Lifelong Learning Programme
Lifelong Learning Programme, Grundtvig - Multilateral Project
Project no.: 142235-2008-LLP-NL-GRUNDTVIG-GMP
Project title: TRICC - Training Intercultural and Bilingual Competencies in Health and Social Care
Interdisciplinary Social Science Department
Utrecht University

Utrecht, the Netherlands
Boğaziçi University
Istanbul, Turkey
COOSS Marche
Ancona, Italy
dock europe e.V.
Hamburg, Germany
PPRE Limited
London, Great Britain


Recommendations for integrating multilingual competencies (Germany)

The following aspects should be taken into account when implementing qualified ad hoc interpreting in institutions:

  • Voluntary engagement of employees
  • An institutional culture of appreciation of the employees and special acknowledgement of interpreting efforts
  • Leave for interpreting services during working hours
  • No interpreting services outside of working hours
  • Clarity concerning responsibility and competence: interpreting is a task involving translation and communication – it is not equivalent to social work
  • Clear organisational structures especially concerning responsibility and who can be addressed with complaints
  • Training of all employees/members of the institution in handling interpreted situations
  • Providing all employees with decision support concerning when to call in external professionals and when to resort to internal interpreting support
  • Determination of quality standards
  • Regular further training opportunities for ad hoc interpreters.

Ad hoc interpreters are not per se responsible for handling intercultural situations. Therefore the following aspects need to be considered for an intercultural mainstreaming of institutions:

  • Raising awareness for intercultural aspects for all employees of an institution
  • Imparting background knowledge on specific socio-cultural aspects
  • Enhancing intercultural competencies of all employees.

Deploying multilingual employees who have been trained in ad hoc interpreting has proven to be a successful approach, as positive experiences with internal interpreting services have shown. This course of action makes use of the available resources, simultaneously acknowledging the abundance of linguistic competencies. It benefits patients/clients or customers who depend on language mediation since it ensures their access to information, care and equal treatment. At the same time institutions save time and money when providing their services, care and counselling because the language transfer helps prevent inappropriate, inadequate or too intensive care.

dock europe e.V.


Recommendations (The Netherlands)

During the TRICC project, The Netherlands conducted interviews with and provided trainings for General Practitioners. They were trained to enhance their knowledge and skills regarding consultations with migrants in which language barriers arise.

Contextual approach
Generally, the use of formal interpreters is being seen as ‘best practice’ to bridge language barriers. Nevertheless it is obvious that the choice for an interpreter depends on the specific situation and the wishes of the patient. We therefore think a contextual approach with regard to interpreting issues is needed, in which flexible solutions are being sought to for the specific situation. This means realistic choices are being made by care provider and patient based on their needs and possibilities. The use of a good interpreter is (cost) effective and efficient, which leads to better care and therefore less visits to the care provider. It is better to invest in the first consultation with an interpreter, in order to shorten the visits afterwards because a good translation enables an accurate diagnosis. Some patients will be better off with a formal interpreter, whereas others will benefit from an informal interpreter (e.g. family member or close friend). Sometimes the care provider will have to search for an ad hoc solution like asking a bilingual colleague to facilitate the consultation. It becomes clear that according to us each patient has a right to a specific, contextual approach in bridging the language barrier. Within interpreted consultations, special attention is needed for the use of children as interpreters. This can not be tolerated, since they are vulnerable and the responsibility that comes along with the task is too much for them. It can often lead to parentification which may cause traumatic experiences. Because of the importance of interpreting, the Dutch government needs to continue to provide interpreter services for care providers. Moreover, she can improve the interpreter facilities and create more awareness of the possibilities among care providers. Further, health and social care institutions are recommended to provide abilities for their employees to work with interpreters, like making policies about bridging language barriers and provide proper equipments (telephone with loudspeaker).

Train the trainers
Since the training ‘Overbruggen van taalbarrieres in de zorg’ turned out to be effective, it is advised to transfer the concept of the training for other target groups in social and health care (e.g. physicians, nurses, paramedics). The training offers useful knowledge and skills to transfer powerless feelings with regard to language barriers into powerfull performance in a fun way. Forum theatre activates the participants because it is not prescriptive and it therefore invites the audience to experiment with new behavior in a safe and non judgmental environment. Trainings with the use of this technique are adequate for all professions in health and social care and beyond. Not only can forum theatre be used for interpreting issues, but for a great number of subjects (like creating rapport, improving listening skills, shared decision making etc.). At the moment, plans are being made to develop and implement these courses for countries across Europe (Italy, Spain, Germany). All these forms of ‘best practices’ will hopefully find their way to teachers from secondary and higher vocational education and universities. In that way forum theatre can be implemented in a broad domain.

From informal to formal interpreting
When migrants come to the Netherlands, they learn a new language. Some of them will come to realize the profit of multilingualism. This can inspire them to investigate their informal interpreting qualities and to increase them through education. What may have been an obligation to family members at first can now be done professionally: formal interpreting. Another option for them is to use their bilingualism in their own profession, like the trainings in Germany and UK have shown within the TRICC-project. In the Netherlands this approach can be adopted within ‘civic integration courses’ for migrants. Attention can be paid to the surplus of multilingualism and to how these qualities can be used for different targets and in various settings. This will also contribute to the integration of migrants in society. Obviously it is equally important to train formal interpreters in facilitating bilingual conversations in health and social care. More information can be given about translating medical terms and the structure and procedures of medical consultations.

