Beyond Words: The Art of Medical Interpretation with Matias Saenz

[00:10] Eyal Heldenberg: Hi, everyone. Welcome to Care Culture Talks. My name is Eyal Heldenberg. I'm the CEO of No Barrier, an AI medical interpreter for healthcare providers. Today with me is Matias Saenz. Happy to have you, Matias.

[00:24] Matias Saenz: Yes, thank you, thank you for hosting me.

[00:27] Eyal Heldenberg: Perfect. So Matias, would love to get to know you a bit, your journey in healthcare, and let's take it from there.

[00:36] Matias Saenz: Yeah, so it all started once I started university basically. I always wanted to have a side job, something I could do and something that was flexible especially. And I came across medical interpreting, starter certifications, training, taking out licenses, courses, all that. That probably took around two to three months.

And then I was able to officially start working, not necessarily certified, but as a medical interpreter without the state certification. Then after two, three months, I got the state certification. So I was officially certified in Washington state, as well as I had the flexibility to be certified in any other state. So I was basically certified nationwide. And it's been amazing, because it offers great flexibility and I can balance my classes, my other ventures, and medical interpreting while doing something that's fulfilling and rewarding and something that keeps me grounded, contributing to my community, contributing to immigrants who come here and need a voice and need someone to speak for them. So yeah, it's great. It feels like social work. It feels like I'm helping people out every day constantly. So yeah, it's a great feeling.

[01:53] Eyal Heldenberg: Yeah, totally. And need to mention that you function as a Spanish medical interpreter, right?

[01:58] Matias Saenz: Yes, Spanish, that's my language of expertise.

[02:01] Eyal Heldenberg: And where is your Spanish from?

[02:05] Matias Saenz: Ecuador, South America. It's a small little country right on the equator. Beautiful country. But yeah, that's where my Spanish and diction and lingo comes from as well.

[02:19] Eyal Heldenberg: Yeah, yeah. So, perfect. I wonder if you can share a moment in your interpreter career that made you realize what's the impact of your role.

[02:32] Matias Saenz: Yes, so when I realized the true impact of my role was after this specific interpreting session I had with an elderly woman, she was in her 80s probably, and she would use her son to interpret for her when she'd go to these medical appointments. And unfortunately, her son had passed away due to a medical condition. And this was her second or third visit without him. So she was struggling to understand.

She wasn't getting medical interpreters. When I met her in this appointment was the first time she got a medical interpreter since her son passed away. So up until then, she was literally not understanding anything the doctors were saying. So I interpreted for her. She seemed very relaxed, very at ease, because she finally had someone who could understand and communicate with her and the doctor. At the end of that appointment, she told me that I reminded her of her son.

And that was obviously beautiful to hear and very, very fulfilling because I realized that my job isn't just about translating words. It's also about making people feel heard and supported. So, yeah.

[03:51] Eyal Heldenberg: Yeah. Can you describe what is a daily routine of a medical interpreter in the hospital, in the clinic? What's your job and the interaction between the different players in the clinic?

[04:07] Matias Saenz: Yeah, daily routine consists of getting to the appointment and being assigned your patient. They're usually surprised when they see you because they don't expect having a medical interpreter because either they are new to the country and they don't know that there was this level of support in the United States or because in the past they've simply never had medical interpreters. So it's always a surprise like, "Hey, a medical interpreter. That's great." You obviously see a sigh of relief on their face and they become happy and relaxed because now they know they're going to understand everything.

Usually after that we go into the doctor's room or wherever clinic we're going to. I go with the patient, I guide them there because part of my job as well is to guide, because the hospitals are usually so big. Part of my job is to know where to go and take the patients with me so that they don't get lost. So yeah, we go to the clinic.

Usually we get the check-in from the nurse, vitals, weight, any signs of infection, any colds, any symptoms of flu or COVID, what's your weight, what's your height, then the nurse goes and the doctor comes in. Whatever explanation it is, whatever the visit is about, I interpret that. I interpret absolutely everything—that's something I forgot to mention. I interpret from the moment the patient walks into the hospital until the moment the patient walks out of the clinic. And that's basically it. Just after once the doctor says what he has to say and the patient also says what they have to say, that's about it. I just translate words and emotions. Yep.

