'Ethiopians Like Injections': Stereotypes, Language Barriers and a Failure of Care

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Gabra* was forty-something years old and dying of cervical cancer. I was accompanying one of the doctors from my medical school's faculty – in southern Israel - to a home hospice visit, and the doctor was explaining that until a few weeks ago, Gabra had not even known that she had cancer. It was too late to treat her now and all the doctor could do was try to manage her pain.

Gabra's 18-year-old son, home from the army, was our translator. Again and again he looked at the doctor and shyly shook his head, unable or unwilling to translate questions, especially when they related to personal things such as bathroom habits. The doctor explained to me that in Western countries it is rare to die of cervical cancer, because it is caught early through regular Pap smears, and treated with outpatient surgery. In Gabra's case, she had been diagnosed with cancer years before, but due to the language barrier, had not understood the diagnosis until a few weeks ago, when her cancer had already spread throughout her body.

This story leapt to mind when I read the recent report that Israeli doctors had been injecting Ethiopian women with Depo-Provera birth control shots, in some cases without clearly informing these women about the ramifications and possible side-effects of this form of contraception. There are very few doctors in Israel that speak Amharic (or other Ethiopian languages) and if you cannot communicate with your patients, the care you are giving them is substandard, and can easily jeopardize their autonomy and their health.

This is not just a problem for Ethiopian Jews. To be sick in a country where one is not a native speaker of the majority language is always difficult. I was hospitalized twice myself in my first several months in Israel, and even with an intermediate grasp of Hebrew, even with the majority of the doctors and nurses having some ability to speak English, the experience was bewildering.

I’ve seen Arab patients struggle in the Israeli system. It affects women and children the most - the majority of the men speak Hebrew, as do many of the younger women, but at least at Soroka hospital in Be'er Sheva, where I’m studying, many wards have at least a few doctors or nurses who speak Arabic fluently. In the pediatric wards, many of the Jewish doctors have made an effort to learn some Arabic (the Arab doctors are generally already fluent in Hebrew). But I have yet to encounter a doctor in Israel who speaks Amharic, or any other Ethiopian language.

In the absence of communication, stereotypes and assumptions take the place of understanding. Multiple doctors have told us students to remember that Ethiopian patients don't believe that they have been treated unless they are given an injection, and to remember to treat them with injections instead of pills whenever possible. These words were well-intentioned, but take on a chilling tone in light of the recent news. Regardless of intentions, good or bad, you cannot know what your patient wants or needs unless you are able to ask them. There is an urgent need to train and hire medical interpreters within the hospitals and the kupat cholim (health maintenance organization) clinics. It’s needed in Arabic, and it is desperately needed in Amharic.

Imagine how things might have gone differently for women newly arrived from Ethiopia if there were professional translators available, empowering them to fully understand what was going on, to ask questions, and to demand answers. Imagine how things might have gone differently for Gabra if there had been a professional translator present when she was told that she had cancer.

It is not uncommon in the United States for hospitals and clinics that cannot provide interpreters to subscribe to a language hotline. The doctor and the patient each pick up a phone, and they dial the hotline, and request a conference call with the appropriate interpreter. I've used this system in the past to speak with a patient who only spoke Mandarin Chinese, and while far from perfect, the result was transformative. A service like this should be made available at the smaller clinics that cannot afford to keep a translator on staff.

Some might argue that the public health system in Israel cannot afford new expenses right now. I would argue that it is the cost of doing nothing that we cannot afford. It’s too late to help Gabra with anything more than managing her pain for her last few months. It’s too late for families who were never able to have the children they had hoped for. And it is past time for the Israeli medical system to make available professional translation services for their patients.

*Names have been changed to respect patients' privacy.

Sarah Meyers is an American in her third year of medical school at Ben Gurion University of the Negev's Medical School for International Health.


A demonstration in Netanya about discrimination against the Ethiopian community, last year.Credit: Moti Milrod

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