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
