Published February 18, 2019
When I started my first week of primary care as a resident physician, I was not expecting to use greetings such as “Bonjour” and “Ahlan wa Sahlan” as part of my interactions with my patients, but that was the reality of working in a city that is ranked among the top ten places for refugee resettlement.
A refugee is someone who is forced to flee his country “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion” (UNHCR, 2013). Between 2002 and 2016, the city of Buffalo resettled over 14,700 refugees, representing over a quarter of the refugees resettled in New York state over the same period. Most refugees in Buffalo and Erie County come from Bhutan, Central Africa, Eritrea, Iraq, Myanmar/Burma, Somalia, Sudan, and Yemen (US Bureau of Population, 2016).
As physicians, it is our duty to provide medical care for all members of our community using the best tools available to us. Unfortunately, cultural differences have proven to be a major obstacle in providing effective medical care. People from various backgrounds often view health very differently, and there is a lot of vital information that is lost in translation, making treatment difficult. I have encountered many patients that have complained of vague symptoms, such as fatigue and malaise. In the past, these patients were sent to multiple sub-specialists and subjected to tests that not only exposed them to unnecessary risks in some cases but also put a strain on the entire medical system.
The inability to communicate with a healthcare clinician creates a barrier to healthcare access, undermines trust of the clinician, and decreases the likelihood of an appropriate follow-up (Brach, 2000; Gazmararian, 1999). My first few patients were native Arabic speakers, and the majority of them were not yet comfortable (or proficient) in conversing in the English language. Many of these patients had also seen multiple sub-specialists and had undergone several tests; however, they often could not recall the medications they had taken, the sub-specialists they had seen, or even the different diagnoses of their medical condition(s). These patients are what doctors refer to as “complex patients with multiple complaints.” The language barrier compounded matters and made it very difficult to achieve an effective treatment plan.
While some health care facilities provide translator phones that connect the provider with an interpreter, some languages, Arabic included, have dozens of different dialects that are unavailable for phone interpretation. My ability to speak and understand the language vastly improved my patient relationships and made them feel that they could openly and comfortably share their concerns. This open discourse then helped me discern whether they needed further treatment.
One example that truly touched me was that of a young woman with family roots in Africa who came in with concerns of fatigue. Her physical exam was normal, and previous her previous blood tests were all within normal limits. Since she did not speak English, her husband translated for her at first; however, as we were talking, I found out that she spoke French. The moment we switched to conversing in French, her body language changed dramatically—she was much more comfortable. We talked and she explained things to me in her own words, including what was worrying her and what was important to her. I listened and I did not interrupt. In the end, we agreed on a treatment plan that consisted of regular visits instead of medication or further tests. The young woman thanked me and left with a smile on her face: in her words, “the first smile I had mustered for a long time.” This was an example of a patient that just wanted their physician to truly understand them.
I remember feeling overwhelmed when I first tried to manage patients who were having difficulties expressing their medical complaints and histories. I soon found that I could use the language skills I acquired early on in my education to our advantage. Being able to converse with these patients in Arabic and French not only vastly improved the accuracy of my diagnoses and treatment plans, but it also filled me with a great sense of satisfaction and helped me feel that I was providing the best care possible to my patients.
When I first started on my journey in the medical profession, my goal was to establish myself as a competent physician so that I would be able to travel and provide medical services as part of missionary trips to less-fortunate and war-torn countries. However, I quickly realized that I had already been doing my desired work in the second largest city in New York state. There is already so much work that we can do here and now in our own communities. I was not expecting that the skills I would utilize the most would be the ones that I did not learn from medical school. Rather, my ability to speak multiple languages has helped me bridge the patient-doctor barrier. These ongoing experiences continually remind me that diversity is an asset, especially in a country where patients come from around the world.