Sharing Best Practices for Effective Multilingual Communication in Healthcare
Can Neutral Spanish be useful for translating medical content in the US? Absolutely, but it does require adding a health literacy component, so that patients obtain the most from English to Spanish healthcare translations.
There are as many variations of the Spanish language as there are regions within the countries where it is spoken. Interestingly, it was this very linguistic diversity that led to an unusual experiment by the movie industry in the early twentieth century. If you are a Spanish speaker and watch an old Hollywood movie dubbed in the 1930’s, you might find some of the expressions used back then to be odd, offensive or even hilarious, and you might not even grasp the meaning of certain scenes. Back in the 30’s, movie studios tried to reach the Spanish-speaking audience using their own version of Spanish. Their goal was to “develop” a Spanish that wouldn’t belong to any particular country, but would be understood by all Spanish speakers. The result was for the most part an unintelligible language that sounded unfamiliar, felt unnatural and lacked the spontaneity and cultural elements necessary to convey emphasis and emotion. Later on, an effort was made to take common elements from various Spanish dialects to attempt to build a “Standardized” Latin American Spanish. The rules adopted were simple: select common vocabulary, exclude terms that may be country-specific and avoid the usage of idioms that may be offensive in certain places. Instead of vosotros, use the second-person plural ustedes for formal and informal interactions. Avoid using vos for familiar interactions, and instead use the second-person singular tú. These rules made it difficult to create characters that sounded natural and credible. Even so, Standardized Spanish is still frequently used to dub American TV shows and low-budget movies.
Recently, however, a different approach has emerged. It uses local Spanish variations and equivalent expressions in the target culture in order to make it familiar. This “Localization” approach makes the translation sound less foreign, more natural, and spontaneous. This approach has been successful at winning over Spanish-speaking audiences. Today you can watch a Mexican or a Colombian version of Shrek dubbed by Mexican or Colombian actors using their own countries’ expressions, and laugh just as hard in either country as you would in the US.
Many US companies that successfully market their products in Latin America follow the localization approach from the movie industry. They adapt their content to appeal to local markets using country-specific language and avoiding symbols, graphics, and colors that could be misunderstood or perceived as insensitive. This works well when your audience belongs to a single locale, but localization poses a particular challenge in the United States, because there are about 58 million Spanish speakers living in the US, and they come from 20 different countries.
Although the attempt to standardize Spanish did not work for dubbing movies, and a localization approach had a much better reception, standardization has still left behind some valuable lessons and guidelines which are quite useful when translating text for the US Latino population. Today many companies still use “Standard Spanish.” Microsoft, for instance, uses “Neutral Spanish” with the simple concept: “communicate precisely without being offensive and without sounding foreign.” This is easier said than done, but it is possible with the careful selection of common words and the use of correct grammar. Diversity continues to be a difficult variable to tackle, in rare instances it is not possible to find a common word for all variations of Spanish. For instance, the word “straw” has 8 possible translations (popote, paja, pajita, pitillo, sorbeto, bombilla, carrizo, and cañita) and there is no universal word that everybody would understand. There are some ingenious techniques for handling these cases and still getting the message across. One of them is the use of paraphrase, which is when an experienced translator describes the word in order to clarify the meaning. In other instances, it may be more practical to use parentheses to include alternative terms.
Can Neutral Spanish be useful for translating medical content in the US? Absolutely, but it does require adding a health literacy component, so that patients obtain the most from English to Spanish healthcare translations. Frequently, there is an overlap between patients with a poor English proficiency level and low health literacy. Medical translations of documents that people use to make important decisions about their medical care, such as enrollment forms, informed consents, discharge instructions, and other vital documents, must be meticulously crafted, taking into account cultural and linguistic factors, so that Spanish-speaking patients can obtain, process, and understand health information and services. For the terminology to be neutral, it must be carefully chosen so that it is clear to a wide audience of Spanish speakers of different origins, and also takes into account their health literacy level. This can be accomplished by developing glossaries that include preferred terms at a 6th grade reading level and using style guides that incorporate familiar wording to describe medical jargon and technical terms. Neutral Spanish in healthcare should aim to translate messages, not words. Patients should be treated as people with whom we interact, not as a passive audience that just receives information from us. Language can be persuasive and inclusive and can help providers create rapport with their patients.
Taking the time to find the “right” Spanish for healthcare pays off. Easy to understand medical translations allow patients to make informed and appropriate healthcare decisions, follow through on tests and referrals, agree and adhere to treatments, and receive a high standard of care.
Providing English to Spanish translations of medical documents may not be as glamorous as dubbing a scene from Gone with the Wind, but healthcare translation serves the higher purpose of providing quality care to a vulnerable population, preventing adverse events, and not to mention avoiding costly medical malpractice claims.