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Lost in Translation: Language as Barrier to Care

Mr. W is an elderly man currently enrolled in French classes, hoping that he will become more functionally independent as he improves. He frequently commented about forgetting what he would learn in class, explaining that his mind always wanders back to his family members who are now scattered everywhere and also back to Syria, the place that he once called home. Tears flooded his eyes. He hastily wiped them off so as to avoid looking too weak in front of me. In the waiting room, I sat back and simply listened as he volunteered his life story.

Mr. W described how they lived comfortably when they were back in Syria. He and his wife were employed. His sons had already completed their university degrees while his daughters were still enrolled in a university.

“They were hoping to continue their education here,” he said.

He, his wife and two daughters have lived in Montreal for months as refugees. His two sons settled in Armenia after fleeing from Syria before the rest of the family did for fear of being taken.

As he spoke about their struggle to leave their home with nothing more than what they could carry, he described how they stayed with his sister in Beirut for some time before moving on to Armenia where his sons lived. On the way back home, he, his wife and one of their daughters were kidnapped by armed men. They allowed his wife and daughter to go back to Aleppo but kept him imprisoned.

He was tortured.

“Many other young men were also captured,” he stated. “I was lucky. I was old. They let me go for 1.5 million Syrian liras. Others weren’t so lucky. Most never come back.”

He described what was happening as a “trade” of sorts. They were paid for every man they captured, and the only way one could be released was by paying a hefty price. No valuables in their luggage were returned. After being released, his health began to deteriorate and included a new diagnosis of diabetes.

What appeared to have wounded him the most, however, was that the men responsible for his capture and torture were commanded by individuals with whom he was acquainted. They had dined together. While his physical wounds may have healed, it was clear that the wound of betrayal still throbbed visibly and continued to cause him immeasurable pain. Despite all of this, he said that he longed to visit Aleppo “if only just one more time” before he dies.

Mr. W seemed to be adapting well to living in Canada: he knew how to navigate the bus and metro system and about the library system. He used his French every chance he could when we interacted with other personnel during our encounter. I would only intervene to interpret when he turned to me for help. He even asked me where he could buy French books so that he may study at home.

With multiple comorbidities, Mr. W liked to keep a record of his blood test results. The secretary kindly provided him with a copy of the analyses that were completed. I explained that the rest would take about three weeks to complete, and his next appointment was booked for the following month so that the physician could discuss the results with him. He was very meticulous, requesting a note that he could give to his French teacher in order to justify his absence. After making sure that he left with no unanswered questions, I escorted him to the exit and waited until I knew he was going in the right direction. I prayed silently that he would soon reunite with his family members and that one day they too would consider Canada a second home.

During the time that I’ve been placed at a clinic that takes care of asylum seekers, I’ve heard many heartbreaking stories like Mr. W’s. While patients like him start the process of settling in a new country, one of the most difficult barriers to overcome is not being able to communicate with the people around them, particularly with health care professionals. There is currently a lack of funding to invest in on-site interpreters in hospitals and to schedule interpreters with La Banque interrégionale d’interprètes (which is quite costly). In a city as diverse as Montreal, the current access to interpreters within the health care system is simply not good enough. In some cases, this can have disastrous consequences.

I heard a story from a friend who speaks a language that is very specific to a small community. There was a middle-aged man who was admitted and discharged soon thereafter when the physicians couldn’t find anything wrong with him and were unable to communicate with him. He left and came back very distressed, and still, no one could understand him. While the room he was in was temporarily empty, he jumped out of the window and committed suicide. The physicians later found out that his wife had taken the children and left. It turns out that he had a psychiatric illness that the doctors couldn’t identify because they couldn’t understand him.

Imagine being pulled into an operating room without having any idea what’s going on. Imagine giving birth for the first time in a place where you are surrounded by people who can’t communicate with you and where you don’t understand anything that’s happening. Likewise, imagine treating a child with asthma or cystic fibrosis without being able to determine if her living conditions may contain an irritant that’s leading to the her deteriorating health.

As a Canadian, I take great pride in my country being a vibrant quilt of cultures and faiths. As a fellow immigrant, I understand the significant challenges that unilingual allophone patients face within the health care system. As a future physician, I am taking this opportunity to highlight the dire need for health care professionals to work within the system to create effective and lasting solutions to this ever-growing language barrier problem in an increasingly multilingual city. Let us work to create a health care system that serves this diversity and empowers our patients, regardless of their backgrounds.

Sondos Zayed (2 Posts)

Contributing Writer

McGill University

Sondos Zayed is a medical student at McGill University who relishes at every opportunity for personal and professional growth, knowing full well that her patients will be her most influential teachers.