Zarita Araujo-Lane, a Massachusetts-based Portuguese interpreter, had heard it all.
During one visit with a client, the doctor took a personal call to discuss a stock trade. Another doctor confided that he suspected his patient was lying, but instructed her not to interpret his comment.
Then Araujo-Lane found herself in an exam room with a patient who recently lost her baby, and a physician preparing to perform a pelvic exam. He bent over to reach for a speculum, revealing a bit of his backside.
“It was not very appetizing,” recalls Araujo-Lane, speaking from her Woburn, Massachusetts office. “He was not the most handsome guy.”
The patient smiled and said in Portuguese, “who could make love to him?”
“I almost passed out because I had to interpret this same thing,” says Araujo-Lane. “I said it in a quiet voice, and he was such a space cadet, he didn’t hear. That’s when I made CIFE.”
CIFE is a tool that helps interpreters lay out ground rules before a session begins. Those includes letting the client and provider know that everything said in one language will be interpreted in the other.
Araujo-Lane, owner of Cross Cultural Communication Systems, developed the tool by pulling from key standards of the International Medical Interpreters Association and National Council on Interpreting in Healthcare.
More than a decade after Araujo-Lane first pitched CIFE , the tool has become a standard for interpreters across the country.
“CIFE is easy to understand, and easy to remember,” said David Brackett, president of the Oregon Health Care Interpreters’ Association. “It’s a win-win situation for interpreters and providers."
CIFE was developed for the healthcare industry. That’s because health care has professionalized interpretation more rapidly than other fields. But the standards and code of ethics extend to social services as well.
Multnomah County staff who work with interpreters can assure their appointments go more smoothly by laying out these expectations up front. That is, if the interpreter doesn't do it first.
Cindy Roat, chair of the committee that establishes and reviews NCIH standards, said whether interpreters use CIFE or not, those ground rules should be laid out before the session begins.
“There are many ways for interpreters to cover the points of a pre-session,” she said, which should be a mandatory element of every interpreted session
“Many interpreters don’t do pre-sessions with providers or patients because they think the doctors are in too much of a hurry,” she said. “Strangely, when I talk about pre-sessions with doctors, they all seem to think it’s a good idea.”
What is CIFE?
C stands for Confidentiality.
Interpreters sign confidentiality agreements but reiterating this at the beginning of each session helps build trust with the patient. Providers should be sure to notify clients when they may be obligated to report information to a third party.
Also clarified here is the protocol regarding written notes an interpreter might take during the session. Notes will be shredded or disposed of in a secure bin immediately following a session.
I stands for “I use first person.”
Interpreters speak in first-person. This cuts down on confusion, provides a more accurate interpretation and allows for genuine dialogue between the client and provider.
F stands for Flow.
The interpreter might ask for clarification during a session or ask the provider or client to slow down. If a session lasts more than 30 minutes, the interpreter might request a break. Providers can empower interpreters at the beginning of a session by saying, “You control the flow of the this meeting. If I’m going too fast, slow me down. If you don’t understand something, or the client doesn’t understand something, ask me to clarify.”
E stands for “Everything with be interpreted.”
The interpreter interprets everything that is said, including intercom announcements, side conversations, phone calls and swear words.