It's appalling that hardly any of the ER staff know even basic Spanish ("Where does it hurt?") and that this problem has not been mentioned prior to "Surrender" as far as I can recall.

The hospital where I work offers Spanish classes for employees, and those who work with patients are encouraged to take them. If County doesn't have a program like this, maybe they'll start one as part of their diversity initiative.

Of course the ER staff can't be expected to be fluent in every language that a patient might speak, but if Spanish is the most commonly spoken language in their area besides English, it would be wise of them to learn some.

-- Driad (driad@mailcity.com), February 02, 2001

Answers

Who couldn't speak Spanish? I don't recall anyone but Luka and maybe Weaver.

-- why? (tkjjd@yahoo.com), February 02, 2001.

Weaver could, and Chuny. Looked as if nobody else could.

-- Driad (driad@mailcity.com), February 02, 2001.

Dave could speak spanish, as well.

-- Ruthie (ruthie_davis@hotmail.com), February 02, 2001.

I don't think the issue is that the staff couldn't speak spanish (I heard Weaver, Benton, Dave and Chuny all ask questions in spanish), however the staff is limited to those that can speak the language flueny (Dave and Chuny). I sure that most of the doctors would have taken a spanish class, but understanding the basics (while better than nothing) probably doesn't cut it when people are panicked.

-- Emma (webbef@hotmail.com), February 02, 2001.

Language acquisition, even for people who are intelligent and otherwise capable of learning other things easily, is Hard. I've been struggling to learn Russian for the better part of six years, and I'm still having a great difficulties understanding anything that resembles normal conversation. This is despite the fact that I'd like to think I have a good ear for languages; I know people who've been fighting all their adult life to learn French.

Spanish is marginally easier to learn because it's orthogonal to English; the syntax is familiar, and we share many root words. I speak "survival-grade medical Spanish," which means I can communicate basic ideas and get a general sense of what's happening to my patients. This has been useful exactly once, when I was in Boston last spring, and working a call with BEMS, and I was the only person who spoke Spanish. "Senora, soy medico. Hablo un poco de espanol. Hay algui aqui qui habla inglis? No? Cramba." Despite this, "No entiendo. Por favor, puede hablar mas despacio," was the most common thing I said throughout the call; I'm not convinced my linguistic skills.

Linguistic barriers are frighteningly common in medicine. We have translators on-call. The most common non-English language around here is probably Cantonese, and none of us can speak it, or even understand it marginally. (You think Russian is hard to learn, take a look at a language that doesn't even vaguely resemble anything you're used to dealing with.) Is this a problem? Yes. Is this something a couple of language classes is going to fix? Not really.

I'm not saying I think this is a good thing or anything, it's just that I rather doubt that it's "appalling," It's an unfortunate consequence of human cognition. Don't forget that language skills deteriorate if you don't use them; since I moved out to the coast almost five years ago, my French skills, which I have had since about age 3, have been steadily declining because I don't have the same circle of French friends to talk with. It's easier to use Spanish in Chicago, but the luck of the draw probably means that eventually, if you don't know it well, you'll probably end up standing over a patient saying, "Uh.. uh.. donde.. esta.. damnit, where does it hurt?!"

-- Mike Sugimoto (phloem@fumbling.com), February 02, 2001.

What I thought was remarkable was how the burned man asked Luka to execute his dying wish, rather than Chuny, who spoke his language and behaved far more sympathetically to him. Of course, if he had made his request of Chuny the conversation would be entirely in Spanish, whereas Chuny's translation for Luka also served the viewing audience. But it didn't strike me as terribly realistic. Maybe ER should consider using subtitles.

-- Sara Solnick (sara@solnick.org), February 02, 2001.

In addition to what Mike said, lets not forget that you can learn the basics of a language, but there are many variations in each country. The spanish people speaks in Argentina is very different from that spoken in Spain or Mexico or Cuba, so a big deal depends of where you learn it or from whom. When I was in school its was easier to understand a cuban speech in english than in spanish, because they seem to speak faster in spanish (in my opinion). Now, imagine that one has the basics of english, learning it in a controlled environment (people speaks slowly and pronounce as clearly as they can) and then you make that person read "The Grapes of wrath" or put him in a conversation with someone who has an accent and "mispronounces" words. It isnt simple and you end using a lot of mimic and imagination. Which isnt easy either because the signs may be different in each culture.

