Episode 5: Loss in Translation

Daniel Eison: 0:01

This is Dan.

Sarah Dabagh: 0:02

And this is Sarah.

Daniel Eison: 0:03

And we'd like to welcome you to PediPal.

Sarah Dabagh: 0:07

A podcast about all things pediatric palliative

Daniel Eison: 0:10

The views in this podcast are ours alone and are

Sarah Dabagh: 0:19

Si habla spanglish, como yo, cuelgue el

Daniel Eison: 0:24

Dear listeners, we did not even attempt the Arabic

Sarah Dabagh: 0:30

I think we're gonna jump straight into this general and for pediatric palliative care.

Amani Zaki: 0:50

Hello, everyone, my name is Amani Zaki. I work at

Daniela Obregon: 0:58

Hello, everyone. My name is Daniela

Sarah Dabagh: 1:12

Dani, I almost want to open up with a question

Daniela Obregon: 1:23

A translator does the written portion. So the translator has the beauty of being able to research for the

Sarah Dabagh: 1:46

I'm wondering if there are other common

Daniela Obregon: 1:53

They're more like a pet peeve, is that interviewing in end-of-life settings or in critical

Amani Zaki: 2:26

Sometimes interpreters are looked at as understand how we're going to approach things. But I will

Sarah Dabagh: 2:57

The two of you represent two very different language with so many different dialects.

Amani Zaki: 3:17

Whenever I'm giving cultural awareness can also be a lot of differences. I was interpreting that the patient eats a lot. And as a diabetic patient, we needed He was like, "No, no, no, no, no, it's green but it's red!" very specific to where they came from.

Daniela Obregon: 4:28

In my case, well, I'm actually Argentinian. little bit. Like for example, like the sound of the double L plenty and plenty and plenty of sessions where I had to ask for it's "cola"-- and the woman looked at me very offended, like then at the end, she told me that the word that I used was very tricky.

Daniel Eison: 6:05

It sounds like one of the important things that we

Daniela Obregon: 6:25

In Latin America, there are many the linguistic perspective, the other thing that-- it's so the mom is the one that makes the main decisions. So all those Or if you have a concern that parents are not understanding encounter. There can be so many things, but it's always super

Amani Zaki: 7:49

Yeah, agreed. And I always like to also mention that more helpful within the session. The other thing to say and to lot. I sometimes have a family that I have helped with familiar face. A lot of times we see the hesitation within the kind of follow throughout their journey, sometimes they get maybe three times before, the family has given the same answer providers do not give us the opportunity. So maybe what I think, maybe part of their background believes in this and

Daniel Eison: 10:04

Can you imagine if we called a consult from another would be unthinkable. And yet, we call interpreters all the

Sarah Dabagh: 10:24

And Amani, you had mentioned not having gone to whole world who have this diagnosis. So we have to do that

Daniela Obregon: 10:51

Or acronyms.

Sarah Dabagh: 10:52

Oh, acronyms!

Daniela Obregon: 10:54

Our worst nightmares.

Sarah Dabagh: 10:59

And we love them in medicine.

Daniela Obregon: 11:01

Yes, you guys really do.

Sarah Dabagh: 11:05

Are there other phrases or practices that we translate?

Daniela Obregon: 11:21

Well, I think we had this conversation with people from other countries, you know? Personally, one of the that, even if we do a literal translation? How can the message

Amani Zaki: 12:10

Part of it is not only because it doesn't being the ultimate entity. So God decides when someone is sick I've helped with, regardless of their religious belief, or maybe understand where they're coming from, you don't get it, you

Daniela Obregon: 13:24

Can I add another example? So, "hospice." "hospice" because by using a word like, for example, that explain what it was before giving it a name. We said, "It's other people call it 'hospicio,' but just so you know, it does had, and will say "the group of people." And the family was not

Daniel Eison: 14:50

Both of you have mentioned culture a lot and it Dani was saying about how palliative care is a very white,

Amani Zaki: 15:17

Some of the times I found challenging is when there regardless of their religious belief or strength of faith, delicate for the family. Because if you keep pushing them to coping mechanisms that the families are holding on to just do not push them or pressure them to accept it

Daniel Eison: 16:40

I have noticed in my practice, that often families end up in the ICU... Whereas in some cases, I feel like if they work better to kind of build the understanding that-- don't ask

Amani Zaki: 17:29

Yes. And I think this is a great question. And that we're prolonging suffering, or like sometimes this is how we this is the day. This is God's choice and decision." And this

Daniela Obregon: 18:24

This is a generalization, I think, it's Decisions are made with the whole family. It's not uncommon talking about extended family, where cousins, aunts, uncles, they need to go back together, and those twenty, thirty people seen as a figures of respect. So you may have seen many times respectful towards you and towards what you're saying. It feel that you guys are the only providers that truly take a huge taking your time. Generally, including me, we like to talk. that part right. Because you guys bring the chairs! Families

Daniel Eison: 21:02

I'm glad someone else appreciates the chairs. I about the head-nodding, but are there other things that are

Daniela Obregon: 21:23

When I went back home a few years ago, one home. I'm not saying that you should hug and kiss a patient, think it goes really a long way showing the human portion.

