Monday, October 20, 2014

Guest Blogger Series: Sarah Azad, MD “Similarities Abound”

“Hello, I’m Dr. Azad.  Do you speak English?”   During my residency, in a hospital where nearly 60 percent of our patients did not speak English, this was the way I introduced myself to every new patient.   Often, since at least 50 percent of our patients only spoke Spanish, my question would be met with a “No, Español.”  I would then restart with “Hola, me llamo Dra. Azad, ¿cómo estás?”  Generally, that one sentence would change everything.   Very skeptical-looking faces would light up; concerned husbands would breathe a sigh of relief.

During my residency years, anyone who encountered me would find little to make one think of a Spanish-speaking Latina.   For 80 hours of the week, I was in scrubs, running around the county hospital.   During my limited free time I was either at the mosque, with my high school girls’ youth group, or out with friends, most of whom also wear the head scarf, or hijab.

But on any given day, you might have run into me on labor and delivery, in our county hospital.   In the triage area, patients who are pregnant and either think they are in labor or have some other concerning problem come to be evaluated.   They never know who is going to walk in to evaluate them.   And we residents never know—when we pick up a chart of a new patient who’s stopped in—what we’re walking into.

About a million times, (at least that’s what it felt like with the crazy hours of residency), I’d walk into a triage room, only to see a very skeptical-looking patient and family members.   It took me a while to figure out what the look meant.   Was it my hijab?  Was it my skin color?  But soon I learned to read the meaning of that look:  am I going to get good care?

One of the most important components of the patient-physician relationship is communication.   For our patients who did not speak English, there was a perpetual fear of showing up and receiving care from a physician with whom they could not communicate.   Yes, telephone translation services were always available, but it’s simply not the same as being able to have a fluid, face-to-face dialogue with your physician.

Midway through my second year of residency, my medical Spanish was fluent enough that I could evaluate and care for patients and address their concerns all on my own.  Every now and then, I’d even get a compliment on my Spanish.   With every new Spanish-only speaking patient I would get the same apprehensive look, and my switching to Spanish would elicit the same smile of relief.  Scarves and skin color were the furthest thing from their minds; these ladies were just grateful to know they could comfortably ask all their questions and understand the answers.

Without a translator, there was more time in each visit to talk with patients about their health and to answer more of their questions.   As with the other multi-lingual physicians, my patient panels would slowly fill with increasing proportions of Spanish-speaking patients.  Seeing these patients was so fulfilling: there was always gratitude in the visit for the language itself, but often there was something more, an eagerness of the patient to ask all their questions in that one visit, highlighting how few providers they were able to comfortably communicate with.  Some days I would speak so much Spanish I would come home and answer my family’s questions with “Si” or “¿porque?”

As I advanced in my training, and began to work with patients needing surgery, I started to discover another level of intimacy with my Spanish-speaking patients.  Several of the more religious women would immediately identify my hijab as a sign of piety and would then openly speak in religious terms when discussing their surgery.   Discussion of the risks of surgery before we signed a consent form were filled with “todo está en las manos de Dios” or “Ore a Dios antes que comience la cirugía. Cuidará de mí” or “Ojala, esas cosas no van a pasar y todo es plan de Dios” and other similar phrases.  Before we’d go back to the OR, patients would ask me to pray for them and to pray during the surgery.  Several older women would ask me to pray with them to the statues of Mary they had at their bedside during the post-operative period.   When I would say “No soy católico, pero voy a rezar por su salud” they would still smile and thank me.  I found that for those of faith, knowing that the person who has your health in their hands has a relationship with God is far more important in these intimate moments than differences in religion.

It is striking to me how for some, my headscarf brings to mind images of oppression and violence, while for others it suggests piety and godliness.   Those moments when my patients would ask me to pray with or for them were some of the most memorable and beautiful of my residency.

After I finished my residency, I traveled overseas with my husband for six months.  Twice in those six months I fell ill and twice I visited the pharmacy to obtain medications.   With my husband serving as translator, I always knew something was getting lost by the time the information reached me.   As a physician, I was comfortable with taking a topical steroid or antibiotics without having a real conversation with the pharmacist, but what if I didn’t have such medical knowledge?  During these experiences I would remember my non-English speaking patients back home, trying to navigate the American health care system.  Watching the physician enter the room, apprehension in their eyes:  am I going to get good care?  At the end of the day, underneath layers of clothing, skin color, language, we’re all of us looking for the same basic things in life.

Sarah Azad is an Obstetrician and Gynecologist in the San Francisco Bay Area and a contributor to the recently published book, “I Speak for Myself” American Women on Being Muslim” (White Cloud Press, 2011).  She is also a committed mentor of young women, where she focuses on inspiring young American Muslim women to lead confident, articulate lives, dignified by Islam.  Sarah takes an active interest in cultural sensitivity training for health care providers of Muslim patients.  In her free time, she’s an avid reader and runner and is working on her fifth language.

Comments

  1. Bilingual staff helps decrease the chances of error at hospitals. I can’t even begin to imagine sitting in a hospital room with a translator on the phone helping me understand, and vice versa, the doctor/nurse in front of me…the thought is just plain out scary…

  2. Sheela says:

    I agree. There’s so much lost in translation and the time it adds to a visit makes it less likely that everything will get communicated. It’s actually more important, in my opinion, to have diverse languages on staff at any medical center than to have diverse people.

  3. I just want to attest to Dr. Azad’s comments. I’m a patient of hers and it’s true, I’ve never gotten such good care (even in English). It’s all about communication and she is amazing.

  4. Mercedes says:

    Getting good care is getting harder and harder, no matter what the language. It’s uncommon to see article like this, where the actual “care” a patient gets seems to be the focus of a physician. I almost always feel it’s about getting me in, checking off boxes on their computer, and then getting me out.