Language as a Social Determinant of Health: Translating and Interpreting the COVID-19 Pandemic (Palgrave Studies in Translating and Interpreting) 3030878163, 9783030878160

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PALGRAVE STUDIES IN TRANSLATING AND INTERPRETING SERIES EDITOR: MARGARET ROGERS

Language as a Social Determinant of Health Translating and Interpreting the COVID-19 Pandemic

Edited by Federico Marco Federici

Palgrave Studies in Translating and Interpreting

Series Editor Margaret Rogers School of Literature and Languages University of Surrey Guildford, UK

This series examines the crucial role which translation and interpreting in their myriad forms play at all levels of communication in today’s world, from the local to the global. Whilst this role is being increasingly recognised in some quarters (for example, through European Union legislation), in others it remains controversial for economic, political and social reasons. The rapidly changing landscape of translation and interpreting practice is accompanied by equally challenging developments in their academic study, often in an interdisciplinary framework and increasingly reflecting commonalities between what were once considered to be separate disciplines. The books in this series address specific issues in both translation and interpreting with the aim not only of charting but also of shaping the discipline with respect to contemporary practice and research. More information about this series at http://www.palgrave.com/gp/series/14574

Federico Marco Federici Editor

Language as a Social Determinant of Health Translating and Interpreting the COVID-19 Pandemic

Editor Federico Marco Federici Centre for Translation Studies University College London London, UK

Palgrave Studies in Translating and Interpreting ISBN 978-3-030-87816-0    ISBN 978-3-030-87817-7 (eBook) https://doi.org/10.1007/978-3-030-87817-7 © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover illustration: Getty Images / oxygen This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword

Health and wellbeing count among the most precious gifts we can enjoy. Sometimes, a crisis or an emergency threatens them. This volume sheds light on the key issue of access to information or services during a time of crisis such as COVID-19. Access on the part of people who do not communicate in the main societal language is gained through language provision (i.e. provision of translation and/or interpreting services). Translation and interpreting services, at times provided with limitations or requested from volunteers without checking quality, other times avoided under the guise of being costly, or simply ignored, or overlooked, have raised their profile during the COVID-19 pandemic. Users of spoken languages became more aware of sign-language as some governments (e.g. Scottish, Welsh, or Northern Irish government) always had a sign-language interpreter in their daily briefings, although others did not (e.g. English government). We read translated news or watched news broadcasted from every corner of the world and understood it through interpreters. Translation and interpreting are essential to navigating crises and emergencies because, through language services, information can be disseminated equally and equitably to linguistically diverse communities that do not access the societal language. When a crisis or an emergency occurs, translation and interpreting provide all people the opportunity to ask questions as well as to express their concerns or fears. Language provision is key to providing equitable access to institutional, national, and v

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international resources. At the same time, language provision is an institutional resource to be shared in a fair and equitable way. While translation and interpreting have existed for as long as there has been contact among users of different languages, we continue to encounter justifications for the challenges of providing language support, or the inability to overcome language barriers. This volume offers us the opportunity to deconstruct these two statements. Languages are not barriers and language support does exist. While, like any other service, translation and interpreting carry a cost, the cost is minimal compared to the cost of non-social integration and/or the cost of human life. Languages, much like identity or diversity, are part and parcel of being human. Languages, like identities, are diverse, but not barriers, even if when one may perceive a different language as a problem or a barrier simply because one cannot use it. Because we are diverse, we do not all speak one language. This fact does not constitute a barrier to communication. The expectation that we should all be able to use a lingua franca during a crisis would be as absurd as the expectation that all human beings should be of the same race or gender. As illustrated in this volume, language diversity is addressed through language provision. In our interconnected world, we communicate with the help of humans and technology. We resort to language professionals who, like other professionals, vary in their degree of expertise and experience as well as in their use of technology. These professionals are translators, interpreters, language mediators, and language brokers—different local legislative frameworks and traditions create a continuum of possibilities and professional profiles. By definition, these professionals are bilinguals, but the relationship between language proficiency and translation/interpreting ability is not symbiotic, instead it is hyponymic. Translators and interpreters are freelancers, members of staff in organizations, they own or work for translation/interpreting agencies. They work for profit and non-profit organizations. They work for government. At times they also volunteer, like other professional groups. They work with written, spoken, and sign languages, deploying their knowledge and skills; they work across two languages or more, they work from a distance or face to face, they work around the clock, individually or in teams. Languages are brokered and there is a continuum of needs in which users

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of non-societal languages seek language provision and some organizations provide it (World Bank organization, 2003). Global crises, like a pandemic, affect us all, however, they affect us all differently. Globalization put these differences on the table. These differences are many. They may be related to geography; to the healthcare systems in place in different areas; to governments’ roles or decisions; to culture, language, ethnicity, socio-economic status, and race. While we are all connected through our human fabric, this fabric is diverse. Some differences may be quite evident and constitute facts to account for as we connect with each other. For example, we live in different geographic locations with different time zones, we have different needs. Consequently, we work out our differences, we take into account these facts to connect with each other. With the self comes the language we use to communicate, to describe, and to interpret our own communities as well as those of others. While globalization in areas such as business, education, entertainment, health, marketing may have made us aware of how interconnected our world is (Pan et al., 2002), globalization has also raised our awareness on how different our perceptions and beliefs can be and how we see the world though our own cultural lenses. It is precisely because we express ourselves through language (whether spoken or signed) that language is central to working out these differences; language is central to integrate others rather than to isolate them. Globalization has been enabled by technological developments which allow interconnectivity. These developments are accessible, feasible, and affordable to many but not to all people. Many international organizations, as well as government and NGOs at national, regional, or local level continue to help bridge the technological divide, to bring people closer. However, at the core of being interconnected lies the ability to access and understand information, to communicate with others. As this volume demonstrates, countries which did well are those that provide translation and interpreting services. These services are available and affordable. There is honestly no justification or excuse for not offering these services when they do in fact exist. This volume successfully explores the COVID-19 pandemic through the lens of access to communication by bringing together studies on

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responses from different areas of the world. Contributors to this volume present much needed research in healthcare communication during a pandemic. Consequently, this volume is a valuable contribution to current debates on social cohesion and social justice. My hope is that the new knowledge presented here informs evidence-based policy making. This will help us ascertain if current policy and practice from different areas in the world converge or diverge when it comes to protecting the right to access healthcare, to give informed consent, to hospitalization and treatment as well as to vaccination during a major crisis like COVID-19. Edinburgh, UK 

Claudia V. Angelelli

References Angelelli, C. (2018). Cross-border healthcare for all EU Residents? Linguistic access in the European Union. The Journal of Applied Linguistics and Professional Practice, 11(2), 113–134. O’Brien, S., Federici, F.  M., Cadwell, P., Marlowe, J., & Gerber, B. (2018). Language translation during disaster: A comparative analysis of five national approaches. International Journal of Disaster Risk Reduction (31), 627–636. Pan, Y., Wong- Scollon, S. & Scollon, R. (2002). Professional communication in international settings. Blackwell Publishers. WHO. (2008). World health organization outbreak communication planning guide. World Health Organization. Retrieved August 6, 2021, from https:// www.who.int/ihr/elibrary/WHOOutbreakCommsPlanngGuide.pdf World Bank Organization. (2003). A document translation framework for the World Bank Group. Retrieved August 6, 2021, from https://documents1. worldbank.org/curated/en/535491468782383662/text/261450 TranslationFramework.txt

Preface

A crisis is a disruption of ordinary ways of life, caused by an event, calling for an urgent response, and a strategy to reduce the risks emerging in the short term and long term with their cascading consequences (Alexander, 2016; O’Brien & Federici, 2019; Seeger, 2006; Sellnow & Seeger, 2013). The COVID-19 pandemic is an international crisis. Not all risks are unpredictable; pandemics are expected but not foreseeable. Hence, emergency health relies on training, planning, protocol, and past experience to deal with the unforeseen. Emergency planning makes dealing with the unexpected more bearable and effective, as it mitigates and reduces risks. Striking a balance between unexpected and sudden events and risk reduction is a central concern of public health planning. Risk communication is an integral part of mitigating the impact of a crisis (Reynolds & Lutfy, 2018); large-scale events such as pandemics have been studied in order to create protocols and plans to reduce their potential impact (Crouse Quinn, 2008; Hewitt et al., 2008; Petts et al., 2010). However, multilingual risk communication is rarely well-integrated in emergency planning—even the influential ‘Crisis and Emergency Risk Communication (CERC)’ manual (Reynolds & Lutfy, 2018) mentions linguistic diversity only in passing. This is a problem. Translators and interpreters (T&Is), if mentioned in emergency plans and risk communication strategies, figured as a service to be commissioned as part of logistic arrangements to be completed at ix

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the onset of a response, until recently. The Project Sphere (2018) considered their role as essential in planning humanitarian operations focused on real community engagement. Why did most countries face poor levels of preparedness regarding multilingual communication at the start of COVID-19? Why did emergency plans underestimate the need for interpreting, signing, and translation in public campaigns of this magnitude? Of course, eventually translations appeared and have continued to appear. Yet, at the onset, limited translation and interpreting capacity was a logistic, health and safety, and organizational problem (Li et al., 2020; Wang, 2020; Zhang & Wu, 2020); during the pandemic some governments gradually became organized (e.g. see detailed analysis of Ireland in O’Brien et al., 2021). In most countries, speakers of non-main languages have relied on multiple sources of information to understand the mitigating measures and restrictions in place. Professional T&Is, bilingual staff members, volunteer bilingual nursing teams, and local staff helped the International Federation of the Red Cross and Red Crescent Societies (IFRC) to disseminate information via their capillary local networks from January 2020. Many have drawn on their linguistic expertise to contribute to communicating risks associated with the spread of and infection by COVID-19, including massively open and international crowdsourcing activities (Zhang & Wu, 2020), migrants’ support (Ahmad & Hillman, 2021), grassroots organizations, charities, NGOs (Respond Crisis Translation, Translators without Borders, and others), foundations (Engage Africa Foundation, Endangered Language Project), social media (see Hu’s Chap. 7 in this collection), professionals volunteering (see the example discussed in Al-Sharafi’s Chap. 6), community volunteers (see an example discussed in Teng’s Chap. 11), healthcare NGOs (e.g. Doctors of the World, EMERGENCY, Médecins Sans Frontières, etc.), and many others. In The Lancet, Horton (2020) encourages scientists to reframe the pandemic in relation to its unequal impact on members of society. Not only a viral outbreak, COVID-19 is in fact a syndemic event. For Singer and Clair (2003: 428), ‘syndemic points to the determinant importance of social conditions in the health of individuals and populations’ (emphasis in the original). The disproportionately unjust impact on socially and economically vulnerable groups makes the epidemiological event a

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syndemic (see discussion of its translation, in Spoturno’s Chap. 4). COVID-19 has paraded all the destructive powers of endemic health inequality locally (e.g. private vs public healthcare, North Italy/South Italy), continentally (e.g. response success rates China/India), or internationally (with the UK, Brazil, and the USA performing terribly on containing the virus spread, and on letting it have an impact directly correlated with the health inequality embedded in their societies; see Lawrence, 2020; Paremoer et al., 2021). Additionally, at the time of writing, inequities in the vaccination roll out make some countries vulnerable to new waves (e.g. Peru), while others are recovering more quickly by accessing more types and quantities of vaccines (e.g. the USA, the UK). Contributors to this volume discuss these issues engaging with the relationship between risk communication and T&I.

Risk in Public Health Successful communication in crisis contexts is extremely complex to achieve and extraordinarily significant in mitigating the impact of risks and their cascading effects. Defining the significance of effective multilingual communication in public health entails contributing to saving lives and reducing morbidity. Risk communication is well-studied; it is worth narrowing the focus here to consider only risk communication connected with mitigating the impact of epidemiological hazards, such as SARS coronaviruses or those of flu pandemic. Before Trump’s administration reduced federal funds, disempowered, and regularly discredited or undermined the activities of the Centers for Diseases Control and Prevention (CDC), this US body had been extremely influential in establishing practical, actionable, and successful protocols supporting disaster management and public health. Its practices include communication strategies, explained in its Crisis  and  Emergency Risk Communication (CERC) manual (Reynolds & Lutfy, 2018). CERC is founded on six principles: ‘(1) be first; (2) be right; (3) be credible; (4) express empathy; (5) promote action; (6) show respect’ (Reynolds & Lutfy, 2018: 3). In the current collection, Al-Sharafi (Chap. 6) analyses credibility in relation to encouraging action and gaining respect among multilingual

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communities, who are excluded from the most widely used channel of communication. During the response phase of any disaster or emergency cycle, these principles are all essential and difficult to respect, which is why preparedness and planning are crucial especially in terms of communication. The principles are valid beyond the response phase, as they also pertain to public health campaigns (e.g. against smoking, in favour of healthy lifestyles, etc.); in fact, ‘Risk communication provides the community with information about the specific type (good or bad) and magnitude (strong or weak) of an outcome from an exposure or behavior’ (ibid.: 4). To engender action and positive outcomes, risk communication depends on becoming credible and showing respect; creating obstacles, such as limiting provision of information in other languages by not including live signers, interpreters, and distribution of translated information in multiple formats, fails to establish a respectful relationship of trust. In Communicating Risk in Public Health Emergencies. A WHO Guideline for Emergency Risk Communication (ERC) policy and practice (WHO, 2017), the glossary entry for ‘Emergency risk communication (ERC)’ describes this type of communication as: an intervention performed not just during but also before (as part of preparedness activities) and after (to support recovery) the emergency phase, to enable everyone at risk to take informed decisions to protect themselves, their families and communities against threats to their survival, health and well-being. (WHO, 2017, p. vii)

Even countries once able to deploy professionals from extensive T&I networks were short of all combinations; the problem was anticipated in evidence emerging after the 2009 H1N1 (Swine flu) pandemic, as this passage assessing the UK pandemic preparedness clearly stated in 2010, We can expect differential ability to access information amongst those from lower socioeconomic groups. Yet, these will be the very people potentially most at risk during a pandemic and least able to take personal protective measures (including time for recuperation from illness). Careful attention will be needed to communication in different forms and languages as well as opportunities for people to listen to messages, not just read them. (Petts et al., 2010, p. 157)

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In England, sign language interpreting was not even provided during the COVID-19 daily conferences, defying legal requirements set out by the UK’s 2010 Equality Act. Analysing poor communication strategies through the lens of definitions of health risk in order to understand their full consequences makes for grim thoughts. The probability of that part of the population with limited English proficiency needing extra information in their own language in stressful situations increases risks in a multiplicative way: Risk is commonly defined as a multiplicative combination of the probability of a hazardous event occurring (e.g., smoking) and the severity of the resulting negative consequences (e.g., lung cancer). This definition of risk, as ‘probability × severity,’ implies that greater probability and greater severity result in greater overall risk (Slovic, 2000). (Renner et al., 2015, p. 702)

Health risks, especially those arising from biological hazards, are magnified when social factors (e.g. limited language proficiency) intertwine with a hazard. This was the situation, for example, when mitigating measures were (belatedly) taken to protect the UK population. Table 1 uses data provided by the John Hopkins’s Coronavirus Research Centre, ordered from the highest to the lowest number of deaths per 100,000 people. Many factors determined high COVID-19 casualties. The figures in Table 1 indicate that there is a correlation in the 20 nations with the highest death toll between their shaky communication strategies and the impact of social determinants of health—in the main language and even worse in other languages used locally—and lack of compliance with mitigating measures, which caused second, more deadly waves (see Lee et al., 2021; Vardavas et al., 2021; Varghese et al., 2021). The impact on these countries’ linguistically diverse populations, often concentrated around densely populated urban areas, also correlates with healthcare systems weakened over years of neoliberal approaches that cut costs in publicly funded and managed health systems through austerity (northern Italy, the UK), despite these health systems being known for their effectiveness and efficiency in the long run (van Barneveld et al., 2020). Dense and populous areas have shown the vulnerabilities of cities (Sharifi & Khavarian-Garmsir, 2020); and neighbourhoods with the largest

xiv Preface Table 1  Mortality rates by country (Coronavirus Research Centre, 2021) Country 10 14 16 17 18 21 22 46 62 63 74 94 95 96 99 139 140 171 174

Brazil Italy Poland United Kingdom United States Argentina Spain Tunisia Israel Canada Oman India Saudi Arabia Qatar Indonesia Australia Guinea-Bissau New Zealand China

Confirmed cases

Deaths

Case/ fatality

Deaths/100 K POP.

16,471,600 4,213,055 2,871,371 4,496,823

461,057 126,002 73,682 128,037

2.80% 3.00% 2.60% 2.80%

218.46 208.97 194.05 191.57

33,251,939 3,732,263 3,668,658 343,374 839,453 1,384,373 213,784 27,894,800 448,284 217,041 1,809,926 30,096 3761 2672 102,960

594,306 77,108 79,905 12,574 6407 25,451 2303 325,972 7334 554 50,262 910 68 26 4846

1.80% 2.10% 2.20% 3.70% 0.80% 1.80% 1.10% 1.20% 1.60% 0.30% 2.80% 3.00% 1.80% 1.00% 4.70%

181.06 171.58 169.73 107.52 70.77 67.71 46.29 23.86 21.4 19.56 18.57 3.59 3.54 0.53 0.35

culturally, ethnically, and linguistically diverse communities within the cities saw disproportionate incidence of cases (see Lawrence, 2020). Out of the 180 countries considered by the John Hopkins Coronavirus Research Centre, Table 1 offers only an overview of the countries mentioned in this volume. The figures clearly show how countries that adopted more reliable, credible, empathetic, and trustworthy risk communication strategies also reduced the health risks for the whole population. China, for example, adopted extremely strict and successful protocols early on to stop the spread and control waves arising from incoming flights. New Zealand had proportionally one of the most effective pandemic plans, and it was accompanied by an extensively multilingual messaging (Brandon & Maang, 2022). The figures are strongly indicative of a relationship between language and the other factors producing cascading effects on number of cases and mortality rates.

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The Contributors’ Aims This volume engages with examples of health communication during the COVID-19 pandemic from across the world. Whereas interpreting needs may be sudden and unforeseen, this volume shows how exploiting existing data and expertise could make translation into a significant risk reduction, or risk mitigation tool (Federici & O’Brien, 2020). The contributors use different data collection methods and various theoretical ways of interpreting the data. All chapters share a common denominator: T&I needs to be better integrated in healthcare communication and in risk communication to mitigate or reduce the impact of hazards on public health. The lack or approximation of T&I services, engendering widespread needs for more or better translations, remains a leitmotif throughout the volume. The book is subdivided into four parts entitled ‘Terminologies and Narratives’, ‘Translating COVID-19 Credibility, Trust, Reliability’, ‘Health and Safety in Risk Communication’, and ‘Communities and Translation’. In these parts, the contributors engage with case studies emerging from national and cross-national examples of issues in disseminating information in a timely, useful, and trustworthy manner during COVID-19’s first and second waves (2020–2021), and the linguistic patterns that influence discourse, narratives, credibility, and trust. To open the volume, Federici in Chap. 1 makes the case for considering translation and interpreting as integral components to achieve higher levels of health equity by discussing multilingual communication strategies in relation to the notion of social determinants of health. In the first part, Chatti in Chap. 2 looks at metaphors in public health communication, with particular attention to Tunisia. Chatti argues that the global outbreak of COVID-19 continued the existing approach to the use of figurative language in medical contexts, namely war metaphors. Building on Conceptual Metaphor Theory, the chapter explores the multiple correspondences between war and COVID-19 as an illustration of the war/fight/battle framing often adopted in healthcare communication. The chapter engages the reader to consider whether a reframe is needed to evoke hope and optimism that affordable and effective vaccines can bring an end to the pandemic. Dawood in Chap. 3 focuses on Australia.

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This chapter analyses translations into Arabic of several English Covid-19 awareness posters, issued by the Government of New South Wales. Analysing the posters, through the lenses of Postcolonial Theory of Translation, Dawood puts forward provocative and grounded reflections on the ways in which English as the dominant language of scientific communication negatively influences translations. From layouts to sentence structure, the Arabic translations analysed manifest a degree of linguistic hegemony that increases the risk of confusion and uncertainty in the target readers, when the leaflets should be informative, clear, accessible, and trustworthy. Spoturno in Chap. 4 contributes to discussing the role of translation in the communication of health risks in relation to the circulation of health narratives from abroad that coexist with local, specific narratives of risk mitigation. Focusing on Argentina, Sportuno assesses the different trajectories of journalistic debates straddling on the one hand presentations of advancements, risk protocols, and recommendations made in Argentina for its residents, and COVID-19 findings and debates imported from abroad through translations from English on the other hand. The chapter investigates the specific role of translation in communicating risks locally and contextualizing the pandemic globally. Using a corpus of news articles published online in Clarín, La Nación, Infobae, Página 12, and Perfil in Spanish, and English articles from The New  York Times, The Washington Post, BBC News, and The Guardian, Spoturno highlights how narratives emerged and continue to develop in the journalistic discourse around COVID-19. In the second part, Nugroho, Prananta, Septemuryantoro, and Basari in Chap. 5 show the urgency of carrying out translations to access crucial information in Indonesia. In March 2020, the Indonesian government commissioned translations of guidelines detailing hospital treatments and mitigation of the contagion. This chapter reports on a project focused on assessing the translation, and its reception, of the Guidance for Corona Virus Disease 2019 (Liang, Feng, and Li, 2020). Written in Chinese, this text was translated into English and published in February 2020; the English version was then translated into Indonesian. The chapter reports the results of the mixed-method approach used to evaluate via a questionnaire the accuracy of the Indonesian translation (involving professional translators as evaluators) and its reception. Surveying specialist readers

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(doctors) and members of the public, the author’s reception study aims to ascertain their understanding of the Indonesian version. The findings of the project are discussed in relation to mistranslation and maltranslation, which are important concepts in medical translation. Al-Sharafi in Chap. 6 focuses on the strategies adopted by the Omani government in establishing credibility in its dissemination of information, so that trust in the messages would endanger compliance with the restrictions and mitigating measures. The chapter uses a corpus of 183 official statements and 23 press conferences issued in Arabic by the Omani Covid-19 Supreme Committee over a period of nine months from January 2020 to February 2021 and their official translations into English, explaining the recruitment of translators, and development of a strategy to complete the translations into English. The discussion is then contextualized by taking into account the linguistic diversity of Oman beyond English, putting forward considerations regarding the effectiveness of adopting this bilingual strategy for trust-building which still excluded many residents, that is, those foreign nationals who do not speak Arabic or English. Hu in Chap. 7 looks at the relationship between official sources of information in translation and additional sources of information in Chinese among Australian Chinese-speaking communities. Focusing on the abundance of (mis) information during the COVID-19 pandemic, the chapter considers how multilingual communities were more exposed to poor or unreliable information, as linguistic and cultural difficulties interfere with distinguishing truth from falsity. The chapter investigates the communicative effects of the Australian government’s translated COVID-19 information in relation to three types of trust (interpersonal, institutional, and cultural). The findings encourage Hu to suggest that translators could act as ethical filters in the context of the COVID-19 infodemic, choosing what and how to translate, and what translation norms to obey to avoid misrepresenting risks, even when they were operating in unofficial channels of communication. In the third part, the relationship between phraseologies, terminologies, and expectations dictated by health and safety regulations are analysed from two different perspectives. Kodura in Chap. 8 focuses on safety instructions, related to COVID-19 mitigation measures, by comparing English versions with their Polish renderings. Drawing on her study of

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the pragmalinguistic shifts introduced in Polish when translating from English, through a detailed analysis, Kodura observes possible correlations between pragmalinguistic dimensions of health and safety discourse and the public’s compliance with the dissemination of information regarding the mitigating measures adopted by the Polish government. Rossato and Nocella in Chap. 9 consider the efforts made in translating health and safety regulations for cruises to support the tourism industry in its recovery from the impact of COVID-19. Issues of safety concerning the promotion of COVID-19 measures are analysed by engaging with the websites of four different cruise lines (MSC, Costa Crociere, Royal Caribbean, and P&O Cruises). As cruises can be overcrowded spaces, heightening the risk of spreading viruses, health and safety discourse became paramount for the industry during the pandemic. Drawing on investigations of the language of tourism and cruises, the chapter examines how cruise lines’ websites talk about risk, safety, and prevention. Rossato and Nocella use multimodal and discourse analysis to compare examples of both written texts and non-verbal content (images, videos, colours). The analysis focuses on cross-cultural elements and the role of images in localizing the message across the different languages. In the fourth part, Pena-Díaz in Chap. 10 reports on a study conducted in La Paz hospital in Madrid after the end of the main lockdown in Spain. The chapter provides an analysis of intercultural communication in health settings as perceived by users of interpreting and translation services. In particular, it focuses on migrants as users of public service interpreting services, and through qualitative data collection (surveys and interviews) the chapter seeks to understand whether there is any correlation between T&I services and the users’ perception of risks. Participants’ responses are used to assess the participants’ perception of risks associated with COVID-19 and to identify risk communication strategies and their effectiveness. Pena-Díaz’s findings indicate that for many participants the perceived quality of access to healthcare services is proportional to their satisfaction with the interpreting and translation services available. This relationship in turn influences trust in institutions and the participants’ perception of risk. Teng in Chap. 11 assesses the involvement of citizen translators in crowdsourcing projects through the conceptual framework of ‘imagined

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community’. Focusing on communities of citizen translators who provided translations into Chinese during the COVID-19 pandemic, Teng discusses three levels of imagined community engagement: weak, medium, and high. In relation to these levels, the chapter assesses the citizen translators’ familiarity with the targeted community and their ability to produce translations of appropriate quality for their target audience. Reflecting on its findings, the chapter considers the training of citizen translators and the role of community engagement in risk communication. Specifically, it focuses on (1) remote community engagement in contrast to onsite interactions; (2) recruitment of citizen translators among multilingual communities in relation to trust-building and solidarity; and (3) the relationship between language needs and channels that grant access to information in the languages preferred by the affected communities.

The Volume’s Aims All contributors and the volume as a whole suggest that there needs to be political willingness to ensure that T&I services contribute to making information about risks accessible to all members of multilingual communities. Many chapters also identify a recurrent issue: lack of preparedness and planning for inclusion of T&I services in the public health campaigns. For instance, guidelines to respond to a SARS-based disease were published in English in 2004 and revised twice (WHO, 2014); the scramble to translate new guidance in February 2020 could have benefitted from having translated the existing information on SARS-type diseases before. Translation of these materials could have informed practices in countries that faced the COVID-19 outbreaks early on. It is difficult to understand why guidelines of this type anticipating the impact of certain hazards are not routinely translated into widely used regional languages, prioritizing regions with under-resourced healthcare systems. Taking time to produce, assess, and validate high quality translations of these documents means being better prepared. Translations of guidelines for known and expected epidemics and pandemics could create language assets that would help to inform translators, interpreters, and sign

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language T&Is when rendering mitigating measures during the response phase of an outbreak, when information flows are constant and overwhelming. It is not surprising that Showstack et al. (2019), basing their experience on the US contexts, encouraged applied linguists and Translation and interpreting researcher to collaborate more than is currently the case in conducting studies that focus on the inclusion of language among the social determinants of health. Even though fairer healthcare systems free at the point of access are always better (van Barneveld et  al., 2020), healthcare cannot address all inequality in health. Inequality is dependent on social factors and healthcare on its own can only treat the symptoms but not the causes. Translation and interpreting provision for multilingual countries as well as for culturally and linguistically diverse communities in predominantly monolingual countries could serve as a powerful risk reduction tool in the context of public health, contributing to the reduction of such inequalities. London, UK

Federico Marco Federici

References Ahmad, R., & Hillman, S. (2021). Laboring to communicate: Use of migrant languages in COVID-19 awareness campaign in Qatar. Multilingua, 40(3), 303–337. Alexander, D. E. (2016). How to write an emergency plan. Dunedin Academic Press. Bastide, L. (2018). Crisis communication during the ebola outbreak in West Africa: The paradoxes of decontextualized contextualization. In M. Bourrier & C. Bieder (Eds.), Risk communication for the future (pp. 95–108). Springer. Brandon, C., & Maang, D. (2022). Translation during a pandemic. Responsiveness to essential language needs of refugee background communities. In S. O’Brien & F. M. Federici (Eds.), Translating crises (pp. in press). Bloomsbury Academic. Crouse Quinn, S. (2008). Crisis and emergency risk communication in a pandemic: A model for building capacity and resilience of minority communities. Health Promotion Practice, 9(4), 18S–25S.

