Meaningful access: The art of interpreting clinical encounters.

摘要

This dissertation examines the difficulties that Spanish-speaking patients face in obtaining quality health care through the use of a medical interpreter. It is difficult to interpret expressions when they are disembodied, when the body language of a Spanish-speaking patient prefigures her speech, or at least the doctor's reception of its translation. The dissertation explores the ways that Executive Order 13166-a Federal mandate signed by President Clinton in 2000 that states that organizations that receive Federal funds must provide “meaningful language access” to all persons—has attempted to encourage culturally competent care in the clinical setting. Working in exam rooms, waiting rooms, and administrative offices in three clinics in a New York City hospital, I investigate through literary analysis how this well-intentioned mandate has largely fallen short of its objectives--how public policy and the experiences of individual bodies do not always overlap. This dissertation follows a humanities-based approach to understanding the stories that are told in individual clinical encounters—by the physician in English; by the interpreter who must move words from English to Spanish and back again; and by the Spanish-speaking patient. While the act of translation by definition has traditionally referred to moving written words from one language to another, this dissertation makes the argument that both translation theory and its philosophical companion, hermeneutics, are applicable and, in fact, quite useful for understanding the interpreter-mediated encounter through a narratively minded lens. The project is an attempt to ask larger questions about the interactions between literature and speech; storytelling and individual bodies; and psychoanalysis and care.