Lifelong Learning Programme
Lifelong Learning Programme, Grundtvig - Multilateral Project
Project no.: 142235-2008-LLP-NL-GRUNDTVIG-GMP
Project title: TRICC - Training Intercultural and Bilingual Competencies in Health and Social Care
Interdisciplinary Social Science Department
Utrecht University

Utrecht, the Netherlands
Boğaziçi University
Istanbul, Turkey
COOSS Marche
Ancona, Italy
dock europe e.V.
Hamburg, Germany
PPRE Limited
London, Great Britain

Educational Methods

TRICC trainings include a wide variety of educational methods – facilitator’s inputs, warm-ups, group discussions, brainstorming, dialogue analysis, working groups, role-play, expressive theatre, Forum Theatre.
Featured here is a report on Forum Theatre, the key learning method of the TRICC project, as well as an overview of the trainings conducted in each country.

Image Theatre / Forum Theatre - A Workshop Report

On July 3, 2009, Kees Deenik from HoutenBeenTheater facilitated a training on Image Theatre and Forum Theatre for TRICC partners in Utrecht. Participants came from the Netherlands, Italy and Germany. The training was conceptualized for trainers, so Kees showed us a variety of methods that can be used for the introduction of participants, for warming up, for evaluating and for closing a workshop. One of the exercises was called Hypnosis and involved leading a partner around the room by the nose (without touching). Another was The box, involving imagining a box (e.g. size, weight) and carrying it across the room. The main part of the training was an introduction to Image Theatre and Forum Theatre, two methods conceived by Augusto Boal. Both can be used in trainings for multilingual ad hoc interpreters in health and social care as well as physicians.

Image Theatre is a series of techniques that allow people to communicate through images and spaces. The method involves individuals or groups creating a living image or statue to communicate a certain message or to illustrate a problem. The message can be varied by changing certain positions or expressions.

Forum Theatre involves a group of actors acting out a scene to make a problematic situation visible. The scene is acted out in such a way that the problems are obvious to the audience. There is a Joker who acts as a mediator between the actors and the audience. After the scene, he or she asks the audience, What did you see? and listens to their suggestions for better solutions. When the scene is acted out again, spectators, now spect-actors, can stop it, take the respective actors’ place and act out their way of handling the situation. If their solution isn’t accepted by the audience, another spect-actor can jump in. We all enjoyed the atmosphere of this training in Utrecht. We learned from each others’ experiences and at the end of the day went home with a lot of new ideas and creative ways of addressing the problems we are faced with in the doctor-patient-interpreter setting. Thanks again to Kees Deenik for sharing his knowledge!

Ekpenyong Ani

Photos by HoutenBeenTheater


Training in the Netherlands

”Do we speak the same language?” - Bridging language barriers in general practice

After identifying the needs of general practitioners (GP’s) on working with (in)formal interpreters, a training was designed for GP’s to enhance their knowledge, attitude and skills on this subject.

Target Group:
20 GP’s working in multi-ethnic area’s in Rotterdam (The Netherlands) participated in the training. These doctors are confronted daily with language and cultural barriers in their surgery.

The first aim of the training was to increase the GP’s knowledge on the Dutch law, regulations and possibilities regarding formal interpreting. Secondly, awareness was strived for with regards to the needs and difficulties of bilingual patients, the role of the interpreter and reflection on the GP’s attitude and practice which are culturally determined. At last, participants were trained to improve their skills in interpreted consultations.

Training forms
To reach the aims, different educational tools were used: knowledge transfer, demonstrations, forum and image theatre (performed by ‘HoutenBeenTheater’), counseling, case discussions and interviews.

Duration training
The training consisted of one training day and a feedback evening, a total of 12 hours. The period between these meetings was one month (29.10.2009 – 01.12.2009).

Download nederlandstalige versie (PDF)


Two day training for health operators in Italy

In Italy, the project activities were carried out in the town of Jesi, with the formal involvement of the hospital and the other territorial health services. The choice of this setting was due to the fact that a cultural mediation service is active since 2003 in the town hospital. Nonetheless, an enquiry carried out at the beginning of the project revealed that a great number of doctors acting within the hospital ignores the presence of this interpreting service, or, if they know it, have a sceptical attitude towards its utility. The prevailing idea is that a word-by-word technical translation is enough to guarantee a qualitative service. The concept of cultural mediation appears disqualified, which doesn’t match the qualitative objectives the hospital has set for the near future. An experimental two-days training course was therefore proposed to health operators, aimed to sensitize them on the importance of a good communication with foreigner patients, to stimulate them to adequate their behaviours to the different situations they face, and to make the concept of “cultural mediator” more familiar.

