アーネストコラム「酒酒落落」 医療通訳者アビー・ニコラス・フリューさん「医療通訳という活動と『MICかながわ』」
アーネストとご縁が繋がった方々がそれぞれの視点で自由にテーマを設定・執筆いただく連載コラム「洒洒落落」。第21回は医療通訳、という少し特殊な分野でご活躍中のアビー・ニコラス・フリューさんにご登場いただきます。
～プロフィールご紹介～
▲Abbey Nicolas FREW (アビー・ニコラス・フリュー)
‘外国語が出来れば誰でも国際人’をいう考え方や表現に真っ向から逆らい、言葉の背後にある異文化の妥当的理解がむしろ大切だと信じる4か国で育った自称「地球人」。
横浜市在住期間が長くなってきたが、意識としての故郷はいつまでも米国カリフォルニア州ロスアンジェルス市。
元スポーツ選手からﾌﾟﾛの舞踊家に転身後、事故で3年近い医療手術と治療の入院・療養生活を体験。その後20代半ばで教育関係に再転身と同時に再び外国生活を一時的に始めるが、日本語研究の傍ら語学教育、通訳、翻訳などを続ける内に横浜に定住（もはや神奈川県横浜市は第二の故郷）。
現在、MICかながわとAIDSネットワーク横浜でボランティア活動を続けながら、東京にある大学の非常勤講師を務める。又コミュニティー活動に積極的に参加する形で、より摩擦の少ない地域の国際化に貢献したいと考える。
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次々と迫る荒波を越える勇敢な心で様々な道を経て、現在は日本語の研究や教育に携わっているニコラスさん。そんなニコラスさんが取り組むボランティア活動、「医療通訳」とはどのような仕事なのか。
今回より全3回でお届けします。
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1、医療通訳という活動と「MICかながわ」
一般に病院と呼ばれるところには色々な科があります。しかし日本に住む外国人には、もちろん外国人専用科などいうものはないため、日本人がかかる医師や看護師に診てもらう事になります。
問診や治療や検査、薬の処方、さらには出産や手術などなど、当たり前のことですが医療に関する通訳分野の幅は日本人が日本語で病院にかかるのと同じ広さがあります。日本語が話せなければ医師に自分の症状を訴えることもできないし、医師や看護師、検査技師や薬局の人の説明も理解することができません。初めて病院にかかるとすれば、問診票の質問に答えたり、○や×を付けたり、既往歴や家族歴やアレルギーの有無などを記入する作業もありますね。また、カルテを持ってどこの何番窓口に行って順番を待てば良いのか、何の検査をするのかも、分からないことが多いのです。
そういった外国人の方をサポートするひとつに、「医療通訳」があります。
通訳者は日本語ができない患者さんの言葉を日本語に通訳して医療機関側の職員に伝え、その逆も行ないます。通訳は病院の受付から始まり、薬局で患者が薬を受け取り、代金を支払うところまでが含まれます。
通訳者は病院の職員ではないので、給料や交通費は病院から支給されずボランティアです。余命などの告知や死の現場など、難しい通訳は精神的な負担も大きく、病院で知らないうちに何かに感染してしまう危険もあります。つまり、医療通訳に従事する者は、経済的・精神的・肉体的な健康が求められます。
そんな通訳者たちの管理・派遣を行なっている団体が、特定非営利活動法人「MICかながわ（正式名は「特定非営利活動法人多言語社会リソースかながわ」）」です。私も医療通訳者のひとりとして、ここに在籍しています。
MICかながわは多言語共生者に向けて「『ことばの壁』をなくそう！」をモットーに、言語や文化の違いによる壁をなくすことで、誰もが安心して医療などの公共サービスを受けることができ、活き活きと暮らせる社会の実現を目指している団体です（一部ウェブサイトより抜粋）。
2002年4月の設立後、色々な認定や承認を受け、現在までに約40近くの医療機関と協定を持ち、通訳派遣事業を行っています。登録通訳者は約150から200名おり、10言語の班に分かれています。日本人も外国籍人もいます。日本人には移住経験のある人もいる一方、日本から出たことがない人も、さらには日本に帰化した元外国籍の人もいるなど様々です。皆それぞれ別の生計手段を持っていて、通訳は食べるための手段ではありません。
▲ミーティング風景
事業内容としては、主に医療機関で日本語での問診や治療が受けられない人たちに通訳を提供します。MICかながわは医療機関以外にも通訳を派遣していますが、ここでは医療通訳のみに限ってご紹介したいと思います。（続く）
★「医療通訳」と「MICかながわ」について、英文でもご執筆いただきました。
こちらもぜひご覧下さい。
MIC Kanagawa and medical interpretation
MIC Kanagawa (“Multi-Language Information Center Kanagawa” Nonprofit Organization) is based in Kanagawa Prefecture, south of Tokyo in Japan and its motto is “Breaking ‘walls of language barriers!’ “. It aims at developing society by eliminating the problems in language and cultural differences so that everyone has the rights and be subjected to public services such as health care and living without fear. (mickanagawa.web.fc2.com/)
Established in April of 2000, receiving many awards and certified acknowledgements, MIC Kanagawa has cooperation agreements of interpreter dispatch activities with about 40 medical facilities in Kanagawa Prefecture today. The number of registered interpreters is 150 to 200, divided into10 languages groups with Japanese as well as foreign residents or non-Japanese national people. Many of them have experience of immigrating or living in foreign countries but also there are Japanese people who never have such experience. Every member has another way of earning living besides being active with MIC Kanagawa. No one can make her/his living being a medical interpreter with MIC, even if tried simply because it would be impossible.
