“Lo que mal empieza, mal acaba” – Eurípides

Para el traductor, la cosa que es la más importante para hacer una traducción buena es saber quien es “el lector público”. Sin esta información, no se puede hacer una traducción precisa. Mira los siguientes ejemplos:

Cuando referir a los continentes del mundo, tal vez tú tendrías sorpresa a saber que, en Latinoamérica, hay 6 continentes: América, Europa, África, Asia, Oceanía y la Antártida. Pero para la gente en regiones donde se hablan inglés, hay 7 continentes: América del Norte, América del Sur, Europa, África, Asia, Oceanía y la Antártida.

En países anglosajones, los gatos tienen nueve vidas. Esta idea se puede averiguar a los días del antiguo Egipto, donde el gato se consideraba un animal sagrado. La deidad Atum-Ra transformaría en gato y él dio vida a otros nueve dioses,  y por eso, los gatos tienen nueve vidas.  Pero, en España, Italia, México y otros países hispanohablantes, los gatos tienen sólo siete vidas. No está entendido exactamente por qué sólo siete, tal vez porque es un número importante en la religión cristiana.

A menudo tenemos que traducir los informes que contienen datos: particularmente fechas importantes. Ten cuidado con la traducción de la fecha, porque en países latinos, es común escribir los datos de la fecha en este orden: día, mes, año. En países anglosajones, se utiliza el orden: mes, día, año.

Si tiene escribir números, ten cuidado con la coma y el punto. En los Estados Unidos, el punto se utiliza para separar las unidades de los decimales, y la coma para separa los millares. Pero en otros países, el opuesto es la verdad:

los EEUU:    52,675.52

otros países: 52.675,52

La mayoría de las frases coloquiales se escrito con el mismo sentido, pero en manera diferente. En los Estados Unidos, cuando algo es caro, va a “cost you an arm and a leg”. Pero en países hispanohablantes, se cuesta un ojo de la cara (it will cost you your face’s eye). Se creído que la frase tiene sus orígenes en el siglo XVI – un tiempo cuando los españoles peleaban con los indios, los Incas, para la región de Perú. Durante una de las muchas batallas, el comandante Diego de Almagro se golpeó por una flecha en el ojo. Cuando él regresó a España, le dijo al Rey Carlos I : “El negocio de defender los intereses de la corona me ha costado un ojo de la cara.”

Y también, en inglés, si piensas que una otra persona trata engañarte con una broma, dices  “Don’t joke with me, stop pulling my leg.” Pero en español es, “no me tome el pelo”, (don’t pull my hair). Se pensaba que la expresión tiene el origen de los días de los romanos y los griegos, cuando una barba era un símbolo de dignidad. Es posible también se originó del acto de rapar la cabeza de los presos y militares. En ese caso, “tomar el pelo” donde no hay pelo se vuelve una burla.

Entonces, te dices a ti mismo, ¿qué importancia tienen frases coloquiales, reyes de España, las comas, los puntos,  los continentes y los egiptos, con la practica de medicina? The answer is that it’s all important. To properly educate your audience, the patient, you have to think clearly about what you want to say and how you’re going to say it depending on where your patient is from. Would someone from another culture who speaks a different language understand you? Would that person have a different way of expressing the same idea? You need to investigate various forms of expression to have any hope of conveying something truly meaningful to your patients.

“We all different, but, in the end, we all fruit.” –Gus Portokalos

References

La Escuela Digital - idioma español – Puntuación http://www.escueladigital.com.uy/espaniol/puntuacion.htm

Origen de las Expresiones. “Tomar el pelo”. http://origenlenguaje.blogspot.com/2011/11/origen-de-la-expresion-tomar-el-pelo.html

Saber es Práctico. “¿Cúantos continentes hay y cúantos son?” http://www.saberespractico.com/estudios/cultura-general/%C2%BFcuantos-continentes-hay-y-cuales-son/

Sabiduría de Escalera. “¿De dónde viene la frase, “Me costó un ojo de la cara”? http://sabiduriadeescalera.com/%C2%BFde-donde-viene-la-frase-me-costo-un-ojo-de-la-cara/

Delicate Arch & La Sal Mountains, Arches Nat'l Park Utah

What sense could you do without?

Doctor: Hola, Me llamo Dra. – ¿Cómo está usted hoy?

Paciente: Mucho gusto. Estoy bien.

D: Venga conmigo al cuarto—(hace señales a la silla)—siéntese acá por favor, empezamos el examen...

(pocos minutos más tarde)

D: Sí, usted necesita lentes para manejar y leer – Le sugiero un tipo de lentes se llama “progresivos”.

