Skip to content

All talk and no comprehension

My first experience using translators in Medicine happened when I was a feckless medical student doing an intake interview and examination for a couple at an infertility clinic. 

The couple were recent immigrants from an Asian country and they brought the husband’s sister along to translate. You can imagine how uncomfortable and awkward that was. The questions in an infertility questionnaire aren’t things you would necessarily want your sister-n-law to know. 

In fact, when we got to the questions on whether the two patients had ever had any STIs. She skewered me with an angry look. “People from my country don’t do that!” and point blank refused to translate the question. Then when I examined the husband and found giant bilateral hernias pulsing away in each scrotum I really, really, did not want to tell his sister that his sperm were being cooked by his medical condition. 

Many years have passed since then, but using family and informal interpreters is still a challenge. When I worked in Ontario there was a provincially mandated translation service called RIO—a telephone service. While the quality can be spotty, it can be a lifesaver and certainly way easier than trying to get a hospital cleaner who happens to speak the right language to explain the ins and outs of cardiac revascularization. 

I recently had a patient with a possible genetic disease so complicated, in heritability and penetrance that my geneticist consultant had trouble explaining it understandably to me. My pregnant patient with her very limited English and French and low health literacy could not really understand what the implications were for her and her family. My teaching site is in an area where there are an enormous number of immigrants and refugees. We serve patients who speak 70 different languages. To care for these people, our clinics use a large proportion of our operating budget to provide different modes of translation. 

The hospital, in this same area, continues to use “informal translators,”—nurses, doctors, secretarial and others are often called away from their other duties in order to provide appropriate and ethical care for our many multi-ethnic and multi-lingual patients. The costs for the hospital are prohibitive, and since the CAQ government has a barely disguised contempt for immigrants, non-francophones and Montrealers generally. The government has decreed that all new immigrants should be able to receive all their healthcare in French after six months in the province. They are certainly not willing to fund the translation services we so desperately need.  

I have to confess that sometimes in L&D, I have sometimes pulled out my little card and called RIO so I could communicate with my freaked out, labouring patient. However when my dear geneticist friend realized that our clinics had translating services, he started setting up consults virtually at our clinic having our residents or nurses be there as the genetic counselor spent an hour doing the detailed intense interview that a genetic counselling session demands. That was OK once or twice, but then again and again one of our clinicians has to book an hour to sit there to enable someone to do their very important and necessary work. When our administrator found out about this, she hit the roof. It’s one thing to lose out on a better air conditioning/heating system in our building or not be able to hire other health personnel because we place our priorities here, but it’s another to subsidize the hospital in their choices while taking time away from our patients who actually need service. To be honest the head of our regional health board is exploring how to bring translation services to the hospital—but we are not there yet!

So I tried to manipulate the system. I spoke to my division leader, I spoke to the chief of OB, to the geneticist, I spoke to the hospital ethicist, I spoke to the hospital lawyer. I made a pest of myself. 

So now, genetics has access to their own translation system. It’s not really what I wanted. But it will have to do for now.