Lotus Dao remembers asking his mother at young age, “What if I like girls?”
His mom was cooking on the stove. She stopped, looked at him, and said “No.”
“I was like, ‘What do you mean, no?’” Dao said.
“She was like ‘You’re not,’ ‘You don’t,’ and I could tell she was kind of struggling. But I remember back then I was confused, so I was like ‘I guess you’re right, I guess I can’t,’” like girls, Dao said.
Today, Dao lives in Oakland and is transitioning from female to male. But when he was going to high school in Garden Grove, California, where he was raised in a Vietnamese-speaking home, he identified as a lesbian. As he started developing feelings for women, he became more aware of words for sexuality through websites like MySpace. He asked his mother if there was a word for “gay” in Vietnamese. She told him the word was bê đê. “That’s the first Vietnamese word that I learned for anything that wasn’t ‘heterosexual,’” Dao said. “We were kind of conservative, but it’s common for Vietnamese families. You don’t talk about sex. You don’t talk about sexuality.”
Before starting his transition, Dao used the word his mother taught him to come out as a lesbian to his family during his senior year of high school. But in college, Dao learned that the term was actually derogatory. “I thought that bê đê meant all-encompassing LGBT,” Dao said, using the acronym to refer to lesbian, gay, bisexual or transgender people. “But then this person that I met was like ‘No, that actually means ‘faggot,’” Dao continued. “When I came out to my mom I didn’t realize that I was saying the equivalent of ‘I’m a fag,’ and she had this really strong response to that, which makes sense now.”
Dao said that his mother probably did not know the word was used in a negative context. “Maybe she would see a gay person, or a lesbian person, or a transgender person, and then hear them get called bê đê,” he said. “I think that that’s why she didn’t know the other words.”
In college, Dao learned that a word for lesbian in Vietnamese is ô môi. He later learned another word— đồng tính. “It’s a little bit more vague than in English,” he said about ‘đồng tính.’ “It’s like ‘same-gender loving.’”
This summer, while on vacation with his family in Vietnam, Dao told his mother he was in the process of transitioning to male. Once again, he could not find a word in his native language to describe who he is to his family.
Dao’s linguistic dilemma is played out not only in many families, but in many doctors’ offices in the United States. Asian LGBTQ people often do not know certain words regarding sex and sexuality in their native language—or their language may not even have a certain word—which can affect the way they communicate with their doctor. It is also a challenge for medical providers, who need to find the most culturally appropriate terms to use for an individual patient.
In the Bay Area, some health care agencies have taken steps to minimize problems in interpreting at the doctor’s office for Asian immigrants who identify as LGBTQ, and who are monolingual. This summer, Asian Health Services (AHS) in Oakland published a glossary in Korean, Vietnamese, Chinese and Burmese for its interpreters and non-English speakers to use.
The 22-page glossary includes words like gay, lesbian, and bisexual, to name just a few. In Korean, the glossary translates bisexual as “a person who loves both sexes.” And in Chinese, it uses the characters for “female” and “same” to translate “lesbian.” The glossary also includes words to describe emotions and social problems: It lists translations for terms like prejudice, social exclusion, trauma and suicidal tendency.
The glossary is meant to help doctors and patients communicate, because some terms are difficult to translate or don’t have the same connotations in other languages that they do in English. Eunice Lee, an intern at AHS this summer who worked on the project, said she began developing the glossary by putting certain terms that exist in English, like “intersex,” “androgynous” and “coming out” into Google Translate. “We had a lot of fun times with Google Translate and have it translate something totally absurd,” Lee said. One time, she got something along the lines of “dragging a king” as a translation for “drag queen” in Chinese, she said.
Some terms, like “queer,” simply do not have an equivalent in some Asian languages. In English, this term is often used to encompass a wide variety of sexual orientations, including being gay, lesbian, bisexual, transgender, intersex or asexual. But some languages don’t have a word for such a concept. In the health center’s glossary, the definition for “queer” in Vietnamese is the same as the definition for “homosexual,” Dao said.
“In English queer is—it’s open and it’s fluid,” Dao said. “I think in Vietnamese there may not be the exact translation yet. I still don’t know how to explain [queer] to my mom…I say, ‘I love men and women and people that are neither,’ and my mom would be like, ‘What? People that are neither?’ So I have to explain it more,” he said.
