Think Out Loud

The challenges indigenous interpreters face in Oregon

By Rolando Hernandez (OPB)
April 25, 2022 1 p.m. Updated: April 25, 2022 10:18 p.m.

Broadcast: Monday, April 25

A bill passed last year required health care providers to work with OHA-certified interpreters in order for patients to have accurate translations. But advocates say this has excluded indigenous speakers from Central and South America.

A bill passed last year required health care providers to work with OHA-certified interpreters in order for patients to have accurate translations. But advocates say this has excluded indigenous speakers from Central and South America.

Kristyna Wentz-Graff / OPB

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Oregon now requires health care providers to work with OHA-certified interpreters in order for patients to have accessible, accurate translations, after a bill passed in the legislature last year. But advocates say this new system has excluded Indigenous speakers of languages from places like Mexico and Guatemala because of the certification requirements. Puma Tzoc is the coordinator for the Collective of Indigenous Interpreters of Oregon and a speaker of the K’iche’ language. Cam Coval is the executive director of Pueblo Unido PDX. They both join us now to share how this new state law has affected interpreters in Oregon and their hopes for the future.

Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. Last year, Oregon lawmakers created a new mandate in the state. They said that health care providers have to work with OHA certified interpreters in order for patients to have accessible, accurate interpretations. As Emily Green wrote in a recent article for the Lund Report. “The idea behind this law is to foster equity and inclusion in healthcare.”

But advocates say the new certification requirements will exclude Indigenous speakers of languages from places like Mexico and Guatemala. Puma Tzoc is the coordinator for the Collective of Indigenous Interpreters of Oregon, and a speaker of the K’iche’ language. Cam Coval is the executive director of Pueblo Unido PDX. They both join me now. It’s good to have both of you on Think Out Loud.

Puma Tzoc: Thank you for having us.

Cam Coval: Thanks Dave.

Miller: Cam Coval first, what was the idea behind this new law?

Coval: My understanding of the intention for HP 2359 was to improve the quality of interpretation provided in healthcare settings, by requiring that health care providers work exclusively with interpreters who have been trained, vetted, and prudentialed by the Oregon Health Authority.

Miller: According to the text of the law that’s behind this new interpreter mandate, it’s intended to respond to the “inequitable business practices of interpretation service companies.” What does that mean?

Coval: My understanding is that’s in reference to, on one hand, interpretation service companies keeping a large proportion of revenue for the interpreters who provide interpretation for their companies, not paying the vast majority of those profits down to those actual interpreters.

And I think more largely is those companies that were utilizing the services of “untrained” interpreters, in order to reduce the amount that they paid those interpreters, or to simply get by and provide the services and maintain contracts with health care providers.

Miller: So just to be clear, would you say you’re in support of the overall goals of this new law? I ask because we’re going to be, for most of this conversation, talking about the ways in which you’d like the rules to change. But do you support the basic ideas behind it?

Coval: I am certainly in support of the goal of improving the quality of interpretation and securing language access for folks or speakers of any language in health care settings.

Miller: But you don’t think this is necessarily the best way to go about it?

Coval: I think this law was designed without input from key stakeholders, and in particular Indigenous language interpreters who are essential in delivering these services. And I think therefore there are some holes that need to be filled.

Miller: You have a number of issues with the proposed rules regarding the certification of interpreters. Let’s take them one by one. What’s wrong with having to show proof of a GED, or education in someone’s home country?

Tzoc: For many of us, we come from different countries. Some of us, we don’t have the opportunity or the privilege to attend school, because of poverty and discrimination and all of that. We don’t have the privilege to go to school. So there’s no way for us to prove our GED qualification. But we know certainly that, as we are kids, we grow up speaking our home languages. And I believe that’s the most important thing. I will say we are professional to speak our own languages.

Miller: Puma, am I right that you’re trilingual? K’iche’, Spanish, and English?

Tzoc: Yes, that’s right. I grew up in my hometown speaking K’iche’, which is a Mayan language, with my family and my whole town. We still speak that language.

