Treating Patients When Language Is Only One of the Barriers

by Mike Reicher
New York Times

“A defective heart, a child detained by border guards — Julia Barquero had already had her struggles. But now her physician at Bellevue Hospital Center, Dr. Danielle Ofri, was trying to explain to Ms. Barquero that she could not receive a heart transplant because she was an illegal immigrant. Dr. Ofri faltered. Her Spanish was not sophisticated enough to convey nuance; she cowered from the task, she writes in her new memoir, “.” Ultimately, a medical resident had to break the news….”“There are so many stories out there about immigrants, about people sucking the system dry,” she said in an interview, “but I don’t think people truly understand their experiences.”This is Dr. Ofri’s third book. Her primary role is as physician in the hospital’s outpatient clinic, while she also works in its inpatient wards and is a doctor in the Bellevue/New York University Survivors of Torture program. In all these settings, she acts as a social worker and a counselor as much as she does a doctor.

Often, though, she feels powerless to help.

How do you tell a Nigerian man whose eyelids were melted because of his political beliefs that you cannot do anything for him, or an Iraqi refugee beaten for working with the World Health Organization that all you can offer is a prescription for restless leg syndrome?

While torture victims may carry the heaviest burdens, Dr. Ofri’s other patients bear the more common immigrant problems: crushing family obligations, isolation, trouble adjusting to the American diet.

On one day she saw three Dominican women in a row who were battling diabetes, hypertension and high cholesterol. One’s finances were constantly teetering because she sent money home, another raised her two teenage grandchildren because her daughter had died of AIDS, and a third had to care for a husband who been hobbled by a stroke.

“They were salt-of-the-urban-earth women, suffering the aches and pains from working as housekeepers and baby sitters, sagging under the weight of being the fulcrums of their families,” writes Dr. Ofri, who attended a Socialist-Zionist camp as a child.

Without support from family members, many of Dr. Ofri’s patients would be far worse off. One Bangladeshi woman would bring her teenage daughter to her many appointments, or send her to pick up prescriptions. Others, like the Iraqi refugee, had to go it alone.

She describes their stories in intricate detail, using the patients’ physical characteristics and mannerisms as clues to their psychological states. Dr. Ofri is a co-founder and editor in chief of the Bellevue Literary Review, a biennial magazine that “examines human existence through the prism of health and healing.”

Again and again, Dr. Ofri describes asking about patients’ life stories and their cultural heritages. When a teenage Bangladeshi girl showed up wearing a veil, Dr. Ofri, who is of Yemeni Jewish heritage, wondered if it was too sensitive to ask about her Muslim dress. But she had been the mother’s physician for about 10 years and felt comfortable enough. She overcame her hesitation, asked a naïve question, and was rewarded with laughter — a warm encounter with a patient and her daughter when previous sessions had sometimes been downbeat.

“Many patients want their doctors to ask about their cultures and their backgrounds,” she said in an interview at the Bellevue atrium cafe, with at least three languages being spoken at nearby tables. “It’s so helpful to their care, it also allows you to connect in a different way, and it just makes medicine more interesting.”

Dr. Ofri has experienced being a patient in a foreign country. She traveled to Costa Rica while four months pregnant, and then gave birth at a local hospital. All went well. Despite her mediocre Spanish, for example, she was able to negotiate the timing of her epidural injection.

At Bellevue, she often uses interpreters; the hospital has phones in exam rooms that connect patients and doctors to interpreters. New York law requires hospitals to provide such services.

New York law also requires hospitals to provide financial assistance to patients, regardless of their immigration status. This means patients like Ms. Barquero can be treated with medications, even though she cannot be placed on the national heart transplant waiting list. Dr. Ofri estimates that 30 percent to 40 percent of her patients are uninsured and that about 25 percent may be illegal immigrants, although she does not ask.

As hospitals in the United States scale back their health coverage for illegal immigrants, patients like Ms. Barquero will have access to fewer resources. Also, the Senate version of the health care bill would not allow illegal immigrants to buy private insurance plans on the newly formed exchanges, while the House version would.

From the New York Times.


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