The Multilingual Hospital: Confessions of a Sociolinguist

Our author and series editor, Viv Edwards, recently found herself in hospital. To divert her mind from her own situation, she seized the opportunity to look and listen to the activity around her…

11 July 2017 started very much like any other day. It ended in admission to an acute stroke unit. The implications of this life changing event dawned only gradually, as did the realization that things could be much worse. For starters, the damage to my brain had manifested itself in left-sided weakness; communication – that most precious of human gifts, particularly for a linguist – was unaffected. And by the time I had transferred from the acute unit to Valley, a neuro rehabilitation ward, it had become clear that this new environment was nothing short of a playground for sociolinguists.

In this world of Brexit, one of the recurrent themes has been the status of the large numbers of nationals of other countries employed in the NHS and concern over what a ‘hard Brexit’ might mean for patient and social care. This concern is certainly well founded.

Graph
These figures vary substantially across England. In London, 114 of every 1,000 staff (11.4%) are from the EU Source

Thus, while the majority of NHS staff are British, a substantial minority are not – some 12% in fact of all staff for whom a nationality is known. Between them, they report 199 nationalities (Source).

As a patient, my interest focuses very firmly on the need to fight immigration policies which risk bringing the NHS to its knees. But my interest as a sociolinguist was on languages spoken rather than nationalities. And while discussion of language in the NHS tends to centre on proficiency in English, this topic forms no part of my own narrative: all medical staff I encountered were fully proficient English speakers. Too narrow a focus on English simply misses the broader picture. In addition, my interests lie in the wider hospital community – the domestic team (cleaners and controllers of the hot drinks trolley) and, of course, patients and their families – and not just the medical staff.

Finding out

As I struggled with neurological fatigue and engaged with physio-terrorists – they who must be obeyed – in learning to walk again, my mission to establish which languages were spoken on Valley ward, and the attitudes towards them, was a valuable diversion. I was clearly dealing with an opportunity sample, not necessarily representative of the hospital as a whole, let alone the picture nationally. Nonetheless, there was potential to offer depth and light on bland official statistics. Ethically, this mission was open to question. I was hardly in a position to seek approval from an ethics committee but I comforted myself with the thought that ethics are rather more nuanced than sometimes suggested in research methodology textbooks. For instance, on hospital admission I have no recollection of having signed a consent form for participation in an international drugs trial so, strictly speaking, didn’t give informed consent. However, given that that the drug in question may have saved me from a catastrophic outcome, I have no desire to take the moral high ground.

In the absence of formal approval, I nonetheless attempted to behave as ethically as possible. The hospital has not been identified and the anonymity of participants respected. In cases such as Polish, the language spoken was transparent from people’s names, bypassing the need for consent. In other cases, I simply explained that, as a linguist, I was interested in which language(s) they spoke at home and, without exception, people were happy to share. I also mentioned what I was doing at a multidisciplinary case conference before I was discharged, where participants volunteered information on the languages spoken by colleagues I hadn’t been able to approach directly. Asking people what languages they speak is clearly a less sensitive issue than asking them where they come from.

Untitled-1
Figure 1: Languages spoken on the ward

Some 17 different languages were spoken on the ward (see Figure 1, left). In almost all staff roles, bilinguals outnumbered monolingual English speakers. The majority of patients, in contrast, were native speakers of English, no doubt reflecting the fact that most people in neuro-rehabilitation have suffered a stroke and are therefore more likely to be older rather than younger; the median age of immigrant communities in contrast, is lower than for the population at large.

Attitudes towards multilingualism

Multilingualism is normal condition

On a global scale, multilingualism is the norm, as captured by the slogan: ‘Monolingualism can be cured: learn another language’. By the same token, the multilingualism that lay just below the surface in Valley ward was, for the most part, taken for granted. Its ‘normalcy’ was neatly captured when a patient, who was admittedly suffering from intermittent confusion, asked Steven, a nurse born and brought up in Southampton, how many years he had been living in the UK.

Today, of course, we are all products of globalization and beneficiaries of the accompanying population movements. Speaking personally, I have two Polish daughters-in-law. One of the physiotherapists was engaged to a Peruvian; the partner of an HCA was also Peruvian; they had a Brussels-based granddaughter growing up with French, Flemish, Spanish and English. An occupational therapist was married to a Dane. The daughter of a Polish HCA was living in Greece and about to start studying in Malta.

