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ARTICLES: Dennis Z. Kuo, Karen G. O'Connor, Glenn Flores, and Cynthia S. Minkovitz Pediatricians' Use of Language Services for Families With Limited English Proficiency Pediatrics 2007; 119: e920-e927 [Abstract] [Full text] [PDF]

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Pediatricians' use of language services - interpretation does not guarantee understanding

Thor W.R. Hansen   (2 April 2007)

Pediatricians' use of language services - interpretation does not guarantee understanding 2 April 2007
Thor W.R. Hansen, Neonatologist University of Oslo, Norway Send letter to journal: Re: Pediatricians' use of language services - interpretation does not guarantee understanding t.w.r.hansen{at}medisin.uio.no Thor W.R. Hansen	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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