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Language, like bedside manners, maketh a doc

  Tuesday, 03 l 08 l 2010 Source:  The Straits Times   
By: Chua Mui Hoong

More dialect-speaking health-care personnel needed to treat elderly

MY MOTHER is 82 years old, has lived in Singapore for 54 years, and still speaks only Teochew – with a smattering of pasar Malay thrown in.

language makes a doctorShe remains, thankfully, healthy enough to get around on her own. Ambulant and alert, she walks around the neighbourhood each morning. She even goes to her regular medical check-ups at the polyclinic on her own, hopping on the bus and remembering to get off at the correct bus stop by herself.

After a major operation last year, my sister hired an Indonesian domestic maid to look after our mother. The maid is under strict orders to keep an eye on her, but is periodically sent off by my feisty mother. “I don’t need her to take care of me. I can walk faster than her,” my mother would say fiercely. “Wa gou ee,” she would say in Teochew, not “ee gou wa”, meaning: “I take care of her, not she of me.”

Problems from a past brush with colorectal cancer, however, dimmed her independence recently. She needed help to get medical attention. So one day I accompanied her to the Ang Mo Kio Polyclinic. Within a few minutes of registration, we were called into a consultation room. To our surprise, the doctor there was a Caucasian woman, who I later found out was from Britain.

I was glad I was present and could act as interpreter. “Very nice doctor,” said my mum approvingly, although she couldn’t understand a word the doctor said. We got a referral for my mum to see a specialist at the Singapore General Hospital (SGH) a couple of weeks later.

At SGH, we braced ourselves for a long wait, as is the norm at the overworked specialist outpatient clinics. When ourturn came, my mother was treated by an Indian woman doctor.

I have seen many doctors examine my mother. This doctor was extremely competent and gentle. Although the procedure in question was invasive, her examination gave my mother no discomfort. She was from India and spoke only English.

I interpreted again. The doctor arranged for a colonoscopy for my mother a few weeks later.

Both the doctors my mother saw were excellent. Whatever they could not convey in words to my mother, they tried to do so through smiles, gestures and reassuring pats. But something was missing, through no fault of their own, because doctor and patient did not share a commonlanguage.

It got me wondering how elderly Singaporean patients who speak no English cope in such situations. Singaporean nurses or staff can help interpret, but may not always be at hand at the right moment.

How many old folks as a result fail to communicate adequately their symptoms to health-care professionals?

I also wondered why foreign doctors who speak only English were being sent to clinics that treat large numbers of subsidised patients, many of whom do not speak English.

There has always been this language gap between Singapore’s first generation citizens and younger, English-speaking service staff in all sectors. But the older folk managed somehow, with the help of a little Mandarin here, a smattering of pasar Malay there. But there is no way to bridge the language gap between a Teochew-speaking old lady who understands a little Mandarin and Malay, and a foreign doctor who speaks only English.

Partly because the doctors could not communicate directly with her, my mother resisted going for a colonoscopy. A word of assurance sounds more comforting, and an order to go for a scan more compelling, when it comes from a doctor whose authority is unmediated by a daughter’s translation.

Public hospitals here should consider incentives to encourage at least a few of their staff, including nurses, to learn to speak dialects, so they can act as translators.

This is especially pertinent in public sector hospitals and clinics, since they see large numbers of the elderly poor, many of whom speak only dialects. Hospitals and clinics should ensure too the presence of enough Malay- and Tamil-speaking health-care personnel to provide similar services to patients who might speak only Malay or Tamil.

We should not assume, however, that dialects are helpful in serving only the elderly poor, as I soon discovered.

After much persuasion, my mother eventually consented to the colonoscopy. I tracked down the doctor who had removed her cancerous lump 12 years earlier. He is now in private practice at the Mount Elizabeth Medical Centre.

The procedure went smoothly and painlessly. Best of all, the doctor could speak to my mother directly, answer her questions and calm her fears. In the waiting room, there was a swirl of people. The language they conversed in? Hokkien!

I later found out that they were Chinese Indonesians.

How ironic, I mused: Singapore’s dialect-speaking elderly may get treated at public clinics by foreign doctors who speak only English; and Singapore’s dialect-speaking specialists can end up treating foreigners.

This, of course, is a gross generalisation. Our public hospitals have many dedicated doctors able to put patients at ease in many languages. And I’m grateful Singapore continues to attract talented foreign doctors; their presence here helps make up for shortfalls in the system. I just wish there were more people in public clinics and hospitals who can speak dialects and act as translators if need be.

One dialect-speaking doctor at SGH did attend to my mother during a follow-up visit. My heart surged when he opened his mouth. A doctor who spoke Teochew!

My mum complained of her bowel problems. “Auntie,” he said in that half-scolding, half-caring tone so beloved of my mother’s generation, “you are 80, not 18. There will be problems, it is normal. But here’s what you can do.”

He gave her advice, prescribed medication and sent her off with a smile on her face. Since then, she has been repeating the story with delight: “The SGH doctor told me, ‘Auntie, you are 80, not 18!’”

“Yes, I guess I am no longer 18,” she would say, laughing.

She won’t say it, but I have a sneaking feeling she is looking forward to her next SGH appointment. I don’t have the heart to tell her that there is no guarantee she will see that Teochew-speaking doctor again.

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