-- Jules (jsheldon@operamail.com), February 02, 2001.

I can speak enough Spanish to get by, but if someone who is panick-stricken and in a lot of pain answered my question, I doubt I would understand a word they said. Knowing the rudiments of Spanish, and KNOWING Spanish, are two different things.

-- Barbara S (barbelaine@hotmail.com), February 02, 2001.

Cubans (Miami Cubans in particular) also tend to slur their words ("ao" for "ado", etc.) and diminutize everything and everyone, making it even harder to understand them if you aren't used to this. I used to be quite profiecient in Spanish in high school, because I took A LOT of it and had the opportunity to use it often. (I lived in California)

I say proficient, rather than fluent, for a simple reason. I can't think in Spanish.

Truly fluent speakers of any language have the enviable ability to THINK in that language. My husband has this ability. But it is not just limited to native speakers. Some of my high school classmates who did a foreign exchange program came back fluent and thinking in the language they were learning. (They say, that a clue to this, is when you start dreaming in that language.) Funny story about an acquaintance who spent a year in Germany- he got back to the States and actually had a hard time thinking and speaking in English! The cop who pulled him over thought he was drunk because he had such a hard time speaking.

It is very hard to fluently learn another language in high school, because patterns have already been set. But it can be done. Kids who learn at an early age are fortunate indeeed.

I think one of the reasons Russian is hard to learn is because the alphabet is so different. So something written in Russian may actually sound like English, but it *looks* radically different. My friend who just went to Moscow told me this. She took a crash course in Russian.

And if you all think learning another language is hard, feel lucky that you aren't just coming to this country and learning to speak English, which is arguably one of *the* hardest languages to learn, because it often doesn't make much sense, especially regarding spelling and pronunciation.

-- S. Trelles (trelles@ix.netcom.com), February 02, 2001.

I remember an episode where Dave talked with an immigrant and immediatly knew what kind of medication they had been taking, even though it was a mexican medication and the name was different, so I was wondering if doctors are supposed to study the names of medications from other countries or if there is some kind of database or book where they can check that. I know that a doctor could read the formula from the box, but what if the label or box is not available?

-- jules (jsheldon@operamail.com), February 03, 2001.

What if u have such a bad 'toung' that understanding is all u can do? My mother is Indoenesian. When i was 3, she was trying to teach me the numbers etc, you know basics, but what i said after a month was "Ma, i don't ant to learn that funny language."! In year 4, i tryed Mandarin (chinese) but failed misrubly. All i did was memorise what to say when and where and if someone asked me a question out of the blue i wouldn't say a thing. (All those symbols were just english sounds to me like suni ect.) Then what? (I can understand Indoenesian a bit, can't speak it for dogs droppings.

-- Ritaann (er_aussie@hotmail.com), February 03, 2001.

But why is it that Hispanics are traditionally the last to learn English?

-- Andreaux (andscott@email.com), February 03, 2001.

LOL, Ritaan! I can read in french and italian but I cant speak either. I wonder if it is actually easier to read a language than to speak it. Anyway, maybe somebody could develop some kind of visual aid for those cases when a translation is not available. I dont know, maybe a bunch of cards with drawings that could help you to comunicate with the patient, no matter what language he or she speaks.

-- jules (jules@operamail.com), February 04, 2001.

As a rule, many imigrants grunt their way through life, once they get here, already.

-- Andreaux (andscott@email.com), February 05, 2001.

