Ranu Upadhya is a nurse on the medical–surgical unit at Oakwood Annapolis Hospital, Wayne, MI. Contact author: firstname.lastname@example.org. The author has disclosed no potential conflicts of interest, financial or otherwise.
Accessibility and lack of bias are both crucial.
A Nepali national who graduated from a U.S. nursing school, I have been working since 2007 on a busy medical–surgical unit in a leading hospital in southeastern Michigan. Our clientele includes a diverse immigrant population that often has problems communicating its needs and expectations effectively in English.
Figure. Ranu Upadhya...Image Tools
Having lived in Burma, Egypt, and the United Arab Emirates before coming to the United States, I considered myself sufficiently aware of cross-cultural concerns and sensitivities to be able to serve this key segment of the patient base. It was only after taking part in a formal training program on medical interpretation, however, that I fully grasped the importance of objectivity and prudence in approaching and responding to each particular situation.
The training, an intensive five-day program, made me reflect on two specific experiences I had faced in the preceding years, one professional and the other personal. The first concerned an elderly woman patient from India on our unit. She kept pointing to her abdomen and raising her hand to indicate the number five.
This constant gesture led her nurse, a native-born American, to administer pain medication, thinking the woman had level-5 abdominal pain. But the medication wasn't helping her. Exasperated, the nurse sought the assistance of two fellow nurses from India who were on duty that night.
The Indian nurses couldn't understand what the patient was saying either. They were from southern India and their local language was completely different from the patient's northern Indian language.
Thinking that the patient could be confused, the nurse in charge asked me—a non-Indian—for help. I discovered that I could understand the patient because her dialect was close to my Nepali language.
It turned out that the patient was far from confused or disoriented. She was trying to explain her difficulties in having a bowel movement, which the pain medication only seemed to have exacerbated. With that clarification, we were then able to begin treating the patient correctly.
The second example involved my father, who had recently undergone liver transplantation. Complaining of constant pain in his jaw, he had asked me to set up an appointment with the dentist and accompany him to the clinic.
On the scheduled day, after examining his teeth, the dentist suggested that my father take all of them out to prevent future infections and any conflict with his posttransplant treatment. My father demurred, saying he didn't think the situation was that bad.
A former civil servant and diplomat in Nepal, my father was fluent in English. But he had difficulty understanding the medical terms used by the young dentist. As I began to translate what the dentist had said, I didn't realize the extent to which I was allowing my concern for my father's health and longevity to supersede his desire to keep his teeth. I insisted that my father do as the dentist advised, but he refused.
Over the years, he would remind me of his reasonably good dental health and how, if he had listened to me, he would have been deprived of the pleasure of chewing his favorite nuts with such natural facility. Sometimes it sounded as if he were implying that he had escaped the duress I would have put him under by a hair's breadth, which upset me.
While undergoing the medical interpretation training, I realized how my emotion-laden translation and advocacy for a specific line of treatment at the dental clinic wasn't the kind of help my father needed. Rather, it served to impede what was supposed to have been unbiased physician–patient communication.
Sound medical interpretation practices remain central to a strong and efficient health care system. In these two examples, I felt I did something right in the first and not in the second. At a broader level, the training program made me recognize that breakthroughs in treatment and technology—no matter how far-reaching—will have limited benefit if the system fails to ensure that all patients get the care they need in a language they can understand. I hope health care professionals don't have to wait as long I did to learn this lesson.
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