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Federici, F.  M., & O’Brien, S. (2020). Cascading crises: Translation as risk reduction. In F.  M. Federici & S.  O’Brien (Eds.), Translation in cascading crises (pp. 1–22). Routledge. Hewitt, A.  M., Spencer, S.  S., Ramloll, R., & Trotta, H. (2008, October). Expanding CERC beyond public health: Sharing best practices with healthcare managers via virtual learning. Health Promotion Practice, 9(4), 83S–87S. https://doi.org/10.1177/1524839908319090 Horton, R. (2020). Offline: COVID-19 is not a pandemic. Lancet, 396(10255), 874. https://doi.org/10.1016/S0140-­6736(20)32000-­6 Lawrence, D. (2020). An avoidable crisis. The disproportionate impact of covid-19 on black, Asian and minority ethnic communities. A review by baroness Doreen Lawrence. Labour Party. Retrieved May 29, 2021, from https://www.lawrencereview.co.uk/ Lee, F. C., Adams, L., Graves, S. J., Massetti, G. M., Calanan, R. M., Penman-­ Aguilar, A., Henley, S.  J., Annor, F.  B., Van Handel, M., & Aleshire, N. (2021). Counties with high COVID-19 incidence and relatively large racial and ethnic minority populations—United States, April 1–December 22, 2020. Morbidity and Mortality Weekly Report, 70(13), 483. Li, Y., Rao, G., Zhang, J., & Li, J. (2020). Conceptualizing national emergency language competence. Multilingua, 1(ahead-of-print). https://doi. org/10.1515/multi-­2020-­0111 Liang, X., Feng, Z., & Li, L. (2020). Guidance for corona virus disease 2019: Prevention, control, diagnosis and management. People’s Medical Publishing House. Retrieved May 29, 2021, from https://www.yoifos.com/sites/default/ files/covid_19_guideline_chn.pdf O’Brien, S., & Federici, F. M. (2019). Crisis translation: Considering language needs in multilingual disaster settings. Disaster Prevention and Management: An International Journal, 29, 129–143. https://doi.org/10.1108/ DPM-­11-­2018-­0373 O’Brien, S., Cadwell, P., & Zajdel, A. (2021). Communicating COVID-19. Translation and trust in Ireland’s response to the pandemic. School of Applied Language and Intercultural Studies, Dublin City University. https://www. dcu.ie/sites/default/files/inline-­files/covid_report_compressed.pdf Paremoer, L., Nandi, S., Serag, H., & Baum, F. (2021). Covid-19 pandemic and the social determinants of health. British Medical Journal, 372. Petts, J., Draper, H., Ives, J., & Damery, S. (2010). Risk communication and pandemic influenza. In P. Bennett, K. Calman, S. Curtis, & D. Fischbacher-­ Smith (Eds.), Risk COMMUNICATION AND PUBLIC HEALTH (pp. 147–163). Oxford University Press.

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Renner, B., Gamp, M., Schmälzle, R., & Schupp, H.  T. (2015). Health risk perception. In J. D. Wright (Ed.), International encyclopedia of the social & behavioral sciences (pp. 702–709, 2nd Ed.). Elsevier. Reynolds, B., & Lutfy, C. (2018). Crisis and emergency risk communication. 2018 Edition (4th Ed.). US Department of Health and Human Services—Centers for Disease Control and Prevention. Retrieved May 29, 2021, from https:// emergency.cdc.gov/cerc/manual/index.asp Seeger, M. W. (2006). Best practices in crisis communication: An expert panel process. Journal of Applied Communication Research, 34(3), 232–244. Sellnow, T. L., & Seeger, M. W. (2013). Theorizing crisis communication (Vol. 4). John Wiley & Sons. Sharifi, A., & Khavarian-Garmsir, A.  R. (2020). The COVID-19 pandemic: Impacts on cities and major lessons for urban planning, design, and management. Science of the Total Environment, 142391. Showstack, R., Santos, M.  G., Feuerherm, E., Jacobson, H., & Martínez, G. (2019). Language as a social determinant of health: An applied linguistics perspective on health equity. American Association for Applied Linguistics Newsletter. Retrieved May 29, 2021, from https://www.aaal.org/news/ language-­a s-­a -­s ocial-­d eterminant-­o f-­h ealth-­a n-­a pplied-­l inguistics-­ perspective-­on-­health-­equity## Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in bio‐social context. Medical Anthropology Quarterly, 17(4), 423–441. Sphere Project (2018). The sphere project: Humanitarian charter and minimum standards in humanitarian response (4th Ed.). Mc Connan. Retrieved May 29, 2021, from https://spherestandards.org/wp-­content/uploads/Sphere-­ Handbook-­2018-­EN.pdf van Barneveld, K., Quinlan, M., Kriesler, P., Junor, A., Baum, F., Chowdhury, A., Junankar, P. N., Clibborn, S., Flanagan, F., & Wright, C. F. (2020). The COVID-19 pandemic: Lessons on building more equal and sustainable societies. The Economic and Labour Relations Review, 31(2), 133–157. Vardavas, C., Odani, S., Nikitara, K., El Banhawi, H., Kyriakos, C., Taylor, L., & Becuwe, N. (2021). Public perspective on the governmental response, communication and trust in the governmental decisions in mitigating COVID-19 early in the pandemic across the G7 countries. Preventive Medicine Reports, 21, 101252. https://doi.org/10.1016/j.pmedr.2020.101252 Varghese, N.  E., Sabat, I., Neumann-Böhme, S., Schreyögg, J., Stargardt, T., Torbica, A., van Exel, J., Barros, P. P., & Brouwer, W. (2021). Risk communication during COVID-19: A descriptive study on familiarity with, adher-

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ence to and trust in the WHO preventive measures. PLOS ONE, 16(4), e0250872. https://doi.org/10.1371/journal.pone.0250872 Wang, P. (2020). Translation in the COVID-19 health emergency in Wuhan: A crisis manager’s perspective. The Journal of Internationalization and Localization, 6(2), 86–107. https://doi.org/10.1075/jial.00014.wan WHO (2017). Communicating risk in public health emergencies. A WHO guideline for emergency risk communication (ERC) policy and practice. World Health Organization. Retrieved May 29, 2021, from https://reliefweb.int/sites/ reliefweb.int/files/resources/9789241550208-­eng_0.pdf WHO. (2014). Infection prevention and control of epidemic and pandemic prone acute respiratory infections in health care. World Health Organization. Retrieved May 29, 2021, from https://apps.who.int/iris/bitstream/10665/ 112656/1/9789241507134_eng.pdf Zhang, J., & Wu, Y. (2020). Providing multilingual logistics communication in COVID-19 disaster relief. Multilingua(0), 000010151520200110. https:// doi.org/10.1515/multi-­2020-­0110

Acknowledgements

Language is one of the socio-economic factors that have an impact on health. I thank the contributors of this volume for engaging with the challenge of taking an active stance from the title of this volume. All the preoccupations in translation, interpreting, sign language, and multimodal ways of communicating risk in multilingual contexts that enrich our disciplines may be perceived as niche, outside our main areas of activity. By focusing on language(s), we speak of a concept that may be more tangible than referring to translation and interpreting for researchers and experts who may not frequently engage with research in work in our disciplines. While titling the volume we made a conscious and committed decision: it forces us to connect languages to health inequalities. Researchers in translation and interpreting studies, sociolinguistics, risk communication, and crisis communication have in different ways taken a stance on language diversity. Now, we hope that considering language in relation to health inequality can be a currency beyond disciplinary barriers for a debate that must attract the attention, criticism, and interaction of experts from different backgrounds. As it is customary, acknowledgements express thanks and gratitude. I have to say the contributors deserve my most sincere thanks for accepting my feedback, observations, and in-depth criticism of their chapters. I learnt a lot from their openness to engaging with my questions and textual interventions. I value their generosity in sharing with me the xxv

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findings of their projects, which not only did they carry out in the middle of the pandemic, but they were also affected directly, through hospitalizations, symptoms, test scares, and ill health. I have never underestimated the editor’s perks of partnering with colleagues from afar, yet the editing process never ceases to surprise me for how rewarding it is. The contributors’ chapters made me look in different directions and consider new methodological approaches. Working on this project with Shaun Pickering, who is embarking on a research project in multilingual communication in a health context, gave me the opportunity of collaborating with a fine proofreader and promising researcher. His questions, comments, and revisions helped this project develop and evolve in eight intense weeks of editing. Figures 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, and 3.10 are reproduced with thanks to the State of New South Wales NSW Ministry of Health that provided the translations for foreign nationals living in Australia. Through the NSW Ministry of Health, under the aegis of the Australian Governments Open Access and Licensing Framework (AusGOAL), the state supports and encourages the reuse of its publicly funded information as CC-BY open licences. I am also thankful to the series editor, Prof. Margaret Rogers, for her support on this editorial project, which was not a poised, pondered research endeavour, but a sprinting event so that the volume could be published in 2021. My gratitude goes to Prof. Claudia V. Angelelli, for finding opportunities to talk about our shared passions about multilingual communication, as well as for her willingness to engage with this project. Her influential work in the field of healthcare interpreting has kept me busy and away from major mistakes. All the mistakes that remain are my sole fault. At Macmillan Palgrave, Alice Green has championed the proposal from the very beginning and made the editing process run very smoothly. As I gradually re-learnt that holidays and weekends are not for working, I thank Theresa, Rhys, and Iwan for accepting my absence over two weekends, when I had to make sure this volume would be published— my love to them is unconditional.

Contents

1 Translating Health Risks: Language as a Social Determinant of Health  1 Federico Marco Federici Part I Terminologies and Narratives  37 2 Military Framing of Health Threats: The COVID-19 Pandemic as a Case Study 39 Sami Chatti 3 Implications of Linguistic Hegemony in Translating Health Materials: COVID-­19 Information in Arabic in Australia 63 Sama Dawood 4 Translating the COVID-19 Pandemic Across Languages and Cultures: The Case of Argentina 93 María Laura Spoturno

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Part II Translating COVID-19 Credibility, Trust, Reliability 119 5 Translation Accuracy in the Indonesian Translation of the COVID-19 Guidebook: Understanding the Relation Between Medical Translation, Reception, and Risk121 Raden Arief Nugroho , Alfian Yoga Prananta, Syaiful Ade Septemuryantoro, and Achmad Basari 6 Credibility in Risk Communication: Oman’s Official Arabic COVID-19 Risk Communication and Its English Translation147 Abdul Gabbar Al-Sharafi 7 Translation as an Ethical Intervention? Building Trust in Healthcare Crisis Communication179 Bei Hu

Part III Health and Safety in Risk Communication 209 8 Health and Safety Discourse in Polish and English: A Pragmalinguistic Perspective of COVID-19 Communication211 Małgorzata Kodura 9 Risk and Safety on Cruise Ships: Communicative Strategies for COVID-19237 Linda Rossato and Jessica Jane Nocella

Part IV Communities and Translation 265 10 Managing Communication in Public Health: Risk Perception in Crisis Settings267 Carmen Pena-Díaz

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11 Citizen Translators’ ‘Imagined Community’ Engagement in Crisis Communication293 Yanjiang Teng I ndex317

Notes on Contributors

Abdul Gabbar Al-Sharafi  is Assistant Professor of Translation and Head of Department of English Language and Literature at Sultan Qaboos University, Oman. There he teaches on, and coordinates, the MA in Translation programme. He holds an MA in Translation Studies and a PhD in Text Linguistics both from Durham University, UK. Previously he worked at Qatar University (2000–2003). He has authored a book entitled Textual Metonymy: a semiotic approach (Palgrave Macmillan, 2004) and several research articles in the area of translation, discourse, rhetoric, and related fields. Claudia V. Angelelli  is Chair in Multilingualism and Communication at Heriot-Watt University, Edinburgh campus, UK, Emeritus Professor of Spanish Linguistics at San Diego State University, USA, and Visiting Professor of Foreign Studies at Beijing University, China. Her research lies at the intersection of sociolinguistics, applied linguistics, and translation and interpreting studies. She is the sole author of Medical Interpreting and Cross-cultural Communication (2004), Revisiting the Interpreter’s Role (2004), and Healthcare Interpreting Explained (2019). She was the world project leader for ISO 13611 Standards on Community Interpreting (PSI), approved as the first ISO Standard on community interpreting/PSI. She co-authored The California Standards for Healthcare Interpreters (2002). xxxi

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Achmad  Basari  is a lecturer in the Department of English Language Studies, Faculty of Humanities at Universitas Dian Nuswantoro in Semarang, Indonesia. He holds his MA in Translation (2007) from Universitas Negeri Semarang, Indonesia. Translation studies is his primary area of research; his projects focus on subtitling. Sami  Chatti  is Assistant Professor of Linguistics at the University of Manouba, Tunisia, Assistant Professor in the Department of English at King Abdulaziz University, Jeddah, Saudi Arabia, and a certified translator. He holds a doctorate and a master’s in English Linguistics from the Université Sorbonne Nouvelle, Paris 3, France, and obtained a second master’s in translation from the School of Interpreters and Translators (ESIT) in Paris. His research interests include cognitive semantics, translation studies and corpus linguistics. He has authored a book on the Semantics of English Causative Verbs (Paf, 2012), and contributed several articles to specialised journals in linguistics and translation. Sama Dawood  is Associate Professor of Translation and Interpreting at the Faculty of Al-Alsun (Languages and Translation), Misr International University, Egypt. She holds her PhD (2013) from Ain Shams University, Egypt, and her MA from Al-Mustansiriya University, Iraq. Her research interests span across translation and interpreting and so do her publications. She contributed chapters to the Routledge Handbook of Arabic Translation and the Routledge Handbook of Translation, Feminism and Gender. She has co-authored a paper on computer-aided interpreting. Her projects focus on the role of translation in multilingual communities and computer-aided translation. Federico  Marco  Federici is Professor of Intercultural Crisis Communication at the Centre for Translation Studies, University College London (UCL). He holds a PhD in Translation from the University of Leeds, UK. Before joining UCL, he designed the curriculum, founded, and directed the EMT MA in Translation Studies at Durham University, UK (2008–2014). His peer-reviewed articles have been published in journals across different disciplines, from Translation Spaces to Disaster Prevention and Management. His research focuses on translators and interpreters as intercultural mediators, online news translation, and the study of translation in crises.

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Bei  Hu  is Assistant Professor of Translation Studies at the National University of Singapore. She holds her PhD in Translation and Interpreting Studies from the University of Melbourne, Australia. Her research interests lie in high-stakes intercultural communication, intuitional translation, and reception studies with a focus on empirical/experimental methods. Her recent work has been published in Target and Asia Pacific Translation and Intercultural Studies. Małgorzata  Kodura is an assistant professor at the Pedagogical University of Krakow, Poland. She holds a PhD in Linguistics. She is a certified translator for English and a translator trainer. She is a staff member of the Department of Translation Education that runs the translation programme affiliated to the European Master’s in Translation Network, initiated by the European Commission. She teaches practical courses in specialised translation and translation technologies. Her research interests focus on translator training in the digital age and translator trainer’s competence. She co-edited Negotiating Translation and Transcreation of Children’s Literature (2020). Jessica Jane Nocella  is a PhD candidate at the University of Modena and Reggio Emilia, Italy. She is working on the diachronic analysis of the semantic changes of the word ‘slow’ over the last fifty years both in Italian and in English, with a special focus on the implications of its new values in the investigation of slow art discourse. Jessica holds a master’s degree in Cultures and Difference from Durham University, UK, and a BA in Portuguese and Russian language and literature from the University of Bologna, Italy. Her main interests concern corpus linguistics, evaluative language, and promotional discourse. Raden  Arief  Nugroho is a lecturer in the Department of English Language Studies, Faculty of Humanities, Universitas Dian Nuswantoro, Semarang, Indonesia. He holds his PhD from the Universitas Sebelas Maret, Indonesia (2017). His main research interests include translation studies and applied linguistics. His research focuses on the development of a translation model for visually impaired translators. Carmen  Pena-Díaz  is Professor of Translation at the Department of Modern Philology at Alcalá University, Madrid, Spain. There, she is the

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director of the European Public Service Intercultural Communication, Translating and Interpreting master’s degree. She is a member of the research group FITISPos-UAH in Spain, which investigates pedagogical issues in Public Service Translation and Interpreting training. She was the principal investigator of InterMed, a project investigating interlingual and intercultural mediation in health settings. Her research areas are bilingualism, translation, and English for Specific Purposes. Her articles have appeared in international journals such as MonTI, Intercultural Education, Babel, and the International Journal of Bilingual Education and Bilingualism. Alfian Yoga Prananta  is a doctoral researcher in Translation Studies at the Department of Linguistics of Postgraduate Program at the Universitas Sebelas Maret, Indonesia. His research interests cover topics in linguistics, translation studies, and literary studies. He also lectures in translation studies and linguistics at several private universities in Semarang, Central Java, Indonesia. Linda Rossato  is Assistant Professor of English Language and Translation at Ca′ Foscari, University of Venice, Italy. She holds a BA in Translation (Bologna-Forlì, Italy), MA in Screen Translation (Bologna-Forlì), and a PhD in English for Special Purposes (University of Naples Federico II, Italy). Her research interests include food and cultural translation, screen translation, child language brokering, non-professional translation, and translation of tourism-related texts. She co-edited the volume NonProfessional Translation and Interpreting (2017) and the Special Issue 21(3) of The Translator: Food and Culture in Translation (2015). She is writing a book on the translation of food discourse and the media. Syaiful Ade Septemuryantoro  is a university teacher and works in the Department of Hospitality Management at the Universitas Dian Nuswantoro, Indonesia. He holds his MA in Management Studies (2014) from STIEPARI Semarang, Indonesia. Management Studies is one of his key research areas. His projects focus on tourism growth, especially around MICE activities (meetings, incentives, conferences, and exhibition).

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María  Laura  Spoturno  is Associate Professor of Literary Translation and US American Literature at Universidad Nacional de La Plata and a researcher with CONICET, Argentina. She is the principal investigator of the project entitled ‘Escrituras de minorías, ethos y (auto)traducción’. Her research focuses on the study of subjectivity and (self )/(re)translation practices, and the relations between translation, gender, feminisms, and exile. Her recent contributions include a special issue of Mutatis Mutandis co-edited with Ergun, Castro, and Flotow on transnational feminist translation (2020) and papers on (re)translation practices and multimodality (Lengua y Habla, 2019; Routledge Handbook of Translation, Feminism and Gender, 2020; and The Translator, 2020). Yanjiang Teng  is a researcher in the International Studies Program at Michigan State University, USA. He holds a PhD from Michigan State University, USA. His research interests comprise language service provision, translation studies, and second language teacher education. His contributions include chapters published by IGI Global, Springer, and Routledge and articles appeared in Research in Language and Education: An International Journal. His research projects focus on emergency language services during the Covid-19 pandemic. He is the assistant editor of the Journal of Second Language Studies (John Benjamins), and a review board member of Chinese Language Teaching Methodology and Technology (Cleveland State University).

List of Figures

Fig. 1.1 Fig. 1.2 Fig. 1.3 Fig. 2.1 Fig. 3.1 Fig. 3.2 Fig. 3.3 Fig. 3.4 Fig. 3.5 Fig. 3.6 Fig. 3.7

Correlations between the social determinants of health (CSDH, 2008) 5 INTERACT crisis communication policy recommendations (Federici et al., 2019) 19 Tanguay’s diagram of how GPHIN works (2019) 21 Cross-domain mapping of war onto COVID-19 in the corpus 48 ‘COVID-19 (Coronavirus): Who to Call’. (© State of New South Wales NSW Ministry of Health) 74 ‘COVID-19 (Coronavirus): Who to Call’ in Arabic. (© State of New South Wales NSW Ministry of Health) 75 ‘Diabetes and COVID-19 (Coronavirus): Look after your diabetes’. (© State of New South Wales NSW Ministry of Health)78 ‘Diabetes and COVID-19 (Coronavirus): Look after your diabetes’ in Arabic. (© State of New South Wales NSW Ministry of Health) 78 ‘Cardiovascular patients and COVID-19 (Coronavirus)’. (© State of New South Wales NSW Ministry of Health) 80 ‘Cardiovascular patients and COVID-19 (Coronavirus)’ in Arabic. (© State of New South Wales NSW Ministry of Health) 80 ‘Stroke and COVID-19’. (© State of New South Wales NSW Ministry of Health) 82

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Fig. 3.8

List of Figures

‘Stroke and COVID-19’in Arabic. (© State of New South Wales NSW Ministry of Health) 82 Fig. 3.9 ‘Arthritis and COVID-19 (Coronavirus): Look after your diabetes’. (© State of New South Wales NSW Ministry of Health)84 Fig. 3.10 ‘Arthritis and COVID-19 (Coronavirus): Look after your diabetes’ in Arabic. (© State of New South Wales NSW Ministry of Health) 84 Fig. 6.1 An integrated model of risk translation  153 Fig. 7.1 Number of WeChat Articles Addressing Nine Subthemes 197 Fig. 7.2 Information sources of the 27 WeChat articles 198 Fig. 7.3 Translators’ interventions 199 Fig. 9.1 ‘Safe Bubble’ image in the English-language MSC website. Courtesy of MSC company 256 Fig. 9.2 Bolla Sociale image in the Italian-language MSC website. Courtesy of MSC company 257

List of Tables

Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 5.1 Table 5.2 Table 5.3

Verbal collocates of ‘Coronavirus’ 50 Verbal collocates of ‘COVID-19’ 51 Nominal collocates of ‘coronavirus’ 52 Nominal collocates of ‘COVID-19’ 53 Risk communication parameters adapted from Strategic Communications Framework for Effective Communications (WHO, 2017a) 70 Assessing source infographic ‘COVID-19 (Coronavirus): Who to CALL’ and its translation against WHO guidelines 77 Assessing source infographic ‘Diabetes and COVID-19 (Coronavirus)’ and its translation against WHO guidelines 79 Assessing source infographic ‘Cardiovascular patients and COVID-19 (Coronavirus)’ and its translation against WHO guidelines81 Assessing source infographic ‘Stroke and COVID-19 (Coronavirus)’ and its translation against WHO guidelines 83 Assessing source infographic ‘Arthritis and COVID-19 (Coronavirus)’ and its translation against WHO guidelines 86 Criteria for selection of participants 127 Translation accuracy quality rating scale (Nababan et al., 2012)128 Categories of accuracy used in the study 130

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List of Tables

Table 5.4 Homogeneity test results of the translation of the COVID-19 guidebook 134 Table 5.5 Participants’ assessment of the translation of C19GB 135 Table 5.6 One way ANOVA for the translation of C19GB 136 Table 6.1 Distribution of foreign languages in Oman as of June 2018 (https://www.omaninfo.om/library/74/show/6143)155 Table 6.2 COVID-19 Supreme Committee press conferences 160 Table 6.3 Structure of COVID-19 press conferences 161 Table 7.1 COVID-19 Information: 14 Chinese translations and their English source texts (DoH, 2021) 183 Table 7.2 List of WeChat articles with over 1000 reads disseminated in Chinese 187 Table 8.1 Searle’s taxonomy of speech acts (1979) 218 Table 8.2 Options for translating an instruction from English into Polish222

1 Translating Health Risks: Language as a Social Determinant of Health Federico Marco Federici

Since 2003, the World Health Organization (WHO) has invested resources in preparing for the threat of ‘the first severe and readily transmissible new disease to emerge in the twenty-first century’ (WHO, 2003, p. 2), which was the severe acute respiratory syndrome, termed SARS. Activities to prepare to deal with the SARS-associated coronavirus that appeared in February 2003 led to recommendations for every country to revise or to introduce pandemic emergency plans (ibid.). Preparations were indeed necessary as the appearance of the Middle East respiratory syndrome–related coronavirus (MERS-CoV) in June 2012 showed that the epidemiological features of this typology of viruses necessitated specific hospital protocols and information campaigns on handhygiene, physical distance to avoid contagion, sanitation, aeration, and so on (WHO, 2014). Ten years before the COVID-19 pandemic erupted, the 2009 H1N1 pandemic, which took 17,000 lives worldwide, was caused by the H1N1 strain of the influenza virus, a strain of 1918 flu

F. M. Federici (*) Centre for Translation Studies, University College London, London, UK e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 F. M. Federici (ed.), Language as a Social Determinant of Health, Palgrave Studies in Translating and Interpreting, https://doi.org/10.1007/978-3-030-87817-7_1

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pandemic. WHO was heavily criticized for activating the pandemic protocol in 2009, as this was considered as overreaction due to an excess of caution. This criticism may have induced complacency in politicians and some members of the public causing an underestimation of COVID-19 and questioning the validity of the WHO’s announcement on 11 March 2020 that the disease caused by SAR-CoV-2, or COrona VIrus Disease, was a pandemic. From 23 January, the efforts to update the WHO website with accurate information about preventing people from contracting the disease were multilingual (Chinese and English) and by 12 February, they were multimodal (including documents, subtitled videos, and webpages). The need for timely crisis and emergency risk communication (CERC) makes time an obvious, but by no means the only constraint to affect translators and interpreters (T&I) during the COVID-19 pandemic. To be able to produce timely translations or to recruit interpreters in the needed languages or modality quickly and efficiently, risk communication strategies ought to consider local language needs as part of emergency planning. The most significant constraint to achieve timely, trusted, and regularly updated communication in multiple formats and multiple languages consists of a widespread lack of recognition of the role of language in ensuring individuals’ protection. By endorsing the call for action laid out in Showstack et al. (2019), this chapter argues that the impact of linguistic diversity is a threat in itself when emergency plans do not accommodate the language needs of the population. The chapter suggests that not only does the Western monolingual ideology (Auer & Wei, 2007) represents languages as ‘barriers’ and problems, which anti-­ immigrant, isolationist, and nationalist policies exacerbate, it also creates the preconditions to disregard the impact of language discrimination on health provision and healthcare for all members of society, including the impact on medical personnel’s time. In the first section, the chapter argues that language is a social determinant of health, as the absence of T&I provision makes healthcare less effective for medical personnel and patients alike. Grounded in examples of T&I activity during the pandemic and in existing studies of multilingual healthcare communication, the claim is explained in relation to risk communication and its conceptual fit with the paradigm of social determinants of health. In the second

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section, the chapter expounds on how rights-based approaches to supporting multilingualism are a necessity dictated by the prevalence of multilingual contexts worldwide. It also critically analyses misconceptions around obstacles to communication. The last section shows how language issues emerging in the pandemic as well as from recent epidemics have raised awareness on the importance of reliable T&I. In turn, this awareness is growing in infrastructural, technology-focused activities, and in actions intending to build local capacity for translating training and information, so as to move beyond the social and economic risks of public health campaigns designed within a ‘monolingual mindset’ (Clyne, 2008).

Multilingual Risk Communication A 2015 systematic review of healthcare communication issues (focused on Canada but referring to studies from the USA, the UK, and the EU) shows the breadth of issues perceived from the point of view of medical personnel (Bowen, 2015). Healthcare interpreting has also documented extensively the trappings of poor resources leading to poor communication (Angelelli, 2019; Hsieh, 2016). Even in the EU where there are statutory expectations for provision of language access, actual access to translated materials, as much as interpreting, was flagged as an issue in Angelelli’s Study on Public Service Translation in Cross-border Healthcare: Final Report for the European Commission Directorate-General for Translation (2015). By commissioning this report, the European Commission acknowledged that the EU multilingual policies were falling short and member states had limited plans to budget for implementations of the policy. Angelelli’s report demonstrates infrastructural deficiencies, in established multilingual healthcare settings that would be serious stressors in an epidemic or pandemic. Despite EU legislation recognizing the right of all citizens to use their preferred language of use, the report proved that there were enormous gaps: all later confirmed by the COVID-19 pandemic. Linguistic diversity shows up health inequalities (De Moissac & Bowen, 2019). Speaking languages other than the main or official language regularly and systematically causes

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additional complications and a higher incidence of specific conditions (Okrainec et al., 2015; Thorne et al., 2005); it increases the likelihood of inappropriate treatment in emergency departments (Cox & Lázaro Gutiérrez, 2016; Cox & Maryns, 2021; Granero-Molina et al., 2018; Hsieh, 2016; Ryan et al., 2017; Schwei et al., 2016), and it has a negative impact in epidemics, as foreign nationals may receive diagnoses with extensive delays, increasing exposure to contagion in other patients (Hines et al., 2014; Kaplan, 2020). Longer hospitalization time (John-­ Baptiste et al., 2004), slower diagnoses, and longer consultation time if poor interpreting is offered contribute to stretching demands on medical personnel. The case for effective translation, interpreting, and accessibility services that are supported and regularly reviewed is writ large; nonetheless, the deficits in these services are evident and extend beyond political motivations alone.

