The current issue (Spring 2012) features:
Letter from the Editor
Donna Furlani discusses transparency and what it takes to publish Caduceus.
Letter from the Administrator
Madalena Sánchez Zampaulo updates us on developments in the Medical Division: a new MD Webmaster, a new Caduceus series, and conference presentations.
Shizuka Matsunaga contributes an interview written by a pediatric nurse.
Ann’s Acronyms and Other French-English Medical Conundrums
Ann Wiles addresses the pitfalls of translating references to the vertebrae.
Challenges in Accurately Diagnosing ADHD and Bipolar Disorder
Carmen Cross explains why these two illnesses are sometimes misdiagnosed.
English-German-Arabic Glossary: ADHD and Bipolar Disorder
Carmen Cross shares her glossary of terms related to diagnosing these illnesses.
Learning Language; Losing Language
Karin Schreiber explores language acquisition and aphasias.
Introduction to Terminology Management, Part 1 of 2
Donna Furlani shares some of what she learned from a few terminology courses in Geneva.
Spring 2012 Consolidated
Letter From the Editor- by Donna Furlani
Transparency is a huge part of being a translator or an interpreter. We want it to seem as if we were never there, as if the end goal of communication just magically occurred between the sender and receiver of the message. We want for both the sender and receiver to focus their attention on the message, and not on the details of how its meaning was made accessible to them.
In other industries, and in everyday usage of the word, ‘transparency’ has the same basic meaning of clearness, but it seems to me that its focus gets turned on its head. Transparency in political or business matters doesn’t imply that the process used to achieve an end result simply fades away until it isn’t even noticeable. Rather, ‘transparency’ in this setting is used to mean that the attention is focused on the process, and that nothing hinders its visibility. This is the type of transparency that is my goal in this issue’s Letter from the Editor. I’d like to shed a little light on what it’s like creating an issue of Caduceus in our new format.
I can’t stress enough that Caduceus is your publication. It all begins with our readers – everything you read here exists because someone had an idea for an article and took the time to write a publishable piece. Granted, I do spend a lot of time contacting people I think might be interested in contributing, encouraging them to write, helping them to brainstorm topics, editing articles, and formatting and uploading the final content. In the end though, everything revolves around a contributor’s desire to communicate with the rest of our readership. (By the way, I heard from new readers in Canada and Belgium – our readership is growing!)
I think the hardest part of editing Caduceus is having to turn down a submission. All of the people who make this publication possible – including Medical Division officers, Leadership Council members, the authors of all the articles, and me as the Caduceus editor – offer their time and efforts as volunteers, and it’s hard to reject anything that took time away from regular paid jobs and busy schedules. In the long term, however, our publication benefits from maintaining our high standards. Judging from your feedback, we all appreciate reading high-quality articles and want to keep them coming. It’s also more enticing to devote time to writing an article for a renowned publication that’s impressive to list on a resume; we’re working on even more ways to publicize Caduceus (so stay tuned!), but a key component is making sure our content is top-notch and well-crafted. If you receive a response suggesting changes needed to get your submission ready for publication, please take this in a constructive way, and rest assured that your time and efforts are greatly appreciated. We understand that there’s not always time to work on the article again in time for publication in the upcoming issue. Please don’t forget about us completely, though; we hope to receive the updated version in time for the following issue!
I want to encourage every one of you to think about how you can contribute to your division newsletter. Be an active member – this publication is one of the requirements for maintaining the Medical Division, but we cannot write it without you. And yes, I do mean you, and not just the “other” people in the division. I used to feel that no one would want to hear what I had to say (and perhaps that’s still true, but I’m writing anyway!) and that only the more experienced division members should be writing for the newsletter. The truth is, though, anyone can write an excellent article. Be willing to devote enough time and effort to do the job right, and think about what kinds of articles would be educational for our readers. If you never formally trained as a translator or interpreter, then write about what you’ve figured out over the years. If you’re truly new to the profession and don’t have any experiences to draw on, then do some research! It’s a great way to advance your expertise in the field, and we’re always looking for articles on medical material or translation/interpreting theory. Have you taken a class? Chances are there are at least a few readers who don’t know what you know and would love to read about what you learned. Too busy with work? Keep in mind that writing a professional article is part of professional development – you’ll be a better translator or interpreter after putting down in words your analysis of what you do, the techniques you use, or something new that you’ve learned. You’ll also get your name out there (free and easy networking and advertising!), and you’ll know you’re an upstanding professional for contributing to your community. Don’t feel intimidated if you’re not comfortable writing in English – as long as we can find someone to edit it, we’re happy to publish articles in other languages! This brings me to another point – I’d love to have volunteers for editing submissions (in your native language only). As always, any submissions or other communications can be sent to me at email@example.com. Submissions for the Autumn 2012 pre-conference issue are due by August 28.
