Even Though I Don’t Speak English: A Letter to Every Healthcare Provider
2002; American Association of Critical-Care Nurses; Volume: 22; Issue: 4 Linguagem: Inglês
10.4037/ccn2002.22.4.47
ISSN1940-8250
Autores Tópico(s)Migration, Health and Trauma
ResumoThe following is a letter of appreciation from a friend who was a patient in a large metropolitan hospital—admitted from the emergency department after a motor vehicle accident, sent to the intensive care unit for a week, and discharged after a 5-week hospital stay.I am not at my best when I come to you. I come to you weak and broken, with tubes coming out of every orifice. I am overwhelmed by the machines and the total environment around me. I am frightened, vulnerable, and in desperate need of your help. My life is in your hands. Even though I can’t speak or understand English, these are things I want you to know.I am a proud, vital human being. I share experiences, a language, and values within my own culture that I am willing to share with you. Even though I may be a member of a specific cultural group, please don’t assume that all members of the group are alike. I am a unique individual. I have intimate knowledge of my own goals, my own preferences, my own important support systems, and clear functional needs for my independence. Help me to share them with you. I have morals, traditions, and beliefs that may be different from yours. Please know that they are not good or bad, wrong or right—they are simply different. These aspects of my life are as important to me as the struggling breaths I take.I may have had some experiences in my past, about being thought of as different, so forgive me if I sound overly sensitive or overly cautious. Not speaking or understanding English simply means not speaking or understanding that specific language. I do, however, understand the gentleness of your voice, the smile on your face, and the concern in your eyes. I can feel when you are in a hurry, if you’re impatient, or if you are not truly present. I know when you are having a bad day. I know when you are doing a good job with my care and when you enjoy being at work. Even though I may express my fears and concerns in different ways, I can still touch your heart and contribute to you.I value my health and that of my entire family. I may know a great deal about health and wellness. I can follow directions and take on responsibility for my own recovery and improving health. I am very teachable.I live a life that I value when I am away from you. I functioned well in my life before I came here. I didn’t plan to be sick or injured, and the last place I wanted to be was in a hospital. I want to go home.I have family members I need and depend on during my illness and recovery. Please be flexible about visiting hours and allowing someone to be with me—especially at night. Please help my family understand what is happening to me and how they can help. Speak to them daily; encourage them to visit; respond kindly to their questions—even though you may not know the answer. My family members love me, they know I can’t get well without them, and they need to know that they are valued and welcome here with me. My family may not know your rules, so help them gently to understand—not just what the rules are, but why the rules are important. I need you to be patient with me and my family; if the things that are familiar in your world are foreign to ours, we are willing to learn. My family members are very frightened for me, and they may express these fears in different ways. Please do not take it personally and know that we feel helpless and are doing the very best we know how. My family and I respect your profession, your knowledge, and your expertise. We wish to be respected as well.I need you to teach me how to get well and stay well. I need you to reach out of your comfort level and be willing to help me without making assumptions and judgments. I need you to be willing to repeat your instructions as many times as necessary. I need you to be willing to learn new things about me—things like what I think and what my preferences are; my family can definitely help you with this need. I need you to remain willing and open-minded to the possibility of change: in attitude, in increased knowledge, and in the learning of new skills.Thank you for introducing yourself and others when entering my room; this behavior is a gesture of respect and acknowledgment. No matter how sick I am, or how emergent life gets, I need and desire privacy. When I, or my family, ask that a person of the same sex give my care; we are grateful that you acknowledge our request. My cooperation and compliance may depend on it. My anxiety and fear may be lessened. I feel a sense of control and greater calm when you tell me what you are going to do before you do it. Thank you for being gentle when you touch me, attentive when you speak to me, and unhurried when you work with me.Even though you do not fluently speak or understand my language, I am definitely more apt to help you when you show an interest, and you go out of your way to learn even a few simple words to speak to me. In my culture, showing an interest in my family and me, before you engage in your task or ask your questions, shows respect. This behavior indicates to me that you care about me, as a whole person, and that you understand how important my family is to me.I appreciate it when you ask me, or my family, about my preferences, and I appreciate that you do not assume that you know. Thank you for asking me what I need, instead of assuming that you know what is best for me. Sometimes, I may not hear what you have said to me; you may need to repeat the information again. I may be nodding my head out of respect for your role, not out of understanding. Ask me to summarize my understanding to be sure. Ask me to repeat what you have taught me.Sometimes, I simply may not understand the words you say and the exact meaning you are trying to convey. To lessen confusion, and even though time may be an issue, I may need someone specially trained to translate. With sensitive issues, it may not be helpful to use a family member or another staff member as an interpreter simply because they speak my language. Even then, I appreciate that you continue to speak directly to me when you engage me in conversation. Thank you for addressing me formally when you speak in my language. This behavior is another sign of respect and value. Tape recorded and written instructions in my language, and drawings of the new and complicated things you are teaching, are extremely helpful.Other things that you do naturally may mean different things to me and to my family. Please don’t be concerned if I don’t look you in the eye when you speak to me; in my culture, it may be a sign of disrespect. I may have difficulty asking questions because, in my culture, asking too many questions may indicate disrespect for you as an authority figure. If a decision is to be made, I may not be able to make it myself. I may need my family’s input before I can answer. You may be asked by my family to speak to the eldest male, who will act as the spokesman.When telling me about my medicines after discharge, I may not understand what a teaspoon is because we do not use different sized spoons at our house. You may need to send home a special measuring cup or a syringe or perhaps suggest a different way of measuring. I may not understand about spoons or cups or ounces for measurement, and may use metric measurements, instead. It may not make sense to take my medicines three times a day with my meals if, at my house, we eat only twice in a day. When you say that you are going to “take” my temperature, I may not understand that you are checking for possible infection; I may be concerned that you wish to remove a part of me that is not yours to take.In my culture, a sustained glance toward my younger family members or me may mean “bad wishes,” whereas a gentle touch to show affection is considered a special gift. An offer to take my picture may actually mean a “stealing of one’s soul.” On the other hand, a gentle touch to my hand, arm, or shoulder may be better than any sedative or analgesic you could give me to calm and relieve my stress. I need you to know when being too close is not acceptable and when being too far implies a lack of concern and caring. Watch my responses very carefully, ask my family, and please do not assume you know. I need you to understand that if I do not look you directly in the eye when you speak to me, it may be a sign of respect, not one of disinterest.Thank you for treating me and my family as a unique and vital part of the healthcare team. Even though I may appear very different from you on the outside or may respond to situations in a different way, I am still very much the same on the inside. You have demonstrated your care for me by how you treated my family and me during this very stressful time.Yes, even though I can’t speak or understand English, I can definitely tell you how very grateful I am—with every fiber of my being—that you have given a piece of your life to me. Maybe someday you will need my help and I can be there for you. Stop and listen carefully. What you hear is our hearts and spirits connecting forever.Respectfully and gratefully, Your Patient for Today
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