Our history, your future - Prabhu Rajendran

As RCPCH celebrates its 25th birthday, 25 members have shared stories about a case that stayed with them. These stories will be published throughout the summer.
Picture of Prabhu Rajendran
Dr Prabhu Rajendran

Language is the biggest barrier to human progress because language is an encyclopaedia of ignorance.

I believe that language barriers can contribute to health inequalities. As communication is so fundamental in the doctor-patient relationship, caring for patients with limited English can be stressful and time-consuming, But imagine the implications on the receiving end. These patients are often seen as a homogenous group, but there are are differences in their expectations and health beliefs, depending on their cultural backgrounds.

Wherever the art of medicine is loved, there is also a love of humanity

Hippocrates

I was a paediatric registrar then, still can’t get over the perturbed feeling of that long weekend. A seven-year-old girl* was brought into A&E unwell with a significant skin infection. Having received a fast-bleep, I quickly rushed to review her as my A&E colleague was concerned. Due to a language barrier, there was limited history from the father. As a team we agreed that it was safe for her to be immediately moved to the Resuscitation cubicle.

I tried to communicate my concerns with the father, that we were worried about his daughter as she was, I said, very sick. There was silence, but he appeared to be visibly distressed. I could feel from his expression that he sensed the seriousness of the situation, but still we were unsure how much information we shared was understood. He remained frozen, as he looked as if he felt helpless.

By this time, we had more people going in and out of the cubicle to review the patient, and discussions were initiated with the tertiary hospital about further management. The initial blood results showed that the kidney function was significantly deranged; we had to start treatment to prevent her from getting any life-threatening heart rhythm changes. We spent hours in A&E resuscitation, as she did not respond treatment and continued to deteriorate in front of our eyes.

Mother then arrived with her friend, both distraught. Almost at the same time, the transport team arrived. After multiple discussions among the various medical teams, it was decided that the girl needed to be transferred to another hospital with Paediatric Intensive Care Unit for further management

Again, there was silence. This time it was insightful, powerful and full of meaning. 

I took both the parents and their friend to the relatives room along with my anaesthetic colleague and nurse in-charge. We tried to explain what was happening. Again, there was silence. This time it was insightful, powerful and full of meaning. I could see the pain and grief in their eyes, but that they still appreciated the efforts being made. I felt this, as I tried to comfort them. I now think of the quote by midwife Ina May Gaskin, "Touch is the most basic, the most non-conceptual form of communication that we have. In touch there are no language barriers".

It took a considerable amount of time for our team, along with the transport team, to stabilise her before she was deemed fit for transfer. After the ambulance left our hospital A&E, we all returned to the ward feeling a bit dreary. Later that evening, we received the sad news from our A&E colleagues that she died en route to the tertiary centre.

One of the important lessons I have learnt in overcoming communication barriers is by being more visual, and I encourage my team to make full use of the visual prompts. We must all work hard on all aspects of our communication and strive to be as unthreatening as possible, especially to those who cannot understand what we are saying.

The good physician treats the disease; the great physician treats the patient who has the disease.

William Osler

In spite of these kind of challenging experiences, I still continue to do what I enjoy doing the most: being a paediatrician and children’s advocate. I strongly believe in the words of Albert Einstein, "Only a life lived for others is a life worthwhile". The language barrier we faced in this situation is just the tip of an iceberg in terms of the real barriers to health, faced by those with limited English proficiency. Moving forward, it would be nice to have a curriculum built into our care model that talks about implicit bias training, cultural sensitivity and cultural competency.


Prabhu Rajendran is a Consultant Paediatrician, with a special interest in Community health strategy and Child health policies, based at Cambridgeshire Community Services in Bedford. Committed to the welfare of the BAME community in the UK, he is also the ‘RCPCH Ambassador’ for the BLMK ICS; advocating for the integration and improvement of local services in ways that benefit Children and Young People.

  • *. Names and other information that could identify someone has been changed.