There’s more to communicating than having a set of vocal chords…

Living and doing medicine in a country where I don’t speak the language has been hard.

Getting the correct story from each patient about the history of their illness has been hard. Communicating to the nurses when and why to give each medicine has been hard. Communicating to a Rwandan doctor the danger of giving a high dose of digitalis (a potentially dangerous heart medicine) to a child who had no heart problem was hard. Talking to a woman who saw her ten children being killed was hard; doing it through a translator, harder. Gaining only the smallest pieces of insight into the dynamics, issues, and politics of a developing hospital in a remote part of a post-genocide country has been hard.

Living and doing medicine in a country where I don’t speak the language has been challenging and rewarding.

Seeing my patients smile (and say “yego or oya”(yes or no)) after I spit out my few basic medical questions in Kinyarwanda (Umezute?(How are you feeling?), Urakorora?(Do you cough?), Uraruka?(Do you vomit?), Urahitwa?(Do you have diarrhea?)) never ceases be rewarding. Describing the frequency and purpose of a medication in my American-accented-beginner-French is a daily source of amusement (always to the nurses and, usually, to me as well). Being able to speak more and more French everyday to the Rwandan doctors as well as communicate how much respect and admiration I have for them is incredibly motivating. Realizing how much a person can find out about another person through a translator has fueled my future interest in cross-cultural psychiatry and counseling. Watching and being part of the struggles, challenges, and victories of a developing hospital in a remote part of a post-genocide country has been challenging, inspiring, and rewarding.

The verdict? I would do it again in a heartbeat!

It probably goes without saying (but I will anyway) that until coming to Rwanda, I took the ability to communicate for granted. Iris Kohl made a comment the other day that stuck with me: “In Germany, we learn two or three languages for very practical reasons --we will likely have to use them someday. In America, however, if a student studies a foreign language it is usually for more intellectual rather than practical reasons.” Before coming here I realized, in theory, that effective medicine requires speaking the heart-language of one’s patients. Being in a situation where I am unable to understand and respond to the concerns of my patients in situations of physical and emotional vulnerability, however, brought home to me the importance of learning-languages in a way that no “cross-cultural” textbook could have. When I am suddenly faced with a woman whose sister has just died, how do I communicate compassion and empathy in a culturally appropriate manner when the “I’m sorry” verb has multiple layers of meaning that I don’t yet understand? How do I have an “end-of-life” conversation with a woman with intractable, inoperable, untreateable cancer in a cultural where instead of saying “you are going to die” you are supposed to say “you are not improving?” How do I have a genuine discussion about philosophy, religion, life, and the God I love so dearly with someone when I can barely say “hello,” “how are you,” and “where’s the bathroom(pit latrine)?”

While we were walking the two minute walk to the hospital one day, Dr. Caleb made an offhand comment that stuck with me. He was telling me about how in the colonial era (and even recently), many of the foreigners in Rwanda never bothered to learn the native language. They were here for trading purposes and trading only. Instead, the Rwandans all learned French (now the second national language of Rwanda). “They could have been sitting around a table, the French talking in French and the Rwandans nodding and smiling and agreeing with them in French, meanwhile discussing something entirely different in Kinyarwandan. The French people would never have known.” Although I certainly don’t mean to defend some of the French people’s behaviors surrounding the 1994 genocide in Rwanda, I do wonder how much this sort of scenario could have been a contributing factor.

All of this to say…to say…TO SAY that I am very grateful to have so many friends at home who speak my same language, know me and understand me. But I am also greatful for the challenge of getting to know people when none of that is available.