[05:53] Eyal Heldenberg: Yeah, so basically you follow the patient throughout different touch points and making sure she or he could feel comfortable and understood at any other touch point from receptionist, nurse triage, billing or whatsoever.

[06:12] Matias Saenz: Yeah, I've had a few moments even in the cafeteria where I interpret for patients who want pizza or something to eat and they don't know how to say it. So yeah, everything.

[06:21] Eyal Heldenberg: Yeah, perfect. So I wonder if you can explain to the audience what exactly is the difference—sometimes they say medical translator, sometimes they say medical interpreter, kind of a blend of terms. Maybe you can kind of explain the differences.

[06:39] Matias Saenz: Yeah, so the difference between medical interpreter and medical translator is medical translators usually translate written documents, prescriptions, legal stuff, consent forms. That's what they do. They translate the written stuff. They do this either through programs, through software or themselves and usually on the computer. Then medical interpreters, they translate the words verbatim, the physical action of being there in person, present with the patient and the doctor interpreting everything. So that's the main difference.

And then for the question about what's the difference between certified and qualified: qualified interpreters have training but no national certification. So that was what I had at the beginning. Those first three months I had a qualified interpreter status. After three months I got my NBCMI certification—that's the test I took. It's a written test that's pretty long actually. It took me like an hour and a half and it goes over, I think it was like 80 questions and asks about medical conditions, it asks about legal stuff, like certain scenarios and what you should do, what's the right action to take in certain scenarios. So yeah, it goes through literally medical stuff all the way to legal. So I had to study for a few weeks for that test. So I took that, then I became certified.

So certified is more official and it basically means that you're officially trained and you've got the highest level of certification and you're the highest quality interpreter there is basically.

[08:24] Eyal Heldenberg: And I think if I remember correctly, the certification is something you need to renew every couple of years, something like that.

[08:32] Matias Saenz: Yeah, I think for the certification, national certification, you're supposed to renew it every three to four years, I believe. And you do this renewal through another written test, but it's not as extensive. It's just to make sure you're still remembering stuff.

[08:50] Eyal Heldenberg: Yeah, yeah. You know, I am under the impression that medical interpreting also involves cultural communication, like cultural context. It's not just word by word. So I wonder if you have any example or time that you felt this is more than words in this encounter that you need to facilitate.

[09:17] Matias Saenz: Yeah, no, definitely. There's been a few instances of this type of scenario playing out in which patients, because of cultural context or backgrounds, they misunderstand or their goals don't align with what the doctor's telling them. For example, once I had a patient who was refusing antibiotics because they trusted herbal medicines or remedies over the antibiotics. So the doctor insisted and insisted, but the patient wasn't convinced.

That's when I realized that there was more of a cultural misunderstanding because they were both very stubborn. The doctor was saying, "You have to take this." And the patient was also saying, "No, I won't." There was really no solution emerging. So that's when I realized and I stepped in and I told the doctor, "Yeah, there's a cultural misunderstanding here. Usually where this patient is from, which I'm not going to mention by name, they pretty much prefer remedies over studied and tested medicine."

So I told the doctor that and to my surprise—I thought the doctor knew this but apparently she was new, she was a new doctor just recently out of school, doing this for like her first two weeks. So that's when I explained to her, "This patient prefers remedies. So this is why she's being so stubborn and she's not understanding you." That's when the doctor adjusted her approach and explained from first principles why remedies don't work because obviously you know why.

[11:06] Eyal Heldenberg: I think that cultural misunderstanding is sometimes overlooked because, like you say, it could be very hard to have this conversation, right? Because everyone has their own opinions and now you need to sometimes find the bridge. And this is where medical interpreters actually could bridge the cultures because they're the mediator, they would know how to communicate it. Do you have any other cultural misunderstanding examples? Could be the patient or the provider. And maybe, what do you do? How do you handle it?

[11:51] Matias Saenz: So yeah, in terms of handling it, my job is strictly translating words, but there are certain instances in which I am morally obligated to identify when there are situations where if I don't step in, the problem will just keep cycling over and over. So when those scenarios come into play, that's when I step in and say, "Yeah, this is happening and we need to fix this because we're not getting anywhere."

