I pulled into the clinic parking lot and caught my breath. It had been a long drive in the New England winter, nearly two hours on the highway, and I was not all that seasoned a roadster. I walked into the building and identified myself to the reception staff who asked me to take a seat. I looked around the waiting room, wondering who my patient was; I often did this and was usually right with my guesses. As a Swahili medical interpreter in not-very-diverse Massachusetts, it was usually easy to spot my patients: black, sometimes individuals but usually families, and almost always looking newly-arrived. No matter how well their attire blended in, there was something about how they carried themselves that gave them away instantly. Perhaps it was the way they sat, as though on benches outside the stereotypical African clinic, that stood in contrast to the muted pleather chairs of the stereotypical American healthcare facility.
A name was called. From the way it struggled to leave the nurse’s mouth, I figured that was who I was there for. Indeed, the nurse glanced my way and nodded, and I got up to follow her and the patient through the double doors into the examination rooms. Arriving for assignments at Planned Parenthood was akin to entering a fortress. There are large main doors, then security guards and scanners, then another set of heavy metallic doors which have to lock before the inner doors can open into the waiting room. Those few seconds in the antechamber are always slightly unsettling, like being in an elevator whose winch takes a few seconds to kick in.
This particular Planned Parenthood branch was unmarked, as many were, and so I had been mercifully spared the protestors who tended to throng the entrance with placards bearing gruesome images, chanting, or kneeling and saying the Rosary. The Catholic in me always wanted to make the Sign of the Cross then tell them to get the hell out of my face.
How did I even get here, in the first place?
It started, as all my assignments did, with an e-mail from the interpreting agency titled “Are you available?”
When I boarded a plane for Boston in August of 2009, I tucked my Swahili under my tongue and was not expecting to use it much. For most of my four undergraduate years, I’d only bring it forth to sweeten my mouth after long days of speaking English—the way one would roll out a piece of candy they’d been saving in their cheek and feel the sugar flood their palate.
Never did I imagine that I would one day serve as a linguistic bridge between Swahili speakers and non-Swahili speaking healthcare professionals. Neither did I imagine that it would not be as cut and dry as simply translating word for word. See, with languages that are as rare in the Northeastern United States as Swahili is, the lines blur: between the shared homesickness and the hospitality mores that infuse our cultures, it is downright impossible to maintain a strictly professional relationship with a patient and their family. To do so feels cold—not that I didn’t try, for fear of inadvertently contravening the ethics of my position. I found an appropriate balance along the way and enjoyed how the younger children in the families came to regard me as an “auntie”, like the little girl who was five years old when I first met her and by the time I sat in on our last appointment together she was going into the third grade. I watched the girl grow, saw her mother become more confident at managing her daughter’s condition, and myself learnt a thing or two about it.
I never asked patients why they were having any appointment—and never needed to, since I usually got to know over the course of conversation. Many were just so happy to have someone to speak to in their language that they ended up pouring themselves and their lives out to me in the waiting room.
All of them were East African, most were immigrants; some refugees, others following spouses, the rest medical visitors. The mother learning how to manage her daughter’s diabetes with minimal English. The parents bringing their son to a clinical trial for a one-in-a-million rare disease. The father accompanying his young child who had sustained severe burns mere weeks after they had landed in the United States as asylum seekers.
And then there were the three women.
Most hospitals have in-house interpreters for the more common languages—Spanish, Mandarin, Arabic. For less frequent tongues, interpreters are sourced from agencies that have a database of contractors whom they reach out to as needed. In this way, the work I did was on an on-call basis. When it isn’t possible for someone to go to a site in person, they interpret via phone or video call. I never had to do either of the latter, but I imagine it would add a layer of awkwardness given the absence of body language.
There is a routine to being a medical interpreter: sign in, introduce yourself to the patient in the waiting room then to the clinician when they arrive, speak in the first person to both parties, have the clinician sign your timesheet at the end of the appointment. Rarely did I know beforehand the exact reason for the appointment. Those details are usually obscured, for patient privacy and because they should have no bearing on the interpreter’s professional capabilities, except in the case of one particular assignment for which the request email clearly states in bold: “Appointment Type: Termination of Pregnancy”.
Abortions are controversial, the world over. My own sentiments about the procedure have evolved over the years, from the religion-informed ideals in which I was raised to the eventual understanding I arrived at after being exposed to real life. The language in which I processed all of this was English, whose lexicon has the flexibility to cushion the controversy. In Swahili, however? I’d only ever heard it as kutoa mimba, usually spoken either in a whisper or spat out with condemnation. I’d never heard the procedure described in a toneless clinical sense, and have therefore had to create for myself the language with which to explain the details to my patients.
