Dipshikha Dahal, the refugee coordinator at Family HealthCare center, enters the birth date, Social Security number and address of the refugee sitting across from the desk from her, an Iraqi refugee dressed in a black hijab and a long dress that covers everything but her face. She came to Fargo alone. She quietly states the answers Dipshikha asks. A medical interpreter sits next to the refugee, looking directly at her while relaying Dipshikha’s questions. The interpreter is also from Iraq, but her hijab and dress look as if they were splattered with a multicolored paintbrush.
Every day, at Family Health Care and other medical centers in the local Fargo-Moorhead area, medical interpreters are building bridges of communication for refugees who are trying to create lives separate from the horrors they experienced at home. Medical interpreters like the one helping the Iraqi woman and Jasmine Gehrig, FHC’s medical interpreters manager, are creating more than communication. Gehrig is building a community that she can be proud of by helping refugees find the life they hope to live through her interpreting and the kind acts she does outside of her job description
When resettling in the Fargo-Moorhead area, most refugees’ first stop is the Family Health Care on New American Day, a refugee clinic set up two to three times a month. Here, they receive vaccinations and medical appointments for any personal health concerns. In able to understand what’s happening to them in this new culture, New Americans need someone to interpret their appointments and paperwork. That is where the medical interpreter comes in.
Dipshikha works with all New Americans who come in for the New American clinic. Refugees usually begin by registering with Dipshikha before their first health screening in the U.S. The interpreters help relay information as refugees go through different stages in the medical clinic. During an appointment with nurse Marlene Espejo, the interpreter and the refugee go over a series of questions to create a current medical history. The interpreter then assists the refugee during the rest of the process by helping him or her understand their shots, blood work and vision and hearing checks. After New American Day, interpreters continue to be there for their patients, within and beyond the walls of FHC.
Since Gehrig has been at FHC, she has helped several refugees make their way through the American medical process. She came to the U.S. from Bosnia in 2001 and was later hired at FHC as a Bosnian medical interpreter for one year. After that she was promoted to management. Since then, she has been managing the interpreters department for nine or ten years.
“We are a little family. We really care for one another,” Gehrig said. “All of us came from a third country because of war or abuse and want to make the best of our lives in a wonderful country.”
Gehrig and her team want to help the refugees do the same by providing them with their interpretive services and skills. Many of the interpreters were refugees and have already gone through the process of settling into the Fargo-Moorhead community. Now that they are in a place to contribute to their new home, Gehrig and her team have decided their mission is to serve everybody, especially New Americans and refugees.
According to Gehrig, the main populations served by FHC are Nepali, Somali and Arabic speaking refugees. FHC has 25 interpreters, all New Americans. They speak 10 languages including Arabic, Bosnian, Kurdish, Nepali, Vietnamese, Kirundi, Swahili, Somali, Spanish and Kinyarwanda. Other languages can be reached through a language phone line.
The complexities of medical interpreting
The service medical interpreters provide to their clients is quite different from that of a social interpreter. Social interpreters, such as education or community interpreters, will receive only one version of training to serve the community. In the medical field, interpreters need to not only learn the cultures they are assisting, but specific medical terminology as well, Gehrig said.
“The biggest difference in the medical field is that it is more sensitive,” Gehrig said. “We offer medical training on a yearly basis to staff. The terminology changes so often and we have to make sure to update people. We also do community training …. because you are talking to different cultures with different rules. Adding terminology is a whole other class.”
Medical interpreter Hari Subedi said that he had to take a total 40 hours for social training and 16 hours for medical terminology training.
The medical interpreters give explanations on how to use medication and make signs in the refugees’ languages on personal hygiene and details on their appointments and personal treatments. They also provide comfort in an unfamiliar place.
Lost in Translation
Despite the hours of training, interpreting medical terminology poses some special challenges. Subedi said that Nepali in particular is hard to translate.
“There are words which we don’t have in English and there are different words we use in Nepali,” Subedi said.
Chandra Acharya, another Nepali interpreter, said he also has trouble interpreting medical terms to his patients. For instance when Acharya refers to radiology, his patients think he is talking about a radio and when he says sonography or MRI, refugees do not understand. Sonography, MRI and radiology are all examples of words that do not exist in Nepal. Acharya said that translating the words “treatment” and “therapy” are challenges as well, because in Nepali, there is no differentiation between the two terms.
It works best to explain the term’s function, Acharya said. “When we say what the particular thing does, then they start using it in their own ways and understand.”
It’s emotionally draining work
Helping refugees understand terminology is not the only challenge in medical interpreting. Gehrig said it’s also important to be thick-skinned.
“You can’t break into pieces in front of a person,” she said.
Medical interpreters walk into sensitive appointments every day. They have to be able to clarify what is wrong, what the patient must do to get better, and what the patient must prepare for. An emotional interpreter cannot relay sensitive and important information without escalating the situation. This doesn’t mean, however, that Gehrig isn’t affected emotionally by the encounter.
“There was once a person dying of brain cancer and she didn’t have any family members but her husband,” Gehrig said. “I made it, but did I leave teary-eyed? Yes, I did. I caught myself saying ‘Do you want to do this?’ or ‘Are you too emotional for this?”
The woman dying of brain cancer had actually lived for 49 days without drinking water. For Gehrig, it was hard to see her in that condition—a living corpse.
“It was the toughest thing ever telling him she had so little time,” Gehrig said. “It was difficult but I shook it off and continued. No one is saying you can’t be sad, but not to the point to where you can’t focus.”
