February 4, 2005

Lost in translation

Sometimes the difficulties with language in a foreign country are enough to make you laugh or cry. Most of the time it is better to laugh, I think. This afternoon at Mulanje Mission Hospital, where I work as an ob-gyn doctor, I went around to see one of my patients recovering from a terrible obstetrical emergency. I knew I would have to find someone who spoke our local language, Chichewa, fluently, as well as the patient’s language, which I thought was Chikokola. My goal was to try to understand the circumstances that had put her life in danger from prolonged labor and childbirth.

Two nights ago I was called to the hospital to see Mrs. R, a young woman brought by ambulance from Mozambique. The nurses who called me already knew what was wrong, “ruptured uterus,” something we almost never see in America. They had started her intravenous line and prepared her for emergency surgery. The story was that she had been in labor for two days in Mozambique.

Today, she seemed more wide awake and alert, but still I could not talk directly with her because of the language barrier. Miss Nkanda was our nurse on duty in the ward in the afternoon. She agreed to translate for me. I asked some questions in English to Miss Nkanda. Miss Nkanda spoke to the patient’s mother in Chichewa. Miss Nkanda could not understand the reply because it was in Chikokola, I thought. A patient in a bed two beds away said that she understood the language and volunteered to translate. We moved over closer to this patient’s bed. The conversation went from English to Chichewa to what I thought was Chikokola. Then Miss Nkanda told me they were speaking Lomwe, not Chikokola. Another woman came over to help with the translations.

It was slow going, but I understood that the young woman went into labor in a village in Mozambique. Then she went to her local health center where she was told to wait for true labor. She was sent back home a second time from this health center. On her third visit, an ambulance was called to take her to a rural hospital in Mozambique, where they cannot do cesarean sections. After she got to the rural hospital, the ambulance took her to the government hospital in Malawi near us, where they were told they could not help, and to go to the mission hospital, our hospital.

The statistics on maternal morbidity and mortality in developing countries in Africa are an affront to humanity. The causes are complex, including poor transportation, poor communication, poor obstetrical care, uninterested legislators and parliamentarians who do not authorize adequate funds for health care, and traditional beliefs that ignore the health needs of pregnant women.

The sadness of losing a firstborn child; the pain, stress, and exhaustion of travel over bumpy roads with a ruptured uterus and bladder; the experience of being shoved from one health facility to another; and the uncertainty of knowing if medical help will be available is something to ponder. On the other hand it seems like this young woman will be restored to her husband and family, and for this, we rejoice.

Many things are lost in translation, but the smiles of the women gathering around the hospital beds trying to be helpful in communication are not lost. The outside financial help that keeps our hospital going when every day of operation we are losing money because we are trying to care for poor people is not lost. Kindness, care, and perseverance are not lost in translation.

Dr. Sue Makin
Obstetrician/Gynecologist
Mulanje Mission Hospital

The 2005 Mission Yearbook for Prayer & Study, p. 337