Barriers to Optimal Patient Care: My Syrian Refugee

(Note: This encounter took place in the context of a Medical Interpretation Appointment.)

Mr. W is an elderly man currently enrolled in French classes, hoping that he will become more functionally independent as he improves. He frequently commented about forgetting what he would learn in class, explaining that his mind always wanders back to his family who is now scattered everywhere, and back to Syria, the place he once called home. Tears flooded his eyes. He wiped them off hastily so as to avoid looking too weak in front of me. In the waiting room, I sat back and simply listened as he volunteered his life story.

Mr. W described how they lived comfortably when they were back in Syria. He and his wife were employed. His sons had already completed their university degrees while his daughters were still enrolled in university. “They were hoping to continue their education here” he said. He as well as his wife and 2 daughters have been in Montreal for months with refugee status. His two sons are in Armenia where they fled from Syria earlier than the rest of the family did, for fear of being taken.

As he spoke about their struggle to leave their home with nothing more than what they could carry, he described how he stayed with his sister in Beirut for some time before moving onto Armenia where his son was married. On the way back, he, his wife, and one of their daughters were kidnapped by armed men. They allowed the mother and the daughter to go back to Aleppo but kept their father imprisoned.

He was tortured.

“Many other young men were also captured,” he stated. “I was lucky, I was old. They let me go for 1.5 million Syrian liras. Others weren’t so lucky. Most never come back.” He described what was happening as a ‘trade’ of some sorts. They were paid for every man they captured. Likewise, the only way one could be released was by paying a hefty price. None of the valuables in their luggage were returned. It mostly all boiled down to money, as per his description. After surviving what can easily be considered the most horrific weeks of his life, his health began to deteriorate. According to him, he developed diabetes.

What appeared to have wounded him the most, however, was that the men responsible for his capture and torture were commanded by individuals with whom he was acquainted and who were very much present in their community. They dined together. While his physical scars may have healed, it was clear that the wound of betrayal still throbbed visibly and continued to cause him immeasurable pain and agony. Despite all of this, he longed to visit Aleppo, “if only just one more time before I die”, he said. After all, it was his home.

Mr. W seemed to be adapting very well to living in Canada. He knew how to navigate the bus and metro system. He also knew about the library system. He used his French every chance he could when we interacted with other personnel during our encounter. I would only intervene to interpret when he turned to me for help. That, to me, was a very reassuring sign. I truly respected his resilience. He even asked me where he could buy French books so that he may study at home.

With multiple comorbidities, Mr. W liked to keep a record of his blood test results. The secretary kindly provided him with a copy of the analyses that were completed. The rest, I explained, would take about 3 weeks to complete and his next appointment was booked in a month so that the physician may discuss the results with him. I kindly reminded him that I was in no position to interpret the results when he asked me to. He was very meticulous, requesting a note that he would give to his French teacher in order to justify his absence. “He will do well,” I thought to myself. After making sure that he left with no unanswered questions, I escorted him to the exit and waited until I knew he was going towards the right direction. I prayed silently that he would soon reunite with his family members and that one day they too would consider Canada a second home.

During the time when I was placed at a clinic that tended to asylum seekers, I have heard many heartbreaking stories. I have also witnessed the colossal challenges of language barriers. I became increasingly acquainted with the lack of a budget to invest in on-site interpreters at hospitals and to schedule interpreters with La Banque interrégionale d’interprètes (which is quite costly). In a city as diverse as Montreal, the current access to interpreters within the healthcare system is simply not good enough. In some cases, this can have disastrous consequences.

I heard the following story from a friend who speaks a language that is very specific to a small community of individuals. A middle-aged man was admitted and discharged soon thereafter. The physicians couldn’t find anything wrong with him and perhaps more importantly, they couldn’t communicate with him. He left and came back very distressed. He was extremely agitated and frustrated, and still, no one could understand him. While the room he was in was temporarily empty, he had jumped out of the window and committed suicide. His wife had taken the children and left. He had a psychiatric illness that they could not identify because they failed to communicate with him. This man’s death should have been a wake-up

Imagine being pulled into an operating room without having any idea what’s going on. Imagine giving birth for the first time surrounded by people who can’t communicate with you and where you don’t understand anything that’s happening. Likewise, imagine treating a child with asthma or cystic fibrosis without being able to determine if their living conditions may contain an irritant that’s leading to the child’s deteriorating health.

As a first generation immigrant myself, I believe that I understand the challenges that unilingual allophone patients face within the healthcare system. As a future physician, I am taking this opportunity to highlight the dire need for health care professionals to work within the system to create effective, lasting solutions to this ever-growing language barrier problem in an increasingly diverse city. There is a crucial role that we can play, as health care professionals, by advocating for underprivileged populations.

As a Canadian, I take great pride in my country being a vibrant quilt of cultures and faiths. Let us work to create a healthcare system which serves this diversity and empowers our patients, regardless of their background.


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