Social Determinants of Health The health of individuals goes beyond the mechanics of the human body, its anatomic specificity, and DNA blueprints. Health is affected by these but also by multiple other factors. The UCL Institute of Health Equity explains, Social determinants of health (SDH) is a term used to describe the social and environmental conditions in which people are born, grow, live, work, and age, which shape and drive health outcomes. Factors that determine how the SDH conditions are experienced across societies include the distribution of power, money and resources. Unfair distribution creates avoidable health inequalities, known as ‘health inequities’. Therefore, social, economic, and environmental factors, as well as political and cultural factors, constitute the ‘social determinants of health’. (Institute of Health Equity, 2021)1

In 2005, the World Health Organization established the Commission on the Social Determinants of Health ‘to marshal the evidence on what can be done to promote health equity, and to foster a global movement to achieve it’ (WHO, 2008, p. 1 ); the Commission released the

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diagrammatic representation of the correlations between these factors seen in Fig. 1.1. WHO endorsed the multi-factor notion of health that Marmot introduced in the 1970s (Marmot et al., 1978) and demonstrated its validity with extensive, solid, statistically valid evidence (Marmot, 2005; Wilkinson & Marmot, 1998). The Commission on the Social Determinants of Health recognizes that inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. The conditions in which people live and die are, in turn, shaped by political, social, and economic forces. (WHO, 2008, p. 1)

The conditions are not immutable and, remarkably, small changes to some factors have a bigger impact on public health than large investments in medical equipment for a single hospital (Marmot, 2015). In short, even if it is possible to avoid the high incidence of some factors,

SOCIECONOMIC & POLITICAL CONTEXT Governance

Social Position Policy Macroeconomic Social Health

Cultural and Societal norms and values

Education Occupation Income

Material Circumstances Social Cohesion Psychosocial Factors Behaviours

DISTRIBUTION OF HEALTH AND WELL-BEING

Biological Factors

Gender Ethnicity / Race Health Care System

SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUITIES

Fig. 1.1  Correlations between the social determinants of health (CSDH, 2008)

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they have statistically evidenced and proven impact, resembling the impact of linguistic diversity, when ignored. The socio-economic factors are often interrelated. From a sociolinguistic perspective, we know how linguistic identities are composite and intersectional; hence, the paradigm of social determinants of health fits logically with T&I researchers’ fields of study. The impact of individual factors is magnified by limitations on accessing information, or healthcare services, determined by the language spoken, the speaker’s proficiency in the main language, and limited language service provision in a country’s healthcare system. The Commission’s report influenced the evidence-based approach to considering ways of protecting health as a human right, beyond the abstract shared notion that it is. In its report, it recognizes that ‘exclusion’ is a health risk: ‘Being included in the society in which one lives is vital to the material, psychosocial, and political empowerment that underpins social well-being and equitable health’ (CSDH, 2008, p. 24). Currently, WHO has a policy on The Right to Health, supported by the Office of the High Commissioner for Human Rights. Factsheet 31 of the policy explicitly reminds us that creation of ‘language barriers’ is an infringement of human rights (OHCHR, 2020). The reference is to migrants being left out of healthcare provisions. However, language as a tool for inclusion is implicitly recognizable in the broader ‘human rights-­ based approach to health’ that, for WHO, ‘provides a set of clear principles for setting and evaluating health policy and service delivery, targeting discriminatory practices and unjust power relations that are at the heart of inequitable health outcomes’ (WHO, 2017, n.p.): excluding groups because of their languages is a breach of this approach. In pursuing a rights-based approach, health policy, strategies and programmes should be designed explicitly to improve the enjoyment of all people to the right to health, with a focus on the furthest behind first.

Showstack et al. (2019) called on language-related professionals, researchers, and scholars of language matters for action: from sociolinguists to applied linguists. It is necessary to gather large-scale evidence on the impact of language as a social determinant of health, because of the

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indissoluble relationship between linguistic diversity and (temporary) exclusion that has an impact on the universal right to health. The right to the conditions necessary to achieve the highest attainable standard of health is universal. The risk of these rights being violated is the result of entrenched structural inequities. Social inequity manifests across various intersecting social categories such as class, education, gender, age, ethnicity, disability, and geography. It signals not simply difference but hierarchy, and reflects deep inequities in the wealth, power, and prestige of different people and communities. (Commission on Social Determinants of Health, 2008, p. 24)

It is opportune to discuss the issue from the superordinate position: and as such to focus on language, rather than T&I. Clearly, together with sign language, T&I are inherently connected with delivering accessible information across divides of a linguistic, cultural, intersectional, and multifarious nature. When addressing the impact of linguistic diversity on social equity, awareness of language diversity is the first activist position to ensure that multimodal healthcare communication improves in all its very different modalities, because it is understood as a core element in risk communication practices. The COVID-19 pandemic irrefutably confirmed that language needs compound other socio-economic factors to have an impact on (temporarily or long-term) marginalized groups. The inability to access information in a language and format that patients understand mirrors and exacerbates health inequality (Espinoza & Derrington, 2021). It can also be argued that language is a social determinant of health per se, for all those who may not necessarily be economically deprived but are in reasonable financial positions and can be affected by limited access to information that could have a critical impact on their health, thus debunking arguments about personal and individual responsibility as causative among the poor. Clearly the level of impact is different, but there is an irrefutable element in common: linguistic preparedness to deal with hazards is rarely a priority.

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In its Right to Health, the Office of the Higher Commissioner of Human Rights reiterated that ‘Non-discrimination and equality are fundamental human rights principles and critical components of the right to health’ (OHCHR, 2020, p. 7). As the first full-blown pandemic of the twenty-first century, COVID-19 has shown how this assertion remains an aspiration. As far as elaborate arguments go, making a case for language to be considered as a social determinant of health sounds easy, obvious, if not even tautological. However, the reality described from the scrambling for linguists in January 2020 in China, through the complexity of delivering messages in the vast and linguistically diverse territories of India in May 2021, suggests that the argument must be made again. If healthcare communication, aided by interpreters and translators, is insufficient in ordinary contexts, then any epidemic or pandemic will show up these lacunae in service provision. If health information is in the language of the aggressive colonizers, which colours regional and international lingua francas, or are only in the main language of the host country, then health information remains connected with the notion that healthcare is for the wealthy few (as perceived by Sierra Leoneans facing Ebola in 2014—see Bastide, 2018). To protect this Right to Health, the perception of language diversity must change. Breaking the ‘Western monolingual ideology’ (Auer & Wei, 2007) is more than a concern for supporters and sympathizers of multilingualism; it is a necessity to improve the management of health risks. WHO has realized this is a priority for effective risk reduction policies in healthcare (2017). After the debacle concerning culture- and language-­appropriate communication during the 2014 Western Africa Ebola epidemic, WHO revised its practices and now recommends its global partners to consider languages as an essential resource to mitigate risks: ‘Accurate information provided early, often, and in languages and channels that people understand, trust and use, enables individuals to make choices and take actions to protect themselves, their families and communities from threatening health hazards’ (WHO, 2017, p. ix). There is no doubt that this principle is noble in abstraction but difficult to implement. Translation and interpreting are ‘natural’ skills only for a very small percentage of the world’s population—the ‘natural translator’ being still a debated topic (Harris & Sherwood, 1978). During the

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COVID-19 pandemic, having efficient, trustworthy, and reliable translation in all the languages needed has been and continues to be a challenge (McCulloch, 2020), as different phases of containment changed requirements, regulations, and expectations. Translators and interpreters train in languages for which there is an existing market; training takes time and resources; without a market there is often no training for combinations out of and into endangered, protected, low-resource languages (those with limited written-down texts, from laws to literature, via websites), and predominantly oral varieties (those that have low literacy levels or were never transcribed, e.g. dialects spoken by the displaced Rohingya in Cox’s Bazar).

The Mother of All Translations Two translations mark the early phases of the circulation of information on SARS-CoV-2 and its associated disease. Emblematic of the twenty-­ first century, the first was an automated translation (31 December 2020), and the second a collaborative translation of the Chinese Guidance for Corona Virus Disease 2019: Prevention, Control, Diagnosis and Management guidebook (6 February 2020). The automated translation showcases how machine learning and automation technologies play a role in preparedness and risk reduction, as discussed in the final section of this chapter. The Chinese translation into English embodies the core role of English as a scientific lingua franca, as it was in fact the English translation that was used as a pivot language for subsequent translations (as discussed in Chap. 5 in this volume). The Guidance for Corona Virus Disease 2019, coordinated by the National Health Commission of the Popular Republic of China, was the first guide to be translated. The English version is accredited to its translators (Liang et al., 2020). The guidebook gives a first glimpse of the urgency of sharing treatment protocols, the importance of personal protective equipment (PPE), and the details known at the time regarding the stages of the disease. As soon as the risk was understood, in January 2020, the localized epidemic in Wuhan became the initiator of the largest translation challenges (besides the translation of religious texts) that has ever happened.

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Indigenous, minority, community, regional lingua francas, and international languages were all needed to support the ever-changing, updating, and prescriptive information that flew from local authorities, central governments, and public health officers. Just like travelling in a globalized world, the flow had to be global in reach and (near)immediate in speed. The epidemic was declared high risk already at the end of January 2020, yet almost inexplicably preparations for extensive, concerted, and reliable campaigns were slow—certainly in Europe, with Italy, Switzerland, France, and the UK seeing early cases in February, yet projecting it as a risk elsewhere. It was difficult to understand the decisions behind Trump’s administration to still play down the risk on 6 March 2020, influencing in translated news the opinion of citizens of other states worldwide. When the pandemic was declared on 11 March, a multilingual campaign with clear information for all language combinations could have been global. Yet it was not so. In order to get a better sense of how this could have been achieved, it is worth looking at some examples of technology-­ aided, massive, online crowdsourcing translations that aimed to respond to the risks by providing information to individuals or at least the healthcare sectors and its workers who often had to learn new techniques and be redeployed outside their areas of (often extremely focused) specialisms. In March, the Korean Centers for Disease Control and Prevention (KCDC) released effective guidelines that Korea was using to isolate infected cases, track, and trace their contacts. In the USA, these guidelines came to the attention of Dr Kwonjune (KJ) Seung, Partners in Health, who asked his computer scientist brother Dr Sebastian Seung, Princeton University, to help to find a way of translating them from Korean into English. A 2-day crowdsourcing project (COVID Translate. org) followed using a Google Doc; sharing specialist expertise as well as translation skills made the text available in English. By May, Italian, Spanish, and Russian versions had been completed through crowdsourcing undertaken by professional translators, translator trainees, volunteers, and medical experts. The sense of urgency drove these projects demonstrating that pivoting on the English version could render the Korean source text into many other languages. Whether or not this specialist text

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would have been better translated according to professional standards thereby achieving higher quality is a question that many would ask. But there is a more fundamental question around the urgent need for translations of this document: guidelines on managing pandemics have existed and been regularly updated since 2003. If the critical importance of language has been recognized by national governing bodies, why are there not translation teams connected with disease control and prevention centres and other public health bodies to work on such documents as standard translations? With regular revisions of the texts, translations could be also revised, while creating terminological and technical resources that could benefit T&I when immediate dangers demand a quick response in multilingual settings. Crowdsourcing projects on this scale remain a notable feat; however, considering language as a social determinant of health could create opportunities to embed translation, terminology management, and multilingual technical writing activities in risk reduction practices. The online repository, COVID-19 Information in Indigenous, Endangered, and Under-Resourced Languages, hosted by the Endangered Language Project (ELP, 2020), has been growing steadily. The repository collects information about the pandemic in multiple formats and modalities. Having these translations online has certainly helped many communities. Web-based translations require important caveats; O’Brien et al. (2021) show how online information does not equate to immediate access for many communities. Firstly, having an institutional webpage with reliable information about mitigating measures in a suitable language and knowing that such a webpage and information exists are not the same. Secondly, COVID-19 has shown that the technological divide is significant, especially for some culturally and linguistically diverse (CALD) communities, indigenous groups, superdiverse cities, and multilingual areas with limited affluence; reaching communities that speak endangered languages needs more than information on a website. For logistically complex tasks, such as the operation of testing sites, many countries deployed the military. Military personnel are regularly involved in risk reduction, rescue, and response operations. In the USA,

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the National Language Service Corps (NLSC) of the Department of Defense translated COVID-19 information, handled multilingual telephone lines, and offered interpreting support. ‘When a person who isn’t English-proficient arrives at a FEMA-established COVID-19 testing site, a call goes out to an NLSC hotline that has an interpreter standing by for the specific language’ (Moon Cronk, 2020). This department alone could cover 500 language combinations, yet as a country the USA has continued to have issues with healthcare communication as reported in The Atlantic, The New York Times, and other online news outlets (e.g. Kaplan, 2020). The call for action to linguists and practitioners by Showstack et al. published in December 2019 suddenly forewarned of the pending risks in the early months of 2020. Language was a visibly and deadly social determinant of health for CALD communities. Translating COVID-19 mitigating measures and interpreting in hospitals became the ‘biggest translation challenge’ (McCulloch, 2020). Interpreters were also affected by the move to remote working, in some cases having to operate on platforms providing remote simultaneous interpreting without any prior training. Translators were affected in different ways; for many, the demand for general translation services dropped, for others the demand for specialist medical translators increased, entailing unrealistic demands on speed of delivery, making the urgency already plaguing ordinary working conditions worse. The impossibility for interpreters of supporting overstretched, fatigued, and at times desperate medical personnel in providing dignified goodbyes in absentia is described as cruel and in the UK was defined as an ‘avoidable crisis’ (Lawrence, 2020). In Europe, sign language interpreters became as visible on TV (with England as an exception) as they have never been before, which is an encouraging sign that something is happening to ensure more inclusive communication that fosters greater trust in healthcare systems. Considering all these factors from the lack of preparedness through the neglect of CALD communities to the extreme pressures on interpreters and translators, language became visibly a social determinant of health.

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Obstacles, Barriers, and Walls Risks associated with the unpredictable impact of a pandemic on ethnic diversity were acknowledged in several studies between 2009 and 2019. Public health experts identified the ‘inevitability’ of a pandemic and its relevance for effective communication (Scanlon, 2014). Country-specific weaknesses in terms of poorly resourced communication strategies to deal with linguistic diversity were observed (e.g. for the UK, see Petts et al., 2010). Language was duly considered as a ‘barrier to accepting public health messages’ (Vaughan & Tinker, 2009, p. S325). The metaphors surrounding multilingual environments predominantly cluster around negative conceptualizations of multilingualism, materializing as variations on the theme of language as a problem. This argument is not new; Auer and Wei (2007) put forward convincing counterarguments against the ‘Western monolingual ideology’, as Clyne (2008) did on the ‘monolingual mindset’; these views underpin this section. Speakers of CALD communities face obstacles to communication, language, and cultural barriers, and walls of incomprehension when trying to communicate with each other, or with the institutions of countries that speak only the main language(s). This is the ‘monolingual mindset’ or ‘seeing everything in terms of a single language’ (Clyne, 2008, p. 348). It is undeniable that superdiverse societies entail cohabitation with once different, alien, and far-removed cultural and linguistic realities, which requires changes in mindset and challenges some long-held, local values. Also, the transfer of meaning across languages and cultures, as all experienced T&I professionals would confirm, is not easy. The fact that the task is difficult does not logically imply that this is a problem, unless one operates within the ‘monolingual mindset’; building viaducts and bridges are incredibly complex engineering tasks too but they are not barriers to building infrastructures. Refusing to acknowledge the needs that come with having to transfer meaning, form, sense, expressions, culture, and verbal and non-verbal clues across divides that were often in the past physical divides of thousands of kilometres feeds the conceptualization of language as a problem. Superdiversity defies the tenets of ‘one language, one nation’ ideologies, the ethnolinguistic nationalism (Bonfiglio, 2010,

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pp. 122–131) that connects colonial pasts of colonizers with their current lack of financial resources to use other languages in their humanitarian activities around the globe. It is true that it is difficult to accommodate all language needs of everybody at a time of crisis, but is it difficult because it is a problem, or is it a problem because it is difficult? Starting to think about multilingualism as the default position may lead to new active ways of rethinking T&I when prevention, risk reduction, risk communication, and communicative situations render T&I services provision a matter of common interest and societal benefit (see Pena Díaz’s argument in Chap. 10 in this volume). Emergency plans are not always actionable to the letter; however, they are born from genuine attempts to create organized responses to mitigate the impact of predicable risks. Language diversity in this perspective is highly predictable. Emergency language planning could follow the same principle: flawless multilingual crisis communication is not immediately obtainable, nor possible, but planning is what emergency planners do to face catastrophic disasters; and effective planning reduces mortality and morbidity. The COVID-19 pandemic has shown the limitations of emergency planning too; having a good plan (Korea, New Zealand), training to deliver it, and enhancing it regularly is an investment in public health. However, lacking an updated plan (as was the case in Italy), not having implemented changes after simulations showed the shortcomings of the existing plan (as was the case in the UK), or being impeded from implementing federal plans (as was the case in the USA) are reminders that plans alone are not enough. Nevertheless, it is impossible to ignore the fact that rigorous plans that worked to soften the impact of the first wave did not need to be expensive (Greece, Vietnam). Some of the most effective measures could have been established using WHO, 2003 guidance. Rigorously applied plans reduced the impact of the pandemic as a whole (Korea and China); and one of the most effective plans had been drawn up in consultation with CALD communities (New Zealand). English dominates scientific publications; the use of a lingua franca is not new, nor are lingua francas unchangeable (Ostler, 2010; Gordin, 2015). Publishing in English means international dissemination, and

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learning English means access to ever-more easily accessible knowledge (in open-access, pre-print, and multiple other forms). However, the risk is that English-language text-types influence epistemological and ontological dimensions (Gaillard, 2019). The risk of importing a ‘monolingual mindset’, associated with the scientific lingua franca, could (and at times does) impede gaining any understanding of the needs of non-­ English language societies when it comes to communication strategies pursing behaviour change and social compliance. The risks of non-­ compliance with the dissemination of information based on scientific evidence to a multilingual and multicultural audience by solely drawing on Western-based scientific paradigms, in English-language publications, are very real. Again, the 2014 Western Africa Ebola epidemic showed how even in the presence of speakers of English as a first language, the absence of an appropriate communication strategy that considered cultural, multilingual, and social specificity made public health campaigns significantly less effective (Bastide, 2018; Burki, 2016; Enria, 2019; Kinsman et al., 2017; Toppenberg-Pejcic et al., 2019). If the dominance of English as the language of international science has immense benefits, especially in relation to health-related publications, the use of English goes beyond the shortcut of a single channel of communication and enforces a perception of monolingualism that systemically erodes other important principles of crisis communication: the creation of credibility and trust. As language is a social determinant of health in communities that may already be adversely affected by socio-economic factors that overexpose them to risks, receiving credible information in suitable formats and in their preferred language increases acceptance and compliance (see Brandon & Maang, Forthcoming; Tesseur et al., Forthcoming). The impact of the monolingual mindset on public health interventions is illustrated by the report by Australian medical personnel reaching Rohingya camps in Cox’s Bazar: As expected, language was an obstacle in effective health service delivery. […] The WHO office in Cox’s Bazar operates in English, which promotes a chain of communication from English to Bengali or Chittagonian to Rohingya. The use of translators and local personnel aided communica-

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tion, especially since Chittagonian is not dissimilar to Rohingya. Language barriers coupled with cultural differences made it difficult to communicate with affected populations and highlighted the role of building capacity by identifying and training bilingual local staff. (Alam et al., 2019, p. 3)

Improving people’s health goes beyond the mechanics of treating the body; disconnecting patient-focused interventions from health provision is more easily done with speakers of other languages. This is why language should be embedded in critical discussions of social determinants of health, because like all other socio-economic factors, language is not always an element immediately controllable by the individual but affected by all the other environmental factors. As an outstanding medical operation, the Australian intervention in Cox’s Bazar illustrates the monolingual ideology in its persuasive form: language is an expected obstacle; yet no measure can be taken until the team arrives in the camps. Local personnel as well as translators aid communication (more likely, interpreters, given the low-literacy level of the Rohingya in the camps). The example is recent and shows an encouraging side: it focuses on building capacity by training bilingual local staff. This affirmation corresponds to what appears to be a change in perspective, as discussed in the next section. For T&I, it brings forward the issue of becoming involved in planning suitably multilingual ways of building communication capacity, in contexts where there is limited or no training, or even any professional accreditation, and little capacity in the needed language combinations. The urgency to engage with the multilingual nature of the twenty-first century necessitated by COVID-19 may represent a cogent lesson when poor multilingual communication strategies are eventually systematically connected with the enormous cost in terms of morbidity (long COVID-19) and mortality for the multilingual or marginalized CALD communities (PHE, 2020; Piller, 2020) that suffered from the syndemic nature of COVID-19 (Horton, 2020). Perhaps objectively assessing the hidden costs of perpetuating under-resourced healthcare systems— including a lack of T&I provision—will reveal the evidence of how far the exclusion of language from emergency planning is an expensive social determinant of health for governments and institutions, when its inclusion could make it a foreseeable expenditure, a controlled budgetary item.

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The absence of the possibility of interacting in one’s preferred language of use excludes individuals from accessing information. Studies of healthcare interpreting (Angelelli, 2019; Hsieh, 2016) have shown how without proper interactions, the standard doctor-patient exchange is bilaterally frustrating (John-Baptiste et al., 2004; Landmark et al., 2017; Ryan et al., 2017); technological alternatives could lead to catastrophic misunderstandings (Moberly, 2018). In a multilingual setting of doctor-­patient exchange, the lack of organized T&I provision for appropriate interpreting, supported by leaflets, videos, and other translated documents of appropriate translations tends to be the prevailing norm. Before the current pandemic this situation affected medical personnel and patients; care was delayed and impeded. COVID-19 has shown how limited specialist personnel are in number, in comparison to a country’s population. Doctors, nurses, paramedics, military medics flying into the EU from Cuba, or from Germany to Italy, were evident signs of how even the best healthcare systems have a finite (and in some cases shrinking) workforce. Even for these reasons, multilingual T&I should be planned to enable wasting limited and ‘expensive’ resources such as the time and skills of medical and nursing specialists. Hampering their tasks by ignoring resolvable communication matters because nothing is done systematically to plan for the linguistic diversity of a country (which is often known in detail through censuses and other data sources) sounds an inefficient way of supporting healthcare systems, while actually widening social inequalities. The social structures that create the relationships of power and marginalize or exclude CALD communities create just such inequalities. In largely monolingual countries CALD communities are at risk of being seen as costly additions, whereas linguistic diversity is the norm in most countries worldwide. Poor access to or exclusion from information may affect responses to public health measures, when information is conveyed only monolingually and questions from CALD community members can only be answered monolingually or via the main language of the country. Poor access to information may further affect their general health when it comes to identifying ordinary and extraordinary information about healthcare.

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 romising Steps: Languages, Rights, P and Technologies Language diversity is protected within a rights-based perspective. Minority and endangered languages, or temporary CALD communities, are to be protected as language is a human right; as de Varennes (2001) points out, the charter of human rights already protects linguistic diversity. For this human right to be respected, language must in particular be considered as a social determinant of health, as lack of access to health information in a language and format that people understand breaks that human right and makes language a factor in exacerbating health inequity. As a result, T&I in medical contexts and health-related emergency plans have indeed been considered as human rights (Dalton-Oates, 2017; O’Brien et al., 2018). The rights-based approach should be enforced by setting statutory expectations in aiding epidemiological task forces by equipping them with appropriate T&I resources and personnel. Guidelines establishing how to recruit, train, and support T&I in public health campaigns could influence policymakers to reconsider how multilingualism is handled; notwithstanding this, excellent policies and emergency plans still depend on effective implementation. Even though the formulation of a policy to accommodate the multilingual needs of a society is not sufficient to ensure satisfactory management of the language needs of CALD communities in health communication, this would nevertheless be a starting point. Revising policies with the direct involvement of CALD communities is paramount and effective (CLING, 2011, 2021). From the recognition of linguistic diversity to action to enhance risk communication, there are openings to support the development of ecosystems of linguistic preparedness (Federici et al., 2021), in which T&I are fully integrated in pandemic emergency plans, as much as any other guidelines that WHO regularly uses and updates to support risk reduction campaigns worldwide. Budgets, investments, and cuts are always affecting healthcare systems (van Barneveld et al., 2020), but a lack of recognition of the linguistic dimension is not justifiable even when it is viewed only through the lenses of costs, financial investments, and economic planning. In this

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perspective, professional T&I associations, sign-language activists, and T&I researchers and scholars have a role to play in transforming the overlapping dimensions of the UN Office of High Commissioner for Human Rights’ The Right to Health and the rights-based paradigm by protecting people from being discriminated against because of their languages into actionable activities. Collaboratively even the language industry can market the message that languages do not need to be barriers. The principle that languages are not a problem but a right underpins the recent policy-related work. The International Crisis Translation Network (INTERACT 2017–2020) has put forward recommendations on integrating translation (see Fig. 1.2), sign language, and interpreting provision in emergency risk communication in September 2019, endorsed as an EU-market ready innovation. Collating best-practices worldwide, the research team distilled ten recommendations that are effective, easy to implement, and focused on engaging experienced professionals and associations even in contexts in which translation and interpreting have no commercial value, no training opportunities, and are carried out by volunteers or bilinguals. In November 2019, the recommendations were

Fig. 1.2  INTERACT crisis communication policy recommendations (Federici et al., 2019)

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published on PreventionWeb, which is managed by the United Nations Office for Disaster Risk Reduction (UNDRR),2 and in January 2020 on the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) site ReliefWeb.3 Both are leading repositories of resources for reliable and timely humanitarian information. Together with the commitment by the international humanitarian sector to ensure community engagement, these recommendations reconcile the unpredictability of responding to crises such as the COVID-19 pandemic with the feasibility of embedding T&I into emergency planning. High-level collaborations involving T&I associations, industry leaders, NGOs, and independent professionals would strengthen high-level activities that rely on translation to monitor health risks globally, which are discussed in the next three sections. COVID-19 has shown that the time is right to call for a shift to take into account the perspective of translation as a risk reduction tool. Risk management technologies monitor outbreaks to issue early warnings. They use language automation technologies in the best possible way and have significantly raised awareness about the need for human-machine interactions in public health. Their features are summarized in these final sections leading the chapter to its conclusions.

Global Public Health Intelligence Network (GPHIN) Early-warning systems enable timely responses, drawing upon analytically analysed data. They integrate machine learning and machine translation. The earliest system was the Global Public Health Intelligence Network (GPHIN), active since 1997, almost shut down in 2019, and restarted in August 2020. Part of the Canadian Centre for Emergency Preparedness and Response, GPHIN was conceived as a multilingual data collection tool, which also used nine multilingual analysts to monitor global outbreaks. GPHIN warns the Canadian government of local epidemics worldwide and directly informs WHO; it successfully signalled the arrival of SARS, H1N1 (2009 Pandemic), and MERS. Its fortunes declined between 2009 and 2019, losing funding and government

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Fig. 1.3  Tanguay’s diagram of how GPHIN works (2019)

support, only to be reignited in August 2020 (Robertson & Curry, 2021). Used by over 85 countries, GPHIN was conceived as a ‘multilingual early warning and situational awareness network for potential chemical, biological, radiological and nuclear (CBRN) public health threats worldwide’ (Tanguay, 2019, p. 3). A state-operated system, GPHIN is an example of the best forms of human-machine interactions, as shown in Fig. 1.3. It harnesses the capacity of web crawlers for data mining, powered by natural language processing and machine learning (artificial intelligence (AI)), balanced by the work of scientists who conduct risk assessment on data flagged as significant by the system. When the Canadian government fully backed the system, GPHIN scientists interacting with the AI processes to analyse the data spoke nine languages (Arabic, Farsi, Chinese—traditional and simplified—English, French, Russian, Portuguese, and Spanish). The Canadian GPHIN was open and global in its aspirations, but the political control over its funding suddenly curtailed its efficacy; this could have not happened at a worse time and its future is uncertain at the time of writing. Its conceptual legacy should not be uncertain, pivoting as it does on the central role it assigned to specialist translation.

