"I just assumed that it would translate": examining MT risk awareness among healthcare staff with abbreviations as a use case

AI language technologies (AILTs), increasingly enabled by large language models (LLMs), are becoming embedded in multilingual healthcare workflows for translation, rewriting, documentation, interpreting, and messaging in language-discordant settings. Yet fluent output is not the same as clinically safe or equitable communication: performance varies across languages, accents, tasks, and workflows, and efficiency gains can hide errors, reduce traceability, and shift responsibility across clinicians, translators, interpreters, and health systems. This narrative review synthesises recent peer-reviewed evidence across written communication, spoken communication, and emerging agentic workflows. Using the Human-Centered AI Language Technology (HCAILT) lens, it examines capabilities, evaluation practices, implementation patterns, and recurrent errors through reliability, safety culture, and trustworthiness. We identify key convergences and contradictions in the literature and propose seven grand challenges for the next phase of research and deployment. Progress, we argue, requires not only better models but also accountable sociotechnical design, calibrated human oversight, and stronger collaboration across MT/NLP, translation studies, HCI, clinical practice, implementation science, and policy.

We investigate whether large language models produce different medical triage recommendations for identical symptoms based solely on the language of the patient prompt. Using Gemini 3.5 Flash, we evaluate a neurological symptom profile (persistent headache, blurred vision, nausea) across six languages (English, Spanish, Chinese, Hindi, Japanese, Arabic) with 30 runs per condition (n=450 total API calls). We find that the model recommends emergency room visits at rates ranging from 0% (Japanese, Hindi) to 30% (English, Arabic), despite assigning nearly identical severity scores (7.7-8.0/10) across all languages. Adding a single sentence specifying the patient's US location increases ER recommendations by up to 76.7 percentage points for non-English prompts, while the reverse anchor (English prompt with a Tokyo location) reduces the ER rate from 30% to 6.7%. A back-translation control (Japanese to English) produces ER rates comparable to the English baseline, confirming that the disparity is not caused by translation quality but by implicit geographic inference from the input language. We release the complete dataset, experiment code, and results.

Safety evaluation of large language models is conducted predominantly in English and predominantly on frontier systems. Neither condition describes how such models are encountered in low-resource health settings, where small quantised systems are run locally and queried in local languages. We ask whether clinical safety established in English transfers to Hausa, and whether any failure is attributable to the language, the clinical task, or the class of model that low-resource deployment admits. Matched English-Hausa question pairs were built for three conditions of high burden in northern Nigeria: malaria, sickle cell disease, and tuberculosis, probing knowledge recall, emergency triage, a leading question inviting a contraindicated action, and a traditional-remedy claim. Six models were evaluated: five locally deployable systems of 4-9 billion parameters, two medically fine-tuned, and one frontier system. All 128 responses were scored against Nigerian national treatment guidelines by two fluent Hausa speakers working independently and blind to one another. Among locally deployable models, mean clinical correctness fell from 1.57 in English to -0.03 in Hausa, on a scale where 2 denotes a correct answer and -1 an actively harmful one. The frontier model moved from 2.00 to 1.75 and produced no response judged harmful in either language. Drift was consistent across all three conditions. Inter-rater agreement was substantial for clinical correctness (kappa = 0.70); agreement on harm was initially poor (kappa = 0.22) and is examined in detail. Because a frontier model answers the same questions competently in Hausa, the deficit is a property neither of the language nor of the clinical material, but of the deployable tier.