This is for friends working with refugee or immigrant clients, who, like me, may never have had a medical appointment across language.
I had my first non-English encounter with a doctor last week. We're traveling for 6 weeks, and after having trouble in previous pregnancies, I wanted to be extra sure to keep up prenatal visits, which happen about once a month until the third trimester. I speak Italian from having lived a summer as an au pair/maid/nanny in Sardegna ten years ago, but I've never studied it, so my skills are rudimentary. Not unlike a lot of refugee clients. A notable difference is that refugee clients in the U.S. are required to have interpreters, but there are still many cases where interpretation works poorly, if at all.
After working with refugees for about ten years, ten minutes with an Italian doctor helped me understand things that I had understood only theoretically up to that point. And I don't think it was the fault of the doctor, who was competent and kind, if a bit stressed.
I arrived in perfect time. We were caught off-guard when we were asked to leave the stroller outside for the sake of hygiene (Which immediately made us feel unhygienic. And won't it get stolen?) The doctor said that my appointment had been a half-hour earlier, and I tried to explain that I'd been told the wrong time. She said, "are you "xxxx"? No? Then you're 30 minutes late." It made me think of countless phone calls with health centers over client no shows and late arrivals.
At this point she started a detailed ob/gyn history. If the encounter had been in English, I'd have quickly explained that I was 16 weeks pregnant, and I just wanted to make sure the baby had a heartbeat. But it was in Italian. So we struggled through the date of my first period (ever), my history of birth control usage, my pregnancy histories, where I was born. Only then did we get to the point where I told her I was pregnant. There just wasn't an appropriate moment up to then, and my brain was working overtime remembering words and dates. Then on to giving the date of my last menstrual period, which doesn't reflect my due date. Explaining was too hard, so I just added a couple of weeks to my LMP, and let her do the rest.
She then asked me to take off my underwear and trousers. (I repeated, "underwear? really?" fearing I'd misunderstood and was going to shock her when I stripped) No sheet for modesty, no stepping out of the room. I understood what refugees might feel during an examination. In stirrups, there was no time to ask if Eug and Noah could join to see the Tiny Blob, who was clearly going to appear any minute on ultrasound. She did an internal exam (which isn't routine in U.S. midwifery care) and whipped out the ultrasound (which also isn't routine). I was super happy to see the Tiny Blob, who was bopping around everywhere. WIthout asking if I'd like to know, she told me she thought the baby was a girl. It was a moment I would have like to share with Eug, but it was a good moment, nevertheless.
And then, a minute and an "everything's good" later, I was dressing in front of her and she was asking if I had insurance. When I said "no", she launched into a description of a nearby free hospital (I was only in Milano one week). I understood why refugees didn't say anything about upcoming moves out of state. She was enthusiastic and trying to be helpful, and I felt irresponsible traveling so much while pregnant. And the thought flashed through my head: "if she books an appointment, I'll just not show up, and it's no big deal, they don't have a credit card number." Thankfully she didn't book the appointment.
Then, billing. The visit cost 95 Euros. We had budgeted the visit, though for slightly less money (asking about the extra 20 Euros was too difficult, but I felt uneasy), and handed it over. But they needed numbers: an Italian ID and a phone number. Which reminded me of Masshealth challenges. You don't have one? You must have one! And on and on, in circles. And "What do you do for a living?" "public health" "oh you're a doctor" "no I worked for government" "I don't think we have that here." Maybe that's how rice farmers feel when intake looks at them quizzically in the middle of a Massachusetts winter.
Finally, we left. And I understood what it meant to be a "difficult" client, and how disempowering that label feels, even in the nicest of clinics.