As a child, I viewed health care as a utopia. All who entered the career sought only to help others; providers were always compassionate and prioritized the patient above all else. As with most ideologies of childhood, I learned this is not always the case. The system is more complicated than that. Systemic racism, xenophobia, prejudice, biases and stereotypes plague health care.
To overcome these faults in our health care system, I believe communication is paramount, particularly in language-discordant patient-physician relationships. The art of speaking with others and learning their stories allows for understanding and compassion between patient and physician. This is especially true of patients from different backgrounds and cultures. While it is often assumed that health care professionals use quality communication practices, my experiences demonstrate otherwise — specifically in regards to language barriers. In one week of my obstetrics and gynecology clinical rotation, I came to witness three failures in health care from such barriers. I will hereby refer to the patients as the days of the week for the sake of maintaining confidentiality.
Patient Monday is a 21-year-old woman in labor for the very first time. She came from Guatemala with her husband who stands by her side. Neither of them speaks English. I walk in excitedly alongside the midwife and a family medicine resident who will be managing the birth of the baby while I manage the birth of the placenta. I am the only one of us who speaks Spanish, so I introduce the team, ask how the mommy- and daddy-to-be are doing and ask them if they have any questions regarding the vaginal delivery they are about to go through. Dad perks up quickly and asks if mom is ready to give birth because he is “sensitive to blood;” he asks if it would be okay for him to step out should he start to feel dizzy. I chuckle and explain in Spanish, “Of course, we don’t want you to be a patient here too!” Mom and dad laugh. We are ready to go.
The nurse walks in to assist and exclaims, “Oh, thank God you speak Spanish!” I translate the entire experience for the mom. I tell her when to push. I count down each time. I explain how the epidural she had been given minimizes her sensation of the contractions, but we can see them through a monitor. I share with her when we see a lock of the baby’s hair beginning to gleam through. I check in on dad as he becomes diaphoretic with sympathetic overdrive. About an hour in, more nurses arrive not to assist but to discuss what they are ordering for lunch. Salad, tacos, soup. All in English. This goes on for almost an hour — I counted.
Mom and dad stare anxiously at the excessive number of people chatting in the corner in a foreign language, wondering if there is something wrong with the baby. Why else would so many other people be crowding their room? Thank God I speak Spanish. I become frustrated by their obliviousness to the patient’s concerns. I explain to the young parents to please not worry; the baby is doing well. I tell myself to not pay attention to them; focus on my counting. “Hasta diez y con mucha esfuerza,” I encourage the laboring mother. She pushes on. Imagine.
Patient Tuesday is a 34-year-old mother of three and roughly 35 weeks pregnant with new-onset hypertension. She is originally from Honduras, lived in Mexico for two years, arrived two weeks ago, spent one week in a detention facility and was released on the same day as President Biden’s inauguration. One week out from detention, she goes to a local community clinic to establish prenatal care. At the clinic, she has elevated blood pressure and is sent to the hospital for monitoring and work-up of suspected preeclampsia. As the medical student on the floor, it is my job to get the full history from the patient for her admission to the hospital. I introduce myself in Spanish and, knowing only part of her story, begin interviewing her.
Suddenly, a nurse walks from behind the curtain in the triage room; the patient is startled. She looks to me and asks who this woman is as this is not the same nurse she had previously seen. The nurse goes straight to the computer next to the patient. No greeting, no acknowledgement of the woman on the stretcher. “Last name?” the nurse asks. I explain to the patient that this is the new nursel the shifts must have just switched. The nurse becomes impatient and sternly repeats, “Last name?” I give the last name to the nurse and explain to the patient that she is just trying to look up her information in the computer. I wrap up my interview, in Spanish, with the patient and tell her that I will be back with the doctor in a few minutes. I ask the nurse if she needs help with anything like translating. I assumed her repeated questions in English (even though our conversation had taken place in Spanish) meant that she did not know the language. She said it was fine.