Amani Zaki: 22:03

I don't mean to confuse you, but please do not of a recommendation that if you are a male provider, please especially within the Muslim majority countries, sometimes actually stretch your hand to shake hands with someone from before and it does make the families I help uncomfortable. very sensitive conversation. And he kept getting closer to her, that I know are very confusing and different to what Dani has

Sarah Dabagh: 24:00

I'm curious to hear a little bit more about this. And I want mom to contribute. And I want to hear distress.

Daniela Obregon: 24:32

Generally speaking for us in Latin But, when we're having a conversation with the whole because he-- because I had been helping them for so long, he everybody by surprise, because we totally thought that Dad was

Sarah Dabagh: 25:42

Amani, how about from your perspective?

Amani Zaki: 25:44

I always say like, every family dynamic is and then I give it-- it's up to the family who is it that they trust. That's how I approach it. But a lot of times very that the mothers or the female figures are not included or do

Daniela Obregon: 26:42

Can I also add some into that? It's, generally will not know the medications the patient is taking or the

Sarah Dabagh: 27:27

Are there any challenges that you think are

Amani Zaki: 27:36

I always say that I feel with pediatrics, even pediatrics is challenging in that sense in that we have to

Daniela Obregon: 28:12

I have worked, I think, equally amount of years go, you know, how life is supposed to go, seeing grieving so fancy, but it's so-- it's so incredible to be able to do that those kids. Allow them to connect with providers the same

Sarah Dabagh: 29:21

Do you think when a child doesn't speak English,

Daniela Obregon: 29:26

Yeah, unfortunately. However, many interpreter, many times they're being left out and they're not

Amani Zaki: 29:52

Yeah, are because a lot of those decision-making that same conversation again. And some physicians do not

Daniela Obregon: 30:22

Many times it has happened to me, parents

Daniel Eison: 30:41

I feel like I've seen that across all cultures that's conveyed by tone of voice, and there's a lot that's

Amani Zaki: 31:10

It's hard. It's hard. Yeah. I think it takes and it's one of those encounters that I'll probably never forget. family's anger and sadness, and denial and, and all of those too. I will try to convey the emotion as well with my relaying touches you. So I would feel it. Every interpreter you probably distract myself from getting involved with it. So I stay with

Daniela Obregon: 33:01

Doing difficult conversations, is again, it's linguistic service. I feel like even though I can be going those families get the right care, the care in a language and I am the auntie that buys a bunch of gifts for them. And you before. And at one point the dad says... (Oh I always cry with cooking for him, and she was always with him, so she's going she was crying. I look next to me to the fellow from Oncology And I felt like this specific topic was very close to my don't get in the middle, but still showing that compassion, like-- I remember a few months ago, I was like, I'm trying to families through how we say, or how we convey, the message.

Sarah Dabagh: 36:29

Both of you have touched a little bit on already gonna throw one thing on it, which is we should tell you

Amani Zaki: 36:56

Those thank-yous, I can tell you very honestly, have trusted that I did convey everything that they have said, process as well. Because that was maybe one of those-- the they reacted that way or... It helps me process my emotions as

Daniela Obregon: 38:03

Unfortunately, as medical interpreters we do don't think I found any training particular for interviewing for between both of them. So they might, you know, subtle the tone that generally will last interpret how they're doing. And training is that were just only a conduit of communication.

Amani Zaki: 39:23

Yeah, I worked as an over-the-phone interpreter just have to get your mind ready for a whole different appreciated moment.

Sarah Dabagh: 39:59

It almost feels like it should be part of the

Daniela Obregon: 40:09

Yes, yes.

Daniel Eison: 40:12

Yeah, and it's such a simple change to make. the next encounter." And so it seems like the obvious thing to

Sarah Dabagh: 40:52

Alright, so what are our main take-homes from

Daniel Eison: 40:55

So I think it kind of goes without saying, but I'll

Sarah Dabagh: 41:02

Well put.

Daniel Eison: 41:03

I mean, just like...

Sarah Dabagh: 41:04

End of episode!

Daniel Eison: 41:06

Yeah, but that's it. That's my take-home. When

Sarah Dabagh: 41:20

And I'll add to that: talk through your

Daniel Eison: 41:29

Yes. Oooh ooh! Pre-brief, debrief, and be

Sarah Dabagh: 41:36

Well put. Yeah.

Daniel Eison: 41:39

I think also, the other thing that I'm taking away

Sarah Dabagh: 41:49

Yes, definitely. And don't forget about the child Thanks for listening. Our theme song is provided by Kevin email on our website. This has been PediPal. We'll see you next

Daniel Eison: 42:22

Go ahead. No, no, I'm gonna... Oh no, you're gonna

Sarah Dabagh: 42:28

Are you okay? Should I send like a... a

Daniel Eison: 42:34

It's um... it's been a long year.