Monday, January 12, 2009

Language is Power II (but know your limits!)

Last week I talked about language, and how making the effort to use it can create bonds and help to seal off deeply running cultural fissures. I find that for the most part, my faltering Arabic is met with endearment, and, as I said in my last post, provides much needed comedic relief within a mostly sober environment. Often, words are used that I know aren’t exactly right in a particular context, however the patients are usually…well…patient, and their forbearing is generally rewarded with better understanding of their care (after they think about it for a second!).

I still like to be fairly certain of the meaning of the word I am using before trying it out on a patient - thanks once again to my Arabic speaking friends whom are constantly being forced to listen and give feedback as I try and twist my tongue and my throat around the unfamiliar sounds and syllables.

HOWEVER. I am also aware that in certain situations, it is not appropriate to have any ambiguity around what is being said. In some instances (usually those which are more emotionally charged), the necessary explanation or command of the language goes far beyond what I am capable of. I have also learned that sometimes, just staying quiet completely and doing your job quickly and expertly speaks louder and more articulately than the most intelligent and thought provoking exchange in any language...

A story to share:

This story is about a nurse (RN) and a doctor (MD) whose identities will remain anonymous (though I am sure many of you will have your suspicions after reading the story).

A patient on a particular hospital word is slotted for a bone marrow biopsy. Any of you who have ever experienced (either receiving, observing, or assisting with) a bone marrow biopsy know well that “barbaric” is a gross understatement in describing the procedure: The patient lies in a semi prone position while the doctor drives a needle (see above picture) roughly the width of a chopstick and the length of your hand from wrist to tip of your middle finger through layers of dermis and muscle, and into the pelvis. The intention is to collect a corkscrew-like sample of bone marrow to analyze for blood cancer (as blood cancers are characterized and can occur at any stage of cell maturation, samples must be obtained not only from the peripheral blood, but also from the early-stage undifferentiated stem cells). I say “with the intention of” because often, it takes more than one trip boring through the fleshy tunnel, and pulling it out to check if the sample attempt was successful. This procedure is done under local anesthetic (a needle as long as your middle finger is driven into the flesh and alternatively eased forward and backwards to ensure that an adequately wide area has been “frozen”). The patient gets some pre-medications for pain and for anxiety, but I liken this to offering someone a Tylenol and a pull of Mary-J before looping the noose around their necks in a lynching ceremony. Get the point? It sucks.

Anyway, this patient has a history of chronic pain and depression, and was particularly anxious and teary prior to and during the procedure. RN had pulled up a chair beside her bed, and was holding both her hands, speaking in her best soothing voice, and trying her best to pass on strength and will to the distraught woman. The woman is crying out in pain as the needle is driven into her pelvis.

The doctor is an incredibly smart man, meticulously conscious of minute details “behind the scenes”, however his bedside manner would no doubt turn Florence Nightengale to the sauce. He is not a native Arabic speaker, but seems to truly believe that knowing how to say “is there pain here”, “you are not feeling pain”, and what is the problem?” in Arabic is an acceptable range of vernacular to competently perform this procedure. As these questions were being delivered in his signature manner with a harsh accusatory “HUH?!” after every question, RNs jaw clenched tighter and tighter as her patient’s cries grew louder. The third “THERE IS NO PAIN, WHAT IS THE PROBLEM, HUH?!” was cut short by an urgent, even statement by RN “With all due respect doctor, I think the crying and the yelling is fairly indicative of the pain, and the problem is that she has an 8 inch needle the size of a pencil stuck into her pelvis…can we just get this over with as quick as possible please?”.

Well, the room was suddenly silent except for the whimpered Koran verses escaping the pursed lips of the young woman. You could have cut the tension with surgery shears. RN calmly met MD’s patronizing stare despite the creeping fingers of crimson slowly making their way up her neck in her signature blush. Just when RN was certain MD was going to stalk out of the room leaving the biopsy needle protruding out of the patient’s pelvis like a Saudi oil rig, MD broke the gaze muttering something about protocol, and the remainder of the procedure was slightly tense, but thankfully quick, quiet, and relatively uneventful.

My point here is that though it is important to know the language, it is also just as important to know your limitations, and to be honest about the range of your abilities both with yourself and others.



Monday, January 5, 2009

Language is Power

Language is power. Power to learn, grow, understand, and expand personal, professional, cultural, and geographical boundaries.