Ten minutes later, a call reaches the front desk where I sit with the resident and attending physician working on documenting the encounter: “The patient is trying to leave. Someone come here to talk to her.” The resident and I rush over. The nurse is seen holding the tocometer in one hand and the fetal heart tracer in the other. She was trying to place them around this woman’s pregnant belly to monitor for contractions and the baby’s heartbeat as she does with all her patients. Upon arriving at the room, we learn that the nurse continued trying to speak to this patient in English despite the patient’s evident inability to speak the language. Following her half-hearted attempt at “patient education,” she proceeded to lift the patient’s gown and attempts to strap on the monitors. As a result, the woman is frightened by her nurse because she is unaware of what this foreign nurse is doing to her and her unborn child. One week out from detention. She is scared. Imagine.
Patient Wednesday is an 18-year-old first-time mom who had just undergone a vaginal delivery of a baby boy. The resident and I walk through the hallway when we catch a glimpse of some new mother’s baby being transported in what could be best described as a baby spaceship. A tiny, newborn lying in a plastic encasement adorned by monitors; a massive binder with an exuberant amount of paperwork for this young life sits atop his temporary home. We look past and enter the patient’s room. This is the first time that we meet this patient and the father of her child.
The resident and I note that the new mom has a flat affect. We begin to wonder what is going on. Is it an issue with the partner? Is it postpartum blues? We ask the usual set of questions to the mom and are met with one- to two-word responses. Next, we ask about the baby, only to realize the baby is not laying in the incubator as expected with both parents in the room. Where is the baby? As it turns out, her baby was the same one we had seen in the baby spaceship earlier in the hallway. He had thrombocytopenia and was being transferred to a different hospital with a NICU for further evaluation and more appropriate monitoring.
I ask the parents if they know what is going on. They say no. The team who came to transfer the baby explained everything in English, a language neither of them knew. I assure the new parents that I would get them the information right away. I ask the transporters if anyone was going to explain to the parents what is going on and where they are taking the child. They tell me the hospital name but that they would get someone to translate for them. None of them spoke Spanish. The baby was already out of the room and ready to be sent off. I wonder what would have happened if no one had spoken up.
A woman arrives a few minutes later and, in a broken Spanglish, explains the situation. I proceed to take notes for the family. She gives them a folder with some documents so they can call the hospital for information about their newborn and eventually visit him. I confirm my notes with the woman and thank her for helping. I ask the dad if I can see the folder he had just been given so that we can review it together. The documents, the ones that were to guide the new parents to their newborn son, were in English — again, a language they did not know. We look at one another frustrated and I tell them not to worry, I will translate it for them and make sure they have all the information they need to see their child.
I take the documents and scurry off to my usual corner of the nurses’ station. I spend the next twenty minutes translating the instructions for them. I return to the room; they tearfully thank me for doing this for them. I come to learn that the mom had crossed the border illegally from Guatemala with her father. He was an alcoholic who abandoned her just over a year ago. She was alone with no family and did not know the language: an “illegal” immigrant. She eventually met her partner and the father of her child who has helped to support her and give her the family for which she was looking. She became pregnant and finally felt like things were looking up. The baby was born and she was so happy, she explains. Then, something happened and he was gone. Imagine.
Imagine being any of these patients. Imagine enduring a grueling journey to arrive at the so-called “Land of the Free,” requiring medical care in this foreign place for the sake of your child and having no idea what is going on. Imagine the gut-wrenching fear, the emotional anguish forced upon you. I have never been as disappointed by the field of medicine as I was on these days. The field that brings about so much hope and support to those who need it the most failed each one of these women.
We failed to provide them the adequate care they needed and deserved. We failed to provide them compassion, basic human decency and respect. We failed to do our job as educators and provide them with information and autonomy over their family’s care. Something so easily rectifiable with a simple phone call to translator services. Maybe “Land of the Free” only applies if you speak the language. Imagine.