#59 One thing about my health got worse when I moved abroad
Why losing your voice leaves you dangerously exposed
Last week I found myself at a loss for words. Not because I didn’t know what I wanted to say, but because I couldn’t articulate it in Portuguese. I was at my local GP surgery in Lisbon trying to get a referral for cervical screening (reminder: don’t put off that smear test!) and I was struggling to communicate with the (very lovely) female doctor. Instead, we made it through a painful 10-minute appointment, propped up by the crutches of my broken Portuguese and her only slightly better English.
Since we’re in Portugal, in an ideal world we’d be conversing fluently in her native tongue. Absolutely. But there is a big difference between the ‘Maria e João foram ao cinema’ of sentence construction and discussing—as I struggled to do with her—the virtues of hormonal contraception and whether I’d had the HPV vaccine (which has been shown to prevent 90% of cervical cancer cases, and is now routinely offered to all 12 and 13-year-olds in the UK).
My brilliant—and incredibly patient—Portuguese teacher (shoutout to her newsletter) is still getting my linguistically challenged brain comfortable with the past tense, so I’m a little far off learning detailed physiology and medical terminology. What’s more, while my vocabulary drastically improves while socialising with a glass of vinho verde (funny that?), the less relaxing environment of a clinical doctor’s office seems to make me cognitively seize up.
Tongue twister
There was another appointment, at the same practice, which also exposed my lack of language ability—yet on this occasion it felt crystal clear how my absence of voice impacted on the care that I was entitled to (as a taxpayer). Another female GP had listened to a pre-translated speech I had written (checked over by a kind Brazilian friend) explaining that I was concerned about moles that had been changing on my fair skin.
I wish that I’d had the words to insist on a referral to a dermatologist—but she brushed off my worries with hardly any investigation. Instead, having absorbed years of skin cancer warnings over the years (it’s the most common cancer worldwide, FYI), I felt like my only option was to pay for an appointment at a private clinic to be absolutely sure. Something that in itself is, I acknowledge, a privilege—and which I could certainly not afford to do all the time.
The male dermatologist (I thought I’d booked in with a Manuela…not a Manuel) also didn’t speak much English, and so we communicated mainly through hand gestures. It culminated in the slightly comical situation where I triple-checked that he did indeed need me to almost completely undress so that he could examine my body to eliminate my skin cancer concerns. I felt relieved when the verdict was a ‘thumbs up’.
I bring up this second anecdote not simply to hold myself even more accountable to practicing my conjugations. Or to moan about what is the literal definition of a First World Problem (how lucky am I to be able to access mostly free healthcare). But, to me, this feels indicative of the dangerous grey area that emerges when we can’t properly speak up for own health in a medical setting.
I’ve always considered myself incredibly fortunate that I’ve been able to advocate for myself in the healthcare system pretty well over the years in the UK. Thanks, in a big way, to having the advice of a trusted medic family member and knowledge from working in health and wellness journalism. But even as I’ve written pieces encouraging people to go see their doctor, I’ve inadvertently become reluctant to engage with a system that doesn’t understand me.
Speech less
Indeed, moving abroad has given me a real taste of the helplessness so many women still feel when sat across from a doctor—even if language isn’t a barrier. Because, despite much progress, I still hear stories all the time from all over the world (not just the UK and Portugal, but also the US, Denmark and Australia) of female patients who feel misunderstood and unheard when seeking help.
There’s a lingering misogyny and racism in healthcare systems that is yet to fully heal. A recent report showed that women throughout their lives experience a lack of empathy surrounding problems relating to menstruation, fertility, childbirth and menopause. Research has also shown that it’s even worse for Black people, with 65% saying they have experienced discrimination from doctors and nurses.
That the best outcomes emerge from good communication was evident in a recent study that found you are less likely to die if treated by a female doctor, with even greater benefits if you are a female patient. Experts theorised it was because women often took the time to better understand a medical situation.
Global healthcare systems know that how doctors and patients interact can be both life impacting and life saving. To bring language back into it, Portugal’s SNS runs an English-speaking phone line (a bit like the NHS ‘111’). Similarly, the UK’s NHS offers free and confidential translation and interpreting services—even to those who have ‘good conversational fluency in English [but] may not be able to understand, discuss or read health-related information proficiently’.
This extends further than one-to-one conversations in an appointment, but also wider public health messaging. The menopause campaigner Meera Bhogal once pointed out to me how while the movement had been embraced by white women, the same awareness hadn’t reached their counterparts in the UK’s South Asian community. This is particularly worrying since there is evidence that this group could especially benefit from things like HRT, since their symptoms begin on average earlier.
However, even if you have health literacy—defined as the ability of an individual to find, understand, and use information and services to participate in the healthcare system and maintain good health—your voice still needs to be heard. Because so many do speak up, but forces in place mean they’re not listened to—and the system has the final word.
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Very interesting read, I felt seen! I am actually a Brazilian living in Germany, so I can totally understand the language barrier and how this affects our day to day and health. Please reach out if you ever need any help with Portuguese! :)
I feel you with the language barrier! 💕