Health and Language Barriers during COVID

On a gloomy August morning, I walked to a public Portuguese clinic armed with my EU residency card, a screenshot of Portuguese Immigration saying my expired card had been temporarily extended, and a letter from Finanças (the Portuguese IRS) confirming my third address change in one year. My purse held prescriptions for several different antibiotics. I was headed to the clinic to get a public health number, which would help cover the costs of these antibiotics. My plan was to get the public health number and then take it and the prescriptions to the nearest pharmacy.

My boyfriend, E, had offered to go to the clinic with me to serve as a translator, but I declined. I’d already depended on him to translate throughout the entire COVID pandemic; he drove me to the myriad of doctors appointments I suddenly found myself faced with and, to top it off, I’d officially moved into his place. I fall into routines easily and I worried about getting too used to someone taking care of me. I needed to get my health number on my own, less I lose some of my staunch independence.

Walking into the clinic and up one floor, I whispered into my mask the phrase E had told me to say: Eu preciso o saudade o tens. (Anyone familiar Portuguese already knows that I’d misunderstood E and was actually repeating nonsense, but I hadn’t yet figured this out.) Red arrows lined the ground, dictating where people could walk or stand. Entrada and Saida signs hung on opposite doors. There was a prominent sanitizing station in the middle of the room. I turned in circles looking for a word that might mean this is where you get official stuff.

Most of my time during the pandemic has been peppered with medical visits like this. Since March, I’ve gone to three different gynecologists, five uterine biopsies, an MRI, dermatology check, eye exam, a cardiologist, and, soon, a neurologist. Each doctor I have seen mercifully speaks English, but the nurses and staff members typically do not. Because of COVID, I enter each hospital alone. The minutes before each appointment are usually punctuated with me wandering around until a nurse checks my temperature and then points me in the right direction. Afterwards, I wander again, punching my ID into the first kiosk I come across, and then wait to see what happens. Twice I have accidentally left without paying, simply because I didn’t know how and didn’t have the words to ask.


Accurate portrayal of me asking where is the waiting room.

An older woman standing on one of the red arrows noticed me and asked if I needed help. At least, I think she did. The Porto accent is thick and people talk fast. Whatever her question was, I responded: Preciso o tens? She stared at me for a moment and then ushered me to a waiting room. A nurse behind plexiglass looked up and I again repeated: Eu preciso o saudade o tens? He pointed for me to go up one more floor.

Upstairs, I waited in line for two more nurses behind plexiglass. The brunette nurse immediately guessed we would struggle to communicate and gestured that I wait for the blonde one. While I did, a line formed behind me stretching into the hallway. Because of social distancing, no one could see that the brunette nurse was free and only the blonde one was helping someone. I didn’t know how to tell the person behind me that he could go ahead, so I just stood there waiting…and consequently making everyone else wait, too.

At this point, I was sweating from nerves, my mask, and the lack of AC. My glasses fogged and I kept trying to adjust the placement of my mask on my nose. I tried to discreetly run my hand under my bangs. I felt like a waterfall was cascading down my head.


As per usual in expat life, there are countless times when you find yourself not understanding a language, custom, or standard way of life in your new country. Maybe there are some expats who, overtime, come to accept their own immigrant blunders and brush them aside as easily as if you sneezed in a quiet library, but I am not one of those expats.

Living in Portugal, I am constantly ashamed and embarrassed at my struggles with Portuguese. Even if I know enough to communicate with someone, most of the time I pretend like I don’t even know how to say how are you? simply because I don’t want to wade through the back and forth of someone not understanding me, correcting me, and possibly eye rolling at their bad luck at getting stuck with a foreigner. Some of this fear comes from being a wordsmith, and having an insane need to speak properly at all times in all tongues. Another part comes from a few people who corrected me too harshly upon my arrival to Portugal, and I can’t seem to gain back the confidence they so quickly knocked down. However, the biggest source of embarrassment is: I’m American.

When locals say to me, ‘I’m sorry, my English isn’t great,’ I always respond, ‘I’m living in Portugal. I should be the one who is sorry for not speaking Portuguese.’ As an American, I am acutely aware of the negative global perception my country, people, government, etc. have. And, if I were to ever forget, I have a rolling news cycle and opinionated coworkers to remind me. Online videos surface constantly of white people in the US shouting at not-white-people to “speak English” and “go back where you came from.” Being pasty white, blonde, and blue-eyed, I look like the antagonists from these videos. This amps up my shame when I live in another country and can’t speak the language because the insecure ticker tape running through my head reads: you look like a “Karen” who would yell at someone for speaking Spanish in Walmart. You have to be better than “Karen” and show that you want to adapt and integrate. When ultimately I can’t and have to force someone in their own country to speak in English with me, I feel like I might as well stamp KAREN across my forehead.


If you’re going to be a Karen, at least be Karen Walker.

When the blonde nurse was finally free, I approached the desk and handed her my documents. By now, I’d figured out I’d been saying a nonsense phrase. What I should have been saying was: Eu preciso o numero saúde utente. Basically: I need a health user number. Before, I had been saying something like: I need the have missing.


Even though I’d figured out what to ask for, the blonde nurse and I still struggled to understand each other. I used my phone to show her a saved Notepad, where I’d typed my phone number, address, and social security number. I tried to explain that my visa was expired, but “in process” due to COVID. Instead, I may have accidentally said I had COVID at some point (although the jury is still out on whether or not I did). I also had to explain why my residence card said I lived in one town, but my letter from Finanças said I lived in another.

Finally, she handed the documents back to me. “Precisas o medico?” she asked.

Medico?” I repeated.


I pointed at my purse as if she were a mind-reader and could see the prescriptions I needed to get filled. “Preciso antibiotic…o?” I said.

She motioned for me take a seat in the waiting room until my name was called. When I did, I suddenly realized my error. I texted E: I think I just made a doctor’s appointment. I relayed the question the nurse had asked me, and my answer. E confirmed: Yes, she asked if you needed to see a doctor. You responded that you need antibiotics.

Thankfully, the doctor I saw spoke English. I pulled my prescriptions out of my purse (which, in hindsight, I should have done from the beginning) and explained everything to her. She took them to the blonde nurse and returned with the public health number. “You had to be issued a number anyways in order to see me,” she explained. I felt like I had taken a really long 45-minute scenic detour for a trip that should have only been a 5-minute drive.

With the public health number in hand, I marched to the pharmacy triumphantly. I again went through a small song and dance of communication errors, before finally being issued my trove of medication. Back at home, I pulled out my phone to enter my new public health number into my saved Notepad of important numbers. This was the Notepad I had shown the nurse, the doctor, and the pharmacist. It’s the same screen I show a lot of people whenever I don’t want to even try repeating my address and various numbers. This Notepad is also where I sometimes write a quick note to myself for later.

As I opened the Notepad to add my new number, my jaw dropped. I suddenly remembered typing a Portuguese phrase in it a week ago. A friend had taught it to me, and I thought it would be funny to bust out in front of E one day.

Now, my face flushed realizing I’d been showing this screen prominently to so many people.

Right above my phone number was the phrase: Meu tesão. Slang for: “I’m horny.”


**Be sure to check out the last time I faced fun language barriers in a hospital!**

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