MIC Kanagawa dispatches spoken language interpreters into medical institutions such as the hospitals and clinics for the patients with LJP or limited Japanese proficiency, to be able to communicate with medical professionals such as the doctors, nurses, examiners, and pharmacists so that the PLJP (people with limited Japanese proficiency could receive fair and accurate medical treatment. Although MIC Kanagawa sends the language interpreters to places where there is no relation with the medicine such as school meetings and international conferences. However, this paper talks only about the medical interpreters.
In general, the hospitals have various departments and visitors usually select and try seeing the doctor according to their symptoms. However there is no “Foreigners Department” made for PLJP so they would see the same medical professionals as other Japanese patients and the needs of medical interpretation can be found in interviews, inspections, treatments, drug prescriptions, even childbirth and surgeries, etc., of course. Hens without enough Japanese language skill, the PLJP would encounter with difficulties in communication with the medical professionals. In other words, the PLJP are not only unable to tell the doctor their symptoms but also unable to understand what the doctor, nurses, or pharmacists say. Moreover they would find a difficulty to do a simple task at their initial hospital visit requires, such as answering the questions or filling out the questionnaire by writing down whether or not they have allergies against certain medication, or indicating their past medical history and family history but their struggle would not finish there then. It follows them whatever they may do and wherever they may go within the hospital; for instance, they might have a hard time finding where they should go and turn in the medical chart, finding out what kind of examination is required, where they have to make payments, etc. From those examples mentioned, it is clear that for any patient, the Japanese language ability is essential in every process in order to receive the appropriate medical treatments. Hens a MIC Kanagawa medical interpreter becomes the mouth and ears of the patient and at the same time, the medical professional’s mouth and ears, which usually includes interpretation work in the hospital and the pharmacy.
MIC Kanagawa’s medical interpreters are not the staff members of the hospitals or the pharmacies therefore they do not receive salaries and travel expenses from the hospitals, either. Even though they sometimes have to travel far away from their home and always think of the time and cost of traveling. In spite of long, expensive traveling, they may face a sudden cancelation or very difficult interpretation when they arrive at the site. A long and expensive trip to the hospital on a stormy or snowy day could make it even worse and if the patients did not show up, how would the interpreter feels? Difficult interpretation jobs can be stressful to the medical interpreters as well. Such as letting a patient know that her or his life on Earth has a very short time left or death announcements could make the medical interpreters feel sad and helpless. In other times, they might face the risks or potential danger of infection with deadly diseases or viruses without noticing. In a manner of speaking, the medical interpreters require the following three kinds of health; economic health, mental health, and physical health.
