On Language and Learning

By: Mary Welter

Mary is from Novato, CA and graduated in 2015 from Whitman College in Walla Walla, WA with a degree in Biology and French. This year she is working as a Patient Advocate at Marie Reed, a beloved community-based health clinic in Washington, DC.

With seven months of experience being a Loretto Volunteer, it feels like there is infinitely more to reflect on than there was in November, when I wrote my last reflection. The other DC volunteers and I have explored countless museums, were fortunate enough to go to New York for the United Nation’s Commission on the Status of Women, and by now are all old hands at our placements. As a patient advocate in a health center, one of the things I like most about my job are the patients. They are who we serve, often imperfectly, and it has been simultaneously challenging and rewarding to learn how I fit into patient care. There are elements of my job that are straightforward, like ordering wheelchairs or calling insurance companies, but direct patient interaction is what I love most, and what I have had to work the hardest to improve at. 

---

When I first started work, in early September, I was swamped with vacation override requests. These requests were essentially patients asking to pick up more than a month’s worth of medications before a vacation. One after another came in, and they became increasingly urgent, with many patients telling me they needed to pick up two to three months worth of their medications within a 24 hour timeframe. Needless to say, explaining this to their insurance companies was not always easy. In a moment of stress and frustration, I irritably asked my supervisor whether early September was really a peak travel time. Oh yes, I was told, it’s a major holiday season! As I found out, September 12 is Ethiopian New Years, and a significant number of our Ethiopian patients were flying home to visit their families. Low and behold, by late September the vacation override requests dwindled to a manageable number, allowing a nice lull before the Christmas rush. I learned my lesson, and was not as surprised by the override requests before Ethiopian Easter!

Another struggle I have had concerns language. As a conversational French speaker, I am sometimes recruited to speak with or translate for West African patients who come to the clinic. This has been quite the adventure, as the majority of the French classes I have taken were focused on reading and discussing medieval French literature. I had not realized that I was lacking some key vocabulary until I was put on the spot by a provider to explain what a pap smear was to a new refugee patient. “Erm,” I said frantically, “Well, It’s a way to make sure you do not have cancer of the....” and then drifted into a very uncomfortable silence while I debated whether I could get away with pronouncing cervix with a French accent in lieu of knowing the actual term in French. A long pause followed my eventual attempt. “Oh,” the patient finally said, gesturing downwards on her body, “You mean the thing they do down there with the swab?” “Yes,” I replied and wished I could melt into the floor instead of translating for the remainder of the 30 minute appointment.

On another memorable occasion, the doctor asked a patient from Cameroon whether she wanted to become pregnant in the upcoming year.  The patient, after hearing the translation, blanched and shouted at me, “Why is that any of HIS business?” It took several minutes and some linguistic fumbling to explain that question was asked due to medical concern rather than prurient interest.

My anecdotes about working with patients are full of minor blunders. Working in a healthcare center has taught me that medical care rarely runs smoothly. More often than not, there are a host of barriers to care, ranging from cultural illiteracy to imperfect language translation to lack of resources. I am very grateful to work in a job where these challenges are viewed as something to be overcome rather than unsurpassable difficulties. I now know that there is no avoiding uncomfortable topics or situations when working with patients, but that thinking outside the box, being flexible, and having a sense of humor can help virtually any misunderstanding. Preparation and learning from past mistakes, of course, are also critical.

As a closing note, I am happy to report that my French medical vocabulary has improved and that I now have an English-French translator on my computer for emergency situations. I keep a list of Ethiopian holidays on my desk and am, bit by bit, learning more about how to tailor care to better serve our patients. And while I still do not know how to say speculum in French, I do have a stack of bilingual Canadian handouts on pap smears ready to hand out to patients in need.