In cultural-broker role, ad hoc interpreters' own interpretations took precedence, risking dilution of the patient's explanatory model

Description #

The study found that ad hoc interpreters frequently acted as cultural brokers, explaining cultural concepts such as ancestral callings to become a sangoma so that they were not misread as illness. The authors note a downside of this role: the interpreter's interpretation of the patient's culturally informed meanings takes precedence, and the patient has no way of verifying it; when interpreters try to make the patient's story more acceptable to a biomedical frame, the patient's information is often lost. This is a qualitative mechanism by which informal interpreting can both aid and distort the cultural content needed for accurate psychiatric assessment.

"Interpreter: Ja, like sometimes it can be because the patient he can talk things like amamfufunyana, the ancestors, okay that man want me to go for sangomas, I'm not crazy because they called me. It's a calling. And I can explain now. Okay, she said no, it's not so sick, it's a calling, it's a culture." (Kilian, 2021, p. 32)

"The interpreter's interpretations of the client's purportedly culturally informed meanings take precedence. The client has no way of conveying whether the interpreter's interpretation of their utterances—their use of metaphor, for instance—is accurate." (Kilian, 2021, p. 34)

"Penn and Watermeyer (2012) have shown that when interpreters try to make the client's story more acceptable to those working from a biomedical understanding of mental health or towards the biomedical ends of the consultation, the patient's information is often lost and their lifeworld is only partially explained. In our study, we observed that this does take place." (Kilian, 2021, p. 34)

Methods Context #

What? #ⓘ

The observable: instances in recorded consultations and interviews where interpreters explained patients' cultural practices/concepts to clinicians, coded as the "cultural broker" role.

"Some of the interpreters took on the role of cultural broker, which involved building bridges between cultures, in this case psychiatry and the patient's respective cultures." (Kilian, 2021, p. 31)

How? #ⓘ

Conversation Analysis of 13 video-recorded interpreter-mediated psychiatric consultations plus content analysis of 18 semi-structured interviews with interpreters and clinicians; verbatim transcription with cross-checked forward/back translation.

"Content analysis was used to analyze the audio recordings." (Kilian, 2021, p. 29)

Who? #ⓘ

Bilingual nurse, social-worker, and cleaner ad hoc interpreters sharing a first language and cultural background with isiXhosa-speaking psychiatric inpatients, interpreting for English/Afrikaans-speaking registrars at a Western Cape public psychiatric hospital.

"This is not surprising, given that they shared a first language as well as a cultural background with patients." (Kilian, 2021, p. 31)

Other Notes #

The authors stress heterogeneity within cultures: even shared cultural background does not guarantee shared expressive nuances, so cultural brokering carries risk as well as benefit (p. 34).

Caveats #

• Small exploratory single-site sub-study of 13 consultations at one South African psychiatric hospital limits generalizability The authors describe this as a small exploratory sub-study nested in a larger project, based on 13 video-recorded consultations and 18 interviews at a single public psychiatric hospital in the Western Cape, South Africa, with ad hoc (informal) interpreters and no formal interpreting service. The findings characterize interpreter roles in this specific resource-constrained, informal-interpreting setting; they should not be read as effect estimates and may not generalize to settings with trained/professional interpreters or other clinical contexts.