So apart from just strictly translating words, I do also have that moral obligation to step in, make sure all parties are on the same page, because I have the advantage to understand both cultures and both languages. So I'll use that tool to improve the situation whenever I can.

[12:42] Eyal Heldenberg: Yeah, yeah, yeah. I have a question specifically about the Spanish language. You know, Spanish has many dialects from different countries and maybe even different cultural aspects. It could be the accent, it could be the word choice, it could be even the pitch, the rhythm of the language. I wonder how do you see the Spanish dialects influencing a conversation where there is a medical interpreter in the room.

[13:22] Matias Saenz: Yes, there are actually many cases like that and that tends to happen at least once a week for me because the Spanish language is so diverse and it's spoken so vastly in so many different countries and each single country has their own versions of certain words. So it gets pretty intense sometimes.

For example, one time a Mexican patient—because in Mexico they say, in some regions, it's not even overall Mexico, some regions within Mexico say "constipado" when they're congested. So a Mexican patient once said, "Yeah, he was constipado." And obviously the similar translation to English is "constipated." So the doctors thought the Mexican patient was saying he's constipated, but in reality, he was just saying he's congested.

And another case of this, which was actually a pretty serious one that I was able to catch and pretty much prevent a serious issue: A patient said she was "embarazada," and that sounds like "embarrassed" if you kind of hear it without paying much attention, which the doctor did as she was in the MRI room doing her work. So she heard "embarazada," thought the patient meant embarrassed and told the patient, "No, don't be embarrassed, you just have to uncover your belly. That's it. Don't be embarrassed."

But in reality, the patient was saying she's pregnant, because "embarazada" in Spanish means pregnant, and we were in an MRI room which is full of radioactive material and x-rays, and pregnant people simply cannot be in rooms with that. So that would have been more serious if I wasn't able to catch that misunderstanding.

So yeah, that's another example of dialect issues. And going back to your earlier question about cultural misunderstandings, I just remembered one instance where a mother was hesitant to give consent for a certain operation and the doctor thought she was just being fearful and scared. So the doctor kept saying, "Don't be scared, don't be fearful, it's not that serious."

But actually, I recognized that in some parts of Latin America, there's this cultural norm to have a lot of family involvement when it comes to making these big medical decisions—and not just nucleus family, not just parents or siblings or daughters or sons. It goes up to aunts, uncles, grandparents, great grandparents, cousins, everyone. So that's when the doctor understood this and gave her time to call everyone and come to a decision.

[16:17] Eyal Heldenberg: Wow, yeah, yeah, family involvement. I think maybe sometimes I'm talking about family members that are involved in the interpreting part, like in the room, because I know that this is less encouraged in places because of sometimes bias, not being so objective. So this is another example of why it's important to make sure that you have a professional medical interpreter in the room that, you know, comes objective to the conversation.

[16:54] Matias Saenz: Yeah, definitely, because sometimes family members also don't ensure 100% accuracy, because they're not trained or certified. So sometimes they don't interpret correctly. And apart from biases as well, there's a lot of bias when a family member is interpreting for you. So yeah, it's important to always have a medical interpreter no matter what. It doesn't matter if the patient is with a family member, that can still be dangerous. I've seen cases where family members skip certain details on purpose because they don't want the family member to know because of a certain bias they have. I'm not sure what the bias is but it's happened and it happens continuously and it's dangerous and it's not fair for the patient so yeah.

[17:44] Eyal Heldenberg: Yeah. You know, healthcare sometimes involves hard conversations, sad conversations. I wonder if you had any chance that you were participating in, I don't know, delivering bad news or something like that.

[18:05] Matias Saenz: Yeah, yeah, it's part of the job. We do have to deliver pretty bad news, like end of life discussions. Those can get pretty heavy and sad, but it's part of the job. An example of this was one time, I had a young girl, she was old enough to give consent on whether or not she wanted to end her cancer treatment. I think it had been like two years already. Unfortunately, yeah, she did not want to continue treatment. She was old enough to make this decision. And I had to interpret for the doctors the conversation she had with her parents about the reasoning why she wanted to end treatment.