Miller: And Spanish in schools?

Tzoc: Yeah, luckily I have that opportunity to go to school. And I learned Spanish at school. And when I came here in the United States, I learned English here basically by myself. I couldn’t attend school, but I still developed English.

Miller: So Cam, this is one of the requirements for certification is showing proof of GED or education in a home country. And as Puma said, there are many people who have real knowledge of these languages, but don’t have a piece of paper to show an official education. What about the background check? What’s your issue with that particular requirement?

Coval: Many of the folks we work with have had a vulnerable immigration status in the past. Even those who may now be lawful permanent residents or have attained citizenship in the United States have a lot of trauma and fear when it comes to sharing information with the federal government, and in particular with immigration enforcement agencies. Requiring a background check or requiring somebody to submit their social security number can really serve to retraumatize folks who have been through a really painful and difficult immigration system.

Miller: Puma, another requirement is for interpreters to be fluent in English. My understanding is that that’s not always even necessary because there can be so-called relay interpreters. Can you explain how that works?

Tzoc: Yeah, that’s right. Relay interpretation means when you involve three interpreters. For example, myself many times I asked for relay interpretation even if I spoke English, because it’s hard for us to translate information that we receive in English, still thinking about it in Spanish, and then go to our original languages. Relay interpretation means that I hear the original language, let’s say English. And then he wrote a quote for a Spanish interpreter, who will interpret it to me in Spanish.

Miller: Just to understand in this case, because your Spanish might be stronger than your English?

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Tzoc: Yes.

Miller: So a doctor would say something in English, a first interpreter would take that from English to Spanish, you would hear that, and then take that to K’iche’? And then the chain goes back.

Tzoc: That’s right, yes. So I interpreted that in K’iche’ to Spanish, and then Spanish interpreter will interpret it in English.

Miller: During the pandemic, was all this happening in person?

Tzoc: No. During the pandemic, we’ve been working mostly remotely. That means phone calls or video calls. That’s what we’ve been doing since the pandemic.

Miller: That sounds like a real challenge in terms of interpretation, even without a relay interpreter.

Tzoc: Oh yeah. It’s challenging but it’s always doable. And for us as Indigenous interpreters, we still have developed those skills with technology too. And as our interpreters or the members of the collective that we have right now, they’ve been working on that, and they put the effort to develop those skills.

Miller: So Cam Coval, if relay interpretation is already established practice, how do you explain the requirement that interpreters be fluent in English?

Coval: We weren’t involved in those conversations Dave, and if we had been, we certainly would have brought this up immediately. I don’t know what to tell you.

I will say that there is a provision in HB 2359 that allows for an interpreter to obtain either qualification or certification with the Oregon Health Authority if they are able to utilize the services or the support of another relay interpreter to eventually get the interpretation into English. So, there was a carveout created in the bill. It’s buried quite deep down in a sub-subsection. But an issue is that that exception or provision is not reflected currently in the Oregon Health Authority’s application materials or their information on requirements for obtaining credentials.

Miller: Another provision is that interpreters have to complete 60 hours of formal training, mainly in medical terminology. I have to say that that strikes me as, as a lay person, a good idea if they’re going to be hearing a lot of medical lingo, which the rest of us may not necessarily be familiar with. What’s wrong with this provision?

Tzoc: The 60 hour training that they ask, it’s mostly in English. And for now from what we know, there is no training in Spanish. So that’s a big challenge too for our interpreters who don’t speak fluent English.

Miller: So not only is there not training in Indigenous languages, but you’re saying the formal training is not even done in very common languages like Spanish?

Tzoc: Yeah, that’s right.

Miller: Finally, Cam Coval, there is a requirement of demonstrated proficiency. What does that mean?

Coval: For an English or Spanish interpreter, that entails passing a language proficiency test to demonstrate that you are fluent in both English and the target language that you’re providing interpretation services for. So for myself, that would be passing a proficiency test showing that I speak fluent Spanish and fluent English. For Indigenous language interpreters, that would require passing a proficiency exam in their original language. And there are currently no language proficiency exams available for the 70 Indigenous languages and the variations spoken in Mexico, or the 24 Indigenous languages and their variations spoken in Guatemala.