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 pidemic Intelligence from Open Sources E (EIOS) System Coordinated by WHO,4 the Epidemic Intelligence from Open Sources is a cross-institutional initiative that draws on the infrastructure of GPHIN. In the words of its coordinators, ‘The goal of [EIOS] is to create a unified, all-hazards, One Health approach by using open-source information for early detection, verification and assessment of public health risks and threats’ (Abdelmalik et al., 2018, p. 268). Its design allows the system to aggregate data streams from other systems, with a capacity to scale up the data-harnessing features of GPHIN by relying on the WHO global network of country-level offices, as well as all the open sources on the internet, and local scientists’ reports and warnings. The first success registered by the EIOS system was the detection, from news accounts, of a localized epidemic of SARS-CoV-2 occurring in China on 31 December 2019. The Independent Panel, assessing WHO’s and governments’ COVID-19 response, indicates that EIOS is working well. On the morning of 31 December, Chinese business publication Finance Sina reported on one of the notices issued by the Wuhan Municipal Health Commission. This report was replicated and picked up by several disease surveillance systems, including the Centers for Disease Control, Taiwan, China, which in turn contacted WHO via email through the IHR (2005) reporting system, requesting further information. A machine translation of the Finance Sina report was published on the website of the Program for Monitoring Emerging Diseases (ProMED). This report was picked up by the Epidemic Intelligence from Open Sources (EIOS) system and alerted WHO Headquarters to the outbreak. (IP-COVID-19 2021, p. 22)

As Wark (2021, p. 65) points out, ‘there can be no doubt about the value of open-source collection and reporting on global health problems, just as there can be no doubt these days about the value of opensource collection and reporting for national intelligence systems.’ Credibility and detail of open-source data depend on local language and local personnel capacity to interact with the system in English, or through machine translation. The machine learning capacity of EIOS, integrating machine

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translation engines, will be essential in enabling the accommodation of the language needs of the areas exposed to future epidemiological outbreaks—and its capacity will depend also on web-crawling information from low-resource languages. The interaction with specialist analysts embedded in GPHIN will hopefully become part of EIOS too. There may be the need to plead the case for the value-added dimension of including professional linguists to increase credibility, reliability, and trust in the early-warning messaging. Pursuing a human-machine integration of this nature, with the involvement of the Fédération Internationale des Traducteurs (FIT) at the highest level of collaboration, should not be considered as science fiction. It could optimize professional deployment of high-quality translation and interpreting service provision, as planning for crisis-related needs can start at the point at which EIOS issues national, regional, or even global warnings. Collaborating with FIT, national associations, professionals, and commercial partners could all be involved and fairly remunerated to pull together resources for medical emergencies of a global scale, coordinating with NGOs and their expertise in operating in the humanitarian sector. Integrating training support and guidance for language combinations that are non-existent, rare, or minoritarian on the global scale of the translation market could enable FIT to pursue its own objectives of supporting and enhancing the profile of the profession. The need for translation training and a support role is now beginning to be recognized as a risk communication priority in public health. In fact, language, translation, and interpreting have been increasingly central to the success of another network that supports preparedness, response, and capacity-building against epidemiological threats: GOARN.

 he Global Outbreak Alert and Response T Network (GOARN) From the outset, the Global Outbreak Alert and Response Network, assembled in 2000, was pursuing WHO’s goal to monitor global health, with a specific focus on epidemiology. In their assessment of the challenges that GOARN faced in its first 15 years of existence, Mackenzie

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et al. (2014, p. 1023) describe its composition as a ‘a network of technical institutions, research institutes, universities, international health organisations and technical networks willing to contribute and participate in internationally coordinated responses to infectious disease outbreaks’. From leading field operations in the first years, the network has become more extensively involved in building local capacity to support sustainable healthcare solutions that allow local authorities to ‘detect and respond to outbreaks’ (ibid.). For example, GOARN network members deliver a course on outbreak management to local emergency personnel. COVID-19 has represented a point of significant change from the perspective of language awareness. It may be argued that just as the US Centers for Disease Control and Prevention (CDC, 2021) and the US Officer of Disease Prevention and Health Promotion have been able to include language among the social determinants of health in the Health People 2020 programme (ODPHP, 2011–2020) and to plan emergencies with clear elements of linguistic inclusivity, GOARN is on the cusp of pursuing the same aim. There are optimistic tones emerging from the deadly impact of COVID-19, a growing recognition of linguistic diversity as a positive force seems to be finally on the agenda, certainly for GOARN: ‘GOARN Partners are also exploring possibilities to “franchise” the training to one or more partners so they can deliver the course independently, in multiple languages to reach a much wider audience’ (Christensen et al., 2021, p. 3). In other words, enabling rather than stifling training, linguistic diversity is acknowledged, multilingualism is respected, and language is perceived in nuce, implicitly as a resource to facilitate sustainable epistemological responses worldwide.

Conclusions By investigating the impact of social differences on individual health pivoting around language, researchers look at ways of improving multilingual communication for the benefit of individuals, ethnic groups, language communities, and, as COVID-19 has reminded us, the whole society. Kelman (2020, p. 1) remarks that the

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COVID-19 pandemic conforms to key baseline conclusions which have emerged from disaster anthropology over past decades. […] the notion of the ‘naturalness’ of a disaster comes into question. Disasters are a socially and politically structured phenomenon, arising from a combination of hazard and vulnerability, with the associated risks reflected in public policies, infrastructure decisions and considerations of inclusion.

As a disaster triggered by a natural hazard such as SARS-CoV-2 (investigations of human-driven experiments are still inconclusive at the time of writing), the COVID-19 pandemic shows that ignoring practical solutions to embed languages in emergency preparedness is a political choice, at a local, continental, or global level. Supranational organizations such as WHO, early-warning systems such as GPHIN, large-scale epidemiological training initiatives such as GOARN, and multilingual training for nursing and medical personnel on specific procedures such as OpenWHO to name a few, show that language does not need to be a barrier. It is an obstacle only if it is ignored. Political choices that reduce access by controlling the languages in which health information is circulated, the services made accessible, the health campaigns promoted, and that ignore multilingualism make language a source of injustice (Piller, 2016). The injustice is not innate in multilingualism, but in the wilful colonial choice of ignoring it. If a monolingual ideology remains the main perspective influencing and actually misleading policymakers, politicians, and high-­ level civil servants in charge of emergency risk communication, progress will not be made in reducing morbidity and mortality. The language barrier is ideological: languages are nothing but a natural phenomenon for human beings; they do not need to become hazards that endanger individuals, groups, or the species—with the incommunicability of the risks associated with climate change and its future impact on more global crises, from pandemics to extreme weather. In COVID-19: Make it the Last Pandemic published in May 2021, the Independent Panel behind this report made only six macro recommendations, the last of which follows: Recommendation VI

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Invest in and coordinate risk communication policies and strategies that ensure timeliness, transparency, and accountability, and work with marginalized communities, including those who are digitally excluded, in the co-­ creation of plans that promote health and wellbeing at all times, and build enduring trust. (Independent Panel Report, 2021, p. 59, emphasis added)

Inclusion and accountability depend on accepting the natural state of being for the human race: we are multilingual by nature, at times monolingual by nurture. Even the success of using one scientific lingua franca and one global language for commerce rests on the natural attitude of speakers of the other languages to learn to speak, write, and use more than one language, for instance, the lingua franca in use. Co-creating emergency plans that are inclusive works. When emergency plans are designed considering local language needs, they are more effective in mitigating health risks as they succeed in supporting disaster management. Countries that have had excellent results in working within the constraints of their healthcare systems have also embedded inclusive communication in their plans. The ultimate example can be found in the New Zealand Influenza Pandemic Plan: A framework for action (NZMoH, 2017). This national emergency plan was drafted having consulted language minorities as well as professional translators and interpreters to better understand the working conditions that medical personnel, patients, and relatives would need to face in a potential pandemic. Of course, there were gaps (Brandon & Maang, Forthcoming), but after a decade of activities to better embedded multilingual communication in responses to crisis situations, through prevention activities (Shackleton, 2018) and effective guidelines (CLING, 2011, 2021), New Zealand has de facto considered language as a social determinant of health. Plans were made to mitigate the impact of language diversity on other social determinants that require long-term actions to be reduced or eradicated; their effectiveness, though faulty in some areas, contributed to the country’s successful response to the pandemic. It took a simple step, considering the country as multilingual and multicultural: the bilingual Maori/ English country took best communicative practices and embedded them in public health risk communication planning. Accepting multilingualism enabled multi-agency emergency planners to consider language as a

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social determinant of health and it worked; risk communication was more effective, credible, respectful, and the internal COVID-19 mitigating measures were extremely successful proportionally to the infrastructural capacity of the country’s healthcare system. One example of success may possibly lead to more actions. Without T&I provision, health risks increase. Without T&I support, clinical diagnoses take longer and hospitalizations last longer (in ordinary and emergency settings). Language is often a compound hazard to existing socio-economic factors. Without language proficiency, interpretation is slower, job opportunities are fewer. Translanguaging and multilingual families were badly hit by the home-schooling and remote teaching solutions during COVID-19, due to the technological divide and language diversity, thus confirming how language can affect schooling, education, and employment opportunities, making language a factor compounding other social determinants of health. What is certain is that the shift to consider language as a social determinant of health needs to be made. Evidence on a large-scale and a small-scale, and from professional and non-professional, projects suggests that T&I contribute to tackling language needs, thus shifting the narrative away from language as a barrier. As the COVID-19 pandemic is ongoing and some countries start a long process of recovery, this is the time to learn and improve. Changes are afoot, T&I researchers and professionals must engage with the need to state what is obvious within the discipline and most professional cohorts: translation and interpreting are more than services, more than professional skills that need to be remunerated; T&I codes of ethics demand that an advocacy role is adopted in order to influence how T&I are deployed and used in these contexts. Activism is needed.

Notes 1. Definition retrieved on January 18, 2021, from http://www.instituteofhealthequity.org/about-­our-­work/action-­on-­the-­social-­determinants-­of-­ health-­# :~:text=Background,shape%20and%20drive%20health%20 outcomes.

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2. See announcement ‘Policy recommendations for the consideration of translation and interpreting in emergency management communication’. Retrieved May 29, 2021, from https://www.preventionweb.net/news/ view/69079. 3. See resource added on January 13, 2020, ‘International network in crisis translation—Recommendations on policies.’ Retrieved May 29, 2021, from https://reliefweb.int/report/world/international-­network-­crisis­translation-­recommendations-­policies. 4. To be exact, ‘The EIOS initiative is a unique collaboration among WHO, the Global Outbreak, Alert and Response Network, the Food and Agriculture Organization of the United Nations, the World Organisation for Animal Health, the Global Health Security Initiative, the European Centre for Disease Prevention and Control, the Africa Centres for Disease Control and Prevention and the Joint Research Centre of the European Commission’ (Abdelmalik et al., 2018, p. 268).

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Part I Terminologies and Narratives

2 Military Framing of Health Threats: The COVID-19 Pandemic as a Case Study Sami Chatti

Introduction The 2020 outbreak of SARS-CoV-2 became a global public health crisis within months of the appearance of the virus in December 2019. Initially a regional epidemic and emergency, by 13 March 2020, the SARS-CoV-2 was declared as a pandemic. The United Nation Secretary-General António Guterres stated on video:1 ‘We must declare war on this virus.’ From that moment onwards, world state leaders and health officials solemnly declared war on this invisible enemy. Lockdowns, confinement, social distancing, face-mask wearing, large-scale testing, and active tracking of positive cases have been just some of the restrictive measures implemented by governments worldwide to contain the spread of the deadly disease in its first 18 months. To galvanise efforts and legitimate actions,

S. Chatti (*) King Abdulaziz University, Jeddah, Saudi Arabia University of Manouba, Manouba, Tunisia e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 F. M. Federici (ed.), Language as a Social Determinant of Health, Palgrave Studies in Translating and Interpreting, https://doi.org/10.1007/978-3-030-87817-7_2

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political and medical authorities resorted to the warfare metaphor as the omnipresent instrument to inform the discourse around health crisis communication. Framing the COVID-19 pandemic in military terms, however, raises, questions about the conceptual significance and communicative relevance given to the public health response. Fear-driven responses related to war imagery may evoke a distorted conception of the pandemic, negatively influencing prevention and treatment. This tripartite chapter discusses the relevance and significance of the war metaphor in medicine. Focusing on the framing of Covid-19, I will elaborate on the persuasive role of the war metaphor in shaping thought and influencing reasoning about diseases. Then, I will explore a corpus of coronavirus-­ related texts to demonstrate the intricate relation between lexical phrasing and metaphorical framing of the Covid-19 pandemic. Finally, I will discuss the implications and limitations of the war metaphor in health communication, to reflect subsequently on the necessity to use sports metaphors as an alternative way to reframe the pandemic.

Metaphors We Heal By Warfare references resonate clearly and consistently within the core ethics and discursive dynamics of business, politics, and medicine. For instance, the business-as-war frame holds that the means and methods of military conflict have some relevance to business conduct, particularly in the merger and acquisitions sector where aggression, conquest, and zero-sum outcomes are required and valorised (see Liendo, 2001). Political agendas in particular tend to resort to military rhetoric to inform policy diffusion strategies (Charteris-Black, 2009; Ferrari, 2007). President Johnson’s war on poverty or President Reagan’s war on drugs emphatically capitalised on the engaging potential of the war frame to galvanise public support for policy change (Davenport & Lloyd, 2019). Likewise, medical and healthcare communication regularly draws on the language of warfare to describe public health threats and to elaborate appropriate responses to pandemic diseases and epidemic risks (Hodgkin, 1985; Sontag, 1979). The ‘medicine is war’ metaphor has been particularly prevalent in health crisis communication, namely in relation to cancer (Reisfield & Wilson,

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2004; Stibbe, 1997) and HIV/AIDS (Sontag, 1979), but also regarding former epidemics like the avian flu (de la Rosa, 2007, 2008) and the severe acute respiratory syndrome (Chiang & Duann, 2007; Joye, 2010), and more recently in framing the COVID-19 pandemic (Seixas, 2020; Semino, 2021; Wicke & Bolognesi, 2020).

Role of Metaphorical Framing Metaphors are prevalent in communication for their potential to highlight salient features of an issue while de-emphasising or hiding less prominent aspects. This capacity to selectively give voice to certain elements and silence others generates alternative perceptions of reality, attesting, therefore, to the pervasive role of metaphors in communication. Framing debating in terms of a boxing game, for instance, highlights the conflicting rivalries and enacts opposing strategies, whilst a tango-dance framing would shift focus onto mutual harmonies and collaborative synergies. Similarly, the trade-as-a-two-way-street frame promotes free trade, whereas the trade-as-war metaphor endorses protectionism and trade barriers (Robins & Mayer, 2000). Elsewhere, it has been argued that thinking about relationships within the unity frame leads a person to focus on interpersonal conflicts, whilst the journey frame reflects more naturally the highs and lows of a relationship (Lee & Schwarz, 2014). Similarly, framing a country as a body encourages people to consider migrants and displaced people as pathogens, leading to social rejection of immigration (Jia & Smith, 2013). Such a perspective-changing function of metaphorical framing is empirically evidenced. Based on reader-response data, Thibodeau and Boroditsky (2011, 2013) experimentally investigated in two sets of studies, the effects of metaphorical framing on reasoning about crime. Framing criminality in terms of a beast or a virus resulted in divergent opinions about crime-solving. Their findings showed that the crime-asa-­beast frame triggers an overall tendency to favour law enforcement policies, whereas the crime-as-a-virus frame prompts a greater preference for social reform measures. The regularity of these framing effects led the authors to conclude that metaphors covertly influence thoughts

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and attitudes. Pursuant to this reflection, Chicago’s crime prevention programme opted for a plan to treat violence as a contagious disease that requires the deployment of social workers to form a sanitary cordon that would prevent the escalation and propagation of violence (Kotlowitz, 2008). This consistency between metaphorical framing and policy preference failed, however, to materialise in a follow-up study to Thibodeau and Boroditsky, conducted by Steen et al. (2014). In contrast to the original studies, Steen et al. (2014) included the neutral frame ‘crime is a problem’ as a control condition to be contrasted with the two metaphorical frames ‘crime is a beast’ and ‘crime is a virus’. Furthermore, the new study added two more experimental conditions which were not accounted for in the original studies, namely metaphorical support and topic exposure.2 Results of this study led the authors to rule out the effect of metaphorical framing on reasoning, since participants expressed a clear preference for enforcement measures irrespective of metaphorical framing or metaphorical support. This exposure-related policy response is evidenced in several studies which draw parallels between media coverage of crime and people’s fear of violence, resulting in consequent support for crime-fighting policies (Smolej & Kivivuori, 2006; Custers & van den Bulck, 2011; Goodall et al., 2013). The follow-up study by Steen et al. (2014) seems, however, to fall short on a number of issues that it failed to notice in the original research. Firstly, the authors arguably claim that the ‘crime is a problem’ frame is non-metaphorical, and that some expressions used for metaphorical support like ‘vulnerabilities’, ‘weakened’, and ‘succumbed’ are unambiguous, despite their potential reference to both frames. Secondly and most importantly, many relevant factors were inadvertently overlooked in the follow-up study, namely age, class, gender, and race, as well as the role of participants’ political sophistication and personality traits in the perception of criminality, and the implications of implicit moral metaphors on decision-making and moral reasoning. Morally valued words such as ‘success/failure’, ‘maintain security’, and ‘decline’, which were used in both studies, seem to instantiate the ‘morality is strength’ versus ‘immorality is weakness’ conceptual metaphors, in turn influencing moral judgement and emotional reasoning about crime (Mayer, 2019). Drawing

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on further empirical evidence, Thibodeau, et al. maintain the validity of their original premise that ‘natural language metaphors can affect the way we reason about complex problems’ (2015, p. 2379, emphasis added). To explore the authors’ findings and further illustrate the role of metaphor in shaping thought, I have replicated Thibodeau’s and Boroditsky’s 2011 experiment, involving 28 Tunisian female participants, all students aged 23–26.3 Following the authors, participants were divided into two groups, with each group being asked to read an Arabic version of the two texts on the crime problem used in Thibodeau and Boroditsky’s study and to select appropriate solutions among a list of suggested measures. For the first group of participants, crime was metaphorically framed as a preying beast, and for the second group as an infectious virus. In line with expectations, fear of the beast led to subjects favouring harsher police measures and stricter judicial policies, whereas concern for virus contagion led people to privilege the treatment of the underlying causes of crime rather than its symptoms, and prefer social reform measures such as reducing poverty, fighting unemployment, and improving education. Further evidence, from a neurocognitive perspective, confirms the value of metaphors in communication. Indeed, metaphorical statements have proved to be more memorable than their literal counterparts, particularly for their imageability (Marschark & Hunt, 1985), leading, therefore, to better recall performance (Whitney et al., 2018). Empirical research has also shown that metaphors are more engaging, at the emotional level, than literal expressions. A recent fMRI study found, for instance, that metaphorical stimuli trigger stronger emotional arousal compared to their literal counterparts and recruit regions of the brain involved in emotional processing, thus confirming the value of metaphor in emotional engagement (Citron et al., 2020). This finding is further supported by studies in behavioural research showing enhanced empathy in response to metaphorical language (Horton, 2013), and accelerated heart rate responses to metaphorical translations compared to literal translations (Rojo et al., 2014). With emotional reasoning being sensitive to metaphorical framing, the use of affective metaphors proactively informs decision-making and problem-solving processes. Therefore, the crime-as-a-beast frame prompts

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a fear-based perspective in reasoning about crime, whilst the crime-as-a-­ virus frame shapes people’s perception of criminality from a hope-filled perspective. Accordingly, the former tends to neutralise criminals through enforcement-oriented policies, and the latter aims to immunise society through reform-oriented measures. The potential of metaphor to change perspective is further evidenced in the literature. For example, deliberate metaphor theory (Steen, 2015, 2017) builds on the value of metaphor in shifting focus and changing perspective in order to elucidate its use for communicative purposes. The literature on metaphor seems to particularly emphasise the role of the war frame in grabbing people’s attention and motivating an audience to focus on the target problem. Studies have shown that framing complex issues in terms of warfare makes them more memorable and enduring (Mirghani, 2011). Flusberg et al. (2018) convincingly argue that war metaphors ‘draw on basic and widely shared schematic knowledge that efficiently structures our ability to reason and communicate […], and reliably express an urgent, negatively valenced tone that captures attention and motivates action’ (ibid., 1). In a recent study of the role of metaphorical framing in shaping attitudes, the authors found that people believe climate change is a more urgent and risky issue when it is described as an enemy in a war, rather than an opponent in a race (Flusberg et al., 2017). In health communication, the description of flu as a hostile entity increases people’s willingness to be vaccinated (Scherer et al., 2015), and brochures that frame the sunlight as an aversive entity can increase people’s willingness to wear sunscreen (Landau et al., 2018). Furthermore, the language of war tends to highlight the threat that diseases pose to public health, and, as a result, leads to increased funding for medical research (Petsko, 2001).

 elevance of the MEDICINE IS R A BATTLEFIELD Metaphor The history of diseases is intertwined with the chronicles of wars, and the trajectory of many epidemics has converged with the routes of warfare. As soldiers crossed borders, diseases circled the globe, travelling the

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highways and sailing the high waters. Ancient and modern soldiers often brandished their weapons on the battlefield, along with invisible pathogens and invasive diseases. Thucydides’ narrative of the plague of Athens that hit the city shortly after the beginning of the second Peloponnesian War contextualises the disease in the wider dynamics of a hegemonic war. His account of the Athenian double misfortune seals the nexus between disease and war and leads to fear and expectation of one in the presence of the other. Many centuries later, the European conquistadors brought to the New World deadly diseases that conquered the Amerindians before the sword could be unsheathed. Modern history is equally replete with stories of wartime epidemics that provide a cautionary tale about the power of disease to decide the fate of war. During the Great War, the severe and crowded conditions of life in trenches provided fertile soil for the spread of war diseases across Europe—notably typhus, typhoid, dysentery, cholera, and influenza. The virulent flu virus, in particular, joined forces with war machinery to claim millions of lives throughout the continent. Unofficial medical records showed that the influenza pandemic killed more men in a few months than firearms did in four years (Byerly, 2010). Diseases as lethal weapons further entrench the visceral relationship between viruses and wars in the collective imagery and inform the use of the language of war to talk about health risks. Lexical representations such as ‘the national sanitary defence’, ‘a vaccination campaign’, or ‘the white-collar army’ explicitly reflect on these conceptual parallels between the medical field and the military field. In addition, hospitals resemble barracks, medical scrubs mirror military uniforms, and the physicians’ Hippocratic oath evokes the soldiers’ enlistment oath. In war as in peace, the mission of physicians remains the same, and the experiences of wartime caregivers have also had an undeniable impact on civilian practices, further fostering the synergy between medical and military healthcare services and protocols (Byerly, 2010). The use of the warfare metaphor in medicine evokes an affordable, ready-made war scenario that draws upon powerful elements of the individual and collective imagery to inform the common understanding of sickness and health: germs attack the body and weaken its defences; to neutralise these invading organisms, medical professionals conduct a

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battery of tests, devise a treatment protocol, and prescribe pharmaceutical bullets to defeat the disease and save the patient’s life (Hodgkin, 1985). This battlefield construct is often evoked to conceptualise the understanding of virulent diseases such as cancer: malicious cells ‘invade’ surrounding healthy tissue, ‘attack’ the body’s natural ‘defences’, and ‘destroy’ the immune system. Equally relevant is the description of radio and chemotherapy treatment in terms of military aerial strikes: patients are ‘bombarded’ with toxic rays to ‘kill’ cancerous cells without, it is hoped, causing fatal ‘collateral damage’ to healthy cells (Reisfield & Wilson, 2004; Stibbe, 1997; Sontag, 1979). The warfare imagery is even more persistent in the event of new epidemics or pandemics which threaten public health and require urgent, large-scale responses. As the drums of war grow louder, society as a whole stands shoulder to shoulder with its medical community and public authority to face and fight the common, invisible enemy. Just as no sacrifice is excessive in time of war, expenditure and coercive measures are no longer policy concerns during a pandemic threat. It is no coincidence that the allocation of medical resources under conditions of shortage is phrased in military terms that connote urgency and necessity. For instance, the triage mechanism informs the distribution and rationing of medication and equipment according to the severity of the patients’ conditions: the younger the patient and more likely to recover, the worthier of treatment and care. This utilitarian priority-setting criterion is ethically ambiguous, however, as it involves some preferential treatment based on a trade-off between cost-effectiveness and social worth. This selective prioritisation strategy extends to the healthcare approach as the warfare metaphor tends to assign preference to critical care over preventive care, and to neglect palliative care when cure is not or no longer possible (Beauchamp & Childress, 2001). Moreover, public authorities may exploit the anxiety that contagious diseases feed and enforce obedience to the restrictive measures deemed necessary to contain the contagion. In times of crisis, the language of war may blur the fine line that separates necessary measures to protect public health from excessive violations of individual rights and liberties. The global outbreak of the coronavirus pandemic is illustrative of the use of

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the warfare metaphor to legitimate restrictive measures and enact coercive procedures in the name of public health interest. The next section will show that the warfare metaphor is limited and limiting,4 as it may curtail society’s ability to address the threat posed by the global coronavirus pandemic.

L exical Phrasing and Metaphorical Framing of COVID-19 The prevalence of the warfare metaphor in the description of the coronavirus pandemic evokes deep-seated parallels between medical treatment and military effort. Governments, public health agencies, and the media around the world resorted to military metaphors to describe this invisible enemy and to galvanise efforts to fight and beat the ravaging beast. From the early days of the pandemic, the ‘white coat army’ of doctors, nurses, and health specialists has become one of the most active ‘frontline forces’ in the global fight against the coronavirus. Akin to war generals, Ministers of Health are meeting daily in ‘war cabinets’ with medical advisors and experts to monitor the health situation and define strategies and policies to contain the spread of the virus and flatten the curve of infections. From this perspective, the warfare metaphor elaborates cross-domain mapping between fighting wars and combating diseases that commonly informs the understanding of the health pandemic.

 onceptual Framing and Collocational Analysis C of COVID-19 Effects Pandemics also engender psychosomatic experiences that establish dynamic relationships between disease agents, methods of infection, and individual bodies. To make sense of these complex interactions, people resort to metaphor as a basic cognitive structure capable of translating this complexity into simpler, more intelligible terms. The warfare metaphor captures the multi-correspondences between the just-war source domain and the infectious disease target domain to project knowledge of

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the war enterprise onto the disease scheme. As a result, inferences about the novel coronavirus pandemic are generated based on stored information about the war phenomenon. The value of this cross-domain mapping lies in selecting background knowledge about a common situation to serve as a vehicle for facilitating understanding of a novel and complex situation. Empirical data from a web-based coronavirus corpus, which consists of 438 million words, collected between January and June 2020,5 show a high frequency of military terms co-occurring with the ‘coronavirus’ and the ‘COVID-19’ words, providing, in passing, compelling evidence of the prevalence of the warfare metaphor in viral discourse about the coronavirus pandemic (Fig. 2.1). These multiple cross-domain correspondences between the welfare experience and the warfare enterprise seem to inform the understanding of COVID-19 and its consequences in the collective narratives. The analysis of the phraseological and collocational patterning of the ‘coronavirus’ and ‘COVID-19’ lexemes offers insightful reflections on the framing of

Fig. 2.1  Cross-domain mapping of war onto COVID-19 in the corpus

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the global pandemic. Collocational analysis of the top 20 most frequently used verbs to appear within four words of the lemma ‘coronavirus’ ranks FIGHT in the 7th place with 10149 hits, together with a relatively high frequency of its synonyms COMBAT, BATTLE, and HIT, ranked in the 12th, 17th, and 19th place, respectively. Top collocates for the ‘COVID-19’ lemma show a similar tendency, with the synonym set of FIGHT frequently co-occurring with the term ‘COVID-19’ and totalling 28514 hits (see Tables 2.1 and 2.2). War-related nouns also dominate the nominal phraseology of these two words with the word ‘fight’ ranked 9th in the lexical environment of ‘coronavirus’ and 12th within the four-word range of the word ‘COVID-19’ (Tables 2.3 and 2.4). These collocational properties are in line with findings from the Corpus of Contemporary American English (COCA) corpus, which lists FIGHT and BATTLE in the top ten verbs to appear within four words to the left of the word CANCER (Hauser & Schwarz, 2020).

Limitations of the Warfare Framing of COVID-19 The jargon of warfare echoes a crisis-centred political rhetoric that established wartime metanarrative in order to legitimate governmental response to the unprecedented public health threat. In France, President Emanuel Macron solemnly declared war against the coronavirus, before claiming, three months later, the ‘first victory’ over the dreadful disease as France enters the ‘green zone’ of lower risk state.6 In Britain, Queen Elizabeth II addressed the nation in a vibrant speech that recalls the ‘stand-alone’ moment of 1940, urging the British to embrace a new age of sacrifice, resilience, and collective endeavour.7 In the United States, President Trump pronounced himself ‘a wartime president’ combatting a ‘foreign threat’.8 The Chinese leader, Xi Jinping, also declared a ‘people’s war’ to defeat the coronavirus.9 In Tunisia, the freshly appointed head of government, Elyes Fakhfakh, declared the country to be in ‘a state of war against the coronavirus’ ten days after he took office.10 His Minister of Health focused his strategy on ‘cutting the supply lines of the virus’,

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Table 2.1  Verbal collocates of ‘Coronavirus’

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Table 2.3  Nominal collocates of ‘coronavirus’

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through the implementation of confinement and social distancing measures. The communicative effects of this war framing are visible and impactful. Rounds of applause are ringing out in many locked-down cities throughout the world, and social media is being flooded with messages of support to health heroes for putting their own lives at risk to help others. In research laboratories, funds are pouring in to help scientists in their race against the clock to find a cure or a vaccine to repel the invading pathogen. To ease the burden on social workers, young people volunteer to deliver food and medication to the needy elderly. Traditional and social media joined forces to share critical and reliable information on preventive and protective measures to reduce the risk of contagion. Powerful hashtags such as—#StayHomeSaveLives; #StopTheSpread; #QuarantineLife; #FlattenTheCurve; #Masks4All—were endorsed by social media influencers to engage the public in the fight to flatten the curve. War comes with a price, though. Winning the lexical battle is only the first step in a long and tedious journey. Words translate into actions, and so did this war of words which soon unfolded into military-like campaigns to contain the spread of the virus. Restrictive measures to reduce social contact and limit physical mobility were enacted, including social distancing, large-scale confinement, quarantine protocols, mass testing and contact-tracking programmes, and complete lockdown of entire cities and countries. To enforce these strict measures, security forces—the police and the military—were granted extensive powers. Many countries declared a state of emergency and adopted a rule-by-decrees mode of governance to respond to the exceptional health crisis. Heavy fines and prison sanctions were introduced to punish violations of the restrictive measures on the freedom of movement and the failure to wear a face mask. In Tunisia, for instance, lockdown violators could face up to two years of prison, by virtue of article 9 of the State of Emergency Law. Location tracking, contact tracing, and big data analysis measures were developed and implemented with no or little consideration for their impact on privacy and data protection standards. In this regard, the use of the warfare metaphor is ethically arguable as it arouses fear and

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exaggerates the health threat in order to secure a total acceptance of painful sacrifices. In the course of war, fear is often used as a way to distort reality and break the will of the opponent. This strategic tactic may backfire, however, when it comes to fighting viral and bacterial enemies. Research on emotional distress has demonstrated that negative feelings are demoralising and demotivating for patients. Reflecting on her own battle in fighting cancer, Sontag (1979), for instance, warned strongly against the demonisation of diseases as dreadful enemies as it stigmatises patients and influences their coping abilities, in turn affecting recovery. Furthermore, the warfare metaphor tends to increase the perceived difficulty of treatment, leading patients to feel guilty (Hendricks et al., 2018), disempowered (Semino et al., 2017), and even to accept fatalistic beliefs (Hauser & Schwarz, 2020). Moreover, the linguistic exaggeration of a health risk without offering an efficient solution could suggest defeat as a potential outcome of a battle, blaming, therefore, the patient for partial or non-­ recovery (Granger, 2014). From these perspectives, military framing of health crises poses more problems than it solves. Indeed, the language of war reflects a fearful description of treatment, negatively affecting people’s receptiveness to health information (Hauser & Schwarz, 2015). Appeals to fear in Aids/ HIV campaigns, for instance, enhance risk perception but decrease prevention behaviour (Earl & Albarracín, 2007). Similar studies have shown that people who conceptualised their struggle with cancer as a battle experienced increased anxiety and depression during treatment, compared to those who conceived it as a journey (Degner et al., 2003). These findings gain further importance in the context of the novel coronavirus pandemic, during which military jargon eclipsed medical terminology. Not only does the warfare metaphor unnecessarily exaggerate a health risk, it also, and mainly so, neglects equally important aspects of the global pandemic such as the effects of confinement and social distancing on the population (Wicke & Bolognesi, 2020). These limitations of the warfare metaphor motivate the need for a plethora of metaphors to inform the communication of various issues involved in the current pandemic. In this respect, the project to reframe COVID-19 in non-war-­ related metaphors, launched by Veronika Koller and Elena Semino in

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April 2020, aims to generate hope-oriented tropes as relevant alternatives to the fear-axed warfare metaphor. To date, the initiative has accumulated 339 contributions in 27 languages and 55 visuals, which select SPORTS as the dominant alternative metaphor to frame the COVID-19 pandemic. The hope-driven dimension of the sports domain, as opposed to the fear-related effect of the war domain, seems to be a more suitable framing for public health communication about COVID-19.

