Tuesday, January 05, 2010

Doctors in Translation

Ofri, D. (2010) Medicine in Translation: Journeys with my patients. Beacon Press.

For two decades, Dr. Danielle Ofri has cared for patients at Bellevue, the oldest public hospital in the country and a crossroads for the world's cultures. In Medicine in Translation, she introduces us, in vivid, moving portraits, to the patients she has known. They have braved language barriers, religious and racial divides, and the emotional and practical difficulties of exile in order to access quality health care. Sharing their journeys with them over the years, Danielle has witnessed some of their best and worst moments, and come to admire their resilience and courageous spirit.

Danielle introduces us to her patients: Samuel Nwanko, who was brutally attacked by a Nigerian cult in his homeland and is attempting to create a new life in America; Jade Collier, an Aussie who refuses to let a small thing like a wheelchair keep her from being a homegrown ambassador to New York City; Julia Barquero, a Guatemalan woman who migrated to the States to save her disabled son but cannot obtain the lifesaving heart transplant she needs because she is undocumented. We meet a young Muslim woman threatened at knifepoint for wearing her veil, and the spitfire SeƱora Estrella, one of Danielle's many Spanish-speaking patients, whose torrent of words helps seal Danielle's resolve to improve her own Spanish, an essential skill in today's urban hospitals. And so she, her husband, and their two young children and seventy-five-pound dog relocate to Costa Rica, where they discover potholes the size of their New York City apartment, a casual absence of street signs or even street names, tangy green-skinned limon dulce dangling in the playground, and sudden rains surging over the craggy edges of roadside ditches. Ultimately, Danielle experiences being a patient in a foreign country when she gives birth to their third child, a "Costarricense" girl.

With controversy over immigrants in our society escalating, and debate surrounding health-care reform becoming increasingly urgent, Ofri's riveting stories about her patients could not be more timely. Living and dying in the foreign country we call home, they have much to teach us about the American way, in sickness and in health.

To read more about Dr. Danielle Orfi, see her blog. You can also read a review of the book in New York Times.

Another beautiful piece by a doctor in a multicultural setting, Dr. Nell Burger Kirst from the University of Michigan, was posted on the New York Times today. I quote a part that particularly touched me:

"Words are paramount in the business of medicine. Diagnoses are illuminated by the patients’ own accounts of their illnesses. Treatment options are discussed using conditional verbs, plans described in the future tense. And in the end everything is documented. We have become so dependent on our words — so reliant on the phrases and spiels we know by rote — that it is almost impossible to imagine what we would do without them.

But there is communication without words, too — an honest-to-goodness human presence that transcends language. Sometimes it is just as essential to healing as our precise and formulaic words.

In medical school I worked with a young infectious-disease physician from India. She was consulting on the case of a middle-aged Indian man who had cancer and a hospital-acquired infection. His infection had improved, but his cancer had become quite aggressive, and I accompanied her to his room to discuss what had become a very poor prognosis.

To learn how to carry on this kind of end-of-life discussion, medical students practice on actors trained to simulate dying patients. It’s a valuable exercise, but a difficult one. I always found myself hung up on the details of what I was supposed to say — important details, like the patient’s life expectancy, remaining treatment options and the logistics of palliative care and hospice services.

When it came to real patients, I found myself similarly fixated on the particulars, doing my best to learn the drill: What lab or exam findings let the physician know it was time for this discussion? Would insurance pay for hospice care? Could she wait for her daughter to fly in from Phoenix before making the decision?

The Indian patient lay quietly in his hospital bed, his wife beside him, elegant in an embroidered dress and a sheer blue headscarf. The doctor began speaking to them in English as the husband and wife took turns translating unfamiliar words into Hindi. I listened closely as always, concentrating on the facts of the case.

I suspect the English was on my account, for when it became clear that the couple was having too much difficulty understanding, the doctor gave up and began speaking in fluent Hindi. I kept listening, but now the music of the language was all I could follow.

English words were peppered in only occasionally — a sentence punctuated by the word “suffering,” then a paragraph weaving “comfortable” and “hospice” into a string of Hindi. I was behind a veil, seeing the dialogue only in silhouettes.

Yet somehow, being outside the language finally allowed me into the heart of it. The conversation was beautiful, hypnotic, meditative. With words out of the way, I could focus on the elements I had always been too distracted to notice — the doctor’s slow and lilting tone, her attentiveness to the patient’s body language, the white-knuckled hands of the husband and wife locked together, a lifetime of love, fear, resignation and hope flickering back and forth in the glances they exchanged.

After several minutes, the patient looked my way and asked, “Should we speak in English, so she can understand?” I was humbled by his generosity, but there was no need; I understood better than I ever had before.

For all your English to Arabic and vice versa translations that will help you expand your business into the Middle East visit Arabic Language Experts at http://www.arabic.com.au/.

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