Different methodological approaches were proposed to the trainees for the two days:

Day 1: (8 hours) Image theatre: based on practical exercises finalised to break the ice, make group, trust the others, increase self-esteem and identify one’s own relational abilities and resistances. Forum theatre: based on the performance of scenes where the interaction between a foreigner patient, a doctor and an informal interpreter was acted. The scenes highlighted the doctor’s erroneous behaviours towards the patient, and the learners were invited to stop the performance and assume the role of the doctor, acting according one’s own idea of correct behaviour. The Forum theatre scenes were video-recorded and introduced during the 2nd training day, to guarantee a continuum between the two days.

Day 2: (8 hours) Dr. Vacchiano, a well known expert in intercultural communication, lead the training day, introducing the concept of “cultural mediator” and its fundamental role in facilitating communication in the health sector. After presenting the Forum theatre scenes, he proposed 4 real cases, assigning the participants, divided in groups, the task to manage them. The conclusions were reported to the audience, and a very participated and animated discussion followed. Qualitative and quantitative evaluation procedures were carried out, whose results will be presented in a dedicated section.



Two-day training for Ad hoc interpreters in the hospital January 7-8, 2010 in Hamburg

Concept and training by Ortrun Kliche and Ekpenyong Ani, dock europe e.V.

The target group for this training were multilingual healthcare workers from various countries involved in a further training programme in healthcare for migrant women provided by “Wege in den Beruf”/Passage gGmbH in Hamburg. The 14 participants came from 8 different countries and were joined by “special guest” Akgül Baylav from our UK TRICC partner. What was striking was that the trainees had sacrificed their free time to take part in this training since the hospital administration had not deemed it necessary to give them time off for the training. Right from the beginning, participants displayed a genuine interest to move forward with this training. In the introduction round, one of them described this with the image of wanting to learn how to fly by using her language resources. After defining what interpreting and specifically ad hoc interpreting is about, we went right into the practical experience participants had already gained in interpreting situations. Participants related or even acted out typical situations with (potential) conflicts.

In one situation, a patient asks a nurse who speaks her language about the medication she has been given. The nurse does not know how to translate the specialist term and needs to check with the doctor. This was a good example for delayed or distance interpreting. The participants were then asked to look at what roles are assigned to the interpreter (by themselves, by the patient/doctor) based on the interpreting stories they related/acted. During the course of the two days, participants negotiated a profile for interpreters. This included qualities and skills as well as the working conditions and the framework they need in order to do a good job.

The rest of the first day was spent analysing the interpreter’s role in a tutorial film. We picked up from there on the second day when we analysed an interpreting dialogue based on a transcript. The participants showed amazing skill in detecting translation mistakes and/or misleading interpretations. To round off the two-day training, the participants analysed interpreting situations using the method of Forum Theatre (by Augusto Boal). The participants were extremely creative in acting out the scenes. It was difficult to convey the idea that the scenes should focus on problems and not solutions. However, after asking the crucial question “What did you see” and an intensive discussion, the group found “crunchpoints” in each setting and these were re-enacted by participants jumping in. In concluding, the participants made several recommendations to the hospital management concerning work standards.

They said they had thoroughly enjoyed and profited from the training and were looking forward to the next opportunity to learn to fly even higher.


Medical Interpreting Training in the Department of Translation & Interpreting Studies at Boğaziçi University in Istanbul, Turkey

The training comprised a six-week (18-hour) module on medical interpreting, incorporated into an undergraduate course on Community Interpreting and (with minor variation) into a course on Dialogue Interpreting taken by students attending the department’s MA in Conference Interpreting. The language combination used in the training was English and Turkish, the latter being the A-language of all the students.

Prior to taking the module on medical interpreting, the students had had six weeks of lessons in which they had become familiar with various aspects of community interpreting, including its definition and history, the (ideal and actual) role of the community interpreter, types of actions undertaken by the interpreter, issues of pragmatics and register, ethical principles (e.g. accuracy, confidentiality, impartiality, professionalism) and examples of good practice (e.g. pre-interview briefing to both parties, positioning, effective note-taking).