P: Pero, mi visión, es peor desde la última visita? ¿qué es mi visión?

D: Bueno, para la distancia, la agudeza visual es 20/60.

P:   ¿Es bueno?

When a patient asks me what his vision is, my knee-jerk response is to answer by providing the Snellen chart number. However, during my years in clinical practice, I have come to find that this number, truthfully, is virtually always meaningless to patients.

Whether my patient is a U.S.-born native English speaker, a Central or South American-born Spanish speaker, whether the patient has had access to higher education or has not, regardless of origin or background, the visual acuity measurement doesn’t appear to hold any value with patients. Again, I am basing this finding on my own personal experience working with patients over the years.

However, there are a few concerns that all patients seem to have in common.  They want to be sure that:

1) Their vision over time is stable

2) Their vision allows them to do the activities that are important to them

& 3) they are not doing anything or, conversely, missing anything that would cause them to lose their vision aka “go blind”.

I have had patients with 20/60 vision come into the office, perfectly content with this level of vision, because they can still, for ex., crochet or watch TV and for them, that is good enough. It doesn’t matter if a cataract is the cause of this visual acuity, and that a surgical procedure can restore perfect vision. These patients are not interested in 20/20, they are satisfied that they can continue doing their daily routine without any problems.

Instability of vision, to many patients, represents a possibility of permanent vision loss or blindness. Here, explaining the cause of the visual change and what to do about it is very important, because some causes are out of their control and others are not. For example, an elderly patient with cataract formation, or a 42-year-old with onset of presbyopia, need to be reassured that visual changes in these instances are a normal part of aging and can be remedied with an eyeglass adjustment. These patients need to be told that the vision will continue to change over time, and this is very normal, and this is why an annual exam after the age of 40 is important.

However, for the patient with glaucomatous optic nerves or the diabetic with wildly uncontrolled blood sugar, he needs to be informed that visual change is a sign of uncontrolled disease, and without a strict treatment plan, vision loss will continue and be permanent.

In 2010 a Lighthouse International survey by Harris Interactive asked Americans what sense (i.e. vision, hearing, smell, touch or taste) they feared losing the most. An overwhelming 82% feared vision loss over all the other senses (8% hearing, 3% smell, 2% touch, 2% taste). Interestingly enough, however, of this 82%, 86% admitted to having an eye disease, diabetes, high blood pressure or high cholesterol and yet do not go for regular eye check-ups with their doctor.

If vision loss is the most feared of all losses, why wouldn’t patients get their eyes checked regularly? Well, this study revealed that the main barrier to regular eye check-ups was that these patients were not having trouble with their vision and therefore, felt they didn’t need to go. Mark G. Ackermann, president and chief operating officer of Lighthouse Guild International stated that with the number of “...aging Baby Boomers and the growing prevalence of such diseases as diabetes and age-related macular degeneration (AMD)...61 million Americans are at high risk for serious vision loss.”

The study concluded that the key to preventing this vision loss is patient education. Informing patients of their eye (and health) status and how this affects or can affect their vision over time is key to providing patients with what they hope to achieve long term:

-stable vision

-usable vision

-maintenance of visual health

Doctor: “Usted tiene una catarata – un cambio en el cristalino natural dentro del ojo. Es una parte normal del envejecimiento, y es por eso no puede ver muy claro, particularmente cuando usted maneja por la noche.”

Paciente: “Qué es lo que tengo que hacer?”

Doctor: “Si yo cambio los lentes, usted ve mejor. Entonces, aquí está la receta por lentes nuevos (le da al paciente una pieza de papel).

Paciente: “Está bien, gracias – (listo al irse)..”

Doctor: “Espere Usted, haga una cita para un reconocimiento de los ojos otra vez en un año. Usted tiene diabetes, y tenemos que examinar la retina al menos una vez cada año.”

Paciente: “Está bien, gracias, con permiso..” (se va)

References

Paunescu, Delia. “Americans Not Properly Protecting Their Vision, Shows New Lighthouse Int’l Survey From Harris Interactive.” http://www.visionmonday.com/article/americans-not-properly-protecting-their-vision-shows-new-lighthouse-intl-survey-from-harris-interactive-23475/

Adirondacks, NY

Todo está bien

Doctor: Veo que usted está aquí por un examen completo de los ojos...se dice en su historia médica que usted ha tenido problemas con ver cosas cercanas...”

Paciente: Sí, cuando trato leer cosas, particularmente letras pequeñas, tengo que poner el papel aquí- lejos de la cara y todavía no lo puedo ver bien.