Conclusion The image of war informs morality with its bipolar oscillation between two opposing narratives: one that embraces the triumph of the self over an evil enemy, and another that mourns the loss and suffering of innocent civilians caught in the crossfire. To weave a positive moral memory of warfare, a just cause condition (jus ad bellum) needs to be fulfilled in order to legitimise the use of weapons and feature war as a necessary, rule-­ governed enterprise rather than a random murder mission. This positive just war imagery upholds the moral limitation of war and transcends the scope of military metaphors. The prevalent use of the warfare metaphor to articulate what is at stake amid the outbreak of the COVID-19 pandemic reflects an understanding of health risks in terms of military threats. The existence of multiple correspondences between the source domain of war and the target domain of disease attests to the significance of the warfare enterprise to inform the welfare experience. Fear of war, however, unnecessarily exaggerates a health risk, and paradoxically euphemises death as an acceptable loss. Given its limited and limiting effects, the warfare metaphor fails to account for the imperative of hope that triggers recovery and resilience. Healthcare communication needs, therefore, to reframe the pandemic within hope-oriented frames that evoke the optimistic race for an affordable and effective vaccine to the disease. Sports metaphors, which highlight victory without dramatising defeat, constitutes an alternative way to frame the COVID-19 pandemic.

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Notes 1. The video entitled ‘United Nations Secretary-General’s Message on the coronavirus—COVID 19 (13 March 2020)’ is available on the UN Channel, http://webtv.un.org/watch/united-­nations-­secretary-­generals-­ message-­on-­the-­coronavirus-­covid-­19-­13-­march-­2020/614149782300 1/?term= (accessed May 19, 2021). 2. Metaphorical support means existence of potentially metaphorical expressions throughout the text which may influence the reader, while topic exposure refers to the reading of crime-related materials before exposure to the metaphor. 3. Participants were equally divided into two groups. The selection of female-­only participants ensures more accurate, though gender-biased, data, given the tendency of Tunisian male youth to consider police action unproportionate and counter-productive due to past decades of police brutality and abuse during the recently ousted dictatorship regime that targeted mainly male youth. 4. See Beyond the battle, far from the frontline: a call for alternative ways of talking about Covid-19, posted by https://www.lancaster.ac.uk/news/ beyond-­the-­battle-­far-­from-­the-­frontline-­a-­call-­for-­alternative-­ways-­of-­ talking-­about-­covid-­19 (accessed May 19, 2021). 5. The Coronavirus Corpus is part of the BYU corpora, created by Mark Davies, and freely available online to search through the BYU web interface (http://corpora.byu.edu/). It is composed of data collected form online English newspapers and magazines. First released in May 2020, the corpus is cleaned up using the jusText software to remove boilerplate material, then tagged and lemmatized. I have used its concordancer tool to create frequency lists for the words ‘coronavirus’ and ‘covid-19’, find collocates, and generate concordance lines. 6. The video entitled ‘President Macron’s national address on the coronavirus (16 March 2020)’ is available on Youtube, http://www.youtube.com/ watch?v=N5lcM0qA1XY (accessed March 18, 2021). 7. The video entitled ‘The Queen’s coronavirus address (5 April 2020)’ is available on the BBC, http://www.bbc.com/news/av/uk-­52174772 (accessed April 10, 2021). 8. The video entitled ‘President Trump press briefing on the coronavirus (16 May 2020)’ is available on YouTube, http://www.youtube.com/ watch?v=mVAhBfRDXec (accessed May 17, 2021).

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9. The video entitled ‘Xi Jinping declares a ‘people’s war’ to defeat the coronavirus (13 March 2020)’ is available on YouTube, http://www.youtube. com/watch?v=mVAhBfRDXec (accessed March 15, 2021). 10. The video entitled ‘Speech of the head of government on the coronavirus (13 March 2020)’ is available on YouTube, http://www.youtube.com/ watch?v=LnkaY75rZxA (accessed March 15, 2021).

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Semino, E., Demjén, Z., Demmen, J., Koller, V., Payne, S., Hardie, A., & Rayson, P. (2017). The online use of violence and journey metaphors by patients with cancer, as compared with health professionals: A mixed methods study. BMJ Supportive and Palliative Care, 7, 60–66. Smolej, M., & Kivivuori, J. (2006). The relation between crime news and fear of violence. Journal of Scandinavian Studies in Criminology and Crime Prevention, 7(2), 211–227. Sontag, S. (1979). Illness as metaphor. Farrar, Straus and Giroux. Steen, G. (2015). Developing, testing and interpreting deliberate metaphor theory. Journal of Pragmatics, 90, 67–72. https://doi.org/10.1016/j. pragma.2015.03.013 Steen, G. (2017). Deliberate metaphor theory: Basic assumptions, main tenets, urgent issues. Intercultural Pragmatics, 14(1), 1–24. https://doi.org/10.1515/ ip-­2017-­0001 Steen, G., Reijnierse, W. G., & Burgers, C. (2014). When do natural language metaphors influence reasoning? a follow-up study to Thibodeau and Boroditsky 2013. PLoS One, 9(12), e113536. https://doi.org/10.1371/journal.pone.0113536 Stibbe, A. (1997). Fighting, warfare and the discourse of cancer. South African Journal of Linguistics, 15, 65–70. https://doi.org/10.1080/1011806 3.1997.9724108 Thibodeau, P. H., & Boroditsky, L. (2011). Metaphors we think with: The role of metaphor in reasoning. PloS One, 6(2), e16782. https://doi.org/10.1371/ journal.pone.0016782 Thibodeau, P. H., & Boroditsky, L. (2013). Natural language metaphors covertly influence reasoning. PLoS One, 8(1), e52961. https://doi.org/10.1371/journal.pone.0052961 Thibodeau, P. H., & Boroditsky, L. (2015). Measuring effects of metaphor in a dynamic opinion landscape. PLoS One, 10(7), e0133939. https://doi. org/10.1371/journal.pone.0133939 Whitney, P., Budd, D., & Mio, J. S. (2018). Individual differences in metaphoric facilitation of comprehension. In J. S. Mio & A. N. Katz (Eds.), Metaphor: Implications and applications (pp. 203–214). Psychology Press. Wicke, P., & Bolognesi, M. M. (2020). Framing COVID-19: How we conceptualize and discuss the pandemic on Twitter. PloS one, 15(9), e0240010.

3 Implications of Linguistic Hegemony in Translating Health Materials: COVID-­19 Information in Arabic in Australia Sama Dawood

Introduction Power as a concept is at the heart of any translation act. Not only do translators deal with different linguistic systems, but they also address power imbalances between the two languages involved. Sociolinguistic markers are a component of the meaning-making process, which happens in a social context shaped by differences and unequal power dynamics, and a perfect balance between speakers remains utopian. Therefore, textual renditions could and often do lead to affirming the position of one language and destabilising that of another. In the last few decades, as a result of conflicts, persecution, unemployment, and poverty, there has been a significant increase in the number of people who were forced to flee their homes and resettle in other countries (UNHCR, 2020). Forced mobility has brought to the forefront of many S. Dawood (*) Misr International University, Cairo, Egypt e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 F. M. Federici (ed.), Language as a Social Determinant of Health, Palgrave Studies in Translating and Interpreting, https://doi.org/10.1007/978-3-030-87817-7_3

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agencies and governments the importance of translation as a central means to bridge the linguistic gap between migrants and the host communities. Awareness of the significance of addressing displaced people in their local language became evident during the 2014 Ebola outbreak, when miscommunication of necessary health instructions got in the way of stopping the spread of the disease (Federici, 2020, p. 183). A number of commitments and frameworks have been initiated by different humanitarian organisations to emphasise the role of multilingual communication to further the engagement of vulnerable communities during crises. However, in certain cases, translation has been exploited as a tool to submerge the language of those migrants beneath the mainstream of the so-­ called global languages. Such a loss of linguistic identity caused by manipulative translation practices has provoked interest in studying translation within the framework of postcolonialism. Imbalance between languages and its effect on translators’ tasks has set the stage for the emergence of postcolonial approaches to translation. With the flare-up of COVID-19 all over the globe, and with dozens of relevant factsheets, newsletters, and posters being released every day to raise awareness and help stop the spread of the virus, multilingual dissemination of health information has become a matter of urgency (see ELP, 2020). Countries have realised the importance of sharing accurate and timely data with their citizens as well as with all migrants within their borders. Denying access to such data to language minorities or overlooking their linguistic needs exacerbates the risk for everyone. This is one of those crises where inequalities between languages play out on the translation scene, and the languages of minorities within a state are put at risk. This chapter reports on a study that adopts postcolonial theory to frame translational activities in order to analyse the Arabic translation of a number of English infographics issued as part of the COVID-19 health awareness campaign in Australia. It zooms in on English language dominance over Arabic and the implications of the translation strategies adopted by the translation agency responsible for translating the infographics into Arabic for the linguistic identity of the target audience. The study aims to answer the following questions:

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1. How do translation strategies help enhance asymmetrical power relations between the source and target languages? 2. What is the impact of the source language hegemony on the responsiveness of the target audience to health information during the COVID-19 crisis?

Considering Translation Through a Postcolonial Lens The development of a postcolonial perspective in Translation Studies cannot be traced back to one single author or to a certain year. Since the 1990s, there has been extensive attention to postcolonial approaches, methods, and positions in challenging linguistic paradigms that might have offered misleading ideas of translation occurring in neutral contexts. Postcolonial approaches to Translation Studies go beyond the linguistic dimension to include cultural, contextual, and multiple factors affecting translation. Such an approach focuses on existing and intrinsic power relations as a common concept in translation practice. The works of several translation scholars fall into this paradigm; this study pivots on the writings of a few of them, such as Niranjana (1992), Spivak (1993), Bassnett and Trivedi (1999), Lefevere (1999), and Tymoczko (1999). Niranjana (1992, p. 33) is among the first scholars to write about the role that translation can play within the context of colonialism. She points out that translation, specifically into English, can be used by colonisers as a means to impose their ideology and reshape the image of the colonised culture. Spivak (1993, p.  182) criticises literary translations that disregard the linguistic uniqueness of the source text. She argues against the idea that languages can be subject to the law of the strongest and considers it a kind of betrayal committed by translators when—‘the literature by a woman in Palestine begins to resemble, in the feel of its prose, something by a man in Taiwan’ (Spivak, 1993, p. 371). Spivak calls for preserving from the source peculiar forms of expression even if this will lead to producing a translation that is vague or does not meet the expectations of the target audience (ibid., p. 186). Following the same line of argument, Simon (1997, p. 475) concludes that since there is no equality between modern cultural systems, the idealistic view of translation as a mediator between cultures is no longer valid.

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Bassnett and Trivedi (1999, p. 2) develop the notion that translation can be approached from a postcolonial perspective, considering it ‘a highly manipulative activity’ that reflects unequal relations between cultural systems. They point out that translation was at the core of colonisation endeavours as it was a tool to empower the coloniser and disempower the colonised. Although most of the chapters of their edited book tackle issues related to translation between the British colonisers and India, and how far the uneven relation between the coloniser and the colony has affected the representation of the latter in translated literature, the same argument could be generalised to the translation practice between other languages where an asymmetry of power between the source and target languages influences the choices of the translator. One of the key contributors to Bassnett and Trivedi’s 1999 publication is André Lefevere. He argues that translators usually work on texts bearing in mind two grids: a textual one that refers to the words used by the original author, and a conceptual grid that is related to the meaning and intentions behind using those words. According to Lefevere, both grids are interwoven and cannot be approached separately, but the type of text may guide the translator to give priority to one over the other. Textual grids take priority in informative texts (e.g. medical ones), but texts of a persuasive nature such as advertisements require that translators pay more attention to the conceptual grid so that the translation can elicit the intended response from the target audience (1999, pp. 75–77). Moving to another significant input, Tymoczko (1999, p. 281) analyses a number of translated Irish literary works, showing that translation can contribute to liberation from colonialism. She insists that translation should always be linked to different aspects of the original, including history, politics, and ideology. She goes even further to support translation theorists who see the main role of translators as that of ‘creators’. Simon and St-Pierre (2000, p. 17) give force to this strand of thought by emphasising that the translator’s task should involve studying the economic and political aspects of the source text through the prism of postcolonialism. Their book includes thought-provoking contributions by translators and scholars from different parts of the world. Chan, for example, believes that the concept of ‘postcolonialism’ is a broad one and does not only apply to translation from or into languages of countries that have experienced

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colonialism. He considers the case in China where there is opposition to the use of Western forms of expression for fear that they will contaminate the ‘pure’ Chinese language (2000, p. 55). He believes that more and more languages are now being defeated by the ‘linguistic colonization’ of English (ibid., p. 66). Gouanvic (2000) tackles the relation between postcolonialism and translation from the standpoint of marginalised groups. He notes that migrants are usually caught up in a clash between their own linguistic and cultural system and that of the host country (2000, p. 102). He contends that translation can impose the values of the source culture on the target culture, and that hybridity helps the dominator, ‘in a sleight of hand’, to serve its interest and reinforce its power (ibid., p. 110). By contrast, Wolf (2000) supports hybridity as she believes that translation is a way of intervening that allows cultural negotiation and enrichment. Since cultural interaction and multiple identities have become characteristics of today’s communities, translation practice should no longer be seen as a mediation between two conflicting cultures (ibid., p. 142). In a later essay, Wolf (2002) focuses on the network of agents in the translation process and how far it directs translation strategies. She believes that those agents are part of a cultural context and that, therefore, their decisions are affected by the power relations between the source and target cultures (see also Wolf, 2014). She maintains that factors such as the identity of the publisher and the translator as well as the criteria for assessing the quality of the translation steer the ‘production and reception’ of any translated work. Mukherjee et al. (2006, p. 1) also raise this same issue, pointing out that the task of translators now involves either establishing a culture or ‘minoritising’ it; the decision in most cases is made by the publisher rather than the translator. Bassnett (2013, p. 340) sets alarm bells ringing by emphasising that due to the unequal power relations between world languages, translation can lead to the disempowerment of entire cultural systems. This view is also shared by Kuswarini et  al. (2020, p. 1293) who warn that when translators and self-translators adopt the language of the coloniser, this can lead to ‘low self-esteem syndrome’ among members of the colonised culture. They believe that westernising translations fosters a sense of inferiority among eastern communities, and should, therefore, be avoided by translators because they are expected to treat all languages across the globe on an equal footing.

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The contributions reviewed so far are concerned with the translation of literary works and how far bias favouring the source language can result in influencing the less dominant target culture. Language bias can have more serious implications when translating other types of texts. Medical translation is a field where discrimination against the target language, especially if it is spoken by a minority, can be life-threatening. The Language Rights for Linguistic Minorities Guide, issued by the United Nations Special Rapporteur on minority issues, gives prominence to addressing minorities in their own language in the context of public health care ‘where effective communication can be a matter of life and death (2017, p. 23). Dalton-Oates (2017, pp. 231–233) takes miscommunication in health-care settings to a political level by giving a historical account of legislation concerning the right of patients to have medical translators. By examining various cases of linguistic discrimination from different parts of the world, the author concludes that the decision whether or not to provide a patient with a translator in medical facilities depends on a number of factors that are in most cases not related to the patient’s health. These include the policy of the country or the medical institution, the preference of the medical staff, and budget considerations. The common underlying basis for all of these factors is discrimination against a subgroup. Montalt et  al. (2018, p.  31) emphasise the importance of using the language of minorities in health communication, raising the issue of translation quality when addressing a minority. Quality multilingual communication should be characterised by correct use of terminology and plain language that can easily be understood by the target audience. Medical translation is also discussed by O’Brien and Federici (2019) within the framework of crisis translation. They argue that lack of access to clear instructions and lack of engagement during crises due to ineffective multilingual communication can put a minority at great risk: during crises, translation is not treated as a priority mainly because it is a costly process and it requires careful planning to build a network of professional translators. They welcome the fact that various international organisations and NGOs have recently started to show growing concern about creating a balance between a state’s official language(s), and its responsibilities to meet the linguistic needs of its minorities (ibid., pp. 131–133).

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 HO Communication Principles: Effectiveness W and Equality To communicate in one’s own language is a social behaviour and practice that hardly requires a law to approve it as a person’s right. Yet, discriminatory practices that prevent minorities from using their own or preferred language have necessitated drawing up legislation to frame this as a human right that should be protected. Several documents have been drafted by organisations to prevent the violation of this right in multilingual communities. These include the UN Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities (1992), the European Charter for Regional or Minority Languages (1992), the Framework Convention on the Protection of National Minorities (1998), and the Language Rights of Linguistic Minorities Guide (2013), among others. De Varennes (2001) notes that authorities should be committed to using the language of minorities in public services, such as in making media announcements and giving instructions. Nonetheless, he objects to using a term such as ‘language right’, arguing that the right to use the mother tongue is already guaranteed by the basic human rights of non-­ discrimination and freedom of expression; see discussion (2001, pp. 20–22). Among the international organisations paying due attention to effective multilingual communication in health-care settings, the World Health Organization (WHO) has taken a distinct role. In pursuit of achieving its goal to build healthy communities, the WHO has laid down the Strategic Communications Framework for Effective Communications (2017a), listing a number of principles to govern communication in health contexts. The Framework (ibid., p.  3) suggests that all health-­ related communication activities, including social media posts, infographics, news releases, videos, and so on should adhere to and respect the specified parameters detailed in Table 3.1. To guarantee successful communication, communicators are advised to make their messages accessible by taking into account the channels that the target audience prefer and can easily have access to. Radio, community billboards, and transportation infographics, for example, are still preferred and

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Table 3.1  Risk communication parameters adapted from Strategic Communications Framework for Effective Communications (WHO, 2017a) Principle

Meaning

Accessible

Disseminate health messages through multiple channels so that they can be accessed by everyone. Design campaigns that move the audience from awareness of an issue towards a decision to protect their health. Ensure that all messages are accurate and consistent.

Actionable Credible and trusted Relevant Timely Understandable

Help audiences see the health messages as applicable to them and others they care about Engage the audiences at the time when the health guidance is needed Provide information that is easy to understand to help the audience assess health risks

more popular than social media messages in some parts of the world (ibid., p. 4). Encouraging the audience to take action and follow advice requires an understanding of, or lacking this, an analysis of their levels of awareness and health practices. Such analysis helps communicators determine the most appropriate message that can lead to change in audience behaviour (ibid., p. 9). Another tenet that communicators are urged to follow refers to trusted global health agencies and authorities. Citing the United Nations health agency, for example, might be an effective way to convince the target audience that the information and tips provided are accurate and consistent (ibid., p. 17); of course, not all countries worldwide show or endorse this agency as a reliable authority (for instance, Trump’s administration adopted a conscious approach to undermine WHO and other supranational authoritative sources of information, pursuing a specific political agenda). Ensuring the message relevance is another principle that communicators need to consider. Addressing the audience while bearing in mind their socio-demographic characteristics can help communicators craft a relevant message to convince the target audience that a certain health issue influences their family, friends, and community (ibid., p. 24). Providing up-to-date information and the prompt timing of messages when the target audience should take action is a core principle of successful health communication: it is a core principle for mitigating health risks. Delayed delivery of information can lead to the spread of rumours or misconceptions and may drive the audience to overreact or to consult non-credible sources (ibid., pp. 30–32). The sixth

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principle, and the one that is the main concern of this study, is that health messages need to be understandable and easily comprehended by the audience. Using plain language, avoiding technical terms, incorporating illustrations, and translating messages into the language of the target audience are among the important techniques that communicators are advised to follow. The Framework states that, if the audience has to go through a health message ‘several times to understand it, they are not likely to act on the advice and guidance in the message’ (ibid., p. 36). Other techniques to foster better comprehension of messages include foregrounding the most important information, using attractive designs, and tailoring messages to the needs of the audience by creating messages ‘in non-English languages rather than translating English messages’ (ibid., p. 39). Moreover, the WHO pays attention to the subject of multilingualism, and the pandemic has heightened its awareness of the importance of language-­appropriate messages. To guarantee equitable access to health information by all world communities, the WHO has adopted a mechanism to make sure that its publications are translated into the United Nations six official languages, and it urges all states and policymakers to follow suit (ibid., p.  51). Among the recommendations that the WHO makes in its Guideline for Emergency Risk Communication (2017b) is building trust with community members to ensure that they become engaged in order to achieve a positive health outcome. This engagement is realised through the transparency, timeliness, and clarity of the messages delivered. Involving the public in decision-making and acknowledging uncertainty of information can increase trust between the community members and official health systems, thus helping achieve social unity and further collaboration to attain the desired goal (ibid., p. 11).

Theoretical Framework This study is underpinned by postcolonial theories of translation and combines these theoretical foundations with the communicative expectations laid out by the WHO guidelines. The combination of these two dimensions here serves as a theoretical framework to analyse the Arabic translation of selected English infographics on the COVID-19 pandemic, issued by the State of New South Wales in Australia. In an article titled

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‘How a trust breakdown left Melbourne’s minority communities hardest hit by Covid second wave’, Taylor (2020, n.p.) reported on the issues affecting communication in Australia, including the comments by Anthony Pym, a professor of Translation Studies at the University of Melbourne. Pym emphasises how the lack of effective multilingual communication with minorities due to mistakes in translation, the use of hard-to-understand English jargon, and failure to provide governmental translators made vulnerable communities suspicious of messages coming from the Australian Federal Government. Some communities, prone to the influence of conspiracy theories, depended on what Pym calls a ‘re-­ narration process’ in which ‘younger family members pick up the message in English and then share it with relatives in their native tongues’ (Taylor, 2020, n.p.). It is worth mentioning that English is the official and dominant language in Australia, yet a significant number of the population speak other languages. In New South Wales, Arabic is the most widely spoken language after English (Cruickshank, 2008, p. 281). The aim of the analysis is to show how far the translation strategies adopted by the translator (whether an individual or an agency) may assert the position of English as the source, even master language, and threaten the linguistic identity of the Arab minority being addressed as the derivative, rather than target language. It is to be noted that most studies that have explored translation from a postcolonial perspective focused on how translators manipulate texts of the colonised to meet the cultural and linguistic expectations of the coloniser’s readership, and the vast majority of these studies refer to the translation of literature, not necessarily of short, informative, and instructional text-types (e.g. Spivak, 1993; Bassnett & Trivedi, 1999; Tymoczko, 1999; Wolf, 2002). Hence, this chapter reports on the findings of a study that investigates the relation between translation and postcolonial theory from another perspective; it could be considered almost a feasibility study. The investigation is concerned with how the dominant language directs the translation process (considering English as a main language in Australia, but in a position where statutory multilingualism is being debated). The study then seeks to ascertain whether the use of English as the colonial source language leads to an assertion of power in translation that could undermine the linguistic identity of the subordinate, secondary, non-main (or colonialised) languages.

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Data Analysis This section includes a number of examples that will prove to substantiate the argument that translation can be used to establish the linguistic hegemony of the source language and produces a sense of inferiority among the target language audience. Before citing the examples, it seems necessary to set the scene by giving a brief contextual background. The data consists of five infographics posted on the website of the Ministry of Health of the State of New South Wales, Australia. At the time of conducting the study, the total number of the infographics on the website was ten. Only five examples are cited here in order to avoid repetition the same points of analysis. According to the Australian Parliament website, Australia is listed among the top immigration nations. It welcomes people from different demographic backgrounds, and it is now a home for over 7.5 million people who have settled there since after World War II. There are approximately 400,000 Arabic speakers in the country, mainly from Syria, Egypt, Iraq, and Lebanon. Committed to the safety and health of all the people living in the country regardless of their linguistic backgrounds, and with the breakout of COVID-19, the Australian Ministry of Health issued factsheets, posters, and infographics in over 50 languages to communicate health information and tips to help stop the spread of the pandemic (Parliament of Australia, 2021). This study is concerned with the Arabic translation of five infographics accessed from the Australian Ministry of Health website.1 The analysis of the translations aims to explore how asymmetrical power relations impact the translation, and the consequent effectiveness of the message in relation to the linguistic identity of the target audience. It is important to be explicit here that the analysis is based on a textual assessment of the translation output; it is very clear and understandable that extraordinary measures and working conditions would have had an impact on the production of some of these translations. Their availability is testament to a degree of institutional awareness, which draws on Australian traditions about migrant communities. Any criticism of the textual dimensions does not correspond to judgmental views concerning the government’s policies on migration.

