Interpreters back in healthcare, please

Explore the ripple effects of language policy changes in Dutch healthcare, and how similar considerations in Sweden may impact patients. Discover the powerful stories and compelling reasons driving the movement to restore professional interpreter services for healthcare professionals in the Netherlands.

Simone Goosen is a prominent figure in the Dutch healthcare sector and is currently running the campaign "Interpreters back in healthcare, please." Together with the NGO Johannes Wier Foundation, they are working to bring back the national interpreter telephone service that was previously available to all healthcare professionals in the Netherlands. In 2011, the telephone interpreter service was terminated to cut healthcare spending and encourage immigrants to learn Dutch. A political decision was made, even though there were patient safety laws about it. The policy was written in such a way that it is not reversible.

As a consequence, people are more likely to bring countrymen to interpret in healthcare situations rather than trained interpreters. Often, these are young family members and children (who often learn the language quicker.) The campaign is focused on informing healthcare professionals about the problems around using children to interpret in healthcare.

We had a chat with Simone Goosen about the situation in the Netherlands, the stories she had heard, and the campaign.

What would you say are the most important reasons that children should not interpret?

"There's a lot of evidence, and we have a lot of terrible stories about children interpreting," says Simone. There are several arguments for not letting children interpret:

The quality of the translation: There could be reasons a relative doesn't want to share certain information or they don't understand the meaning of what they are translating or what is important. This is especially true for children. "We know that people don't tell everything when a family member interprets," she continues.

Too much responsibility for a child: Children translating become responsible for their parent's well-being and health, which gives them a larger responsibility than they should have.

Can lead to emotional trauma: "I've spoken with many people, even my age, that still feel the trauma of having to translate a diagnosis of cancer or sexual and mental health issues. This is really something you don't want to hear as a child or even as an adult family member," says Simone.

They miss out on school: These youngsters are missing a lot of classes to follow parents, family members, or even neighbors to their appointments. As a consequence, it’s very difficult for them to excel in school. If they do internships, companies and organizations wouldn't understand why they are absent. There's very little awareness among both healthcare professionals and teachers about these effects.

"If a child is translating in your consultation room, that same child has probably been translating in many, many other places. And the load is heavy on these children."

What would you say to someone who works in healthcare and knows that it's not right to use children to interpret but feels like they have no other choice?

"It is one thing to use adult family members for translating. If the topic of the healthcare consultation is not too complex or too private, and you are aware that the quality of the translations might be lower, it could work. For example, by using the talk-back method and confirming that everything has been understood, it's fine to use them if no other options are available. The children translating will be harmed, and often, parents don’t even know."

"One of the women we spoke to had to translate on sexual health issues for her mother as a child. She told us that if the medical doctors had told my mother that it was not good for me, she would have gone for another solution. She would never, ever have wanted to harm me, but she didn't know."

In situations like this, there are always other options, whether it’s rescheduling to a time when an interpreter can be present or using Care to Translate or other digital tools. "We need to raise a lot of awareness on both the harmful aspect of it with respect to the child as well as for the quality of care," Simone continues.

"This is a child, not an interpreter" campaign poster

That's very interesting that healthcare professionals should do an assessment of the situation. Ask questions like ‘What is the topic of conversation? Who's the person with them? Is this something that this person can handle to translate?’

"In the UK, they have guidelines on language barriers in healthcare. There is a statement that healthcare professionals need consent in those situations. If the family really wants a relative to do the translation, they should insist on speaking to the patient with a professional interpreter first to make sure that it's really the wish of the patient."

In some cultures, they are in favor of giving the important role of translating to a family member. From a legal perspective, we really need to know that this is the wish of the patient. And also, you have to be very sure that you are getting the patient’s opinion and not the family members.

"I've heard terrible situations of abuse of elderly people in families and healthcare staff not knowing about it because they would never communicate with the person themselves."

In Sweden, the government is currently investigating whether they should take away funding for interpreters for immigrants that have been in Sweden for more than 5 years. Meaning that these patients will have to pay for interpreters themselves. What can you say about effects that you've seen in the Netherlands since your government did a similar policy change?

“I would want to say to healthcare professionals in Sweden: Don't accept duration of stay limitations to access interpreters. It's never right. Go back to your basic human rights, go back to your health laws. And I assume that you have a similar law on communication and shared decision making as in the Netherlands. Go back to UN health law and human rights and dignity issues.”

She continues: “It's not going to help or stimulate people to learn the language. That should never ever be associated with access to healthcare. These are situations where a person is very vulnerable. People might have been in the country for a long time but never had the chance to learn the languages. Because the policies were different, because they were busy providing for their families, because they were illiterate, or not in touch with natives enough. It's so unjust to tell these people that there is a cut-off point, and now you have to pay for your own interpreter. My guess is that most of these people are also on social aid and in a strained financial situation, not affording to pay for interpreters.”

“We cannot make healthcare professionals dependent on the patient to hire an interpreter.”

This campaign is about driving change, and making that happen is such a long game. You must need a lot of patience.

"Yes, but my hope lies in the next generation. I have stories of, for example, medical students who have been children translating themselves. Today they might work either as interpreters or medical doctors. In their job, they are confronted with something that they have experienced themselves, and now they're working together with their supervisors, advocating for interpreter services to provide better care where they work. So these persons are really motivated to change things, and this is where our hope for change lies. It's really about raising awareness of the importance of equal access and chances to receive good care. On the other hand, we have seen healthcare professionals who don't understand that it is not appropriate to use children as interpreters.

“I think of an example where a midwife did a home visit at a family because the mother had given birth to a premature baby. The nurse had the other two daughters interpreting during the visit and was proudly saying how well they had translated. But this was a refugee family with a mother that probably had PTSS or postnatal depression, also under financial pressure and so on. How can she raise her issues when the children are interpreting?”

These are the most vulnerable families that need help. This made me realize that we need to increase the knowledge and change the attitude of health care staff. 

The work that you do is so important to many patients and their families in the Netherlands. Thank you for taking the time to speak to us, Simone. We wish you and the Johannes Wier foundation the best of luck in your campaign!