Please remove your clothes

Everything at the refugee clinic is complicated.

Because most patients do not speak English and come from cultures vastly different from Canada's, the simplest tasks become difficult. Taking an obstetrical history, explaining an ultrasound procedure, defining anemia or recommending aspirin are challenging.

Then there's the physical exam.

My obstetrical patient today was due for her complete physical. After explaining the procedure, I handed her a gown. "Please take off all of your clothes," I said, miming the removal of my own shirt and pants, "and put on this gown."

The Swahili interpreter repeated my instructions, the patient smiled and nodded, and I pulled the curtain between us. I heard brief rustling; then all was still. I looked around the curtain to see the patient lying supine on the table, fully clothed.

"Please remove all of your clothes," I reiterated, again supplementing with gestures. "I need you to take off your shirt, pants, bra and underwear. Everything." She made an exclamation of understanding and I turned back to my desk to prepare the requisitions.

When I next pulled back the curtain, the patient was lying full-length on the table, pants on, sweater half over her head, with her bra bunched around her throat. This time I addressed the interpreter directly. "She didn't understand. She's still dressed. All of her clothes must come off."

Shortly thereafter I heard a burst of activity behind the curtain. I looked in to see the patient standing on the table. My six-foot pregnant patient was briskly disrobing while standing on a slender vinyl-covered exam table forty inches above the floor.

I decided it was safer not to intervene, and went back to assembling the speculum and swabs. A moment later she called out that she was ready.

And she was, lying on the table, naked, with the gown rolled up into a ball and tucked beneath her head.