Lost in Translation

Treating patients in a newly found language has been an interesting ride. It’s been the source of much frustration, many laughs and far too many marathon treatment sessions.

The 3 Zulu phrases I learnt on my first day was “Hello”, “How are you?” and “What are you here for?”. The first 2 phrases are fine-they have generic answers-the universal response to “hello” is “hello/hi/yo/*grunt*” and most people respond to “how are you?” with “I am fine”…the last phrase on the other hand opens Pandora’s Box. It marks the beginning of an adventure that generally consists of me frantically searching for remotely familiar Zulu words, running between colleagues  to relay + translate unknown phrases that keep coming up and to ask follow-on questions - all of this activity to START the physical evaluation in order to identify and treat the cause of the problem.

The "Universal" section of the treatment session, where respective greetings are exchanged. Hello. How are you? I am fine, How are you?

Upethwe yini? Translated into English "what are you here for?" aka The calm before the storm

The course of events between me asking "what are you here for?" and the patient giving me a long answer in Zulu. My brain responds to this verbal outflow by embarking on a frantic search for familiar words. This search inevitably ends in my brain short circuiting, frazzling and atrophying.  

Up until 3 months ago I found myself feeling overwhelmed, lost and forlorn every time a patient walked through the therapy doors into my cubicle as my Zulu vocabulary is “limited” and gesticulating only gets you so far (try gesturing “3 point touch weight bearing” to a patient with a fracture and you’ll get a taste of a typical therapy session). One of the teachers who attend our church came to save the day. The Chrin and I were advised to contact two local lads who have subsequently become our super-hero translators. 

Super C fist pumping on the left in blue and Tenacious Tutu on the right in green. 

Super C and Tenacious Tutu sit in on treatment sessions relaying my questions to the patients and their answers to me. This has been an answer to prayer as patients receive optimal treatment and rehab programmes and I no longer run the risk of treating the “wrong” problem – one stormy afternoon I worked out an elaborate strengthening home programme for a patient with a degenerative condition…one hour later I learnt via translation that all he wanted was a wheelchair-wheelchairs take 5 minutes to measure 10 minutes to adjust and 3 minutes to do the paper work. Super C and Tenacious Tutu are super-star translators, the patients; on the other hand have a tendency to try ones patience with their long winded and sometimes irrelevant answers. The patient type determines whether the session will occur in 2 parts or 4 phases.

Type 1 Patient

Definition: These patients are generally young –> middle aged. They have been referred to physio for fractures, sprains or pain of a specific cause. They generally have a good baseline health level. Their sessions are straight forward and occur in 2 parts.

Part 1: They come in, greet, tell you the problem

Part 2: They answer the questions and receive treatment.

Portion of population: These patients make up ±10% of my patient population.

Average treatment time: 45min to 1 hour

General vibe post treatment: Happy patient, happy therapist – therapist was challenged but felt productive

Type 2 Patient

Definition: These patients are generally middle aged –> old. They have their primary problem + 10000000000000000 other ones (eg. Fractured leg, but they have had a stroke and they have had arthritis for the past 10 years) alternatively they have 1000000000000000000 problems with 1 primary cause which they don’t acknowledge (this may be by choice or default). For example their WHOLE body aches because they have arthritis, in addition to this they get crazy head aches but this is caused by their arthritis and their legs and arms swell after they’ve had a busy day….but you guessed it-it’s from the arthritis.

Due to the nature of these cases these patients give long-winded and many times irrelevant answers. These patients have 4 phase treatment sessions which can be marked by varying levels of frustration.

Phase 1 - Bright Eyed and Bushy Tailed: The universal greeting and establishing the main problem.

Phase 2 - Hopeful : Asking 1 of the 5 "clearance questions" which determine the severity of the problem. The patient usually responds with a long winded answer.

Phase 3 - Frustration: The question is posed a second time in a different manner. The patient responds with yet another long winded answer.

Phase 4 - Desperation: The question is posed for the third time in the form of an ultimatum "yes/no" question.

Patient Scenario: Gogo comes to physio with a 2 year history of headaches and neck pain

Phase 1: Bright Eyed and Bushy Tailed - With the help of the translators the physio executes the Universal greeting and the dreaded Upethwe yini with grace and ease.

Phase 2:Hopeful - The clearance question is asked "Do you ever see double?" The patients answer is verbose, but the physios bright eyes indicate that she is listening intently-hopeful that the answer will be hidden somewhere between the patient telling you about her cat and the colour and shape of her 9 different tablets.

Phase 3: Frustration - The question is repeated in a different form. The patient responds with another slightly off course answer. Note, the physio's tail and eyes droop as frustration kicks in, the number if patients in the waiting room increases and the time ticks on.

Phase 4: Desperation - The same question is posed for the third time in a closed form. "Gogo, you are only allowed to answer yes or no...do you EVER see double?" To which the gogo finally responds..."No"

Portion of population: These patients make up ±80% of my patient population.

Average treatment time: minimum of 1 hour

General vibe post treatment: Patient happy/annoyed depending on the perceived outcome. Therapist….on the verge of tears-and we haven’t even started on the physical evaluation.

Type 3 Patient

Definition: These patients are generally children, middle aged or old. They are in-patients (ie patients who have been admitted to the hospital and chill in the ward) and have been referred to physio for a number of different causes. These patients are the source of colourful treatment sessions which generally involve me making a fool of myself as I try to win their co-operation, most times my effort is in vain! Their session also occurs in 4 phases.

Phase 1: I come in, greet, give an instruction.

Phase 2: They patient looks at me like I fell out of a tree.

Phase 3: I recruit a translator in the form of a Nurse/Super C/Tenacious Tutu.

Phase 4: The patient grunts/blinks/ looks at me + the recruit as if we have fallen out of the tree together.

Patient Scenario: Gogo with pneumonia referred for chest physio, gogo is required to take deep breaths as part of treatment and evaluation.

Phase 1: Universal greeting, physio tries to explain in broken Zulu/with gestures the aim of treatment as well as the exercise to be done. 
Example: Gogo, I need to listen to your chest so please take a deep breath (pefumla kakhulu) 

Phase 1: Physio demonstrating a deep breath. Note the exaggerated facial expression-massive eyes, flared nostrils and shoulder shrugging to elicit a breath. 

Phase 2: Patient blinks...twice

Phase 3: Nurse is recruited to supervise-check that the physio is pronouncing the word correctly and to reinforce the instruction.

Phase 4: Patient response: Patient politely goes moves from sitting to lying and pretends to sleep. 

Portion of population: These patients make up ±10% of my patient population.

Average treatment time: 15 to 30 min

General vibe post treatment: Therapist: Hysterical, humiliated, defeated or manic. Patient: indifferent, amused or victorious