Mere kaalje me chees si laag ja ae. Raat me kati nyu ei bhadak ho jaya kre!”, the patient said in Haryanvi, whom I was assigned to in my ‘medical-history-taking’ class during the first year of the medical school, when I inquired about her health.
My friend translated it verbatim to English which meant, “My heart is on fire. Especially in the night, the flames seem to flare.” My professor laughed uncontrollably at my lack of understanding of Haryanvi, a Hindi dialect, as I presented the case in front of the class, confidently assuming the symptoms to be of a ‘heart attack’.
“The patient has acidity that exacerbates during the night,” my professor explained. I had lost it in the translation!
That was my first lesson in understanding how language can be both a blessing and a hindrance in establishing doctor-patient relationships. Madhya Pradesh has recently become the first state in the country to introduce medical textbooks in Hindi, a drift from the traditional English-based curriculum. This decision has caused an overnight buzz in the medical community.
Some doctors support the move with a nationalist thump of the chest, proclaiming Hindi’s superiority over all languages while dismissing English as ‘residual scum’ of the British Raj.
Others are outspokenly opposed to the move, claiming it is a political intrusion into the sacred world of medicine, attempting to impose Hindi over other regional languages and upending the holy status quo of standard medical textbooks, which are mostly written in English.
As the debate heats up, a third group of doctors simply doesn’t care and is enjoying the wholesome barrage of memes and jokes circulating around the idea of translating complex medical terms into funny Hindi movies dialogues. I decided to weigh in on the debate.
One must wonder, why does the language of doctors and nurses sound so alien? Why is a doctor’s prescription so difficult to comprehend? The answer lies here – the language of medicine has evolved along with medicine itself. First, in the Greek era, Hippocrates, widely regarded as the father of medicine, gave us words like ‘diarrhoea’ (loose stools), ‘catarrh’ (mucus in the nose), and ‘dyspnoea’ which means shortness of breath.
These words are still in use today as popular as they were centuries ago. The Greek era was followed by the Latin era after the period of Renaissance. Words like ‘muscle’, ‘vein’, and ’nerve’ are all of Latin origin. Almost all medical books in the early 1400s to 1800s were written in Latin with Greek words still embedded into it.
Even when the Germans, Dutch, and Scandinavian medical textbooks were written, Greek and Latin terms remained and were not replaced in their native languages. Some suffixes like ‘-itis’, which indicates inflammation, for example gastritis which means inflammation of the stomach, dermat-itis, i.e., inflammation of the skin or pharyng-itis which is inflammation of the throat, are still so in vogue that they constitute the general vocabulary of doctors and have no alternate better terms, yet.
Finally, we have arrived at the era of ‘medical English’, which has brought doctors from all over the world together to share their knowledge through textbooks, journals, and conferences using words derived directly from English that may mean something different in layman’s English and something entirely different in a physician’s English. For example, the word ‘block’ may mean ‘stop’ in native English but to doctors it means ‘to anaesthetise a nerve’.
The word ‘gloss’ means luster or shine in English but in a doctor’s parlance of prefixes, it means ‘tongue’. A conversation between two medics can leave you confused about your symptoms.
The necessity of studying local patient’s language
Textbooks written in native/regional language might prove to be an important asset for students of rural and marginal communities to get ingrained comfortably into mainstream medical standards of education.
These textbooks will also assist students from various states who converge into a remote medical college in improving their understanding of the local lingo with greater authority. There have been various research studies that show that language barriers in healthcare led to miscommunication between medical providers and patients, decreased patient satisfaction, increased cost and duration of treatment and higher incidence of adverse complications eventually. It’s true and it has been proven again and again. Hence, the need to study the local patient’s language becomes not just a necessity but a professional duty for the physician.
However, regional languages cannot be the sole medium of instruction as it would lead to difficulty in communication between doctors of two different regions, prevent foreign medical graduates (FMGs) who have studied in foreign countries to settle back into India, and discourage exchange of latest technology, research and scientific data between countries.
The medical world came together globally to fight the Covid-19 pandemic, which was made possible in part because access to the majority of standard journals, mostly written in English, were made free of cost to ensure that even the most remotely located doctor on the planet could access them.
Medical language sounds English but is more than that. It is centuries of so many languages melted and poured into one ‘unnamed’ golden universal language of physicians. It can’t be translated in its entirety.
All attempts to translate it into regional languages may assist in better understanding of this ‘unnamed’ language but to wish that it will replace the original, would prove to be a fantastical futile idea of fools. However, using other languages to practise medicine in a personalised manner while keeping in mind the health needs and requirements of the population served is entirely up to the medical professional’s discretion.
After 10 years in medicine, I am now fluent in the Haryanvi dialect and proud of it.
Dr Kamna Kakkar, MD, is senior resident doctor of the department of anaesthesia and critical care at Vardhman Mahavir Medical College (VMMC) & Safdarjung Hospital, New Delhi. Views are personal.
(Edited by Tarannum Khan)