The specific aim of the medical interpreting module was to motivate students to act confidently and responsibly, and with maximal conformity to international professional norms. (At present, in Turkey there are no official codes of best practice or ethics for medical interpreting.) The modules consisted of four main parts, culminating in a final exam.

General introduction to medical interpreting (week 1)
To start with, students’ thoughts about, and experiences of, the particular challenges of interpreting in medical settings were elicited. This was followed by the modelling of a situation intended to highlight these challenges, with one trainer (a practising doctor) playing a Turkish doctor and the other taking the role of an English ex-pat in Turkey. The conversation was interpreted by a volunteer student who had not been briefed about the patient’s complaint. After a discussion on the modelled situation and the interpreter’s performance, the class discussed the utility of standards of best practice and codes of ethics, looking at the example of the ‘National Standards of Practice’ (2005) developed by the (US) National Council on Interpreting in Health Care ( While the students were encouraged to derive guidance from the Standards, which seemed to offer clear answers to some of their questions, it was also emphasised that sometimes there were no simple answers and that even the National Standards contained grey areas and potential contradictions.

Focus on discursive and cultural aspects of medical interpreting (week 2)
At the end of week 1, students had been assigned to read two academic articles on linguistic and discursive aspects of medical interpreting. These were summarised and discussed in class and their practical implications debated. Then the focus turned to the place of culture and cultural differences in medical encounters. As a lead-in to this topic, the class examined the online ‘Cultural Reference Guides’ prepared by the Ohio State University Medical Centre. It was stressed that such guides could easily encourage essentialist thinking and stereotyping and prevent health workers from considering the individual patient with a minority background as an individual. All the same, the categories used in the Cultural Reference Guides (‘Language’, ‘Spiritual / religious practices’, ‘Communication’, ‘Food practices’, ‘Family’, ‘Health practices’, ‘Death / dying’) provide a handy framework for thinking about characteristics common to (or stereotypes attributed to!) members of certain communities as well as discussing differences within societies and social groups. Using these categories, the class prepared and discussed a Cultural Reference Guide for patients from Turkey.

Simulations and presentations (weeks 3 and 4)
The third week’s class began with short interpreting simulations in groups of 4 on the subject of minor medical ailments that students had been asked to think of. After general problems emerging from the simulations had been discussed by the whole class, students (working in pairs) gave informative research presentations on topics related to medical interpreting that had been allotted at the very beginning of the module, such as a comparison of the Turkish and UK health systems, traditional medical practices in Turkey, and medical tourism and interpreting in Turkey.

Scripted trialogues and glossaries (weeks 5 and 6)
The fifth week’s lesson began with a discussion of three scholarly articles on cultural issues in health care and interpreting, the first of which was particularly relevant to interpreting for Turkish-speakers. We then moved on to an activity intended to enhance students’ familiarity with medical terminology and discourses. Earlier, students had been divided up into groups of 3 or 4 and each group was ‘assigned’ one of eight relatively common medical conditions. In week 5, every group (every individual student in the postgraduate class) presented a glossary of 20 Turkish-English pairs of terms related to the condition they had been assigned, together with a script for an interpreted encounter between a doctor and a patient with symptoms of this condition. These glossaries and scripts were discussed, and the trainees were asked to revise and resubmit them if necessary. They were also supposed to share the second draft of their glossaries and trialogue scripts with their other classmates.

Exam (week 8)
Since the module took up a large proportion of a formal university course, it was necessary to grade students’ effort and achievement. Their classwork and assignments were evaluated, as was their performance in the exam, which had the format of an interpreted consultation between a Turkish-speaking doctor and an English-speaking patient, with the roles played by the trainers. Each student had to interpret for a patient presenting with symptoms of one of the conditions covered in weeks 5 and 6, except for the condition they had worked on for their trialogue and glossary. The students’ performances were graded according to the criteria of general interpreting performance, terminology, and use of English, the latter criteria being included due to the department’s aim of maximising students’ proficiency in this foreign language.




This brief introductory course to cultural and linguistic competences was designed as a pilot course for bilingual individuals who have to interpret on an ad hoc basis for their families and friends, generally without any awareness or skills training, either out of the „goodness of their hearts‟ and/or their perceived sense of duty.

