daily basis Your child will be given the normal medication thatshehe receives during any dressing change These dosages of medication have been prescribedby the doctor when your child was admitted to the burns unit With all burn injuries one ofthe biggest problems that our patients experience is pain At the moment the professionals inthe burns unit do not know if there is something other than pain medication that can help todecrease your childrsquos pain Certain studies have proven that using a technique called VirtualRealty (VR) can distract a child and thereby decrease their pain during a specific procedureVirtual Reality is a program that we will use to allow your child to watch a video game throughgoggles that will be placed on their face Half of the treatment will be done using only the painmedication The other half of the dressing change will be done using the pain medication andthe VR We will then interview yourself and your child to find out how you your child feltabout this process and if you feel that Virtual reality can help to decrease your childrsquos painDuring the interviews with youyour child and nursing staff information may be recorded on a

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tape recorder so that we can check all our information We will also be videotaping alldressing changes and using information from those tapes to help us with this study

Why has your child been invited to participateIn order to see if this process of VR is going to worknot work we have to assess it on at least250 children All children who are over the age of 5 and who do not have a face burn can takepart in this study You and your child have the option to participate in this study andparticipation is completely VOLUNTARY

What will your responsibilities beBy agreeing to let your child participate in this study you will allow us to ask your child tocomplete a questionnaire You will also be interviewed

Will your child benefit from taking part in this researchAt this stage we cannot say if your child will benefit from the study that we are doing If whatwe are doing does work then your child will experience less pain during the dressing changesIf the results are positive then it means that in the future more patients with similar injuries toyour child can be helped when they are experiencing pain during dressing changes

Are there any risks involved in your child taking part in this researchThere are no reported risks The only reported side effect of the VR is sickness If your childdoes experience any sickness due to the VR it will be stopped immediately

If you do not agree to allow your child to take part what alternatives does your child haveYou and your child have the option not to participate in this study participation is completelyVOLUNTARY Your child will only be entered into the study with your permission If youchoose not to enter the study we will still treat your child to the best of our ability and it willnot change the way you are treated You can leave the study at any time after you join

Who will have access to your childrsquos medical recordsAny information gained from this study and testing will be kept strictly private and no oneoutside of the people in the study will know youryour childrsquos results without your permissionIf the information is published to educate other health care professionals we will not use anynames Thus you and your child will never be able to be identified by anyone except studypersonnel Similarly no person outside of the study will have access to audio and videorecordings that may have been made during the dressing changes

Will you or your child be paid to take part in this study and are there any costs involvedYou or your child will not be paid to take part in the study and there will be no costs involvedfor you if your child does take part

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Perspectives Studies in Translatology 15

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