Kuo et al report that most US pediatricians use untrained
interpreters to communicate with LEP patients and their families. They
conclude that there is an urgent need to promote appropriate language
services through the use of (trained) interpreters. This is sage advice.
However, I would like to offer a note of caution to remind the readers of
Pediatrics that even correct translation of the words does not guarantee
understanding on the part of the listener. In our age of refugees from all
corners of the globe, some of our patients and their parents do not have
concepts of the body, health, and disease which can be reconciled to our
scientifically based understanding of nature. In such cases we may delude
ourselves if we think that even a professional interpreter can bridge the
gap in words and cultural background.
Recently an infant was hospitalized in my unit to be worked up for
suspected liver and renal disease. The mother was a recent arrival from a
Third World country and spoke no Norwegian and very limited English. She
insisted on the need to immerse the baby in a watery extract of leaves
from her native land. She was not sure of the name of the plant from which
the leaves originated, but did eventually suggested a name. This plant
turned out to be a rich source of a serotonin precursor, and exposure of
the infants' entire skin surface to this chemical might carry significant
risk given the baby's underlying condition.
We used a professional interpreter, as we routinely do, in trying to
convey to the mother the dangerous nature of what she was doing. However,
although the words were hopefully correctly translated (I have no way of
knowing, since her native tongue is not part of my repertoire), the
concepts of transcutaneous absorption and toxicity were not part of her
understanding of nature. The disease, she insisted, was of a spiritual
nature, and the treatment thus was only to be understood in the spiritual
realm. Having no effects in the physical world, it was not possible that
it could be dangerous to the baby.
We met repeatedly, but no attempts to explain our thinking were able
to take away her fear of what the spirits might do if not appeased by the
herbal baths. In the end, enlistment of child protection services and
actual physical restraint were necessary to prevent her from administering
the, in our understanding, potentially toxic herbs to her infant.
Although perhaps a somewhat extreme example, I believe it illustrates
that even when we use the best of interpreters to communicate, we may not
infrequently fool ourselves if we believe that we have actually
"explained" or "communicated" with patient or parents. Thus, the challenge
of communication involves more than words and literal translations.
Thor Willy Ruud Hansen, MD, PhD,
Department of Pediatrics,
Rikshospitalet-Radiumhospitalet HC,
University of Oslo,
Norway
Conflict of Interest:
None declared
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