I am realizing this more and more every day. I know now that language is the link between truly understanding a culture and simply accepting (or rejecting) a culture based on your own (possibly incorrect) interpretations. I am quickly learning that one cannot truly state understanding of a culture simply by living in it for an extended period of time. In this case, opinions of what one may observe are based solely on whatever frame of reference our own cultures have instilled on us as we have grown up. To truly grasp the intricacies, history and breadth of a culture, we have to be able to ask our own questions, and we need to hear the answers based on the response of one who answers from the heart and soul of the culture in which we are but humble visitors. The language connection is much more profound than simple verbal communication, though dialogue is undeniably an important component.

Language in the nursing world is critical:

In terms of the more obvious gains, the more Arabic I learn, the better I can care for my patient in terms of assessment, explaining medications, procedures, etc. Another crucial component of care for me is psychosocial considerations which includes but is not limited to, being able to chat and bond with my patient, as well as being able to joke around a bit when appropriate.

On the next level, speaking even a bit of Arabic, shows an effort is being made on the part of the nurse, and this generally serves to gain a moderate amount of extra respect from the patient. Respect generally leads to compliance, something which is often difficult to attain in my work. The respect earned is amplified if one can actually put a few sentences together. If interest is made clear, many patients will willingly teach the eager learner (a.k.a. me) new words on a daily basis. This in turn takes language still to the next level as the teaching and learning serves to greatly strengthen the therapeutic bond between nurse and patient (= greater compliance! Hamdullallah! See below for translation…)…not to mention, the pronunciation attempts often provide comic relief for both.

As a general rule, trust is directly proportional to the breadth of the vocabulary built up. As knowledge grows, the nurse can better explain medications and procedures, and the patient feels the nurse truly understands voiced concerns, and can thus ask questions about their care and treatment. As the tables are turned in terms of language anywhere outside of the hospital, I can strongly attest to the loss of control and humbling resignation when one cannot voice a concern or ask a simple question to get what one needs. The benefit to gain honourable mention with mastery of this level of language is the power to negotiate and compromise…a skill which is incredibly important working as a nurse in Saudi culture!

The last level, and one which I am only just starting to understand and graze the edges of, is the deeper understanding gained of the culture as a whole based on the actual use of words and structure of the language itself. For example, there are many expressions used which involve reference to Allah (God):

- “Hamdullallah” (thanks be to God) is used generally after anything positive e.g. in response to “how are you?”, “the procedure is over”, “did you sleep well last night?”, etc. The word is often accompanied by a finger pointing up, and a quick glance to the heavens…

- “as-salamu-aleikum/wa-aleikum as-salam” (peace be upon you/and upon you peace) is the standard greeting and reply in Arabic. It is EXTREMELY important to reply to this greeting in the proper way

- “inshaallah” (with God’s will) almost ubiquitously accompanies any (positive) action one is hoping or intending to happen in the future, e.g. “inshaallah I will be there at 8pm”. It can sometimes be frustrating at first as an outsider as realizes that God’s will often pushes that meeting back to 9pm or later…however, after a bit of time here, one inadvertently starts using the expression just as freely, and accepting that God’s will sometimes has its own schedule…

- “wallah” is an expression for which I have not quite figured out an exact translation yet, as there seem to be many. It seems to be most often used as “well then!”, “oh my God!”, or “no way!” though I am sure many of my Saudi friends are cringing at these Canadian interpretations of mine!

- “mash’allah” is also another one I have not yet deduced a proper translation for…this one is sort of like “wallah”, but more of an endearing expression which is frequently used after gaining knowledge of a new piece of positive information pertaining most often to a person e.g. following “my sister is getting married” ( ;) ), or “I was accepted into university” (inshaallah!)

Once one is able to recognize just how often these expressions are used as well as the contexts in which they are spoken, one begins to realize just how seamlessly intertwined Allah is in the everyday life of a Saudi National.

I would like to take this opportunity to thank all my Arabic-speaking friends who put up with my constant barrage of “how do I say this in Arabic? What does this mean?”. Shukkran jazeelan koolo intum. Inshallah ana kalam Arabi alatool gabel shugulee hina kalass sabaa shahar!

I have a story to share with you about knowing the limits of your knowledge (or lack thereof) of a language, but as it is too long to tack on to this post, I will leave you on the edges of your seats until next week!



PS - The Arabic script above means "Allah".