Jules, I think it's easier to remember the reading and writing and grammar, than the actual speaking part. I myself have the same problem/issue. In fact, I'll often help my husband with grammar and spelling when he's trying to write something in Spanish. (He never actually took Spanish in school) But he does all the speech interpreting! :-)

In answer to Andreaux's pointed and rather rude question/assumption, there is a simple explanation, at least in the great state of California, where I went to school. It's called bilingual education. The theory is this: when a student gets to this country, they will place them in classes where the basic subjects are taught in the students native language by bilingual teachers. This way the student will not get behind grade level in math and science and history, etc. They will also be taught English. The theory is that the student will be able to join a regular classroom in time and with their age group.

This is a nice theory, but it doesn't work as well in practice.

Apparently, for elementary school children, it is quicker just to throw them to the deep end and have them swim. Believe me, they learn English in record time, even if another language is spoken in the home. I know this because my spouse went to school in another state and didn't have the "benefit" of bilingual education. He struggled mightily for a year or so until his language skills caught up, but then he was fine. And he speaks and writes English better than many so-called "native speakers".

And now to answer your question about Hispanics. There are more teachers who are bilingual in Spanish/English than there are teachers bilingual in Chinese/English, Laotian/English, Croatian/English or whatever have you. There are also simply more Hispanic immigrants than other cultures. As a result, Spanish speaking children are more likely to be tracked into bilingual classes. The Asian, Croatian and etc. kids are more likely to be thrown to the linguistic deep end and will learn English a whole lot faster.

In Los Angeles a few years back there was actually a movement BY HISPANIC PARENTS to do away with bilingual education. They felt that their children would learn English faster if they stayed in regular classes all day.

Does that answer your question Andreaux?

-- S. Trelles (trelles@ix.netcom.com), February 05, 2001.

That tidbit about Hispanic parents in L.A. is interesting--and it has, for some reason, raised a mild curiosity in me on another point.

Are there any med schools in this country that offer non-English classes? That is, can a "native speaker" of Spanish or some other language learn medicine in his/her native language, in this country? (Or Canada, or England, for that matter?) Since so many other things, such as driving a car, can have a Spanish version and an English version for the manual (which mildly distubs me, since most of the street signs, etc., are in English), is it applied to medicine as well?

-- Cecelia (evilstoat@hotmail.com), February 05, 2001.

I don't believe so Cecelia, and here's why.

There has been a lot of backlash recently about bilingual education, and not just from parents. It seems that some kids are tracked all the way through school in bilingual classes and as a result, their language skills are not up to par for college work.

When a student from another country comes to an American university, his/her English skills are usually good enough to deal with English 1A and the rest of the writing that college entails, and their language and writing skills improve the longer they are here. I find it appalling that some kids that have gone to elementary and high school HERE, IN THIS COUNTRY, are not prepped this way. FOREIGN COUNTRIES do a better job of teaching English than we do!

Do you find this embarassing? I do.

-- S. Trelles (trelles@ix.netcom.com), February 05, 2001.

I do, as well...But that's another rant for another time and board, I'm afraid. :)

-- Cecelia (evilstoat@hotmail.com), February 05, 2001.

Several points worth addressing:

Anyway, maybe somebody could develop some kind of visual aid for those cases when a translation is not available. I dont know, maybe a bunch of cards with drawings that could help you to comunicate with the patient, no matter what language he or she speaks.

They exist. We've got a couple of packages for French, Spanish, and (I think) German in our ED. They don't work particularly well, but they let you communicate general concepts, which is more than you might otherwise be able to do. It's kind of a lame system; on one side of the card is the English information, along with phonetic transcriptions; on the other (presumably the side you point at the patient) is the phrase written out in the target language. I'm not terribly fond of them.

Are there any med schools in this country that offer non-English classes? That is, can a "native speaker" of Spanish or some other language learn medicine in his/her native language, in this country? (Or Canada, or England, for that matter?)

If by native language you mean French, then yes. There are three French-speaking medical schools in Quebec, at UQAM, Laval, and Sherbrooke. (By contrast, there's one English speaking school in Quebec, at McGill.) They produce some excellent physicians and for a brief period in my life I gave semi-serious consideration to going to one of them.

