How to interpret life and death news

With more than 100 languages spoken in the UAE, it is rarely easy to explain complicated, and often disturbing, health issues to patients.

Badi Kanaan, left, translates for Dr Irena Khostanteen, the head of rheumatology.

ABU DHABI // In the busy emergency department at Sheikh Khalifa Medical City it is not only the doctors who feel the burden of delivering the bad news and the relief of announcing the good. Behind the scenes dozens of translators act on behalf of the medical staff and patients, relaying information in what are often life or death situations.

With more than 100 languages spoken in the UAE, it is essential that nothing is lost in translation. Ibrahim Khatan, 58, has been a unit clerk and translator at Sheikh Khalifa Medical City for almost a decade. Originally from Yemen, Mr Khatan said he was well equipped, emotionally, to handle the traumatic situations he encountered almost daily. "Working in the emergency room you see a lot, but also learn a lot," he said. "You see life or death situations every day. I feel I am more related to life just by seeing all these people with different sorts of illnesses; it makes me very thankful for what I have."

As the main trauma centre in the capital, the hospital's emergency rooms receive hundreds of people every day. They arrive with ailments ranging from burns and cardiac arrests to serious injuries sustained in car crashes. Mr Khatan is responsible for translating between Arabic-speaking patients and families, and the doctors and nurses. "Especially in bad situations you have to control your emotions," he said. "That is the worst part. You also have to be culturally aware; if there is bad news you have to deliver it smoothly."

Cancer is still something of a taboo in much of the Arab world, and although there is an Arabic word for cancer, it needs to be used with care. "You don't just blurt it out; there are ways of doing it because the religious basis is very deep," Mr Khatan said. "You have to be careful and break news slowly." For the father of four who lives with his wife in Abu Dhabi, the hardest part of his job is handling the death of young people. He tries not to carry the emotional strain home with him.

"I see life and death everyday, so I have to leave it at work," he said. "I choose instead to feel thankful and really realise how fortunate I am." All of the hospital's translators undergo training, especially with medical terms. Languages that can be translated into English at the hospital include Chinese, Tagalog, Malayalam, Portuguese, Cantonese, Urdu and Punjabi. But linguistic skill and extensive training alone do not necessarily make good hospital translators.

"There are specific skills I look for," said Filsan Oglay, supervisor of the unit clerks and translators in the outpatient services. "There are certain people that have the degree but don't have the right personality. You need to be compassionate but not too compassionate so you can't distance yourself. A translator needs to act on behalf of the patient and the doctor. They need to get things exactly right. I can tell right away if someone is going to say too much or too little. The patient and the doctor need to have confidence in the person."

Mrs Oglay, a mother of two who is originally from Somalia and has lived in Yemen, the UAE and the US, is responsible for 44 translators. They work in various services including oncology, neurology, diabetes, orthopaedics, surgery and paediatrics. "The advice I always give the translators is to treat the patient as they would like to be treated," she said. "The bad news is the difficult thing. Some people have a hard time if they have to tell a patient they have a life-threatening illness. They try to get around it, but they have to get the message across one way or another."

In other medical fields such as social work, professionals are given counselling sessions to help them cope. This is not the case for translators, Mrs Oglay said, but being able to separate oneself from the job is one of the most important attributes. "It really is a huge job to be a translator," she said. "To go in there and have the ability to be there for the patient and yet be professional enough to deliver the right message in the right way is hard. They need to make sure they give all the right and relevant information from the patient to the doctor, and vice versa."

Badi Kanaan, 38, has been a translator in outpatient clinics since 2000, working now as an Arabic-English translator in the dermatology clinic. Since starting, he has fine-tuned his skills and can cope with almost anything that comes his way. "The patient and doctor both have expectations, and you really have to know how to handle them," he said. "There are different personalities involved, but I just focus on delivering a word-for-word translation. I like it because I feel like I am helping people; I am doing something good."

The translators at Medical City are not only juggling different languages but also managing different cultures. "The Arabic language itself is longer, so doctors might ask if I have translated everything because the English took a shorter time," Mr Kanaan said. "Family is very important in Arabic culture, so sometimes you have a room with five people and everybody is talking and asking questions. It is harder to be the middleman."

Mr Kanaan, who lives in Abu Dhabi with his wife and two young children, is originally from Lebanon but grew up in the UAE. He has a strong grasp of the different Arabic dialects but mainly translates between English and Arabic. "If it is something difficult and even though the patient can speak English, they prefer to talk in Arabic," he said. "It is easier for them." All the hospital's translators are given manuals and keep up to date with medical terms. They are not provided with official counselling, but all have a strong support network in the hospital.

"I would say they are the voice of the doctor and the patient," Mrs Oglay said. "And with that comes all the baggage that goes with being both of these. It is not an easy job, but it is very rewarding." [e-mail]