Yilu Ma, MS, MA, CMI, Director, Interpreter Services Department

Euridice Rivas-Ringquist, medical interpreter, and Steven Palmer, RN, nurse-in-charge

Euridice Rivas-Ringquist, medical interpreter, and Steven Palmer, RN, nurse-in-charge

A Guatemalan couple recently brought their 2-month old baby boy to an emergency room with breathing difficulties. The baby was diagnosed with a ventricular septal defect, and the attending physician and his team recommended surgery. However, instead of agreeing to the plan, the mother accused the nurse of causing the situation by touching the baby and casting an “evil eye.” She asked for her son to be discharged so she could take him to a traditional healer. The situation seemed irreparable.

While this scenario did not occur at BWH, it is important to consider because it demonstrates how cultural values impact medical care. Such disagreements are familiar yet challenging, and caused in part by clashing belief systems. Instead of holding the Western view of illness as being caused by bacteria, tissue changes or gene mutations, other cultures have different perspectives. For example, non-traditional, holistic medicine has a long-standing place in Latino culture. There are naturalist healers who use herbs and plants to treat illness, while others might use the power of the saints to heal, aid, and counsel individuals. These approaches are often used without regard to socioeconomic status, and are sought for social, physical, and psychological purposes.

Some Asian patients believe that illness is caused by the disharmony of yin and yang, where the former represents positive energy that produces light, warmth and fullness, and the latter represents negative energy, the force of darkness, cold and emptiness. According to this system, foods and diseases are categorized into either hot or cold, not referring to the temperature, but the substances associated with their nature. This belief is also followed in Latino culture. So someone who has a cold or lung disease needs to eat a significant amount of hot food to restore equilibrium. This might explain why nurses might find a hospital food tray left untouched.

The diagnostic process can be confusing to some. For instance, a Chinese patient might feel embarrassed if asked if he or she is sexually active or uses recreational drugs. He or she may experience repeated questioning to confirm consistency as an intrusion. Similarly, while using standard patient questionnaires is considered best practice in the U.S., asking certain questions can cause confusion. For example, a patient who has fled war or suffered domestic violence may have trouble responding to a doctor who asks if he or she feels safe at home. Their lived experience in a war-torn country or with an abusive partner might prevent them from ever feeling completely safe.

In terms of treatment, some cultures practice within an authoritarian or paternalistic philosophy of care, in which doctors dictate and prescribe, and patients follow orders. For example, confusion can arise for patients of many different cultures when a U.S. doctor outlines various treatment options with the good intention of involving the patient in the decision-making process. In many countries, patients come to the hospital only as a last resort, oftentimes late in the course of their disease, with an overwhelming feeling of hopelessness; U.S. doctors may not understand why they have waited so long.

In the Guatemalan family’s case, a medical interpreter successfully bridged the cultural gap between the clinical team and the patient’s family through engagement and conversation. The family was able to understand the gravity of the situation and appreciate the team’s priority: keeping the baby healthy. With the help of the interpreter, the providers developed a better understanding of the family’s concerns and questions. In the end, the baby’s parents consented to a timely and lifesaving surgery.

While these examples of cultural values are useful and give some guidance, daily communication between the provider and the patient is much more complex, and involves a myriad of socio-economic, geographical, generational, ethnic and gender factors that come into play. There is no cookie-cutter solution for all situations. However, the good news is that BWH has a strong team of professional interpreters, versed in many cultures and capable of interpreting and explaining cultural nuances. They are a great resource to tap into.