For Young Joe, the most rewarding part of being a medical interpreter is the look of relief that takes over patients and doctors’ faces as soon as she enters the room. Without her, conversation is impossible.
Her job is to interpret exactly what each person says from Korean to English or vice versa. She isn’t advocating for either of them — she’s simply a neutral conduit between the patient and their health care provider.
Joe works for the Provincial Health Services Authority (PHSA), one of the two non-regional health authorities that administers specialized and province-wide programs like BC Children’s Hospital, BC Cancer, BC Transplant and Trans Care BC. Provincial Language Services is a department under PHSA which provides services from certified medical interpreters in over 200 languages, allowing health care providers to book people like Joe for appointments at facilities that fall within these health authorities.
PHSA's Language Access Policy requires health care providers who are unable to communicate with a patient to use an interpreter. Even so, Joe said health care providers frequently refuse to use interpreting services.
Joe once overheard a conversation where a patient’s family member said they couldn’t take time off work to interpret during an appointment. Joe jumped in to mention that under PHSA policy, they could have an interpreter.
“I was just stating a fact to inform the doctor, and he just flips … yelling at me, [saying] ‘You only said that because that’s how you make money.’”
This is just one of many uncomfortable interactions Joe has witnessed in her work.
Family members acting as interpreters is far too common and much more harmful to all parties involved than one might think.
Dr. Benjamin Cheung is a psychology lecturer and the minor advisor for UBC’s Asian Canadian and Asian Migration (ACAM) program. Next year, he’ll be teaching ACAM 330: a course on the health and well-being of Canada’s Asian diaspora, including topics like how discrimination influences well-being and the psychosocial impact of traditional systems of medicine.
He’s also an example of a ‘translator kid’ — a phenomenon in immigrant families where children are expected to accompany older family members to things like medical appointments and act as an interpreter, which can place a huge mental and emotional burden on children.
“You’re relying on a lay individual to have the requisite medical knowledge in both languages, to be able to translate things effectively for both the physician and the patient,” Cheung said, pointing out that the children of patients also need to be in a position where they have time to invest in this labour.
“If they are lower socioeconomic status, and that means that the kid isn’t able to take time out of their schedule to take their grandparents, for example, to go to see the physician, then what happens to grandma? What happens to grandpa?”
Joe’s main concern is that this erases the patient’s perspective.
She’s sat in on appointments where people opted not to use an interpreter and noticed how anxious patients look as they’re sitting in an appointment, watching their relative converse with the doctor entirely in an unfamiliar language. They often end up approaching Joe to ask for help because they want to participate in the conversation.
“I’ve seen a lot of cases [where] they had to do the whole thing again because of the hidden voice [that] was not there,” she said.
Family members think they know the patient best and can speak for them, but there may be details they aren’t aware of because the patient doesn’t feel comfortable with them knowing. Joe said things get even more complicated when the family member is a health care provider themselves and insert their own opinion framed as a fact, which doctors often don’t verify with the patient.
“When that happens, the patient [has] no voice. It’s not going to be a patient-centred conversation,” Joe said.
“Because it’s convenient and doctors are busy, rather than asking the patient questions and asking that the family members interpret what they say … they just have a conversation with the family members and the patient has no agency.”
Often family members interpret out of love, but sometimes they’re the aggressors — out of malice, they might omit or add details that impact the patient’s care. Joe notices this most often in discussions around wills, organ donation, medical assistance in dying and domestic violence.
She recalled an instance where she was called in to interpret at the last minute. When she got there, a child had already been asked to describe what appeared to be a case of violence between their parents. There wasn’t just a risk of receiving potentially inaccurate information but also of causing trauma to the child.
Joe believes one of the main reasons people are reluctant to use interpreting services is because they have in the past and weren’t satisfied with the quality. She encounters a lot of people who have been interpreters for a while, yet don’t have a good grasp on the ethical considerations or even the language skills required for the job.