Example 3.1

Fig. 3.1  ‘COVID-19 (Coronavirus): Who to Call’. (© State of New South Wales NSW Ministry of Health)

Fig. 3.2  ‘COVID-19 (Coronavirus): Who to Call’ in Arabic. (© State of New South Wales NSW Ministry of Health)

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Example 3.1 is an infographic titled ‘COVID-19 (Coronavirus): Who to Call’ (Fig.  3.1 in English and Fig.  3.2 in Arabic). The infographic provides some phone numbers for people to dial in emergencies and gives some relevant tips on how to keep oneself safe during the pandemic. In the Arabic version of the infographic, the title is accurately translated into Arabic except for the term ‘COVID-19’ which is left as is in English. This same term, ‘COVID-19’, is also left untranslated in three other places in the Arabic document. The strategy of leaving source language lexical items untranslated infringes upon the right of the target audience to receive understandable messages by being addressed in their own language. To help the audience comprehend health issues and risks, and take appropriate actions, the WHO recommends communicating with the public in an easy-to-understand language (2017a, p. 35). Since a significant number of Arabs living in New South Wales cannot speak English and they still communicate in their mother tongue (Cruickshank, 2008, p. 281), such incomprehensibility would probably affect how far the audience trust the information presented, and how convinced they will be to take the desired action. The WHO links the guideline of delivering understandable messages to those of credibility and actionability by noting that ‘people are more likely to trust and act on information they understand’ (ibid., p. 36). For infographics to serve the purpose they are designed for, they should meet the linguistic needs and preferences of the public by being presented in their local languages (ibid., p. 39). Being addressed in a language other than their own will probably make the migrants distrust the information presented and discourage them from acting on the advice given. Most importantly, it will give them the indication that their mother tongue is subordinate to English. The intended message of the infographic would have been more effective if ‘COVID-19’ had been transliterated using Arabic characters as -19 ‫ كوفيد‬which is an adequate Arabic translation (in fact, a transliteration) of the English term. Furthermore, at the bottom of the page of the English infographic ‘COVID-19 (Coronavirus)’, there is a small illustration showing hands being washed, two people keeping 1.5 metres distance, and a house,

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with the caption ‘wash hands, keep distance, stay home’. In the Arabic version, the three illustrations are still there (see Fig. 3.2), but only two illustrations have translated captions in Arabic. The translation of the phrase ‘Stay home’ is omitted. Deleting content while translating a message into the language of a minority breaches a set of effective communication principles recommended by the WHO. It does not follow the principle of relevance which is related to providing the audience with clear ‘steps that they can take to reduce the risks to their health’ (2017a, p.  24). Without the verbal reference to ‘home’, the ‘home’ image now appears irrelevant to the translated caption. By not incorporating clear and full instructions with the drawings, the verbal text does not provide the target audience with an understandable message (ibid., p. 36). This may well affect the audience’s trust in the information provided, as they might be puzzled by the message. Most importantly, it contradicts the tenet of actionability. The omission could be interpreted as disregarding the linguistically diverse community members by their being kept unaware of important information or tips to protect their health and keep others safe. This, in turn, can affect their response to the health regulations followed in the community they live in and make them look unresponsive and uncooperative, thus (probably unconsciously) reflecting another case of hegemonic language reducing details and nuances in the target language of a language minority (Table 3.2). Table 3.2  Assessing source infographic ‘COVID-19 (Coronavirus): Who to CALL’ and its translation against WHO guidelines English infographic

Arabic infographic

COVID-19 (Coronavirus): Who to Call Stay Home, Keep Distance, Wash Hands

(‫)كورونا فايروس‬ COVID-19 ‫وسائل االتصال‬ ‫ اترك‬،‫اغسل يديك‬ ‫مسافة آمنة بينك‬ ‫وبين اآلخرين‬

WHO’s guidelines WHO’s guidelines broken respected Actionability, credibility & trustworthiness, understandability, Actionability, relevance, credibility & trustworthiness, understandability

Accessibility, relevance, timeliness Accessibility, timeliness

Example 3.2

Fig. 3.3  ‘Diabetes and COVID-19 (Coronavirus): Look after your diabetes’. (© State of New South Wales NSW Ministry of Health)

Fig. 3.4  ‘Diabetes and COVID-19 (Coronavirus): Look after your diabetes’ in Arabic. (© State of New South Wales NSW Ministry of Health)

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Example 3.2 is the infographic titled ‘Diabetes and COVID-19’, which illustrates another example of limited alignment to WHO’s guidelines. A potential consequence may be to increase the Arab minority’s feeling and perception that they are being discriminated against, and that their language is unacknowledged in the community they live in (Figs. 3.3 and 3.4). Rather than leaving only one term in English, as in Example 3.1, the translator of this infographic keeps four phrases without translation. The Arabic translation includes the phrases ‘sick day action plan’, ‘management kit’, ‘sick day’, and ‘action plan’. This is against the recommendation of the WHO to address people in their local language (2017a, p. 48). All these terms have common equivalents in Arabic, which Arabic speakers would find familiar; hence the decision to leave them untranslated is inexplicable. Such unnecessary lexical hybridity is a form of linguistic injustice, from a hegemonic language into Arabic, as it could imply that Arabic is an inferior language that needs to be enriched with some English lexical items (Table 3.3). The infographic ‘Cardiovascular Patients and COVID-19 (Coronavirus)’ considered here as Example 3.3 follows the same strategy in borrowing ‘COVID-19’2 in the Latin alphabet as in the previous examples, despite an accepted version of the term in Arabic script being widely used. Moreover, the term ‘Coronavirus’ is translated into an Arabic term that is not commonly used by Arabic speakers. Opting for an Arabic medical term ‫الفيروس التاجي‬rather than using the term that has been used in all types of media since the onset of the pandemic, namely ‫فيروس‬ Table 3.3  Assessing source infographic ‘Diabetes and COVID-19 (Coronavirus)’ and its translation against WHO guidelines English infographic

Arabic infographic

Diabetes and COVID-19

‫و السكري‬COVID-19

Sick day action plan/ management kit/sick day/ action plan

Sick day action plan/ management kit/sick day/ action plan

WHO’s guidelines broken Actionability, credibility & trustworthiness, understandability,

WHO’s guidelines respected Accessibility, relevance, timeliness

Example 3.3

Fig. 3.5  ‘Cardiovascular patients and COVID-19 (Coronavirus)’. (© State of New South Wales NSW Ministry of Health)

Fig. 3.6  ‘Cardiovascular patients and COVID-19 (Coronavirus)’ in Arabic. (© State of New South Wales NSW Ministry of Health)

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‫كورونا‬, contradicts the tenet stressed by the WHO that communicators ‘must translate technical information into messages non-expert audiences can understand’ because people tend to mistrust and ignore information they do not comprehend. Specialised language may require multiple readings of the information, leading to a limited understanding of the message (ibid., p. 36), which in turn makes the readers indifferent to its content (Figs. 3.5 and 3.6). Furthermore, translating the English term ‘corona’ as ‫( التاجي‬literally means ‘coronary’) could cause confusion as it usually occurs in the collocation ‫‘( الشريان التاجي‬coronary artery’). Arab migrants who cannot read English would probably think that this infographic is about heart disease, not coronavirus. This is an example of a bad linguistic choice made by the translator that hinders comprehension. The crucial health message may go amiss, as readers might skip reading this document, thinking that it is not about the pandemic. Leaving a linguistically diverse community misinformed about important health information increases their susceptibility to the crisis (O’Brien & Federici, 2019, p. 131) (Table 3.4). Example 3.4, the ‘Stroke and COVID-19’3 infographic, educates and informs patients on stroke symptoms. The English uses the ‘FAST’ acronym: ‘Remember the FAST message: Facial drooping, Arm weakness, Speech difficulties, Time is of the essence’. Acronyms intend to stimulate mnemonic retention of the message; however, inserting the word ‘FAST’ without translation in the Arabic infographic defies the objective. ‘FAST’ makes the content summarised by the acronym quite unrecognisable in Arabic (Figs. 3.7 and 3.8). Table 3.4  Assessing source infographic ‘Cardiovascular patients and COVID-19 (Coronavirus)’ and its translation against WHO guidelines Arabic English infographic infographic Cardiovascular patients and COVID-19 (Coronavirus)

‫االمراض القلبية‬ ‫الوعائية و‬ COVID-­19 (‫)الفيروس التاجي‬

WHO’s guidelines broken

WHO’s guidelines respected

Actionability, credibility & trustworthiness, understandability

Accessibility, relevance, timeliness

Example 3.4

Fig. 3.7  ‘Stroke and COVID-19’. (© State of New South Wales NSW Ministry of Health)

Fig. 3.8  ‘Stroke and COVID-19’in Arabic. (© State of New South Wales NSW Ministry of Health)

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The initial letters of the Arabic words for Face, Arm, Speech, and Time (translated literally in Arabic as ‫ وجه‬،‫ ذراع‬،‫ كالم‬،‫ )وقت‬do not correspond to the four letters of the English words. To use a mnemonic in Arabic, the translation needs to read along the lines of ‫وذكو‬, which is a combination of letters that does not form an Arabic word. Adding the English acronym to the Arabic text contradicts four of WHO’s guidelines, namely, actionability, credibility and trustworthiness, relevance, and understandability. Tailoring content to the needs of the audience and providing them with easy-to-recall and attention-grabbing information help connect the audience to the health issue and make them more aware of the risks (WHO, 2017a, p. 28). The mnemonic ‘FAST’ helps the source language audience remember the symptoms, whereas for the target language audience, it is just a combination of four letters which make no sense in their language. It creates a barrier between the target audience and the intended message. The Arabic infographic is confusing and fails to give the same important message to the target audience and might therefore have serious health consequences. It makes it appear that only those who know English will be able to quickly save their lives when they experience stroke symptoms and remember ‘FAST’ (Table 3.5). Example 3.5, the infographic titled ‘Arthritis and Covid-19’,4 illustrates the importance of design. Both design of the information and its illustrations fall short of meeting the WHO guidelines. According to the Organization’s communication framework, understandability involves ‘clarifying sequences, timelines and relationships with drawings to show the steps in a process’ (2017a, p. 38) (Figs. 3.9 and 3.10). Table 3.5  Assessing source infographic ‘Stroke and COVID-19 (Coronavirus)’ and its translation against WHO guidelines English infographic

Arabic infographic

Stroke and COVID-­19 (Coronavirus)

‫السكتة الدماغية و‬ COVID-­19 (‫)الفيروس التاجي‬

WHO’s guidelines broken

Actionability, Remember the FAST ‫ تذكر رسالة‬FAST credibility & ،‫ارتخاء في الوجه‬ message Facial trustworthiness, ،‫ضعف في الذراعين‬ drooping, Arm relevance, ،‫صعوبات في الكالم‬ weakness, Speech ‫الوقت هو أمر جوهري‬. understandability difficulties, Time is of the essence

WHO’s guidelines respected Accessibility, timeliness

Example 3.5

Fig. 3.9  ‘Arthritis and COVID-19 (Coronavirus): Look after your diabetes’. (© State of New South Wales NSW Ministry of Health)

Fig. 3.10  ‘Arthritis and COVID-19 (Coronavirus): Look after your diabetes’ in Arabic. (© State of New South Wales NSW Ministry of Health)

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Incorporating visual elements in factsheets and infographics enhances communication since they can reach all people regardless of their educational level (WHO, 2017a, p. 38). Besides the issue of borrowing terms in the Latin alphabet, the Arabic infographic also exhibits some problems in the presentation of its visual elements. Arabic, unlike English, is written from right to left. Emphasis is produced by positioning the most important information and illustrations on the right-hand side. This concept was not considered, and the infographic design was not altered in the translation. Caballero (2021), an expert in design, points out that infographics should have ‘a flow’ where the eye moves effortlessly from one chunk to the next. He notes that in Western cultures, infographics go from left to right and top to bottom, but this does not apply to all languages and cultures. Clearly this is the case for Arabic. The infographic includes icons with a ‘tip’ in verbal text next to each icon, conventionally organised in English with the most important tips on the left-hand side and the least important ones to the right-hand side; keeping them in the same order in the Arabic version erases the hierarchical order based on the importance of individual points. As understandability depends on organising information in a logical order where the most important content comes first (WHO, 2017a, p.  36), the infographic of the Arabic translation fails to replicate the order of significance in the leaflet. For example, on the left-hand side, people are urged to stick to the medication prescribed by doctors, whereas the tip on the righthand side is not to stop the medication unless advised by the doctor, but Arabic readers expect to move their eyes from the right to the left while reading the document. Here, their order of priorities is reversed: they are told that they should avoid stopping medications prescribed by the doctor first, then the advice to take the medication according to doctor’s prescription. In another similar case, a block on the left in the English infographic warns the audience to test for COVID-19 if they have symptoms, and on the right-hand side, there is an ambulance and a tip to dial 000 if the symptoms become more serious. Consequently, the infographic in Arabic reads as if readers are expected to call for an ambulance and then to test for COVID-19. The WHO stresses that messages whether verbal or visual should be tailored to the needs of the audience and underlines the importance of

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visual elements as they enhance the effectiveness of campaigns; thus, WHO recommends positioning visual elements in a logical sequence to clarify any instructions given (2017a, p. 48). Ignoring the writing and reading direction of Arabic renders the message awkward in a way that could alienate the target audience. Violating the principle of understandability involves, as has been mentioned before, the two other principles of credibility and trustworthiness, and of actionability. If people do not understand a message, they would probably mistrust and ignore it (ibid., p. 36). Furthermore, the Arabic infographic also counters the principle of relevance highlighted by the WHO that urges communicators to make sure that the audience are provided with clear steps they can take to reduce the health risks (ibid., p. 24). Respected in the design in English, the principle is overlooked in the Arabic translation. This is an example of poor localisation competence and can be read as linguistic bias favouring the source language. The English document is treated as the default with the Arabic translation as its duplicate. By not observing the format and direction of writing of the target language, the Arabic infographic provides the target audience with an awkward organisation of ideas and confusing steps (Table 3.6). The findings of the study strongly indicate that translation can reinforce the hegemony of the source language. The hegemony of English as the language of the original text brings to mind the outdated notion that translation is just a copy of a superior original text. Perhaps this is the main reason why the WHO stresses that health messages should be Table 3.6  Assessing source infographic ‘Arthritis and COVID-19 (Coronavirus)’ and its translation against WHO guidelines English infographic

Arabic infographic

Arthritis and COVID-19 (Coronavirus)

‫التهاب المفاصل و‬ WHO’s COVID-19 (‫الفيروس‬ guidelines ‫)التاجي‬ WHO’s guidelines broken respected

Direction of Direction of content and content and drawings is from drawings is from left to left to right right

Actionability, credibility & Accessibility, timeliness trustworthiness, relevance, understandability,

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written in non-English languages rather than being translated from English (2017a, p. 39). Hybrid translation where English text is inserted in what is supposed to be an Arabic document reinforces English hegemony and jeopardises the linguistic identity of the Arab minority. Furthermore, selecting inaccurate or unfamiliar translation equivalents of lexical items negatively affects how the target audience receive the message. Instead of feeling appreciated because the host country is translating the infographics into their language, the Arab minority could be offended because of the lack of attention given to their linguistic conventions and forms of expression. Such feelings can only increase the sense of isolation and otherness among minority members of the community. Deleting verbal or non-verbal elements from a source text during translation could be seen as a form of linguistic oppression because the target audience are denied access to content that is only available for the source language audience. The findings show that as Chan (2000) has explained, postcolonial translation theory can be applied to other text types beyond the realm of literary translation. Much of what Chan says about translators who are ‘contaminating the Chinese language’ through importing Western expressions (ibid., p.  55) can be said about the examples mentioned here. Reference also needs be made here to Gouanvic (2000, p.  102) who believes that what he calls ‘hybrid translation’ is used by the more powerful to further confuse migrants who are caught up in a linguistic identity crisis as they settle into life in a new country. The results of the present study contradict the view held by Wolf (2000, p. 142) concerning hybridity as a way to enrich cultures. Inserting English lexical items in the Arabic documents analysed here is actually a form of distortion rather than enrichment. It can lead to what Kuswarini et al. (2020, p. 1293) describe as ‘low self-esteem syndrome’. Arabic speakers will feel that their mother tongue is inferior, as it has been necessary to keep some expressions in English. The findings also support the opinions expressed by Montalt et al. (2018) and O’Brien and Federici (2019) that translation quality is an overriding priority during crises as ineffective multilingual communication can put a minority at great risk. This study does not intend to undermine the importance of having such translations. Also, the author recognises that these translations were

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achieved under pressing and, in some cases, unprecedented working conditions. Regular professional networks might have been broken down, and lesser experienced translators deployed to carry out these versions. These aspects were not considered in assessing the translation as a product, because ultimately the rendered texts had to achieve the same function of the source text. The study draws the attention of those involved to some, probably unintentional, discriminatory practices that could have far-reaching consequences on language uniqueness and the identity of its speakers.

Concluding Remarks In this age of diaspora, translation is expected to function as a primary tool aiding millions of migrants all over the world to relocate in their new communities. Reporting on the study of whether linguistic conventions of the target readership were compromised in the COVID-19 information campaign into Arabic in Australia, this chapter makes two important points. Firstly, the translation examples discussed here seem to confirm that the production of the Arabic versions may have been affected by a dominance of the source language over the target. Secondly, the analysis of the translation of the infographics, which focused on how the choice of a certain translation strategy can reflect and enhance unequal relations between the involved linguistic systems, seems to indicate contradictions of WHO’s recommendations for effective multilingual communication. Since postcolonial translation theory perceives translation as a process that is not limited only to making linguistic decisions, but also involves addressing differences on the cultural and political levels (Bassnett & Trivedi, 1999, p. 6), the findings of the contrastive analysis of the COVID-19 factsheets (Examples 3.1, 3.2, 3.3, 3.4, and 3.5) suggest that this interpretation can be valid for translations of public health information. However, with such biased practices as the ones discussed in the examples, translation now seems to be relegated to the position of being the apparatus of the more powerful, the dominant, language to assimilate the less powerful language, which tends to be the language of groups who may, temporarily or for a long period, be less powerful groups. The

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examples show the inability of those involved in the translation of the infographics to successfully communicate important health information and tips to the Arab minority due to inadequate translations. Failure to decide on the most appropriate translation strategies resulted in translations where Arabic groans beneath the oppression of English. Such flaws bring to mind the long-standing misconception that the original text is superior to the translation. Most importantly, they indicate that discrimination between languages can still govern the practice of translation. Therefore, in the modern globalised environment, translators need to be heedful of which translation strategy to follow so as not to be instrumental in allowing the invasion of a minority language by a dominant one.

Notes 1. All translated factsheets can be found online at https://www.health.nsw.gov. au/Infectious/covid-­19/Pages/multilingual.aspx (accessed May 11, 2021). 2. The infographic ‘Cardiovascular disease and COVID-19’ © State of New South Wales NSW Ministry of Health can be found at https://www. health.nsw.gov.au/Infectious/factsheets/Factsheets/covid-­1 9-­c ardio-­ arabic.pdf (accessed May 11, 2021). 3. The infographic ‘Stroke and COVID-19’ © State of New South Wales NSW Ministry of Health can be found at https://www.health.nsw.gov.au/ Infectious/factsheets/Factsheets/covid-­19-­stroke-­arabic.pdf (accessed May 11, 2021). 4. The infographic ‘Stroke disease and COVID-19’ © State of New South Wales NSW Ministry of Health can be found at https://www.health.nsw. gov.au/Infectious/factsheets/Factsheets/covid-­1 9-­a rthritis-­a rabic.pdf (accessed May 11, 2021).

References Bassnett, S. (2013). Postcolonialism and/as translation. In G. Huggan (Ed.), The Oxford handbook of postcolonial studies (pp. 340–359). Oxford University Press. Bassnett, S., & Trivedi, H. (1999). Postcolonial translation: Theory and practice. Routledge.

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Caballero, A. (2021). 18 infographic design tips every marketer should know. Retrieved April 20, 2021, from https://visme.co/blog/infographic-­design-­tips Chan, L. T. (2000). Colonization, resistance and the uses of postcolonial translation theory in twentieth-century China. In S. Simon & P. St-Pierre (Eds.), Changing the terms: Translating in the postcolonial era (pp. 53–69). University of Ottawa Press. Cruickshank, K. (2008). Arabic-English bilingualism in Australia. Encyclopedia of Language and Education, 5, 281–294. Retrieved May 20, 2021, from https://link.springer.com/referenceworkentry/10.1007%2F978-­0-­387-­304 24-­3_131 Dalton-Oates, B. (2017). Medical translation: The neglected human right. International Journal of Human Rights in Healthcare, 10(4), 228–238. De Varennes, F. (2001). Language rights as an integral part of human rights. International Journal on Multicultural Societies, 3(1), 15–25. ELP. (2020). COVID-19 information in indigenous, endangered, and under-­ resourced languages. Retrieved May 11, 2021, from https://endangeredlanguagesproject.github.io/COVID-­19/ Federici, F.  M. (2020). Translation in contexts of crisis. In E.  Bielsa & D. Kapsaskis (Eds.), The Routledge handbook of translation and globalization (pp. 176–189). Routledge. Gouanvic, J. M. (2000). Legitimacy, marronnage and the power of translation. In S. Sim & P. St-Pierre (Eds.), Changing the terms: Translating in the postcolonial era (pp. 101–111). University of Ottawa Press. Kuswarini, P., Hasyim, M., & Chotimah, I. N. H. (2020). Othering the self as a form of mimicry in the English translation of Hirata’s Laskar Pelangi. Journal of Critical Reviews, 7(19), 1286–1295. Lefevere, A. (1999). Composing the other. In S. Bassnett & H. Trivedi (Eds.), Post-colonial translation: Theory and practice (pp. 75–94). Routledge. Montalt, V., Zethsen, K. K, & Karwacka, W. (2018). Medical translation in the 21st century-challenges and trends. MonTI.  Monografías de Traducción e Interpretación, 10, 27–42. Retrieved May 17, 2021, from https://doi. org/10.6035/MonTI.2018.10.1 Mukherjee, A., Godard, B., & Mukherjee, A. (2006). Translating minoritized cultures: Issues of caste, class and gender. Postcolonial Text, 2(3), 1–23. Retrieved February 23, 2021, from https://www.postcolonial.org/index.php/ pct/article/viewFile/501/309 Niranjana, T. (1992). Siting translation: History, post-structuralism, and the colonial context. University of California Press.

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O’Brien, S., & Federici, F. M. (2019). Crisis translation: Considering language needs in multilingual disaster settings. Disaster Prevention and Management: An International Journal, 29(2), 129–143. https://doi.org/10.1108/DPM-­11­2018-­0373 Parliament of Australia. (2021). Migration statistics. Retrieved April 12, 2021, from https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/ Parliamentary_Library/pubs/rp/rp1617/Quick_Guides/MigrationStatistics Simon, S. (1997). Translation, postcolonialism and cultural studies. Meta: Translators’ Journal, 42(2), 462–477. Simon, S., & St-Pierre, P. (Eds.). (2000). Changing the terms: Translating in the postcolonial era. University of Ottawa Press. Spivak, G. C. (1993). Outside in the teaching machine. Routledge. Taylor, J. (2020). How a trust breakdown left Melbourne’s minority communities hardest hit by Covid second wave. The Guardian. Retrieved May 18, 2021, from https://www.theguardian.com/australia-­news/2020/aug/30/ how-­a-­breakdown-­of-­trust-­left-­melbournes-­ethnic-­communities-­hardest-­ hit-­by-­covid-­second-­wave Tymoczko, M. (1999). Translation in a postcolonial context: Early Irish literature in English translation. Routledge. UNHCR. (2020). Global Trends Report. Forced Displacement in 2019. Geneva: United Nations High Commissioner for Refugees. Retrieved May 11, 2021, from https://www.unhcr.org/globaltrends2019/ WHO. (2017a). Strategic communications framework for effective communication. World Health Organization. Retrieved August 20, 2020, from https://www. who.int/mediacentre/communication-­framework.pdf WHO. (2017b). Communicating risk in public health emergencies. A WHO guideline for emergency risk communication (ERC) policy and practice. World Health Organization. Retrieved May 18, 2021 from http://apps.who.int/iris/ bitstream/10665/259807/2/9789241550208-­eng.pdf?ua=1 Wolf, M. (2000). The third space in postcolonial representation. In S. Simon & P.  St-Pierre (Eds.), Changing the terms: Translating in the postcolonial era (pp. 127–146). University of Ottawa Press. Wolf, M. (2002). Censorship as cultural blockage: Banned literature in the late Habsburg monarchy. TTR: Traduction, Terminologie, Rédaction, 15(2), 45–61. Wolf, M. (2014). Culture as translation—and beyond ethnographic models of representation in translation studies. In T. Hermans (Ed.), Crosscultural transgressions: Research models in translation studies II, historical and ideological issues (pp. 180–192). Routledge.

4 Translating the COVID-19 Pandemic Across Languages and Cultures: The Case of Argentina María Laura Spoturno

Introduction Wednesday 11 March 2020 singles out the day when our lives became individually and collectively affected by the COVID-19 crisis. On that day, the World Health Organization (WHO) declared the pandemic status of the public health crisis. As I finish writing this chapter in May 2021, the WHO reports over 162,184,263 coronavirus cases, of which 158,819,817 people have recovered and 3,364,446 people have died. In Argentina alone, over a total of 3,269,466 reported cases, 3,199,613 people have recovered, and 69,853 people have died.1 On 19 March 2020, President Alberto Fernández established a nationwide measure that introduced social, preventive, and mandatory isolation in all the This research was supported by the Agencia Nacional de Promoción Científica y Tecnológica [PICT 2017–2942], the Consejo Nacional de Investigaciones Científicas y Técnicas, and the Universidad Nacional de La Plata [H/825], Argentina.

M. L. Spoturno (*) Universidad Nacional de La Plata, Consejo Nacional de Investigaciones Científicas y Técnicas, La Plata, Argentina © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 F. M. Federici (ed.), Language as a Social Determinant of Health, Palgrave Studies in Translating and Interpreting, https://doi.org/10.1007/978-3-030-87817-7_4

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Argentinean territory. The measure, locally known as ‘Aislamiento Social, Preventivo y Obligatorio’ (Preventive and mandatory social isolation) or by its acronym, ASPO,2 was eventually extended through successive presidential edicts to last 234 running days. A transition period complemented the ASPO, initiated in November 2020 and locally known as ‘Distanciamiento Social, Preventivo y Obligatorio’ (Preventive and mandatory social distancing) or DISPO.  Like other regions of the world, Argentina is today facing a second and much more aggressive wave of COVID-19. By presidential edict, circulation and gatherings have been restricted again and school activities moved online to prevent the wider spread of the virus and the collapse of the health system in the Buenos Aires Metropolitan area, known as AMBA, which concentrates about 40% of the population of Argentina. COVID-19 health policies implemented by the national government have found resistance in different social and political sectors. Most notably, the centre-right opposition has claimed that the measures imply a restriction to personal freedoms. Last month, the city of Buenos Aires filed a pledge against the National State to keep schools open that reached and was successful in the Supreme Court. The COVID-19 crisis has significantly affected the way in which science and politics relate, with governments and the public showing profound distrust in scientific advice (Horton, 2020a). Unlike other crises, the so-called COVID-19 pandemic has penetrated every aspect of our lives, transforming the way we experience, perceive, and talk about reality, and altering once and for all what had been traditionally understood as ‘normality’ (Alexander, 2016, p. 14). Language has been distinctly affected by the increasing presence of the virus in our lives. For the Spanish language, the Real Academia Española has already introduced new words in their language dictionary to acknowledge the new reality. Notably, the noun Covid, which can be used either as a feminine or masculine form, is defined as an ‘acute respiratory syndrome produced by a coronavirus.’3 The word confinamiento (confinement/ lockdown) has been redefined to acknowledge its use related to the specific situation of the COVID-19 pandemic lockdown. In the same fashion, the verb cuarentenar, a derivative of the noun cuarentena, now describes preventive isolation due to sanitary reasons.4 Similarly, English has experienced processes of lexical resemanticisation. The expanded use

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of words such as ‘lockdown’ and ‘peaks,’ which often acquire specific meanings within the same country, have required people to become fast learners in the fields of ‘semantics as much as epidemiology’ (Pérez-Peña, 2020). Lexicographers have registered an ‘exponential rise in usage of a single word,’ ‘COVID-19,’ with the power to ‘dominate global discourse’ (Flood, 2020: online). This surge prompted lexicographers to revise the Oxford English Dictionary (OED) to record the impact of the crisis in the English language. A descriptive entry for ‘COVID-19’ was introduced in the OED in April 2020.5 Naturally, the COVID-19 crisis has also had a massive impact on scientific productivity yielding ‘a torrent in science,’ a ‘flood of research on the coronavirus’ (Else, 2020, p.  553). These increasingly critical times have shown how scientific research, which typically translates into research papers and circulates among the scientific community, is now quite rapidly reframed through intra/interlingual as well as intermedial/ modal operations into news articles, reports, commentary, editorials, and explanatory videos that are disseminated locally and globally in the (social) media for wider and, no doubt, diverse audiences. While COVID-19 related scientific advancements, risk protocols, and recommendations made in Argentina are communicated in Spanish in nationwide newspapers and other media, a relevant portion of the news in this field is introduced in the local Argentinean scenario through the translation of materials originally disseminated in English in Anglophone spaces, which, in turn, many times reproduce parts, extracts, or reviews of scientific research or relevant political communications. These spaces, which appear as significant to understand and prepare for the different stages of a cascading crisis (Alexander & Pescaroli, 2019; O’Brien & Federici, 2019; Grimson, 2020), actively contribute to shaping public opinion. Thus, language and translation play a key part, albeit seldom recognised, both in shaping and in communicating the sanitary global crisis (Federici, 2016; O’Brien & Cadwell, 2017; O’Brien & Federici, 2019). The crisis has also had a dramatic effect on the already strenuous conditions affecting the production, translation, and recontextualisation of news reports, articles, stories, and editorials, doubling, in some cases, the workload of translators (J. Arrambide, personal communication, 11

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May 2021). In the context of an unprecedented crisis that perpetuates and enhances inequalities, the social and ethical role of media communicators and translators is crucial for raising awareness, securing access to health services, and reducing risks and hazards.

