By Cameron Schlegel
The Frist Global Health Leaders (FGHL) program affords young health professional students, residents, and fellows the opportunity to serve and train abroad in underserved communities for up to one semester. In doing so, they will bolster capacity in clinics in need of support as well as offer training to community health workers to promote sustainability upon their departure from these communities. As part of the program, they blog about their experiences here. For more information, visit our program page.
"If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart," -- Nelson Mandela
"The good physician treats the disease; the great physician treats the patient who has the disease," -- William Osler
There are an estimated 68 languages spoken in Kenya, with 70% of the population speaking one of the national languages, Swahili, and an estimated 15-19% have some competency in the second national language, English. I take for granted that I live in a country where over 80% of my patients and I share a language, and as such, share an avenue to open a door, to connect, to “go the heart” as Mandela references. While I am fortunate to be surrounded by colleagues who elegantly flip between Swahili and English, try to assist me when they can with piecing scattered English into longer Swahili conversations, and patients who know enough English for us to have a broken conversation, I feel Mandela’s words more here than I have anywhere else.
As a surgery resident, we encounter patients from many walks of life; a common language and time give us an opportunity to build a bridge, to perhaps not stand in each other's shoes but strive for that, to connect. One of the things that drew me to this career path was not simply the surgery, but the journey of taking a patient pre-op, through their operation, and caring for them as they recover. That journey is built on language, the explanation of their disease, of the operation, of the risks of that operation, and the challenges we face together after their operation. How to overcome that distance here has been a hurdle that I would say I have still not successfully cleared.
Language barriers are a challenge we hear often about in the medical world – in the US alone, as physicians we often grossly overestimate our patients’ understanding of their medical condition, surgical options, and our ability to explain either to them. A 2006 NEJM article found that 18% of families in the US speak a primary language at home other than English (Flores N Engl J Med 2006; 355:229-231), yet I would hazard a guess that interpreters are not involved in 18% of all physician-patient encounters. I now find myself on the other side of this 18% as a provider, and while I am learning to treat the diseases here, finding uncommon comfort in the OR or the trauma bay, often nonverbal places of disease focus, Osler would say I have yet to successfully treat the patient.
This does not begin to describe the cultural barriers layered within the languages I don’t speak. I watch as the intern in clinic who is kind enough to translate for me talks to our patients in Swahili, holding long conversations translated to English in short, or as she somewhat awkwardly, or with great effort perhaps tries to translate around the edges of the question I am trying to ask for cultural or personal reasons, about such taboo subjects as bowel movement or surgical history, pregnancy or pain. I have avoided consenting patients, as I feel consenting in most people’s third language begs for misunderstanding, yet as I take my juniors through the risks of an operation and get to things like the risk of death in some of these serious, sick patients, I sense this may not be directly shared with the patient. These barriers beyond language are equally significant to reaching the heart of the patient, their family, their disease. As I shake hands for a little longer, smile a little bigger, share my few Swahili words and try to be present with my patients, I am trying to learn and treat without words, but have quite the distance still to travel.