“Lower quality interpreters … stay in this industry because they cannot find better jobs or better payments. The reason good quality interpreters are leaving the industry is because we don’t get paid enough,” Joe said.
According to Joe, giving everyone access to a high-quality interpreter and encouraging more health care providers to comply with using interpreting services comes down to providing more accessible medical interpreting training and finding ways to keep skilled interpreters from leaving the field.
Vancouver Community College (VCC) used to run a medical interpreting program where Joe trained when she first entered the field. She says it was fairly affordable and “one of the best programs in North America back then.”
However, it was shut down while Joe was pursuing her master’s in Australia. It eventually re-opened, and Joe served as an instructor in the program until it was shuttered yet again in 2012.
VCC’s interpreting program is only one of several that have been scrapped within the past 20 years. Joe taught in one at UBC which also no longer exists. She approached SFU nine years ago and started a medical interpreting program there, which was quite successful — 90 students were enrolled in 2023.
SFU shut that program down the next year, along with the university’s English Language and Culture program, which was intended to help international students transition into studying in English. The university claims the closures were a result of budget shortages, but the Teaching Support Staff Union raised concerns around why interpreting and translation programs were targeted, especially without prior consultation with the union.
Joe is now an instructor at The Interpreter’s Lab, a private online interpreter training program. Because of a limited budget, the people running the program also receive next to nothing in terms of compensation for their work. They also don’t have the resources to offer the program with proper language teachers — they can only teach the concepts of interpreting in English.
“We have some language proficiency and efficiency tests before they can join … But when I’m in the class, I see a lot of students’ language [skills are] not good enough to be an interpreter.”
There are some students who Joe believes are good enough, but she keeps seeing the same problem repeat itself — students get offered higher-paying positions in other industries and leave interpreting behind.
“Not many people are taking this job seriously,” she said. “So again, the vicious cycle go[es] on.”
Joe tried combating these issues by initiating a petition calling on the federal government to develop a training and recruitment plan for qualified medical interpreters; ensure mandatory training for health care providers on how to work with interpreters and put a federal-level policy in place to enforce the use of trained interpreters in health care settings. The petition points to how the United Kingdom, United States and Australia all have strict government policies regarding the use of trained interpreters in health care settings, while Canada does not.
In the Ministry of Health response to the petition, Joe was told that it was a matter for the provincial government to resolve.
“I know that already. We need extra budget to support that. That budget [would] come from the federal budget [to] support BC and, hopefully, it would be the same for all over Canada,” she said.
Joe hopes to one day do research comparing Canada, United States and Australia — the three countries she’s worked in as an interpreter — analyzing whether using trained interpreters at the primary care level can reduce health care-related expenses further down the line.
Interpreting services are typically only available in higher care facilities, like hospitals, since family doctors are not reimbursed by the system if they provide the service.
She believes accurate communication facilitated by an interpreter could help primary care providers catch problems earlier in the process of diagnosing and treating patients and, in turn, reduce long-term costs.
Many patients go to the emergency room to take advantage of available interpreters even if their questions could typically be answered by someone like a family doctor. Health care providers may also order unnecessary medical imaging or make referrals to specialists just because patients aren’t able to clearly communicate the issues they’re experiencing. Ultimately, prices of these services end up higher than what it would have cost to hire an interpreter at the primary care level.
Coastal Health has a few public primary care locations where patients can request interpreting services, like Three Bridges Community Health Centre, but Joe would like to see this expand — she suggests offering a subsidy to family doctors who utilize remote interpreters in their offices.
Language barriers are a long-standing issue faced by immigrants navigating BC’s health care system, but the COVID-19 pandemic brought these issues into the public eye more than they had ever been before.
The Hua Foundation is a grassroots organization dedicated to running workshops and public programming related to anti-racism, and gives youth the chance to advocate for the needs of Vancouver’s Asian diaspora. It worked closely with the Chinatown community during the pandemic and noticed that a lot of people, especially Chinese and Vietnamese-speaking seniors, were missing out on crucial health information because most public health notices were only sent out in English and French.