Doctor: (mira al paciente, observa ojos bien rojos). Otro que la visión,¿ hay otras síntomas quiere decirme antes de empiezo el examen?

Paciente: No, todo está bien- sólo necesito lentes.

Doctor:(continua..) Síntomas como, por ejemplo, ¿picazón de los ojos, o la sensación rasposa, ardor, u enrojecimiento de los ojos?

Paciente: Pues, no.

Doctor: Bueno, entonces, vamos a ver... (empieza el examen)

I have noticed that when some of my male Latino patients come into the office for an eye exam , they are not always willing to fully elaborate on all of their symptoms. Many times, they come because they have to:  they are of presbyopic age and need readers, or they need their DMV form filled out. But they will sit in my exam chair with eyes that reveal more issues than a mild refractive error . Eyes that I can tell are uncomfortable, irritated, dry, burning or scratchy. Their eyes may be red, or teary. Their eyelashes have collarettes or sheathing at the base. They have inflamed pterygia. Yet when I push them on symptoms, they act as if nothing is wrong:

Doctor: Entiendo que necesite lentes para leer, pero la agudeza visual hoy es 20/60 en cada ojo. ¿No tiene problemas cuando maneja, particularmente por la noche?

Paciente: ¡No! Veo la distancia perfectamente bien, y puedo leer la mayoría de las cosas sin lentes. Sólo de vez en cuando...es muy raro...que necesito algo para leer.

At some point I began to wonder, is this behavior just a reflection of this particular individual?  Or, is this what is referred to as the Latin machismo?

Allow me to preface the remainder of this article with the following:  Note that I say the word “some” male Latino patients, I didn’t say “all”. I had an anatomy professor in medical school who was well-known around campus for this statement: “The ‘all’ word creates a situation.” What he meant by that is that neither he, nor I nor anyone can make sweeping generalizations about people. Even if it seems a majority falls into a category, not everyone does. Hence, I have noticed some of my male Latino patients exhibiting this behavior, but not all.

Blogger Ashley Bennink, author of Ayuda,Doctor-- a blog about Spanish language in medicine-- explains the Mexican definition of machismo in her entry ‘Teaching Culture – Machismo’. She talks about how at its most positive, machismo describes an honorable and respectable man who is loyal and polite, trustworthy, and a strong leader and caretaker of family. At its most negative, machismo is, in her words, “exaggerated manliness”, a great need to “..differentiate himself from what is feminine and define himself as a man.” This results in various behaviors, namely, the need not to show weakness, traditionally viewed as a feminine quality i.e. ‘the weaker sex’(although any modern-day woman would argue most vigorously that this can’t be farther from the truth!).  As a result of these ingrained beliefs, Ms. Bennink continues in her entry, “The Effect of Machismo on Health & Well-Being” that such a man would avoid routine health care check-ups, or refuse to submit to the authority of a doctor or, in general, would find the experience of seeking help for some malady to be emasculating.

I think about these issues when I come across a patient as described in my conversation above. Perhaps he does fall into this category, and does practice machismo. Maybe he’s just stubborn. Maybe he’s as my grandfather was, someone who became so nervous about health-related issues, he’d bury his head in the sand. Regardless of where this behavior comes from, I handle it the same way with all my patients. I tell them what I see on exam, and the symptoms that these findings often cause, and what to do to treat it:

Doctor: (después del examen). Bueno, primero, quiero decirle que tiene ojos muy sanos, no tiene signos de diabetes y los nervios no son sospechosos por glaucoma. Sin embargo, estoy de acuerdo que usted necesite lentes para manejar – especialmente por la noche – y lentes para leer. Por eso, escribo una receta ahora para usted.

Paciente: Está bien.

Doctor: También, veo que tiene párpados hinchados y inflamados, y eso significa algo se llama “blefaritis”. Con blefaritis, es posible tener síntomas como: ojos rojos, picazón, ardor, lagrimeo reflexiva o la sensación del polvo dentro del ojo. A veces, no hay síntomas. Pero cuando una persona tiene signos de blefaritis en el examen, es importante tratarlo, porque lo que puede suceder si no la se trata es: el orzuelo, sequedad de los ojos u infecciones como celulitis.

Paciente: No tengo los síntomas que dice.

Doctor: Pero tiene blefaritis. En mi opinión, debe empezar un régimen de limpieza de los párpados diariamente. Aquí ( le da al paciente un atomizador de líquido)...utilice este limpiador por la mañana y por la noche cuando se lava la cara. Rocíe el líquido en una almohadilla de algodón y frote los párpados y las pestañas bien fuerte. (le demuestra la acción al paciente). También, le doy muestras de gotas artificiales a poner dos a tres veces al día dentro de los ojos.

