translation - 18Disabled

Bridge across the Helmand River. Photo by Mohammed Omar Lemar

A long time ago……no, too depressing.

Some time back……no, too vague,

Once upon a time…..yep, that’ll do.

(Ahem) Once upon a time, I found myself with my ODA, sitting on a bridge over the Helmand River in Southern Afghanistan.

A pre-dawn raid was being conducted in a nearby village by another team and we were there to stop people from leaving the party early via the bridge. Due to the timing, we were forced to skip our morning coffee and as the sun rose and things calmed down, our Afghan Army counterparts broke out the necessary bits and began to brew up a pot of tea.

When it was finished, they offered us some and a teammate asked if it was safe to drink and did I want a cup? I replied that if it was made with bottled water or he saw it boiling, then it was safe and yes, I would very much like some morning caffeine. He went back over with the interpreter, who verified that it was indeed made with bottled water and returned with a cup for me.

As I sipped mine, I looked out over the river and watched two men washing a car in the shallows, a man and his son watering their goats by pushing the whole herd out onto a sandbar, and several women washing clothes while 3 children bathed nearby.

I was near the end of my cup, thinking that the tea had a rather earthy aftertaste and as I watched one of the goats lift it’s tail to relieve itself in the slow flowing water, I felt some grit between my teeth. The tea was sweetened with raw sugar, so an undisolved grain or two was to be expected, but I looked at the, now visible, bottom of my cup and upon examination, the grit was unmistakably sand, with a small pebble or two added in.

I waved the interpreter over and explained my concerns. He went back to ask our tea makers about the water quality. He was raised in Southern California and even though English wasn’t his first language, it was the one he slipped into as I heard him exclaim, “What??!! Oh, no!”.

Turns out that there was a bit of misunderstanding/misinterpretation on both sides. The water had come out of a bottle. An empty bottle that had been filled at the river’s edge, near the base of the bridge. It had also not been boiled because time was variable and the thought was that boiling would make it too hot to enjoy right away.

I dug through my bag and enjoyed a nice chaser of Ciprofloxacin and gave some to everybody that had drank the tea. Well, almost everybody. I didn’t get to everyone in time and that unfortunate soul had to suffer, both the wrath of the river and my less than stellar bedside manner, but that’s another story.

The point of my story today is to make an addition to a previous post about understanding the language and managing expectations between you and your healthcare team. The information you and your team share has to be clearly understood by both parties, as do any expectations. As the head of your own healthcare team, (which you should be, by the way), the responsibility falls on you.

Those of us with multiple sclerosis have, medications, therapies, assistive devices, etc, etc, to consider. It behooves you to understand and have a realistic view of the risks and/or benefits of all these.

For example, I have an intrathecal baclofen pump. The decision to have one implanted was not entered into lightly and was not made before weighing every expectation, possible benefit, and risk. In the end, it was this honest and, understood by all parties, “weighing” that made me decide to accept the risks and inconveniences in favor of the possibility of a better quality of life.

That’s an extreme example of both sides understanding the difference between bottled water and water from a bottle, but hopefully the point is made. When it comes to MS, make sure you understand what is being said to you and that what you’re saying is understood.

Not the uniform in 2006, but you get the idea.

The worldwide, special operations community is pretty small and over the years, I’ve been priviledged to work with and learn from, units from all over the world. The job attracts a certain kind of person, so, the personalities are very similar despite, the different equipment, tactics, and languages.

When it comes to language barriers, the right interpreter is worth their weight in gold, because they don’t just directly translate the words, but also the idioms, cultural cues, and even subtle nuances of body language and gestures. As you might imagine, this is vitally important when interacting with someone whose language you don’t speak, but maybe it’s just as important when conversing in a language thought to be common to both parties.

For example, my native language is English but back in Afghanistan in 2006, I learned that when among troops from the UK, we might all be talking in English, but we weren’t speaking the same language.

I didn’t know then, but I know now, that when a British officer slaps his knees, says, “Right!”, and stands up, that means the meeting is over and the annoying young American medic, (“Who the devil invited him to this briefing anyway?”), needs to stop asking questions and “what iffing” everything to death.

Later, his Sergeant Major had a “quiet” word with me outside the briefing room. He was of Scottish descent and though his body language was unmistakable, there were parts of his spoken English that were a little less clear.

When he began, he used many of the same words I had often heard in my own Army (universal, I guess) and I had no doubt that he was very put out with me. Then, in two separate sentences, he called me a “weapon”, so I began to relax, knowing all was well and that he obviously thought I was sharp, keen, and maybe even a bit dangerous.

I later learned that he did not, in fact, think that I was sharp, or keen. He did probably think that I was dangerous, but only to myself if I should ever be left alone and unsupervised…….. with string.

There was something lost in translation.

Remember when I talked about your healthcare team? You know, the one that I think you should be the head of? You might all be talking in English (or your native language), but you are probably not speaking the same language. I’m not suggesting that you go take a course in medical terminology, Greek, or Latin, but I am suggesting that it is very…..very important that you and your healthcare provider(s) understand each other completely.

The burden is on all parties involved, but it’s your health, so maybe it should be even more important that you understand fully and are understood fully. Like I’ve said before, both my neurologists are wonderful and know more about multiple sclerosis than I ever will, but they don’t have MS. As much as I wish it wasn’t, my MS is mine. It is unique to me and I’m (unfortunately) the expert on it. If you are not already and are capable of it, you should be the expert on yours. This includes communicating clearly about medications (including the cost and availability), pain levels, emotional changes, cognitive changes, quality of life issues, mobility problems, sensations and the lack thereof, etc, etc, etc.

Speaking the same language is even more important when communicating with your non-neuro providers. My wheelchair makes my multiple sclerosis “visible”, or at least quickly “discoverable”, but yours may not be. Your family doctor may need to be reminded that your MS related choking/aspiration risk is why you’re concerned about getting a pneumonia vaccine. Your orthopedic doctor may need to be reminded that your weak grip or inability to raise that arm on your more affected side is probably just MS and not because of a torn anything. Your optometrist needs to know that you’re seeing double, or having eye pain most likely because of your MS. Your physical terrorist……..I mean therapist needs to know when you have MS fatigue and that it’s not the same as being tired, weak, or having a bad attitude. (Mine does, I’m just giving him a hard time).

The list of examples goes on and on. Don’t let anything related to your health and well being get lost in translation. Please be clear with your providers and ask for clarity when you need it.

For the record, several of my providers think I’m a “weapon”, but they’re clear about it.