The first sentence of "Hills Like White Elephants" contains the name of a river that might only be familiar to the geography wiz or the wearied traveler. This is a little disorienting for many readers, and might be similar to the feeling of being "a stranger in a strange land." The story is set in Spain, which puts us and the globe trotting characters in a bilingual atmosphere. The question of foreignness is woven into the bigger issue the characters face – what to do about an unplanned pregnancy when one character wants to keep the baby, and the other does not.
The story seems to be trying to deliberately confuse the reader by playing with the idea of translation.
Both characters are considered foreigners in Spain, which seems to echo the fact that they are becoming foreigners to each other.