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NYT Blog: Treating Patients When Language Is Only One of the Barriers

Tuesday, January 05, 2010

Complete Article:

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, “Medicine in Translation: Journeys With My Patients.” Ultimately, a medical resident had to break the news.

Dr. Ofri often faced this type of challenge while caring for her immigrant patients, who suffer from both physical and emotional traumas brought by genetics and geopolitical winds they cannot control. She and other staff members at Bellevue try to soothe their pain, but they are often hindered by language and cultural barriers, and by the huge gulf between their life experiences.

“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 and the second medical memoir by a Bellevue doctor to be released in the last few months. 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.”

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