Understanding Portuguese

How an interpreter can take the fear and confusion out of a doctor’s visit for Brazilians.

What if you arrived at the hospital emergency room with an acute medical condition and no one could understand what you were trying to say? In its first year and a half, the Island Medical Interpreter Service helped about 1,000 Portuguese-speaking people to communicate what’s needed to be said. The nonprofit program of Island Health Inc. began in April 2006 after a study showed that language was the primary barrier to accessing health care for the Brazilian population on Martha’s Vineyard.

The program is supervised by Miryam Gerson, a bilingual nurse who first came across the problems that limited-English speakers face at Family Planning of Martha’s Vineyard, where she worked for seventeen years. She says, “The interpreters are a very devoted group, who do it even though they are already doing many other things and have other jobs. People are sick or scared when they come, and then they find this very competent person there to help.”

Interpreter Mary Anny Deyette, who’s twenty-three, moved to the Vineyard from Brazil five years ago. She started studying English seriously in high school and always wanted to do this kind of work. “Having an interpreter is better than having a friend interpret,” she says. “A friend might not think something the patient says is important, but the doctor might.”

In the forty-eight-hour medical interpreters’ training course, taught over two or three weekends, University of Massachusetts Medical School’s Lisa Morris teaches methodology and medical vocabulary – much of it unfamiliar even in one’s native language. Role playing helps prepare for retaining and transferring information, which can be challenging – especially if a patient is speaking emotionally. When Mary Anny finds it hard to concentrate, she says, “I focus on the words and don’t look at the person. You listen; you speak. Sometimes I imagine myself being a tape recorder.”

But medical interpreters also need to be cultural brokers, so sensitivity to beliefs and conventions is stressed in training. Because language is intertwined with the culture of the people who speak it, interpreters already know some of these differences, and they continue to learn from each other in monthly staff meetings.

“As an interpreter, you have to be accurate, and to be accurate you have to explain the differences of the culture,” Mary Anny says. If there is a potential for misunderstanding, the interpreter can stop the process and explain a language expression or cultural reference made by either the client or the provider. For example, Mary Anny says, “If a Brazilian person tells the doctor she thinks she got a cold because of eating ice cream, I can explain to the doctor that that’s a Brazilian belief.”

Interpreter Gabrielle Knight, a native English speaker, has found that Brazilians often describe lower back pain as a “kidney ache” – more to locate the pain – which is something she might mention to the doctor. Gabrielle, who’s twenty-six and grew up on Chappaquiddick, has been speaking Portuguese for about three years. She had a grammar book but mostly learned from talking to people.

Gabrielle remembers that when she started working in the Brazilian-owned restaurant Tropical, before she learned the language, she used to unintentionally interrupt people having a conversation in Portuguese. Language is such a basic and unconscious part of who we are that it can be difficult to relate to another’s language as actual communication. Gabrielle says, “It was as if they were just making noises.” For a similar reason, she finds that some people have difficulty waiting for the interpreter to finish translating. She says, “It’s like they think, ‘I said what I said. You’re just saying what I’m saying and I’m done, so you should be too.’”

Gabrielle finds that Brazilian patients are more used to telling a doctor everything that’s going on with them, emotionally as well as physically, which can run counter to an American doctor’s focus on discovering the physical symptoms. She says, “Brazilians want to tell their whole story; that’s what they do in Brazil. Here, the doctor is: ‘Well, where’s the pain?’”

Of the fourteen interpreters who work as subcontractors for the service, thirteen are Portuguese speaking (nine as their native language) and one is Spanish speaking. Interpreters sign up for twelve-hour on-call shifts for the hospital or work as needed for non-emergency appointments at Island Counseling Center, the Massachusetts Department of Social Services, the Island school system, Dukes County Regional Housing Authority, Island Elderly Housing, and some private physicians’ offices. In the future, the service may be available to any individual who calls, but presently interpreters are accessed through the contracted agencies.

Interpreters are taught to behave in a professional way in order to make it clear to the clients that it is safe for them to speak openly. Partly because of the small size of the Brazilian community here, Miryam says, “Confidentiality is huge in this line of work. The interpreter is privy to a very personal interaction that does not normally have an observer.”

Interpreter Vanileze (Vani) Pessoni, age thirty-two, came to the Island as an adventure and to learn English – but did not plan to stay. She ended up working at Louis’ Take Out in Tisbury for eight years. She says, “In the beginning I thought, ‘I’m not ever going to understand what people are saying.’” In Brazil, she studied English for three years after college. Here she took an evening course at the regional high school, but mostly she learned by talking to people and watching a lot of TV.    

“It was my mother’s dream that I be a doctor or dentist, but no: I hate blood,” she says. When she started interpreting, she continues, “I’d never know what I was going to see, but we were taught that we are the voice; you don’t have to see anything. But I’m used to it now; I can look and I don’t go crazy.”
The work brings its own satisfaction. Vani adds, “You don’t remember you’re getting paid; you just remember that you’re doing something for people. You’re glad you can help.”

Because of the experience here, Gabrielle is considering a career in translating and is continuing to develop her skills; in the fall, she took a course at Boston University. Mary Anny, on the other hand, is moving to Las Vegas to work and attend aesthetician school. Because of the growing Brazilian population there, she may find herself interpreting as well. She says, “It’s very rewarding work; you’re helping the person really a lot. When I do it, I feel good.”

Through the Interpreter Service, individuals certainly benefit, but the service has had an impact on the Vineyard at large. Mary Anny says, “The Interpreter Service has helped make it so the Brazilian community is not afraid to go to the hospital.”