Lee said Dr. Kerry Kay, a physician, saw a need for a resource like the glossary when treating monolingual patients at the Frank Kiang Medical Center, a clinic operated by AHS. Kay said that as a doctor, the biggest linguistic challenge is not knowing when to use either the colloquial or formal form of words related to sexuality or sex. “It depends on patient to patient and culture to culture,” Kay said. “In the Cantonese culture, what I have found is that terms are a lot more colloquial.”
And, he said, there are currently not many other resources medical providers can offer to Asian patients who don’t speak English. “It’s not like a gay or transgender person who speaks perfect English—then I can send them down the Internet or to community centers they can go to,” Kay said. “When you are monolingual, or you work all the time, there are no resources for you.” This can be isolating, he said.
But using appropriate language can make patients feel comfortable when talking to their medical providers. “Correct terms can tell them that we’re not going to judge them, that we’re going to be welcoming, no matter what they tell us,” Kay said. “I think that that’s why it’s important to our patients that we’re competent in the language that we use.”
When developing the glossary, AHS took drafts of it to the Asian and Pacific Islander American Health Forum to gather a wide range of opinions from interpreters and LGBTQ community-based organizations on the definitions to use. The forum is an organization that works to promote health equity among Asian Americans, Native Hawaiians and Pacific Islanders.
Ben Cabangun, the capacity building manager for the forum, said AHS began the project by looking at the resources generally available in LGBTQ health care from groups like the American Medical Association, the Gay and Lesbian Medical Association or the Healthcare Equality Index, and saw how they could adapt them to their patients’ culture.
Health care providers who are linguistically competent and also understand their patients’ cultures are rare outside the Bay Area, Cabangun said. “What’s even more rare is to have a provider that reflects the language and ethnicity of their patients, but also be competent and experienced in serving LGBT communities,” he said. “So I think that’s what the core issue the terminology glossary attempts to address.”
There are practical problems for LGBTQ patients who do not speak English, Cabangun said. One of them is the use of the medical translation service LanguageLine, which doctors sometimes use when they do not have an interpreter present. Through LanguageLine, a doctor can reach an interpreter on the telephone while he or she is with a patient in the exam room.
“Although they’re very competent in the language, they’re often not trained to discuss really sensitive issues when it comes to LGBT-related health, such as HIV, STDs, sex, sexuality and other related health disparities that are often seen as taboo among Asian American, Native Hawaiian and Pacific Islanders,” he said. The LanguageLine interpreters “may not have the right slang to use, and it acts as a barrier to being truly aligned with the values a provider might be trying to portray to their patients.”
Another common problem is using family members as interpreters. “When it comes to discussing really taboo topics that have to do with sex and sexuality and the sexual health of LGBT people, those taboo issues are hard to discuss with a family member in the exam room with a doctor,” Cabangun said.
Juno Obedin-Maliver, co-director of the Population Research in Identity and Disparities for Equality Study at UC San Francisco, which aims to gather long-term health and disease data in the LGBTQ community, said there is a lack of understanding in medicine about how to support people from different backgrounds and who speak different languages. “In many different medical contexts, straight translation, as it were, isn’t sufficient,” said Obedin-Maliver, who is an ob-gyn and a clinical instructor at UC San Francisco Medical Center.
She gave the example of the 2013 National Health Interview Survey, which asked people about their sexual orientation. According to the study, the survey gave people the following options: lesbian or gay, straight, bisexual, “something else” or “I don’t know the answer.” However, according to the study, when the question was asked to Spanish speakers, the options were modified “because there is no conceptual translation for the word ‘straight.’” In Spanish, “heterosexual”—which spelled the same as it is in English—is most commonly used.
“These are words are situated in a linguistic and cultural context,” Obedin-Maliver said. “It would really take someone who is a bilingual, bicultural person to really understand and start to help us all.”
Language is important in the relationship between patient and physician, she said. “In medical school, we’re taught that 70 percent of figuring out what’s going on with somebody is about their history and talking to them in the interview,” she said. “If the way that the interview is done—the words that are used, the nonverbal components as well—are off-putting to somebody, I think that can damage the therapeutic relationship and make people less comfortable to share what’s going on in their lives.”
In 2014, the Association of American Medical Colleges released a document to all medical schools called “Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who are LGBT, Gender Nonconforming, or Born with DSD,” an acronym that stands for “Differences of Sex Development.” The document, intended to be a resource for medical instructors and doctors, is meant to improve patient care through medical education about sexual orientation, gender identity, gender expression and biological sex development. It points to outdated terminologies that physicians should refrain from using, such as using “homosexual” and “heterosexual” as nouns to identify a person. Instead, these words should be used to describe behaviors, according to the report.