Re: bilingual educaton. I'm from a generation of Canadians who were taught from a very early age that speaking both English and French was of critical importance; my parents bought in to the idea, and as a result both my sister and did pretty much all of our primary education in French (I stayed in the French programs longer than she did). Up until third grade, I was not taught any English at all, and today, I think I'm better off as a result, even if I'm rapidly losing my ability to speak the language intelligently. Looking back now, particularly after my aforementioned troubles with Russian (which, incidentally, have nothing to do with the Cyrillic alphabet :)), I'm astonished that it was possible for me to do so well in so many different technical subjects in a language that ostensibly was not my own.

It amazes me how easily kids learn languages. I'm jealous as hell.

-- Mike Sugimoto (phloem@fumbling.com), February 05, 2001.

Thanks for answering, Mike--though I was really thinking more along the lines of a "foreign-language" school in a country which primarily doesn't speak that language, and French seems almost equally native to Canada as English is (if not more so). I'd expect there to be a French-language med school there, since it's a "native language," but I'd be surprised if there was a Spanish-language med school--in Canada or the U.S. Hmmm.

-- Cecelia (evilstoat@hotmail.com), February 05, 2001.

I should have said "certain areas of Canada," actually--I know the whole country isn't infested with French-speakers. ;-)

-- Cecelia (evilstoat@hotmail.com), February 05, 2001.

--"Re: bilingual educaton. I'm from a generation of Canadians who were taught from a very early age that speaking both English and French was of critical importance;"

Actually, Mike, that isn't the "bilingual education" to which I was referring. We do have programs similar to this though. We call them immersion programs and I love them to death. Students are taught all subjects almost entirely in another language (usually Spanish) and all classroom discussions are conducted in the other language. If the primary language spoken at home is English, the result is bilingual kids.

The "bilingual education" I'm referring to is where the *teacher* is bilingual and teaches students new to this country (USA) subjects in the students' native language. They pass their subjects in their own language and move on to the next grade. Some kids keep getting tracked into bilingual classes from year to year. The result of this is kids that never learn English.

The recent trend here (which I'm sure you've heard about and which thankfully is changing) was to just shove students through the school system, passing them from grade to grade, whether or not they were actually performing at the level they should. I'm sure you've heard of high school graduates (US natives, even) that couldn't read a 3rd grade primer. Bilingual education sort of drifted into this mentality. That's why it's gotten such a bad rep. It was good in theory, but it sort of got corrupted. I think a better program for kids new to the country is something like what you were in. Total immersion, with a lot of extra help. The current system only does these children a disservice in my opinion.

--"I'm astonished that it was possible for me to do so well in so many different technical subjects in a language that ostensibly was not my own."

Do you think it was because you were actually educated in it, as opposed to speaking in it? I'm curious, because my husband is sort of faced with this dilemma. He's sort of become an unofficial liasion to foreign colleagues, primarily because he speaks Spanish & French, I think. He was tapped to present a paper in Chile, but he wound up turning it down due to a.) scheduling conflicts and b.) learning curve. I said, "Just translate your paper from English to Spanish, duh!" He said, "it's not that simple." Since he was never *educated* in Spanish, he really doesn't get "technical Spanish" (his words). And he didn't learn to read and write Spanish til he was an adult. And he taught himself how to do this. I will sometimes help him with spelling and grammar when he's writing to friends and relatives. I think going to Chile would be cool, but hubby would have to find the time to rewrite his paper in Spanish, taking into account the time it would take him to learn "technical Spanish", and he would have to do this in his abundant spare time. So far it hasn't happened.

--"It amazes me how easily kids learn languages. I'm jealous as hell."

Me too! my niece is completely bilingual cuz she learned 2 languages right as she was learning to talk. I've always said that youth was wasted on the young.

-- S. Trelles (trelles@ix.netcom.com), February 06, 2001.

