Crozet Annals of Medicine: At Home in the World
By Guest Columnist Amita Sudhir, MD
“Dr. Sudhir, we need your help in room 21,” said a flustered-looking nurse and resident. “There’s a Korean patient, but the interpreter phone doesn’t seem to understand her and we can’t get a history!”
I walked over to the room and a young woman sat on the bed, gesturing and talking in the direction of the phone. The disembodied voice of the interpreter kept telling us in English that she couldn’t understand the patient. I looked at her. She didn’t look Korean. I don’t speak or understand Korean, but the language she was speaking didn’t sound like Korean, either.
I logged into the computer and pulled up the patient’s last visit to UVA’s Medical Center, a routine office visit to her family practitioner. Under “Social History,” the note said: Patient is a Karen Burmese refugee.
The problem was now obvious—a misreading of the paper the patient carried with her led to the wrong language being selected.
I did a quick Wikipedia search. (Readers will be relieved to know that I draw the line at researching medical information on Wikipedia, but it has been an invaluable tool in the ED, helping us understand everything from patient’s alternative remedies to strange tattoos). The political situation in Burma led to ethnic minorities’ fleeing the country to refugee camps in Thailand. One of these groups is the Karen. They and their language are not related to Koreans or Korean, but the reader can probably understand how the confusion arose.
Imagine being in a strange country, not speaking a word of the language, having a medical emergency, and then being faced with yet another strange language that everyone expects you to speak and understand! We were able, thanks to the invaluable Cyracom phones that connect us with interpreters of literally hundreds of languages, to find an interpreter and help our patient with her problem.
Working in a town in rural Virginia, I didn’t expect to find myself taking care of such a diverse population, but Charlottesville’s status as a refugee resettlement location means that we see patients from all over the world. They often come from places and political situations I was unaware of. I consider myself a well-informed reader of newspapers, a global citizen, but the disenfranchised citizens of the globe sometimes come from places whose conflicts don’t even merit a passing mention in the paper.
Many of these patients have experienced only a medical system that is vastly different from our own (or no medical system at all). Some have never lived outside a refugee camp. The simple act of handing someone a prescription is not so simple after all. In many places, the concept of a pharmacy is unheard of and the patient has no idea why you think a piece of paper is going to cure their illness. It’s hard enough to explain the difference between a viral illness and a bacterial one to a native speaker of English; complicate that with having to go through an interpreter (and sometimes two, in the case of the rarer languages where a direct interpretation to English is impossible) and the possibilities for misunderstanding are astounding. And that’s why being a physician to these patients (and perhaps all patients) means staying informed about what goes on in the world outside our beautiful Albemarle County.
I’ve learned a lot from the travelers from the far reaches of the globe who find themselves in our emergency department. I’ve learned about political clashes, languages, geographical regions and customs I never knew existed. Some of them took a circuitous route to get here.
One of the few times I have spoken Hindi since leaving my native India was with a Kurdish man who had spent many years in New Delhi and who was more comfortable speaking Hindi than English. Since my knowledge of medical terms is limited to those parts of the body you can eat if they come from an animal, I relied on a medical interpreter for that part of the conversation, but we had a lively reminiscence about a land that was once home to both of us, in a different land that had opened its arms to us too.
From Dr. Reiser: Thank you Dr. Sudhir. The same thing happened to me, speaking Chinese (also via Cyracom) to a woman who said she was Chinese. The interpreter told me she thought the patient was mentally handicapped because she could not understand her Chinese at all. It turned out the patient was actually from Vietnam, but she was ethnically Chinese. Her family had lived in Vietnam for centuries but never identified themselves as Vietnamese, even though that was their language. This is aparently common in Vietnam.