Clinical Training Snapshot: Working with a Translator — and Sometimes Without

Photo courtesy of Emily Paul
Acupuncture and Oriental medicine student Emily Paul

The patient was in pain. He didn't speak much English. And there was no translator. Emily Paul, an acupuncture and Oriental medicine student at Bastyr University, found herself figuring out cross-cultural communication on the fly.

Paul was working at the Rainier Park Medical Clinic in South Seattle, in one of the most ethnically diverse neighborhoods in the United States. Actually, she has worked twice without a translator, once with a Somali patient and once with a Vietnamese patient. Each time, the patient and clinician used body language and hand gestures to reach understanding.

Paul, a third-year student in Bastyr's acupuncture and Oriental medicine (AOM) master's program, says this real-world clinical training has been "hugely eye-opening."

"I'll never forget learning that it's possible to communicate like this," she says. "I still think it's important for somebody to be able to explain their condition in their own language. But when that's not an option, we can still have a beneficial treatment — and then make sure the interpreter is available the next week."

That sort of learning is exactly the goal of Bastyr's external clinical training shifts. After completing training at Bastyr Center for Natural Health, students in AOM and naturopathic medicine programs can apply for a number of shifts at neighboring health clinics and hospitals. That allows them to train with different populations, health issues and working conditions.

"They gain a lot of flexibility of mind through off-site training," says Kathleen Lumiere, DAOM, LAc, a supervisor at the Rainier Park clinic and a core faculty member in the School of Acupuncture and Oriental Medicine. "They have to adapt to a setting different than where they've been trained. They may have to improvise with a treatment or adapt to a different exam room or timeline. It's an important thing to learn."

Working Through a Fear

Paul is no stranger to other cultures: She was working in Sri Lanka as a human rights activist when the 2004 Indian Ocean tsunami struck. As the world's eye turned to the devastation in South Asia, she coordinated volunteers. That experience, along with studies in yoga and Thai massage, helped her discover a calling to do healing work.

But she wasn't sure about her scientific abilities.

"I was looking for a school and honestly was intimidated by Bastyr at first because it has a strong science-based curriculum," she says. "For some reason, the searches I was doing kept bringing me back to Bastyr. So I thought, 'OK, maybe I need to look at this fear of science. Maybe it's time to work through that.' As soon as I made that decision, this was the only school I considered."

Paul returned to the United States and completed prerequisites in biology and chemistry, along with an anatomy and physiology course that an admissions advisor recommended. "That class opened my curiosity and just gave me more confidence about the steps I was taking forward," she says.

Like other students in her program, she began clinical training in the winter of her first year, as a secondary clinician who observed, prepared the examination room and helped with non-needling therapies such as moxibustion, tui na, and cupping (a form of acupuncture often used for pain). After a year, she took the University's clinical entry exam and began work at as a primary clinician.

All Around Seattle

Paul understands why her program requires students to train at Bastyr Center first. They have ideal facilities there and time to discuss cases with faculty supervisors before patients arrive. She's also glad for the challenges provided by community clinics, which typically bring a higher patient load than students experience at Bastyr Center.

"At the external clinic shifts, everything tends to be condensed," she says. "You still have the opportunity to discuss cases with faculty, but it's not as regimented. It's more free-flowing, like it would be at an integrative clinic."

Some of the AOM training sites focus on chronic fatigue, cancer care or HIV/AIDS. Some also target different patient groups: One is located at a senior nursing center, another is for recent immigrants and several, like Rainier Park, serve many low-income patients.

Visits last an hour, with students spending 10 to 15 minutes administering "intake" — listening to patients and gathering information. Then they consult with the faculty supervisor and implement a treatment plan. At Rainier Park, Paul has used a variety of modalities within Oriental medicine: moxibustion, ion pumping cords and others.

"Working under the faculty’s supervision, I'm able to use any modality that feels relevant," she says.

More Independence

Students at the Rainier Park clinic typically work without secondary or co-primary clinicians, which means they get used to having more independence, Dr. Lumiere says. It's an integrative practice, which means students also work alongside medical doctors (MDs) and learn to make referrals when necessary.

"They get to work with other care providers, often in public health settings that are fast-paced and interesting," says Dr. Lumiere. "I like working in public health because the people drawn to it have such generous spirits."

After graduation, Paul plans to pursue doctoral-level training, then find work in an integrative clinic. She hopes to eventually return to South Asia to work, which adds to the appeal of the intense training she’s receiving with diverse patients, she says.

"Out in the real world we're going to be seeing patients back-to-back," she says. "Once practitioners are experienced, they operate in multiple rooms at a time. To do that, you have to be focused and present with the patients, and ready to take on whatever shows up. I'm getting a sense of what that will be like."