“It was like a game of telephone. A lot of the main pieces of information were getting across, but some of the smaller details [weren’t],” said Christina Lee, the Hua Foundation’s Director of Community Capacity and Strategic Initiatives.
“Whether or not seniors and other more vulnerable communities … were actually getting access to possibly life-saving information wasn’t immediately clear to us.”
During the pandemic, Lee took the lead on the Hua Foundation’s Language Access Project (LAP), which aimed to make these resources more accessible.
C19 Response Coalition was one of the LAP’s main initiatives. The website built in collaboration with translators and organizations like the Bảo Vệ Collective — which provided language services for the Vietnamese-speaking community, but shut down after the pandemic — provides COVID-19-related information in traditional and simplified Chinese, Vietnamese and Tagalog. It also has resources to help readers distinguish trustworthy news from myths and potential scams.
Language accessibility isn’t just about translation — the way information is conveyed also matters.
In a 2022 study, UBC researchers conducted interviews with medical professionals, health communication specialists and community organizers to learn more about how Asian communities in BC reacted to public health information during the pandemic. Some interviewees reported that Asian communities were wary of the health system because of past experiences with racial discrimination and lack of medical interpreting and that a lot of outreach services that once served these communities had been cut in the years leading up to the pandemic, making it challenging to re-establish a sense of trust.
Lee pointed out how even when official government messaging was translated into multiple languages, the people who needed it were unable to navigate government websites to find these translated PDFs. Through working with culturally-specific organizations that directly engage with racialized communities on a regular basis, the Hua Foundation made sure they were using channels and language people would be receptive to.
“[Community organizers] are the ones who you know are actually directly interfacing with folks who may be having language access barriers,” said Lee.
“These service providers are often the ones that directly have the trust of people who are facing these barriers and, a lot of the time, they will know how to get information out into particular networks because not every community is the same and not every community uses the same pathways for accessing information and sharing with each other.”
Further initiatives within the LAP have been put on hold for now. The Hua Foundation has four staff members and one of them only works part-time — a situation exacerbated by minimal funding — so the organization doesn’t have the capacity to sustain or expand on this work.
“We’re doing all this work on the ground in response to these community needs, but how do we advocate for this at a more official or structural level to happen so that it’s not falling on the hands of translators and kids and family members to do this?” Lee said.
“In an ideal world, those types of things should be sustained by those governments and institutions internally, as well.”
Cheung emphasized that governments should be working with grassroots organizations as often as possible because they know best — and without support, they may shut down or reduce capacity like Bảo Vệ Collective or the Hua Foundation.
He also believes there’s a space for academics in the conversation. The Hua Foundation has had a long-standing partnership with ACAM, in part because Lee graduated from the program herself.
“People will sometimes raise the critique of academics [being] completely separated from the community — all theory, no practice, no action. I’d like to think that ACAM is slightly different in that regard,” Cheung said.
Lee said that working with scholars has given the organization access to grants and experts with knowledge in certain areas that they wouldn’t otherwise have.
Cheung also noted that academics, especially those in the ACAM program, are constantly collecting race-based data and doing research on how racialized communities might be impacted by certain health-related issues in different ways.
“Without that, the government does not know what communities are most impacted by the pandemic or by whatever public health crisis is happening,” Cheung said. “We also have to understand the reasons why some communities were particularly impacted.”
He hopes to see the government prioritize reaching out to academic units and grassroots organizations going forward.
“Working with scholars [and] community organizations at the same time … can allow us to create plans and protocols that would really best serve communities in a conscientious, thoughtful and ethical manner.”
Shortly after the LAP launched, the City of Vancouver instituted an administrative policy for language accessibility. There’s still much more work to be done and many other languages to uplift, but Lee believes it’s a step in the right direction.
“I think even the staff that worked on it will admit that it’s not perfect, but it’s the first step in terms of building a tangible policy that supports language accessibility across multiple departments,” she said. “[It] was really exciting to see something like that come to fruition.”
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