As a parting thought regarding the other kind of transparency: Please continue to be transparent as translators and interpreters, but not as division members! We want to hear your voice, know your thoughts, feel your presence, and learn from your experiences. Don’t be invisible!
Letter From the Administrator - by Madalena Sánchez Zampaulo
Spring is more than upon us! For many of us, the winter was short-lived (I know we aren’t complaining about that…). With spring comes a lot of sunshine and, hopefully, new projects and exciting things in our work and personal lives. Our Division has some exciting things going on that I would like to share with you, too.
In our last issue of Caduceus, we told you about our Leadership Council and some new changes to our newsletter. Since then, we’ve had a couple of meetings with the LC and we have some great plans for the Division in the works. For one, we’ll be revamping the website a bit with our new webmaster, Daniel Greuel. He came to us with a lot of enthusiasm for volunteering his time to work with us on the site and helping us continue to develop the material we host on it for you all. In the short time he’s been working on the site, Daniel has updated our site to include the latest contact information for us, as well as the most recent member count. In the coming months, you should see more changes being made to the site and we hope you’ll give us feedback on these as they are developed.
Another new series you’ll see starting in this issue of Caduceus is the Member Spotlight, and we're kicking it off with a double feature! We felt it timely to begin the Member Spotlight with Daniel and also Alcira, one of our Leadership Council members, so now you can put faces to their names. Be sure to check out their write-ups! We are currently asking for you to nominate members that you feel have made a contribution to the field of medical translation and/or interpreting by sending the person’s name as listed in the ATA Member Directory and contact information including email address to Donna Furlani, our editor (firstname.lastname@example.org). We hope you’ll enjoy reading about your colleagues and can find inspiration through one another.
I would also like to take this time to say thank you to all who submitted a proposal for this year’s Annual Conference in San Diego. As always, there were many, many well-written and fascinating proposals. Be sure to watch the ATA website in the coming months for a preliminary program of who will be presenting. We are looking forward to sharing the Medical Division’s speakers and presentations once ATA has finalized everything. We will do our best to share the presentation information via our website and Caduceus so that those not able to attend the conference this year can get a sense of the outstanding presentations as well.
Finally, I would like to encourage everyone to take the time to put your work and wisdom into words for our newsletter’s upcoming issues. We are always happy to receive well-written and scholarly articles on issues and research taking place in the medical translation and interpretation fields. We especially urge you to share your work in the event that your proposal for the conference is not accepted this year. Caduceus is a great platform to share your work with our members and its reach is without borders!
Best for a pleasant spring, and again, thank you for all you do for our Division and industry.
Madalena Sánchez Zampaulo
Administrator of the Medical Division
Member Spotlight: Daniel Greuel, Milwaukee, Wisconsin
My interest in translation and interpreting as a career began as an undergraduate at the University of Minnesota–Twin Cities. As part of an individualized degree program that also encompassed Sociology and Global Studies, I completed coursework for the healthcare track of the certificate program in Interpreting. The program’s single translation class turned out to be my favorite class of them all, and I came to the conclusion that translation was better suited to my skills and personality. I don’t like pressure; I much prefer having time to think, do research to gain a better understanding of the situation, and polish my translation rather than having to come up with something on the spot. I also think I am a better writer than speaker (I’m somewhat soft-spoken and often have to repeat myself in conversation).
I continued my pursuit of translation during a study abroad program in Barcelona my junior year by taking another translation course and doing some volunteer Spanish-to-English translation for a local non-profit organization. After completing both my undergraduate degree and a Master’s program in Language, Literature and Translation at the University of Wisconsin–Milwaukee, I lived in Barcelona again for a six-week internship at a translation agency.
Currently I work full-time as a translator from Spanish and Catalan into English. I’d say Catalan probably accounts for around 15-20% of my work volume. Almost all of my clients are agencies, but my few direct clients have all been for Spanish-to-English or monolingual work. I think that probably makes sense given my location in the U.S. rather than Catalonia.
Most of my work is in the medical field, translating patient records, procedure reports, journal articles, clinical trial documentation, and other texts. I also branch out into other areas, such as business and education, and occasionally do editing and proofreading work as well. On the side, I’m a computer programmer and I’m currently working with a colleague on developing some Macintosh translation software. I’ve also recently accepted the position of webmaster of the Medical Division website.
My favorite aspects of the translating profession are the opportunities to work with people from all over the world and constantly learn about new and fascinating things. I also very much enjoy being able use my language skills to help others – I was recently delighted to receive a personal note and gift in the mail from one of my direct clients thanking me for doing a good job and saving his company from embarrassment.
