No Habla Espanol

For those of us who are linguistically challenged, medical trips to Latin America often have an added layer of confusion. During our trip to the the Dominican Republic an obvious barrier to overcome was the language gap. Despite the fact that our peace corps translators were fantastic, there is no substitute for understanding words straight from the patients mouth. Out of the 8 medical students on the trip 2 were functionally fluent, 2 were able to get by, and the other 4 of us really lacked any Spanish language skills at all. This made for times in clinic that could be as frustrating as they were entertaining. For example, take my often asked question, "How many times have you had a sore throat in the last year?" Right around 100% of the time this question would send the patient into a monologue of at least several minutes in duration, none of which I would understand. At the end of the rant my translator would mutter something else in Spanish, and then turn to me and say, "Once." The first couple times this happened I asked what else the patient had said. The translator would then proceed to tell me how the patient talked about the "gripe" they had six months ago, the concerns they had with the local hospitals, how they didn't like the doctors in the DR, none of which had anything to do with my original question. And, while I was well versed in dealing with tangential answers and redirecting patients in the U.S., my lack of Spanish comprehension made it impossible to do so in the DR. By the end of the first couple patients, I found that I had to trust my translator to filter out the things that were insignificant to the chief complaint. Having them translate every single word would cause us to spend over an hour with each patient. This was something that we could not afford when each student needed to see 15-20 patients in clinic each day to get through everyone.

The peace corps translators were very capable, intelligent people. As one can read in previous posts, they all had amazing projects that were doing much more for these communities than our 1 week surgical trip. They had a solid command of the language and were absolutely vital throughout the entire trip. Yet, one problem I found as our the days wore-on was that the translators were being forced to play doctor. The peace corps translators were doing what we had been learning these last four years, except without any medical training. They were listening to the patient's story, ignoring those parts deemed to be insignificant and then picking out the salient details to communicate to us. And, while I did have faith in the peace corps volunteers' abilities to pick up on the basics of obstructive sleep apnea or recurrent tonsilitis, I did not expect them to be functioning on the level of nurses or physicians. Yet, this is the position many were forced into during the long days in clinic. It is important to note that rarely, if ever, during our trip was this sort of analytical translation ever detrimental to patient care. Still, I believe it was definitely less than ideal to have the translators doing as much doctoring as the medical students. Unfortunately, the time constraints and absent Spanish skills of students like me necessitated this approach. The question then is how would we be able to avoid this in the future? The simple solution is we would need more medical students who were fluent in Spanish. Only then would the patients get straight from the doctor medical advice.

The sad fact is that there are many medical students like me who lack basic foreign language skills. I would venture to guess that far less than a majority of medical students in the United States have conversational fluency in a non-English language. It is something that I regret every day when on-service at Loyola, not being able to converse with the multitude of Spanish speaking patients. I can get by with my "Te duele?" or "Respire profundo," but I really lack the ability to conduct a meaningful history and physical. At Stritch, we have Medical Spanish as an elective you can take, or as a course you can take outside of school. I believe having Medical Spanish as a required part of our curriculum would be beneficial. Given our schools commitment to international medical outreach and ISI trips, it makes sense to teach the language skills that so many of our students will need in the near future. More importantly, Medical Spanish is a skill that is often required in our community here in Chicago and all across the U.S. Indeed, its inclusion in our curriculum would serve to improve the capabilities of the class as a whole in future clinical practice at home and abroad.

Brian D'Anza, MS4
Santiago, DR