March 25, 2012


The group of health care providers I worked with

I recently returned to Windward after spending a few weeks in the Ecuadorian Andes, the region where the interplay between the human- and eco-systems inspired me, at the age of 18, to seek out and help to create a place like Windward.

The purpose of my travels this time around was to serve as a Spanish-English translator for a group of physicians, nurse practitioners and physical therapists that provide health care to people living in remote regions that have difficult access to health care or otherwise cannot afford it. The group has been traveling to Ecuador for about a decade, and this was my third year providing translation services.

A Pediatrician assessing a child's respiratory system
For me, most of day was spent translating pain, providing me with a very intimate window into the lives of the people that would travel for hours, sometimes by foot or sometimes by bus, and then wait in line for much of the day to spend 15 minutes with the health care providers. We averaged between 200 and 300 patients a day, from new born babies to the eldest elders who were still mobile enough to travel.

Yet despite spending all day talking about arthritis, headaches, back pain, poorly healed broken bones, failing eyesight, burning urination, menopause, parasite medication, blood pressure and poor appetite, by the time I fell asleep each night I couldn't help but be impressed by how very healthy this population, primarily comprised of subsistence farmers, is.

The Andean countryside

As someone who is choosing to live a life far closer to how these Andean farmers live than the lifestyle of a typical American, I am well aware of the physical demands such a life puts on the body, and I am not trying to trivialize their pain or romanticize their life. These are people that work hard, and with few modern amenities to ease the labor, their bodies show the wear and tear, at what we might consider a relatively young age.

But they also suffer from relatively low rates of what are often referred to as diseases of affluence: obesity, diabetes, high blood pressure, high cholesterol etc.

A 91 year old
We see the sickest people in a several mile radius of every town, and the vast majority of the medications prescribed are vitamins, Tylenol/ibuprofen, treatments for water and soil born parasites and treatments for acid-reflex (which is believed to be so prevalent because of a bacteria, Helicobacter pylori, that infects the mucous lining of the stomach). There are always a few cases each year when the medicine and care the American health care providers give significantly improves the standard of living of a patient or even saves his life.

However, by the age of 60, what many of the patients want the most is a pair of reading glasses because, as one older gentlemen said to me while he laid on the floor getting an injection in his leg to reduce the inflammation in his severely arthritic knee, "to seek wisdom is to live a good life".

Our trusty travel bus with all our medicines
(about to get stuck crossing this stream washing away the road)
For me, medical translation in rural Ecuador is a reminder that there are multiple kinds of translation and multiple manners of communicating. For example, one can translate words, translate meaning, or translate culture-- three distinct types of translation, all of which I would suggest are necessary when being tasked with giving a health care provider enough of an understanding of the patient's history for her to be able to give appropriate care (however, training for professional medical translators suggests otherwise).

The perspective I provide above assumes that words convey a fundamental meaning, as opposed to having meaning in and of themselves, and that meaning is relevant only within the context or the frame of reference in which it is experienced or understood. Additionally, while it is well understood that people can communicate and share information about themselves without using verbal communication, different cultures have developed distinct mannerisms to convey the same sentiment, thought or emotion. So interpreting body language and gestures across cultures, particularly if using them to identify symptoms or diagnose illness, can be a misleading practice.

Providing health care on a local bus

While this may appear esoteric or off-topic, being stewards of the land means we are in the business of translating and communicating with the world around us, the world that is our home and that provides us with the resources we need to live. We need to be responsive to its needs and promote its health, yet for most of us the language of the natural world is a foreign language that we hear with all our senses and speak with our actions.

If we only listen to the metaphorical words of the natural world (e.g. individual data points strung together in a series), as opposed to seeking to understand the meaning conveyed, and if we assume the meaning such signals carry is the same across habitats or regions, we become vulnerable to getting lost in translation.

More beatiful mountains
Getting lost in translation ultimately means making mistakes, and while many such mistakes are harmless, the value of being right in such matters is well worth the effort of training ourselves to be good translators. Just like in any spoken language, to be a good translator of the natural world requires full immersion in its language and culture to become fluent or at minimum deeply knowledgeable.