The most challenging thing for me as a freelancer is managing the workload and deadlines while trying not to spend every waking moment at home, alone, sitting in front of a screen. It is certainly tempting to accept every assignment that comes in, but in the end the quality of our work (and our physical and mental health) depends on learning when to say no.
For coping with the isolation and sedentariness, my advice would be to get a change of scenery once in a while (meet people for lunch, do some work at a coffee shop/library/park) and make exercise a part of your daily routine. I have found that a brief walk or bike ride is an excellent way to de-stress and reinvigorate my brain.
Last year in Boston was my first ATA Annual Conference, and I definitely plan to make it to San Diego this year!
Member Spotlight: Alcira Salguero, San Francisco, California
I was born and raised in Mexico City; in the 1980s, the company I worked for moved me to the United States. By the time I got into interpreting, I had worked for companies in legal services, hospitality, engineering/construction, and bio-pharmaceuticals. In 2003, I began training as a legal interpreter in a program at San Francisco State University. My work on a high volume of workers’ compensation cases is what pulled me into the world of medical interpreting. I began official training as a medical interpreter through the National Center for Interpretation at the University of Arizona in 2009.
Since 2009, I have been working as an in-house medical interpreter for California Pacific Medical Center. I work five or six days a week. Three of those days, I interpret primarily for standard medical office appointments in various specialties: endocrinology, cardiology, neurology, psychiatric, pulmonology, oncology, and others. The other two days, I work directly with attending physicians, surgeons, and resident doctors, who round on inpatients daily.
The two days working with inpatients at the hospital are fast and challenging in every way. One moment I may be interpreting for a nephrologist, hepatologist, or other specialist. The next minute I may be sitting in a conference room – with a social worker, palliative care doctor, oncologist, hematologist, infectious disease doctor, and a family of five – and having to interpret devastating news about the family’s loved one.
Having been trained as a legal interpreter has given me great insight into the differences between standard practices in both fields. The common denominator of both legal and medical interpreting is that interpreters play an important role in people’s lives; we have their lives at the tip of our tongues. In the medical environment we are expected to be advocates, but in the legal environment we do not advocate for anyone at all.
I am passionate about rendering an interpretation that delivers accuracy, objectivity, veracity, respect, excellence and overall compassion for people. I am also passionate about raising the standards of the medical interpreting profession; to accomplish this, we need to keep many goals in mind. It is crucial that we pursue further education at all times and never think that we know it all. Before we take on any new job, we have a responsibility to ensure that we can do our best and to observe our code of ethics at all times. We need to keep in mind that our jobs are to provide a service to the community. As such, we owe it to ourselves and our colleagues to proactively participate in events that will improve the competency and standards of our professional community.
My advice to new interpreters:
· never stop studying
· never accept a job that is beyond your ability just because the money is good
· never be afraid to ask for clarifications when you don’t know a specific topic
· before you go into a new assignment, try to review the pertinent vocabulary that may come up in the appointment
· always arrive on time
· periodically review the National Standards of Practice and Code of Ethics for medical interpreters through the NCIHC, CHIA or IMIA organizations
As I’m walking to my first appointment of the day, I always take two or three deep breaths, exhale, clear my mind of any thoughts, and visualize myself surrounded by clarity in my mind. As I step in to greet the patient and doctor, I smile, grant myself full presence of mind, and acknowledge positive intentions. After my first appointment, I am 100% focused for the rest of the day!
Initial Examination: Pediatric Nurse
(submitted by Shizuka Matsunaga)
I am a Registered Nurse. A nursing degree is needed to obtain this title; I got my Bachelors of Science degree in Nursing (BSN), but there are also Associates Degree and Diploma programs.
· Where do you work?
I work for an outpatient clinic that is affiliated with a larger hospital in the 2nd largest city in Michigan. I work in an outpatient clinic that is for children with lung issues such as asthma, cystic fibrosis, chronic lung disease of infancy, conditions that necessitate the use of a ventilator, and other issues.
· What does a typical day for you entail? What’s the hardest part of your job?
A typical day includes answering phone calls from parents (regarding whether their child is sick, and other issues), calling in refills of medications to pharmacies, obtaining authorizations from insurance companies for medications and procedures, and working with a large team of doctors, nurses, dietitians, social workers, medical assistants, research associates, and other disciplines. Once a week I prepare for the clinic, where I check in patients (interviewing parents and patients, asking them about the child's symptoms, etc.).
· Please talk about the types of interactions you have with other medical professionals.
Working as part of a large team, I work with many other medical professionals - including doctors, nurses, dietitians, respiratory therapists, social workers, psychologists, genetic counselors, and others - in many different ways.
· Do you know more than one language, and if so, do you ever use these language skills at work?
