Communication in Healthcare and Where It Can Go So Wrong

In January 1992, I was on an overnight train traveling from Madrid to Seville, Spain. I was living in Madrid at the time, teaching English at an after-school academy. I had been invited along to a weekend trip with friends, and that wasn’t something I would say no to.

Sometime after, we settled down to try to get some sleep (sitting up; we weren’t in a sleeper car, ah youth!), and as the train clicked along the tracks of the Spanish countryside, one of my inner ears started to ache. I couldn’t imagine what this was as earaches weren’t something I’d experienced since I’d learned how to talk.

I asked the couch attendant (all dressed up in his uniform) if there were any painkillers available, but there weren’t. So I tried to get some rest and decided to re-evaluate in the morning.

We arrived, had breakfast, and checked into a hotel so we could leave our baggage behind to do some sightseeing. In the early afternoon, I couldn’t take the pain anymore and took a taxi to the nearest hospital/clinic. I presented my national benefits card and was soon seen by a young doctor. I don’t remember if he came close enough to examine me; he must have. But all I can remember from our interaction is him sitting across the room from me and asking me several times, ‘Does it hurt?’ We were speaking a common language, but he was clearly very uncomfortable. Was he new at this, I thought? Has he never treated a foreigner? Someone from the United States? He finally wrote a prescription, and I left to go to the pharmacy.

I felt a sense of relief that my ear pain would soon be treated. I looked down at the prescription while I was in the taxi to see he had prescribed me an anti-inflammatory. This was not what I expected. I could have gotten this kind of med over the counter. I thought he would prescribe me an antibiotic and tell me to visit a clinician in Madrid if it didn’t get better.

I filled the prescription and went back to the hotel to rest.

By the time my friends returned and were getting ready for dinner, I had developed a fever. I stayed in bed that Saturday night and took a morning train back to Madrid. I felt horrible and kept having to get up to throw up.

Monday morning, I called my local clinic and got an appointment. They diagnosed me with bronchitis and prescribed antibiotics. When I wasn’t better three days later, I went back in. This time they took X-rays and diagnosed me with pneumonia. I saw a pulmonologist who seemed upset that I hadn’t taken my temperature. As a foreigner in a foreign land, a thermometer was not something I had at my disposal.

Needless to say, I eventually recovered, but not before developing pleurisy and being out of work for three weeks. I hadn’t felt homesick until this happened, and I suddenly longed for my doctor, my family, and my healthcare system. Even though I spoke the language and had state-sponsored insurance, it was little comfort to me when I was sicker than I had ever been in my 28 years.

So when I interpret for those who don’t speak the dominant language and may not have the options that health insurance can provide, I feel a profound sense of empathy. Rarely are we more vulnerable than when our health is at risk. To be surrounded by all that is foreign and to be misunderstood in these moments evokes the most helpless of feelings. I think the emergency room doctor thought I was a “seeker’; someone who seeks pain medicine and who is not really ill. Because of that, I ended up a lot sicker than I needed to be.

This was a perfect “put yourself in their shoes” experience. I will never look at a sick person in a foreign land the same again.

What experiences have you had that made you an even stronger advocate for language access?

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