"It's like you’ve been heard but nobody was actually listening...": Changing the Landscape of the Immigrant Patient Experience

An interview with Susan Mirabal, M.S.

I became interested in medicine largely because of my parents and my collective experience with cancer as immigrant patients: I got to see a side of medicine that shaped me.

Susan Mirabal was born in Peru to Spanish-speaking Peruvian parents. From a young age, Susan was exposed to multiple languages: when she was still quite little, her family relocated to Brazil, where she learned Portuguese. Then, at the end of Susan’s middle school years - at about 12-years-of-age - her father decided that he wanted to pursue a degree in higher education. The family left for the United States.

Prior to departure, Susan had had a bit of exposure to English through her English classes in school. But, like most other cases of early language acquisition in an academic environment, there is little that truly sticks from those initial lessons except for basics: (ie) colors, numbers, vegetables and fruits. Arrival to a life completely in English in the States was a shock to the system.

“The younger you are, the easier it is for you to learn. Being the youngest, it became my job to translate things. I was the one to schedule doctors appointments, go grocery shopping every week; I was the one who had to call the companies to pay the bills. It was me up against the world! In a way, it was great, because I got a lot of exposure and my language skills kicked in almost immediately, but it also opened up this other view of the world, where - had it been my mother on the phone instead of me, for example - the services or treatment my mother would get were not equivalent. I noticed this very early on.”

Susan’s experience of this phenomenon only became more apparent as time went on. Susan and both of her parents are cancer survivors, and it was during these medical processes that she recognized she was passionate about language issues.

It’s like you’ve been heard but nobody was actually listening...

“I became interested in medicine largely because of my parents and my collective experience with cancer as immigrant patients: I got to see a side of medicine that shaped me. I remember going to my dad’s doctors appointments - he was the first one in the family – when he was battling prostate cancer, and I knew he was being treated differently. Maybe it was a combination of language and culture - the way we looked, the way we dressed - but at the end of the day there was something different. You have a different taste in your mouth after one of these encounters, like you’ve been heard but nobody was actually listening… With those medical experiences - then it was my mother and then it was me - you get a different idea of what it means to be an immigrant and to speak a different language… I try my best now with the patients that I have who are Spanish-speakers to make a point to speak with them, not just in the same language, but using mannerisms and phrases they’ll be familiar with: being sensitive. I’ve always been interested in language. I’ve always had this drive: maybe it’s an overreaction to the treatment I perceived as being different for immigrant populations...”

Susan is active in her efforts to change the future landscape of language and cultural issues in medicine. She co-authored the recent paper, “¿Hablas Español? Language Assessment in Medical Students.” The study evaluated medical students’ interest - at the University of New Mexico School of Medicine - in improving their skillset in a second language in addition to collecting data on self-reported language proficiency, and measuring the effects of the completion of a formal language assessment on comfort level using this second language in a clinical setting. The study involved a combination of surveys and formal language assessment. One of the most interesting findings of the paper is that self-reported Spanish proficiency is correlated with formally assessed language ability, but students who graded themselves highly in ability (proficient/ fluent) demonstrated decreased comfort level following formal language assessment. This “false fluency” is an important behavior to be aware of.

Susan’s goal for the study: to draw attention to language issues. If UNM School of Medicine encourages and supports a more linguistically-competent and culturally-sensitive student body, they can be a model for other institutions.

“We are the only medical school in the state - which is a huge state - and we are one of the most bilingual states in the nation. Why is it that we do not invest more meaningfully in the language skills that some students already bring with them? I’ve sometimes gotten myself into a bit of trouble for speaking out a little too loudly about this! Mostly with my attendings. When we have twenty-something patients to see and there are only two of us, perhaps I take too much time speaking to and translating for the Spanish-speaking individuals when I should be more mindful of everyone’s time. I’m not meaning to provide special treatment, I just think that we need to be aware that they might be receiving inferior care. Awareness means that the problem can start to be addressed. The unfortunate element is that people get complacent. And, I think that’s where problems arise. Because we say, “yeah that’s good enough…” This complacency, it’s not on purpose. But, to get past it, these issues need to be constantly addressed.”

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Susan Mirabal graduated magna cum laude with a degree in Biology from the University of New Mexico (UNM). She then pursued her masters in Biology with a concentration in Biophysics from UNM. At present, Susan is a third year medical student at the School of Medicine at UNM. Susan worked as an intern on a health policy with the National Hispanic Medical Association (NHMA), advocating for health policies with benefit to Hispanics and Minorities in Washington, DC. She is the recipient of multiple awards and honors.