Lost in Translation

Lost in Translation:

Many interactions involved in medicine require well thought out, straight forward and at times compassionate communication. One of the hardest parts of working at Mseleni is the communication barrier. The primary language is Zulu, some speak some broken English, but not at a level capable of communicating a complete medical history without the help of an interpreter. My Zulu is limited to short greeting phrases and limited medical questions, “What brings you here today? Where does it hurt and for how long?” Obviously, just because I know the questions does not mean I can understand their answers. But at least the fact that I am trying helps in making the patient feel more comfortable, and at least some get a good laugh at my attempts. Its not easy, the three different “clicks” and “hl” sound… which to me sounds like a start of a luge (if you don’t know what that is, just google it, or ask my sister, Beth, she was the luge queen;)… Adding to the barriers is the nurses who translate have limited knowledge of pathophysiology (the physiological processes of how things go wrong in our body) and are often unable to translate the message across or gather the important intricacies of an individuals’ symptoms to us in a clear way. Time course is also confused. Many state that the problem started years ago, at which point I always ask, “what is it that brought you in for this problem today…” answers are somewhat comical at times… for example a patient who presented with knee pain, stated that it started 10 days ago, but he came in today because it itched a little 3 years ago, and 5 years ago he vomited once… and that’s where the answer begins??? Leaving me a little reluctant to ask the next question. However, I have learned if you ask “what happened today to your knee, you get a better answer… which makes me wonder what the nurses are asking…

I am not saying that the nurses are bad, actually quite the contrary. The large majority do a great job and are an irreplaceable part of the medical team.

My inability to communicate is most apparent when it is most important. Those times, when a death has occurred or when patients are going through a very difficult situation or don’t clearly understand their treatment. For instance, a vibrant, 22-year women had a miscarriage today. I felt completely unable to make her feel heard, and to make sure all her questions were answered. I was also unable to ease this undoubtedly painful, scary, and confusing time for her.

Another woman with underlying mental illness was abused by her family because she had HIV. (This is NOT the norm; please do not generalize this family’s dysfunction toward South Africa). She was obviously in a terrible situation, and I was lost at how to make her feel heard as well. She looked physically and mentally broken. And now she had to re-tell this awful situation through an interpreter. I wanted to let her know that she was safe here and that she could tell me whatever she felt comfortable with at this, but this doesn’t translate well. I have used translators in the U.S., but for reasons that aren’t fully clear to me, it is slightly easier.

In addition, I will never fully appreciate what South Africa’s apartheid era was like. Where white people represent oppression, abuse and discrimination. Does this play into our interaction? Yes, but I don’t know how.

Long story short, I have never been so aware of how important communication is in the patient-doctor relationship. Things that come easy in my own culture… the right body language, intonation, empathy… I am not very good at here. But I am working on it.