I know a small amount of Spanish. I do use it to communicate with patients and families if there is not an interpreter present, but I only speak with them in Spanish for small talk. I wait to have an interpreter in person or on the phone before speaking about medical issues.
· In what way, if any, do you come across translation and/or interpretation in your work?
I use interpreters when speaking to families that speak other languages. We have some interpreters available from the hospital we are affiliated with, and we use a phone service as well.
· What do you wish medical interpreters and medical translators understood better?
I can't really think of anything specific. It would be nice if you told us your preferences, for example, how many sentences you are comfortable interpreting at a time. I wish there were a routine structure. If the interpreter has questions for us specifically, then they should interrupt us to clarify.
· Does your institution have a structured system in place for when interpreters and/or translators are needed?
Yes, but sometimes there are major glitches.
· What do you wish would change about the way you and/or your institution interact with translators and interpreters? What good practices do you see already in play?
I wish there were some sort of in-service instructing us on what the interpreters see that works well and what doesn't. So many times I get off the phone with a telephone interpreter and feel frustrated because it was a difficult conversation, and I hope the family member understood everything. But there seems to be no way to double-check except by asking, "Do you have any more questions?"
· Feel free to add any other comments or to describe a specific experience involving an interpreter or translator.
I am very appreciative to have interpreters! There is no way we could do what we do without having a way to speak to patients and families who have different primary languages than our own!
Ann’s Acronyms - by Ann Wiles
ANN'S ACRONYMS and other French-English medical conundrums
This issue: T versus D
As you may remember from an anatomy class, the five divisions of the spine from top to bottom are the cervical, thoracic, lumbar, sacrum, and coccyx. Most people have 7 cervical vertebrae (C1 to C7) with C1 providing the articulation with the skull. Then come the 12 thoracic vertebrae (T1 to T12) that articulate with the ribs. Next, the 5 lumbar vertebrae (L1 to L5) bear much of the body's weight in the low back. The 5 fused vertebrae of the sacrum (S1 to S5) articulate with the pelvis, and the 4 fused vertebrae of the coccyx give us a vestige of a tailbone.i
The spinal divisions are straightforward in English, but French medical records commonly use D1, D2, etc. when referring to a vertebra of the spine. Where is that? Sometimes, an imaging report will call the same fifth thoracic vertebra ‘T5’ in one paragraph and ‘D5’ in another. Huh?
French-English medical dictionaries aren't always very enlightening. Oneii gives both D/dorsal and T/thoracic as the translation of D from French to English. There is no entry for dorsal, but the translation of "rachis dorsolombaire" is given as "thoracolumbar spine."
So, French medical records use either dorsal or thoracic to refer to the 12 vertebrae just below the cervical vertebrae. Some use dorsal and thoracic interchangeably, which is even more confusing. In English, however, only ‘thoracic’ or ‘T’ should be used.
After I translate the D/dorsal in French to T/thoracic in English when referring to spinal vertebrae, someone usually asks me if I'm sure. Yes, but I thought I'd better double check. So I asked a neurosurgeon whose practice includes spinal surgery at the University of Michigan Hospitaliii. He told me that he occasionally sees "dorsal" used when referring to the thoracic spine but only in "old" operative reports from the 1970s and 1980s. His opinion was that "dorsal" is not used anymore in this context. Medical English uses "thoracic" today. I have to agree, having worked in hospitals for many years with countless orthopedic and neurosurgery medical records.
Another reason why it is important to use only "thoracic" or "T" in English is that "dorsal" is commonly used in medical English, but not in reference to the spinal vertebrae. Some appropriately used definitions of dorsal include: anatomically toward the back (including back of the hand and top of the foot) as in posterior, the posterior part of an organiv, posteriorv, "pertaining to the dorsum [back]", and "a synonym of posterior in human anatomy"vi. Another example is dorsiflexion, which means bending your foot toward your nose and has nothing to do with the spine.
In summary, "dorsal" and "D" in French should be translated as "thoracic" and "T" in English when referring to the spinal vertebrae just below the cervical vertebrae. For example, the French medical record of a patient who has a fusion of T1-T5 may term it a fusion of T1-T5 and/or D1-D5 in French, but the English translation should term it a fusion of T1-T5 in all instances. A fusion of the "rachis dorsal" should be translated as a fusion of the "thoracic spine."
i Elaine N. Marieb, Human Anatomy & Physiology, Fourth Edition (1998).
ii Svetolik P. Djordjević, Dictionary of Medicine: French-English (Schreiber Publishing, 2004).
iii On staff at the University of Michigan Health System, Ann Arbor, Michigan.
iv Le grand dictionnaire terminologique, Office québécois de la langue française, http://www.granddictionnaire.com.
v Termium, The Government of Canada's terminology and linguistic database, http://www.termiumplus.gc.ca/.
vi Dorland's Illustrated Medical Dictionary (Elsevier, 2003).
