Features of cultural brokerage in interpreted child psychiatry interactions: a case of paradoxical practice

Abstract

Many intercultural health care interactions take place in the presence of a third party who is usually expected to serve a function which extends well beyond that of mere language interpreter. An examination of these features is likely to provide insight into the wider organisational and environmental context and provide directions for training. We report on a study in a child psychiatry clinic in South Africa which examined a partnership between a physician and a cultural broker. The interactive and language dynamics of 10 mediated interviews were explored using qualitative methods and video-recordings of interactions and interviews with participants. Data analysis included transcription, translation (from Xhosa) and back-translation using principles of conversation and thematic analysis. Two organisational routines emerged in the triad (use of asides and quotatives) which had a paradoxical effect: while they helped to break down the typical asymmetry of the interactions and enabled displays of mutual understanding, there were also occurrences aligned with problematic interpreting practice. While some of these triadic features seem unconventional, paradoxically they may have validating and relationship consequences that can be understood within a framework of the Ethics of Care and suggest the need for models of evaluation and training more sensitive to context.