You all have made great point re language acquisition. Truth be told, I work for the New York City Board of Education, and I have heard all sides of the argument regarding bilingual ed. From my perspective, although it might have benefited a certain amount of students, it has inhibited others from obtaining true "bilinguality." If one visited New York for the first time, one might quickly come to the conclusion that clearer, more correct English could be better heard on the streets of Amsterdam, Copenhagen, Stockholm, or even Zurich...because we have allowed students - in the folly that is part and parcel of the "self-esteem" movement - to maintain their own language and culture to such a critical degree, that English is of second or third priority...and, thusly, students languish through their years in public education speaking nothing but a mongrel's tongue...usually a "spanglish" or something elsewise offensive to the ears.

I am a second generation American myself (Swiss mama), so I cherish the notion of being able to speak multiple languages. Yet, I am equally proud of first generation newcomers, who INSIST that their children learn ENGLISH in their respective AMERICAN schools.

Bilingualism works in certain places in Canada, (Montreal, Ottawa) because both French and English are official languages, and have been so for a very long time. It is incredible to walk about in Montreal, and here a person switch so elegantly and gracefully between both languages......envious, indeed.....

-- Andreaux (andscott@email.com), February 06, 2001.

Andreaux, you're not far off about hearing more correct English on the streets of European cities. When I did my "European Tour" in college I spent a week with some family friends outside of Frankfurt. The husband worked at a local high school and took me to a school sponsored end-of-the-school year party he was chaperoning. I started talking to a young man who spoke perfect, accentless English. I got the impression he was an American exchange student from San Diego. The music was pretty loud, so I must have misheard. He was a student at the high school and was *going* to be an exchange student in San Diego the following year. He had been very anxious to talk to me to practice his English! He was actually worried that his English wasn't up to snuff! I told him he had nothing to worry about.

I ran into similar scenarios all through Germany, and I discovered that most Europeans speak reasonable English. I was able to get along just fine.

-- S. Trelles (trelles@ix.netcom.com), February 07, 2001.

I have to first say that I thought it was really rude of Cecelia( I hope I spelt that right) to say"infested with french-speakers." Iam from the north of Ontario( No I don't mean like 2 hours north of Toronto or I don't mean living in an igloo, I mean like Winnipeg, I hope people know where that is, sorry i like brackets:)) And pretty far from Quebec but I speak french through schooling when I was younger. I think that IS important for some people to know spansish butthat it is overacting to find it "disgusting". Since Spanish is not an offacial language of the United States it shouldn't be expected that so many people have to know it. There are many Ukraniens in my town, does that mean the hospital should offer service in Ukranien? I don't think so, but it is always useful to know another language, my special regards for ?Mark Suigmoto?(I hope that was spelt right) for learning Russian a language I too am struggling with, but to expect the ER staff to know the language is a little much. Also not to be witchy but french IS spoken in other regions of Canada besides Ottawa and Montreal. I guess that was mean but Iam just bitter because people in my own province don't know that my region exsists. Alors je juste veux dire Allo a tout mes amis qui parle francais dane la monde et aussi j'etait jalouse qu'il avait d'espangol( je ne sait pas comment appeler:) et moi je voulait le francais. Alors Bonjour et merci pour ecouter a mon opinion stupid.

-- Kyla-Marie (muskie_chick@hotmail.com), February 07, 2001.

Your opinion isn't stupid, Kyla (surprise, my Grandma was from Brittany, I comprehend French passably myself), but I think you failed to notice the little wink at the end of my post.

Jules, where are you? You're supposed to remind me of the mandatory "JOKE ALERT!!!!" warning that we're supposed to be adding to our posts. :)

-- Cecelia (evilstoat@hotmail.com), February 07, 2001.

Alors! Nous avons ici une conversation, ya'll!

Tabernacle!!!

-- Andreaux (andscott@email.com), February 07, 2001.

Sorry Cecelia...this time I really thought that nobody could seriously think that "infested" was other than a joke. I guess I´ll have to pull the old "Joke Patrol" uniform and the "Joke Ahead: Proceed with caution" signal. ;)

-- jules (jsheldon@operamail.com), February 08, 2001.