Attitudes towards language learning

It is therefore not altogether surprising that many members of this multilingual community showed an interest in languages and language learning. There were many examples. A Spanish-speaking nurse who had volunteered to take part in a research project on bilingualism was happy to share her experience of an MRI scan of her brain. Some of us took a first tentative step in Twi, the language of my Ghanaian ‘roomie’, encouraged by her visitors who always warmly greeted other ‘residents’ with ‘Eti se?’ [How are you?]. When a physiotherapist learning Spanish in preparation for a trip to Peru discovered that I had a basic grasp of the language, she suggested we could conduct our therapy sessions in Spanish. When push came to shove, however, both activities required more concentration than either of us could muster and we rapidly reverted to English.

Language and laughter

The healing qualities of laughter are well attested. Increased endorphins facilitate feelings of well-being while higher levels of DHEA, a steroid produced by the adrenal glands, have been associated, among other things, with enhanced mental abilities. Improbable as it may seem, laughter was the hallmark of life on Valley ward. In such a multilingual environment, there were many opportunities to use other languages in unexpected contexts with the intent of making people laugh. One of the nurses quite often produced apparently random expressions in French and Italian. My own nursery Polish, acquired in my role as grandmother to a half Polish grandson, was surprisingly transferable to a clinical setting, given that Polish was the language with the largest number of speakers after English (tak [yes], nie [no] kupa [poo] koniec [finished], dobra noc [good night] and so on. When a member of staff was clearly tired at the end of a shift, the use of kochanie [darling] or miśu [sweetiepie] was usually successful in raising a smile. So, too, was the call from a doctor across the corridor of ‘Voulez-vous danser avec moi?’ [Do you want to dance with me?] as I practiced my first wobbly steps. The absurdity of this request in a setting where patients’ main challenge was to stay upright in the battle for forward propulsion certainly lightened the mood.

Language in the service of society

When requested, this hospital, like most others, routinely offers interpreters for outpatient appointments. Of course, this provision is not practicable in the context of longer term care. Here, multilingual staff are thus an asset, though staff repertoires aren’t necessarily a match for the languages of patients. I observed two cases of the value of multilingual staff but, for reasons of patient confidentiality, felt unable to probe further. The first concerned a Nepalese man, with extremely limited English, whose family members were unable to help. It isn’t difficult to imagine how reassuring he must have found it when a Nepalese member of the domestic team delivered hot drinks, or when the only Nepali-speaking nurse was on duty. The second case was a Polish woman, also with limited English, for whom access to Polish speakers was rather easier.

Languages – the secret weapon of the NHS

So, summing up, linguistic diversity is a fact of life in a globalized world. While wanting to avoid exaggerating its importance, it can be argued that it is a source of both hope and healing. In terms of hope, bilinguals are always pleasantly surprised to learn of evidence that speaking another language can delay the onset of dementia by up to four years (Bialystok et al, 2007); while the use of language-related humour has a potential role in creating feelings of well-being. Last but not least, multilingual staff are a valuable resource in the context of provision for multilingual patients.

In thinking about the nature and extent of diversity, however, it is important not to lose sight of the common humanity that underlies all difference. I find myself at one with Malcolm X on this:

I remember one night at Muzdalifa with nothing but the sky overhead, I lay awake amid sleeping Muslim brothers and I learned that pilgrims from every land – every color, and class, and rank; high officials and the beggar alike – all snored in the same language (Wolfe, 1998).

Many thanks to Viv for sharing her experiences with us. We wish her all the best for her continued recovery.

Bialystok, E., Craik, F. & Freedman, M. (2007) Bilingualism as a protection against the onset of symptoms of dementia. Neuropsychologia 45(2): 459-464.

Wolfe, M. (ed.)(1998) One thousand roads to Mecca: ten centuries of travelers writing about the Muslim pilgrimage. New York: Grove Press.

One thought on “The Multilingual Hospital: Confessions of a Sociolinguist

  1. To be able to express oneself in the language one has been nurtured with and being treated with affection is wholesome; the mental attitude changes, the patient is willing to get cured, and treatments can turn out to be more effective.

    Three are cases of people who at an old age because of dementia forget completely that other language he/she had to learn as an adult, only being able to communicate, even if with imperfections, in that vital language of his/hers…

    Once I wrote: ‘Idiomas visten las almas en su paso por esta vida’ (Language is the garment of the soul in its passage through life).

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s