Cristina Perazzo Is a Medical Go-Between

Day in, day out, nearly 10,000 people show up at Boston University — not to go to school, but to go to work. Often unsung, their efforts make everything possible. This is one in a series of stories about jobs on campus and the people who do them.

A young girl from Guatemala, who spoke only her native Spanish, hadn’t been in the country very long when she needed to be seen at Boston Medical Center. She was assigned a male doctor. She also was assigned an interpreter.

“The doctor had to do a pelvic exam, and I could see terror in the girl’s eyes,” says her interpreter, Cristina Perazzo. “She was just so embarrassed. She whispered to me, ‘I’m a virgin.’ She was just so shy and so uncomfortable with the situation.”

Perazzo pulled the physician aside. Latina women are often very reserved about their bodies, she explained. In their cultures, it is rare for a female patient to see a male doctor. “He was grateful that I spoke up,” Perazzo says, “and we immediately found a female doctor for the girl.”

Medical interpreters like Perazzo are integral to hospitals that treat patients from different languages and cultures — which means almost every hospital in the nation these days, but especially urban ones like BMC. Besides having a solid linguistic footing, they must understand and explain medical concepts and procedures, translating nuances and cultural differences as well as words.

The need for medical interpreters has never been greater. At BMC, officials expect that interpreters will be used in 200,000 cases this year, up from 170,000 in 2006.

“The theory is that the more robust interpreter services a hospital offers, the more communities find out that they can be seen,” says Oscar Arocha, director of interpreter services at BMC. “If you have a full-time interpreter who speaks Somali, that news spreads in the Somali community.”

Interpreters are available in 18 languages at BMC, including Spanish, Chinese (both Cantonese and Mandarin), Arabic, and American Sign Language. The hospital has about 70 interpreters, on staff and freelance, compared with only 8 interpreters in 1996, according to Arocha.

A native Spanish speaker, Perazzo is slim, with square glasses and short, dark hair; she laughs a lot as she talks. Born in Argentina, she came to the United States almost 30 years ago. She has worked as a graphic designer and a chef, even owned a bed-and-breakfast. In 2001, she began looking for a new career that would make use of both her English and her Spanish. She felt that she had lost too much Spanish to translate, so she considered interpreting.

The difference is deep, but often misunderstood. Translating is a literal transcription of a written document and demands a thorough, precise understanding of grammar, syntax, and vocabulary. Interpreting is more about explaining intent and meaning than re-creating individual words.

Perazzo has always been interested in medicine, so she gravitated toward medical interpreting. She earned a certificate from Cambridge College, in Cambridge, Mass., took classes in anatomy, physiology, and cross-cultural communication, and interned at Massachusetts General Hospital. She has worked at BMC for more than a year and previously had interpreted at Children’s Hospital Boston and Shriner’s Hospital for Children, in Boston.

Arocha and Perazzo point out that there is no national certification requirement for medical interpreters. Some universities, including Cambridge College and Boston University, offer certificate programs for medical interpreters, but those programs are few and far between.

“It is crucial for interpreters to be certified,” says Perazzo. “I think it’s important for the state to know you’ve reached a certain level of medical interpreting.” The Boston-based organization International Medical Interpreters Association is pushing for a national certification program.

Being bilingual does not necessarily make someone a good interpreter. “Bilingual speakers aren’t trained in medical terminology,” says Perazzo, “and a family member translating wouldn’t want to deliver bad news to a mother or brother.”

“If you don’t use an interpreter and instead use any bilingual speaker, there is less of a quality interpretation and that could lead to bigger issues,” says Arocha. “Patients without interpreters have more of a chance of coming back to the ER.”

Perazzo tells of a patient from Colombia who repeatedly told the doctor that she had a “desperate” pain in her chest. Perazzo didn’t understand the term at first, because she spoke a different Spanish dialect. Finally she understood that the woman was not trying to say she was having a heart attack — she was feeling deep anxiety.

“You’re not just interpreting words,” Perazzo says. “Somehow you have to get across to the doctor how the patient feels or what is ailing them.”

“You find yourself in so many different scenarios,” says Arocha. “A child in the emergency room, a rape case — that can really shake people. Cristina can go from that directly to a cath lab. She’s very professional about all the aspects of medical interpreting. She understands confidentiality, she has poise, and she knows how to conduct herself during different kinds of scenarios. She can put up a shield, and she does that well, but she does it with a great attitude and compassion.”

Perazzo says that her “favorite thing about this job is that I get to relate to people. You feel as if you have really, really helped someone.” But she becomes serious when asked about her job’s difficulties.

“Sometimes patients come in with these illnesses and then on top of that they tell you about their family situation, and it just seems that everything is not going right for them,” she says. “It just breaks your heart.”

Amy Laskowski can be reached at amlaskow@bu.edu; follow her on Twitter at @amlaskow.

This story was originally published on July 8, 2009.