Does My Translator Look Big In This?

Musings on Fujitsu Laboratories’ wearable translation device

I love the idea of technological advances in healthcare. Not only in the “traditional” sense of treatment, such as in the operating theatre, diagnostics or information sharing, but also innovative solutions that reach out to patients in remote locations, cut down unnecessary journeys to see healthcare providers, or render health services more affordable. I truly do think that technology has the power to bring a greater sense of “democracy” to healthcare, bringing it within the reach of patients who perhaps had previously been excluded, either for reasons of geography, finances, poor health, or lack of an adequate support network.
I came across an article while ago on the development by Japanese company Fujitsu of the “world’s first wearable, hands-free speech translation device, suitable for tasks in which the users’ hands are often occupied, such as in diagnoses or treatment in healthcare”. Wow! Sounds awesome! Right? There has been a positive slew of such devices and applications in recent years, and more are coming on to the market all the time, sprouting like mushrooms, especially in light of the Winter Games in Korea in 2018, and the Summer Games in Tokyo in 2020. So what makes this one different, if at all?

The premise on paper, of course, is positively glowing. The translator itself is a very pretty blue, reminiscent of a tropical seashore, which colour psychology tells us should have a calming effect. “No need to physically manipulate the device to communicate while care giving in hospital wards and a variety of other situations”, the blurb announces proudly (I can hear the infection control department rubbing their hands in glee as we speak). “With the increase in the number of visitors to Japan in recent years,” it continues, “there has been demand for the commercialization of a multilingual speech translation system that helps to overcome communication problems.” Fujitsu claims a speech detection accuracy of 95% “in an environment with comparable noise levels to an examination room in a large hospital”. And my car does twenty-eight miles to the gallon. Just like the advert said it would.
Fujitsu “decided on a hanging name-badge form factor style that enables the healthcare provider to freely use both hands, with button icons, form and markings that enable intuitive operation, as well as a rounded shape to provide a pleasant and unobtrusive impression to both the healthcare provider and the patient.” Thank Heavens for a “rounded shape” – no risk of taking someone’s eye out as I flush their central venous catheter. But “unobtrusive” is another matter entirely.

In the promotional photo, worn by a female nurse in white scrubs, this thing looks pretty big, appearing to cover pretty much all of her left breast. With everything that nurses have to carry on a daily basis– ballpoint pens, maybe a highlighter (I needed a yellow one in cardiology to mark urine output), stethoscope, scissors, artery forceps, torch, tourniquet for blood draws, notes taken at handover…, this thing just looks irksome. Maybe it’s just the angle (“does my wearable translator look big in this?”) – maybe it’s actually the size of a postage stamp. Still, given the vulnerability of healthcare staff to assault and violence from patients, relatives and members of the public, it could be used to deflect blows like Wonder Woman’s Bracelets of Submission. Or in a manner akin to Captain America’s shield, virtually indestructible under all conditions, absorbing blows and striking multiple opponents in quick succession.
Putting its physical form aside for the moment, our little blue friend is tempting us with very high speech recognition accuracy. 95%!!! Is this solution that will carry us effortlessly over all those obstacles that Language has strewn in our path? But someone who has worked in various clinical settings, my mind begins to bump over the practicalities of the thing and all its technological promises, singing like the Sirens in the Odyssey, as these begin to form mental potholes in the gloss of the press release. (Not forgetting that the 5% of speech not recognized by our translator may hold a piece of information vital for patient care. But let’s not split hairs).

What about a patient whose words are incoherent due to medical issues – facial palsy, intense pain, or tiredness? Or a patient who doesn’t speak Italian, only dialect? Regional slang? Heavy accent? According to ISTAT, the Italian national institute of statistics, although the number of people who speak only in dialect is decreasing every year, in 2015, 32% of over-75s spoke exclusively or prevalently in dialect at home or when with friends. The institute also notes that this phenomenon is more common in those who are less well-educated.
One wonderful characteristic of languages is their unique quirks, words and phrases which do not easily translate from one language to another. Sergio Choy, who interprets between English and Spanish, says “You hear things like, ‘I’m feeling a little blue today,’ in English, but not in other languages. You can’t feel a color in Spanish.” He notes that this is particularly true in expressions which relate to emotions. One similar example in Italian is “passare la notte in bianco”, which far from meaning “to spend the night in white”, as Google Translate suggests, means “to have a sleepless night.” A detail which might be very important when examining a patient or taking their medical history, but if Google Translate had its way, risks being glossed over or dismissed as gibberish without much thought.

A real, live, breathing, walking interpreter can also advocate for a patient “if, for example, a doctor isn’t acknowledging that the patient’s religious beliefs prevent them from taking certain medications”, says Said Shaiye, who translates between English and Somali (https://www.tcdailyplanet.net/medical-interpeters/). He also notes that as part of his culture, people do not tend to communicate their problems, since sharing them is perceived as weakness, so “talking to a medical professionalis a way for patients to share experiences and stories that they might not have otherwise talked about with their families.” Given the cultural issues inherent in communication with certain sectors of the population, a blue plastic device is probably less likely to succeed in bridging the language gap than an interpreter with skills in cultural mediation.
An interesting quote comes from Andrew Ochea, CEO and founder of Waverley Labs, the startup behind a similar product to the Fujitsu translator – the massively hyped Pilot earbuds – whose “breakthrough translation technology “promises “more than translation – communication.” When pressed on the product’s supposed technological wizardry in an interview published in Forbes magazine in 2016, Ochea was quick to point out that “We don’t want to make any promises or references that this is incredibly real-time or that we could give you an earpiece and drop you off in the middle of Tokyo. That is not what we’re trying to convey at all.” (https://www.forbes.com/sites/paularmstrongtech/2016/05/17/i-just-spoke-with-pilot-and-i-dont-know-if-its-real/#3b85030d432a) Still, as we prepare to head into 2019, who knows…
Another interesting insight comes from Gerard Castañeda in Slator, who writes “Despite the headlines, the universal translator for conversational speech has not arrived just yet. Microsoft, whose machine translation technology powers Skype Translator — which probably comes closest — admits as much. In a paper, Microsoft said they observed the “clear negative impact” of inserting Skype Translator into a conversation. They found that people spoke more slowly, used “restricted vocabulary.” and would often “need to ask clarification questions when results are not understandable.”” (https://slator.com/technology/microsoft-releases-corpus-so-clients-can-help-improve-skype-translator/)
Last but not least, there will always be cases where a patient’s words convey one thing, while they quite clearly mean another. In such cases, a sensitive interpreter may often succeed where a little blue badge fails, in communicating what the patient truly wants to say.

Sadly, as is often the case, those who stand to lose the most from this technology as it stands are the most vulnerable people in the community – the less well-educated, those who speak only dialect, or who have difficulty in communicating their symptoms, whether for cultural, social or health reasons. While wearable technology such as the one developed by Fujitsu for healthcare settings will undoubtedly be positive in some ways, it also risks letting some of those who need it most fall through the gaps in the system. Scratching the surface of what appears to embody all the principles of patient-centred healthcare reveals a chimera, in all senses of the term. For there are certain aspects of healthcare that a little blue badge can never replace.