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T. R. Girill Society for Technical Communication/Lawrence Livermore National Lab. email@example.com Technical Writing: The ESL Connection in Pharmacy The Risk In May, 2010, pediatricians Iman Sharif and Julia Tse published a revealing evaluation of the adequacy of computer- generated medicine labels for non-English-speaking pharmacy patrons (I. Sarif and J. Tse, "Accuracy of Computer-Generated Spanish-Language Medicine Labels," Pediatrics, 2010, 125(5), 960-965). They studied 286 pharmacies in the Bronx (New York City), where 72% translated prescription medicine labels at least daily into Spanish (and other languages) to help their ESL patrons (and as required by law). The vast majority (86%) used commercial computer programs rather than bilingual staff members to generate the Spanish label text. Iman and Tse carefully compared the (English) input and (Spanish) output in these cases. They were disturbed to find that 43% of the translated labels contained incomplete or flawed text, often in a Spanish-English jumble (Spanglish). In this situation biochemistry and software design meet social responsibility with high stakes: such medicine labels are supposed to offer reliable, explicit instructions for administering life-saving drugs or potentially dangerous chemicals to sick patients, often children. Iman and Tse found the high rate of textual errors and omissions "frightening to any physician, [with] obvious opportunities for harm" (p. 964). The Cases A closer look at the flawed-label cases reveals a classic failure of text usability. Many Spanish-speaking pharmacy customers have enough "social English" to manage routine transactions (shopping, for example). But they often lack "academic English"; hence the importance of reliable medicine- label translations for them. To be effective, dosing instructions need to contain enough relevant details to correctly (self-)administer the prescribed medication. A translation that omits or confuses those key details renders the instructions unusable and perhaps dangerous. The software employed by the Bronx pharmacies combined basic translation algorithms with a database of English-Spanish medical terms to convert English labels into Spanish with no help from the clerk who ran the program at pill-delivery time. Iman and Tse, however, found crucial gaps or flaws in those databases that removed vital details from the "translated" output (pp. 962, 964): * Amount: "Dropperfull" is a common pediatric dosing unit, for example, yet the three most widely used translation programs omitted it from their term database. Hence this word ended up uselessly untranslated in the Spanglish output ("tome dos dropperfulls..."). * Manner: "Apply topically" or "take orally" are critical way-to-administer details, yet simple database spelling errors often rendered such strings meaningless in Spanglish ("by mouth" [boca] became the unintelligible "a little" [poca], for example). * Rate: Some medically-relevant words occur in both English and Spanish but with very different meanings. Thus "once a day" is ambiguous in Spanglish, since it could mean "1 time" (English) or "11 times" (Spanish). This particular confusion has resulted in several documented patient deaths in New York. Teaching Techniques How can technical writing practice in science class prepare your students to avoid or mitigate such serious usability problems? Refining kitchen recipes turns out to present students with just the same text-design, detail-management issues as Iman and Tse found in medicine labels, but with no specific medical (or Spanish) knowledge presupposed. For example, effective instructions for making something as simple as cranberry sauce demand details analogous to the troublesome ones above (see http://www.ebsct.org/TechLit/analysis4.html): * Amount: Omitting "2 cups of sugar" from an early step causes the recipe to fail. * Manner: "Uncovered, without stirring" fills the same key role in this recipe that "take orally" does on a medical label. * Rate: Like most fruit, cranberries are sold by weight but cooked by volume. Hence, the conversion "1 pound of cranberries equals 4 cups" is a vital enabling detail. Students who scrutinize kitchen recipes from the usability perspective not only become sensitive to precisely the instruction flaws that Iman and Tse detected in translated medical labels, but they also hone the text-design skills to correct those flaws. Relevance to Life Today's science students could easily find themselves tomorrow in any of three roles in the real-life medicine-label scenario: * the influential software designer who develops a usable label-translation tool on which some major pharmacy chain blindly depends, * the pharmacy technician who (perhaps alone on the night shift) has to verify or clarify a translated label by personally explaining how to reliably use a prescribed medication, or * the distraught parent, regardless of their native language, who needs to be savvy enough about text usability to not leave the pharmacy without getting adequate usage instructions that they fully understand. Preparation for all three roles can start with the technical writing principles that you introduce. After all, fixing recipe flaws prevents cooking frustration, but fixing medical-label flaws can literally save lives.