By Cadet Austin Welch
For our CULP mission we were tasked with assisting in a humanitarian aid mission to Panama as translators for medical personnel. All of us were fairly fluent in Spanish, but for the mission to be successful we needed to learn medical terminology in Spanish.
Throughout our first week at Fort Knox, Ky., we were exposed to advanced Spanish language training that covered themes such as taking a patient’s medical history, social history, and background, as well as terms used by medical professionals and their Spanish language counterparts. The advanced medical language training augmented medical familiarity for us and provided a deeper understanding of the Spanish language as well.
The course, taught by retired Maj. Gen. Burn Loeffke, was instrumental in our success throughout the course and our cultural immersion in Panamá.
Loeffke’s course began with an assessment of our prior levels of Spanish understanding. He seemed immediately impressed with our existing Spanish abilities and because of this, he tailored the course to facilitate a higher level of understanding our CULP mission. His book La Medicina Abre Puertas (Medicine Opens Doors) was instrumental in our medical Spanish foundation.
The first lesson involved several pre-course modules—in a classroom setting—designed to serve as a refresher covering verbs, salutations or greetings, and different body parts. As Loeffke described to us, different cultures use different verbiage for the same things. Because of this, he adapted all of our lessons for the Panamanian region. Because of his time as the USARSO commander stationed in Panamá City, he had firsthand knowledge of cultural customs, norms, and terms which were imperative to our understanding and learning.
The team’s next series of lessons covered medical history to include: complete medical history, sample medical interview practices, history of present illness’, past medical history, social history, and finally family history. With each of these lessons, Loeffke created helpful mnemonics, or acronyms, that enabled us to move step by step through each portion of a medical interview but not omit any important information.
Through his cultural lesson, he drilled into us that in Panamá it’s very important to focus on the individual to whom you are speaking. Anything to the contrary could be construed as highly inappropriate and could denigrate from the abilities of the doctor or interpreter to gain an accurate medical picture of the individual. His coaching and mentoring taught us to take a complete history through a series of 33 questions was made easy through his mnemonics. By the end of the lessons, we were able to do an interview, summarize, and then report the findings to a physician without taking a break to translate in the middle of questioning the patient. While difficult to do, it proved invaluable once in-country and facilitated the full cooperation and respect of the patients which we saw.
To lend perspective to a typical interview, the following demonstration of the mnemonics OLDCARTS, a method to gain a history of the patient’s complaint, establishes its usefulness as a tool to gain the required information. The mnemonics, line by line, was asked in the following fashion:
Onset: ¿Cuando Comenzo? (When did your pain/sickness begin?)
Location: ¿Dónde está el dolor? (Where is your pain?)
Duration: ¿Cuánto dura el dolor? (How long does the pain last?)
Characteristics: ¿Cómo es el carácter del dolor..pulsante, constante, cuchillada? (What are the characteristics of your pain i.e. pulsating, constant, knifing?)
Aggravating/Alleviating factors: ¿Que agravia/alivia el dolor? (What aggravates/alleviates pain?)
Radiation: ¿Se mueve el dolor…donde? (Does the pain move – to where?)
Time: ¿Cuándo tiene el dolor? (When do you have the pain (time of day)?)
The answers to these questions were summarized by the translator back to the patient to confirm its validity. Once the information was verified between the patient and the translator, it was then be provided to the physician who made a diagnosis, performed additional tests, or asked any follow on questions. Armed with this acronym, along with the other mnemonics, we were able to affectively converse with the patients and gain necessary information for the physician to provide treatment.
Loeffke’s training put us in a unique position to have a large impact on the overall success of the mission and to allow more patients to be effectively treated. The physicians seemed impressed with our level of medical Spanish proficiency, which was due to the success of our training beforehand. Overall, the level of patients seen was higher because of our ability to use mnemonics, like OLDCARTS, while still maintaining and exercising cultural customs, norms, and respects.
The week of training at Fort Knox clearly had a positive impact on this mission and we are very thankful for the hard work that Maj. Gen. Loeffke put into his training program to prepare us.