Tuesday, November 7, 2017

Unintelligible Medicine

  This Blog Post Written By

  Krista Amira Calvo 


 “Los medicos no saben nada” (doctors don’t know anything) is a common phrase echoed in the halls of the few and far between migrant clinics in the American Southwest and along the Western Coast of the United States. This phrase is very disconcerting, as it embodies the way that the majority of migrants feel about the Western healthcare system. There is a wild misconception that migrants who cross the border from Mexico into Arizona are all Mestizo. This misinformation stems from language fed to us by the press that generalizes Latinx peoples as all having come from one place, that place being Mexico. In actuality, the migrant diversity is very wide; border crosser demographics include Hondurans, Guatemalans, El Salvadorans, Panamanians and the occasional Belizean. 

These populations can be broken down into even further marginalized groups of the Indigenous populations of the aforementioned countries. With Spanish being broadly spoken in Mexico and Central America, these Indigenous communities are at a loss in regards to communication with Spanish speakers and, more critically, the English speaking clinicians that struggle to provide adequate healthcare on the U.S. side of the border. 

Image by John Barletti

The Triqui people, Indigenous to Oaxaca, speak Trique, a language belonging to a Mixtecan branch of Mixtec languages. Trique is a tonal, pre-Columbian language, and is as related to Spanish as English is to Mandarin (Porzucki 2016). In addition, four varieties of Trique are spoken in different geographical regions of Oaxaca. The inability to communicate with their peers on the farms, overseers and other staff hinder their ability to acquire the basics they need to survive; among these needs is proper medical care.

            Clinics accessible to migrants are often under-funded public facilities that take patients from every walk of life. From the moment a migrant steps in the door, there is an aversion to treatment because of anticipated communication issues. This is due largely to the fact that interpreters in these clinics are very few and far between, and the majority only speak Spanish. 

One of the most common issues faced is in obtaining accurate information about the patient’s symptoms and medical history, a seemingly impossible feat when such an aggressive language barrier is the elephant in the room. In his 2013 book, Fresh Fruit Broken Bodies, Dr. Seth Holmes tells the story of one such Triqui migrant named Bernardo. Bernardo was admitted to a local hospital with complaints of stomach-pain. There was no translator available to create a communication pathway between Bernardo and his physician, forcing his Mixtec daughter in law who spoke no Trique and minimal English to serve as the linguistic liaison. Despite doing her best, his medical history was summed up as Bernardo having been an “older boxer who wonders if possibly the blunt trauma to his abdomen could contribute to his present condition.” The physician, who assumed Bernardo to be a hispanic who spoke poor Spanish, noted that he “tended to perseverate on unrelated things from the questions that were asked, but these things were usually not translated to me.” In his frustration, the physician wove his own story in order to fulfill the requirement of creating a medical history for Bernardo, but decided that Bernardo did not have one at all. 

TTUHSC El Paso 


Due to the temporal and linguistic limitations of the medical interview, the physician was unclear about the location and quality of the pain (Holmes 2013). What Bernardo was desperately trying to communicate to the physician is that he believed his pain was caused by a lifetime of hard labor in the fields in conjunction with physical abuse at the hands of the U.S. funded Mexican military. The juxtaposition of Bernardo’s experiences with what was documented on his chart is alarming. More shocking still was the lack of care given to explaining a follow up to Bernardo; he left the hospital “against medical advice” and was charged $3,000 for a visit that offered him nothing at the end of the day. 

          Occurrences like these exemplify one of the major problems Indigenous peoples face when they encounter Western medicine, a mostly linguistic issue that can exacerbate the deaths of those who have no means of communication with Spanish or English speakers. The argument against this is always the “well, learn English” argument, but English course are inaccessible to the marginalized migrant. So what is the government doing to rectify these issues?

 All health care facilities receiving public money are under legal obligation by both state and federal law to provide interpreters to every patient who needs one, and very few health care providers have made Indigenous farmworkers an explicit priority (Raff 2015). This is an unknown fact to many Indigenous peoples who, because of language barriers, have no awareness of what they are entitled to. However, these things are starting to shift. In 2016, California overturned the ban on provision of bilingual education. This positive movement allowed for the progression of migrants out of the field and into the health care setting, serving as interpreters for marginalized people like Bernardo. Indigenous Interpreters Plus, an organization started at Natividad Hospital in Salinas, California, aims to train interpreters who speak the rich Indigenous languages of Oaxaca and other parts of Mexico.

 
The accessibility of proper healthcare is crucial to quality of life, and when something as simple as having the right interpreter stands between a patient, life and death, it is an indicator that something needs to change. Organizations like Indigenous Interpreters Plus can have a huge effect on migrant mortality rates and the overall experience of the migrant worker in the U.S. Already victims of structural violence and systemic racism, one’s language should not be the death of them. For the Indigenous populations of Mexico who come to the U.S. for something better, the relationship between language and mortality is beginning to dissipate.
  Works Cited: Holmes, Seth. Fresh Fruit Broken Bodies. University of California Press, 2013.


Porzucki, Nina. Why a hospital is taking farm workers out of the field and training them as medical
interpreters. PRI. Nov. 2016,https://www.pri.org/stories/2016-11-04/fields-icu-how-one-hospital-training-field-workers-be-medical-interpreters Raff, Jeremy. Hospitals Struggle To Help Farmworkers Who Speak Triqui or Mixteco. NPR. Sept.
2015,http://www.npr.org/sections/health-shots/2015/09/29/444223248/hospitals-struggle-to-help-farmworkers-who-speak-triqui-or-mixteco