Challenges in Accurately Diagnosing ADHD and Bipolar Disorder - by Carmen Cross
It goes without saying that two of a health care professional’s main functions are to diagnose and then to prescribe a suitable treatment plan based on a patient’s medical history. Even though this sounds relatively straightforward, the mechanics seldom are. All too often a patient is misdiagnosed and given a treatment that can do more harm than good. While this can happen in any medical specialty, it tends to occur more frequently with mental and behavioral disorders. Patients are sometimes treated for an illness they don’t even have.
Attention deficit hyperactivity disorder, or ADHD, is a neurobehavioral disorder that often presents during childhood or adolescence and continues into adulthood. Due to various factors, patients with ADHD – both children and adults – can be misdiagnosed as having bipolar disorder, and vice versa. ADHD and bipolar disorder are susceptible to being misdiagnosed for one another because their outward symptoms overlap to some extent. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV, acknowledges three types of ADHD: Predominately Inattentive, Predominantly Hyperactive-Impulsive and Combined. Symptoms include irritability, restlessness, racing thoughts and distractibility. Bipolar Disorder I is characterized by the presence of at least one full-blown manic or mixed episode accompanied by abnormal and disruptive behavior. Symptoms of mania can include all of the symptoms listed above for ADHD, as well as excitement and increased energy. A succinct list of the patient’s symptoms is therefore not enough for a correct diagnosis; further details and in-depth interviews and/or observations are also necessary. In addition, approximately 60% of children diagnosed with ADHD continue experiencing symptoms into adulthood. This compounds the problem by masking the disorder with age-related changes, adaptive processes, avoidance mechanisms, etc.
The nature of the symptoms themselves can also hinder an accurate diagnosis. Unlike a headache, which often indicates a person is not feeling well, most healthy people exhibit some or all of the symptoms of bipolar disorder and/or ADHD at some point; these symptoms are not necessarily an indication that someone is unwell. Thus, qualified medical professionals, in consultation with the patient and/or their advocate, must determine when the symptoms become disruptive enough to warrant further treatment.
Related to the similarity of symptoms is comorbidity, defined as a medical condition that is simultaneously present but independent of another medical condition in a patient. ADHD can be a comorbid disorder of bipolar disorder and vice versa, which means that a patient can have both of these illnesses at the same time. Therefore, when making a diagnosis, the clinician must be aware of this and not diagnose one while failing to diagnose the other. It is generally advisable for comorbid conditions to be treated separately and not grouped into the ADHD diagnosis (if one is made). In medicine as in life, one size does not fit all, and if a patient has a symptom that is usually not associated with ADHD, then the clinician must suspect a comorbid disorder, investigate the matter, and take the appropriate follow-up measures.
Another factor that complicates an accurate diagnosis of either bipolar disorder or ADHD (or something else altogether) is that there is no universally-accepted etiology or cause of either disorder. In fact, it is thought they may be influenced by multiple factors, including genetics and the environment. As such, there are currently no laboratory tests than can provide a definitive diagnosis. These illnesses are usually diagnosed after a psychiatrist or other qualified health professional interviews the patient and asks about their family medical history. This is done by differential diagnosis, in which other conditions are eliminated based on the patient’s available medical history. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD) describe the diagnostic criteria for both bipolar disorder and ADHD.
What can patients who have been diagnosed with bipolar disorder and/or ADHD do to help ensure that their diagnosis is correct? The first step is to ask their qualified health care professional how the diagnosis was made and what the reasoning was behind the diagnosis. Also, it is important that a patient be regularly evaluated over a period of time, not just on the first visit, since bipolar disorder is a mood disorder that tends to occur in episodes with periods of normal mood mixed with depressive and manic and/or hypomanic episodes. A key to distinguishing between ADHD and bipolar disorder can be multiple observations to see how the patient’s behavior and attention patterns may change over time. For child patients, it is recommended that the qualified professional either talk with or receive written reports from their teachers. Last but not least in ensuring correct diagnosis, the patient and/or their advocate must be willing to accept some responsibility by asking questions and staying informed. Despite the technical advancements in medicine and the best intentions of health care professionals, accurately diagnosing and treating mental and behavioral disorders is still an inexact science, and it is in our best interests to take an active part in diagnosis and treatment to help ensure a higher quality of life for all involved.
William Coryell, “Mood Disorders”, The Merck Manual of Diagnosis and Therapy (Whitehouse Station, NJ: Merck Sharp & Dohme Corp, 2011), pp. 1538-52.
Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (Washington, DC: American Psychiatric Association, 2000).
“Bipolar Disorder or ADHD”, WebMD, http://www.webmd.com/add-adhd/guide/bipolar_disorder_or_adhd.
Learning Language; Losing Language - by Karin Schreiber
The brain is an amazing structure of tissues that is jelly-like in consistency and weighs approximately 3 pounds. Within this structure there are more than one trillion cells, including between 80 and 120 billion neurons (or nerve cells). Riding a bike, reading a book, eating, thinking about how the weather is going to determine how we dress, watching a movie, or even moving a part of our body are all processes that are articulated and structured by those trillions of cells in our brain.
Expressing our thoughts, reasoning, thinking, and even experiencing emotions are also processes managed by the brain, but these are accomplished specifically by language. When we formulate thoughts and express them (output), we are relying upon input that our brain has collected within a linguistic context. This linguistic context is addressed in many theories about how we learn, including the Universal Grammar theory developed by Noam Chomsky, in which he defines the relationship of the linguistic properties of all natural human languages. But given the involvement of linguistic context, how can we fully understand the complex process of how we learn how to speak, think, and develop conclusions?
The process of learning our native language is extremely difficult to analyze if approached from a social or psycholinguistic point of view. Trying to learn or acquire a second language thus seems like an impossible mission, but every minute step of the language learning process is performed quite effectively by our brain, the perfect reasoning machine that makes us unique individuals.
Bernard Spolsky presents a social and psychological model of the learning process that generates linguistic and non-linguistic outcomes. His chart explains the learning model of second language acquisition. To understand this, we need to differentiate the learning of a language from the acquisition of a language.
Human capacity to process language
Human beings are unique in their capacity to express reasoning through verbal signs. The cerebral cortex and cortical areas are the regions of the brain that play a specific role in language production. The left hemisphere of the brain processes linguistic meaning as well as the stress, intonation and rhythm of the speech. The right hemisphere of the brain processes the emotions of the linguistic meaning.
Aphasia is a language impairment that appears when a person suffers a brain injury that affects Broca’s or Wernicke’s area. Aphasia can affect language production (ability to speak) or language comprehension (ability to understand when someone is speaking).
Paul Broca, who conducted research on children with language disorders and aphasias, discovered an area in the left side of the brain that is crucial to language processing. Broca’s area of the brain is involved in the process of how we understand grammar.
Broca’s aphasia, or motor aphasia, affects the production of the language by limiting the formation of words or sentences; patients with this type of aphasia can’t correctly transform their thoughts into words. This is known as telegraphic speech, because the meaning is clear but the syntax is missing. Some of the blood vessels that are affected in Broca’s aphasia also affect the motor control of one side of the body, resulting in other impairments such as hemiparesis, hemiplegia, alexia and agraphia.
· Hemiparesis is muscle weakness in only one side of the body.
· Hemiplegia is the inability to move a group of muscles in one side of the body. It is also known as palsy.
· Alexia is caused by an injury to the area of the brain that processes visual language. Alexia can prevent a person from reading, but it doesn’t affect the ability to write. Alexia is also known as text blindness or word blindness.
· Agraphia is a neurological disorder through which the ability to write is lost.
Another type of aphasia is Wernicke’s aphasia, caused by damage to Wernicke’s area, a region of the brain that is also central to language. This type of language impairment manifests with a series of incomprehensible speech or a varied array of randomly chosen words. This kind of speech is known as logorrhea. Patients exhibiting logorrhea generally are not aware of their impairment (this unawareness is known as anosognosia) and has the feeling of having been understood.
Global aphasia is caused by a brain injury that extends into both Broca’s and Wernicke’s areas. A person with global aphasia is unable to understand a spoken language or to speak it, but has the ability to communicate thoughts through written language.
According to statistics cited in an article issued by the University of Arizona, about 100,000 people in the United States will develop aphasia each year, as a result of a stroke, brain injury, or brain tumor. An astonishing discovery in the search for treatment for aphasia is that the brain can still benefit from a systematic training process of speech and language therapy. Such treatments are specifically aimed to strengthen the neurologically healthy areas of the brain. The speech language pathologists provide a wide range of therapies which involves the use of interactive software programs that focus on phonation, articulation, phonological awareness, verbal naming, oral reading, and word retrieval, among other tasks.
M. Da Silva & Signoret, Temas sobre la adquisición de una segunda lengua, 2nd ed. (Trillas, Mexico: 2005).
University of Michigan Aphasia Program, http://aphasiahelp.com/aphasia/news/ (accessed 04/17/2012).
Institute of Education Sciences, http://nces.ed.gov/ (accessed 04/17/2012).