The first time I received such a request, I was unruffled; if anything, I was curious. If I personally knew anyone who’d had an abortion, they hadn’t shared the experience with me— nor had I undergone one myself, so naturally I wondered what actually transpired during the procedure. Yes, the internet exists, but my imagination nevertheless ran wild and I found myself a bit nervous on the morning of the first encounter. I am always slightly nervous before an interpreting assignment anyway, because the job requires thinking on one’s feet in the face of complex medical jargon, but the sensitivity of this particular appointment made smooth command of the language that much more crucial.
When not being bastardised as “yuterasi”, a uterus in Swahili is tumbo la uzazi or mji wa uzazi.
The birthing stomach.
The place of parenthood.
How do you adequately but professionally convey the multiple levels of invasiveness into this most private space? The specula, the scraping, the suction. The tissue being vacuumed away; “tissue”, while so delicate in English, would translate as nyama in Swahili—meat. Could it sound any more barbaric?
There I am, wielding my fourth language, trying to manipulate it into a pillar of cloud to guide someone I’ve only just met through a deeply intimate experience. The goal is sterile clinical accuracy, but the occasional pole dada slips my lips because I am only human. We are all human. You cannot judge a woman until you’ve walked a mile in her shoes—or sat by her stirruped legs while she winces through an abortion.
The very first of the three was a young woman who had a fiancé back home but had a for-the-time-being man while she was here, and their dalliance had had consequences which she would have been unable to explain to her betrothed. I listened without judgement as she shared with me, of her own volition, how she came to find herself in the predicament that led to our meeting. During triage, the ultrasound technician asked if she wanted to see the foetus. The patient shook her head in refusal and looked down at her lap, pain etched on her face. I looked at the screen, as if on her behalf, then looked away.
The second I don’t recall much of, save for that she came with her partner who seemed supportive. Theirs was a relationship that simply wasn’t ready for a child. He waited for her in the front room, while I accompanied her into the back. After the surprisingly brief procedure (about ten minutes is all it took), I sat with her silently in the recovery area. We bade each other farewell, without much ado.
The third was a confident lady who spoke little English, but what words she did have she was so eager to use that I offered to take a backup role unless needed. The physician explained exactly what was going to happen, what to expect, how she might feel physically; the patient took it all in stride, and I took up my position next to her. Thereafter, she and I retired to the lounge to await her ride. One chair between us, the silence was pregnant.
The patient’s voice came from my right: “We’ve killed.”
I turned and found her looking up at the ceiling, expression plain, voice even.
“We’ve killed a creature of God,” she repeated in a matter-of-fact tone.
I did my best to maintain a neutral expression, but internally my eyes widened at the gravitas of the statement and at being implicated. Not wanting to express sentiments in one direction or the other, I found myself fumbling for words.
Do I refute her declaration?
Do I agree for agreeability’s sake?
The decision had evidently been difficult for her, yet one she had deemed necessary enough to choose. I had been present solely in the name of duty, yet at the table of guilt she had served me a plate. But I wasn’t hungry. It discomfited me that I had met her less than an hour earlier, yet by her edict it was as though we had planned this whole thing together. I shifted in my seat and glanced at the clock, willing her transportation to arrive so that the bubble of camaraderie could burst and free me from eternal damnation.
There are many, many more stories I could tell from my half-decade of moonlighting as a lifter of linguistic veils. But those will be for another day.
At the end of each appointment, regardless of its nature, I feel a sense of relief when parting ways with the patients. Like I’ve been relieved of certain responsibilities: of shouldering the entire American healthcare system, explaining it, defending its methods, answering for its flaws. Relieved of the guilt I often feel for not sharing in the patients’ backgrounds, because how I came to and exist in the United States is different in a privileged way. Relieved of how weirdly apologetic I feel in the face of the healthcare providers’ irritation at the patient’s foreignness—as though they’ve mentally written them off as stupid simply because they don’t understand English.
Most days I just want to get the job done well and flee for home. But medical interpreting is not the kind of work that you leave at your doorstep; the encounters follow you in and take a seat on your couch, watching you sip your evening tea. One encounter that particularly remains on my heartstrings was the family that had travelled for a clinical trial. Having just landed at Logan Airport the day before, in what was a brutal Boston winter, this family was in the midst of many firsts: first time outside their village, first time on an aeroplane, first time outside Tanzania. First time finally learning the name and nature of what was ailing their child, and what could potentially be done about it. On meeting this family on the morning of their first appointment, I greeted them and explained who I was and why I was there. When we sat down in a consultation room shortly after, the father grasped my hands and said to me with a relieved smile, “Now that I have seen you, I feel at home.”
Sylvia K. Ilahuka is Tanzanian writer living in Uganda after a decade in the United States. Her essays and poetry have been published in Lolwe and Iskanchi Magazine; she has also reviewed music for Bandcamp Daily. She is a graduate of Wellesley College.