Priya Kandaswamy, associate professor of women’s gender and sexuality studies at Mills College, said that vocabulary for sexual identity changes over time. Words like “gay” or “lesbian” have replaced previous words like “homosexual” or “homophile,” she said. Words to describe LGBT people “in the past usually came from medicine or psychology and have really negative connotations, like there’s something wrong with you—like a disease diagnosis,” Kandaswamy said.
In time, LGBT people have reclaimed words that were often used to negatively describe them. “Part of it is taking away the negativity of the word,” she said. An example of a word that has been reclaimed is “queer,” which many people now use to describe themselves in a positive way.
“If someone calls you queer in a derogatory way and you and other people can say ‘Actually, to me, being queer is something positive,’ it is a way of fighting back against that power structure,” she said. “As you reclaim words, then those words cease to have the negative power they once had.” However, Kandaswamy said, some people from older generations are still hesitant to use these words because, for them, the word still carries a negative connotation.
A sense of community is created when people start using certain words to identify themselves, she said. “Words like gay or queer—the reclamation of those words—are linked to social movements that brought people together and worked to change institutions of heteronormativity,” she said.
Kay said the number of patients he treats who identify as LGBTQ is low, but that’s possibly because people are not coming out. In some Asian communities, there is a stigma attached to being LGBTQ, and people fear not being accepted. “When people don’t come out, and when they don’t have the right language for it, I think their health suffers,” Kay said. He has had patients test positive for HIV, he said, and it is only then he finds out that they were engaging in risky sex.
Kay said he has a patient who does not speak English and whose wife remains in their home country. “He just said he has sex with men. I don’t know what he calls himself,” Kay said. “I think that’s part of the stigma problem.” Kay said that unlike American patients, he cannot talk to this patient about coming out, because culturally it would not be acceptable. There are also no language-specific support groups he would be able to send the patient to, he said.
Laura Nelson, associate professor of gender and women’s studies at UC Berkeley, researches gender in South Korea. In the case of LGBTQ Korean immigrants, it could be difficult for them to come out in the Korean American community, since a majority of that community practices Christianity “in a mode that tends to be unaccepting of non-normative sexuality,” Nelson said. “They would have to manage their persona with other Korean immigrants in a different way they manage their persona with the rest of the U.S. community.”
And, Kay said, sexual terms are often not discussed in Asian culture in general. Dao said he has never talked with his mother about sex, and only recently learned the Vietnamese words for “vagina,” “sex” and “masturbate” from the AHS glossary. He learned Vietnamese from his mother, so “the silence was passed on,” he said.
For now, the glossary has been distributed to the translators and medical assistants at AHS, Kay said. “I think it’s important for us to give them the tools, so that they can do a good job, so that they can provide sensitive care for our patients,” Kerry said.
And notably, the last page of the AHS glossary was left blank—allowing users to write in additional terms, or adapt as language continues to change.
Today, Dao works as a social worker for the San Francisco Homeless Outreach Team. He said that he wishes the glossary would be more publicized, because he believes it would make it easier for some people to come out. “When I talk to my friends about their coming out process as a lesbian, queer or trans, I think the commonality that a lot of them have is that we didn’t have the language to come out in a articulate and thoughtful way,” he said. “We came out clumsily.”
Having the glossary in clinics could open up conversations about sexuality, sex and reproductive health, he said. “Whereas I think if the glossary wasn’t there, then this conversation may not even happen,” Dao said.
Dao said he would like organizations representing Asian communities to push conversations about sexuality and gender. “Some people think that being queer is a result of being Americanized,” he said. But talking more may help reduce the stigma toward being LGBTQ, Dao said.
For Dao, some of his language problems have been resolved, but for others, he’s still searching for the right words. Dao now uses the Vietnamese word chuyễn giới, which translates to “transgender,” to describe himself to his mother. “I know for a fact that I’m trans, and she knows too, and there’s a word for that,” he said.
But when trying to describe who he loves in Vietnamese, the definition remains murky. “In terms of my lifestyle, and that aspect, there hasn’t been a word yet,” Dao said.
Correction: On Dec. 16 the post was updated to correct the name and job title for Dr. Juno Obedin-Maliver.