Paciente: Gracias.(se pone de pie, listo para irse)

Doctor: Aquí, lleve este papel a la frente – las gotas y el atomizador le esperan ahí.

And then, of course I always give an appointment in a few weeks to check progress. It’s my opinion that  patients should and deserve to know all the findings of their exams as well as possible treatments, whether or not their cultural beliefs dictate otherwise. People are people, and in a manner of speaking, informing and educating someone plants a seed of thought in the mind. Whether or not that thought takes root is up to the individual, but I’ll continue to sew and to tend, as is every doctor’s job to do.

...

References

Bennink, Ashley. “Teaching Culture: the Effect of Machismo on Health and Well-Being”. https://ayudadoctor.wordpress.com/2013/08/01/teaching-culture-the-effect-of-machismo-on-health-and-well-being/

Bennink, Ashley. “Teaching Culture: Machismo Part 2”.   https://ayudadoctor.wordpress.com/2013/07/24/teaching-culture-machismo-part-2/

 

Ponderosa Pine, lone survivor in the desert, Utah

  

La distrofia de Fuchs

La serie <Cómo explicar conceptos complicados de oftalmología en español> les presenta:

¿Qué es la distrofia de Fuchs?- What is Fuch’s Dystrophy?

Aviso Legal:  La información que está incluido aquí representa información general de los ojos -- no está aquí para diagnosticar o tratar una condición. Si usted ve algunos cambios en la visión o en los ojos en general, debe visitar su oftalmólogo inmediatamente por un examen completo. La información aquí no se debe utilizar en lugar de un reconocimiento médico.

Legal Notice: The information included here represents general information of the eyes – it is not here to diagnose or treat a condition.  If you see changes in your vision or in the eyes in general, you should visit your ophthalmologist immediately for a complete exam. The information here should not be used in place of a medical examination.

¿Qué es la distrofia de Fuchs?

La distrofia de Fuchs es un trastorno de las células de la capa interna de la córnea, se llaman células endoteliales. Para entender esta distrofia, tiene que saber como funcionan las células normales del endotelio. Ellas funcionan para prevenir el fluido del ojo de acumularse en la córnea. Si la córnea se hincha con fluido, el ojo pierde la habilidad para ver claro. Este es el proceso que sucede con distrofia de Fuchs.

What is Fuch’s dystrophy?

Fuch’s dystrophy is a disorder of the cells of the innermost layer of the cornea, called endothelial cells. In order to understand this dystrophy, you have to know how the normal endothelial cells function. They work to prevent fluid inside the eye from accumulating in the cornea.  If the cornea swells with fluid, the eye loses the ability to see clearly. This is the process that occurs with Fuch’s dystrophy.

¿Qué causa la distrofia de Fuchs?

La distrofia de Fuchs se puede heredar. Si un pariente tiene el trastorno, el hijo tiene  un chance de 50% tener distrofia de Fuchs. No obstante, es posible tener la distrofia sin una historia familial.

What causes Fuch’s dystrophy?

Fuch’s dystrophy can be hereditary.  If one parent has the disorder, the child has a 50% chance of getting Fuch’s dystrophy.  However, it is possible to inherit the disease without a family history.

¿Qué son los síntomas de la distrofia de Fuchs?

En el principio, no hay síntomas de Fuchs. Se hincha la córnea, aunque la hinchazón resuelve gradualmente durante el transcurso del día, con evaporación del fluido de la superficie de la córnea. Sin embargo, medida que se desarrolla la enfermedad—generalmente después de la edad de 50 años—la  hinchazón no resuelve y la persona tiene visión nublada, borrosa y a menudo es sensible a la luz.  En tiempo, debido de este proceso, la persona pierde la visión.

What are the symptoms of Fuch’s dystrophy?

In the beginning, there aren’t any Fuchs symptoms.  The cornea swells, but the swelling resolves gradually during the course of the day, with evaporation from the corneal surface.  However, as the disease progresses, generally after 50 years of age, the swelling does not resolve and the person has cloudy, blurry vision and oftentimes is light sensitive.  In time, as a result of this process, the person loses vision.  

¿Cuáles son los tratamientos para la distrofia de Fuchs?

En el principio, para la hinchazón por la mañana, se puede utilizar un ventilador o secador de cabello ligeramente cerca de los ojos para evaporar el fluido. También, hay gotas y cremas que se puede comprar sin receta de la farmacia para disminuir el nivel de fluido de la córnea. A veces, no es posible que estos tratamientos eliminan los síntomas completamente. En ese caso, hay una cirugía que un especialista de la córnea puede realizar para sacar la capa interior de la córnea y reemplazar el tejido enfermo con el tejido donante sano.

