Global and worldly Englishes: Discommunities and subcultural empires

(essay)

English, community, discommunication

Under the headline “Doctor couldn’t spell ‘acute’” an article in the Barrier Daily Truth (5/01/01; originally published in the South China Morning Post) reports that “A Hong Kong doctor left the word ‘acute’ out of a dying heart patient’s diagnosis because he didn’t know how to spell it…" The story goes on: “The patient was treated for a less-serious condition as a result and died in hospital hours after going to Dr Chau Chak-lam with chest pains…” The patient, Chiu Yiu-wah, was admitted only as an “urgent" case, two steps down from the “critical" case, as a result of the referral letter. At the inquest, the doctor admitted that he “should have put the word ‘acute’” on the instructions to the hospital. He “had acute angina pectoris in mind” but had omitted the word ‘acute’. The crux of this sad story is in the doctor’s explanation: “I was not sure about the translation" and “I did not know the English spelling…Asked by the coroner why he did not use Chinese, Chau said he was following the common practice in Hong Kong of using English in referral letters”. Unfortunately, the brief story stops there without further details about the use of English in Hong Kong medical contexts. All we have is a Hong Kong Chinese doctor and patient, a problem with English, and an avoidable death. It looks as if highlighting the issue of the doctor not being able to spell ‘acute’ misses the point: It was more that he couldn’t think of the English translation. And why indeed should he, as a Cantonese doctor with a Cantonese patient in a Cantonese city?

Let me jump to South Africa. Crawford’s (1999) study of communication between patients, nurses and doctors in Cape Town (RSA) health services highlights “the problem posed by doctors being linguistically unequipped to care for Xhosa-speaking patients, whose numbers continue to grow rapidly as people move to town from the rural areas" (p.27). Here we see the complexities of relations lying behind a ‘language barrier’; at issue here are questions of language and power within medical contexts as well as within the whole broader context of South African society. “It is not possible," suggests Crawford, “to isolate the patient disempowered in terms of the language barrier from the whole biomedical discourse in which patients occupy a disempowered position” (p.29). Neither is it possible to see issues of language, interpretation and medical discourse as separate from the class, gendered and racial relations of South Africa: “The patients are positioned at the bottom, largely passive bodies whose own version or narrative of their illness is not considered central to the processes of diagnosis and formulation of a realistic treatment strategy. The nurses, often also used as (unpaid) interpreters in South Africa where a wide gulf of social class, race, language, and gender frequently separates doctor from patient, occupy a conflicted and ambivalent position intersecting the space between them” (p.29).

This gives us, then, a more complex picture than the newspaper sketch of a patient dying because his doctor couldn’t spell ‘acute’. Here we see a fuller picture of how language is embedded in social relations and indeed is part of the system that perpetuates inequality. And, as Crawford argues, change can only be brought about by addressing questions of language as well as other social, economic and political concerns: “To fashion a new integrated social order out of a severely traumatized past, to accept and work with the reality of black suppression and rage at white domination, requires, among other things, a sophisticated grasp of the social meaning of the use of a particular language, and a commitment to overcome the discrimination against and exclusion from power of those who speak languages other than English" (p.32). While on the one hand, then, we may want to acknowledge the usefulness of English as a language of global communication, we clearly also need to acknowledge it as the language of global miscommunication, or perhaps discommunication. And I do not mean this in any trivial fashion - I am not merely talking here of misunderstanding, but rather of the role of English as a language that is linked to inequality, injustice, and the prevention of communication. Thus, when we talk of language communities and the possible benefits of communication they may bring, we must also consider who is simultaneously left out of such cultural empires and what the onsequences may be.

For my final example of English and medical discommunication, I would like to turn to a passage from Han Suyin's (1956) novel... And the Rain my Drink, which draws on her own experiences as a doctor in pre-independence Malaya:

Among the doctors few can speak to all the patients, for in Malaya a university education, by its very insistence upon excellence in English, hampers a doctor from acquiring the vernacular languages of this country.

And thus at night, when the patients confide in the darkness and in their own tongue what they have withheld from physician and nurse, I begin to understand the terror, the confusion, the essential need to prevaricate of those who are always at someone else's mercy, because they cannot communicate with those who decide their fate, except through an interpreter.

In the process, how many deviations, changes, siftings, warpings, and twistings; how many opportunities for blackmail and corruption, before, transformed, sometimes unrecognizable, the stories of the poor who do not speak English reach their rulers, who are hand‑picked, among their own peoples, on the basis of their knowledge of English. (p.31)

These brief stories - a newspaper story about a death in Hong Kong, a study of communication in Cape Town hospitals, a novel set in pre-independence Malaya - are inter-connected in a number of ways: All speak to the range of contexts into which English has penetrated; all speak to the ways in which English becomes linked to forms of institutionalized power; all speak to the ways in which English functions as a class-based language; all speak to the tension between local, multiple vernacular languages and the monolingualism of the language of power; all speak to the ways in which English is as much a language of global discommunication as it is a language of global communication. ............