Lost in translation? Experience of the non-Lithuanian psychiatrist from Lithuania in Norway
- Goda Tikniūtė
- Jan 7, 2018
- 8 min read
Interview with Artiom Charkavliuk
In our 21st century world, the idea of "bloom where you are planted" is no longer so trendy. Instead, we are increasingly taking advantage of opportunities to move, experience, and seek self-fulfillment wherever we want and wherever we find opportunities. I guess this is even more appealing to those of us who have lived behind the Iron Curtain for a long time. Alongside the excitement that these opportunities bring, there is also another side to consider – the work of a psychiatrist requires a deep and broad understanding of contexts and communication, and this is not just a matter of verbal communication. I talk about these and other challenges today with my colleague, psychiatrist Artiom Charkavliuk, who left Lithuania and now works as a psychiatrist in Norway.
The theme of this issue is "Lost in Translation?" How much does this theme relate to you and your situation as a professional?
I think this topic affects everyone. I mean, people travel, and so do patients and doctors. For most people, communicating in another language is a random occurrence, but in my case, it is an everyday occurrence. I have had to practice in a language other than my native language in both Lithuania and Norway.
What challenges are worth mentioning in your intercultural professional history?
Emigration, especially professional emigration, is not just a question of language. Of course, language is a priority, but the healthcare system and cultural environment are just as important. Learning Norwegian is part of the job; being a doctor in Norway is more than just a medical degree and language courses. It's a slightly different role with different expectations.
In my opinion, the Lithuanian healthcare system is more hierarchical, competence-oriented, and seems more independent from other state institutions. Again, I don't want to say that the Lithuanian healthcare system is better or worse, it's just different. In Norway, cooperation, consultation, and consensus among institutions are central. This does not mean that doctors cannot make independent decisions within the limits of their competence, but treatment is understood as a collective effort rather than the responsibility of a single doctor. Some decisions in the Norwegian healthcare system are made through teamwork, both within institutions and between institutions. I work with other specialists, such as psychologists and nurses, at my institution (DPS). At the same time, my institution cooperates with the municipality, the employment office, family doctors, etc. It is important to understand not only how the patient will be treated at the institution, but also how the institutions will cooperate with each other. Discharging a patient without informing the municipality about the patient's care needs or without informing the family doctor about treatment needs would be considered bad practice.
I obtained my medical degree and basic Norwegian language skills before coming to Norway, and I improved my Norwegian over a couple of years, but becoming a doctor in Norway is a longer process.
What areas of "miscommunication" were the most important, most in need of improvement, and worth investing energy in?
"Reading between the lines", cultural and historical references, and pronunciation/dialects. Language courses provide basic knowledge. Reading between the lines and cultural and historical references are a long-term investment. For example, cultural and historical references are usually acquired at school and in the family. Foreigners have to invest time and be patient. It is possible to understand intellectually what janteloven (unwritten rules of Scandinavian society that emphasize community rather than individualism) or dugnad (collective voluntary work) are, but to truly understand and feel how they work is something else entirely.
Pronunciation is also important. In Lithuanian, pronunciation and spelling are roughly the same, but in Norwegian it is different. It is important to understand not only the spelling, but also the correct pronunciation. I will amuse readers a little, especially Norwegians. In Lithuanian, the word "dozė" or the English "dose" is pronounced with the letter "o." In Norwegian, "dozė" is written "dose." But there is a nuance! The Norwegian "o" is pronounced like the Lithuanian "u", while the Lithuanian "o" is the Norwegian "å". At first, I pronounced "dose" in the Lithuanian/English style with an "o" (Norwegian "å") until a young female patient after 6 months (!!!) told me that the way I was pronouncing it meant something else. I thought I was going to die in the office when I found out that the pronunciation with "o"/ "å" meant female reproductive organs. I thought I was going to die in my office when I found out that the pronunciation with "o"/"å" does not mean dose, but female genitalia. So imagine, for six months I was telling patients about various female genitalia, how we would enlarge them, reduce them, etc.
Dialects are also worth mentioning, especially in Norway. In Norway, as in Lithuania, there are many dialects. There is only one difference – dialects are more acceptable in Norway than in Lithuania. A Norwegian from Vestland or Finnmark can, for example, move to Vestfold and speak their dialect. This is acceptable. To a foreigner, dialects may seem like a different language, especially at first, when one colleague speaks one way and another speaks completely differently. For example, my first patient was from Finnmark, and I could only communicate in the eastern dialect ("østlandsdialekt"). The experience was interesting, but I understood more than I expected, so there was no disaster. Norwegians also "recognize" other Scandinavian languages, such as Danish and Swedish. So it may happen that one colleague is Danish and another is Swedish, and they speak their own language.