What are the treatments for Fuch’s dystrophy?

Initially, for the swelling in the morning, one can use a fan or hairdryer lightly near the eyes to help evaporate the fluid.  Also, there are drops and ointments that one can buy over-the-counter at the pharmacy to decrease the level of fluid build-up in the cornea. Sometimes, it is not possible for these treatments to eliminate all the symptoms completely.  In this case, there is a surgery that a corneal specialist can perform to remove the interior layer of the cornea and replace the diseased tissue with healthy donor tissue.

Para más información de membrana retiniana y otras enfermedades de los ojos, visite usted el sitio en la red: www.ojossanos.org . Es información médica patrocinado por la Academia Americana de Oftalmología (AAO).

For more information about Fuch’s dystrophy and other eye diseases, visit this website: www.ojossanos.org (Spanish) or www.geteyesmart.org (English).  This information is provided by the American Academy of Ophthalmology (AAO).

 

Bryce Canyon, Utah, storm brewing

Membrana Epiretiniana

Beyond the everyday common diagnoses of dry eye, viral conjunctivitis, stye and cataract, there are certain ophthalmologic conditions that can be difficult to explain in plain language to a patient, regardless of the formal language in which the doctor and patient communicate. During the March through June period of 2014, my blog entries focused on some of these common, often-diagnosed eye problems. With this new series I am starting: “Cómo explicar conceptos complicados de oftalmología en español” I hope to create a series within a series, so to speak, this time around addressing less common diagnoses, many of which fall under the umbrella of subspecialty, and require more in-depth explanations and efforts at breaking down the information so a lay person can comprehend.  My goal is to help the non-native Spanish speaking doctor easily tackle the deconstruction of these often complicated medical concepts in English and fluidly relay this information in Spanish. My first subject: the concept of Epiretinal Membrane – Membrana Epiretiniana Macular.

Aviso Legal:  La información que está incluido aquí representa información general de los ojos -- no está aquí para diagnosticar o tratar una condición. Si Usted ve algunos cambios en la visión o en los ojos en general, debe visitar su oftalmólogo inmediatamente por un examen completo. La información aquí no se debe utilizar en lugar de un reconocimiento médico.

Legal Notice: The information included here represents general information of the eyes – it is not here to diagnose or treat a condition.  If you see changes in your vision or in the eyes in general, you should visit your ophthalmologist immediately for a complete exam. The information here should not be used in place of a medical examination.

La serie <Cómo explicar conceptos complicados de oftalmología en español> les presenta:

¿Qué es una “Membrana Epiretiniana” (Epiretinal Membrane)? 

¿Qué es una membrana epiretiniana macular?

Para comprender qué es una membrana epiretiniana, usted tiene que comprender las estructuras del ojo. Dentro del ojo, hay una capa fina que cubre el interior entero del ojo, se llama: la retina. Este tejido funciona para permitirle al ver. Imágenes se enfocan en la retina central: la macula, y esta información se envía al cerebro. Si la retina no funciona, por una razón u otra, usted no puede ver.

En algunas personas, las células debajo del tejido de la retina migran sobre la retina y forman una membrana en la superficie de la retina. Esta membrana provoca una arruga en la macula, y, con eso, hay distorsión y pérdida de la visión.

What is an epiretinal membrane?

To understand what an epiretinal membrane is, you have to understand the structures of the eye.  Inside the eye, there is a thin layer that covers the entire inner part of the eye, called: the retina.  This tissue works to allow you to see.  Images focus on the central retina, the macula, and this information is sent to the brain.  If the retina is not functioning, for one reason or another, then you cannot see.

In some people, the cells underneath the retinal layer migrate above the retina and form a membrane on the most superficial part of the retina.  This membrane causes a wrinkle in the macula, and as a result, there is distortion and loss of vision.

¿Qué causa la membrana epiretiniana?

Esta membrana se puede formar de estados varios del ojo: cuando hay inflamación, por ejemplo, después de algún tipo de cirugía del ojo, o un episodio de uveítis. También, después de la separación del vítreo de la retina (un proceso normal y esperado con envejecimiento) se puede formar la membrana. Si hay un hueco o abierto de una parte de la retina, hay la posibilidad de membrana. Y si hay una membrana en un ojo, hay riesgo de 20% para desarrollar dentro del otro ojo.

What causes epiretinal membrane?

This membrane can form as a result of various conditions of the eye: when there is inflammation, for example, after some type of eye surgery, or an episode of uveitis.  Also, after the vitreous separates from the retina (a normal process expected with age) a membrane can form.  If there is a hole or opening in a part of the retina, there exists the possibility of membrane formation.  And if there is a membrane in one eye, there is a 20% risk of a membrane developing in the other eye.