Our recent scoping research into the extent of ad hoc interpreting within the Turkish/Kurdish speaking communities in Hackney and the Bangladeshi community in Tower Hamlets has shown that interpreting for family and friends/ relatives is quite wide spread amongst these communities. This finding was quite unexpected because there are high numbers of trained and qualified language support workers, interpreters and bilingual advocates employed in the statutory and voluntary sectors in the areas where the research was carried out, to improve access to public services for people with little or no English. The results highlighted the need to upgrade the skills and knowledge of these (mostly young) individuals to act as interpreters more competently and more confidently.

The learners were bilingual adult College students on Access courses leading health and social care, teaching or science higher education courses.. The highly focused nature of the Access course meant that our brief course was optional and they had to give up their free time to attend the sessions on a day when they had no other lessons.

Aims and Objectives

The aims and objectives of the course were:

  • To enhance participants‟ language and cultural competencies
  • To familiarise them with the terminology of the health and social care agencies they will be working in
  • To train them in community interpreting skills and techniques
  • To raise their awareness of culture-specific issues around health
  • To raise their awareness of the public services and familiarise them with a variety of health and social care settings where they will be supporting their “clients”
  • To train them in collecting, collating and analysing relevant local information

Duration & venue

All training sessions took place in the classrooms of Tower Hamlets College, a further education (FE) College in East London.

There were three half days initially, with a follow up of another half a day 4-5 weeks later, with one-to-one support, as needed by individual learners, for the completion of the assignment. A final session was offered in July 2010 for a final check over the final drafts of the finished glossaries.


A self selected group of seven bilingual adult College students enrolled in Pathway to Nursing, Pathway to Science, Access to Nursing, Education and Teaching, Youth, Community and Social Care. Six were women and one was a man.

The communities they came from and the languages they spoke included1

Cyrus – Iranian, speaks Farsi and Turkish. He is on Pathway to Education course, wants to study Humanities at university.

Buba – Congolese, speaks French and Lingala. She is on the Access to Nursing course, wants to become a Nurse.

Tholo – Zimbabwean, speaks Swahili, Ndebele and other local dialects; She is on the Pathway to Science course and wants to study agricultural sciences at university.

Mahmooda – Bangladeshi, speaks Hindi, Urdu, Bengali and Sylheti; she is on the Pathway to Science course and wants to become a teacher.

Fathema - Bangladeshi, speaks Hindi, Urdu, Bengali and Sylheti; she is on the Pathway to Education + Childcare course and wants to become a teacher/Teaching Assistant.

It is worth noting that there are over 120,000 children who speak these languages in London‟s schools, more than a third school children speaking minority languages and more than 10% of pupils overall.


Table 1 - Numbers of pupils (5- 16 in state schools) speaking languages of THC ad hoc interpreters

They all had experience of ad hoc interpreting with their family members, friends and relatives, sometimes at the receiving end, so they understood the value of the course as a benefit to themselves in whatever job they will end up in.

Their comments included:

“They (doctors) were just asking my brother-in-law and he was answering for me without asking me!”
“They (doctor) was asking about sexual habits and intercourse between my older sister and my uncle. It was too embarrassing for me. Also forher. (...) I wanted to walk out.”
“I had to interpret for my old uncle. Although I was not a child, I just could not do it. I refused to interpret, but the doctor kept forcing me.” “This is important job. Should be done professionally.” “I wish I could have said NO”.

The learners‟ expectations reflected their understanding and appreciation of the short course. They hoped to:

  • Learn interpreting skills
  • Get accreditation for future
  • Learn to interpret accurately and appropriately
  • Learn technical terminology
  • Increase my language awareness and understand myself better
  • Learn to express things in book language and in folk language
  • Learn to set and protect my boundaries (be able to say no and not get involved)


In order to make the sessions interesting, enjoyable and educative, a variety of learning methods were employed, such as:

  • Individual/pair and group work
  • Tutor input
  • Practical work and role plays
  • Visual and aural input (e.g. DVD, video cassettes)
  • Games
  • Forum theatre

Additional learning support

Four hours tutorial input was offered to support students to complete their bilingual glossaries (before the follow up session) to achieve an additionality for their respective courses. When two Bengali students requested further support, this was arranged to be provided by a trained and qualified Bengali/Sylheti speaking Community Interpreter who could help with the necessary research skills and usage of words for the glossary.