Gehrig will never regret becoming a medical interpreter, because of experiences like these. It may be hard, but there are so many rewarding moments that come with the sad.
“[In Bosnia] my experience was bad. There was rape, killing and then you come here and everything that happened back there is now nothing,” Gehrig said. “People had war and were kicked out, but the goal is seeing these people escaping and coming to a new world and living a new life.”
Helping others like herself
Before Gehrig came to America, she had a pretty normal life in Bosnia and had a two-year degree in business and German. Then everything changed.
“War started and we were scattered,” Gehrig said.
Her family came to the U.S. in 1996 and Gehrig followed in 2001.Her experience at FHC was different from that of more recent refugees; at the time FHC was less organized, smaller, and offered fewer services. Now FHC not only helps screen refugees for medical histories, but provides treatments for physical and mental illness and check hearing, vision and dental.
“Now, we are more established,” Gehrig said. “We hold great relationships with main clinics and one of our biggest vendors is Sanford.”
Gehrig began to learn English while working at a window factory.
“Having co-workers with only English forces you to learn more. Within eight months I was on my own and did not use anyone to help with paperwork.” Gehrig said.
Soon, Gehrig was helping interpret in her community for people who struggled with English. Eventually someone referred her to Family Health Care. Since then, she has been in awe of how much she can help to others.
“It has been amazing how much you can do for unfortunate people who are not educated and who do not speak English,” Gehrig said.
Joining the mission
Hari Subedi has been interpreting at FHC for two years and he speaks Nepali. Previously he had interpreted for area schools and for Cultural Diversity, an organization that works to increase the understanding of the value of culture and diversity in communities.
When Subedi and his family arrived in the U.S. their health provider was FHC. Later, when Subedi had gotten a job at Cultural Diversity, he returned to FHC for training. He was interested in what the medical interpreters did for refugees there and he wanted to join them in their mission. Subedi was introduced to Gehrig when he showed interest in the job, and once a space opened, Gehrig hired him on.
“She is an awesome lady,” Subedi said. “She is helping in all the ways we need and she is flexible and helpful.”
Going beyond your limits
For Subedi, the ability to help someone change their life is the most important aspect of his job, and the everyday tasks he performs at FHC have an influence on those around him.
“I always do good for everybody,” Subedi said. “I smile to everybody and say hi.”
Subedi said that in a typical day at the office, he has a schedule that lists his several appointments. Health providers and interpreters have their own schedules but they link together so that there is an interpreter for every doctor’s appointment. Some of these appointments will be within FHC and some will be at Sanford or Essentia, or in Grand Forks.
“We have forty minutes for one person,” Subedi said. “Everything is tight.”
During his time at FHC, Subedi has always been more than just an interpreter as he performs various roles. If Subedi happens to have a free slot from a no-show or unscheduled time, he goes to the receptionist desk or the pharmacy to give some extra help there.
Gehrig went beyond her job description when she helped a refugee named Niyokwizera Yotam. Yotam and his sister, originally from Burundi, came to America in 2008 after living 12 years in Mtabli refugee camp in Tanzania. Once they made it to the states he was surprised by the cold.
“I didn’t know why the ground was white and they told me that it was snow, but I didn’t know why it was so cold,” Yotam said.
When they finally reached Fargo, a UNHCR representative was there to escort them and gave Yotam and his family jackets to wear for the cold. Yotam never had to wear such a contraption.
“I was wondering why I was putting on this?” Yotam said. “It was really cold outside and my question was, ‘Am I going to survive here?”
Soon after settling in Fargo, someone referred him to Family Health Care to do some interpreting and Gehrig was more than happy to hire him on. Two weeks in, he was communicating and relaying information in Swahili from patient to doctor. Despite Yotam’s success at FHC, he was struggling at home. When Yotam came from Kenya he had nothing but the clothes on his back and his sister. He didn’t know how to drive a car so he had to wait for the bus to travel to appointments.
Gehrig would not have that.
“I told him that when he comes to the clinic, that I will drive him to locations so he didn’t have to stand in the cold,” Gehrig said.
Then when Yotam got a different job and started saving money, Gehrig’s husband helped Yotam buy his first car and taught him how to drive it. For Yotam, getting a car was almost too good to be true.
“In America, a car is very essential, but not an expensive one because you are still building yourself. It was the first car I ever owned in my life. I never dreamed of owning a car in Africa,” Yotam said.
Gehrig and her family also helped Yotam find his second job at Integrity, a local windows company.
Once Yotam got his own place, Gehrig and her husband got him his first television, a few chairs to furnish his apartment and a sofa for the “sitting room.”
After everything Gehrig and her family have done to help Yotam survive his resettlement, they have become his American family.
“I call Jasmine my sister. She played a big role in my transition when I came here,” Yotam said. “Jasmine is a good friend to me and her family is good, a family you can rely on.”
Yotam is now settled into his new community and despite his new found independence and new job, he and Gehrig still stay in touch.
“He is grateful for us mentoring him and for helping him in his situation,” Gehrig said. “I am so proud that he turned out good. He is married with a boy and has his own place. That was my proud moment and my gift to him that he turned out to be a good person.”
Reflecting on his relationship with Gehrig, Yotam knows she is more than the medical interpreter who helped him understand. She became his support, his friend and his family, Yotam said.
“She had a unique heart of helping.”
This piece was completed for the Investigating and Narrating the News course where all students reported on refugee issues and stories in Fargo-Moorhead.