Research Aims and Methodological Approach The overall aim of this chapter is to contribute to the broader discussion of the role of language and translation in the communication and determination of health risks and hazards across linguistic, cultural, and health systems through the example of Argentina. I will argue that translation in the media is instrumental in shaping discursive configurations and public opinion with a strong but different impact on the perception of COVID-19 related risks and hazards in various sectors and regions of the country. Informed by scientific debates and looking at how these translate into media news and events, I explore the specific role of translation in locally communicating the COVID-19 pandemic. This investigation is based on a ‘mixed’ approach that combines the study of discursive, rhetorical, and contextual features with the consideration of their effects on translations as products in the field of news production. The texts selected for this study consist of a set of digital news articles and reports published in the online versions of the Argentinean newspapers Clarín, La Nación, Infobae, and Página 12 during the ongoing COVID-19 crisis. The selected news items bear a direct relation to COVID-19 findings produced and disseminated within the scientific community which have been reported in the online versions of The New York Times, The Washington Post, and in the BBC News online news coverage. As will be seen below, these texts can be seen as the result of multiple processes of translation, translation being here understood in a broad sense. The selection also includes COVID-19 related news items which, because of their political significance in the global scenario, become locally relevant. Unstructured interviews with translators, journalists, and a bioethics expert, conducted during May 2021, have complemented the analysis of the texts and of the process of translating in the media. The news articles and reports illustrate three COVID-19 relevant

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areas: how COVID-19 crisis is named, the methods implemented to control the spread of the virus, and the possibility of treatment against COVID-19. The news items selected are representative of the role of translation in the local media in Argentina. Through a qualitative methodology, the analysis firstly looks at the general mechanics of news production and translation in the media, that is, the reshaping, synthesis, and transformation of information to adjust to the new context and target conditions (Bielsa & Bassnett, 2009; Scammell, 2018), to later focus on the situated socio-discursive reconfiguration of meaning performed through various forms of translation into Argentinean Spanish. Translation in the media often implies various degrees of linguistic, discursive, generic, as well as cultural transformation (Gambier, 2006;  Schäffner & Bassnett, 2010). The specific nature of the current study imposes the consideration of such transformations as they are materialised in textual chains across the fields of science, public health systems, international politics, investigative (scientific) journalism, and translation in the context of the COVID-19 crisis. The methodological approach adopted here intends to clarify these transformative translation processes and operations which highlight the dialogic nature of textual chains in news production, translation, and dissemination. In the last section, I present a few conclusions derived from the analysis conducted and a comment on certain aspects common to news translation and translation in the news in the current global sanitary emergency.

Case Studies What’s in a Name? Designating an Unparalleled Crisis By declaring the COVID-19 crisis a pandemic, the WHO determined its magnitude and the kind of strategic approaches that should be adopted to deal with the sanitary emergency. However, within the scientific community, the status, and, therefore, the term used to describe the COVID-19 crisis have been a matter of open discussion. Reputed scientists such as Richard Horton and Merrill Singer point out that the spread

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of COVID-19 should be addressed as a syndemic, rather than a pandemic. The term ‘syndemic’ would, in their opinion, better account for the complex interaction of health, social, and environmental crises at stake in this extraordinary global phenomenon. Adopting such a critical perspective implies acknowledging that poorer countries and minority communities are ‘disproportionately targeted in terms of both morbidity and mortality’ (Singer & Rylko-Bauer, 2021, p.  8) and, consequently, that a ‘more nuanced approach is needed’ inasmuch as ‘a purely biomedical solution to COVID-19 will fail’ (Horton, 2020b, p. 874). In other words, the term ‘syndemic’ points to the relation of COVID-19 to much deeper structural problems such as poverty and social inequalities. Other specialists believe that given the large population affected by COVID-19, it is pragmatically more operative to use the term ‘pandemic,’ although they note that ‘every pandemic is, in fact, syndemic’ (J.C. Tealdi, personal communication, 29 April 2021). On 26 September 2020, Horton, the editor-in-chief of The Lancet, published a one-page comment in this medical journal, in which he stated his position regarding the syndemic nature of the current crisis, pointing out that the approaches adopted so far were too limited in scope and, therefore, ineffective (Horton, 2020b). As described in the literature, COVID-19 infection may, and often does, fatally interact with certain non-communicable diseases,6 especially within more vulnerable populations (Clark et  al., 2020; Kluge et  al., 2020). In Horton’s and other scientists’ opinion, a more nuanced integral approach is crucial if health policies are truly to protect people’s well-being. This is of vital importance particularly in the case of less privileged groups such as the elderly, health workers, and minority ethnic communities, in poorer countries and in some regions of Asia, Latin America, and the US. Following various interlingual and intermedial translation processes, Horton’s comment and other sources of scientific information originally produced in English were diversely recontextualised and transformed through different genres across languages and cultures.7 The translation of scientific contents to be disseminated among non-specialist readerships implies different degrees of selection and adaptation oriented to serve specific goals, values, and interests. BBC News Mundo published two news items that had an impact on the Argentinean media: a short

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article in Spanish summarising the opinion of scientists Horton, Singer, and Tiff-Annie Kenny (October 9, 2020) and a short article on the same subject with an explanatory video in Spanish (October 14, 2020), a format which is probably accessible to wider audiences. Incidentally, it should be noted that this topic did not make it into a news article in English within BBC News Services but was exported, in this case, through BBC Mundo Spanish to Spanish-speaking Latin America. The day after BBC News Mundo released their second article and video, the international section of the nationwide paper La Nación (2020a) in Argentina reproduced its verbal and audiovisual components almost exactly. A hyperlink to the explanatory video is also included in the publication. Presented with its characteristic iconography, the service BBC News Mundo is credited as the source of information in the Argentinean paper. As part of BBC World Service, BBC Mundo Spanish has syndication partnerships with different media in Latin America, including La Nación. In practical terms, this syndication partnership enables a number of news items to be reproduced in the Argentinean paper. Out of the first selection of items made by the British news service, local editors make their own selection according to local editorial policies and targeted readerships. News circulation works on dynamics that artificially and at times ideologically limit the number and types of items that may be disseminated. A comparative analysis of these materials reveals the extent of editorial intervention materialised in the addition of bold type, question marks in the title, and a photo, all of which serve to stress the interrogative nature of the headline and orient readers’ attention to certain key terms while guiding their interpretation of the article. No further discursive or institutional adjustments relating to the conditions of news reception are made evident. The publication of such articles, which may foster the illusion that their readers access BBC Mundo Spanish ‘first hand,’ contributes to shaping the profile of the ideal reader of this local paper. A different approach towards this debate is adopted by the daily newspaper Página 12. Published online in the section ‘Sociedad’ on 10 October 2020, the article presents the terminological problems relating to the nouns ‘pandemic’ and ‘syndemic’ but fails to stimulate, however, any reasoned or useful discussion on the subject for the new receiving readership. Introduced by a general reference to The Lancet, the article in Página

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12 directly equates what may be this journal’s editor-in-chief ’s opinion, expressed through his comment, with the general view of this scientific journal: ‘La revista médica The Lancet [sic] considera que se está adoptando un enfoque demasiado estrecho para manejar el brote de coronavirus.’ (The medical journal The Lancet [sic] believes the approach that is being adopted to manage the outbreak of the coronavirus to be too narrow).8 An overall metalinguistic character is suggested in the interrogative statement in the headline: ¿Por qué especialistas afirman que el coronavirus no es una pandemia? (Why do specialists believe that the coronavirus is not a pandemic?). The statement specifically emphasises the linguistic element of the debate, moving the focus on talking about the terminology in use, hence considering some metalinguistic features that the journalists found important to front in their articles. Hence, this metalinguistic character is explicitly materialised through the use of inverted commas to mark the noun ‘sindemia’ (syndemic) in the sub-­ head and reinforced through the use of bold type in the headline. All of these devices serve to single out the term ‘sindemia’ that is being defined in the article. This editorial choice evidences an awareness of the new readers who may not be familiar with the term at all as the term ‘sindemia’ has not yet been recorded in the Real Academia Española language dictionary. Bold type is also employed to highlight the names of scientists Richard Horton, Merrill Singer, and Tiff-Annie Kenny as well as the use of direct translated quotes. The glosses used to specify the syndemic nature of the COVID-19 crisis build mainly on these translated excerpts which have been extracted from Horton’s comment and from other articles and interviews disseminated by the BBC. Even if the hyperlink to the British publication is included, the translational nature of the passages is not explicitly acknowledged, creating, at least for some readers, the impression that the scientists were speaking or writing in Spanish. More experienced readers may identify the traces of a marked syntax in the title and in some of the translated passages. This, together with the addition of the hyperlink, is revealing of the article’s organisation and structure, which relies on the assemblage of (translated) fragments with no evident argument of its own regarding the actual and local relevance of the topic for the new receiving readership. Travelling across genres, languages and reading cultures, the scientific content has been subject to fundamental

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transformation through different translation procedures. The focus on the metalinguistic meaning of the term ‘syndemic’ has clouded the complex bioethical issue at the heart of the source texts. All stages in this recontextualisation process must be attributed to editorial intervention as no journalist takes credit for the article. Signed by health journalist Valeria Chavez, the third news article selected was published online in Infobae on 3 October 2020, that is, a few days before the BBC publications. A vague reference to a publication in The Lancet serves as the lead to the article, which, as was the case with Página 12, provides no exact reference to Horton’s piece but includes a hyperlink to his text. The headline actually echoes the title of his comment confirming that COVID-19 is not a pandemic but a syndemic. This notion is only partially developed in the news article, which rather elaborates on the problem of non-communicable diseases affecting the local scenario during 2020. In dealing with the data recorded at health centres in the area of Buenos Aires, the article neglects the role socio-­ economic inequalities play in an already existing complex situation, now further exposed by the sanitary emergency. The voices of well-known specialists in the areas of oncology, cardiology, and neurology contribute to raising awareness about the impact regular check-ups have on the early diagnosis and treatment of various non-communicable diseases. Statistics and data provided describe this scenario in Argentina and other countries, as compared to 2019. Effected through various translation processes, recontextualisation seems to serve the goals and interests of a targeted receiving readership with access to (private) health-care services. The core argument of Horton’s piece, the source text, is diluted amidst references to sophisticated check-ups and surveys. Overall, by readjusting the focus of interest, the scenario portrayed in the article is alien to the critical perspective that infuses the debates on the syndemic nature of the COVID-19 crisis. As is customary practice, translated texts, which are not acknowledged as such, have been rendered into Spanish by the journalist (V. Chavez, personal communication, 5 May 2021). While the fact that there is no explicit information regarding the status of these texts as translations is not exceptional (Schäffner & Bassnett, 2010), it, nonetheless, reinforces the passive role the readers of such news are assigned in such publications.

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 erd Immunity at the Crossroads of Public Health H Policies, Science, and Ethics By October 2020, the question whether to slow or hasten the spread of the virus as a response to the COVID-19 crisis became a major concern across the globe. The issue raised considerable controversy among scientists, medical specialists, and health policymakers and planners. On 4 October 2020, three distinguished scientists based in influential institutions of the US and the UK released a document called the Great Barrington Declaration (GBD).9 The GBD, published now in 43 languages on its official site, has to date been endorsed by 844,643 people worldwide, most of whom are concerned citizens. The recommendation of a so-called Focused Protection approach, that is, a strategy that could ‘balance the risks and benefits of reaching herd immunity,’ allowing ‘those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk’ (Kuldorff et  al., 2020, p. n.p.), inspired both approval and criticism. In a public briefing on 12 October 2020, WHO Director-General Tedros Adhanom Ghebreyesus categorically stated that there is no precedent in the history of public health for the use of herd immunity as a strategy to respond to a pandemic.10 The possibility of implementing such a ‘method’ would be, in his opinion, ‘scientifically and ethically problematic.’ The problem, as he pointed out, lies in the definition of ‘herd immunity,’ which should be understood as ‘a concept used for vaccination, in which a population can be protected from a certain virus if a threshold of vaccination is reached.’ This view, however, has been contested even within the WHO, as is suggested by Dr David Nabarro, a WHO special envoy, in an interview with The Spectator.11 In a critical and direct response to the proposal of a herd immunity approach, on 14 October 2020, a number of scientists published a document known as the John Snow Memorandum (JSM) in The Lancet and later online.12 Signatories of the JSM agreed that ‘[a]ny pandemic management strategy relying upon immunity from natural infections for COVID-19 is flawed’ (Alwan et al., 2020, p. e71). It is, in their opinion, ‘a dangerous fallacy unsupported by scientific evidence’ (ibid.). Indeed, evidence so far would

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suggest the opposite: ‘controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months’ (ibid., p. e72). In Horton’s opinion (2020a), the prevailing disagreement among scientists (GBD vs JSM) should not lead us to believe that individual responsibility is the way out of this critical situation nor make us oblivious to the fact that ‘[i]nfection doesn’t guarantee immunity’ and that ‘[l]ong COVID-19 is a cause for concern’ (ibid., p. 1319). The proposal in the GBD was subject to serious consideration in the White House, although top presidential advisor Anthony Fauci publicly disqualified a herd immunity strategy as ‘total nonsense’ (Fauci, 2020). President Trump’s administration nevertheless embraced herd immunity as a strategy to cope with the sanitary crisis, which triggered a wide range of media publications across languages and cultures. US national papers such as The Washington Post and The New  York Times and the weekly magazine Newsweek promptly reported on the event. Published online on 14 October 2020, Joel Achenbach’s report in The Washington Post, of special interest in this chapter, drew attention to the harsh criticism that the herd immunity or Focused Protection approach received among many scientists and health workers around the world. Made on a tight deadline, the translation of Achenbach’s report was published in the international section of La Nación almost simultaneously. As mentioned above, the specific news articles that may be disseminated through translation in the Argentinean paper depend on the existing syndicate agreements between the two companies. It is not the norm for newspaper companies in Argentina to have in-house translators, La Nación being an exception to this rule. The translation of this news report was rendered and signed by Jaime Arrambide, translator-in-chief of La Nación (2020b). In the case of this translated report, editorial intervention is reflected in the final version of the headline and in the use of bold type, which serve as a reading instruction establishing what is to be read as central. However, the voracity of online publishing has meant that digital articles are no longer subjected to the scrutiny of style correctors. Rendered by a professional translator, the report in Spanish illustrates key aspects of news translation. A conscious awareness of the new receiving readership guides the internal reorganisation of the article, in which

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recontextualisation techniques, including the use of explanatory and specifying glosses and the replacement and addition of names, roles, or other relevant information, are in order: ‘in at least one state capitol’/‘en la legislatura de al menos uno de los estados norteamericanos’ (in the legislature of at least one of the US American States); ‘Atlas’/‘el neurorradiólogo Atlas’ (neuroradiologist Atlas); ‘Florida Gov. Ron DeSantis’/’el gobernador de Florida, el republicano Ron DeSantis’ (Florida Governor, the Republican Ron DeSantis); ‘Sun Belt states’/‘la región conocida como el “cinturón del Sol”’ (the area known as the ‘Sun Belt’). Both rationalisation and expansion play a significant role in building Arrambide’s voice as a news translator of La Nación: ‘A senior administration official told reporters in a background briefing call Monday’/‘El lunes, en conferencia telefónica con periodistas, un alto funcionario de gobierno’ (On Monday, in a telephone press conference with journalists, a senior administration official). Over the years, Arrambide has managed to establish a name as a translator, perfecting his style with a clear idea of his readership in mind. The urgency of translating the COVID-19 crisis led Arrambide (personal communication, 11 May 2021) to elaborate an ‘emergency translation code’ with his readers, a ‘scaffolding’ that would serve as a dynamic basis for each new translation. A consistent COVID-19 glossary shapes the translator’s work. This translation, for example, has contributed to introducing the technical neologism covid-prolongado (‘long-covid’), which is used to refer to the prevailing effects of COVID-19, into everyday Spanish. The translator’s subjectivity is embedded in the text in the use of certain words and local idiomatic expressions. For instance, the more matter of fact ‘it presents no data’ is rendered colloquially as ‘no presenta un solo dato’ (emphasis added), which underscores the lack of evidence in the GBD. Similarly, the already colloquial ‘just doing whatever they damn want’ becomes ‘simplemente hacer lo que se les cante’ (just doing it willynilly), a local expression Arrambide uses in order to bridge the distance with his readership and to talk to people ‘in the first person’ (J. Arrambide, personal communication, 11 May 2021). In the same fashion, by singling out certain terms such as ‘protección focalizada’ (‘Focused Protection’ in the source text), the translator is drawing the readers’ attention not only to the term but also to the validity of the concept, now presented as

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contested in the translation. Also remarkable in the translated article is the word ‘lockdown,’ which is strategically rendered as ‘cuarentena,’ rather than ‘confinamiento,’13 The term ‘confinamiento,’ which is reminiscent of the language used during the last dictatorship in Argentina, was resemanticised in the discourse of sectors who were critical of the public health policies implemented by the Argentinean government at the outbreak of the crisis. An open letter signed by a number of intellectuals, politicians, and scientists was locally circulated in the media and social networks in May 2020 (Clarín, 2020). The implications in the blended neologism infectadura (infección/infectología + dictadura) created in that letter to characterise government policies also met with adverse reactions in other sectors of society (Ballarino, 2020; Tealdi, 2020). As is usually the case with international news presented as translated news, the overall structure and contents of Achenbach’s original report are preserved, and there is no room to discuss the validity of the herd immunity approach in Argentina. A different, broader perspective on the subject and other COVID-19 relevant topics is offered in the report signed by science journalist Florencia Cunzolo, published in the online edition of Clarín on 22 October 2020. Through processes of synthesis, reorganisation, and translation, her article presents scientific data produced both in Argentina and abroad providing a personal insight on eight aspects of COVID-19. Careful enough not to explicitly assert her subjectivity, the report still conveys the journalist’s position in the section ‘La falacia de la inmunidad de rebaño,’ which translates the critical judgement in the JSM (Alwan et al., 2020). Scientific information and jargon are skilfully reframed through smooth syntactic patterns, which make the report more accessible to a wider educated but non-specialised readership. Probably by editorial intervention, at a discursive level, bold type, which is used to focus on certain terms and fragments, operates as a precise reading instruction. Hyperlinks to other news articles published in the same paper and the addition of a didactic video on aerosols contribute to the better readability of the article as a whole. While Clarín offers professional translation services, Cunzolo (personal communication, 5 May 2021), as much as her colleagues, typically provides her own translations. A cautious journalist, even when translations are offered by news agencies, Cunzolo makes sure to double-check

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those translations against the originals. In this case, the journalist has produced interlingual and intralingual renderings of several fragments from different scientific and non-scientific sources. The translations in the report do not always offer exact renderings but rather synthesise ideas published in English in videos, open letters, interviews, and scientific papers. Of the eight aspects featured in the article, four are of most significance to the debate on the validity of herd immunity: COVID-19 long-term symptoms and sequels, reinfections, vaccines, and the fallacy of herd immunity. The development of these aspects mainly relies on scientific knowledge produced within well-known health institutions based in the US and British and US scientific journals such as Nature, The Lancet, or Science. Scientific data are introduced in the local report through various forms of generic, language, cultural, and institutional transformation. More often than not, the elaboration of news reports relies on pre-existing texts, which function within the conventions of other genres in quite different contexts (Schäffner & Bassnett, 2010). The dialogic translational nature of scientific journalistic discourse is clearly revealed through this example. Reference to the original sources of information is rather indirect and opaque as hyperlinks lead to other news items published in Clarín.

 opes for Treatment and Treatment Hopes Against H COVID-19 As public health policymakers and government COVID-19 task forces spent most of 2020 trying to design and implement strategies to contain or mitigate the COVID-19 crisis, scientists, pharmaceutical companies, and certain governments were actively engaged in developing safe and effective vaccines against the infectious disease. While this challenge was successfully completed in record time, the effectiveness of clinical treatments for COVID-19 has so far been modest in comparison. In April 2020, the Covax scheme was set up to ensure ‘global equitable access to COVID-19 vaccines.’14 As I write this chapter, only a few countries have managed to inoculate a substantial portion of their population. In many countries, people still hold out hopes for treatment against COVID-19.

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According to the WHO, approved drugs for COVID-19 treatment such as dexamethasone and remdesivir are not equally effective in all cases and should be assessed in relation to each patient’s clinical history and condition. Despair and the unknown may drive and have driven people to self-administer drugs and substances under the false belief that this could serve as preventive treatment. In March 2020, chloroquine and hydroxychloroquine hit the headlines worldwide after President Trump, a major player in the COVID-19 global scenario, publicly promoted their use to treat COVID-19 (Crowley et al., 2020). Since then, the WHO and other health institutions have fully clarified that these drugs, typically employed to treat malaria and some autoimmune diseases, have not yet been proven effective in hospitalised COVID-19 patients, emphasising that their administration without medical supervision may produce serious side effects. In spite of the error in Trump’s pronouncements, his words were immediately and globally reproduced and translated. Framed within an unstable political climate, the journalistic report of this news, although generally quite overtly condemnatory, triggered diverse reactions. Much to the benefit of certain businesses, some health centres in the US were driven to purchase large stocks of these medications. However, that was hardly the most serious problem as some ordinary people also took action. In March 2020, according to journalistic reports, at least one person in the US was reported to have died from ingesting a chloroquine product, and multiple poisonings were reported in Nigeria where several people treated themselves with chloroquine (Halle, 2020). Despite public widespread condemnation, ignoring health experts’ opinion again, Trump took a further step and suggested that home disinfectants should be tested against COVID-19 at a public briefing on 23 April 2020. Key extracts of this press conference were rapidly and widely reproduced in English through different intermedial translation operations to become the object of fierce criticism in the written media (BBC, 2020; Noor, 2020). Reframed through intermedial and interlingual translation processes, the news of President Trump’s absurd idea was also the object of condemnation (Lugones, 2020) and mockery (Mathus Ruiz, 2020) in nationwide newspapers in Argentina. In these news articles, the Spanish translation of Trump’s declarations is usually presented

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as direct speech interspersed with the word of scientists who discredited them. In Lugones’s article, published in Clarín on 24 April 2020, this translation operation serves to bridge the distance with the new readership as it inscribes the mandatory’s wrong notion in a familiar discursive environment. Translation in the article does not substantially contribute to creating a clear-oriented representation of the news reported in terms of its potential health risks and hazards for people. Rather, this news article as much as the report by Mathus Ruiz, a correspondent of La Nación in the US, frames Trump’s sanitary ‘nonsense’ within his political agenda and bad relationship with the press. In an electoral year, the scandal contributed to weakening his image and popularity as a presidential candidate even if he soon said that he was just being ‘sarcastic’ (Dale, 2020). By August 2020, the use of disinfectants as treatment against COVID-19 was still a serious problem. Sadly, US presidential advisor Dr Fauci’s fear that people would do imprudent things after hearing the President suggest ‘injecting’ bleach to ‘treat’ COVID-19 disease became true, and not only in the US (Riotta, 2021). On 2 August 2020, Argentinean show-business figure and journalist Viviana Canosa posted a tweet in support of Andreas Kalcker, one of the leaders of the ‘bleach “cure” movement’ (Pilkington, 2021) and world-famous chlorine dioxide advocate. Two days after Canosa’s tweet, the Argentinean National Administration of Medicines, Foods, and Medical Technology (ANMAT) issued a public communication advising on the damage such a substance and other related products may cause to people’s health. Coincidentally or not, just a day after ANMAT’s public release, Canosa aroused great controversy as she drank what she assured viewers was chlorine dioxide on live TV. At the time, the journalist said in a careless and circumspect tone: ‘I am not making any recommendations, I’m just showing you what I do,’ a gesture that was regarded as sarcastic in some sectors who believed Canosa was already crafting her defence in the event of potential legal actions. A day after Canosa’s show, popular singer Andrés Calamaro also ventured his uninformed opinion on Twitter and said that ‘“dioxide” is the only cure we know’ for COVID-19. The local media reported on this, strongly condemning both Canosa and Calamaro, but the effects were dire. On 15 August 2020, in Plottier, a small town in the Province of Neuquén, Argentina, a healthy five-year-old child, who had been

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administered chlorine dioxide by his parents, suffered a multiple organ failure and died. The journalist was accused of illegal practice of medicine by a member of congress but was absolved in November 2020. The public communication of scientific findings implies a social and ethical responsibility, more so in the context of a global sanitary crisis that is taking the lives of thousands every day. As Trump’s and other figures’ declarations were being translated and reported through intra/interlingual, intermedial operations, their underlying seriousness was rather lost amongst criticism meant to discredit their public image. When ‘anecdotal as opposed to science-driven information’ (Fauci in Riotta, 2021) prevails, the danger that people’s health might be compromised is a major public concern. In the current predicament, this kind of scientifically uninformed dangerous declarations, disseminated widely through translation, tend to affect the most vulnerable more severely. The consequences can be and have been incommensurate.

Concluding Remarks This chapter has sought to explore how language and translation may contribute to determining the perception of health risks and hazards across discursive, cultural, and health systems in the communication of news related to the ongoing COVID-19 crisis. Accordingly, particular attention was given to news items which strongly rely on professional or journalistic translation in shaping their argument, structure, and discourse. Drawing on a broad notion of translation, the analysis has examined the way scientific knowledge is transformed across and within genres, languages, and cultures for communication to wider, diverse, non-specialised readerships. A set of articles and reports published in the Argentinean online newspapers Clarín, Infobae, La Nación, and Página 12 was selected according to three COVID-19 related areas of interest. These news items variously relate to others published online in The New York Times, The Washington Post, and the BBC News Services. Together they illustrate the dynamics of news travelling through translation, which is, at least, partially dependent, in some of the cases studied, on existing syndicate partnerships. As some of the examples have shown, by limiting

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what may actually be ‘imported’ (through translation) and disseminated locally, these partnerships influence the effective selection of news published, having, to a certain extent, the power to set agendas across language and cultural boundaries. Local targeted readerships, consumers of these ‘imported goods,’ are often unaware of the localising and recontextualisation processes carried out by translators, journalists, and editors. The first case selected examined the extent to which translation and localisation procedures may contribute to locally promote a debate on the underlying critical issues enclosed in the denomination of the ongoing crisis. The discussion of the syndemic nature of the crisis would imply acknowledging the existence of profound global structural social inequities and, consequently, calling for actions of collective solidarity as a global community. Conclusions are certainly not definitive but the debate over the more appropriate approach to address the sanitary emergency, materialised in the use of the key terms ‘pandemic’ and ‘syndemic,’ should have the potential to stimulate the discussion of socially and ethically relevant issues. However, the principal part translation may play in locally generating such discussion, which involves scientific data and their discursive presentation, is debilitated, as relevant data regarding the syndemic aspects of the sanitary emergency are not examined or produced at all. By alienating the critical component, the focus of the discussion is readjusted to better suit the interests and values of the new targeted readerships, with little transformative potential. The second case exemplifies the use of professional and journalistic translation in two news pieces, which contribute to locally introducing and questioning the validity of herd immunity as a strategy to cope with the COVID-19 crisis. The first, a translated news report, comes from the authorised committed voice of an experienced translator who, through successive translations, has managed to establish a translation COVID-19 code with his readers. Quite effective localisation techniques are made evident in the second piece, a news article signed by a science journalist who rejects herd immunity as a valid strategy in the current context. Relevant scientific debates produced both in Argentina and abroad are introduced in this report by a journalist with the capacity to communicate those debates to non-specialised readerships. Infused by an assertive tone, journalistic translation has, in this case, the potential to enable

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critical informed discussions within the new context of reception. Partial translations of key scientific papers and declarations, news items and communications included in these and other articles have contributed to resemanticising terms like ‘inmunidad de rebaño’ (herd immunity) in Argentinean Spanish and to introducing others such as ‘Covid-­ prolongado’ or ‘Covid-largo.’ The third case bluntly exposes how the perception of news related to COVID-19 risks and hazards may vary enormously across sectors and regions, even within the same country. Initiated internationally by powerful political leaders, and, locally, by show business celebrities, the discussion of the use of unproven or false dangerous treatments against COVID-19 triggered a significant number of both news articles and technical reports by sanitary authorities. It is a well-known fact that the selection, gathering, and recontextualisation of information may strongly contribute to shaping public opinion. This case questions the social and ethical role of media communicators and translators in accurately representing the potential damage the unsupervised ingestion of drugs and other substances can have. When the focus on health safety becomes secondary, the right to integrity is compromised leaving the most vulnerable sectors of society exposed. Translating the COVID-19 pandemic in the news is particular for a number of reasons. In the first place, the global nature of the crisis means that the international news items that are translated are of actual direct and immediate regional relevance. Consequently, the communication of COVID-19 related risks and hazards through translation in the news must simultaneously attend to local and global contingencies. To this end, translation, whether journalistic or professional, should account for the discursive, cultural, political, and economic aspects shaping the contour of health systems locally and across the world. Next, the urgency of communicating the crisis, the need to translate the COVID-19 pandemic, means that news translations and translation in the news is, more than ever, subject to extreme time constraints as well as other contextual factors (Holland, 2012). In addition, factors typically affecting textual reorganisation through translation in the news, such as differences between languages and rhetorical traditions as much as the needs of the new targeted readership must here be specifically interpreted in the

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context of an overwhelming sanitary crisis. No traditions are yet established, and people’s needs, which far exceed the remit of communication, must be apprehended in connection with the internal context and current public health policies and strategies in operation. Finally, this global crisis, which reinforces social inequalities and the disparity of access to health services, imposes additional ethical constraints on translators and communicators in general as they should estimate, as much as possible, the emotional, health, and physical impact COVID-19 related news may have on potential readers in various receiving contexts and readership cultures. Acknowledgements  I am extremely grateful to bioethics expert Juan Carlos Tealdi (Hospital de Clínicas, Universidad de Buenos Aires) and translator Jaime Arrambide (La Nación) for taking the time to answer my questions. I also thank journalists Florencia Cunzolo (Clarín) and Valeria Chavez (Infobae) for their contribution to my research.