MIC Kanagawa’s 10 fundamental demands for readiness
On-site medical interpretation is supported by the members of NPOs (non-profit organizations) with their personal volunteerism at the moment in Japan and the system needs to be improved, yet the volunteers should not provide irresponsible in a halfhearted way interpreting jobs. They should be sensible and have right attitude as the medical interpreters, which are as important as the language skill. Every medical interpreter of MIC Kanagawa has to follow the ten rules in order to stay as a trustworthy NPO that the patients and medical professions can rely on. Here are the ten fundamental readiness demands for their work.
01) Accurate interpretation:
It is necessary for the medical interpreters to keep studying languages repeatedly for being able to do the accurate interpretation. Try to void free translation or guessing but interpret words and phrases meticulously as possible because some simple words might indicate principal keys for doctor to make a patients’ diagnosis. Unlike Japanese, it is more important to make subjects, verbs, adjectives, and tenses clear in English and perhaps some other languages. Taking notes is also essential at times and memorizing basic medical words is, of course, helpful though it is not enough as medical interpreters may encounter unknown disease names, strange medical words, or brand new phrases any time during their work. Then it is absolutely all right to use a dictionary. The medical interpreters can also request the doctors to repeat phrases, paraphrase, or speak in short sentences, to make it easier for them to maintain the accuracy of interpretation. Likewise they may want the patients to speak sentence by sentence instead of telling the doctors everything at once, which often happens. Then the interpreters should ask the patients to do so or interrupt their speech in the middle if it is necessary.
02) Acquiring the basic medical knowledge:
To be familiar with the basic human body system and the common diseases, reading newspaper articles and publications relating to the medical field would be a good idea though it is not necessarily important to memorize difficult medical terminology. Simply it helps the interpreters to do the job more smoothly if they knew more about the medical related matters.
03) Confidentiality of personal information:
Various kinds of problems of the patient’s life are mentioned or spoken in the dialogs between the doctor and the patient in the interview room at hospitals yet the interpreters must not tell any part of them to anyone else, except the medical professionals who are involved. The patients as well as the medical professionals could trust the interpreters by only making it sure that one’s privacy is strictly maintained or it would never leak out by the interpreters. Therefore the interpreters should be careful when they see the patients outside of the hospital or on the street, not to greet them casually or carelessly as they might not want to be seen with the interpreters outside. Moreover, the protection of confidentiality is not just talking about the patients’ but also all the medical professionals’ and other workers’ in the institutions.
04) Making it easier for the patients to speak:
There might be times that the interpreters find out the patients’ occupations, visa statuses in Japan, or living situations by accident and the findings might not be pleasant. However the interpreters should not show their uncomfortable feeling or disapproving thought against it in their attitude or on facial expressions. No matter what the findings turn out to be, all the feelings inside of the interpreters’ have to be hidden because the slightest negative action of the interpreters’ would stop the patients from opening up and talking. Being able to contact anyone with welcoming attitude is absolutely indispensable for the medical interpreters. Therefore in the interview room, the medical interpreters should make sure that the patients and the doctors can have their dialogs without difficulty by finding a spot where the interpreter stay without blocking their eye contacts. Avoiding wearing strong perfume or shocking looking clothes are also part of readiness for welcoming the patients.
05) Avoiding mixing the patients’ words and the interpreters’ opinions:
Fundamentally, speaking the patients’ ideas or opinions is not the interpreters’ job to begin with. Therefore the interpreters only have to interpret the words or the patients’ and the medical professionals’ unless there was a reason that the patients’ cultural backgrounds or customs, which may affect the patients’ treatments badly or the patients might face unfavorable burden because of not letting the medical professions know the reason. In such a situation, it is wise to make a comment after confirming that the both patients and doctors agree.