In conclusion, we can say that language barriers in health and social care need to be bridged by a good interpreter. It is important to understand each other and to build a relation of trust between patient, interpreter and care provider. The use of interpreters contains more than just a transfer of information; above all it has to do with trust and mutual respect. Patient satisfaction is not only determined by medical-technical solutions but also by a good communicative approach. Care providers are more satisfied with their work when they can build a good contact with their patients. In this respect, getting the message across makes all the difference!

If you are interested in the Dutch project results and further recommendations, you can order our Best practice handbook ‘Als je niet begrijpt wat ik bedoel’, tolken in de zorg at (only available in Dutch).


Final recommendations (Italy)

Planning tailored and high quality services, promoting innovation, managing new and complex social phenomena, facing changes, are imperatives that migration has brought to the attention of managers, policy makers and administrators involved in the planning and provision of health and social services. Multi-culturality is a recent phenomenon in Italy, particularly in our regional area, and it has been modifying the relationships within the society. The consolidated habits the Italian and local entities were used to, need to be modified and adapted to this new multi-cultural reality. The health professionals’ working and relational methods need to be updated accordingly, and proper tools to acquire intercultural competences should be made available. The professional educational curricula do not foresee the enhancement of cultural competences among their disciplines: tailored educational interventions should therefore be planned to help the health staff to increase their cultural competencies, to acknowledge the individual diversities and to consider them an enriching opportunity more than an inconvenience. Focusing on the centrality of the human being should be the starting point, and not the application of a generic “ethical label” to the company policy.

Increasing the cultural competences in the health professionals requires therefore the organisation of short courses for the health professionals: the TRICC experience is a valid and concrete example in this sense. The training initiative experimented in Jesi indicated the effectiveness of a participative and highly interactive method, as the Image and Forum Theatre is, in meeting these educational needs.


Recommendations for medical interpreting policy and the training of community and medical interpreters (Turkey)

As our research and other studies have shown, a considerable (though seemingly declining) number of patients in Turkey face difficulties communicating with health workers, which obviously has a negative effect on the medical care they receive, if they receive any at all. This problem is particularly pronounced in the East and South East of the country, where around a third of the population have minimal proficiency in Turkish, but it also exists in other areas (especially cities like Istanbul, Ankara, Izmir and Mersin), which over the years have seen an influx of (largely poorly-educated) Kurdish-speaking migrants, as well as immigrants and refugees. Now that most Turkish policy-makers have stopped wilfully denying the multilingual and multicultural realities of Turkish society and the challenges these realities bring, and health-workers have started to address the language issue in health care head on, concrete solutions need to be found, including the provision and training of interpreters.

In the East, an ever-increasing number of medical personnel are ‘locals’, and non-governmental organisations like the Diyarbakır Chamber of Medicine are striving to encourage these, and other doctors from farther afield, to improve their Kurdish, so that they can be in a position to communicate with patients in that language if need be. All the same, there is still widespread use of untrained ad hoc interpreters, with all the problems this brings, and this situation is unlikely to end in the foreseeable future. For this reason, at the same time as encouraging (or at least tolerating) the efforts of the non-governmental organisations, the state should act to enable citizens to avail themselves of the right to an interpreter granted to them (albeit indirectly and vaguely) in the Regulation on Patients’ Rights (1998). (Meanwhile, citizens who find themselves deprived of this right should be encouraged to seek legal recourse based on it, thereby perhaps helping to create legal precedents and thus speed up change!) In the short-term, training similar to that provided by the partners in TRICC could be offered to individuals who currently carry out informal interpreting on a regular basis, provided they have a good knowledge of both languages and are not minors. The trainees could be Kurdish-speaking health-workers, who frequently interpret for their non-Kurdish-speaking colleagues, or young adults from the area. (In Eastern and South Eastern Anatolia, there are a whole host of political, socio-economic and cultural problems, foremost among them mass unemployment, which induce despondency, aimlessness and religious and political extremism in the large young population. Encouraging young people to value their bilingualism and their important role as mediators might give them a greater sense of worth.) Such training would ideally be provided by local universities with faculties of medicine and departments of translation or Kurdish language and literature. These universities should also play a lead role in developing more extensive training for professional community interpreters, who in the future will hopefully do most of the work currently done by informal interpreters. (This said, one would expect that many of those who might choose to become professional interpreters will have previous experience of doing this work on a voluntary basis).

As mentioned above, problems in medical communication are not restricted to Eastern Anatolia but occur across Turkey. What is more, since Turkey will probably change its legislation soon and start granting asylum to applicants from non-European countries (which it currently refuses to do, owing to a geographical limitation it placed on its signing of the 1951 Geneva Convention relating to the Status of Refugees), it is likely to become a target for even more migrants, who will also require interpretation.

At present, formal interpreting services simply do not exist in the public health sector in Turkey. Much work needs to be done to draw attention to the need for them. The symposium on ‘Community Interpreting in Turkey’ sponsored by TRICC and held at Boğaziçi University on 22-23 November 2010 was a first step, but interested parties should continue raising the issue, with researchers having an important role in documenting the current state of affairs, analysing the processes and effects of the ad hoc solutions used at present and drawing on experiences from other countries. In conjunction with other stakeholders, they can also initiate a discussion of interpreting ethics and best practice, and help show ordinary citizens and politicians alike that the status quo in medical communication in Turkey is in no one’s interest and that a moderate degree of investment, training and professionalization in medical interpreting could make a huge difference.