Western Hospital Meets Eastern Beliefs: What healthcare professionals need to learn about refugees and immigrants in the U.S.
Treating refugee patients: Advice for healthcare professionals working with refugee patients and individuals with different backgrounds.
As an interpreter, I’ve witnessed many confusing incidents between refugee patients and their American doctors.
When I say that there was a misunderstanding between a patient and a doctor even with the presence of an interpreter, many people promptly jump to the conclusion and think it’s because of the “incompetent interpreter.” Most people assume that the linguistic difference is the only issue between Refugee patients and their American doctors. However, linguistic difference is just the tip of an iceberg. The real challenge is to build a bridge between two people whose cultures profoundly differs from each other. With that being said, individuals’ personalities differ from each other even within the same cultural groups.
I am going to precisely highlight the issues at doctor’s office due to a difference in refugee patients’ culture and distinct beliefs in treatment process compared to their doctors.
To clarify my point, let me recreate a visual misunderstanding scenario at the hospital.
First, let me introduce my fictional characters (based on real people):
Ganga Maya is 56 years old. She has four kids. Three sons, and one daughter. Her two oldest sons and her daughter are married. Her oldest son lives in a different apartment with his family of four. Her daughter, who is also her second child, lives with her husband in a different part of the city. Currently, Ganga Maya lives with her husband, her third son, her daughter-in-law, her grandson and her youngest son. She was married at a very young age and never went to school. She likes to cook for her family, and that’s what she’s been doing her entire life. She’s has a lot of love and support from her family members. But she gets agitated with her daughter-in-law all the time. Her daughter-in-law is not from the same caste and Ganga Maya thinks that her son drinks because of the guilt of eloping with a lower caste person. Ganga Maya wants her youngest son to get married, of course to someone from own caste, so she could move in with her youngest son and his wife.
Ganga Maya has some issues with her stomach. It gets worse during night hours. She’s not exactly sure what is going on but she knows that she’s been dealing with her stomach ache problem since her son got married. She thinks her daughter-in-law has something to do with it. She thinks her daughter-in-law might have cursed her but she has not talked about it with anyone. She knows the fact that her son does not believe in traditional witchcraft. Her son, on the other hand, takes her to the hospital every time she gets sick. Ganga Maya knows that the western pills are not helping and really think she needs to stay away from her daughter-in-law to permanently cure her illness.
Dr. Steven is in the late thirties and got his residency not so long ago. He lives with a small family of three in a suburban area. His wife is a school teacher. His child goes to private school. Dr. Steve is very witty and is loved at the hospital for his senses of humor. He likes 80’s music, and he is a big Star-wars fan. He grew up in a very remote farm and had very little contact with other cultures in his college years.
Dr. Steve is very passionate about his job. He reads magazine and journal reports on medical discoveries. He sometimes feels overwhelmed with his son and his job. He typically works extra hours. He is a gastroenterology specialist.
When Ganga Maya goes to see Dr. Steven:
Ganga Maya’s son called a cab to take her to the hospital for her appointment. Her sons and her daughter-in-law had to go to their work so they couldn’t personally take her to the hospital. She’s instructed that the interpreter will meet her in the waiting room and guide her to the doctor’s office. She is anticipating a ride from an interpreter to come back from her appointment.
At the waiting area, Maya meets the interpreter who brings her a form. The Interpreter starts to ask her series of questions, including whether she’s working or not. She thinks the interpreter should know that she can’t work because of her age and her English.
She followed her interpreter when she was called inside. Her doctor says hello and asks her if she had trouble finding a parking. She is confused. Interpreter promptly replies no.
The doctor then asks Maya this very vague question, “what’s going on?”
Ganga Maya’s goal after meeting this doctor was also to get a report saying that her illness impedes her ability to study and pass her citizenship test.
So, she replies, “Well, I am old and you know how hard it is when someone is old. There will be lots of issues and you don’t feel like you have enough energy to deal with those issues. At this age, a strong support from a family is crucial but not everyone is lucky to have family members who want to provide good care and support. When my stomach hurts and my sons aren’t home, I feel sad about moving to America. You, know there’s nothing harder than not knowing a language.”
Dr. Steve wasn’t very clear what she was trying to say through an interpreter but he knew she’s got some stomach issues. To confirm his understanding, he asked again, “So, if I understand correctly, is it the stomach ache? By the way, I understand what it is like to be placed with people who speak a different language. I once had an awful Thanksgiving dinner with my wife’s French Canadian relatives in Montreal. I thought they spoke some English. Oh boy! I had to be quiet for the whole dinner time.”
Ganga Maya responded, “Yes, it is stomach pain but I also have some headache and it’s hard for me to learn anything at this age.”
Dr. Steve asked her if she’s got any pain right now. Ganga Maya nodded and Dr. Steve asked her to rate her pain from the scale of zero to ten. Ganga Maya asked her interpreter what number she should say. Interpreter tried to explain how rating works and she quickly said it is number 10. However, Ganga Maya had to drop that number down to 7 after Dr. Steve explained that she would be crying if she’s experiencing that much pain. Dr. Steve records her pain scale on his computer. Then, he asked another question, “What’s the reason for your abdominal pain?”
Ganga Maya found this question confusing because she thought a doctor is supposed to find her illness. She then replied, “I don’t know, but it started since my son got married…well, technically it’s not a marriage without our permission as far I am concerned.”
Dr. Steve sarcastically asked, “I just wished I got the invitation for your son’s marriage. You see, now I don’t EXACTLY know when he was married.”
Ganga Maya responded, “It was last summer” Dr. Steven now moved next to her and asked Ganga if he can take her vitals (temperature, blood pressure, and other preliminary checkups). She again nodded her head. After taking her vitals, Dr. Steve asked Ganga Maya to say yes to the medication that she’s taking. He wanted to make sure she’s talking all the medication she needed.
Unfortunately, Ganga Maya forgot to bring her pill bottles and she didn’t even know how many medications she was taking. Then, Dr. Steve asked if she had any metabolism issues. To make it a little easier for an interpreter, he repeated his question in simpler language, “Do you digest well?”
Ganga Maya replied, “Yeah! But I only eat very little. I don’t feel like eating a lot. You don’t feel like eating when the cook isn’t very nice to you.” Dr. Steve with confused face says ‘Okay…’ and starts typing on his computer.
Few other questions continued, including her family histories and surgical histories.
Ganga Maya continued to provide her answer with a slight hint that her daughter-in-law was the reason for her stomach ache. However, Dr. Steven was completely unaware of what she was saying and eventually ran out of his time and scheduled another follow-up appointment. He prescribed a few painkillers and instructed her to take one tablet three times a day.
This is a typical medical room conversation between older refugees of different culture and an American doctor. It’s quite fascinating to observe a chaos of misunderstandings when a western hospital encounters an eastern believe system.
However, those misunderstanding could potentially be very harmful to the patient. Thus, it’s crucial for the doctors to understand their patient’s background including their beliefs, cultures, histories and more importantly their priorities of life.
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