Personal Perspective: The Tigers Outside My Window
I arrived in the U.S. in 1999 after being separated from my husband for three years. The marriage wasn't working -- he spent too much time and money drinking with his friends. When I spoke up about it, he became more and more abusive. Then he hit me and I decided to leave him. I didn't want my son growing up in this environment. I spoke with a cousin who was living in Chicago and she helped me get a one-way ticket there. I had studied nursing in the Dominican Republic and my goal was to certify myself as a nurse in the U.S.
But in late 2001, I began to feel very tired and noticed I was losing weight. I got tested for everything and the doctor even did an HIV test, although he said it was not something I needed to worry about since I had only had one man and never used drugs. Plus, he said people in my age group weren't at risk -- I was 47. When I came back for what I thought was a simple follow-up visit, I was told that I had HIV. My doctor referred me to a hospital that he felt would be able to help me better than he could. But I had developed a relationship with my doctor -- he took care of my son and my cousin. He also spoke Spanish and his office wasn't far from where I lived -- all of that made me feel at ease.
So when I went to the hospital, I felt lost. It was large and there weren't any doctors who spoke Spanish. Each time I went I'd see a different doctor and get a different interpreter. And there were times that I was told I couldn't be seen because there weren't any interpreters available. It was also difficult to communicate with my case manager -- she didn't speak Spanish and I had to rely on an interpreter, when one was available. But I felt I didn't need any social services, anyway. I was taking care of myself -- I decided not to waste my time. I began taking HIV medications and didn't have any problems. I had read that people had problems but I guess I was one of the lucky ones.
But then, my doctor asked that I be admitted to the hospital, and I didn't understand why. Little did I know that I would end up in the psychiatric unit for observation. The entire time I was there I had psychiatrists, interns, students, and residents asking me all sort of questions: "Are you hearing voices now? Do you hear voices inside your head, or outside? What type of voices do you hear? Have you tried to hurt yourself or others?" I responded "no" to everything. When I got out a couple of days later, no one took the time to explain why I had been admitted.
A couple of years later, a case manager introduced himself at my doctor's office. He seemed friendly so I decided to stop by and see what he had to say. We talked about how I was feeling and he asked if I would see him each time I had a doctors appointment. It soon became routine.
But the next couple of times I saw him he began to ask me those same questions I was asked when I was in the psychiatric unit. I again said that I had never heard voices in my life and that I was perfectly fine. He continued to ask if I had still heard "tigres" by my window. I said no, since I now lived on the third floor. He asked me if I heard any other animals. I was confused at first, but then I told him that "tigres" aren't animals. I explained that when Dominicans say "tigres" we are referring to young men and not any sort of animal. He asked, "So it was young men making noise at your window late at night and not tigers?" I said "Yes, they (los tigres) wouldn't let me sleep."
He then asked me if I was taking my medications. I told him I rarely missed a dose. He asked if I took my medications orally or if I had taken hot baths with the medication. I mentioned that before starting my medications, I had decided to take a medicinal bath. It was a belief instilled in me as a child, a custom I had learned from my grandmother. She was an herbalist, a spiritualist and a "curandera." We mixed our medications and herbs in a hot bath before taking them -- it was her belief that it allowed us to take medications without any problems.
The social worker seemed to understood now. He told me that my medical history belonged to me, and that it might be useful for me to request a copy. He said it would help me understand why I was placed in the psychiatric unit. When we read it, I learned that soon after I began to take my medications, one of the doctors wrote that he suspected I was "mentally retarded" or had a psychiatric illness because I was using the medications in a hot bath, when in fact I had only done this once to get my body accustomed to them (and I feel that it has worked wonders for me -- I have never had any side effects). In a later note, it mentioned that I was "hearing tigers at my window," so I was being put under psychiatric observation to rule out hallucinations, delusional ideations, or schizophrenia.
It was funny in many ways, and good to finally put all the pieces together. My case manager explained to my medical providers that I really didn't have a mental health problem, or much less that I was mentally retarded. I was doing all I needed to take care of myself, and the results of that could be seen in my viral load and CD4 counts. They had improved significantly in the first few months after I began taking medications.
I've learned that there is a need to have providers and interpreters who not only speak your language but who also are sensitive to your beliefs, customs, and culture. Sometimes it's not enough to have a person that speaks your language -- you need someone who can understand the terms and words you use. If they don't understand, they should be able to ask.
I've also learned to use different Spanish words that the interpreters can understand. There aren't many Dominicans in Chicago and none of the interpreters were familiar with the terms we use. I've since become involved with a health care interpreters project at the hospital, to allow them to include terms that might be misunderstood. I feel so much better knowing that I'm helping people so that the same thing doesn't happen to others.
And I was finally able to get certified as a nurse.
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