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Interpreting Medicine Across Cultures

Bisharo Kasim, Katia Chavez and Nicholas Monte
Bisharo Kasim, a Somali Bantu and interpreter, (in red sweater) meets with medical students, including Katia Chavez and Nicholas Monte. (Photo by Raj Chawla, UVM Medical Photography)

At times, translating medical terms from English into Somali requires more than just finding the right word. Bisharo Kasim, a medical interpreter who speaks several languages, often finds herself detailing the symptoms or consequences of a disease, knitting a connection between what the doctor says and the language a patient understands.

“Some of the diseases you have a name for – we don’t have a name for back home,” she said. “I have to explain the effects.”

Kasim, who is originally from Somalia, shared her story and talked about medical interpretation with first-year medical students at the University of Vermont College of Medicine in their Professionalism, Communication and Reflection (PCR) course. PCR is part of the College of Medicine’s Vermont Integrated Curriculum.  Nine interpreters from the Burlington area met with students in February, discussing everything from translating in the labor and delivery room to the nuances of interpretation over the phone. Hailing from countries including Somalia, Burundi, Bhutan, Burma, Congo, and Iraq, the group also shared some of their own stories as refugees from conflict-ridden areas of the world.

This is the second year medical interpreters have visited the PCR course, said Lee Rosen, Ph.D., PCR course director and assistant professor of psychiatry. During the 33-week course student build connections with their peers and reflect on their experience in medical school. When the interpreters visit, he said he sees students think about medicine in ways that goes beyond what they’re learning in labs and lectures. The interpreters have often overcome great odds to be where they are, and bearing witness to their stories can be a meaningful reminder of the responsibility inherent in being a physician. Students write reflections about what they learned from the interpreters, he said, and have a discussion in their small groups.

Kasim came to the United States in 2004. Born in Somalia, her family moved to Tanzania to escape civil war when she was three years-old.  At 13, her family fled to a refugee camp in Kenya. She spent three years there before coming to Rochester, N.Y., with her husband. About two years later she relocated again to Vermont to meet her parents and several siblings, who were able to leave Kenya and settle in Burlington.

For her family and for many others, the Vermont Refugee Resettlement Program (VRRP) helped ease the transition to a new culture. The program, which is a field office of the U.S. Committee for Refugees and Immigrants, supports refugees as they find housing and jobs, enroll children in schools, and acclimate to life in the U.S. The program also administers the interpretation service, coordinating interpreter trainings in medical and legal settings, in addition to other areas. The VRRP has interpreters on staff for more than 25 languages.

There are many nuances to the process of interpreting, especially in a doctor’s office or hospital where patients may not be familiar with the interaction. Professional interpreters know how to make sure both parties are heard and understood.

“All of the interpreters are trained to sit beside the patient,” Kasim told the group of medical students she met with. This facilitates eye contact between the physician and the patient, helping to empower the patient and make them feel in control.

Cultural differences also play into how the interpreter communicates. Aline Niyonzima, from Burundi, said HIV/AIDS came up in her group as a particularly difficult disease to discuss given the stigma attached to it in some countries.

“When they are here they don’t want people to know about [their diagnosis] and they don’t want the interpreter to know,” she said in a discussion with fellow interpreters. Negotiating this dilemma requires diplomacy and patience as the relationship between the physician, interpreter and patient develops.

In some cases, especially for chronic conditions, a doctor may call the same interpreter back for multiple visits. Treating mental health issues in particular often benefits from one interpreter staying with a patient over time, said Sita Luitel, an interpreter from Bhutan. This is in part because patients, too, come to trust an interpreter and develop a rapport.

Bijoux Bahati, an interpreter who came to the U.S. from the Democratic Republic of Congo eight years ago, talked to her group about her journey to the U.S. She arrived knowing no English, and recently started working as an on-call interpreter. For her, the work allows her to stay connected to fellow refugees, and her own language. In many ways she sees her role as “interpreting culture” while she’s facilitating a conversation between doctor and patient.

“It’s not just passing on the words,” she said. “It’s building community.”

The conversations with interpreters left an impression on first-year medical students.

“The biggest lesson that I took from this meeting was that remaining non-judgmental and keeping the lines of communication open with your patients is probably the most valuable skill of a clinician,” said Shane Greene ’16. “Although it helps to be aware of common practices within, for example, the Somali community, every patient is different and much can be learned by trying to determine the cultural context that helps them understand their symptoms.”

For Nick Monte ’16, the experience opened his eyes “to the realization that our interpreters serve an essential role that extends far beyond their translation skills.”

“[They] are fundamental in helping to bridge the cultural and social gaps that are vital to providing comprehensive care that meets all of our patients’ needs,” he said. “This experience is one that I will carry with me throughout my career, and one that I am certain will enhance my ability to care for my future patients.”

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