Thursday, November 15, 2012

Multi-cultural communication at heart of community care

by Aimee Tow, PT, physical therapist, MGH Chelsea Health Center

My name is Aimee Tow, and I am a physical therapist at the MGH Chelsea Health- Care Center. As a physical therapist, I use empirical and subjective data to examine and evaluate my patients. In other words, I look, and I listen. What I’ve learned after years of working with a diverse, multi-lingual patient population is that listening is open to interpretation (pun intended).

According to the 2010 census, the population of Chelsea is 48% white, 9% black, and 62% Hispanic/ Latino. One of the benefi ts of working in Chelsea is meeting people from all over the world. I speak English and Spanish, and through my work, I’ve met
people of many other languages and cultures. In a typical week, I see approximately 50 patients. About half of those patients prefer to speak in Spanish; others speak English, Portuguese, Somali, Bosnian, Nepalese, Arabic, Amharic, Vietnamese, Kirundi,
Italian, French, and American Sign Language.

Working in such a diverse community comes with a unique set of challenges. One of which is certainly communication. Fortunately, we have easy access to MGH medical interpreters, who do more than just translate words — they act as cultural liaisons — helping to de-mystify cultural differences. I’ve learned that multi-cultural communication involves more than just translating words.

In my role as a physical therapist, I interpret all the time for English-speaking patients who grew up right here in the United States. For instance, one of my English-speaking patients wants to get back to gardening. When she says, ‘gardening,’ I think I know what that means, but I still have to clarify (interpret) because there are different ways to garden. So, I ask questions to help me understand.

Because of her answers and because we share a similar cultural background, I soon have a clear idea of what she means by gardening.

Now consider this scenario with a patient from Bhutan (southern Asia), who speaks Nepalese. I request a Nepalese interpreter and begin my evaluation. I learn that his chief complaints are pain in his right knee, diffi culty walking, and pain on the right side of his back. I ask if he did any type of exercise before surgery. The interpreter relays my question but says the word, ‘exercise,’ in English.

A moment later, outside the treatment room and away from the patient, I ask the interpreter why she said the word exercise in English. She explains that many people don’t know the word for exercise in his language, so interpreters usually use the
English word.

No word for exercise in this patient’s language? How will the word have meaning for him? How do I explainwhat exercises to do if he has no concept of what the word means?

Back in the treatment room, I begin my examination, noting that the patient has many impairments. Soon his story emerges. He’s had knee pain since living in the refugee camps in Nepal. He lived in the camps for 20 years until emigrating to the United States in 2009.

As I try to create a meaningful image of this patient’s life, I realize I have no idea what it means to live in a refugee camp. He must feel the same way about the word exercise as I do about refugee camps in Nepal.

On subsequent visits, I learn that this patient had been in the army. He has been tortured by a machine that squeezed his leg. That explains the atrophy of his right thigh. As horrifying as it is to hear this, I realize that if he was in the army, he was accustomed to doing exercises. He could appreciate the importance of an exercise program.

Another patient is originally from Somalia. She is 64 years old and at one time lived as a refugee in Saudi Arabia and the United Arab Emirates. She never had any formal education, has never been employed, she raised eight daughters, and wears brightly colored robes and head-coverings.

When I ask about exercise, the interpreter says the word in English. Later, the interpreter tells me there is no Somali word for exercise. She says they call it, ‘work.’

Again I wonder. What does this patient think when I recommend she do exercises, which she interprets to mean ‘work’? I wonder what it would be like to be 64 years old living in a culture so different from your own and have someone ask you to do something
you’ve never done before. Even though I’ve explained it through the Somali interpreter, I wonder what meaning she attaches to the
words, ‘strengthening’ and ‘exercise.’

We are fortunate to have access to professional medical interpreters who speak so many languages. And I know first-hand how valuable theyare in establishing communication between patients and clinicians. But some aspects of inter-cultural communication
go beyond simple verbal interpretation. It’s up to the provider (in this case, me, the physical therapist) to fi gure out what vital pieces of information might be missing and find a way to close those gaps in communication.

Every day, I ask myself: How am I going to understand what this patient is telling me in the context of his or her life? How will I convey what we’re going to do inphysical therapy? Whenever I begin an initial evaluation with a patient whose language or culture is different from mine, I know what I have to do. My patients have taught me. Ask questions. Keep asking questions. And keep
an open mind. We’re all the same in that respect — we all just want to be heard and treated with respect.

Back to Top