Interpreters in culturally responsive healthcare: navigating dual roles and systemic gaps in Aotearoa New Zealand

Aotearoa New Zealand is one of the most linguistically and culturally diverse nations in the world, home to over 200 ethnicities and more than 160 languages.^1,2 According to the 2023 Census, nearly 30% of New Zealanders were born overseas, reflecting a demographic shift that has seen the proportion of foreign-born residents rise from 17% in 1996 to over 27% today.³ This diversity enriches our society but presents significant challenges in healthcare delivery, particularly for individuals with limited English proficiency (LEP).

While the health system must prioritise Māori health advancement, reflecting Te Tiriti o Waitangi obligations, it simultaneously carries a duty to all communities. The Oranga Tamariki guidelines⁴ acknowledge that interpreters may be required even when individuals are New Zealand-born, due to linguistic preferences within whānau or communities. Interpreter services are not a discretionary add-on; they are a public health necessity and a reflection of our collective commitment to equity.

While advances in artificial intelligence (AI) have led to the development of instant translation tools, these cannot replace professional interpreters in healthcare settings. Nuanced understanding, cultural context and emotional sensitivity are critical—especially when working with vulnerable populations—and these elements are beyond the scope of current or foreseeable AI capabilities.

Effective communication is a cornerstone of quality healthcare, and language barriers can lead to misdiagnoses, poor adherence to treatment plans and feelings of isolation and mistrust.⁵ As the demographic landscape continues to shift, the need for professional interpreters has become increasingly urgent. Languages such as Samoan, Mandarin and Hindi are now among the most commonly spoken in Aotearoa New Zealand after English and Māori.³ In this context, interpreters are not merely linguistic conduits; they are essential facilitators of equitable, culturally responsive care.

In high-stakes or emotionally charged contexts, such as post-trauma care, interpreters may also experience psychological strain. Their proximity to distressing content and vulnerable clients can impact their wellbeing, underscoring the need for appropriate support and the risks associated with informal or unsupported interpreting practices.

Language barriers and informal interpreting risks

In some communities, older individuals who arrived through family reunification schemes may have had limited opportunities to learn English. These people may rely on adult children or grandchildren to interpret during medical consultations. While this practice is often well intentioned and driven by privacy concerns, it raises important issues around accuracy, emotional burden and confidentiality, especially when discussing sensitive health matters.⁶

Family members may lack the medical vocabulary needed to convey complex information, while patients may withhold details due to embarrassment or fear of burdening their relatives. These dynamics underscore the need for professional interpreters trained to navigate medical terminology and maintain confidentiality. In emotionally sensitive situations, the presence of a professional interpreter can be the difference between silence and disclosure.

The case for professional interpreters

Professional interpreters play a critical role in bridging communication gaps between healthcare providers and patients from diverse backgrounds. Their presence can transform clinical encounters, ensuring that patients understand their diagnosis, treatment options and follow-up care. Studies consistently show that trained interpreters improve communication, increase patient satisfaction and contribute to better health outcomes.⁵

Beyond linguistic accuracy, interpreters often serve as cultural brokers, helping to navigate cultural nuances that may affect patient–provider interactions. This role becomes especially important in trauma contexts, where emotional safety and cultural sensitivity are paramount.

Lessons from the mosque attacks and dual relationships

Our research team from the University of Otago in Christchurch recently conducted a qualitative study exploring the experiences of Muslim professionals who supported members of their own community following the 15 March 2019 mosque attacks. These people often navigated dual relationships, simultaneously holding both personal and professional roles, which added emotional and ethical complexity to their work. Several participants also acted as interpreters in addition to their primary roles.

Their experiences highlighted the challenges of interpreting in trauma-related environments, especially when working with individuals they knew personally. As one participant explained, “Our [Muslim] community is all about trust… if they don’t trust, they can’t open up.” Yet, paradoxically, being known within the community sometimes undermined trust: “Some people started avoiding me… they were not comfortable [with me] anymore because I knew [all the details of] their court case.”