Jose Vega MD, PhD, “Broca’s, Wernicke’s, and Other Types of Aphasia”, http://stroke.about.com/od/unwantedeffectsofstroke/a/Aphasia.htm (updated 03/09/2008; accessed 04/17/2012).
Introduction to Terminology Management, Part 1 of 2 - by Donna Furlani
It is undeniable that medical translators and interpreters need to be well-versed in medical terminology in order to do their jobs well. Still, despite how crucial terminology is to our profession, I find that not enough attention is paid to effective terminology management techniques. I learned just about everything I know about terminology management from Bruno de Bessé and Donatella Pulitano, two excellent instructors of a series of terminology-related courses offered at the University of Geneva’s ETI (now FaTI). Their courses covered the theoretical base of terminology study and also practical guidelines for creating and using term banks, or systematic collections of terms and related information. The majority of this article represents their teachings, which I am simply expressing in English using my own examples drawn from the medical domain. While I cannot cover all the detailed concepts addressed in their courses, my aim is to impart some practical basics, convince more of us to spend time maintaining personal term banks, and perhaps even spark interest in independent exploration of terminology theory.
What’s in it for me? The benefits of correct terminology
In any specialized field, terminology is used to impart a great deal of specific information in a single morphological unit. Terminology is what makes “medicalese”, “legalese”, and other insider languages seem exclusive to specialists in the given domain and incomprehensible to non-specialists. Very simply, we need to be able to name specific things, and moreover, to communicate precisely about these things. All of the information conveyed by terms can be explained in plain words, but it’s much quicker for a medical professional to use a term than to spell out all the specific details that the term implies. As medical translators and interpreters, we are often the link between two “insiders” and can thus expect to deal with a high density of terminology in the text we’re translating or the speech we’re interpreting. (Perhaps interpreting includes more communication between a specialist and a non-specialist, but there are still patients with chronic illnesses who are extremely knowledgeable in the subdomain of their particular conditions and sling terminology around like a pro.) Correctly transmitting terminology is not only crucial to the accuracy of the target text or utterance, but also to its credibility. (Would you trust the quality of a medical report written only in words that the average ten-year-old could understand?) Therefore, we as language professionals need to be well-versed in the concepts and terminology of our specialty domains if we are to successfully translate or interpret specialized material. Memorizing all the terms in all of our languages is a tall order, though, and this is where it benefits us to keep efficient records of our knowledge. While this is especially true for medical translators, medical interpreters may also find it helpful to have well-organized terminology so they can drill only the relevant vocabulary before a specific assignment. Proper term bank maintenance means we don’t end up having to redo our work and re-research terms we neglected to document in enough detail. Finally, following good practices in term bank formatting allows us to share our knowledge within our community.
What is a term? Terms, definitions, domains, and concepts
To better appreciate the importance of terminology, it helps to clearly differentiate terms from words in your mind. When a physician tells a patient, “Your throat is going to feel better soon,” those are all words. The physician could also say, “The pharyngitis should resolve soon,” and “pharyngitis” and “resolve” are both terms – they convey specific information and defined concepts within the given domain. Terms are different from words, even when the actual morpheme is the same. In everyday speech, I might say that my stomach hurts to communicate that I’m experiencing abdominal pain. In this instance, “stomach” is a word. In a surgeon’s report, however, “stomach” would be used only as a term, a term that designates a specific organ of the digestive tract and all of the details associated with the medical definition of “stomach”. This is a basic differentiation between a word and a term; as we continue to discuss the qualities inherent to terms, the idea should become even clearer.
In the end, the concept is really the central component. A concept is delineated by its domain, its definition, and the term used to represent it. Each term refers to a distinct universal concept. For example, I might imagine a different item than you would upon hearing the word “knife”, but the term “No. 10 blade”, if we’re familiar with it, can only conjure up one image. The concept of a No. 10 scalpel blade is universal. Often, terms and concepts have a one-to-one pairing: each term represents a single concept (this is called monosemy) and each concept is designated by a single preferred term. You can’t precisely name a No. 10 blade except by that term, and the term “No. 10 blade” can only refer to that one specific concept.
It’s also important to note that “No. 10 blade” is one term (not three) because it represents one concept. Terms can be, and often are, composed of several words. Usually, though, even complex terms have a single base element. They can include many descriptors (ex. “No. 10”), but in the end are usually describing one thing (ex. “blade”). Other examples include “elevated blood glucose level” and “non-sclerosing Hodgkin’s lymphoma”. The point is, if you find yourself with more than one base element, it’s possible you’re actually dealing with more than one term and should log them as separate entries in your term bank. To make sure you’re not separating away components of the actual term, though, keep in mind that terms, like the concepts they represent, are indivisible. You can’t drop off parts of a term (except in some cases of abbreviations) and still have it represent the same universal concept. With the term “milk of magnesia”, nothing can be dropped without a total change in meaning, but in “two tablespoons of milk of magnesia”, the “two tablespoons of” is not part of a longer indivisible term.
