The help of a translator

My first placement of the year was a musculoskeletal placement. I encountered patients from many different backgrounds, one of these being a lady who spoke very little English. The reason for her appointments was rehabilitation for her ankle which she had broken and she seemed to be progressing quite well, however her main complaint each time she visited me was of a sore back. As she was a public patient and refered to us for her ankle her back was not something we were supposed to be treating unless it was related to her ankle but all things that it seemed may be causing the back pain if it was as a result of her ankle, such as incorrect use of her crutches or longs periods of uneven weight distribution through both feet, had been rectified and advice given. the pain still did not cease. I was finding it difficult to take a proper subjective of her back pain, especially finding out aggravating activities and if the advice we had given had made any difference.
One day the lady brought her daughter in to sit in on the appointment and help with anything that she did not undertstand. We spent the entire hour appointment talking and a lot was revealed. It turned out that the lady had been continuing to do all of the housework and not letting her children help despite having difficulty getting into comfortable positions to do the work due to her ankle. She told me it was always after doing the housework that she found the pain was at its worst. I provided education on the need for active rest even though it was a few months post-surgery and the need for her to allow her children to help her with any duties she was having troulbe with or were aggravating her back.
Having the daughter come in to translate (and provide a little background information!) saved a lot of time in treating a problem that could have been fixed by eliminating or reducing some activities from her day. To begin with I felt bad that this lady had not received any hands on treatment from me and that the entire session had been spent talking, but then i realised the lady left appearing more happy and confident than she had from any of the previous treatment sessions.
This experience made me realise that many patients may not realise that an activity they are doing is doing them any harm, or aggravating an injury and therefore may not ever raise the issue witht hte therapist. It highlighted for me that in future a very thorough subjective assessment should always be performed, especially if one has already been taken and the cause of the problem does not seem to have been revealed.
It also made me think about the value of a translator. Although they are not available in all cases, I felt as though in this case it may have been very difficult to have ever ascertained the cause of the back pain without one.