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Patient care and language barriers

Aviva Friedman is a 4th year MSIH student currently on her Global Health Clerkship Experience in Canada.

by AVIVA FRIEDMAN – Thursday, 1 February

Parlez-vous francais? I think one of the biggest unexpected realities of Sudbury, and of practicing medicine here, is the language barrier. I had no idea that this town, which is only a few hours north of Toronto, is “unofficially” bilingual. At least 40% of the population are French speakers; you can hear the language and the unmistakable accent everywhere you turn. As a physician here, having French language skills is a bonus and a necessity. We had a patient this week who came in to learn results of cognitive testing. She insisted that she was able to communicate both in English and in French, but the physician emphasized how important it was that she be offered cognitive testing in French, and how the results could have been skewed because of the language change; he then reverted to speaking to her in French, which was clearly more comfortable for her.

The Big Nickel - Sudbury, Canada
The Big Nickel – Sudbury

The encounter reminded me of some of the challenges I faced in Israel with Hebrew-speaking and Arabic-speaking patients (and Russian-speaking, and Tagrinian-speaking….), and of the tools and tricks I used there to get around: a mishmash of broken Hebrew, improvised hand signals, and help from friends and strangers. I do understand a small bit of French, much like I understand some Hebrew, so I am able to listen to patients and use what minimal French I know. But still, I recognize that because I am deficient, I am unable to provide the best possible care – things get lost in translation. As in any global health setting, I am reminded that you often need to call upon all resources at your disposal to communicate with patients who may not speak your language. This was truly exemplified this week when I sat down with an elderly Chinese couple, and struggled for nearly 30 minutes to get a complete history from them. As I stumbled down the hallway looking to consult with my preceptor, I bumped into my colleague K, who, notably, is a fluent Cantonese speaker. K changed the fate of these patients – she sat with them for nearly an hour, extracting information that would have gone unrecorded otherwise. This was another reminder of how important translational services are when working across languages and cultures, and also of how cool and important K is.