Child translators are traumatized in health care. Mom, you have cancer

“I was 15 when I was in the oncologist’s room with my mother and brother. The doctor said my mother had cancer. It was incurable,” says 23-year-old Dickie Yee from Amsterdam.

“To the right I heard my brother crying, and my mother was among us. My Chinese mother who doesn’t speak Dutch, but she immediately realized it was bad news. She said nothing. She sat quietly. I was shocked. I thought: What can we do? Is there really nothing we can do?” doing it?

Then I had to translate it to my mother. “You have cancer and it cannot be saved.”

That moment changed their lives. Help Yi with the housework and taking care of his mother when home care is not coming. Sometimes employees cancel at the last minute. Because his mother did not speak the language, Ye made arrangements and every week he goes to the OLVG hospital in East Amsterdam. At first, they went by car, until his mother became ill and could no longer drive. Then they went by public transportation.

He felt lonely and isolated. “I thought no one in the world suffered from the same thing.”

At school they took Yi into account and allowed him to miss classes. He replaced VWO with HAVO, so that he had more time to spend with his mother. I loved school. “I could forget all those dates for a while. Then again I felt like a normal fifteen-year-old boy.”

Interpreter fee abolished in 2012

Daphne Tabak, GP in East Amsterdam, speaks to the many patients each day who bring their child for translation. This always happens during school hours. You never realized that interpretation can have such a huge impact on a child. “I actually like the fact that there is an interpreter, so I can better communicate with the patient.”

There are no official figures for the number of child interpreters, but caregivers have seen a clear increase since the abolition of interpreter fees in healthcare in 2012. Minister of Health.

Simon Goosen, epidemiologist and initiator of the campaign Translators back to care please, we can well remember that time of the first Rutte cabinet, from VVD and CDA with the support of PVV. Despite protests from professional organizations and patients, fees for interpreters in health care were abolished.

“The cuts were typical of a government that puts citizens’ self-reliance first,” Gossen says. Since then, caregivers and the institutions themselves have to pay for the interpreter.

“It was always a matter of deliberation when translating for his sick mother, Ye thought. Do you understand this?”Patrick Post’s photo

Her son had to keep asking to see how it actually went

But translation, Gossen says, is too stressful for young people. They sit in conversations where they translate rationally, when in fact it is often emotionally exhausting. The pressure on young people is high. “I sometimes go to the doctor with my parents, but my parents are less dependent on me.” Goosen speaks to many young people who are afraid of making a mistake while translating. They constantly ask themselves: Do I translate well enough?

Yi also felt this fear. He had to explain medical terms he didn’t know in Dutch to his mother in Cantonese. The word radiation, for example, was never learned at home. He came up with a concept in Chinese and then explained it to his mother. It was always back and forth. “Does my mother understand this? Does she understand the choices she can make?”

When the doctor asked how things were going, his mother first told Ye how she was feeling. So Yi can translate it. According to Yee, there were many times when his mother would cover up her pain. She didn’t want to make him feel bad. Then he had to keep asking to see how things actually went. “Only after a few questions did she give an honest answer. It was hard for both of us to be the one I had to translate.”

It is often related to vulnerable families, these children are already having a hard time

Ye went to hospital appointments with his mother every week for two years. In those years, no health care provider asked if she needed an interpreter. Although he would have liked. “Sometimes I fill in things myself while translating. The translator doesn’t do that, he can be thorough and pragmatic.”

Two years after the diagnosis, when Ye was about 17 years old, his mother passed away. After that he got a lot of psychological support. When asked if he ever felt guilty, he should think. “Yes, I had a lot of problems after that. Can I translate better? I have handled it now and I am at peace with it.”

Psychiatrist and writer Forough Karimi is concerned. “By eliminating the interpreter fee, you are legitimizing the children doing this work.” According to Karimi, these families are often vulnerable, may have fled or migrated, and thus are already experiencing untreated trauma. “These kids are really having a hard time. And then that comes in if one of your parents gets sick.”

These young people find it difficult to get along with their peers

“As a government you have a choice, you pay the interpreters now or you pay the damage later,” Karimi says. Children take on the role of the parent and take care of them instead of the other way around. “These are the years when you discover yourself: Who am I and what do I want to become? When they are busy taking care of their parents, they cross a stage in their development in an unnatural way.”

This is harmful, Karimi says. They are young adults advanced in intelligence, but emotionally immature. According to the psychiatrist, the consequences vary greatly. For example, young people may have difficulty standing up for themselves. They took care of one parent for a long time, constantly taking into account the weakness and needs of their parents. “You are angry, but at the same time you also have a needy parent. There is no room for that anger, because care comes first.”

Another consequence, according to Karimi, is that these young people may find it difficult to get along with their peers. They navigate two worlds: at home with all the care assignments and abroad. Karimi says the responsibilities are very different from those of their peers.

The language barrier between patient and health care provider is dangerous

There are not only consequences for the child, but also harm to the quality of care, according to Karimi. Children are used because there is a language barrier: the caregiver and the patient are unable or barely able to communicate with each other. Professional interpreters are trained to translate well and accurately, while children are not. According to Karimi, this is a violation of the Medical Treatment Convention Act (WGBO). This states that the health care provider is obligated to ensure that the patient understands information regarding, for example, the diagnosis, treatment, and consequences.

Julia Tankink, a PhD candidate within the Igalit Project (Erasmus MC), researches language barriers and the quality of birth care, among others. “We know from research that the language barrier between patient and health care provider poses a risk to quality of care and patient safety.” According to Tankink, there is a risk of all kinds of problems. Think, for example, about medication errors, poorly understood treatments, misinterpreted diagnoses and tips and missed appointments.

Tankink points to recent Dutch research among women who died during pregnancy, childbirth, or a year after childbirth. In 41 maternal deaths among women of non-Western immigrant background, 5 cases had patient-caregiver communication problems. This was one of the possible causes of death. “This is just one study, multiple studies have shown links between communication difficulties and acute outcomes.”

Ye now wants to become a doctor herself

According to Tankink, reintroducing the translator’s fee is an important first step, but the problem is not yet resolved. “Ultimately, you want to strive to provide personalized care to everyone, where minority groups are no longer at a disadvantage.” According to Tankink, part of the solution lies in training. During her medical studies she never trained with an interpreter.

Ye realizes this. His childhood dream was to become an architect. After years of experience with his mother in the hospital, he wants to become a doctor himself. He is now in his third year of studying medicine at VU University in Amsterdam.

“During the internship, I sometimes see patients who do not speak the language very well. I immediately say that a translator is needed. It does not always happen, it is often very expensive. When I become a doctor later, I will do it differently.”

Gatul Katowy is an editor at Live Journalism, De Balie’s research editorial team. This article is part of a live press survey of informal caregivers.

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