These tensions reflect the fragility of trust in dual-role contexts and the need for clear boundaries and support structures. The concept of dual relationships is well documented in mental health literature,⁷ but its application to interpreters remains underexplored.

Systemic challenges and emotional risk

Despite their qualifications and experience, interpreters in our study sometimes reported feeling professionally undermined. Their competence was often judged through the lens of ethnicity or community familiarity rather than formal training. One participant shared, “It feels like doing this job makes me seem unreliable or not trustworthy [in the community].” Others described being unfairly blamed for miscommunications: “The client said that the simultaneous interpretation was so bad that she couldn’t understand what they [the phone interpreter] said… she thought it was me, but I wasn’t even doing that interpreting.”

The study revealed significant gaps in agency support and standardisation. Some interpreters were assigned to sensitive cases with minimal preparation or follow-up. “There was not even an email, nothing [to check on me]… just a timesheet… out and go. It was the most tough job.” Agencies lacking trauma-aware protocols left interpreters vulnerable to psychological harm and professional isolation.

Systemic issues such as poor co-ordination between agencies and inadequate training were frequently cited. As one interpreter noted, “I was never told what the discussion would be, what it could look like…” Another involved an interpreter who was asked to assist in a legal case related to the 15 March attacks. The material was highly sensitive and graphic, and the case concerned an individual they knew personally who had been killed. The interpreter received no prior warning, no briefing and no psychological support afterwards.

Despite the challenges, interpreters also reflected on positive aspects of their work. One noted a client saying, “You helped me a lot, I got through this”, while another emphasised, “Knowledge is power… I want my community to get the power back for themselves”, reinforcing the role of information in promoting agency.

Interpreter training and certification

In response to these systemic challenges, efforts have been made to professionalise and standardise interpreter services. Following the 15 March attacks, free interpreter and translation training courses were provided to build community capacity and support bilingual professionals. The Interpreter Standards Transition Support (ISTS) programme, which ran for 3 years and concluded on 30 June 2024, supported interpreters to achieve professional credentials through NAATI (National Accreditation Authority for Translators and Interpreters) certification.⁸

From 1 July 2024, interpreters working in the New Zealand public sector are required to hold NAATI credentials or be actively working towards them. This ensures interpreters meet consistent standards of skill, ethics and professionalism, giving agencies confidence in their ability to manage complex, sensitive and trauma-related interactions.⁸

Trauma-informed practice and interpreter wellbeing

Trauma-informed care emphasises safety, trustworthiness, peer support and cultural responsiveness, not only for clients but also for those who work with them.⁹ Interpreters working in trauma-related settings often absorb emotional distress without adequate support, but their wellbeing is integral to the quality of care delivered. Support should include:

• Pre-session briefings to prepare interpreters for emotionally charged content.
• Post-session debriefings to process psychological impact.
• Access to supervision and psychological support.
• Recognition of interpreters as part of the care team, not peripheral staff.

These measures are essential to protect interpreters from burnout, vicarious trauma and professional isolation, especially when working within their own communities or navigating dual roles.

Conclusion

Interpreters play a vital role in ensuring equitable, culturally responsive healthcare, but their proximity to trauma, community expectations and systemic gaps can place them at significant personal and professional risk. A trauma-informed approach must extend to those who interpret, not just their clients.

Supporting interpreters through training, supervision and recognition is not optional; it is a prerequisite for ethical, effective care in diverse societies. Their wellbeing is integral to the quality of service they provide. Not only will these efforts contribute to individual wellbeing and professional satisfaction, but they will also enhance the capacity of interpreters to serve their communities effectively.

Inaccurate translation by untrained or informal interpreters can have serious consequences, including clinical errors, breaches of confidentiality and compromised patient safety. Professional interpreters bring not only linguistic expertise but also an understanding of medical terminology, ethical boundaries and cultural nuance—all of which are essential for safe and effective care.