In one of my other posts I mentioned language barriers. This, to me, is one of the most challenging barriers to overcome. There have been several instances where language has been a point of struggle. For me, I had to take a trip to the emergency clinic for a severe sinus infection. The people I interacted with luckily spoke some English. However, there were a few people that spoke limited English and communicating my insurance, symptoms, and what medicines I was taking was challenging. There was a lot of Google Translate being used. To my knowledge, the translations were mostly accurate but I was lucky they knew some English to get a sense of what was happening. I also had other people I interacted with that were available for translating if needed. I remember feeling so relieved when someone spoke good English. I felt understood and really heard. It reminds me of how many times I have encounters with patients in a language I know nothing of. It can be uncomfortable and frustrating for patients when they cannot get their full message across. It is also frustrating for the physician because they want to get the full story to properly treat the patient. There have been times were we have a telephone interpreter where they have an entire conversation with the patient after we ask a question and the response the interpreter gives is not word-for-word what the patient said. Today was an interesting encounter as there was a language barrier between the doctor and a patient from Afghanistan. The patient brought a friend that knew a little bit of Greek but not enough to fully interpret. There was confusion between whether or not the patient was having a fever or not. Since the patient was having joint pain, it was a crucial part of information to narrow our differential. Ultimately, the friend called another friend to help translate and it turned out that the patient thought we were asking about hot conditions and he responded, "yes", since he works in a green house but he was not talking about a true fever. That one piece of information was very important in how we decided what to do with him. I can only imagine what else gets lost in translation without the proper translating options. This reinforces my previous comment about the importance of having the proper translation options available. It also reinforces that in the US, we should be better about learning other languages to better close these language gaps that we have with at least some of our patients.

In Crete, a vast majority of the island is Orthodox. During this week, it is the end of Holy Week- the week Jesus dies and rises from the dead. Before this week, there is a fast for 40 days to represent the 40 days Jesus spent in the desert fasting. Individuals choose how much they want to participate in this fast. At the most extreme, people will not consume any animal-based products for the whole 40 days. Others will just not eat meat or not eat meat Wednesday and Fridays. Depending on the person, this can play a major role in a person's health. In some ways it can be beneficial specifically for cholesterol to refrain from eating animal proteins and focus on plant-based proteins. However, with the lack of meat in the diet, people tend to add in more carbs which can affect blood sugar in those with diabetes the most. People also will add more salt to their meals which can raise blood pressure. Another thing my preceptor mentioned is that a lot of people will get diarrhea after the easter holiday from re-introducing meats and the abundance of foods and sweets consumed. I noticed that many of the conversations were revolving around education about fasting and how to manage their religious practices with chronic diseases. Since it was towards the end of the fasting period, conversations were also focused on reconciling the disturbances created from the fasting period. In the US, I find that we are often unaware of the religious holidays outside of the Catholic Christian holidays. Another big fasting holiday is Ramadan for Muslims. As physicians, we need to be aware of these times for our patients to make sure they are able to practice their religion the way they want but also be sure they are doing so safely.

Today was a special day! We took a team to go on a home visit. It is common for those in primary care to do home visits for patients unable to make it to appointments on their own. This particular patient was bed bound and needed a catheter changed. We gathered supplies from the clinic and then walked to the patient's home. When we knocked on the door, the patient's relatives that cared for them opened the door. The resident and nurse we were with told us that this was a very traditional Greek city home. The marble staircase winded up to the room where our patient was. They had a hospital bed set up for the patient along with a TV, chairs for company, family pictures, and medical supplies. The patient had a stroke several years ago which lead them to be bed bound and trouble feeding. It is common for patients' families to take care of their elderly parents/in-laws as the family unit is extremely tight here. It puts strain on the family but they would not have it any other way. There are not many nursing facilities on the island of Crete, which is also an emphasis on taking care of your family members. I feel this concept has been lost in the US. Many families now rely on nursing homes and other care facilities to take care of their elderly family members. Although, many of them do not want to go to these facilities for lack of outstanding treatment or conditions. We also do not feel the strong family bond of taking care of our elderly as if we do not "owe" it to them for raising and caring for us. While I see the strain it puts on people for time, responsibility, and stress, I do see the value of taking in older family members. I wish there was better support in the US for keeping our elderly patients in our homes. You could feel the love and care the family had for the patient and the appreciation for us being there. The patient was also extremely grateful for our presence and offered us candy before we left. With the growing elderly population, I think we should have better resources for families to care for our loved ones and/or better and cheaper facilities for them to be in.

Today is day 4 of getting settled into the day to day in this rotation. The medical students have been our right-hands in navigating this atmosphere. They translate the conversations between doctors and patients as well as help us understand where we should be and how to either participate or stay out of the way. They are also our window into the Greek culture. We have talked about everything under the sun from school, politics, the weather, and where to eat. An interesting concept that we discussed was misinformation and mistrust with the medical system from the influence of the internet. This phenomenon was exacerbated by COVID19 and has since taken off. We expressed the frustration with health influencers' 'medical advice' even though they do not have the education to back up what they are saying. This is also a problem in Greece. We discussed how patients will start taking advice from health influencers, try supplements or hear misinformation about subjects like cortisol and ask for labs, medications, and tests that are not significant or effective. Then, some patients will not trust your opinion anymore or question or your validity. It is scary and difficult to navigate as a physician when juggling misinformation and patient trust. It was interesting to hear that we share many of the same problems with social media, specifically. Politics were another point that we talked about. I found it fascinating how much the Greeks knew about the history and politics of the United Stated but we knew nearly nothing about theirs. Similar to how they all now English and we do not focus on learning other languages. It feels privileged and borderline entitled to be able to expect other people to adapt to your language. I wish that was something that we did better in the US. Other countries are so willing to learn about the US but we are very self involved and don't necessarily pay close attention to the history and politics of the rest of the world if it does not involve the US. It makes me thankful for the experience here to be able to learn about other cultures.

It's like the first day of school! But all in a foreign language-Greek!

I am excited and nervous to begin my experience in Crete, Greece. I have been trying to do my research, have been doing Doulingo for 3 moths, and have packing for weeks but still don't feel ready. I don't think any amount of research could prepare you for living and working in a new country than diving in head first. Unfortunately, as I sit here before my flight, I am feeling so sick. I woke up yesterday under the weather so many medications were purchased to withstand the flights and travel. With my medicated, sick, nervous brain, several thoughts occur to me. I wonder if many people speak English. Being in the US, we rely on people speaking English during medical visits but are not expected to know other languages. We do not do a good job being culturally welcoming in the US especially in the medical setting. It will be good to get a taste of our own medicine (for lack of a better phrase). I also wonder how primary care will be viewed in Crete. From research, there seems to be a strong emphasis on primary care but anecdotally, I have heard otherwise. I am also curious about the National Healthcare system in Greece. This type of system with universal coverage is a foreign concept to us but a medical bill may be foreign to them. As a future family medicine physician, I am curious about the path to becoming a family family medicine doctor. As the boarding announcements begin, I can't wait to embark on this journey