Lost in translation

30 September 2009

Sundays have become very important to me here, particularly Sunday afternoons. We officially have a six day work week, and though most Sundays I have to go into the hospital as well, it is usually only for a quick ward round or to assist with one or two emergency patients.

This means that Sundays give me some time to myself to read, to think and to write – very valuable moments to myself during what can be a hecti
c pace of life.

Most of these blogs you have been reading are conceptualised on quiet Sunday afternoons, often while sitting on the expansive flat roof of our house. The view is one of greenery and the slopes of the jagged mountain range that surrounds our town.

As a Capetonian far from home, it is a great comfort to me to be living in sight of a mountain again – yes, yes I know how we “Capies” like to go on about our famous mountain, but it really is beautiful to me and I miss it a great deal.

So, “Pashto Peak” as I have unofficially dubbed the closest part of the range (after the Pashto language which is predominantly spoken here), has become a favourite point of contemplation. This brings me to the challenges of providing medical care when you are twice removed from the patient by the barriers of language.

If my combined language abilities were to be somehow summed up on a cocktail menu, then I would be mixer of the following: A large portion of English Lager, a generous dash of Afrikaans “Mampoer” (this is a form of South African moonshine a little bit like schnapps but quite a lot stronger), a squirt of Xhosa Umqombothi (a traditionally home brewed beer) and a tiny drop of Spanish Sangria.

Now I have no idea how this would taste in reality, or what it might be called – “Lost in Translation” perhaps? – but so far it has served me pretty well in the working and social environments in which I have found myself.

Here in Pakistan, however, this cocktail is quite useless (not to mention the fact that  alcoholic drinks are forbidden, and mention of such is considered culturally insensitive…). I am totally reliant on translation in order to function effectively here, and it has re-emphasised for me the importance of good communication in healthcare settings.

The two senior staff with whom I work most closely in the clinical context both speak very good English, which is a good first step. But, neither of them is from this region, so their first language is Urdu rather than the locally spoken Pashto. But almost all the patients we see in the ER and IPD (inpatient department) speak only Pashto…and so we are stuck again!

Luckily, almost all the more junior nursing staff speak Pashto as their first language and Urdu as their second and so altogether, and with much patience (and not a little bit of frustration), we navigate patient interviews as follows: me to the senior nurse in English to junior nurse in Urdu to patient in Pashto.

The patient then contemplates a response and then: patient to junior nurse in Pashto, to senior nurse in Urdu, and back to me in English.


During much of the sometimes lengthy discussions, I am silent and this has been an interesting experience in improving my ability to interpret facial expressions and body language (not always too accurately I’m afraid).

Exactly how much is lost in this tautological transfer of information is hard to say, but I am often surprised by the answers that eventually come back to me: either far too short, far too long or totally off the point altogether. Not to mention the frequent intrusions by family members of the patients who are very fond here of giving their version of the story which, once translated, not infrequently turns out to be rather different from the patient’s own version…sigh. And so, we start again with a re-phrased enquiry until finally, the necessary details start to become clear.

This slows things down a lot of course, but the staff and patients are very tolerant of my persistent questioning and somehow we manage to get it done.

Oh, how much easier things would be if we all just spoke the same language! Except of course that with language and culture being so closely linked, how much unique and valuable diversity would be lost as well?

In the end then, there is nothing for it but to push on through and keep sipping this new language cocktail, which is starting to taste better and better by the day.

Perhaps, by the end of my time here I will be able to add a sprinkle of spicy Urdu and Pashto to my own cocktail of languages and they might just be the secret ingredients which turn it into something truly delicious.

So, for now I will say: “Pa ma cha de cha” (travel well on the road ahead) until next time.