Lost in translation

Every so often I have been offered an opportunity to donate a week or 2 of my pediatric skills in an underdeveloped country, mostly in Central and South America, but occasionally in Africa. The offers sound exciting, but the din from a chaotic waiting room and exam rooms overflowing with sick children made it difficult to imagine extracting myself long enough to take advantage of those opportunities to practice abroad. With weekends off in short supply, I would always fall back on the flimsy excuse that charity begins at home. I am embarrassed to admit that in those preretirement days, time was money. The lost income during my time away and the cost of the airfare left me feeling a bit uneasy. But now, I have been made redundant, and time and money have been disconnected. Time is just time, and I have enough to share.

So, when I received an e-mail a few days ago, offering me the chance to work with children in Central America, I had time to consider it seriously. I would be expected to pay about $700 in room and board and, of course, purchase my own plane ticket. I would be working with a group of other North American physicians and a few translators to supplement a full-time physician.

It sounded appealing. By March, I would have had enough cross-country skiing and snow shoveling and would be ready to enjoy some warm weather. And, of course, the chance to work with children again would make it a real feel-good experience.

I began to envision what my days in the tropics would be like. Shorts and a loose-fitting flowered shirt, I could wear those new sandals I bought at that end-of-summer sale last year. But, what exactly would I be doing? I doubt there would be many, "Does my child have attention-deficit/hyperactivity disorder?" discussions. Was I going to see any children with functional abdominal pain? I’m good at that, particularly if it is triggered by school anxiety. Although I’m pretty skillful with an otoscope and a stethoscope, the skills that have become the sharpest over the last 4 decades are those of taking a targeted history and then sorting out the red herrings. Most of the time, I have arrived at the diagnosis before I even put the stethoscope in my ears.

As I considered what I have become, I realized that my skills are primarily language based, and I don’t speak Spanish. Of course, there would be translators, but in the short space of a week, would the translator and I understand each other well to make sure that my questions and the patients’ answers were properly nuanced. Like all experienced physicians, I also read body language, but I have noticed that different cultures speak body language with accents that I sometimes don’t understand. I’m comfortable diagnosing the common dermatologic problems in North America, but I fear that just as I wouldn’t recognize the tropical birds, I would need a serious field guide to the rashes of Central America.

Having listened to other physicians who have been on similar missions, I am sure that I would enjoy myself. I would see new flora and fauna, eat some different foods, and meet some wonderful people. I have no doubt that everyone would make me feel appreciated.

But, then my thoughts drifted back to money, the damn money. I now have enough time and money so that I can easily afford the adventure. But, if my primary goal was to improve the health of disadvantaged children, would my thousand dollars do more good if I wrote a check for a refrigerator to store vaccines or a pump and filter to make safe water more available? How valuable a gift is a week of my language-challenged skills going to be?

I have time to decide, and I will talk to some physicians who have made the trip before. If I decide to go, I’ll send you all a note from the tropics to let you know how it went.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say ‘No’ to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com.

Every so often I have been offered an opportunity to donate a week or 2 of my pediatric skills in an underdeveloped country, mostly in Central and South America, but occasionally in Africa. The offers sound exciting, but the din from a chaotic waiting room and exam rooms overflowing with sick children made it difficult to imagine extracting myself long enough to take advantage of those opportunities to practice abroad. With weekends off in short supply, I would always fall back on the flimsy excuse that charity begins at home. I am embarrassed to admit that in those preretirement days, time was money. The lost income during my time away and the cost of the airfare left me feeling a bit uneasy. But now, I have been made redundant, and time and money have been disconnected. Time is just time, and I have enough to share.

So, when I received an e-mail a few days ago, offering me the chance to work with children in Central America, I had time to consider it seriously. I would be expected to pay about $700 in room and board and, of course, purchase my own plane ticket. I would be working with a group of other North American physicians and a few translators to supplement a full-time physician.

It sounded appealing. By March, I would have had enough cross-country skiing and snow shoveling and would be ready to enjoy some warm weather. And, of course, the chance to work with children again would make it a real feel-good experience.

I began to envision what my days in the tropics would be like. Shorts and a loose-fitting flowered shirt, I could wear those new sandals I bought at that end-of-summer sale last year. But, what exactly would I be doing? I doubt there would be many, "Does my child have attention-deficit/hyperactivity disorder?" discussions. Was I going to see any children with functional abdominal pain? I’m good at that, particularly if it is triggered by school anxiety. Although I’m pretty skillful with an otoscope and a stethoscope, the skills that have become the sharpest over the last 4 decades are those of taking a targeted history and then sorting out the red herrings. Most of the time, I have arrived at the diagnosis before I even put the stethoscope in my ears.