¿Qué son los síntomas?

Cuando la membrana crece sobre la retina central, se afecta la visión central. Si la membrana se contrae, suceden distorsiones o visión ondulada. En tiempo, es más difícil hacer actividades tal como leer y escribir.

What are the symptoms?

When the membrane grows on the central retina, it affects the central vision.  If the membrane contracts, distortions or wavy vision develop.  In time, it becomes more difficult to do activities such as reading and writing.

¿Cuál es el tratamiento – hay un tratamiento?

Si tiene un membrana epiretiniana, es importante consultar con un especialista de la retina. Él o ella puede determinar si la condición exige una cirugía para sacar la membrana y mejorar la visión. Afortunadamente, la mayoría de casos de membrana retiniana se estabiliza con tiempo y no necesitan cirugía, sólo observación. Su médico le puede dar una rejilla de ‘Amsler’ para vigilar los cambios en la visión.

What is the treatment – is there a treatment?

If you have an epiretinal membrane, it is important to consult with a retinal specialist.  He or she can determine if the condition requires a surgery to remove the membrane and improve the vision.  Fortunately, the majority of cases of epiretinal membrane stabilize in time and don’t require surgery, only observation. Your doctor may give you an Amsler grid to watch for changes in your vision.

¿Hay riesgos con esta cirugía?

Todas cirugías tienen beneficios y riesgos. Con el procedimiento para sacar la membrana epiretiniana, hay riesgo de formar catarata, desprendimiento de la retina, u infección del ojo—cualquiera de estas cosas puede resultar en ceguera.

Are there risks with this surgery?

All surgeries have benefits and risks.  With the procedure to remove an epiretinal membrane, there is a risk of cataract formation, retinal detachment or eye infection—any one of these conditions can result in blindness.

Para más información de membrana retiniana y otras enfermedades de los ojos, visite usted el sitio en la red: www.ojossanos.org . Es información médica patrocinado por la Academia Americana de Oftalmología (AAO). 

Ladybug invasion, van Cortlandt Manor

Dios le bendiga

Doctor: “Está bien. Siéntese atrás. Primero, quiero decirle que tenga ojos muy sanos.”

Paciente: “¡Ajj, Gracias a Dios!”

Doctor: “No hay signos de diabetes, y la presión del ojo es estable. Ahora, es importante que continue usted controlar el azúcar, para mantener una retina sana.”

Paciente: “O, sí, gracias a Dios por sus bendiciones, todo esté bien.”

Doctor: “Aquí, lleve este papel a la frente, hacemos una cita  para otro examen en un año.”

Paciente: “Gracias, doctor, pase buen día, Dios le bendiga.”

This conversation at the end of  a visit with my Spanish-speaking patients is quite typical. In this particular case, I am telling a diabetic patient that his eye exam is normal. He shows no signs of diabetic changes in his eyes. The patient expresses happiness and relief by thanking God for this good result. Though I reiterate during the exam that it’s his good blood sugar control that has kept his retina healthy, the patient continues to speak as if it’s not good blood sugar control that equals a healthy retina, but that garnering God’s many blessings equals a healthy retina.

There are many articles that chronicle the topic of “fatalismo”,  a particular concept of Latino culture where a person’s fate determines his outcome in any given situation. In the piece, “Cultural Values of Latino Patients and Families”, author Marcia Carteret, M. Ed. discusses how Latinos “... have a strong belief that uncertainty is inherent in life and each day is taken as it comes.” The term “fatalism” refers to the belief that because we are all assigned a pre-determined fate, there is little that can be done to alter the natural course of things.

When applying the idea of fatalismo to health care, Latino patients are less likely to seek out preventative care or continue a particular treatment. They may not follow up on testing or treatments or even want to know that they have a particular diagnosis like cancer because they believe the disease to be a punishment by God. In the case of my patient above, his good eye health was the direct result of God’s blessings. For others, conversely, diabetic retinopathy is the end result of someone’s fate, not poor blood sugar control.

For people who believe their fate is out of their hands, there is less emphasis on trying to control things in their environment. Time, for example, is flexible in the minds of many Latino immigrants. Being punctual for medical appointments is not necessarily valued and tardiness, in fact, is the societal norm. The author goes on to remark how in US American culture, there is a sense of discomfort that goes along with uncertainty in life. As a result, US born non-Latinos seek control of the natural chaos in life by tightly managing time: setting appointments, keeping them, multi-tasking. Non-Latinos focus on the individual when it comes to decision making, thereby putting “...little faith in fate or karma.”

