“Can you ask her if she has a cough?” His eyes quickly shifted from me towards my mother, hinting at the interaction he wanted. My hand flicked the end of the plastic firetruck I had just gotten from the toy machine on the way over. I had begged my mom to stop at the supermarket as soon as I saw the machine. Even in her illness, she obliged, maybe because she knew that the wait at the clinic would be long. I looked up to my mom who gave me an encouraging nod. “El pregunta que si tienes toz?” (He’s asking if you have a cough?”). Sensing his urgency, she quickly responded “Si”, but quickly caught herself, “Yes.”
“How long has it been going on for?” he asked. This time directing his question directly at her. Her eyes narrowed, and brow furrowed as if one could see her actively translating each word in her mind but failing. After a few seconds of silence, both their eyes looked back down to me. “Que dice, mijo?” (What is he saying, my son?). “Cuanto llevas con la toz?” (How long have you had the cough?”). She raised two fingers and uttered “semanas.” His eyes narrowed, and brow furrowed. His eyes darted back to me, “Is that days or weeks?” I fidgeted with my firetruck even quicker, “Weeks…2 weeks, doctor.” “He quickly shot back, “has it been productive?” I stopped fidgeting with my toy. My eyes narrowed, and brow furrowed. I felt as if I was right back to vocabulary class earlier in the day, “productive.” I had never heard the word. I tried to sound it out loud “pro…duc…tive.” I looked back at my mother trying to find the right word, but all I could fall back on was a mix of literal translation and “Spanglish.” “Que si ha sido productiva?” “Productiva?”, she repeated back. “Si” I stammered back. Now we were both back at my morning vocabulary class with words we had never heard of. The confused silence persisted until he barked, “Phlegm!” We were saved by cognates in this case. “Flema? Si…Yes…Flema.” She responded quickly as we both let out a collective sigh. With each question and response, their eyes both darted back to me, until eventually they both just looked down at me. I continued to fidget with my firetruck until eventually one of the wheels silently snapped, but thankfully I was too concerned with my role as interpreter to mourn the loss.
That would not be the first time I would serve as an interpreter for my mother, father, cousin, aunt, grandmother, or other family members at the urgent care clinic, primary care clinic, hospital, or other healthcare setting. With each visit, my medical vocabulary expanded while the pressure and stress remained. I grew no more comfortable with my role, but my family depended on it. For the 25.6 million limited English proficient (LEP) people in the United States, language brokering is part of daily life.1 Language brokering refers to the use of children as interpreters and translators in adult situations.2My experience is not unique. Throughout medical training, I have witnessed supervisors and colleagues willingly engage in “getting by.” The use of the ad hoc interpreter is common with clinicians relying on family members as the primary mode of interpretation. The convenience of “getting by” to facilitate communication comes at a cost given its association with medical errors. Federal guidelines, including the Culturally and Linguistically Accessible Services, mandate the use of interpreters and the provision of language equitable care, yet the use of ad hoc interpreters persists.3 Though these guidelines are well-meaning, the clinician-perceived barriers of using an interpreter in addition to a lack of funding for interpreter services create a conflict for systems that struggle to achieve language equitable care.
The burden of serving as the vehicle between your family and medical care creates a new dynamic for the relationship between children and their family. By serving as an interpreter, the ad hoc child interpreter takes on the role of caregiver. The children of adult LEP patients may not have adequate fluency in either languages—their parents’ preferred language or English. Children already face the challenge of language barriers at school, facing the anxiety of being an English learner (the educational term for LEP) in not only learning new subjects but learning a new language. This anxiety is amplified as an involuntary interpreter for their family in high-stakes clinical encounters. These clinical encounters may also involve sensitive topics that may strain the parent-child relationship. This is an unfair expectation for children. Although children can play the role of interpreter, they should not. In fact, the Affordable Care Act has addressed this issue by prohibiting the use of children as interpreters.4 Thus, clinicians should be wary to use children as interpreters given these policies barring their use.
The forced role of interpreter places the burden of medical care on family members who may not be willing to play this role if given the choice. My experience language brokering would extend beyond verbal interpretation and into the translation of written health information (forms, educational materials, insurance letters, prescriptions, etc.). It also extended beyond healthcare into interactions in situations of daily living. Interpretation can be provided through many modalities, in-person, phone, video, but should not be provided through children.
American Community Survey 5-Year Estimates 2013-2017. Selected Social Characteristics in the United States. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_DP02&prodType=table. Accessed October 10, 2019.
McQuillan J, Tse L. Child language brokering in linguistic minority communities: Effects on cultural interaction, cognition, and literacy. Language and Education. 1995;9(3):195-215.
Culturally and Linguistically Appropriate Services. Think Cultural Health. https://www.thinkculturalhealth.hhs.gov/clas. Accessed June 21, 2019.
Health and Human Services Department. Nondiscrimination in Health Programs and Activities. https://www.federalregister.gov/documents/2016/05/18/2016-11458/nondiscrimination-in-health-programs-and-activities. Published May 18, 2016. Accessed October 10, 2019.
I would like to thank Natacha Meyer for her educational perspectives and edits to this piece.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Rodriguez, J.A. My Son, My Interpreter. J GEN INTERN MED 36, 3232–3233 (2021). https://doi.org/10.1007/s11606-021-06867-6