Notes 1. See https://www.who.int/publications/m/item/weekly-­epidemiological-­ update-­on-­COVID-­19%2D%2D-­18-­may-­2021 (accessed May 25, 2021). 2. All legal norms of Argentina are published in the Boletín Oficial: https:// www.boletinoficial.gob.ar/ (accessed May 25, 2021). 3. Unless otherwise specified, all translations are my own. 4. See: https://www.rae.es/noticia/palabras-­nuevas (accessed May 25, 2021). 5. See: https://oed.com/view/Entry/88575495 (accessed May 25, 2021). 6. Non-communicable diseases include cancer, cardiovascular and respiratory diseases, diabetes, hypertension, obesity, and renal disease. 7. On recontextualisation processes, see Wodak (2000) and Blackledge (2005). 8. All translations into English are my own. 9. Written in English, the GBD is offered in 43 languages. Translations are attributed to specific individuals or translation agencies. See: https:// gbdeclaration.org/ (accessed May 25, 2021). 10. See: https://www.who.int/director-­general/speeches/detail/who-­director-­ general-­s-­opening-­remarks-­at-­the-­media-­briefing-­on-­COVID-­19% 2D%2D-­12-­october-­2020 (accessed May 25, 2021).

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11. See: https://twitter.com/i/status/1314573157827858434 (accessed May 25, 2021). 12. The JSM is presented in 10 languages on its website page with English signalled as the definitive version. The task of volunteer translators is acknowledged. See: https://www.johnsnowmemo.com/ (accessed May 25, 2021). 13. The Spanish version of the GBD uses the term confinamiento followed by ‘lockdown’ between parentheses. 14. See https://www.who.int/initiatives/act-­accelerator/covax (accessed May 25, 2021).

References Achenbach, J. (2020, October 14). Proposal to hasten herd immunity to the coronavirus grabs White House attention but appals top scientists. The Washington Post. Retrieved May 4, 2021, from https://www.washingtonpost. com/health/covid-­herd-­immunity/2020/10/10/3910251c-­0a60-­11eb-­859b-­ f9c27abe638d_story.html Alexander, D. (2016). How to write an emergency plan. Dunedin Academic Press. Alexander, D., & Pescaroli, G. (2019). The role of translators and interpreters in cascading crises and disasters. Towards a framework for confronting the challenges. Disaster Prevention and Management, 29(2), 144–156. Alwan, N. A., Burgess, R. A., Ashworth, S., Beale, R., Bhadelia, N., Bogaert, D., Dowd, J., Eckerle, I., Goldman, L. R., Greenhalgh, T., & Gurdasani, D. (2020). Scientific consensus on the COVID-19 pandemic: We need to act now. The Lancet, 396, e71–e72. Ballarino, F. (2020, June 3). Médicos repudiaron la referencia a una ‘infectadura. Perfil. Retrieved May 18, 2021, from https://www.perfil.com/noticias/ciencia/medicos-­repudiaron-­la-­referencia-­a-­una-­infectadura.phtml BBC. (2020, April 24). Coronavirus: Outcry after Trump suggests injecting disinfectant as treatment. BBC News. Retrieved May 10, 2021, from https:// www.bbc.com/news/world-­us-­canada-­52407177 BBC News Mundo. (2020, October 14). COVID-19: qué es una sindemia y por qué hay científicos que proponen llamar así a la crisis del coronavirus. BBC News Mundo. Retrieved April 30, 2021, from https://www.bbc.com/mundo/ noticias-­54543375 Bielsa, E., & Bassnett, S. (2009). Translation in global news. Routledge.

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Blackledge, A. (2005). Discourse and power in a multilingual world. John Benjamins. Chavez, V. (2020, October 3). Por qué el COVID-19 es una sindemia, no una pandemia. Infobae. Retrieved April 30, 2021, from https://www.infobae. com/america/tendencias-­a merica/2020/10/03/por-­q ue-­e l-­c ovid-­1 9-­e s­una-­sindemia-­no-­una-­pandemia/ Clarín. (2020, May 29). ‘La democracia está en peligro,’ la carta abierta de intelectuales y científicos que alerta sobre el ‘eficaz relato de la infectadura.’ Clarín. Retrieved May 18, 2021, from https://www.clarin.com/politica/-­ democracia-­peligro-­carta-­abierta-­intelectuales-­cientificos-­alerta-­eficaz-­relato-­ infectadura-­_0_AxrZQ6O5F.html Clark, A., Jit, M., Warren-Gash, C., Guthrie, B., Wang, H.  H. X., Mercer, S. W., Sanderson, C., McKee, M., Troeger, C., Ong, K. L., Checchi, F., Perel, P., Joseph, S., Gibbs, H.  P., Banerjee, A., & Eggo, R.  M. (2020). Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: A modelling study. The Lancet Global Health, 8(8), e1003–e1017. Crowley, M., Thomas, K., & Haberman, M. (2020, May 4). Ignoring expert opinion, Trump again promotes use of hydroxychloroquine. The New York Times. Retrieved May 10, 2021, from https://www.nytimes.com/2020/04/05/ us/politics/trump-­hydroxychloroquine-­coronavirus.html Cunzolo, F. (2020, October 22). Coronavirus: 8 cosas que aprendimos en los últimos meses. [online] Clarín. Retrieved May 5, 2021, from https://www. clarin.com/buena-­vida/coronavirus-­8-­cosas-­aprendimos-­ultimos-­meses_0_ nyeiAHb2W.html Dale, D. (2020, April 24). Fact check: Trump lies that he was being ‘sarcastic’ when he talked about injecting disinfectant. CNN. Retrieved May 19, 2021, from https://edition.cnn.com/2020/04/24/politics/fact-­check-­trump-­ disinfectant-­sarcastic/index.html Else, H. (2020, December 16). COVID in papers: A torrent of science. Nature, 588, 553. Retrieved May 12, 2021 from https://www.nature.com/articles/ d41586-­020-­03564-­y Fauci, A. (2020, October 15). Interview. Good Morning America. Retrieved May 5, 2021, from https://www.youtube.com/watch?v=zUR01LCJ50U Federici, F. M. (2016). Introduction: A state of emergency for crisis communication. In F. M. Federici (Ed.), Mediating emergencies and conflicts (pp. 1–29). Palgrave Macmillan.

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Flood, A. (2020, April 15). Oxford dictionary revised to record linguistic impact of Covid-19. The Guardian. Retrieved May 13, 2021, from https://www.theguardian.com/books/2020/apr/15/oxford-­d ictionary-­r evised-­t o-­ record-­linguistic-­impact-­of-­covid-­19 Gambier, Y. (2006). Transformations in international news. In K. Conway & S. Basnett (Eds.), Translation in global news. Proceedings, University of Warwick (pp. 9–22). University of Warwick. Grimson, A. (2020). Presentación El futuro después del COVID-19. In A.  Grimson (Ed.), El futuro después del COVID-19 (pp.  1–8). Jefatura de Gabinete de Ministros, Argentina. Retrieved May 13, from https://www. argentina.gob.ar/sites/default/files/el_futuro_despues_del_covid-­19.pdf Halle, T. (2020, March 23). Man dead from taking chloroquine product after Trump touts drug for Coronavirus. Forbes. Retrieved May 16, 2021, from https://www.forbes.com/sites/tarahaelle/2020/03/23/man-­d ead-­f rom-­ taking-­chloroquine-­after-­trump-­touts-­drug-­for-­coronavirus/?sh=710de0e 72e91 Holland, R. (2012). News translation. In C. Millán & F. Bartrina (Eds.), The Routledge handbook of translation studies (pp. 332–346). Routledge. Horton, R. (2020a). Science and politics in the era of COVID-19. The Lancet, 396, 1319. Horton, R. (2020b). COVID-19 is not a pandemic. The Lancet, 396(10255), 874. Kluge, H. H. P., Wickramasinghe, K., Rippin, H. L., Mendes, R., Peters, D. H., Kontsevaya, A., & Breda, J. (2020). Prevention and control of non-­ communicable diseases in the COVID-19 response. The Lancet, 395(10238), 1678–1680. Kulldorff, M., Gupta, S., & Bhattacharya, J. (2020, October 4). Great Barrington declaration. Retrieved May 26, 2021, from https://gbdeclaration.org La Nación. (2020a, October 15). Covid-19: ¿qué es una sindemia y por qué hay científicos que proponen llamar así a la crisis del coronavirus? Retrieved May 3, 2021, from https://www.lanacion.com.ar/sociedad/covid-­19-­que-­es-­s indemia-­que-­hay-­cientificos-­nid2480397 La Nación. (2020b, October 14). Coronavirus: la idea de acelerar la inmunidad de rebaño atrae a la Casa Blanca, pero aterra a los científicos (J. Arrambide, Trans.). Retrieved May 4, 2021, from https://www.lanacion.com.ar/el-­ mundo/la-­opcion-­acelerar-­inmunidad-­rebano-­capta-­atencion-­nid2479240/ Lugones, P. (2020, April 24). Coronavirus en EE.UU.: Trump sugiere inyectar desinfectante a los enfermos para matar al virus. Clarín. Retrieved May 10, 2021, from https://www.clarin.com/mundo/coronavirus-­ee-­uu-­trump-­sugiere-­ inyectar-­desinfectante-­enfermos-­matar-­virus_0_Kyr2jtcoz.html

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Mathus Ruiz, R. (2020, April 24). Coronavirus: los briefings de Trump, un show diario que deja atónito y perplejo a EE.UU. La Nación. Retrieved May  10, 2021, from https://www.lanacion.com.ar/el-­mundo/coronavirus­briefings-­de-­trump-­show-­dejan-­atonito-­nid2357916/ Noor, P. (2020, April 24). ‘Please don’t inject bleach’: Trump’s wild coronavirus claims prompt disbelief. The Guardian. Retrieved May 20, 2021, from https://www.theguardian.com/us-­news/2020/apr/24/trump-­disinfectant-­ bleach-­coronavirus-­claims-­reaction O’Brien, S., & Cadwell, P. (2017). Translation facilitates comprehension of health- related crisis information: Kenya as an example. Journal of Specialised Translation, 28, 23–51. O’Brien, S., & Federici, F. M. (2019). Crisis translation: Considering language needs in multilingual disaster settings. Disaster, Prevention and Management, 29(2), 129–143. Página 12. (2020, October 10). ¿Por qué especialistas afirman que el coronavirus no es una pandemia? Retrieved May 3, 2021, from https://www.pagina12. com.ar/298297-­p or-­q ue-­e specialistas-­a firman-­q ue-­e l-­c oronavirus-­ no-­es-­una-­p Pérez-Peña, R. (2020, April 4). Peaks, testing, lockdowns: How Coronavirus vocabulary causes confusion. The New York Times. Retrieved May 13, 2021 from https://www.nytimes.com/2020/04/03/world/europe/coronavirus-­ language-­confusion.html Pilkington, E. (2021, April 15). US company illegally peddling ‘miracle cure’ bleach for new Covid variants. The Guardian. Retrieved May 19, 2021, from https://www.theguardian.com/us-­news/2021/apr/15/us-­company-­florida-­ oclo-­bleach-­covid-­variants Riotta, C. (2021, January 26). Fauci feared Americans may ‘start doing dangerous and foolish things’ after Trump suggested ‘injecting’ bleach. The Independent. Retrieved May 16, 2021, from https://www.independent.co.uk/ news/world/americas/us-­p olitics/fauci-­t rump-­c oronavirus-­i njecting-­ bleach-­b1793023.html Scammell, C. (2018). Translation strategies in global news: What Sarkozy said in the suburbs. Palgrave Macmillan (E-book). Schäffner, C., & Bassnett, S. (2010). Politics, media and translation: Exploring synergies. In C. Schäffner & S. Bassnett (Eds.), Political discourse, media and translation (pp. 1–31). Cambridge Scholars Publishing.

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Singer, M., & Rylko-Bauer, B. (2021). The syndemics and structural violence of the COVID pandemic: Anthropological insights on a crisis. Open Anthropological Research, 1, 7–32. Tealdi, J.  C. (2020, June 14). Paternalismo y autonomía. El cohete a la luna. Retrieved May 20, 2021, from https://www.elcohetealaluna.com/ paternalismo-­y-­autonomia/ Wodak, R. (2000). Recontextualisation and the transformation of meanings: A critical discourse analysis of decision making in EU meetings about employment policies. In S. Sarangi & M. Coulthard (Eds.), Discourse and social life (pp. 185–206). Longman.

Part II Translating COVID-19 Credibility, Trust, Reliability

5 Translation Accuracy in the Indonesian Translation of the COVID-19 Guidebook: Understanding the Relation Between Medical Translation, Reception, and Risk Raden Arief Nugroho , Alfian Yoga Prananta, Syaiful Ade Septemuryantoro, and Achmad Basari

Introduction In 2020, the world was struck by the COVID-19 pandemic. As of 21 March 2021, 39,550 people had died due to COVID-19 in Indonesia.1 In the context of risk management of the COVID-19 outbreak in Indonesia, the Task Force for Handling the COVID-19 Outbreak launched a massive information campaign targeting the wider community (Ardiyanti, 2020). From the outset, the campaign disseminated information through one text entitled Guidelines for Corona Virus Disease

R. A. Nugroho (*) • S. A. Septemuryantoro • A. Basari Universitas Dian Nuswantoro, Semarang, Indonesia e-mail: [email protected] A. Y. Prananta Student of Doctorate Program of Linguistics, Universitas Sebelas Maret, Surakarta, Indonesia © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 F. M. Federici (ed.), Language as a Social Determinant of Health, Palgrave Studies in Translating and Interpreting, https://doi.org/10.1007/978-3-030-87817-7_5

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2019. Prevention, Control, Diagnosis, and Management (Liang et  al., 2020; henceforth C19GB). This text is originally in Chinese, but in 2020 it was translated initially into English by a group of translators from the School of Public Health, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China. The Task Force for Handling the COVID-19 Outbreak produced information distributed through various media (television, radio, social media) and continued to use multiple media and modalities to deliver its messages (e.g. audiovisual materials, leaflets, comic strips, short guidebooks). Information drawing upon the information contained in C19GB includes medical texts, infographics, and pictures. The Indonesian government amplified the campaign informed by the activities of the Task Force to reach the general population and the medical community alike. Its multimodal versions were circulated and were well-accepted by stakeholders in various communities. The Task Force aimed to educate the general population and the medical community about the dangers of the SARS-CoV-2 to reduce the spread, handle the contagion, cure those who contract it, and break the chain of the spread of COVID-19 in Indonesia (Bakhtiar et al., 2020). The COVID-19 pandemic entered Indonesia on 2 March 2020 (Ratcliffe, 2020). Early on, information about COVID-19 was still difficult to obtain. Many guides about this virus were available from abroad, especially from China, which published numerous texts both in Chinese and in English to disseminate risk management measures to deal with the disease. The Indonesian government based its information on these sources and began publishing its own guides in translation. The Indonesian translation discussed in this chapter is the result of translating the English version of C19GB. The English version itself was a translation carried out by the Chinese Preventive Medicine Association. Even though the official medical association presided over its translation, the profiles of the translators assigned to translate the original Chinese text into English were not easy to find, and their competence levels were not assessed by the authors of this chapter. The only information we could find was that the original Chinese text was translated by three translators, who are given the same prominence as authors (see Liang et al., 2020).

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Although translations of information about SARS-CoV-2 and COVID-19 are central in disseminating information to the public and the medical community, translating public health messaging is a highrisk activity (Fishbach, 1962; Karwacka, 2014; Montalt et al., 2018). As stated by Pym (2010a), medical information is likely to be one of the high-risk translation problems. Public health messaging falls into this category as information about SARS-CoV-2 was very new and scarce at the beginning, clouded in uncertainty. More studies then investigated its impact on the human body thus clarifying details that could be used to enhance the public health campaign. The interpretation of Indonesian translation neologisms and terminology concerning the disease poses issues at times for the target language readers. This is particularly acute among the general public due to low-literacy levels among the Indonesian population (Dilas et al., 2019). Furthermore, some of the English terminologies stirred strong reactions once translated. For instance, ‘social distancing’ was translated early on as ‘pembatasan sosial’ (‘maintaining social distancing’) and interpreted as constraining social mobility among the population. This interpretation caused anxiety, as could be expected when translating in crisis contexts. Eventually, the initial translation that created the ambiguity around social status was ditched, and a different term was chosen to indicate that spread is reduced by keeping a physical distance between people. The semantic misinterpretation of the translated guidebook has resulted in various losses across communities, ranging from financial losses to death (Dharmawan et al., 2019). After considering specific concepts of medical translation, this chapter discusses the findings of a study on translation accuracy. The study was carried out using a mixed-method approach involving three groups of participants. The first group consisted of experienced translators who evaluated the Indonesian translation of the English-source text (ST) of C19GB, which was the earliest reference book on handling COVID-19 and circulated widely in Indonesia in both English and Indonesian. The second group consisted of specialist readers (doctors) who were surveyed to gauge their reception of the translated text. The third group consisted of general readers who were also surveyed to gauge their understanding of the translated Indonesian version of C19GB. Different from the previous two groups, the latter group was the only group that did not read the

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English C19GB source text, because we assumed that any general readers must be able to read and extract information from the target text (TT) without checking the source text. Moreover, the findings confirm the risks connected with mistranslation and maltranslation (Dharmawan et al., 2019); the significance of this study for current debates concerning medical translation is analysed in the last two sections of the chapter.

Medical Translation Dissemination of medical information in translation creates a problem when the information can be misinterpreted by the community (both specialist and general readers) regarding the understanding of COVID-19 information (Nasir et al., 2020). In this case, the misinterpretation stems from the inaccuracy of translation from foreign languages into Indonesian (Ramadhani, 2020), whereas, in ideal circumstances, as Wallis and Wisnovsky (2014) remind us, medical text translators should become important agents in shaping and re-contextualising transmitted medical texts to the readers. In Indonesia, early information about SARS-CoV-2 and COVID-19 has been dominated by information in foreign languages, especially English. Terminological and phraseological accuracy is particularly acute concerns: using definitions put forward by Dharmawan et al. (2019), medical terminology is exposed to mistranslation, that is, a wrong rendering that hampers communication but does not result in the death of the patient. However, in an extreme case of medical information translations that deviate greatly from the intended meaning, some translations can turn into maltranslations, that is, translations that result in the death of patients. A limited understanding of COVID-19 guidelines and, in other countries, poor understanding resulting from misinterpretation of these guidelines caused by low-quality translation was shown to cause distinctive effects such as insomnia and excessive stress (Lin et al., 2020). Mistranslations or translation errors result in a poor-quality translation (Nababan et al., 2012). Among the parameters considered when assessing translation quality (TQ), three aspects are especially significant concerning medical translation: accuracy, readability, and acceptability. To avoid misinterpretation, mistranslation, and maltranslation, accuracy is key.

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Translation accuracy, broadly understood, is achieved when messages in the source language are successfully delivered in a culturally, linguistically, and textually (text types, conventions, etc.) appropriate manner into the target language (Nugroho et al., 2016). C19GB was to be read not only by specialist readers (e.g. doctors, nurses, or any medical personnel) but also lay readers (the general population). This text is a challenge to translate, as it needs to balance neologisms, medical terminology, and performative functions of the source text. Without an accurate translation, this text was at risk of being misinterpreted and misunderstood. The development of medical text translation in the twenty-first century is also examined by Montalt et  al. (2018). They assume that the translation of medical texts has evolved through the development of healthcare and biomedical research directions, which are usually exclusive and narrow, into patient-centered care (PCC), personalised medicine (PM), and translational medicine (TM) research. Furthermore, they highlight weaknesses in medical translation research, in its narrow focus on terminology, rather than on larger language units in the text. Their study recommends that research in translating medical texts also focuses on resources, text, communicative situations, organisations, contexts, and participants. In another study, Muñoz-Miquel et al. (2018) carried out an experiment focusing on the importance of English to Spanish translation training for translators of medical texts. Their work emphasises the  importance of translation training to address issues of understanding the content of cancer-related fact sheets for patients (FSP) in Spain. They emphasised three core skills: (a) ability to deal with specific medical terminology (expert knowledge); (b) understanding of elements of text empathy (personalisation of communication and tenor adjustment); and (c) familiarity with different text types or genres. Only when the medical translators acquire these skills, the authors conclude, can they truly translate medical texts that are accurate and accessible for medical personnel as well as comprehensible for patients. The importance of the quality of translation in medical texts is also discussed in the research of Dharmawan et al. (2019). Their research discusses the quality of translation in Dorland’s Medical Dictionary (DMD) in both its human and machine-translation versions. As an analytical tool, Dharmawan et  al. (2019) refer to translation techniques and

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translation quality assessment to measure the degree of risk of medical translation for patients. There are two interesting findings in this study: firstly, both human translation of medical texts and machine translation produce mistranslations; secondly, the translation of medical texts produced by both means produces maltranslations. Dharmawan et al. (2019) identify in their study translation patterns indicating how misunderstanding in reading high-risk medical texts can lead to misdiagnosis, mishandling, and misdirection  concerning both health promotion and disease prevention. Therefore, in the context of the English-Indonesian language combination or vice versa, they recommend the involvement of specialist readers and translators with a background in medical science. Important gaps in the literature pertain to accuracy, perceptions of specialist readers (doctors), and perceptions of general readers (e.g. lay people, patients). We believe that research focused on these aspects is important (Askehave & Zethsen, 2000; Nisbeth Jensen & Zethsen, 2012; Nisbeth Jensen, 2013). This is especially valid in the context of analysing the Indonesian translation of C19GB.

Methodology Research Approach The objective of this study is to assess the translation accuracy of the COVID-19 Guidebook (C19GB) from English into Indonesian and to know the perceptions of target text audiences of the translation. Data collection involved qualitative (open-ended) and quantitative (close-­ ended) ways to answer research questions. Qualitative data collected using content analysis techniques is then analysed to identify, describe, and explain problems relating to translation accuracy. Quantitative data, collected using survey techniques, are used to identify, describe, and explain the perceptions of the specialist audience (doctors) and general audiences regarding the translation of the C19GB. The analysis also integrates the three methods, namely data merging, connecting, and embedding.

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Participants There are three groups of participants in this study, namely: translation evaluators (rating the quality of the translation), specialist readers (doctors), and lay readers (general audience). The criterion of education played an important part in the selection since 55% of Indonesians who finish school still struggle with literacy (Dilas et al., 2019). During the COVID-19 pandemic, participants were recruited using the authors’ networks. The criteria for participants’ selection are detailed in Table 5.1.

Techniques of Data Collection Through qualitative data documentation techniques, we collected assessments of translation accuracy (henceforth ‘accuracy assessment’). The assessment of accuracy was conducted in a focus group discussion in which translation evaluators discussed and assessed every sentence in detail. The accuracy assessment is based on the qualitative parameters of the translation quality rating scale proposed by Nababan et al. (2012). Table 5.1  Criteria for selection of participants Role

Participant no.

Criteria

Evaluators

3

Specialist readers

50

General readers

50

Must have (1) theoretical and practical skills in the field of translation studies; (2) at least a master’s degree in the field of translation studies; (3) 5 years of experience assessing translation quality. Doctors must have (1) at least 5 years of experience working as a doctor; (2) English proficiency as evidenced by a minimum TOEFL score of 525. Must be (1)  a minimum high/secondary school level; (2)  willing to take the time to read the C19GB; (3)  willing to get involved in research.

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Table 5.2  Translation accuracy quality rating scale (Nababan et al., 2012) Scale Qualitative parameter 3

2

1

The meaning of words, technical terms, phrases, clauses, sentences, or source language texts are accurately transferred to the target language; there is no distortion of meaning Most of the meanings of words, technical terms, phrases, clauses, sentences, or the source language text have been accurately transferred to the target language. However, there are still distortions in the meaning or the translation of double meanings, or the meaning is omitted, which disturbs the integrity of the message. The meaning of words, technical terms, phrases, clauses, sentences, or source language text is inaccurately transferred to the target language or omitted (deleted).

The Indonesian evaluators who assessed the quality of the translations are familiar with the rating scale detailed in Table 5.2, which was preferred to more complex and complete quality assessment parameters, such as those detailed in the Multidimensional Quality Metrics (MQM) (Lommel et al., 2013). Furthermore, a questionnaire was used to collect responses to the translation from the other two groups (the general population and doctors) using a 5-point Likert scale. Random sampling techniques were used to recruit 50 doctors and 50 public participants to determine the readers’ responses to the translation. It is worth noting that most participants from the general public had low English language proficiency; they were not asked to assess the quality of the translation through a comparison of the source and target text. Thus, doctors and public participants were administered questionnaires with questions formulated with slightly different wordings. Both questionnaires, however, had five questions concerning (1) the ease of reading this guidebook in general, (2) the ease of understanding medical terms, (3) the ability of the text to improve the reader’s understanding of COVID-19, (4) the limitations of the Indonesian version of C19GB, and (5) the quality improvement of this guidebook. Quantitative data were gathered by a questionnaire that the respondents completed online/inperson/over the telephone.2 Likert scales were used in the questionnaire, as they enabled our research team to classify the variables; measurement results were expected to be free of errors. The

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answers to the measurement scale were: Strongly Agree (SS/5), Agree (S/4), Neutral (CS/3), Disagree (TS/2), and Strongly Disagree (STS/1). Each question had a weighted value of 1 for the Strongly Disagree choice up to a value of 5 if the Strongly Agree option is chosen.

Techniques of Data Analysis In this study, the qualitative data analysis techniques used are domain selection, taxonomic analysis, componential analysis, and finding a cultural theme. The domain of this study is C19GB and its medical terms. No information about the number of translators involved in translating C19GB is available at the time of this study; therefore, it was not possible to ascertain whether or not the translation process complied with industry standards for translation services (ISO 17100: 2015/2017). The taxonomic analysis is conducted against the 3-level categorisation of accuracy rating translations: (1) accurate, (2) less accurate, and (3) inaccurate. In addition, taxonomic analysis is carried out by classifying the causes of accurate and inaccurate translations. Componential analysis is performed to show the relations between the level of accuracy of the translation and its causes. In the ‘Discussion of Findings’ section, we elaborate on the possible explanation of the relationship between the evaluators’ rating and the content analysis of the translation, used to extrapolate a cultural theme through the content analysis. We analysed the results of the questionnaire using the one-way analysis of variance (ANOVA) model. One-way ANOVA is used to compare two data groups using the mean score calculated on the responses to the questionnaires given by the population of each data group (specialist and general readers). ANOVA is used to determine the difference in scores between the dependent variable, calculated from the different scores of the independent variable so that it is possible to compare more than two conditions. Data were processed using SPSS 24 for Windows. Before carrying out the one-way ANOVA test, it is necessary to test the distribution of normality and homogeneity. The data distribution of the normality test aims to obtain the normal distribution of the independent variable score. A significant score greater than or equal to 0.05 implies that the

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data is normally distributed; a significantly smaller than 0.05 implies that the data is not normally distributed. The homogeneity test is used to show that two or more groups of data samples come from populations that have the same variation. Finally, the descriptive test is used to show a complete description (mean,  the standard of deviation, significance, minimum and maximum data) of the samples drawn.

 nalysis of the Translation of the COVID-19 A Guidebook (C19GB) The authors strongly suggest that the translator(s) of C19GB completed a translation that carries forward the information and details of the original, though it presents a few defects. In other words, the translation is what could be called ‘overall accurate’. Overall accuracy here means that the most translated sentences gained a 3 score from the evaluators and only a few of them gained a 2 score for accuracy, as shown in Table 5.3. In addition to that, the translator(s) attempted to retain the accuracy of the source message in several ways. Firstly, the text was translated by accurately conveying the message of the original in the target text. Hence, the protocol information in dealing with the deadly virus is retained in the translation and is conveyed to the specialist readers in the way it was presented in the original, as Example 5.1 shows. Example 5.1 Treatment protocol ST: Rest patients in bed, strengthen supportive treatment, and ensure adequate nutrition. TT: Istirahatkan pasien di tempat tidur, tingkatkan terapi suportif, dan pastikan nutrisi yang adekuat (back translation: Rest patients in bed, improve supportive treatment, and ensure nutrition adequate.) Table 5.3  Categories of accuracy used in the study Category of accuracy

Number of data sentences

Accurate (Score 3) Less accurate (Score 2)

1089 93

5  Translation Accuracy in the Indonesian Translation… 

131

The treatment protocol of the source text is accurately transferred in terms of meaning in the target text. No shift of message was found in translated passages of this domain (treatment protocol). In several instances, the informative details of the source text, provided in medical terms (acronyms included), are borrowed in the translation, as in Example 5.2. Example 5.2 Terminology ST: Respiratory distress, RR ≥ 30 breaths/min TT: Respiratory distress, RR ≥ 30 kali nafas/menit; (back translation: Respiratory distress, RR ≥ 30 breaths/minute)

The medical term ‘respiratory distress’ is common in a medical context, both in English and Indonesian literature. The borrowing of the term in the translation might be motivated by this very fact. In other cases, the translator(s) added the English medical terms after their Indonesian translation. Pure borrowing is most probably an attempt to convey the message of the original to specialist audiences, who may also be familiar with the English, as in Example 5.3. Example 5.3 Indonesian translation retaining English terms as a gloss of the Indonesian term ST: Use lung-protective ventilation strategies, which means small tidal volume (4–8 mL/kg ideal weight) and low inspiratory pressure (platform pressure