Through my own experiences with my patients, I was about to conclude that only foreign-born or immigrant Latinos surrender to fatalismo, but an article by Amanda Machado says otherwise. In her piece, “Why Many Latinos Dread Going to the Doctor”, Ms. Machado writes how generations of Latinos in the United States still struggle with relying on Western medicine for their health care needs. They prefer turning to natural remedies used by family members to address any health ailment. She states that, though many of these plant and herbal remedies can be ineffective or even dangerous, Latinos still feel more at ease using them because “..“There’s greater trust for what has worked for your family or what you’ve heard has worked for others in your community.”

I see a large community of Latino patients in my practice. I have to admit that when I first started working there and noted how many of the patients came 15, 20 even 30 minutes late, -and regularly so- I felt frustrated because  1) I took it as a sign of disrespect for me, my time, and my other patients’ time and 2) I had to struggle to rush and squeeze in their exams so I didn’t make the other patients who came on time wait to be seen. However, after reading this information on fatalismo, and understanding the meaning behind it, I now see that the lateness of these patients is not a sign of disrespect. It’s part of a natural belief about life, that there are many things outside our control and that perhaps there’s no point in stressing about every minute, second or microsecond.

This laxity about time does have its benefits. I’ve rarely if ever had a Latino patient complain about waiting to see me. I’ve never had them start screaming at me in the exam room like some of my non-Latino patients, about how time is money and time is everything and I’ve wasted theirs. If time can’t be controlled and fate is out of our hands, then I can breath a little easier. I can give my patients the attention they deserve without rushing. And I can do my doctorly duty and explain a disease and how to prevent it. But if my patient chooses to believe that God and not lifestyle guides his health status, who am I to disagree? I happen to believe in something I’ll call ‘fatalismo plus’: that some of our life is scripted and some of it we write on our own. If we take the extra time to listen to, respect and help one another, then indeed we’ll find ourselves in a world of many blessings.

References

Carteret, Marcia, M. Ed. “Cultural Values of Latino Patients and Families.”http://www.dimensionsofculture.com/2011/03/cultural-values-of-latino-patients-and-families/

Machado, Amanda. “Why Many Latinos Dread Going to the Doctor.” http://www.theatlantic.com/health/archive/2014/05/why-many-latinos-dread-going-to-the-doctor/361547/

Adirondack Balloon Festival, Queensbury, NY

El acrónimo

I am in the process of translating a consent form for the glaucoma laser procedures Argon laser trabeculoplasty and selective laser trabeculoplasty.  When we speak of these laser surgeries in English, we often use their acronyms, ALT and SLT, simply for ease of use and flow of the text. We usually introduce the acronym along with their corresponding words when they are first mentioned in the text. For example:

“Indications. The Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) surgeries are used for patients with open angle glaucoma. The laser is utilized to treat the drainage system of the eye.”

But what happens when this is translated for the Spanish reader?

“Indicaciones.  La trabeculoplastía con láser de árgon y trabeculoplastía selectiva con láser son procedimientos los que se usan para los pacientes con el glaucoma de ángulo abierto. El radioláser se utiliza para tratar el sistema de drenaje del ojo.”

Do I shorten “trabeculoplastía con láser de árgon” to TLA, which is the acronym corresponding to the Spanish words, or do I use the familiar ALT which is how this procedure is known by a U.S. audience?

In my own research of acronym translation, I have seen this situation handled differently. On the website TrustedTranslations.com an article posted by Scott J addresses these different approaches.

First, you can always write the acronym as it corresponds to the text in your target language, but then add in parenthesis something to the effect of “for its acronym in language of origin”.  I did this with a recent translation I did for an MTA (Metropolitan Transportation Authority) in Spanish:

 MTA – Metropolitan Transportation Authority ( la Autoridad Metropolitana de Transporte – en adelante MTA en inglés) A su servicio

Second, world-renowned organizations will have their own translation in each language:

            NATO=OTAN

Third, acronyms related to health and medicine usually have their own default translation. As seen above:

trabeculoplastía selectiva con láser (TSL – en adelante SLT en inglés)

Síndrome de Inmunodeficiencia Adquirida (SIDA – en adelante AIDS en inglés)

Lastly, the article emphasizes that it is always important to do some investigations for a potential acronym in the target language. Especially for job titles, country names, political parties, “some acronyms have a standardized translation and others do not.”