And yeah, that was obviously pretty heavy. All the doctors, they came into the room, a lot of staff came into the room, visited her. We said our goodbyes, including me. And yeah, it was heavy. We were all crying. But at least I knew I was there to facilitate communication and I knew I helped the parents with what they were trying to convey and say to the doctors.

[19:34] Eyal Heldenberg: Yeah, yeah, sometimes it could get very hard. I wonder if there are any mental difficulties that medical interpreters could take home, for example, around those situations, is there any impact?

[19:55] Matias Saenz: Yeah, there certainly is. It does happen when I get home sometimes and remember what I interpreted, this very heavy, very sad appointment I had. And it sticks with me for a while. I mean, it lingers for a while and it's there. But then usually a day or two later, I have to move on because, you know, this is a job. It's strictly work. And there's so many cases of interpreting bad scenarios and bad outcomes that if I keep on, if I let these things get to me, I'll just constantly be sad and depressed. So that's obviously not something that anyone wants.

So yeah, I do have to separate the work from my personal life and not let it affect me too much in my personal life. When I'm at work, I'm all in. I'm there for the worst case or the best case. It's my job. I'll be there and I'll interpret everything no matter what obviously. But once I get home and once I leave work, I tend to divide it more and separate a bit more.

[21:09] Eyal Heldenberg: Yeah, I guess this is natural to make sure that the medical interpreter is safe and can continue to operate and live their life.

[21:20] Matias Saenz: Yeah. And it's not for everyone too because I guess doctors and nurses are people who can relate to this because they're also there. But as you know, there's doctors and nurses who prefer not to work in the medical industry because it is filled with bad news and bad scenarios. So if you're someone who's constantly, if you're someone who's greatly affected by negative stuff, then interpreting, being a doctor, being a nurse is not the right career for you, or social work. I mean there's many different roles but yeah it's not meant for everyone and there are certain interpreters who start interpreting and a few months later they quit because it's too much for them.

[22:11] Eyal Heldenberg: Yeah, totally understood. You mentioned that you now work in a children's hospital. Is there any difference between interpreting for children versus adults?

[22:23] Matias Saenz: Yeah, there is certainly a difference. For children, I think it tends to be less serious sometimes because obviously they're children. So they come in sometimes playing around or laughing. So they lighten the mood a little bit. And in terms of translation and interpretation, you have to even interpret what the child says. So if it's a seven or six-year-old child who only speaks Spanish, even if he says the most ridiculous thing, which children tend to do, you have to interpret it. So even if he mentions something embarrassing about the mother or embarrassing about the doctor and tells the doctor "you have a weird nose" or something like that, I have to interpret it. So yeah, it lightens the mood for sure.

Obviously also when it comes to heavy and sad news, it feels heavier for children because they're children. It becomes, I wouldn't say worse but yeah it is a bit more difficult to interpret bad news to children instead of just adults. You both are sad and all but yeah for children it's even worse honestly.

[23:50] Eyal Heldenberg: Yeah, totally. I wonder if you find yourself sometimes simplifying the language of providers, because sometimes providers tend to use very professional terms, terminology. I wonder if you find yourself trying to get it to a more explainable version of it.

[24:16] Matias Saenz: Yeah, so I have to interpret everything the doctor says, even if it's the most complex thing that I know the patient won't understand, I still have to say it. But the thing is, doctors know this, so they simplify it for you. They, off the bat, simplify it as much as possible so that the interpreter can relay that simplified version to the patient. I've rarely had cases where doctors have used extremely accurate medical terminology to explain some type of condition to a patient, because obviously there's thousands of words that the patient won't know.

But yeah, it's happened, but very few times. And when it happens, the reaction from the patient lets the doctor know everything he needs to know. Because the patient will just have a confused look on their face. They'll just be like, "What did you just say?" And then that's when the doctor corrects and says something that makes more sense or something more simple and digestible.