Concepts and terms are also specific to their domain – the term “tissue” in the medical domain differs from the term “tissue” in the textile industry, because they represent different specialized concepts. In many cases, even a domain such as “medical” provides insufficient information on a given term, and it becomes necessary to specify a subdomain. Take “cast” as an example. As a word, “cast” has many meanings, and it also exists as a term in several diverse domains that include metallurgy, angling, earth sciences, and nautical navigation, as well as medicine. Imagine, however, that you once included “cast” in a term bank and marked the domain as simply “medical”. This won’t help you much once you’ve long since forgotten the original concept for which you researched the equivalent term in another language. Just as an example, the Spanish translation for “cast” will be “yeso” or “escayola” in the subdomain of orthopedics, but “molde” in dentistry, and “cilindro” in urology. In this example, we see that the term “cast” in the medical domain is actually three different terms (with the same morpheme) because it represents three different concepts.
How do I translate a term? Ideal processes and resources
When we come across a term in our work, most of us turn to a specialized bilingual dictionary to find the equivalent term in the target language. How do these equivalences get established in the first place, though? Ideally, the terminologist will collect terms from a specialized original source deemed to be accurate. In the medical field, sources for terms in English could include the Diagnostic and Statistical Manual of Mental Disorders, the Merck Manuals, or other such publications considered to be standard reputed references. Sources could also include the communications of domain specialists (here, health care professionals), if the language the terminologist is seeking is both their native language and the language in which they studied medicine. The terminologist will carefully extract terms from the sources, along with the definitions of the concepts that the terms represent. Examples of the term used in context and careful notation of the sources of the term, definition, and usage examples are also important steps of this process. Then, the same process is repeated in another language, using trusted resources in that language as well. It is actually the concepts that are matched up, not the terms directly. If the definitions match, then the concepts and therefore the terms are deemed to be equivalent.
Obviously, this is a much more involved procedure than most of us have time to undertake while translating a typical assignment; this is why we rely on specialized dictionaries and glossaries where the legwork has been done for us. Still, when a term just can’t be found in any trustworthy source, it’s a good practice to keep the terminologist’s process in mind, search out the term and its supposed equivalent in context, and make sure that they are used to represent the same concept. I’m sure you’ve all appreciated the extra efforts of forum contributors who cite sources or include links to back up their suggestions, as opposed to simply throwing a word out there without any justification of why it’s the correct equivalent. I think it’s high time we all started citing sources and examples on a regular basis. If we truly want to help one another and contribute to our field, doesn’t it make sense to have one person do the research to confirm a correct translation rather than having every person repeat the same searches to verify it?
It’s difficult to teach the instincts for recognizing a trustworthy source as opposed to a dubious one, just as it’s difficult to teach effective online searching methods (aka Google-Fu). At the very least, I can provide some suggestions for starting points. Obviously, a reputable specialized dictionary is an excellent option that saves a lot of time and effort. For terms that aren’t included in your dictionaries (whether print or online), your best bet is usually searching online to find the terms used in context. Corporation websites are often a treasure trove of information on medical devices, instruments, and pharmaceuticals. Some international companies will even have multilingual catalogues that label images of their products in more than one language. If you’re not lucky enough to find a multilingual catalogue, finding monolingual catalogues for each language can be helpful in some cases if you can see from the image in each catalogue that the concepts are in fact the same. Obviously, this works best with finding terms that refer to physical objects. For more concepts with more complicated definitions, product instruction manuals and material on the website itself can prove useful. It’s important to remain skeptical of translation quality, however; many businesses rely on underpaid and lower-quality translators who may not have used proper terminology practices when “deciding” what the equivalent terms are. For this reason, I tend to lump hospital websites in with businesses rather than government or international institutions. Government and international institutions are more likely to employ in-house translators and terminologists, so I usually consider their websites and glossaries to represent more “official” usage. For this reason, I also regard professional term banks (created by professional terminologists) with higher esteem, but unfortunately, these precious resources are often not available to the general public. A notable exception is Termium, an online term bank that started off as a closed resource of the Canadian government but was opened for free public consultation in 2009. Professional forums, such as Proz.com, are not quite as trustworthy as closed databases since entries are only as reliable as the people who post them, unless they also cite external sources. Still, I find that these forums are the best resource for neologisms (newly-created terms) and more marginal terms. An added benefit, of course, is that you can post a query yourself if you have the time. Finally, all of these fountains of information can be used to keep up your own personal term bank, and in this way you should only have to research each term once in your career.