06) Cooperation with various medical professionals and knowing their roles:
Because the medical interpreters can understand the patients’ languages and communicate rather easily, the patients could develop a feeling of dependency toward the medical interpreters in many ways. When it happen, the patients might start requesting the interpreters to solve their emotional struggles, financial problems, or other difficulties in their lives though it is impossible for the medical interpreters to undertake them. Instead, it is better to cooperate with other professionals such as counselors, social workers, NGOs, etc. to help the patients. Thus by knowing what kinds of the professionals are available and where to find them or how to contact them, the medical interpreters can become the patients’ bridges to the professional though they are not the experts of the system.
07) Clarifying the role of the medical interpreters:
First, the medical interpreters should let the patients as well as the medical professionals know the job or the role of the interpreters’. The requests other than the language interpretation at medical institutions may come from not only the patients or the medical staff. It is important to be aware that the interpreters are allowed to decline any request which is beyond the medical interpreting work or the interpreters’ ability, or even it may be an easy or possible job. As extra work could become a heavy load, which could lead the medical interpreters to not only making errors in interpretation but disappointing the people who requested if the medical interpreters failed to meet the expectations of the requesters’. After all, the patients who requested a favor of the medical interpreters would suffer a loss the most.
08) Consultation with the coordinator:
When the doctors have to notify the patients they have developed cancer, AIDS, or seeing a small child with serious illness, the medical interpreters can be emotionally disturbed or they can feel down, even though because of the duty of confidentiality, such sad thoughts and mind cannot be expressed or tell anyone else, even the family members. Although the protection of personal information seems rather easy, it could influence the interpreters’ health negatively, which should be avoided before it is too late by consulting with the coordinators and the staff members of the organization where the interpreters belong or the medical interpreters could become needy themselves as they are facing the risk of becoming patients constantly. They cannot continue with their activities as medical interpreters if they become sick, instead of being help.
09) Learning the services that the foreign residents can use:
Perhaps a medical interpreter may find out and feel sad that a patient has no financial ability to pay the medical costs because of not having a health insurance. However there are a few systems which enable the foreign residents to reduce the medical costs or receive special treatment without having a status for the health insurance in Japan. Using such as the Tuberculosis Control Law and workmen’s compensation insurance are good examples yet the medical professional in charge of the patient’s might not know or understands it. If it was the case that the patient cannot get any help, then the medical interpreter can suggest that the patient go and see a MSW (medical social worker) or other professionals in the related area when asked by the patient.
10) Staying healthy:
Naturally being healthy is required for all the medical interpreters as they do the work at the medical institution sites. They have to worry about not only catching a disease themselves but also passing it to someone else in the hospitals consequently the interpreters have to stay home and refuse to attend the hospitals for the work if they had even a slight cold. In other times, the medical interpreters may contact the patients with infectious diseases therefore receiving regular health check-ups is needed, especially when coughing continued after meeting the patient of tuberculosis, they should see the doctor and tell that they attended the medical interview with the patient suffering from tuberculosis.
Those mentioned above are the members’ ten basic demanding rules that the all medical interpreters of MIC Kanagawa have to follow. Each category includes more detail and it expands much wider areas than written above though only by keeping learning, reviewing, renewing their knowledge and skills, the medical interpreters of MIC Kanagawa can continue to serve the communities and societies where the foreign residents can gain their human rights and dignity.
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MICかながわウェブサイト
公開講座なども開講中
http://mickanagawa.web.fc2.com/
リフォームから、施工までの
アーネストグループ全体サイトはこちら
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アーネストコラム「酒酒落落」 医療通訳者アビー・ニコラス・フリューさん「一般通訳と医療通訳の違い・通訳の際に気をつけておくこと」
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