Language Barriers

Language barriers are often the most difficult and isolating barrier to overcome in a foreign country.  I have been taking Swahili lessons almost daily in hopes of becoming fluent.  In addition to my one hour lessons, many others try to give me mini-lessons forcing me to use their language as much as possible.  At the hospital, I can usually get an OK history and understand the gist of the patients' complaints.  I usually elicit plenty of laughs from the Casualty staff and even patients at my efforts.  Sometimes I say the right thing, but my BrAzil accent can make it difficult for some to understand.  As is with learning any language, I frequently mix up words that sound similar (example - the other day I asked someone if they were vomiting potatoes (unatapika) instead of if they were cooking potatoes (unapika)). 

Despite the busyness today, my communication attempts gave us all a good laugh.  Casualty was packed so I started seeing patients in the waiting area.  Because everyone was so busy, I had to rely on my own Swahili to get through patient interactions.  I was seeing a patient with back pain and lower extremity weakness that had been progressing over the past 2 months.  She was now unable to walk or even move her legs.  In addition, she had been having fevers during this time frame.  After being seen at several hospitals, she was referred to us.  I did my workup, reviewed her films, and started antibiotics and pain medications.  She had several compression fractures of her spine and impingement on her spinal cord.  With the fevers, I was worried about an infection.  I was having a hard time explaining this to her and the family.  I finally borrowed one of the clinical officers to help.  After he spoke with the family, he looked at me and said, "They are worried about the big sore on her butt."  It all came together for me..."Ahh, that explains why she keeps grabbing my butt."  The staff all started laughing.  During my history and physical, the patient's sister kept grabbing my butt while telling me something, but I obviously didn't understand and wasn't sure what to make of it...Is she just misplacing her hand?  Is this cultural?  No, they were just trying to communicate with their limited Swahili-speaking doctor.  Now time to learn what "butt" is in Swahili.