A concept over-burdened

The political and social transformations taking place in South Africa have given rise to a mood of optimism regarding the speed and extent of the changes that are possible in a short space of time. In the context of limited language resources for the delivery of health care, the role of the interpreter has particular currency. However, interpreters' multiple roles in health care contexts have been extensively and, at times, controversially described. These are briefly reviewed before we turn to a detailed consideration of the debate on the question of interpreter latitude. The issues raised regarding roles for interpreters are explored through the evaluation of an interpreter project at a Western Cape psychiatric hospital. We describe four themes in the talk of the service providers and the interpreters themselves that are nuanced in particular ways by high expectations and the social context. The themes of the interpreter as 'language specialist'; as 'culture specialist'; as 'patient advocate'; and as 'institutional therapist' are all explored in turn. We identify three potential areas of difficulty arising out of an uncritical acceptance of advocacy roles for South African interpreters. The question of organisational support for the advocacy role; the dynamics and micro-politics of multi-disciplinary team work, in psychiatry in particular; and the need for sub-specialisation in aspects of clinical psychology are all considered. These factors can be seen to operate at three levels in institutional contexts.