¡Qué alegría saber que hay tanta gente que estudia español en la escuela!! I´m a medical student from Spain, happy to see what people think about my language. Regarding europeans speaking english I must say that although in most countries people speak fluently, Spanish are in the bottom list, as our english education has been quite poor until now. I was wondering what kind of language education do medical students get in the US? Here in medical school we don´t get nearly any, we have lo learn language by ourselves, which I find embarrassing. Un saludo especial para Mike Sugimoto desde Sevilla, España. He leido varias explicaciones tuyas a preguntas y me ha gustado mucho tu claridad.

-- Inés (inesuca00@terra.es), March 10, 2001.

With all this talk about different languages I was suprised to see no mention of Sign Language (ASL). I am a high school student who is taking ASL level one. Being a big ER fan it is exciting see a couple of episodes included sign language. As far as doctors knowing it- only Kerri and Benton do- as far as I know anyway. I think it is important for the doctors to be able to communicate with their patients and should be required to know at least a little bit of the major languages the come across in the work place. Anyone have any thoughts having to do with ASL. I know this si a pointless reponse, but I felt I had to do ASL some justice by mention the fact that it is a foreign language and deserves some recongnition as one.

-- Shana (Skk4286@aol.com), May 04, 2001.

Cleo knows sign language too. I learned sign language when I was young and has come in handy quite a few times.

-- James (eorejim@aol.com), May 04, 2001.

is the language "american sign language" really limited strictly to american-english-speaking people? i don't see how it could be, but i always wondered about that. i think it's only natural that peter and now cleo know sign language, considering that his son is deaf. i'm also surprised that more people on the show don't know either sign language or spanish, considering it is, i think, the second-most widely spoken language in america, but also, county is a big hospital, and we only see the work and lives of the doctors that "er" focuses on. it's possible that there are hundreds more employees at the hospital who are bilingual. so although i do think more of them should be familiar with other languages, at least a working knowledge of them, it might not be unrealistic that this particular group just isn't very bi- or tri-lingual.

-- e. kerry (efields01@yahoo.com), May 05, 2001.

Hi

There are many types of sign language for the deaf. ASL, American Sign Language for the Deaf is based on a form developed in France and is actually more similar to French Sign Language for the Deaf than it is to either British Sign Language or spoken English. This occurred for historical reasons: the first people to come to the U.S. and establish schools for the Deaf were French. ASL has replaced a number of indigenous sign languages from the U.S., most notably a form used on Martha's Vineyard Island in Massachussetts, where not only did there used to be a lot of inherited deafness but fishermen used the language to commmunicate from boat to boat (see Everybody Here Spoke Sign Language by Nora Groce). There are also some people who are deaf but not culturally Deaf, who may not have learned ASL. Some of these people use some other form like Signed English, or they use some ideosyncratic form of home signs or try to rely on visual and contextual cues and written notes. Some other countries have one or more forms of signed language in common usage, like Japan, for example, but there are many countries where no official form of sign language exists and deaf people have limited communication abilities except with people who know them very well. This is an important problem, not only from the point of view of improving conditions for the disabled, but also because it makes deaf people very vulnerable to exploitation, especially in an immigration situation. There have been a number of cases of deaf people from Latin America being brought to the U.S. as underpaid workers and being unable to escape because of the dependency created by the combination of their disability and their legal status. Learning ASL will allow you to communicate with most educated culturally Deaf people in the U.S., but will not help much with non-educated deaf people or immigrants.

-- Linda-Anne Rebhun (linda-anne.rebhun@yale.edu), May 07, 2001.

Linda I know exactly what you mean. I used to work at a factory where they had a temporary worker who was deaf and instaed of trying to really communicate with him they threw him on a job. Fortunately I was there to step in and help him with learning what he had to do.

Also sign laungage changes through the years. For instance. When i learned how to say "HI" you just signed the letters "H" &"I" now you wave your hand side to side. I guess I should get my joy of signing book out

-- James (eorejim@aol.com), May 07, 2001.

ASL, just like most other languages is a constantly changing one. It also tends to differ in different parts of the country; just like english has different accents in diferent places. I am excited to see all the responses having to do with ASL. Even I am learned a little.

-- Shana (skk4286@aol.com), May 11, 2001.