I came to appreciate the importance of language in health care when my bilingual mother returned to live in Brattleboro after spending a few months with her sister in Puerto Rico. Suddenly and without apparent reason, she began to speak only in Spanish.
In the eight months before her death, only one of the many nurses, caretakers, therapists, lab technicians and emergency personnel who attended her spoke or understood Spanish.
None of the providers saw this as a problem. “We communicate well,” the director of the assisted living facility told me when I asked “how do you know what she needs?” “Oh, we point and gesture; we ask ‘si,’‘no.’ Checking out a list to order her meals helped, but when the nurse brought the juice cart at 3pm, she decided what to serve my mother, because she could not ask my mother, "Do you want apple or orange juice?" She could not say, “ Jugo de manzana o de china?”
Eight months later, the care preference question would be: would you like ongoing transfusions to keep your blood count up, even if we can’t cure what’s wrong, or would you prefer hospice care? When my mother spoke in Spanish to her doctor, the doctor spoke back in German, hoping my mother would respond in English. My mother laughed and continued in Spanish.
Reverting to speaking in your native language is one sign of Alzheimer’s. The memory clinic staff assured me translation would be available, but on the day of our visit there was no interpreter. “How are you going to deal with the language issue,” I asked. “We used Google to translate the tests and Mark here speaks some French,” the doctor answered. But I know that Google Spanish translations are not reliable because they can’t distinguish between male and female nouns, conjugate verbs, or use the correct syntax. Instead of discussing my concerns about my mother’s symptoms, I spent that morning translating tests.
Meeting the care needs of 5% of refugees, immigrant workers, and increasing language minorities in Vermont will require sensitivity to their language differences. But, because dementia, strokes and other neurological disorders can all cause a return to one’s first language, many senior Vermonters who were raised speaking languages other than English can face challenges similar to my mother’s.
Patients and their families need to exercise their right to interpreting services guaranteed in the Vermont Patients’ Bill of Rights. And health providers need to deliver on the national Health Services call to improve health care by addressing “the unique culture, language and health literacy of diverse consumers and communities.” Only then, can we ensure that all of us will get the best and most culturally competent care possible.
