Beyond translation and medicine: Initiating exchanges between translation studies and health humanities
$ebnem Susam-Saraeva and Eva Spisiakovd
health and illness, borrowing methods and frameworks from the humanities and social sciences to bear on biomedicine, clinical practice, and the politics of healthcare. To this end, several disciplines in the humanities, such as literary studies, film studies and cultural studies, have so far been used to shed light on health matters.
Considering that discourses around health and illness are dependent on languages for their transmission, impact, spread, acceptance and rejection in local settings, one can begin to appreciate the wealth of data, theoretical approaches and methods translation studies can offer in studying health and illness globally. Conversely, translation studies can learn from the developments in health humanities regarding the expansion of topics for research, recent frameworks and debates shaping areas of health. Therefore, while this handbook ensures that well-established research areas in translation and medicine are covered, it also intends to open up new avenues of exchange between translation studies and health humanities by initiating research into previously neglected areas.
Compared to medical humanities, interdisciplinarity and interprofessionality are much more emphasised and encouraged in health humanities, bringing in contributions from groups previously marginalised in the former, such as allied health professionals, nurses, patients and carers (Jones et al. 2017). The implications of such a broadening of the field for translators and interpreters cannot be underestimated; it would mean more interaction and cooperation between the different professions, as translators and interpreters become an organic part of care-giving, involved in the developments and decision-making processes in healthcare settings.
It is increasingly recognised that ‘medicine is only a minor determinant of health in human populations alongside other social factors’ (Jones et al. 2017: 933), such as class, education, occupation, religion, environment, race, disability, sexuality and gender. Given these overlapping determinants - and the influence of other disciplines such as women’s studies, disability studies, postcolonial studies, and queer studies starting to have a bearing on medical education - courses ‘far more concerned with individual and cultural experiences of illness and disability and with the social/structural/political impediments to health and healing’ have begun to be offered as part of medical education (ibid.). This shift is in line with an emphasis on intersectionality, another key concept borrowed by health humanities, which highlights the health-related discrimination and disadvantages caused by the interconnected nature of social categorisations as they apply to a given individual or group. In this volume, we endeavoured to reflect the impact of intersectionality on translation and health-related concerns, in chapters focusing on women’s health, disability and health in LGBTQ communities.
In translation studies, the focus has traditionally remained on translation and interpreting within biomedicine, ‘owing to its economic and political power and prestige’ (Montait in this volume, p. 134). Examining translation and interpreting both in relation to biomedicine and outside its boundaries, several contributions in this volume underline the links between translation, medicine and power (e.g. Baldo, Bessaih, Kang, Moreland and Swabey, Sandset, Spisiakovâ, Susam-Saraeva and Carvalho Fonseca). The power in question goes beyond ethical considerations surrounding the interpreter/ healthcare provider/patient triad, and encompasses a range of issues, such as patient autonomy, informed consent, empowerment of oppressed and/or marginalised groups, challenging institutional attitudes and practices, and the connection between the adoption of ‘Western’ medical knowledge and nationalism, including the processes of modernisation. Other contributions on enhancing health literacy through improving accessibility and readability, on recent projects in medical terminology and machine translation, and on knowledge translation between science in laboratories and clinical application reveal further implications regarding the positioning of the ‘patient’ vis-à-vis biomedicine.
Healthcare-focused research in translation studies
While the topics covered in this handbook are, in many cases, well-established areas of research either within or outside translation studies, there has been, to our knowledge, no single volume that brought together such a range of topics on human health and wellbeing as seen through the prism of inter- (and intra-)lingual transfer. The following brief overview outlines some of the most prominent general works on the subject of health in translation, in order to complement the highly specialised information included in the contributions to this handbook.
