By Chelsea Tinnion, Mind & Body writer; McGill Accounting Society member

Imagine an elderly woman living in a long-term care facility, suffering from a worsening cold that requires medical attention. With no friends or family who visit regularly, she depends entirely on the facility’s staff.

A nurse’s aide comes into the room, and the woman tells her “I have a cold.” The aide, for whom English is a second language, uses her best high-school English and translates “I have a cold” as “j’ai froid”. The aide returns with a blanket, but a nurse or doctor is not called. The woman’s untreated cold becomes a major health problem.

This happens far too often, and not because of a lack of care. The vast majority of health care and social service workers genuinely want to help people. Most nurses, aides and social workers do not choose their profession for the money. Using English as a second language is difficult at the best of times, given the number of English words that have multiple meanings and the many expressions and colloquialisms. With the addition of confusing technical jargon of the medical profession misunderstandings are bound to occur.

Consider the case of an English-speaking middle-aged man who went to a clinic because of chest pains. During the course of the examination, the patient missed a lot of what the French-speaking doctor said, but he did pick out the words “mal au cœur” a few times. The poor guy spent the rest of the day convinced he had a bad heart – that he was having, or about to have, a cardiac crisis. When he arrived home, his wife explained that mal au cœur actually has nothing to do with the heart; the doctor was talking about nausea.

Another is the French term bleu for bruises. If a French-speaking nurse wants to ask a patient if she bruises easily or has bruises (“Avez-vous des bleus?”) she is quite likely to ask “Do you have a blue?” The patient answers, “A blue what?” and communication breaks down. Even when the nurse recognizes the problem and tries to sort it out, challenges remain. The French “contusion” for bruise is translated in many dictionaries as “contusion” in English. Unfortunately, many English speakers are not familiar with the word contusion, so they are no further ahead.

Culturally inappropriate language can also be a problem. For many people raised in French-speaking Quebec, an expression like “c’est fucké” or an expletive like “ah shit” is acceptable. However, most English speakers would be taken aback to hear such terms from their health care provider.

Francophone health care workers enrolled in English classes are currently being taught to recognize what is inappropriate and more importantly not to repeat the foul language, especially not in a professional context. Including this element as part of the curriculum helps avoid misunderstandings, putting both the caregiver and the patient at ease.

Bilingual patients are usually more comfortable using their first language in stressful or emotional situations. Similarly, practitioners and care providers with a good command of a second language may find themselves in stressful situations where communication becomes difficult. A nurse at a CHSLD (long-term care facility), whose English is very good, said she is comfortable talking with English-speaking residents and their families on a daily basis. However, under more stressful circumstances, such as when she must contact a family to inform them of a death, she feels her English is never adequate. The kind of care required for delivery of this sort of news is a challenge in one’s first language; it is magnified many times in a second language.

These communication problems extend to social services, where social workers can find it particularly challenging to work in a second language. A social worker from a centre de réadaptation en déficience intellectuelle said that one of the greatest challenges she faces working in a second language is catching the nuances and the underlying meaning of the words. This is particularly important when working with a client who has delusions. To be able to help her client, she must determine what is real and what is the product of a delusion. This requires a strong command of the subtlety of the language.

Several measures are being taken toward improving communication within health and social services, including ESL (English second language) training, offered to healthcare workers throughout the province. These courses are very popular. L'Institut de cardiologie de Montréal together with École de langues de Lanaudière recently initiated an ESL program offered to a beginner group of frontline workers. Ten spots were available in the course; forty-six employees applied. It incorporated an interesting aspect. The manual alphabet (which is the same in American and Quebec sign languages) was used as a pedagogical tool in order to help the students learn the English pronunciation of each letter. This helps to avoid catastrophic errors in the spelling of a name or medication, and has the added benefit of teaching employees to better serve the English and hearing-impaired communities.

A recent publication, Petit lexique de la santé et des services sociaux, français-anglais, helps caregivers and patients maneuver through the intricacies of second language communication. The lexicon, which is also designed for ESL training, is available at the McGill bookstore and addresses all of these issues. It has received high praise from health and social service agencies across the province.

Journal L’Express, 2 juin 2007

 

Health-Care and Social Services Workers Receive English Lessons

(left to right) Jacques Gervais, Karine Boudreault, Martin Caouette, Cynthia Cloutier, Line Baril, Pascal Diarte,

Julia Tinnion (President, Académie Linguistique Les Mots-Dits Anglais), Mélanie Belleville (missing is Nathalie Bourgeois).

Employees from the Rawdon offices of Le Centre de réadaption La Myriade are heading back to the classroom as they enthusiastically work at improving their English.

The educators and social workers, who help people with intellectual handicaps or mental health problems, are receiving English-second-language instruction in order to help them serve their clients more effectively.

The lessons are part of a three-year project designed to improve access to English-language care within the health and social services sector.  The project is jointly coordinated by l’Agence de la santé et des services sociaux de Lanaudière, McGill University, and financed by Health Canada.  Rawdon’s Académie Linguistique Les Mots-Dits Anglais provides the courses for health-care and social services employees, in Lanaudière.

Julia Tinnion, president of Les Mots-Dits Anglais, said the employees’ dedication to their clients makes them remarkably motivated students.  “They genuinely care about their clients and patients, and try to communicate in English even when it's a struggle,” she says.  “We can see their skills and confidence growing.”

Tinnion said the students’ efforts demonstrate their commitment to providing service to all their clients.  “We, as anglophones, occasionally need to be reminded that our own attitude and gratitude toward their efforts can tremendously help to break down communication barriers,” she said.