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The purpose of this paper is to give a general account of the translation and interpretation problems health care personnel face everyday in relation with immigration, as they have not been provided with any means or knowledge to cope with these matters. Not only do they have a language problem, but important cultural differences may also appear and thus pragmatic barriers as much as linguistic ones must be overcome so that effective communication takes place. In order to account for the situation we shall consider the contrast (and similarities) between two very different social contexts in Spain: a mainly rural/fishing region in the North of Galicia and a big city such as Madrid.
El objetivo de este trabajo es presentar un estado de la situación de los problemas de traducción e interpretación que afectan al personal sanitario a diario con los inmigrantes, ya que no tienen medios ni conocimientos para solucionar los problemas que puedan surgir. No sólo tienen problemas lingüísticos, sino que también pueden surgir importantes diferencias culturales que dan lugar a problemas tanto pragmáticos como lingüísticos y obstaculizan una comunicación eficiente. Para describir la situación consideraremos el contraste (y similitudes) que tiene lugar en dos contextos sociales muy diferentes en España: la zona mayoritariamente rural y pesquera del norte de Galicia y una ciudad grande como Madrid.

Having analysed the questionnaires, we can clearly see that translators or interpreters are a necessary figure that should be working in all health care centres in which there are immigrants. Family and friends are not a good enough option for such an important task which may result in important and life saving situations. Leaflets and drawings are also a very weak solution to the existing communication barriers.
Not only interpreters or translators, but mediators are needed. As we have seen, the mediator is a new figure which is slowly beginning to appear. Not only does s/he deal with the linguistic transfer of ideas and concepts but also with the cultural aspects which seem to occur very frequently. As we have seen, health care personnel have communication problems with Latin Americans, although they speak the same language due to different customs, traditions, beliefs… cases in which a mediator could help to explain to the patient why they are treated in a certain way, the correct behaviour in the country they have emigrated to, etc., as for other nationalities which have the cultural and linguistic problems communicating with their doctors, it is obvious that they would always need mediators, specially in areas such as Madrid, where more than half of the patients are foreigners. Due to there not being proper staff at hand to deal with communication problems, family members and friends end up translating which could be problematic as most times they are not fully fluent either.
On the other hand, it is very interesting to notice that in Madrid health care personnel claim they need mediators, whereas in Burela they do not think so. This is probably because of the number of foreign patients they deal with, in Madrid it is very high and thus communication barriers between patients and doctors is a very important problem, whereas in an area with less immigration it is not on top of their priorities list. However, due to the increasing immigration in Spain, it will be more common to find a greater number of foreigners everywhere and not just in large cities. This is probably the reason why the problem, in a general national scale, has not been solved earlier, as immigration is relatively new to Spain.

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