[25:23] Eyal Heldenberg: Yeah, yeah, yeah. So you said that probably most of the providers read the room, understand who's here and kind of naturally simplify the language. Yeah, it makes sense. I have another question about when you think about where we are right now and future and how we're to evolve these interpretation services, what do you see as the biggest opportunity for improving cross-cultural communication?

[26:03] Matias Saenz: Yeah, I think there's a lot of opportunity to improve cross-cultural communication. There are opportunities in technological advancements and innovation, such as AI. There are certainly many different opportunities, especially when it comes to improving the interpretation of regional dialects or very advanced, sophisticated medical terminology. I think that's where AI can do a very good job because not everyone has expertise in all dialects.

For example, I'm from Ecuador, so we have a different version of Spanish. And when I'm interpreting for someone who is from Guatemala, I try my best to switch to their regional dialect, but obviously I don't know the whole difference. There are a lot of variations. There are many different words that I don't know that people in Guatemala use. So that's where AI can come into play because AI or technology would know exactly what words to use if it's a person from Guatemala.

Also for medical terminology or complete accurate translation, we're human and sometimes we have our faults and we forget a detail or a word or two. We can omit very important details and that's dangerous, that's risky for the patient. AI or technology will never forget, will never skip a word. So that's also something I do take into consideration. So yeah, that's where I see this technology very much improving cross-cultural health care.

[28:08] Eyal Heldenberg: Yeah, technology could make more bridges and make them kind of more accessible. I agree on that. I have a question about the rewarding part of being a Spanish-speaking interpreter. What's the rewarding part of the job during those sessions?

[28:43] Matias Saenz: Yeah, I think the very rewarding part is learning about different cultures and gaining more diverse perspectives about different communities and different cultures. Like before this job, I had no idea there were so many variations of Hispanic people. And learning about their food and culture and festivities is very fun because you learn. And personally, I like learning.

You gain deeper perspectives. And also, I tend to connect with these patients. And sometimes, I even become friends with them. And when I see them around at the hospital, I sit down and have a conversation with them. And this obviously leads to more understanding of where they're from. And I learned many new things. I think last week, I learned that a certain plate of food was actually from Honduras. Beforehand, I thought it was from Mexico but actually it was from Honduras. Obviously the person told me this was from Honduras so it might have been biased because there's always these debates on where food is from, but still I had no idea this debate even existed in the first place so it was interesting learning about just stuff like this, just learning more. That's the rewarding part.

[30:28] Eyal Heldenberg: All right. Maybe last question for this episode, for the providers that listen to this episode. Could you give us some tips for working with a medical interpreter in the room, how to kind of make this experience better?

[31:05] Matias Saenz: Yeah, yeah. I think obviously the provider's role is extremely important. And we really respect providers and doctors and nurses when they come in. We know they've been through years of studying. They've been through years of classes and exams and tests. And they're extremely knowledgeable and smart people. We know this. And we sometimes admire them and really respect them and want to be like them eventually too.

So yeah, there's that kind of dynamic. And one piece of advice would maybe be more patience. I feel like sometimes I encounter providers who want to hurry up the process and I get cut off a lot as an interpreter. I'm saying something and get cut off. And I understand that's not with ill intent. That's not because they're underplaying what I say or they don't respect what we do, obviously it's not the case, but it is important to be mindful that we have to interpret everything and if we feel hurried or pressured then sometimes we naturally, certain interpreters, they might cut what they say and they might skip a detail or two, which is obviously not good.

Yeah, apart from just patience, everything's good. There's good teamwork and good clarity and the dynamic is cool. Doctors, I feel like they are appreciative for the role we do, for what we do. They know our role is important and it's crucial in the healthcare setting. They know this and so yeah, there's mutual respect on both sides. But yeah, I understand doctors can be in a hurry a lot of times. They're pretty much all day working non-stop, but sometimes yeah, I get cut off a lot. So that's just the one thing I'd say—maybe more patience. Yeah, that's it.

[33:13] Eyal Heldenberg: Yeah, totally understood. Perfect. So Matias, was great having you in Care Culture Talks. I learned a lot and appreciate it.

[33:23] Matias Saenz: Thank you, Eyal, for having me. It's great speaking about my experience. I've always wanted to speak about interpretation, and now I had a chance. So yeah, thank you.

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