Nabeela Kajee September 9, 2016
The night I stepped out of New York Presbyterian Hospital (NYPH) for the first time I looked up at a starless sky in New York City and sighed, feeling overwhelmed. It had been a busy day on the renal consultation service. My first patient was an Indian gentleman who was an immigrant. He sat perched on his seat, wide-eyed as I spoke to him. He fingered his long greying beard as I asked him his name and full age. He shook his head and smiled as I realized that he had not understood a word spoken. Coming from Cape Town for a medical elective in the renal consultation service at Weill Cornell Medical Centre, I had never expected to need to look up a language besides English. I came to understand that he was Hindi-speaking, and it occurred to me that I could talk to him using a telephonic interpreter. When the interpreter uttered his mother tongue, his eyes sparkled, and he excitedly talked into the receiver. He explained the difficulties he had faced in his past, the struggle to stay healthy in a challenging and changing social environ that had led him to ignore the reddening of his urine and the pains he had felt for years in his back. After assembling the history and examination, I presented him to my supervising Attending and Fellow. We were soon able to reach a differential diagnosis, and as I said goodbye to my patient, he closed with his last words to our interpreter: ‘Thank you for understanding me.’ As I walked out of the consultation, the words of Nelson Mandela echoed in my mind, ‘If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language that goes to his heart.’ It reminded me of the cosmopolitan and global nature of the medical ambit. Despite eleven official languages in South Africa, our commonwealth historically has favored English as the primary communication modality in health services. Similarly, I had witnessed the effect of English’s dominance in the United States and language’s potential to both divide and unify. This challenge is neither a new nor a diminishing one. The mass migration of people that we are now witnessing across the globe has impacted both New York and Cape Town. Encountering patients with linguistic, social and cultural differences has become unavoidable in any hospital setting, and rightly so. Cape Town has seen the splinters of political turmoil, emergence of democracy, and challenges of social inequality rebound within health care delivery. My teaching hospital in Cape Town stands as a reminder of this dim part of our history. Its physical structure remains symmetrically built based on past principles of separation and division. When I look beyond the historic walls, I see an extrapolation of the remarkable struggles of people of all walks, languages, races, religions and nationalities. I see, too, the many patients who were denied access to care or faced medical inequality based on race, nationality and language - people not dissimilar from my first patient at NYPH. Beyond the moral argument for equality of care, the distant past gives us reason to right the injustices of the past in medicine. This resolution to provide care in the ‘best interest of my patient’ must extend to creating a safe and familiar therapeutic milieu for all who seek it. Today, it is the nuances of equal care, the daily practice of interpreter services, socio-cultural understanding and tolerance that will hold us to account. Creating these changes as protocol requirements and as a norm is neither easy nor always convenient. However living in South Africa has taught me the value of collective accountability in the pursuit of advancement. There is no easy path to reaching the next communication frontier, and this can never be accomplished without collaboration and a focus on improving doctor-patient connection. In this experience I have found common ground in the quest for the common good. As a global citizen my elective fostered the belief that in the medical environment all providers are united in serving and building with the interest of people of the same stripes, stars and dreams, regardless of affiliation or background. This is illustrated by that fact that even for a month New York welcomed a senior medical student from South Africa. Coming from Cape Town, a city that itself is located at the very bottom of the world map, I am encouraged by how very far I have come, and yet how close I feel to my home in a distant House of Medicine. I wondered why, when I had asked a long-time mentor from home in Cape Town for a pearl of wisdom, his parting advice had been, “Nabeela, don’t forget to look up.” Our lives are connected by more than the stars we all see. When we realize our shared humanity, especially in healthcare – a language written in cells, markers and lives – we transcend our differences.
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