In Lithuania, dialects are more of a local phenomenon. If someone from Samogitia moves to a big city, such as Vilnius or Kaunas, they are expected to speak standard Lithuanian. Of course, you can use some Samogitian in everyday life, but at work, for example, you will quickly be asked to speak Lithuanian. I don't think that one variant is right or wrong, they are just different.
How did you feel at the beginning when communicating with your colleagues? How did the situation develop?
In my professional field, it wasn't as difficult as it might seem. Much of the medical jargon is international, and in Norway, doctors often use English words, probably for convenience. Of course, jargon is not enough, but it helps a lot, especially when you need to communicate accurately and quickly. Perhaps informal, non-professional language progressed more slowly, and that requires social contacts outside of work. But digital progress helps, for example, audiobooks in Norwegian helped me.
My first Norwegian department head and colleagues from Eastern Europe (Romania and Poland) also helped me. The department head had experience with foreigners, and other colleagues, who were doctors, helped me a lot.
Artiom Charkavliuk: "In Lithuania, dialects are more of a local phenomenon. If someone from Samogitia moves to a big city, such as Vilnius or Kaunas, they are expected to speak standard Lithuanian."
A significant number of Norwegians complete their medical and psychology studies in Europe, including in our country. Many return home, so they also understand our mentality to some extent. When I first returned to Lithuania, I was surprised by how many Norwegian tourists there were in Vilnius.
The language barrier is indeed an obstacle at first, but later on, a lot depends on personality traits and the desire to adapt to the new system and work culture. Norwegians are quite flexible when it comes to language and are very patient in this regard, but they place a lot of emphasis on functioning/fitting into the team.
What experiences, or lack thereof, were obstacles in communicating with patients? And what helped?
I already had similar experience in Lithuania. In the city where I grew up, most of the residents did not speak Lithuanian. When I moved to Kaunas to study, it was like emigrating to another country. So, this experience helped me in the beginning, because I knew roughly what to expect, when my language skills would improve, etc. I have a certain intuition for languages. This means that I don't need to understand every word in a sentence to get the gist of the message. Of course, digital translators are also very helpful.
Perhaps I should mention accents, but I talked about that earlier.
My colleagues and the patients themselves have also helped me. It was a dynamic process. I feel like I've helped a bit myself, because there are patients from Lithuania, Ukraine, and Russia. Lithuanians are the third largest ethnic minority in Norway. I've often helped my colleagues with translation or certain cultural aspects, such as what superstitions are common in Eastern Europe and why they are not delusions.
How much do you feel connected to the local cultural environment in a non-professional context? Do you feel that it nourishes you enough to be able to do your energy-intensive job for a long time?
Immigrants must be prepared for their non-professional life to develop at its own pace. Many social connections are formed early on—family, street friends, neighbors, school, university. This is a natural process. We leave our social network when we move to another country and have to build a new one in the new country. This process is not so spontaneous and requires more efforts.
At first, the language barrier and lack of historical and cultural knowledge were obvious. Shortly after moving to Norway, the COVID-19 pandemic began. These two factors severely limited socialization outside of work. I wouldn't say that it was emotionally difficult for me personally, but as I mentioned, language and integration outside of work developed more slowly. For example, when the conversation turned to some cultural phenomenon (such as a public figure or something similar), it was difficult to keep up because I didn't know what they were talking about or how to express my opinion. You speak your native language automatically and usually however you want, but in a foreign language you have to speak not how you want (what you think), but how you can at that moment (what you are physically able to say), i.e., using a more limited vocabulary. So, in the beginning, you either have to speak briefly or remain silent.
I knew a little about Norway before I moved there, for example, that one of my favorite painters is Edvard Munch and my favorite writers are Knut Hamsun and Henrik Ibsen (I have their works in Russian, Lithuanian, English, and Norwegian), and I had studied Norwegian history during World War II (history is my hobby). So I arrived already somewhat familiar with Norwegian culture. Getting to know people outside of work was a bit slower because of the things I mentioned, but after two years I started to see results. I made friends with locals and started to feel more at home, which helped me overcome my natural anxiety about fitting in and the language barrier. People often say that northerners are quite cold, but I like the temperature here, I just need to get used to it.
I quickly got to know local emigrants from Lithuania, Latvia, Poland, and Ukraine. Some of them are colleagues, some are acquaintances outside of work. I have friends from Lithuania, and even my classmate lives here, just in another city. The linguistic and cultural nuances were not a barrier, so I didn't feel very isolated at first.
What I really wasn't prepared for was how much I would miss Lithuania, and that makes life here a little harder. I guess longing is the price immigrants pay for new experiences.
I can answer your question like this: I am well fed and the menu is varied, but I miss cold beetroot soup. □
