Lost in translation, bad for your health

Misunderstandings in bilingual health care can pose serious risks

Imagine an elderly woman living in a long-term care facility, suffering from a worsening cold. A nurse’s aide comes into the room, and the woman tells her, “I have a cold.” The aide, for whom English is a second language, uses her best high-school English and translates “I have a cold” as “J’ai froid.” The aide returns with a blanket, but a nurse or doctor is not called. The woman’s untreated cold becomes a major health problem.

This happens far too often, and not because of a lack of care. The vast majority of health care and social service workers genuinely want to help people. Most nurses, aides, and social workers do not choose their profession for the money. English as a second language is difficult at the best of times, given the number of words that have multiple meanings and the many expressions and colloquialisms. With the addition of confusing technical jargon of the medical profession, misunderstandings are bound to occur.

Consider the case of an English-speaking middle-aged man who went to a clinic because of chest pains. During the course of the examination, the patient missed a lot of what the French-speaking doctor said, but he did pick out the words “mal au cœur” a few times. The poor guy spent the rest of the day convinced he had a bad heart – that he was having, or about to have, a cardiac crisis. When he arrived home, his wife explained that mal au cœur has nothing to do with the heart; the doctor was talking about nausea.

Another is the French term bleu for bruises. If a French-speaking nurse wants to ask a patient if she has bruises (“Avez-vous des bleus?”) she is quite likely to ask “Do you have blue?” The patient answers, “Blue what?” and communication breaks down.

Even when the nurse recognizes the problem, challenges remain. The French “contusion” for bruise is translated in many dictionaries as “contusion” in English. Unfortunately, many English speakers are not familiar with the word contusion, so they are no further ahead.

Culturally inappropriate language can also be a problem. For many raised in French-speaking Quebec, an expression like “c’est fucké” or an expletive like “ah shit” is acceptable. However, most English speakers would be taken aback to hear such terms from their health care provider.

Francophone health care workers enrolled in English classes are currently being taught to recognize what is inappropriate, and more importantly, not to repeat the foul language, especially not in a professional context.

Several measures are being taken toward improving communication within health and social services, including ESL (English second language) training, offered to health care workers throughout the province. These courses are very popular. L’Institut de cardiologie de Montréal and École de langues de Lanaudière recently initiated an ESL program offered to a beginner group of frontline workers. Ten spots were available; 46 employees applied. It incorporated an interesting aspect. The manual alphabet (the same in American and Quebec sign languages) was used as a pedagogical tool to help the students learn the English pronunciation of each letter. This helps to avoid catastrophic errors in the spelling of a name or medication, and has the added benefit of teaching employees to better serve the English and hearing-impaired communities.

Chelsea Tinnion’s parents own a language school (École de langues de Lanaudière) which has produced the Petit lexique de la santé et des services sociaux, français-anglais, a publication that helps caregivers and patients maneuver through the intricacies of second language communication. The lexicon, designed for ESL training, is available at the McGill bookstore.