August 6: Dealing almost daily with the unexpected and with schedule changes are the rule on surgical trips to underserved areas. Each trip is unique in the nature of the challenges.
Communication is always a challenge in remote parts of the world with different languages, dialects and cultures. I particularly remember a time in Ziwane, Kenya. We accessed a remote village using 4-wheel drive trucks traversing dried river beds and wash-outs, over 45 minutes from the nearest road of any form. The clinic was set-up in a 2-room structure with a dirt floor. Each of the blankets we spread on the floor was a separate “treatment area.”
My patient was an elderly man, age unknown: below his head dress, his deeply lined and sun-weathered face featured a scraggly beard dyed a deep red color more typically seen streaking the hair of attention grabbing adolescents at an urban mall. I had a translator who spoke Kiswahili, the language dominant in Kenya; my translator brought another translator who spoke a local dialect different enough from Kiswahili. When I asked a question, my English-Kiswahili translator translated to her translator who spoke to the patient; however, translator#2’s dialect was different enough from that of the local tribe, that my patients very young daughter translated one more time for my patient.
You can picture the scene: I sat patiently as many words passed in sequence in our small circle. The time it took for the response to make its way back to me was longer than the delay in sending messages up to a satellite in outer space and back, again. Though the distance traveled by our Kenyan question and answer was infinitely shorter than words bouncing off a telecommunications satellite, the reply I received from my series of translators was much more garbled and totally irrelevant to my initial question.
Somehow, here in Pingliang, China, it is not because of esoteric dialects. Here it seems more “administrative.” One of our greatest obstacles has become having our patients ready for surgery. Unfortunately, some of the local caregivers independently overrule our preoperative orders, resulting in surgery cancellations for the day, and leaving us with gaps in our schedule. Some of the babies have been postponed three times! Imagine the frustration of the parents/family who cannot understand why “the doctors inexplicably keep changing things!”
Each day, we try different things to assure best direct communication and coordination, but still so much is “getting lost in translation.”
Yet, thoughts about communication problems vanish when I complete a cleft lip repair that reveals just how cute these babies are.
The smiles on the parents’ faces are wordless expressions that require no form of translation.