Miller: That’s for nearly 100 Indigenous languages in just these two countries, there’s no proficiency test. So, am I right that after you pushed for a while, the Oregon Health Authority said alright, there is a potential workaround?

Coval: Yes, and we were not made aware of the workaround until the Health Authority responded to the one report article that came out about our advocacy.

Miller: I should say again, it’s the article by Emily Green in the Lund Report that alerted us to this issue. You’re saying after she wrote that article, that was the first time you heard about a potential workaround?

Coval: That’s right. And since that article was released, we’ve had conversations with members of the advisory council, the Oregon Counsel on Healthcare Interpreters, which advises OHA, some of those members shared with us that in their work committees, they identified this gap, or the absence of language proficiency exams for Indigenous language interpreters and other interpreters of languages of lesser diffusion, and therefore decided to create an alternate proof of proficiency application as a workaround.

Miller: And Puma Tzoc, do you have a sense for how that would work, the alternate ways to demonstrate proficiency?

Tzoc: Yeah. From what I hear, the Indigenous interpreter has to provide two or three letters from some X, Y person who said that interpreter speaks fluently his native language. We asked ourselves, who’s gonna say that person spoke his Indigenous language fluently?

Just for example, I want to be an interpreter, and I go and ask, “hey Cam, can you write me a letter where it says I’m fluent in K’iche’?” And he wrote the letter, and I go and present that to the OHA. And Cam, he does not really know me as well. He doesn’t know my background, he doesn’t know where I come from. He just knows that I’m a K’iche’ speaker. And I think that’s an issue, who will really prove that the interpreter speaks fluently?

Miller: I mean it seems like one of your concerns here behind, your fear is that people could actually be certified as interpreters of these languages who truly are not proficient, but somehow they got a letter to say that they are, and the state would have no way to check that?

But Cam Coval, if there are no written proficiency tests for these hundreds of languages, and we can imagine there are many other languages around the world where speakers of them could live in Oregon and need interpretation services, if there aren’t tests for them, and if you don’t like the idea of letters from three individuals, what system would you agree to to actually show proficiency?

Coval: So Dave, we think in the short term that this alternate proof of proficiency application is a step in the right direction. I think it can be a helpful workaround, because there are folks who require interpretation today in languages for which there are no proficiency exams. So we’re not rejecting the idea of this alternate proof of proficiency application based off of references.

But we think that that’s not a reliable mechanism, the most reliable mechanism possible, and we think that there are some longer term solutions that can be developed. One example that has been piloted successfully in Mexico by the National Institute for Indigenous Languages, or INALI,  was a process that included recruiting multiple speakers of the same language and same variation. And let’s say that there’s three of them. Those folks would participate in roleplay exercises and peer interviews, and assess each other. And so by consensus, with multiple raters they determine between themselves, “my peer is indeed proficient or fluent in this target language,” and vice versa. And in that way INALI was able to not only determine that one or two or three people were indeed fluent, but then those folks are then able to determine future applicants, whether they are proficient or fluent. And so it’s a mechanism to develop raters who could then put their rating or qualification services to use for others who are trying to enter the field.

Miller: Puma. Just to take a step back before we say goodbye, I’ve read that, like many Indigenous languages in the United States, K’iche’ was actively discouraged in Guatemala by the state. What does it mean to you now to be working professionally using this language?

Tzoc: It’s a gift for me to be here right now in this position, using my Indigenous languages as a way to help my people who are still being discriminated at this time. It’s really important to me, and I’m really thankful for this gift, to speak my own language. And I know that doing this interpretation can help many of my people. And that’s just me. And I’m thinking about those other folks that have been doing this interpretation in Indigenous languages, that we use our voices to help our people. That is a big motivation for me to still doing this work that I’m doing right now

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