As I considered what I have become, I realized that my skills are primarily language based, and I don’t speak Spanish. Of course, there would be translators, but in the short space of a week, would the translator and I understand each other well to make sure that my questions and the patients’ answers were properly nuanced. Like all experienced physicians, I also read body language, but I have noticed that different cultures speak body language with accents that I sometimes don’t understand. I’m comfortable diagnosing the common dermatologic problems in North America, but I fear that just as I wouldn’t recognize the tropical birds, I would need a serious field guide to the rashes of Central America.

Having listened to other physicians who have been on similar missions, I am sure that I would enjoy myself. I would see new flora and fauna, eat some different foods, and meet some wonderful people. I have no doubt that everyone would make me feel appreciated.

But, then my thoughts drifted back to money, the damn money. I now have enough time and money so that I can easily afford the adventure. But, if my primary goal was to improve the health of disadvantaged children, would my thousand dollars do more good if I wrote a check for a refrigerator to store vaccines or a pump and filter to make safe water more available? How valuable a gift is a week of my language-challenged skills going to be?

I have time to decide, and I will talk to some physicians who have made the trip before. If I decide to go, I’ll send you all a note from the tropics to let you know how it went.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say ‘No’ to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com.

Every so often I have been offered an opportunity to donate a week or 2 of my pediatric skills in an underdeveloped country, mostly in Central and South America, but occasionally in Africa. The offers sound exciting, but the din from a chaotic waiting room and exam rooms overflowing with sick children made it difficult to imagine extracting myself long enough to take advantage of those opportunities to practice abroad. With weekends off in short supply, I would always fall back on the flimsy excuse that charity begins at home. I am embarrassed to admit that in those preretirement days, time was money. The lost income during my time away and the cost of the airfare left me feeling a bit uneasy. But now, I have been made redundant, and time and money have been disconnected. Time is just time, and I have enough to share.

So, when I received an e-mail a few days ago, offering me the chance to work with children in Central America, I had time to consider it seriously. I would be expected to pay about $700 in room and board and, of course, purchase my own plane ticket. I would be working with a group of other North American physicians and a few translators to supplement a full-time physician.

It sounded appealing. By March, I would have had enough cross-country skiing and snow shoveling and would be ready to enjoy some warm weather. And, of course, the chance to work with children again would make it a real feel-good experience.

I began to envision what my days in the tropics would be like. Shorts and a loose-fitting flowered shirt, I could wear those new sandals I bought at that end-of-summer sale last year. But, what exactly would I be doing? I doubt there would be many, "Does my child have attention-deficit/hyperactivity disorder?" discussions. Was I going to see any children with functional abdominal pain? I’m good at that, particularly if it is triggered by school anxiety. Although I’m pretty skillful with an otoscope and a stethoscope, the skills that have become the sharpest over the last 4 decades are those of taking a targeted history and then sorting out the red herrings. Most of the time, I have arrived at the diagnosis before I even put the stethoscope in my ears.

As I considered what I have become, I realized that my skills are primarily language based, and I don’t speak Spanish. Of course, there would be translators, but in the short space of a week, would the translator and I understand each other well to make sure that my questions and the patients’ answers were properly nuanced. Like all experienced physicians, I also read body language, but I have noticed that different cultures speak body language with accents that I sometimes don’t understand. I’m comfortable diagnosing the common dermatologic problems in North America, but I fear that just as I wouldn’t recognize the tropical birds, I would need a serious field guide to the rashes of Central America.

Having listened to other physicians who have been on similar missions, I am sure that I would enjoy myself. I would see new flora and fauna, eat some different foods, and meet some wonderful people. I have no doubt that everyone would make me feel appreciated.

But, then my thoughts drifted back to money, the damn money. I now have enough time and money so that I can easily afford the adventure. But, if my primary goal was to improve the health of disadvantaged children, would my thousand dollars do more good if I wrote a check for a refrigerator to store vaccines or a pump and filter to make safe water more available? How valuable a gift is a week of my language-challenged skills going to be?

I have time to decide, and I will talk to some physicians who have made the trip before. If I decide to go, I’ll send you all a note from the tropics to let you know how it went.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say ‘No’ to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com.