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The majority of health interactions in South Africa are mediated by a third party whose role is little understood. Studies on the role of the interpreter in health interactions suggest a number of factors which influence the success of the process. The effectiveness of communication between doctors and patients does not just depend on the training or experience of the interpreter but on a range of factors including the type of interaction, illness variables, and relationships between the participants, as well as the site of practice. The research reveals at least two distinct profiles of practice - one which facilitates the mediated process and one which inhibits communication. A number of guidelines are suggested for improving cross-language interactions.