The students were offered one Unit entitled “Creating a Bilingual Glossary in Health and Social Care” that is accredited by the national Open College Network at Level 2 as well as a Certificate of Attendance (and Achievement where relevant) from the College. It was very encouraging that the students were encouraged by their mainstream tutors to “go for it” as an additionality as it would enhance their chances in future. In the event only one student has completed it so far.

Topics covered and assignment

Over two half days, the following topics were covered and discussed:

What is interpreting?

  • Modes of interpreting
  • Models of interpreting
  • Legal, ethical issues

Knowledge and Skills in interpreting

  • Importance of language and culture in communicating in health settings
  • General/Specialist terminology (including own language)
  • Planning and conducting the interpreted consultation

Experience of Interpreting

  • Categories of issues (e.g. confidentiality)
  • Reconciling personal and family/ community priorities
  • Power relationships with users and service providers
  • Managing and coping strategies

Interpreting in communities

  • Knowledge of communities (own and others‟)
  • Feelings towards communities (own and others‟)
  • Inequalities in society
  • Understanding of community dynamics as it relates to their job and function (formal/informal)

The students also were offered the choice of completing a formal assignment which was to create a Bilingual Glossary of 200 terms commonly used within two or three public services. This is a Unit of the Community Interpreting course accredited by London Open College Network.

The tutor also prepared a learner-friendly version of the tasks, detailing the task as well as the layout and how to write references for making the Unit information more accessible for the students.

Language compilation sheets were also prepared and handed out to the students from the first day so as to get them started on their vocabulary and glossary work. They added to these during the sessions and also at home as part of their homework.

Forum Theatre

The last session used Forum Theatre as a way of consolidating and enhancing learning. Led by an experienced drama director, this proved a very enjoyable session which also gave students a great chance to explore expressing themselves in different, unconventional ways.

The process of the FT workshop was aimed to bring about reflection on the relationship between the theory and practice of the ad-hoc interpreter‟s role. The participants did not have a clear what was going to happen. The process is hard to envisage for people with no previous experience of it. A DVD lasting about 15 minutes illustrates both the process and the outcomes of using Forum Theatre with this group.

After introductory exercises aimed to stimulate creativity and communication, the participants were asked to work in small groups to make a set of images, like snapshots, of situations which had raised problems for them in the course of their work. Each group chose an image to present to the other participants.

The images portrayed the aspirations and commitment of the participants (in their role as ad hoc community interpreters) to make a contribution to society by helping people. The scenes were set in doctors‟ surgeries and exposed the practical gap between the ideal and the actual practice. Participants who said they wanted to facilitate an equal relationship were inadvertently and repeatedly drawn into conversations that excluded the service user and privileged the powerful service provider and the interpreter.

When participants were asked why they were allowing this to happen, it became clear that the interactions were “automatic”- over-determined by everyday habits, assumptions and practices on which they had not reflected as such though, paradoxically, they had all, like all of us, suffered from the consequences of them.

As group members began to identify and then “re-rehearse” their behaviours and practices, they became more able to analyse and characterise the problems and to propose alternative ways of working, to explore the ethics and values behind what was needed in a conscious way. Then the move from “good feelings” to what might be considered a more ethical practice became possible. The tutors‟ view was that the behaviour of the group members became more confident, almost transformed, and they stayed beyond the planned end of the session. At the end of the session, they embarked on a process of reflection and in their feedback, they identified the following key thoughts and issues about the role of an informal or ad hoc interpreter:

  • Flexible in approach but accurate in detail
  • Learn from mistakes
  • Do not touch without permission
  • Importance of reflecting on situation and own performance
  • Boundary
  • Sensitivity
  • Power of the interpreter – the interpreter has power to change things
  • Language – speaking to the health professional and to the client is different, importance of moving from technical to simpler language, depending on the level of the client
  • Interpreter can talk to the client privately at any point confidentially
  • Each case has a different level of complexity
  • Interpreter has to work with uncertainty and unpredictability

This process, short though it was, transformed their behaviour and perceptions. They had the knowledge that made this possible: the theatre was a creative instrument that helped them apply and be usefully aware of the relationship between their knowledge and its practical use. Perhaps the most important achievement was that the students became more conscious of the gap between ethical intentions and ethical practice and took the opportunity to begin to close that gap .

1 There were also a Filipino student and another Bangladeshi student for whom further details are not available
2 Eversley J et al (In Press) Language Capital – Mapping the languages of London’s school children, CILT/IoE