Fighting Hepatitis in Cambodia: The Art of Interpretation

MSF medical staff come from all over the world. Just like our patients. But how do you describe your symptoms to someone who doesn't speak your language? And how do you make the right diagnosis if you don't understand someone's words? MSF doctor Theresa blogs about a key member of the team...

When you go on assignment with MSF, you have to expect to face some linguistic challenges. For example, the hepatitis C treatment project in Cambodia is an English-speaking project run by MSF’s Operational Center in Paris. Most of the coordination staff are primary French speakers. Meanwhile, the patients speak Khmer, but laboratory requisitions and radiology reports are in French. 

Having Von in the room with me is like sitting next to my twin

In practical terms, this means that I speak English most of the time, read medical reports and occasional communiqués in French, hear French and English spoken in the hallways of our office, and English and Khmer in our clinic. Oh, and because some of my Cambodian colleagues prefer to speak French rather than English, I will occasionally discuss medically complex patients with them en Français.
Get the picture?
Of course the most perplexing part of this is the fact that our patients speak Khmer and I do not. Fortunately I’ve been working with an experienced medical interpreter, Von Sem. 
Von Sem at work. Photo: Theresa Chan / MSF.
Von performs medical interpretation the way you’re supposed to do it. If I ask a question, he translates the question without adding or subtracting meaning. There is no way to translate my questions word for word, because languages simply don’t line up like that, but Von is experienced in medical terminology and the social subtleties of the medical interview. He understands my meaning and chooses the best phrasing in Khmer to express it. He does the same when delivering the patient’s answer back to me. So when I asked a patient to rank his health on a scale of zero to one hundred (a standard question on our progress note), Von translated the patient’s answer as “normal”.
“What does normal mean?” I asked.
“He says he means he feels the way he always feels.”
Another interpreter might have told me from the start: “He feels the way he always feels,” which doesn’t sound like much of an error, until you realize that missing out on the first response—“normal”—means you wouldn’t have understood that “normal” to this patient means he feels exhausted, weak and dizzy all the time, which is how this man described his daily symptoms. In other words, because Von told me how the patient was feeling in the patient’s own words, I got an insight into how this man’s entire world was etched by the experience of hepatitis C.

This is deep stuff, I know. 

Working with Von I don’t even feel like I’m working with an interpreter. The questions, answers, and insights he reports to me feel as direct and trustworthy as if I had been speaking directly with the patient in our shared language. Having Von in the room with me is like sitting next to my twin, except that Von is much calmer and nicer than I am, so that’s not much of a compliment to him.
By the time you read this, Von will have moved on to a different job with another NGO. I’m glad he’s going to have the satisfaction of a new professional challenge, but I’m sad to lose the privilege of his company. Not only is he a skilled interpreter of words and meaning, he is also a perceptive observer of Cambodian culture and a skillful navigator of its nuances. Interpretation is not just about moving between one language to another; it also about moving people from their own experience into the experience of others. That's why interpretation is an art, and Von? One word: Picasso.