But going back to my ALT/SLT translation from English to Spanish, another important fact to consider is, who is your reading public? For whom are you writing this? In the case of this particular consent form, the reading public includes a small immigrant population of Spanish-speakers living in an English-predominant area. The majority of these people did not have access to medical care in their home country, and if they did it was limited. Therefore for these people, I think the best approach is to write the name of the procedure in Spanish, add the Spanish acronym, but clarify what the English acronym would be, too, so they could recognize it should they come across print ads or informational brochures written in English.

Remembering the audience- knowing who your reader is- is almost as important as knowing the translation itself.

References

Trusted Translations: Translating Acronyms and Abbreviations  http://translation-blog.trustedtranslations.com/translating-acronyms-and-abbreviations-2012-06-07.html\

Purple Heron, Kopački Rit, Slavonia, HR

Subjunctivitis - Seeing is Believing

In my ever-constant pursuit of Spanish fluency, I have come to notice like any struggling student the advantages and the pit-falls of the written versus the spoken word. There are certain things you can easily “get away with” saying to someone in a grammatically incorrect way,  that unfortunately stand out as glaringly wrong in written form. For example, when I’m speaking with my patients in Spanish, sometimes I’ll say something that, the split second I say it I know I should probably be using a verb conjugated in the subjunctive. But, I’ll get unsure of myself and nervous about changing a “puedo” to a “pueda” or a “va” to a “vaya” and instead I’ll just gloss over it, using the present indicative, and hoping the listener didn’t catch my mistake. And, it’s very possible they didn’t catch my mistake, if I say it fast enough or with a lilt of an accent. But when I’m writing something in Spanish, well, I can’t evade grammatical errors so easily. It’s right there, smack in front of the reader. In black and white. Yikes!

Throughout my med school and residency years, and now especially while in private practice, I have always done mini-translations from English to Spanish. These included simple explanations of eye diseases, instructions to patients on how to use their eye drops and consent forms for various procedures. While I feel I’ve done fairly well with these translations, I’ve never had any formal guidance as to whether or not I’m actually doing them correctly. I want my grammar to be correct. I want the end-product to look professional. So, I finally decided to enroll in a translation course to gauge just what I’ve been doing, and how to improve upon it.

The truth is, when something is written in a sloppy way, with many grammar and punctuation errors, it doesn’t give the reader much confidence in what he is reading. Now imagine a doctor’s office and a consent form for cataract surgery. If poorly written, with incorrect word choices and mistakes, it really will make the patient doubt the skills of his surgeon.  After all, if the surgeon doesn’t take the time to make sure his descriptions of the surgery are pristine, maybe he doesn’t take the time to focus on all the fine details of his surgery, as well? It may seem like I’m reaching too far with this analogy, but truly, the manner in which we present ourselves dictates our attention to detail, care, skill (or complete lack thereof).

My first item of business is to try and tackle the idea of the subjunctive. I’ve been looking for some online resources and found an interesting article from the language blog FluentU.  Nick, author of “How to Survive the Spanish Subjunctive”, describes subjunctive as, “... a mood. It is not a tense because it has nothing to do with time, rather it conveys a sense of uncertainty or conditionality.”He continues on to give word “triggers” that serve as little warning signs that the subjunctive conjugation should follow. For example:

Yo quiero que tú vayas al cine conmigo.   *     I want you to go to the movies with me.

Ella espera que él tenga un buen viaje.   *    She hopes/wishes he has a good trip.

Dudo que ella esté aquí.  *   I doubt that she is here.

No es cierto que hagamos el trabajo hoy.  *   It isn’t certain that we’re doing the job today.

Essentially, any sentence that starts off with words indicating uncertainty or a desire propels the rest of the sentence into the subjunctive. In Spanish, many times these phrases will use “que” or  “that” as in,

I hope that she is coming to the party.  *   Espero que ella venga a la fiesta.

The confusing part is, we don’t always use the word ‘that’ in English, but it is still subjunctive nevertheless:

I hope she’s coming to the party.    -- No ‘that’ in this sentence, but still a subjunctive clause.

The blog article concludes by saying that even if you neglect to use subjunctive in your speech, chances are “...Spanish speakers will understand what you’re trying to say.” This is true. If you make mistakes when conversing, you probably can get away with it.

But as for my Spanish languages goals, I want to do more than simply gloss over my mistakes. I want to speak and write in a polished way.  I want my patients to have confidence in what they are hearing and reading. I am hoping that this translation course helps me to reach these goals.  I suppose then the only ‘cure’ for my subjunctivitis is continued work and perseverance--a willingness to try and learn from my mistakes.

References

FluentU “How to Survive the Spanish Subjunctive”  www.fluentu.com/spanish/blog/spanish-subjunctive

Mountain Goats, Zion National Park, Utah