When Victor Lopez-Carmen graduates from Harvard Medical School, he’ll be one of only about 3,500 Native American physicians. This relatively small number means that Native Americans often can’t get representative care: For every 100,000 Native people in the United States, there are only 65 physicians of the same background. This imbalance replicates itself for indigenous people throughout the world. The COVID-19 pandemic has brought the problem to the fore as these communities have faced some of the virus’s most brutal outcomes. In the United States, Native Americans test positive at 3.5 times the rate of white people, on top of having higher rates of poverty and compounding factors like hypertension and diabetes. Across the globe, indigenous communities have been left stranded without resources, culturally relevant care, or public health information in their native languages.
Lopez-Carmen, a member of the Crow Creek Sioux and Pascua Yaqui Tribes, tried to address that last problem by launching Translations 4 Our Nations in April. Starting with English guidance from the Centers for Disease Control and Prevention, he and his co-founders worked with faculty at Harvard Medical School and Mount Sinai in New York to create pithy and medically vetted fact sheets in English and Spanish. The sheets describe common symptoms of COVID-19 infection, who’s most at risk of contracting the virus, and how people can keep themselves safe. Now, 140 indigenous translators — recruited from around the world by Translations 4 Our Nations and paid for their work through grants — are reframing this information into the 100 languages they collectively speak. In just five months, work is already completed in 45 of those languages, spoken mostly in Latin America, Asia, and Africa.
The job requires much more than directly translating from one language to another. “There are some practical things in the CDC guidelines that were immediately flagged as not as applicable to indigenous nations,” says Lopez-Carmen. For example, translators are removing references that assume the reader has access to clean water or hand sanitizer or is part of a nuclear family. Along with advising people to wash their hands for 20 seconds after every encounter with the outside world, many of the indigenous translations include the qualification “if these resources are available.” Translated pamphlets also acknowledge that many people are sharing a home, or even a single room, with eight or 10 other people, and quarantining the sick person may not be possible.
Sometimes, however, there’s just no word that will do a translation justice.
Emily Lerosion, a leader from the Samburu Tribe in northern Kenya who is working with Translations 4 Our Nations, says that describing some of the symptoms of COVID-19 became a stumbling block for her. “When you talk of [fatigue], hallucinations, or confusions … I had to get deeper and actually explain what these mean because it doesn’t have a specific word in Samburu,” she says.
Lerosion sat down with her father, an elder in the community, to figure out how to describe these symptoms in lieu of a simple noun to do the job. Now she relies on schoolchildren in the tribe to act as conduits for the information. They take her pamphlets home to read aloud to their parents and relatives, many of whom can’t read themselves. Respecting how information flows in each indigenous community, whether it’s through the young people, women, healers, or elders, is part of the translational process that goes beyond words.
Lopez-Carmen says the organization has also encountered languages that don’t even exist in a digital typeface. So some translators have gotten creative, recording themselves reading the guidance in their language and then broadcasting the public service announcements over the radio, which also helps reach those without smartphones or Internet access.
Although this coronavirus is new, translating public health guidance in creative ways is a challenge familiar from other global crises. During the height of the AIDS epidemic in the 1990s, Western doctors — working in Zimbabwe, Malawi, and Haiti, in particular — were having trouble getting off the ground with public service announcements about the virus. They didn’t fully understand that talking about sexual health was verboten in many communities. But singing about it carried less of a stigma. Eventually, health workers began teaming with local musicians to cloak their messages in song.
Any physician from these communities probably would have thought about things like that earlier, which is what drives Lopez-Carmen’s work: The more people who can relay health information to the communities they call home, the fewer opportunities there are for information to literally get lost in translation.
“This is why representation in the medical field is so important,” he says. “I hope this sets a standard for future emergencies, for how global health can be applied to indigenous communities in a more culturally applicable, sensitive way.”
Julia Sklar is a freelance science journalist in Boston. Follow her on Twitter @jfsklar.