The first volume bringing together research on a range of topics related to translation in medical settings was Henry Fischbach’s Translation and Medicine (1998). The volume explores topics such as the historical and cultural aspects of medical translation, the training of translators in healthcare settings, and the translation of medical terminology, and as such, could be considered an early precursor to the current volume. With the rise of translation studies as an academic discipline in the early 2000s came the increasing specialisation of its subfields, and research on subjects related to translation and health have gradually become more subject-specific. Out of these subjects, the most comprehensively covered one relates to interpreting in healthcare settings, reflecting the growing need to ensure equal access to medical care in increasingly multilingual societies. The first volume bringing together research articles on the subject was Franz Pôchhacker and Miriam Shlesinger’s Healthcare Interpreting: Discourse and Interaction (2007), which focuses on cross-cultural communication, the role played by interpreters in healthcare settings, and the discursive patterns of interaction involving a medical interpreter. A later volume by Brenda Nicodemus and Melanie Metzger, Investigations in Healthcare Interpreting (2014), centres on the communicative aspects of interpreter-mediated encounters in healthcare, and explores the different methods for improving accuracy in these encounters. The bilingual volume (Spanish and English) Translating and Interpreting Healthcare Discourses! Traducir e interpretar en el ámbito sanitario, edited by María-José Varela Salinas and Bernd Meyer (2015), comprises both interpreting and translation, and touches upon subjects such as sign language interpreting, quality assurance in the translation process, and translation of specialised medical texts and terminology. The most recent addition to the field is the Handbook of Research on Medical Interpreting, by Izabel de V. Souza and Eflfrossyni Fragkou (2020), which covers areas such as healthcare administration and education, patient care and safety, and interpreting for victims of violence, amongst others.
Another area frequently explored in studies on medical translation and interpreting is the question of intercultural communication. Claudia Angelelli’s volume Medical Interpreting and Cross-Cultural Communication (2004) has an ethnographic study of a bilingual hospital at its core, and uses interviews with interpreters to highlight their agency in situations where they are required to bridge cultural as well as linguistic divides. Health, Communication and Multicultural Communities: Topics on Intercultural Communication for Healthcare Professionals by Carmen Valero-Garces (2014) places an emphasis on the communicative element of interpreted encounters, and offers reflections and experiences from the author’s long career in training mediators and translators in multicultural medical settings. Elaine Hsieh’s Bilingual Health Communication: Working with Interpreters in Cross-Cultural Care (2016) likewise uses interviews with both interpreters and healthcare providers to explore the phenomenon of bilingual healthcare in a wide range of language combinations. Finally, Multicultural Health Translation, Interpreting and Communication by Meng Ji, Mustapha Taibi and Ineke Crezee (2019) brings together a range of research topics in empirical health translation, and covers both macro questions concerning national healthcare systems and micro studies of areas such as mental health interpreting.
Several other volumes in the field of medical translation are aimed specifically at professional translators and interpreters with no formal training in interpreting within healthcare settings. These volumes are particularly important, as not all institutions teaching translation and interpreting offer specialised courses on the topic. Ineke Crezee’s Introduction to Healthcare for Interpreters and Translators (2013) serves as a comprehensive guidebook for those with no prior experience in healthcare interpreting, and provides a well-organised overview of the terminology, concepts and systems they are likely to encounter. The handbook has generated versions for specific languages, including Spanish (Crezee, Mikkelson and Monzon-Storey 2015), Japanese (Crezee and Asano 2016), Chinese (Crezee and Ng 2016) and Arabic (Crezee, Gailani and Gailani 2016). Claudia Angelelli’s recent volume Healthcare Interpreting Explained (2019) is likewise a guidebook for students and practising interpreters, and teaches problem-solving strategies through real-life examples, alongside chapters on ethics, protocol and professionalisation. Vicent Montalt and Maria González Davies’ volume Medical Translation Step by Step (2007) turns towards the problem of translation in the medical sphere and offers a comprehensive overview, including detailed instructions on the writing and improving of drafts, and large-scale issues related to the role and responsibilities of translators specialising in medical texts.
It is on the basis of this existing body of research that this handbook intends to propel studies on translation and health into areas beyond healthcare interpreting and medical translation. Crucial though the emphasis on the interpreter/translator working in/on medical encounters/texts has been, we hope that contributions in this volume will demonstrate the significance of other agents translating and interpreting in relation to health, as well as of the various contexts that sustain or hinder translation and interpreting.
