Lost in Translation

I work in a setting where a vast majority of my patients speak English. I also happen to speak English. It works out for the most part. Sometimes however, my patients do not speak English, and because I was schooled in America, I do not speak another language with any degree of fluency. That leaves both the provider, me, and the patient in an incredibly vulnerable situation. I have a lot I need to communicate and make sure is understood. My patient, who must have her body touched, examined, and samples taken from, needs to feel comfortable, understood, and empowered to be in charge of the situation. 

Luckily, the the federal government has some loose legal frameworks for access to language services in the medical setting. Each state regulates exactly what the role and responsibilities of providers to ensure that their patients have access to an interpreter, and luckily, most states do have very clear laws. 

I have a patient, newly pregnant, who popped up on our schedule recently, who does not speak English, and no interpreter was ordered for the appointment. I sat in the room, and the woman’s husband insisted she could understand me, but just couldn’t speak English that well, so he would translate. Legally, we cannot have family translate. I was in a sticky situation. Did I go ahead with the exam and make sure we got an interpreter for next time, or, directly against the patient’s wishes, insist that they cancel their appointment and get an interpreter the visit? 

There are huge moral and legal implications to having a family member, especially a husband, translate. I ran through my list of questions that we ask at every initial prenatal visit, to the best of my ability, but how does one ask a woman, whose husband is her only means of communication to me, if she is safe at home? If she has a history of sexual assault or trauma? If she’s ever been pregnant before? If she’s ever had any sexually transmitted diseases? If she’s in a monogamous relationship or not? 

I saved those questions for the next visit when I could have an interpreter, but even then, I knew that her husband would probably be in the room, which brings me to another point: asking the tough questions when partners, mothers, sisters, or friends insist on staying for the exam. In school they tell us that it is often a red flag when a partner or husband insists on staying in the room, in order to make sure that the correct answers are given to all those difficult questions. This always has to remain in the back of my mind when I conduct an exam, but we have all had patients who show up with bruises in unexplained places even though their partner “seemed so sweet and engaged,” it is our duty to ask at every visit, “Have you been kicked, slapped, or hit during this pregnancy?”

I love working with translators, but translators come in all shapes and sizes, and degrees of competency. One of the hardest things to have happen is to try and explain complicated information about genetic testing, for example, or a diagnosis of gestational diabetes, through a third party. Some of the best interpreters I’ve worked with will interrupt when they need to start translating, and will explain in full what I’m talking to the woman about. Hopefully, the woman will feel comfortable enough with the interpreter, or with me, that she’ll do the same thing I do: talk directly to the person I’m communicating with, and the interpreter is a fly on the wall, creating a common language link between us almost seamlessly. Not all women are able to do this, for whatever completely valid cultural or language-based reason.

Instead, what often happens is I start to explain something, and, like in this case, the interpreter gives a response that is a quarter as long as I just talked for. I don’t speak the language being communicated in, but I can tell that not everything I have said is being translated. I get frustrated, because what’s the point in having an interpreter if my patient isn’t going to get all the information they need anyway?

In my academic life, I am working on research talking to primarily Spanish-speaking women on their experiences giving birth in the United States. The general themes that have emerged is that no one talks to women who do not speak English. Not just in the literal way, that providers have difficulty communicating, but that even when there are interpreters available, they are not secured in time for the woman’s appointment or birth. Providers do not talk directly to the woman, they talk to the interpreter. Forms are not provided in their language of choice, and many women have expressed fear that they did not know what they were signing when they signed informed consent paperwork at hospitals. This is the opposite of “informed consent,” folks.

We have an obligation, both legally and morally, to do better for the women who do not speak the dominant language of the medical field, and hopefully everyone will start listening to women, even when they cannot speak directly to us. 

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